• Do I need to contact my Senator, Representative or the Governor’s offices to get the bill passed?

  • No! The Governor signed HB1, on June 15, 2019. HB 1 includes Rider 32: Intensive Behavioral Intervention. Contingent on the Health and Human Services Commission (HHSC) adding intensive behavioral intervention (IBI) as a Medicaid benefit for persons under age 20 with a diagnosis of Autism Spectrum Disorder, HHSC may expend funds appropriated above in Strategy A.1.5, Children, to reimburse for provision of IBI services.

• When will this go into effect?

  • HB1 goes into effect on September 1, 2019

  • The initial draft of the revised HHSC Autism Policy, including IBI/ABA, was available for review in late September, 2019.  Public comments were due on 10/7/2019. 

  • Rate hearings will be  in early 2020 in Austin. An exact date and location is to be determined. Please note, this is a recent change and the hearing is no longer formally set for December 13, 2019.

  • At the rate hearing, HHSC will be hearing public testimony regarding their proposed rates. Rates may or may not be revised following this hearing.

  • This benefit is effective 2/1/2022 and revised rates will be implemented on 3/1/2022.

• My child is enrolled in the HHSC CAP Program, will I lose funding?

  • Funding for the HHSC Children's Autism Program will continue for two years according to the recently approved State budget. Beyond that, we cannot say what will continue, though the TxABA Public Policy Group intends to monitor the situation closely, supporting continuation of the HHSC Children's Autism Program because some families without insurance will not qualify for Medicaid funding and cannot afford to pay for ABA services out of their own pocket.

​

• Will all ABA Providers accept Medicaid?

  • No, just like private insurance, an ABA program can elect to go “in network” with any funding source.An ABA provider will need to contract and credential with the MCO's (Managed Care Organizations) before they can provide services.

​

• Will there be wait lists?

  • This will vary clinic by clinic; but, yes, there will probably be some type of wait for services.

​

• I’m a provider, how do I contract with Medicaid/ the MCO’s (Managed Care Organizations)?

  • The first step in this process will be to enroll with TMHP using the PEMS system. A link to the PEMS systems is included in the updates above. You should also reference the MCO service area map to determine which MCOs are in your area. You will need to contract and credential with those MCOs before providing services. the entire process can take up to 180 days to complete. If you are providing services in a center, TMHP will complete a site visit before approving your application.

​

• How long will it take to complete the contracting and credentialing process?

  • Much like private insurance, it may take as much as 180 days to complete this process. While this seems like a long time, please be aware that HHSC/ The MCO’s will be inundated with numerous contracting and credentialing packets. You can help to speed up the process by ensuring that your packets are complete and accurate and/or that you follow the steps outlined above.

• How do I obtain prior authorization for assessment or treatment for a client with Texas Medicaid?​

  • First, you should ensure that the individual is actively enrolled in Texas Medicaid, use the TMHP portal and the Tex Med Connect link to verify eligibility and ensure that Medicaid is the primary funding source (the client does not have a commercial insurance plan and Medicaid).​

  • Next, ensure that the rendering LBA has been approved by TMHP and is in network with the clients MCO.

  • Ensure the client's diagnostic report meets medical necessity criterion: is no older than three years, includes background information including trauma history and co-morbid diagnosis, includes a valid diagnostic tool, includes symptomology associated with ASD and includes a level 1,2, or 3.

  • Obtain a referral for ABA- review the TMHP Provider Manual, Volume 2: Children's Services Handbook, for specifics regarding what must be included within the referral. 

  • Submit required documents to the MCO per the MCO's provider manual for prior authorization. Be sure to include the diagnostic evaluation, referral and prior authorization form specific to that MCO. 

• What are the rates?

  • The revised rates are included in the updates above in the form of a table. Rates are per 15 minute unit of time, except for the last two rates, which are per meeting.

​

• What services will LBA's be able to bill?

  • HHSC is using the standard Category 1 CPT codes, specifically: 97151, 97153, 97154, 97155,  97156 and 97158. In addition, they are allowing for IDT meetings to take place using code 99366.

​

• Will LBA's have to provide services directly?

  • HHSC will be adopting a tiered service delivery model, with LBAs, LaBA's and a behavior technician. The Behavior Technician must be either an RBT, ABAT or a BCAT.

• Why does this apply to only individuals age 20 and under?

  • The Center for Medicaid Services (CMS) at the Federal level, advised state Medicaid offices in July 2014 that they needed to pay for ANY medically necessary treatment for autism spectrum disorders, including ABA.CMS indicated that the benefit applies through a program within Medicaid called EPSDT (Early Periodic Screening Detection and Treatment). EPSDT is for children, individuals under age 21, and is a more robust benefit. The intent is to prevent, treat or decrease the risk of chronic illness or disease of any kind- from diabetes to autism. 

• Will this apply to CHIP?

  • Funding will apply to all areas of Medicaid where EPSDT is applicable. At this time THSteps (EPSDT) is not a benefit for children enrolled in CHIP or CHIP Perinatal.   We hope to continue to advocate for the inclusion of CHIP in the future.

​

• Will ISD’s be able to bill Medicaid for behavioral services?

  • ISD billing through SHARS has not been included in the initial policy.