Applied Behavioral Analysis for Children with Autism Spectrum Disorder

January 27, 2022

New Information

Effective February 1, 2022, autism services are a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Medicaid clients who are 20 years of age or younger, and who meet criteria outlined in the Texas Medicaid Autism Services Policy . Highlights of this policy are shown below.

Action Now

If you believe your patient may have a diagnosis of Autism Spectrum Disorder (ASD), and they would benefit from treatment with Applied Behavioral Analysis (ABA) and other autism services, the diagnosis must first be confirmed by any of the providers listed below:

  • 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)

A diagnosis of ASD requires a comprehensive diagnostic evaluation (CDE) performed by one of the provider types listed above. To qualify for ABA services, the CDE must be conducted no earlier than three years prior to the initiation of ABA therapy, and the CDE must recommend ABA services as part of any treatment recommendations. The CDE must include:

  • Diagnostic criteria and symptom severity level according to the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
  • A validated diagnostic assessment tool or combination of tools, using the most current editions or versions of the tools, as age and clinically appropriate, such as the Autism Diagnostic Observation Schedule, the Autism Diagnostic Interview-Revised (ADI-R), the Childhood Autism Rating Scale, or another validated diagnostic tool, as clinically appropriate.
    • Screening tools such as the Screening Tool for Autism in Toddlers and Young Children (STAT) may not replace the use of validated diagnostic assessment tools.
  • Documentation of diagnosis must include:
    • Age of the child/youth
    • Date of the initial ASD diagnosis
    • Documentation of any known co-morbid behavioral or physical health disorders
    • Documentation of trauma history

Texas Medicaid also offers an array of medically necessary services to support individualized treatment plans for children and youth up to 20 years of age with ASD. These services may include one or more of the following but are not limited to:

  • Applied behavior analysis (ABA)
  • Case management/care coordination (with parent permission)
  • Early Childhood Intervention (ECI)
  • Nutrition, when provided by a Licensed Dietitian
  • Occupational therapy (OT)
  • Outpatient behavioral health services
  • Physician services, including medication management
  • Physical therapy (PT)
  • Speech-language pathology (SLP; also called speech therapy, ST)

Applied Behavior Analysis (ABA) refers to the application of current, evidence-based specialized principles of the applied behavior analysis discipline by a provider, such as a licensed and certified behavior analyst (LBA), trained in this intervention. The intent of ABA therapy is to effect meaningful changes, which are durable and generalizable, in socially significant behaviors in everyday settings. ABA focuses on treating behavior difficulties and shaping behavior patterns through environmental adaptations and consistent reinforcement and consequences across settings and situations.

ABA providers addressed by this policy include Texas LBAs as well as a Licensed assistant Behavior Analyst (LaBA) or behavior technician (BT) working under the supervision of an LBA. ABA services can be provided in office, home, clinic, and community settings.

After a diagnosis of ASD and a referral for ABA services are made, the ABA provider conducts an ABA Initial Evaluation, during which a treatment plan is composed. Because caregiver involvement is necessary for success with ABA services, the treatment plan is thoroughly discussed with caregivers, consent is obtained, and attendance for ABA therapy sessions is recorded along with treatment records and progress summaries. Initial approval of ABA services is for 90 days, with a primary extension of 90 days if services remain medically necessary. Caregivers must attend at least 85% of therapy sessions for ABA services to be extended, along with documentation of progress with therapy. For an additional 180-day extension of ABA services, a re-evaluation of the member’s current clinical status and treatment plan progress must be performed within 60 days of the extension request. Of note, criteria for discharge from ABA services must be included in all treatment plans.

Interdisciplinary team meetings are the gold standard for care of people with ASD. Texas Medicaid reimburses for twice yearly interdisciplinary team meetings that include at least three licensed professionals (one of which is a Licensed Behavior Analyst (LBA)) meeting with the child/youth and/or family/caregiver simultaneously. Team members may include licensed Medicaid-enrolled practitioners of the following disciplines:

  • Licensed clinical social worker (LCSW)
  • Licensed behavior analyst (required team member)
  • Licensed dietitian (LD)
  • Licensed professional counselor (LPC)
  • Licensed psychologist (LP)
  • Occupational therapist (OT)
  • Physical therapist (PT)
  • Physician, physician assistant, or nurse practitioner
  • Speech-language pathologist (SLP)

Disclaimer: Interdisciplinary provider must attach the attendance form to the submitted claim to receive payment.

Visit TMHP website for full details of the Texas Medicaid Autism Services Policy.


For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-Children with Special Health Care Needs (CSHCN) Services Program Contact Center at 1-800-568-2413.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.