Texas ABA Medicaid Information
News and Updates
Since Governor Abbot Signed Rider 32 Into Law
Requiring Medicaid to Cover ABA Therapy...
How Long Have Texans Waited
FOR COVERAGE TO ACTUALLY START?
BREAKING NEWS - TEXAS MEDICAID COVERAGE OF ABA TO START MARCH 1, 2021
August 26, 2020
TxABA PPG has been made aware that the Medicaid implementation date for ABA coverage is estimated to be March 1, 2021
Reference: TxABA Public Policy Group
COVID-19 Delays Implementation
July 14, 2020
Per HHSC they are "assessing the implementation and timeline (of the ABA benefit) in light of COVID-19 activities"
Reference: TxABA Public Policy Group
Telehealth Options for ABA through Texas Medicaid
February 18, 2020
HHSC responded to public comment regarding ECI services and informed stakeholders on 2/6/2020 about Telehealth options for ABA through Texas Medicaid.
Comment: A couple commenters recommended that applied behavioral analysis and provider delivering these services be added to the Telehealth Services Medical Policy.
Response: HHSC is currently reviewing public comments related to the draft Autism Services policy that was posted September 24 - October 7, 2019. That policy included the proposed addition of applied behavior analysis and the addition of licensed behavior analysts as eligible for enrollment with Texas Medicaid. As proposed, procedure codes 97151, 97155, 97156, 97158, and 99366 would be reimbursed when services were remotely delivered. Providers should indicate that remote delivery occurred using the 95 modifier.
There is not a specific deadline by which HHSC expects to make final policy decisions and post responses to public comments on that draft policy. Final policy decisions, including those regarding the role of telehealth and the use of modifiers, will be available in the HHSC responses to public comments on that policy.
Reference: TxABA Public Policy Group
Rumors Surface Re: Lack of Funds for ABA Through Texas Medicaid
December 2019
TxABA PPG was notified by providers and families that they were hearing from various Medicaid funding sources that ABA/ IBI was delayed to 2021 due to lack of funds. TxABA PPG followed up with HHSC and received confirmation that HHSC plans to roll out ABA/IBI services in Spring 2020 as planned and is standing by that timeline.
Reference: TxABA Public Policy Group
HHSC Finalizing Revisions State Plan - Rate Hearings Postponed
November 2019
HHSC was finalizing revisions to the state plan and responding to public comments. Public Comments on the draft policy were submitted to HHSC with an October 7, 2019. A revised final policy has not been released.
Rate hearings that were set to occur on or about December 13, 2019 in Austin have been pushed back to early 2020; date is TBD.
Implementation will occur sometime in 2020; exact date is TBD.
Reference: TxABA Public Policy Group
Governor Abbot Signed HB1 Rider 32: Intensive Behavioral Intervention
June 2019
Governor Abbott signed HB1 which included 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.
Reference: HHSC HB1 Rider 32 Autism Services
Texas Issues First Ever Licenses for BCBAs and BCaBAs
July 2018
The Texas Department of Licensing and Regulation (TDLR) issued the first licenses for BCBAs and BCaBAs.
Texas Passes SB589 to License BCBAs
July 2017
Texas legislature passed SB589 to license Board Certified Behavior Analysts. This ensures that vulnerable Texas will be protected by mandating that only appropriately trained and licensed professionals can provide ABA therapy, as well as Intensive Behavioral Interventions as defined as a requirement from Federal Medicaid.
This was a critical step towards requiring Texas Medicaid Plans to cover ABA services.
Reference: Texas SB00589
Open Enrollment Began Under the Affordable Care Act
November 2014
Open Enrollment for healthcare plans in the Affordable Care Act began, which provided ABA therapy to hundreds of not thousands of clients across the nation that may not have been able to receive services in the past. Parents were able to purchase "child-only" insurance plans solely so that their child could access ABA services.
CMS Addresses State's Concerns Re: Autism Services
September 2014
CMS released a set of Frequently Asked Questions to respond to questions raised by states and stakeholders regarding autism services.
Reference: Medicaid Autism Services
CMS Informs States that Medicaid Must Cover ABA by Licensed Practitioners
July 2014
The Centers for Medicare and Medicaid Services (CMS) informed states in a bulletin that medically necessary treatment services for children with an autism diagnosis, including ABA, was to be covered in all Medicaid state plans.
Federal Medicaid requires that all reimbursable services be provided by a “licensed practitioner of the healing arts.” In 2014, Texas did not offer licensure for Board Certified Behavior Analysts (BCBA) and therefore did not have to follow this mandate.
Reference: CMS Information Bulletin 07-07-14
Mandated Private Insurance Coverage Extended For Learners Over 10
September 2013
SB 1484 was passed into law which extends benefits for learners after they turn 10, which includes $36,000 per year for ABA services. The unlimited coverage specified for children under the age of 10 remains the same.
Reference: Texas SB01484
The Original Texas Autism Insurance Mandate is Passed
January 2010
Texas legislature passed HB 451 (expanding previously passed HB1919). This bill requires health benefit plan to provide coverage to an enrollee who is diagnosed with autism spectrum disorder from the date of diagnosis until the enrollee completes nine years of age.
If an enrollee who is being treated for autism spectrum disorder becomes 10 years of age or older and continues to need treatment, this does not preclude coverage of treatment and services.
Treatment may include services such as: evaluation and assessment services; applied behavior analysis; behavior training and behavior management; speech therapy; occupational therapy; physical therapy; or medications or nutritional supplements used to address symptoms of autism spectrum disorder.
HB1919, passed in 2007, only mandated insurance companies to cover medically necessary interventions for children with autism between 3-5 years old.
Note: Certain insurance plans are exempt from state mandates. Please contact your plan administrator to see if your plan includes state mandated autism spectrum disorder benefits. Ask specifically if your plan is considered a "self-funded" plan or a "fully-funded" plan.
Reference: Tex. Ins. Code Ann. §1355.015