Provider Alert! Health and Human Services Commission (HHSC) Release of Autism Services Benefits

Date: October 20, 2021

Attention: Primary Care Providers and Neurologists

Effective Date: February 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Effective for dates of service on or after February 1, 2022, Autism Services, to include Applied Behavior Analysis (ABA) evaluation and treatment, will be a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP). This is not a benefit for CHIP program. Benefit qualifications include the following:

• This applies to Texas Medicaid recipients who are 20 years of age and younger and who meet the criteria outlined in the Autism Services benefit description.
• The new Medicaid Autism Services benefit includes coverage of medically necessary ABA services for individuals with Autism Spectrum Disorder (ASD) and provides for coordination of the service array in interdisciplinary team meetings.

The Medicaid Autism Services benefit includes the following:

• Applied Behavior Analysis (ABA) as a new benefit
• Requirements for prior authorization for ABA evaluation and treatment
• Clinical documentation requirements
• Licensed Behavior Analyst (LBA) as a new provider type and descriptions of licensed assistant Behavior Analysts (LaBAs) and Behavior Technicians (BTs) who may work under supervision of an LBA. LaBAs and BTs may not be a Medicaid Provider or bill for the service.
• Requirements for interdisciplinary team meetings
• Prior authorization, billing, and reimbursement for procedure codes 97151, 97153, 97154, 97155, 97156, 97158, and 99366

How this impacts providers: The CCP Prior Authorization Request Form will be updated to enable requests for prior authorization of ABA services. Requests for prior authorization for new Autism Services benefits will be accepted on or after February 1, 2022. Claims may be submitted for dates of service beginning February 1, 2022.

The provider rates associated with this benefit can be found at this link: Reimbursement Rate Updates for Autism Services Procedure Codes Effective February 1, 2022.

Next steps for providers: Beginning July 30, 2021, Licensed Behavior Analyst Providers Can Submit Texas Medicaid Enrollment Applications. More information can be found at this link: TMHP’s Provider Enrollment on the Portal

To enroll in Texas Medicaid, LBA providers must:

• Be licensed as a Licensed Behavior Analyst (LBA) by the Texas Department of Licensing and Regulation (TDLR) or the appropriate state board where services are rendered.
• Have a national provider identifier (NPI).

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers