---
title: Parkland Community Health Plan ABA coverage (Texas Medicaid MCO).
url: "https://carelu.com/payers/parkland-community-health-plan"
markdown_url: "https://carelu.com/payers/parkland-community-health-plan.md"
state: TX (Texas)
payer: Parkland Community Health Plan
kind: Medicaid managed care plan (MCO)
parent_program: Texas Medicaid (THSteps-CCP)
description: "How Parkland Community Health Plan administers Texas Medicaid ABA in Dallas County — the September 2025 move of behavioral health from Carelon to direct PCHP administration, its PA code list, and submission mechanics."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Parkland Community Health Plan ABA coverage (Texas Medicaid MCO).

_Payer Guide · Parkland Community Health Plan · Last updated September 2026 · 7 primary sources_

> Dallas County safety-net STAR plan; BH insourced from Carelon 9/1/2025; PA covers 97151-99366, not 0362T.

Parkland Community Health Plan (PCHP) — a program of Dallas County Hospital District serving STAR, CHIP, and CHIP Perinate across seven North Texas counties (Dallas, Collin, Ellis, Hunt, Kaufman, Navarro, and Rockwall) — delivers the state Autism Services benefit for members ages 0–20 with an ASD diagnosis made or reconfirmed within 3 years, available on STAR only (CHIP is excluded, matching the statewide rule). The operational fact that matters most for intake right now: PCHP transitioned behavioral health administration away from the Carelon Behavioral Health network and brought it in-house, effective September 1, 2025 — providers who contracted with Carelon for Parkland's BH network had to re-contract directly with PCHP, and older Carelon-branded provider manuals for this plan are no longer current.

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 — per the statewide TMPPM benefit; PCHP's own PA list confirms 97151 and every treatment code [1]
- **Prior auth for treatment**: Required — Texas Standard PA form; behavioral health moved from Carelon to direct PCHP administration 9/1/2025 [1]
- **Autism diagnosis required?**: Yes — ASD per the statewide TMPPM criteria (ages 0-20, diagnosed or reconfirmed within 3 years) [5]

## At a glance

- **Plan type:** Texas Medicaid MCO (Dallas County Hospital District) — STAR, CHIP, CHIP Perinate (7-county Dallas service area)
- **Clinical rules:** TMPPM Autism Services criteria; PCHP publishes no distinct ABA clinical policy beyond its PA list
- **Prior auth:** Required — PCHP's own PA list: "required for ABA evaluation, initial course of treatment, and subsequent re-evaluations for recertification"
- **Behavioral health:** Insourced from Carelon Behavioral Health effective 9/1/2025 — administered directly by PCHP now
- **Submission:** BH-specific fax 214-266-2064 / 1-844-266-2064; general PA fax 214-266-2085 / 1-844-303-1382
- **Rates:** Not published — contract-specific

## What PCHP's own PA list confirms

PCHP's Prior Authorization Requirements document (effective September 1, 2025) states plainly: "Prior authorization is required for ABA evaluation, initial course of treatment, and subsequent re-evaluations for recertification." Its code table lists 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, and 99366 explicitly under an "Applied Behavior Analysis" category — 0362T does not appear anywhere in the list, and we found no PCHP document addressing that code specifically, so treat its status as unconfirmed rather than assuming it is or isn't required. The document points to a supporting-documentation appendix for code-level specifics that we could not independently verify — confirm current documentation requirements with PCHP provider services before your first submission. [1][2]

## The September 2025 behavioral health transition

PCHP announced it was "transitioning Behavioral Health services from Carelon effective Sept. 1, 2025," with providers required to contract and credential directly with PCHP to remain in-network for behavioral health, and new member ID cards issued with updated BH information. PCHP's own 218-page provider manual, last revised September 2024, still describes "Carelon and PCHP will work together" and contains no ABA-specific content at all — it predates both the transition and any ABA-specific policy detail, so treat it as materially out of date for behavioral health and ABA purposes. The PA requirements PDF and direct contact with PCHP provider services (1-888-672-2277) are the more current sources. [3][4]

## Intake gates

The questions that decide whether a family can start with Parkland Community Health Plan, and what they have to bring.

- **Age limit**: Ages 0-20 for STAR members, per PCHP's own member-facing ABA benefit page; CHIP is excluded, matching the statewide rule. [2][5]
- **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. [5][1]
- **Who may diagnose**: Follows the Texas Medicaid (TMPPM) rule; PCHP's own member-facing benefit page names a developmental pediatrician, neurologist, psychiatrist or licensed psychologist. [2][5]
- **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. [5][1]
- **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. [5][1][7]
- **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. [5][1]
- **Prior-auth decision time**: Parkland's table: "Medicaid Routine/Non-Urgent 3 business days | CHIP Routine/Non-Urgent 2 business days (approval) 3 business days (adverse determination) | Medicaid & CHIP Urgent/expedited 3 calendar days," with hospitalized requests within 1 business day and post-stabilization or life-threatening within 1 hour. A request is not expedited when "The date of service is greater than one week from the request date," and "Urgent," "Expedited" or "STAT" labels that do not meet the definition are processed as non-urgent. Incomplete requests: the plan "will notify the requesting provider and member, by phone and in writing, of missing information no later than three (3) business days after the prior authorization receive date"; if nothing arrives in the stated time the medical director decides on what was received. Lead times: initial requests "a minimum of three business days prior to the start of care"; recertifications "at least 60 calendar days prior to the expiration of the current authorization" (the 30-day exception list names only PT/OT/speech, private duty nursing and PPECC — not ABA). [8][1][9]
- **Other insurance (who pays first)**: "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." Parkland's pay-and-pursue language covers trauma and subrogation cases, not other health insurance. The manual does not say whether Parkland's ABA PA is still needed when it pays second — request it. [8][10]

## Delivery and billing rules

Coverage decides whether Parkland Community 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. [5][1][6]
- **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. [5][1]
- **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. [5][1]
- **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. [5][1]
- **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. [5][1]
- **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. [5][1]

## What intake should collect for Parkland Community Health Plan

- **STAR vs. CHIP:** ABA is available for STAR members only — CHIP is excluded, per PCHP's own member-facing benefit page.
- **ASD dx + recency:** Diagnosed or reconfirmed within 3 years, by a developmental pediatrician, neurologist, psychiatrist, or licensed psychologist.
- **Current BH contracting status:** Confirm your practice is credentialed directly with PCHP (not still routed to Carelon) post-9/1/2025.
- **PA channel:** Use the BH-specific fax (214-266-2064) or PCHP's provider portal — don't default to a Carelon-era process.

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

## Verification of benefits (VOB) data

How Parkland Community Health Plan ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** 66917 — 66917 is confirmed by THREE independent sources agreeing exactly: Availity's own master payer list, PCHP's own EDI page ("Payer ID # 66917"), and Optum's Real-Time Eligibility Payer List — the strongest cross-validation among the 6 new TX guides. One caveat: Optum's list also carries a legacy/alias entry, "Schaller Anderson Parkland Community PRCHP" (Schaller Anderson was an earlier third-party administrator) — flagged as likely deprecated but not fully confirmed dead; don't use PRCHP.
- **Payer ID (Change Healthcare / Optum):** 66917 — Same 66917 code confirmed in Optum's official Real-Time Eligibility Payer List ("Parkland Community Health Plan 66917 ALL").
- **Supports 270/271 eligibility:** Yes — Confirmed via Availity/Optum payer lists; also rides the centralized TMHP 270/271 feed as every other MCO in this file.
- **Behavioral health administrator:** none — PCHP transitioned behavioral health administration from Carelon Behavioral Health to direct in-house administration effective 9/1/2025 — providers who had contracted with Carelon for PCHP's BH network had to re-contract directly with PCHP. Shipped 'none' for the CURRENT state; PCHP's own 218-page provider manual (last revised Sept. 2024) still describes a Carelon relationship and is treated as materially out of date for BH/ABA per PCHP's own transition announcement.
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### 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 | Yes, per Parkland Community Health Plan's own Prior Authorization Requirements list (eff. 9/1/2025) — contradicts the "not on Texas's billable ABA code set" finding shipped for 97152 elsewhere in this file; treat as a confirmed PCHP-specific exception, not the statewide default. | Required — PCHP's PA Requirements document states plainly that PA is required for ABA evaluation, initial course of treatment, and re-evaluations/recertification, and lists 97152 explicitly under "Applied Behavior Analysis." | — | — | — | — |
| 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 | Yes, per Parkland Community Health Plan's own Prior Authorization Requirements list (eff. 9/1/2025) — contradicts the "not on Texas's billable ABA code set" finding shipped for 97157 elsewhere in this file; treat as a confirmed PCHP-specific exception, not the statewide default. | Required — PCHP's PA Requirements document states plainly that PA is required for ABA evaluation, initial course of treatment, and re-evaluations/recertification, and lists 97157 explicitly under "Applied Behavior Analysis." | — | — | — | — |
| 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:** PCHP's own PA Requirements document (eff. 9/1/2025) states plainly PA is required for ABA evaluation, initial treatment, and re-evaluations/recertification. Submit via the BH-specific fax 214-266-2064 / 1-844-266-2064, the general PA fax 214-266-2085 / 1-844-303-1382, or PCHP's provider portal — behavioral health was insourced from Carelon effective 9/1/2025, so confirm your practice is credentialed directly with PCHP, not still routed through a Carelon-era process.
- **97152:** PCHP's PA Requirements document (eff. 9/1/2025) lists 97152 under "Applied Behavior Analysis" even though 97152 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 text or TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — independently confirmed this pass. Verify current documentation requirements directly with PCHP provider services (1-888-672-2277) before assuming this applies to any other Texas Medicaid plan.
- **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:** PCHP's PA Requirements document (eff. 9/1/2025) lists 97157 under "Applied Behavior Analysis" even though 97157 does not appear anywhere in the TMPPM Children's Services Handbook §2.3 text or TMHP's "AUTISM SERVICES" static fee schedule (PRCR615C) — independently confirmed this pass. Verify current documentation requirements directly with PCHP provider services (1-888-672-2277) before assuming this applies to any other Texas Medicaid plan.
- **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:** 1-888-672-2277 (STAR) / 1-888-814-2352 (CHIP/CHIP Perinate)
- **Hours:** 8:00 a.m.-5:00 p.m. Central Time, Monday-Friday (except state holidays)
- **Portal:** [Parkland Community Health Plan Provider Portal](https://providers.parklandhealthplan.com/)
- **Fax:** BH-specific 214-266-2064 / 1-844-266-2064; general PA 214-266-2085 / 1-844-303-1382

Questions to ask on a verification call:

- Since PCHP insourced behavioral health from Carelon effective 9/1/2025, confirm our practice is credentialed directly with PCHP (not still routed through a Carelon-era process) before submitting an ABA PA.
- Is there a confirmed EDI payer ID for 270/271 eligibility checks — pVerify shows no match for "Parkland" at all?
- Is the ABA copay or coinsurance charged per visit or per day, and does the plan's out-of-pocket maximum apply?
- PCHP's own PA Requirements list names 97152 and 97157 under "Applied Behavior Analysis," contradicting the statewide TMPPM code set — what are the unit caps, POS, and modifiers for these two codes specifically?
- Is CPT 99366 billable under this plan's Autism Services benefit?

### VOB data sources

- https://providers.parklandhealthplan.com/Uploads/Public/Documents/Provider/PCHP%202025%20Prior%20Authorization%20Requirements%20v2.pdf (accessed 2026-07-23)
- https://parklandhealthplan.com/living-well/blog/articles/pchp-benefits-update-changes-to-behavioral-health-services/ (accessed 2026-07-23)
- https://providers.parklandhealthplan.com/our-network/behavioral-health/ (accessed 2026-07-23)
- https://parklandhealthplan.com/living-well/blog/articles/aba (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://providers.parklandhealthplan.com/claims-payments/electronic-data-interchange/ (accessed 2026-07-23)
- https://www.optum.com/content/dam/o4-dam/resources/pdfs/guides/optuminsight-rt-eligibility-payer-list.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://parklandhealthplan.com/phone-directory (accessed 2026-07-23)

## Common questions

### Does Parkland Community Health Plan cover ABA?

Yes — the Texas Medicaid Autism Services benefit for STAR members ages 0-20 with an ASD diagnosis, on TMPPM criteria. CHIP members are excluded.

### Is behavioral health still carved out to Carelon at PCHP?

No — PCHP transitioned behavioral health administration from Carelon to direct in-house administration effective September 1, 2025. Providers had to re-contract directly with PCHP.

### What codes does PCHP require PA for?

97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, and 99366, per PCHP's own Prior Authorization Requirements list (eff. 9/1/2025). 0362T does not appear on that list — its status is unconfirmed.

## Primary sources

1. [Parkland Community Health Plan — Prior Authorization Requirements (eff. 9/1/2025, PDF)](https://providers.parklandhealthplan.com/Uploads/Public/Documents/Provider/PCHP%202025%20Prior%20Authorization%20Requirements%20v2.pdf)
2. [Parkland Community Health Plan — ABA benefit overview (member-facing)](https://parklandhealthplan.com/living-well/blog/articles/aba)
3. [Parkland Community Health Plan — Behavioral Health Services Transition Announcement](https://parklandhealthplan.com/living-well/blog/articles/pchp-benefits-update-changes-to-behavioral-health-services/)
4. [Parkland Community Health Plan — Behavioral Health network page](https://providers.parklandhealthplan.com/our-network/behavioral-health/)
5. [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)
6. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
7. [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)
8. [Parkland Community Health Plan — 2025 Provider Manual, STAR Medicaid and CHIP (eff. June 2025) (PDF)](https://providers.parklandhealthplan.com/Uploads/Public/Documents/Provider/PCHP%20Provider%20Manual_20260504.pdf)
9. [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)
10. [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.