What is Autism?
Autism Spectrum Disorder (ASD) is a developmental disorder that affects communication and behavior. It is characterized by restricted, repetitive patterns of behavior, interests, or activities and deficits in social communication and social interaction, with onset of symptoms occurring in early childhood.
Who is eligible for Autism benefits?
Effective February 1, 2022, Autism Services, to include Applied Behavior Analysis (ABA) evaluation and treatment, became a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Texas Medicaid recipients who are 20 years of age and younger and who meet the criteria outlined in the Autism Services benefit description. This benefit is not available for CHIP recipients.
Does this service require prior authorization?
Yes, prior authorization is required for evaluation and treatment. A great place to start is your child’s Primary Care Provider (PCP). They may recommend a Provider that meets your child’s needs. A signed referral must be submitted to the ABA Provider to accompany their Authorization request.
Who can evaluate my child?
Your child can be evaluated by any of the following health care providers.
- A developmental pediatrician
- A neurologist
- A psychiatrist
- A licensed psychologist
- An interdisciplinary team composed of a physician, physician assistant or nurse practitioner in consultation with one or more providers who are qualified child specialists who have expertise in autism limited to:
- Any provider listed above
- Licensed clinical social worker
- Licensed professional counselor
- Licensed psychological associate
- Licensed specialist in school psychology
- Occupational therapist (OT)
- Speech-language pathologist (SLP)
To find a provider, visit https://providersearch.communityhealthchoice.org or call Member Services at 713.295.2294, or toll free at 1.888.760.2600.
