Dell Children's Health Plan is not a new entrant — it has administered CHIP in Central Texas since 2000 and was selected to run STAR and CHIP Perinatal in the Travis service area starting March 1, 2012, and it currently serves 40,000+ members across 8 counties. The plan is affiliated with Dell Children's Medical Center and Ascension Seton (its provider manual and staff correspondence run through @seton.org and @ascension.org addresses), giving it a pediatric-hospital-system orientation. For ABA specifically, the plan delegates behavioral-health prior authorization to Magellan Healthcare rather than administering it in-house, and it publishes its own current PA code list confirming ABA as a covered STAR benefit.
Dell Children's Health Plan's own provider manual states it plainly: "Dell Children's Health Plan has been an administrator of CHIP since 2000 and was selected to administer the CHIP Perinatal and STAR programs in Central Texas beginning March 1, 2012." It currently publishes actively-maintained documents dated into 2026 (a Prior Authorization list effective 6/1/2026, provider directories dated 3/2026), and independent reporting describes it as serving 40,000+ lives across 8 counties. The plan's email domains (@seton.org, @ascension.org) and homepage both tie it to the Seton/Ascension health system that also runs Dell Children's Medical Center — though we could not locate a single primary-source document stating the exact legal entity structure (e.g., a specific "Seton Health Plan d/b/a" formulation), so treat the precise corporate relationship as indicative rather than a verbatim-confirmed fact.[1]
The plan's STAR Member Handbook and provider manual both explicitly list "Applied Behavior Analysis (ABA) therapy" as a covered STAR behavioral-health service, and the member-facing behavioral-health page states ABA "is now a benefit for STAR members as a covered benefit through Texas Medicaid," requiring prior ASD diagnostic testing "by a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an autism diagnosis team." The plan's Prior Authorization List (effective 6/1/2026) confirms PA is required (marked "Yes") for 97151, 97153, 97154, 97155, 97156, 97158, and 99366, each cross-referenced to the TMPPM Children's Services Handbook. One discrepancy worth flagging rather than silently resolving: the same PA list also shows code 97157 with PA=Yes, even though 97157 is confirmed absent from Texas Medicaid's actual THSteps-CCP Autism Services billable code set per TMHP's own fee schedule and handbook — treat 97157's status with this plan as needing direct confirmation. Separately, the provider manual's STAR-covered-services list explicitly names ABA, but the CHIP-specific covered-behavioral-health-services bullet list in the same manual does not repeat ABA by name (it lists inpatient/outpatient mental health and substance-use-disorder services only) — this is genuinely ambiguous in the plan's own document, so confirm ABA coverage for standard CHIP (non-STAR, non-Perinatal) members directly with the plan rather than assuming either way.[1][2][3]
Unlike some Texas MCOs that handle BH in-house, Dell Children's Health Plan delegates behavioral-health services — including ABA-related prior authorization and referrals — to Magellan Healthcare. The member-facing behavioral-health page tells families to "self-refer directly by calling Magellan toll-free at 1-800-424-1764," and the provider manual lists dedicated Magellan-branded forms (Behavioral Health Prior Auth Form, Initial Review Form, Concurrent Review Form, Discharge Assistance, Provider Search) accessed through the Magellan member/provider portal. The dedicated BH PA fax is (866) 354-8758, distinct from the plan's general medical PA fax (844-981-3329). General Provider Services runs at 1-844-781-2343; the plan's provider portal for eligibility, PA status, and claims is the HealthX Provider Portal.[2][1][4]
Dell Children's Health Plan lists a value-added benefit directly relevant to autism families: the GoManda learning app, free for one year to CHIP/STAR members ages 2 to 8 with autism or speech delay, available with a referral. It's not a substitute for ABA, but it's worth mentioning at intake as a no-cost supplement families may not know they have access to. No dedicated autism specialty clinic or autism-specific clinical program beyond the standard ABA benefit and GoManda was found in the plan's published materials. No plan-specific ABA fee schedule is published — the PA list's references point back to the TMPPM/TMHP baseline already covered in our Texas Medicaid guide.[5]
The questions that decide whether a family can start with Dell Children's Health Plan, and what they have to bring. Each maps onto something intake should ask on the first call.
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.[9][3]
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.[9][3]
The plan states it on its own member-facing behavioral-health page: ABA requires prior ASD diagnostic testing by a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an autism diagnosis team — the same set the TMPPM names.[2][9]
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.[9][3]
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.[9][3][8]
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.[9][3]
Dell Children's timeliness standards: "Non-urgent pre-service: … a decision will be made within three business days. Urgent pre-service: … within one business day but not later than 72 hours or three calendar days"; urgent concurrent within 24 hours; standard timeframes may be extended when information is insufficient. Incomplete requests are not approved; the reviewer asks for the missing documentation, and "If no additional information is received within the designated time frame, the … medical director will make a determination based on the information previously received." The September 2025 manual sets no submission or reauthorization lead time and nothing ABA-specific.[10][11][12]
"Federal and state laws require Medicaid, including the STAR program, be the payer of last resort … Providers must submit claims to other health insurers for consideration prior to billing us. A copy of the other health insurer's EOB/EOP or rejection letter should be submitted with the claim." Deadline: "submit clean claims within 95 calendar days of receiving a response from the third-party payer." The manual does not say whether Dell Children's ABA PA is still needed when it pays second — request it.[10][13]
Coverage decides whether Dell Children's Health Plan pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
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][7]
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]
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.[9][3]
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]
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]
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. Behavioral health, including ABA prior authorization, is delegated to Magellan Healthcare (1-800-424-1764) rather than administered by the plan, so authorizations use Magellan's forms and portal even though the claim still follows the state's enrolled-LBA structure.[2][9]
No — despite sometimes being described as newly launched, the plan's own provider manual confirms it has administered CHIP since 2000 and STAR/CHIP Perinatal in the Travis service area since March 1, 2012.
Yes for STAR members — explicitly listed as a covered behavioral-health benefit, with prior authorization required on assessment and treatment codes. CHIP-specific (non-STAR) coverage of ABA is not explicitly confirmed in the plan's own materials — verify directly for CHIP-only members.
Magellan Healthcare, under delegation — call 1-800-424-1764 or use the Magellan provider portal, not the plan's general medical PA line.
The Travis service delivery area: Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, and Williamson counties.
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.
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