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Update to a Prior Authorization Requirement for Autism Services Effective April 1, 2025

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after April 1, 2025, a prior authorization requirement will be updated for Autism Services for Texas Medicaid.

Applied Behavior Analysis (ABA) 90-day Treatment Extension

The prescribing provider signature will no longer be needed on the completed Comprehensive Care Program (CCP) Prior Authorization Request Form when requesting the 90-day treatment extension.

The initial treatment plan must be signed and dated by a prescribing provider for the full 180 days. The 90-day treatment extension is to continue the same treatment frequency or submit new goals, if needed.

Providers may refer to the Texas Medicaid Provider Procedures Manual (TMPPM), Children’s Services Handbook, subsection 2.3.11.4, “ABA 90-day Treatment Extension,” for additional information.

For more information, call the TMHP Contact Center at 800-925-9126.