Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
For the Texas Medicaid Autism Services Policy, MCOs must follow all aspects of the Medicaid Autism Services Policy as outlined in this draft notice. Providers should contact the client's specific MCO for specific administrative processes.
Effective for dates of service on or after February 1, 2022, the Comprehensive Care Program (CCP) Prior Authorization Request Form and Instructions will be updated to include applied behavior analysis (ABA) services.
Requests Submitted Through PA on the Portal
The following updates will be made for prior authorization (PA) requests submitted through PA on the Portal:
- A checkbox will be added for prior authorization requests for ABA services.
- ABA evaluation, ABA reevaluation, and ABA treatment will be added to the Type of Request list.
- ABA evaluation and treatment will be added to the Primary Practitioner’s Certifications list.
Providers may refer to the article titled “Reminder: Autism Services Policy Effective February 1, 2022” for more information about ABA services.
For more information, call the TMHP Contact Center at 800-925-9126.