---
title: "RightCare (Baylor Scott & White) ABA coverage — plan is winding down."
url: "https://carelu.com/payers/baylor-scott-white-texas"
markdown_url: "https://carelu.com/payers/baylor-scott-white-texas.md"
state: TX (Texas)
payer: "RightCare from Scott and White Health Plan (dba Baylor Scott & White Health Plan)"
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "RightCare from Scott and White Health Plan (MRSA Central STAR Medicaid) is exiting Texas Medicaid managed care August 31, 2026. What that means for ABA prior authorization, claims deadlines, and transition planning — plus the plan's ABA policy while it remains active."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# RightCare (Baylor Scott & White) ABA coverage — plan is winding down.

_Payer Guide · RightCare (Baylor Scott & White) · Last updated September 2026 · 9 primary sources_

> RightCare/MRSA Central — plan is WINDING DOWN, exits Texas Medicaid 8/31/2026 (regulatory approval pending).

Read this first: RightCare — Baylor Scott & White Health Plan's STAR Medicaid product for the Central Texas Medicaid Rural Service Area (MRSA Central) — is exiting the Texas Medicaid managed care program effective August 31, 2026, subject to regulatory approval. TMHP's own announcement and the plan's own site both confirm it. Its sister brand, FirstCare Health Plans (MRSA West/Lubbock), is exiting on the same date. For any family newly presenting with a RightCare STAR card, factor the wind-down into onboarding — a family's Medicaid managed-care assignment is likely to change soon regardless of what you do. For active RightCare cases, the plan's guidance is that prior-authorization processes remain unaffected during the transition, so keep following the process below through the exit date.

This plan administers the **Texas Medicaid (THSteps-CCP)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Texas Medicaid (THSteps-CCP) guide](https://carelu.com/payers/texas-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — 97151 on RightCare's own Medicaid PA code list (PA required since 1/3/2020); PA process unaffected during the wind-down [3]
- **Prior auth for treatment**: Required — 97153, 97154, 97155, 97156, 97158, 99366 all PA-required; defers to TMPPM criteria per Medical Coverage Policy 206 [3][4]
- **Autism diagnosis required?**: Yes — ASD, per TMPPM (Medical Coverage Policy 206 defers to TMPPM for Medicaid; own criteria apply only where TMPPM is silent) [4][9]

## At a glance

- **Status:** EXITING Texas Medicaid — last date of service accepted 8/31/2026 (regulatory approval pending)
- **Claims deadline:** Providers have until 8/31/2028 to submit claims for DOS through 8/31/2026
- **Service area:** MRSA Central — 30 counties per RightCare's own network materials (see below)
- **ABA clinical rules:** Medical Coverage Policy 206 (Autism Spectrum Disorder) — defers to TMPPM for Medicaid
- **PA-required ABA codes:** 97151, 97153, 97154, 97155, 97156, 97158, 99366 — matches the TMHP statewide code set
- **BH administration:** In-house — "RightCare Behavioral Health Management," not a third-party carve-out
- **Rates:** Not separately published — defers to the TMHP Autism Services fee schedule

## The wind-down: what it means for active and new cases

TMHP's July 17, 2026 announcement states Baylor Scott & White (MRSA Central) and FirstCare Health Plans (MRSA West/Lubbock) will end participation in Texas Medicaid managed care, with the final date of service TMHP will accept being August 31, 2026; claims with a date of service on or after September 1, 2026 will be rejected, and providers have until August 31, 2028 (24 months) to submit claims for dates of service through the exit date. RightCare's own site carries the same notice: "Our plans end on Aug. 31, 2026, subject to regulatory approval." The announcement is explicit that prior-authorization processes remain unaffected during the transition — so continue submitting and tracking PAs normally for now — but build the plan-reassignment conversation into intake for any new RightCare family, since members will need to select a new STAR MCO before the exit date. TMHP's Contact Center (800-925-9126) is the right first call for transition-specific questions. [1][2]

## While the plan remains active: ABA authorization

RightCare's own Medicaid/CHIP Prior Authorization Codes list (effective 7/1/2026) confirms PA-required ABA codes 97151, 97153, 97154, 97155, 97156, 97158, and 99366 — each showing a PA-requirement effective date of 1/3/2020 — with 97152 and 97157 absent from the list, matching the TMHP statewide THSteps-CCP Autism Services code set exactly. Requests submit through the RightCare Self-Service Portal or by fax to the Medical Management line. The plan's separate clinical policy, Medical Coverage Policy 206 ("Autism Spectrum Disorder," effective 7/1/2026), explicitly defers to the TMPPM first: "For Medicaid plans, please confirm coverage as outlined in the Texas Medicaid Provider Procedures Manual (TMPPM). If there are no applicable criteria to guide medical necessity decision making in the TMPPM, use the criteria set forth below." Note that Policy 206's own CPT code table (which lists 97152, 97157, 0362T, and 0373T alongside the others) is the plan's general/commercial-oriented table, not the operative Medicaid PA gate — the PA code list above is what actually governs a Medicaid claim, and it matches the narrower TMHP set. We could not confirm a RightCare-specific authorization-period length (e.g., a 90-day or 6-month cycle) beyond the general TMPPM baseline — treat auth-period length as inherited from the state rules and confirm any RightCare-specific timing with the plan directly. [3][4]

## Behavioral health is in-house, not carved out

RightCare runs behavioral health administration itself, under the branded units "RightCare Behavioral Health Management" and "RightCare Behavioral Health Disease and Case Management" (phone 1-855-395-9652, fax 1-844-436-8779) — no third-party BH vendor (no Cenpatico, Beacon, Magellan, Carelon, or Optum) appears anywhere in the plan's current provider manual or PA materials. That BH line is distinct from the medical Prior Authorization/Medical Management line (1-855-691-7947, fax 1-512-383-8703 or 1-800-292-1349) — we could not confirm from published materials which channel ABA codes route through specifically, since the PA list groups 97151–97158/99366 alongside general PT/OT/rehab codes; confirm the correct submission channel with RightCare before your first request. General Provider Relations runs at 1-855-TX-RIGHT (1-855-897-4448). [5]

## Service area and rates

RightCare's own 2025/2026 network materials list a 30-county MRSA Central service area: Bell, Blanco, Bosque, Brazos, Burleson, Colorado, Comanche, Coryell, Erath, Falls, Fayette, Freestone, Gillespie, Gonzales, Grimes, Hamilton, Hill, Jackson, Lampasas, Lavaca, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, and Washington. A separate internal document from a different Texas MCO listing MRSA Central for its own STAR Kids product adds a 31st county (DeWitt) not on RightCare's own list — we could not resolve this discrepancy and flag DeWitt as unconfirmed for RightCare specifically rather than asserting it either way. No RightCare-specific ABA fee schedule was found; the plan's own provider manual states reimbursement follows the Medicaid fee schedule "when available" — meaning the TMHP statewide Autism Services fee schedule (PRCR615C) already covered in our Texas Medicaid guide is the reference point, not a RightCare-negotiated rate. [6][5]

## Intake gates

The questions that decide whether a family can start with RightCare from Scott and White Health Plan (dba Baylor Scott & White Health Plan), and what they have to bring.

- **Age limit**: Follows the Texas Medicaid (TMPPM) rule: birth through 20 years of age on the date of service, with eligibility ending the day of the 21st birthday. CHIP members are excluded from the ABA benefit. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exits Texas Medicaid 8/31/2026. [9][3][4]
- **Diagnosis recency**: Follows the Texas Medicaid (TMPPM) rule: the ASD diagnosis must be made or reconfirmed within 3 years of initiation or recertification; past 3 years a comprehensive re-evaluation of ASD symptom severity levels per DSM criteria is required first. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exits Texas Medicaid 8/31/2026. [9][3][4]
- **Who may diagnose**: Follows the Texas Medicaid (TMPPM) rule: a developmental pediatrician, neurologist, psychiatrist, licensed psychologist, or an interdisciplinary diagnostic team (a physician, PA or NP in consultation with qualified child specialists with autism expertise). Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exits Texas Medicaid 8/31/2026. [9][3][4]
- **Diagnostic tools required**: Follows the Texas Medicaid (TMPPM) rule: a reliable, valid, standardized diagnostic assessment tool or combination of tools — the manual names the ADOS, ADI-R and CARS as examples. Screening instruments alone (STAT, M-CHAT-R) do not substitute. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exits Texas Medicaid 8/31/2026. [9][3][4]
- **Referral required?**: Follows the Texas Medicaid (TMPPM) rule: a signed, dated prescriber referral for the evaluation, signed within 60 calendar days before or on the anticipated evaluation date; and for treatment a signed, dated referral from a physician or allowed practitioner (MD/DO, PA, NP, or CNS with delegated authority) stating frequency and duration, signed on or before the service start date and no more than 3 months old. Since 4/1/2025 the prescriber signature is no longer required on the CCP PA form for the 90-day extension. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exits Texas Medicaid 8/31/2026. [9][3][4][8]
- **Telehealth**: Follows the Texas Medicaid (TMPPM) rule: synchronous audio-visual only, modifier 95, on 97151, 97155, 97156, 97158 and 99366. One-on-one direct treatment delivered to the child by a behavior technician or LaBA must be in person — telehealth is prohibited for BT/LaBA-delivered direct service. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exits Texas Medicaid 8/31/2026. [9][3][4]
- **Prior-auth decision time**: "RightCare Medical Management processes prior authorization requests within 3 business days after receipt of a completed request" — the same language appears for behavioral health — and inpatient or concurrent requests "within one business day after receipt of a completed request." Lead time is a requirement, not a suggestion: "the requesting/performing provider must contact RightCare Medical Management at least 3 business days before the requested services are provided. Failure to timely request prior authorization may result in denial," and RightCare "does not process requests for retro-authorization." No ABA-specific reauthorization lead time is published. [5][10]
- **Other insurance (who pays first)**: "If a RightCare member has insurance other than Medicaid, the other insurance becomes the primary carrier and claims should be submitted to that primary carrier first," then filed with RightCare with the EOB attached "within 95 days of settlement with the primary carrier." Authorization still applies when RightCare pays second: "RightCare's authorization procedures must be followed to receive payment." The manual's exceptions to billing the other insurer first are "Texas Health Steps exams and family planning services" — not ABA. [5][11]

## Delivery and billing rules

Coverage decides whether RightCare from Scott and White Health Plan (dba Baylor Scott & White Health Plan) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the Texas Medicaid (TMPPM) rule: the manual sets no numeric ratio of its own, requiring LBAs to directly supervise LaBAs and behavior technicians in accordance with Texas licensure and deferring to the certifying body's minimums — for RBT-credentialed staff the BACB floor of supervision on at least 5% of service hours each month with two face-to-face contacts. Only direct supervision, where the LBA observes the LaBA or BT with the child, is reimbursable (under 97155); indirect supervision is unpaid. [9][3][4][7]
- **Concurrent billing (97153 + 97155)**: Follows the Texas Medicaid (TMPPM) rule: concurrent billing is prohibited — Texas Medicaid will not reimburse multiple ABA providers during one session with the child when more than one provider is present. The single exception is when the family and the child receive separate services and the child is not present in the family session. Total authorized hours may be requested under either 97153 or 97155 and billed as the code matching the service actually delivered — not both for the same clock time with the child present. [9][3][4]
- **Daily limits / MUEs**: Follows the Texas Medicaid (TMPPM) rule: direct treatment is capped at 8 hours (32 units) per day combined across 97153, 97154, 97155 and 97158; 97151 is capped at 6 hours (24 units) per evaluation and per re-evaluation; group treatment runs 2 to 8 children. Authorization periods are two consecutive 90-day terms then recertifications of up to 180 days. No RightCare-specific authorization-period length could be confirmed beyond the TMPPM baseline. [3][9]
- **Session-note signature**: Follows the Texas Medicaid (TMPPM) rule: rendering ABA providers must sign each entry with full signature and credentials, with additional supervisory signatures per state licensure. Treatment notes carry the child's name, date of service, start and stop times, goals addressed, progress and a summary of interventions; 97155/97158 notes add protocol-modification decision points. The 97151 evaluation and the 90-day progress summary each need a dated signature from the LBA and from the parent or caregiver. [9][3][4]
- **Place of service**: Follows the Texas Medicaid (TMPPM) rule: home, clinic, office and community settings are payable. In schools, services delivered by a behavior technician as a shadow, an aide, or as general support are excluded; school personnel participating to coordinate care are not counted as duplicate providers, and interdisciplinary team meetings bill under 99366 against an ABA PA. BT and LaBA direct treatment must be in person in every setting. [9][3][4]
- **Bill as provider**: Follows the Texas Medicaid (TMPPM) rule: only the LBA enrolls in Texas Medicaid and bills. LaBAs and behavior technicians may not enroll — their services go out under the supervising LBA's NPI with the credential modifier identifying who rendered (HO = LBA, HN = LaBA, HM = behavior technician; 97151 takes HO only, 97155/97156/97158 take HO or HN). The LBA must directly employ or contract with every LaBA and BT on the team. [9][3][4]

## What intake should collect for RightCare from Scott and White Health Plan (dba Baylor Scott & White Health Plan)

- **Plan wind-down awareness:** RightCare exits Texas Medicaid 8/31/2026 — confirm the family's plan-reassignment status and don't build long-term authorization plans around this plan past that date.
- **ASD diagnosis + TMPPM-standard documentation:** The plan defers to TMPPM criteria for Medicaid — reuse the same packet you'd build for any Texas Medicaid MCO.
- **Correct submission channel:** Confirm with RightCare whether ABA PA routes through Medical Management (1-855-691-7947) or Behavioral Health Management (1-855-395-9652) — not independently confirmed from published materials.
- **County of residence:** Confirm MRSA Central coverage for the family's specific county, especially near the DeWitt County boundary.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How RightCare from Scott and White Health Plan (dba Baylor Scott & White Health Plan) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — "RightCare Behavioral Health Management" is an in-house unit, not a third-party BH vendor (no Cenpatico/Beacon/Magellan/Carelon/Optum named anywhere in the plan's current provider manual or PA materials)
- **BH administrator payer ID:** N/A

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** MH
- **Deductible applies to ABA:** no
- **Cost-share type:** plan-dependent
- **271 response quality for ABA:** high

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes — ABA Initial Evaluation / Re-evaluation, by the LBA | Required — CCP PA form + signed prescriber referral; not reimbursable unless the evaluation was submitted for authorization of payment; must be billed within 30 calendar days of the first date of service | 24 units (6 hours) per evaluation or re-evaluation event per per evaluation event; re-evaluations authorized no more than once every 180 days | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual only, delivered by the LBA (LaBAs and BTs/RBTs may not deliver any service remotely) | HO (required — LBA only) |
| 97152 | Not confirmed (see code notes) | — | — | — | — | — |
| 97153 | Yes — direct 1:1 ABA treatment (BT-complexity level), delivered per treatment-plan protocol | Required — covered under the treatment authorization (90-day initial + 90-day extension, then 180-day recertifications; no prescriber signature on the 90-day extension since 4/1/2025) | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | No — 1:1 direct treatment must be delivered in person | No modifier required (HO/HN/HM may be reported for information only) |
| 97154 | Yes — direct group ABA treatment (BT-complexity level; group is 2–8 children/youth) | Required — covered under the treatment authorization (90-day initial + 90-day extension, then 180-day recertifications) | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | No — group direct treatment must be delivered in person | No modifier required (HO/HN/HM may be reported for information only) |
| 97155 | Yes — protocol modification / direct 1:1 time by the LBA (or delegated LaBA) | Required — covered under the treatment authorization (90-day initial + 90-day extension, then 180-day recertifications) | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual, delivered by the LBA only | HO or HN (one required) |
| 97156 | Yes — parent/caregiver education & training, by the LBA (or delegated LaBA) | Required — covered under the treatment authorization | — | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual, delivered by the LBA (LaBAs may not deliver this — or any — service via telehealth, even by delegation) | HO or HN (one required) |
| 97157 | Not confirmed (see code notes) | — | — | — | — | — |
| 97158 | Yes — group protocol modification, by the LBA (or delegated LaBA) | Required — covered under the treatment authorization | Shares the 8-hour (32-unit) combined daily direct-treatment cap, shared with 97153, 97154, 97155, and 97158 (TMPPM §2.3.12). per day | office, home, clinic, community | Yes — 95 modifier, synchronous audio-visual, delivered by the LBA only | HO or HN (one required) |
| 99366 | Yes — interdisciplinary team meeting, attended by qualified nonphysician health-care providers | Not separately authorized — reimbursable when a PA for ABA evaluation, re-evaluation, or treatment is already on file; reimbursement limited to primary diagnosis F84 | — | office, home, clinic, community, remote participation for team members (95 modifier) | Yes — 95 modifier for remote participation by team members | No modifier required (95 for remote participation) |
| 0362T | Not confirmed (see code notes) | — | — | — | — | — |
| 0373T | Not confirmed (see code notes) | — | — | — | — | — |

Code notes:

- **97151:** RightCare's own Medicaid/CHIP PA Codes list (eff. 7/1/2026) confirms 97151 as PA-required since 1/3/2020, matching the TMPPM baseline exactly. PLAN IS WINDING DOWN — exits Texas Medicaid 8/31/2026 (regulatory approval pending); PA processes remain unaffected during the transition per TMHP/RightCare's own notices.
- **97152:** 97152 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **97153:** Either 97153 or 97155 may be billed for direct individual treatment hours — bill the code matching who delivered the session.
- **97154:** Either 97154 or 97158 may be billed for direct group treatment hours.
- **97155:** Also the code used to bill the required progress summary submitted after the first 90 days of treatment. Only DIRECT supervision (LBA observing the LaBA/BT with the client) is reimbursable under this code — indirect supervision (caseload review, data discussion) is not billable.
- **97156:** Continued treatment authorization considers caregiver attendance at ≥85% of planned sessions.
- **97157:** 97157 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **99366:** School-district personnel may participate and count toward the 3-participant licensed-professional minimum but are not separately reimbursable.
- **0362T:** 0362T does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.
- **0373T:** 0373T does not appear anywhere in the TMPPM Children's Services Handbook §2.3 Autism Services or in TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — cross-checked against both independently. Texas's actual THSteps-CCP Autism Services billable code set appears to be limited to 97151, 97153, 97154, 97155, 97156, 97158, and 99366. Verify via: TMHP provider relations / Online Fee Lookup — confirm whether this code is billable under Texas Medicaid THSteps-CCP Autism Services at all, under a different program, or not covered.

### Contacts

- **Provider services phone:** 1-855-691-7947 (Medical Management/PA) or 1-855-395-9652 (Behavioral Health Management) — confirm which routes ABA specifically
- **Phone menu path:** General Provider Relations: 1-855-TX-RIGHT (1-855-897-4448).
- **Portal:** [RightCare Self-Service Portal](https://rightcare.swhp.org/providers)
- **Fax:** Medical Management/PA: 1-512-383-8703 or 1-800-292-1349; Behavioral Health Management: 1-844-436-8779

Questions to ask on a verification call:

- CONFIRMED: RightCare is exiting Texas Medicaid managed care effective 8/31/2026 (TMHP 7/17/2026 announcement) — confirm this family's post-exit MCO reassignment status.
- Does ABA prior authorization route through Medical Management (1-855-691-7947) or Behavioral Health Management (1-855-395-9652)? RightCare's own PA code list does not separate these codes by routing channel.
- What EDI payer ID should be used for this member's 270/271 eligibility check?
- Is the ABA copay or coinsurance charged per visit or per day, and does the plan's out-of-pocket maximum apply?
- Does a RightCare-specific authorization-period length apply (vs. the general TMPPM baseline), and does DeWitt County fall within the MRSA Central service area for this plan specifically?

### VOB data sources

- https://rightcare.swhp.org/-/media/project/bsw/sites/rightcare/documents/forms/medicaid/RightCare_Authorization_List.pdf (accessed 2026-07-23)
- https://wadcdnstorageprod.blob.core.windows.net/bswhp/Medical-Policies/206.pdf (accessed 2026-07-23)
- https://rightcare.swhp.org/-/media/project/bsw/sites/rightcare/documents/provider-manual.pdf (accessed 2026-07-23)
- https://pverify.com/payer-list/ (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23)
- https://www.tmhp.com/sites/default/files/file-library/edi/D00026_270_271_Medicaid_CHIP_Eligibility_Companion_Guide.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_04_Childrens_Services/2_04_Childrens_Services.htm (accessed 2026-07-23)
- https://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx?fn=%5C%5Ctmhp.net%5CFeeSchedule%5CPROD%5CStatic%5CTexas_Medicaid_Fee_Schedule_PRCR615C.pdf (accessed 2026-07-23)
- https://www.tmhp.com/news/2026-07-17-baylor-scott-white-and-firstcare-health-plans-will-end-participation-texas-medicaid (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Is RightCare/Baylor Scott & White still a Texas Medicaid option?

Only through August 31, 2026 — the plan is exiting Texas Medicaid managed care (regulatory approval pending), per TMHP's July 2026 announcement. Claims for dates of service on or after September 1, 2026 will be rejected; providers have until 8/31/2028 to submit claims for earlier dates of service.

### Does RightCare cover ABA therapy?

Yes, while active — PA-required codes 97151, 97153, 97154, 97155, 97156, 97158, and 99366, matching the statewide TMHP code set, with criteria deferring to the TMPPM. Prior-authorization processes remain unaffected during the wind-down.

### Is ABA carved out to a behavioral health vendor at RightCare?

No — RightCare administers behavioral health in-house through its own "RightCare Behavioral Health Management" unit, not a third-party vendor like Magellan or Carelon.

### What happens to my RightCare client's ABA authorization after the plan exits?

The family will be reassigned to a different STAR MCO before the 8/31/2026 exit date — confirm current status with TMHP's Contact Center (800-925-9126) or the family's new MCO once assigned.

## Primary sources

1. [TMHP — Baylor Scott & White and FirstCare Health Plans will end participation in Texas Medicaid](https://www.tmhp.com/news/2026-07-17-baylor-scott-white-and-firstcare-health-plans-will-end-participation-texas-medicaid)
2. [RightCare — plan homepage (exit notice)](https://rightcare.swhp.org/)
3. [RightCare — Texas Medicaid/CHIP Prior Authorization Codes List (eff. 7/1/2026)](https://rightcare.swhp.org/-/media/project/bsw/sites/rightcare/documents/forms/medicaid/RightCare_Authorization_List.pdf)
4. [BSWHP Medical Coverage Policy 206 — Autism Spectrum Disorder](https://wadcdnstorageprod.blob.core.windows.net/bswhp/Medical-Policies/206.pdf)
5. [RightCare — 2026 Provider Manual](https://rightcare.swhp.org/-/media/project/bsw/sites/rightcare/documents/provider-manual.pdf)
6. [RightCare — Medicaid (STAR) Network Flyer](https://wadcdnstorageprod.blob.core.windows.net/bswhp/Providers/Network/2025/MD-RightCare.pdf)
7. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
8. [TMHP — Update to a PA Requirement for Autism Services (eff. 4/1/2025)](https://www.tmhp.com/news/2025-02-14-update-prior-authorization-requirement-autism-services-effective-april-1-2025)
9. [TMPPM Children's Services Handbook, § 2.3 Autism Services](https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_04_Childrens_Services/2_04_Childrens_Services.htm)
10. [Tex. Gov't Code § 540.0303 — MCO PA determinations for nonhospitalized recipients (eff. 4/1/2025)](https://texas.public.law/statutes/tex._gov't_code_section_540.0303)
11. [TMPPM Vol. 1, Section 8: Third Party Liability (TPL)](https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/1_08_Third_Party_Liability/1_08_Third_Party_Liability.htm)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.