Driscoll Health Plan — the children's-hospital-affiliated plan serving STAR, STAR Kids, and CHIP across South Texas — administers the state ABA benefit with no distinct clinical policy: TMPPM criteria govern. Its operational profile is unusually low-friction for practices that already work statewide, because Driscoll uses the statewide Texas Authorization Referral Form (TARF) rather than a proprietary form, and it runs a public per-code PA lookup portal that answers "does this code need auth?" without a phone call.
Autism (ABA) Services appear on Driscoll's Prior Authorization Requirement Portal (driscollhealthplan.com/priorauthcheck) — the plan's own tool for verifying PA requirements code by code, which is the right first stop before any submission. Requests submit through the DHP portal or by fax to 1-866-741-5650 using the Texas Authorization Referral Form. Because the TARF is the statewide form, a practice already producing TARFs for other plans has no form-conversion work here — attach the state-baseline clinical package (signed prescriber referral, recency-checked ASD diagnosis, per-code units) and follow the TMPPM's 90/90/180 cadence.[1][2]
Everything on the Texas Medicaid guide applies unchanged: PA on the 97151 evaluation (24-unit cap), the April 2025 removal of the prescriber signature on 90-day extensions, the 3-year diagnosis recency rule, the 8-hour daily direct-treatment cap, credential modifiers, and the telehealth restrictions. Driscoll's only plan-specific wrinkle is workflow — verify the code on the portal, submit the TARF, track through the DHP portal.[3]
The questions that decide whether a family can start with Driscoll 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.[3][1]
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.[3][1]
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).[3][1]
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.[3][1]
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. Driscoll takes the statewide Texas Authorization Referral Form (TARF) rather than a proprietary form, submitted through the DHP portal or fax 1-866-741-5650.[1][3][5]
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.[3][1]
STAR and STAR Kids requests "submitted with complete supporting clinical information and documentation: Within three (3) business days from the receipt of a preauthorization request"; CHIP within 2 business days for approvals and 3 for adverse determinations; urgent "no later than 24 hours from receipt." Incomplete STAR/STAR Kids requests go through Driscoll's Lack of Information process: a letter within three business days gives the provider three business days to respond, and the process "will not exceed 10 business days/14 calendar days from date of receipt." Renewals: "DHP allows for timely submission of continuation of service requests/renewal of an existing prior authorization up to 60 days before the current prior authorization expires" and will decide, "if practicable, before the existing authorization expires" — but where a renewal needs assessments or progress notes more recent than 60 days, Driscoll will ask you to resubmit closer to the end date, which is the ABA situation.[6][7]
"DHP is the payer of last resort. Providers must bill all other carriers and receive payment or denial prior to billing DHP," attaching the denial letter or EOP when the other payer denies. Driscoll is the one Texas MCO that says plainly what happens to authorization when it pays second: "Some outpatient services/procedure codes may require prior authorization regardless of DHP as secondary payer," so check the DHP Prior Authorization Portal; and "If the services are known to be a non-covered benefit by the primary payer, prior authorization is required by DHP and proof of non-coverage of benefit must accompany the claim submission." For ABA, where many commercial plans exclude or cap the benefit, get the Driscoll PA.[6][8]
Coverage decides whether Driscoll 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.[3][1][4]
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.[3][1]
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.[3][1]
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.[3][1]
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.[3][1]
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.[3][1]
Yes — the Texas Medicaid Autism Services benefit across its South Texas service areas, on TMPPM criteria, with PA required (Autism/ABA Services are listed on the plan's PA portal).
The statewide Texas Authorization Referral Form (TARF), submitted via the DHP portal or fax to 1-866-741-5650 — no proprietary plan form.
No — it publishes no distinct ABA criteria. The TMPPM baseline governs; the plan-specific layer is the PA lookup portal and TARF workflow.
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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