Medicaid Applied Behavior Analysis Services for Children and Youth With Autism
Date: 02/24/23
As a reminder, Texas Health and Human Services (HHS) added a new Medicaid benefit for Applied Behavior Analysis (ABA) services for individuals 20 years of age or younger* with Autism Spectrum Disorder (ASD). Effective February 1, 2022, this Medicaid benefit was made available for the following Superior programs:
- STAR
- STAR Health
- STAR Kids
- *STAR+PLUS Medicaid for Breast and Cervical Cancer (MBCC) Program
If a patient is eligible for ABA services, they can receive services delivered in the home, community or in a clinic by a Licensed Behavioral Analysts (LBAs). ABA services can help with:
- Encouraging positive and adaptive behaviors.
- Applying skills across everyday settings, so to improve member health, safety and independence.
- Creating treatment plans to teach strategies to use at home and in the community.
- Coordinating with the patient’s therapists to ensure a team approach to treatment.
Patients will need an evaluation to determine if they qualify for Medicaid ABA services. You can help patients by:
- Checking the criteria needed for the diagnosis of ASD, found in the Texas Medicaid Provider Procedures Manual.
- Advising them to call:
- Their health plan using the phone number on the back of your health plan ID card.
- The Texas Medicaid & Healthcare Partnership (TMHP) Contact Center at 800-925-9126.
- Sharing the following guide for patients to look up an LBA in their area: Licensed Behavior Analyst (LBA) Online Provider Lookup (OPL) with Texas Medicaid & Healthcare Partnership (TMHP)
To see additional details for members related to ABA and autism services, please reference the following flyer:
- Medicaid Applied Behavior Analysis (ABA) Services for Children and Youth With Autism (PDF)
- Servicios de Análisis Conductual Aplicado (ABA) de Medicaid para niños y jóvenes con autism (PDF)
As a reminder, Superior requires prior authorization be obtained for all ABA services prior to the delivery of service. To see additional information on prior authorization requirements and procedure codes for the ABA benefit, please review the following notice: UPDATED: Effective February 1, 2022: New Medicaid Benefit for Applied Behavior Analysis Services - Prior Authorization Required