Superior HealthPlan — Centene's Texas plan and one of the largest Medicaid footprints in the state — administers the THSteps-CCP Autism Services benefit on the TMPPM's criteria; its provider notices point straight at the state manual for diagnosis and clinical rules. Two things make Superior structurally important for ABA intake: its breadth (STAR and STAR Kids across multiple service areas including Bexar, El Paso, Hidalgo, Lubbock, Nueces, MRSA West, and Travis), and its exclusivity — Superior is the only STAR Health plan, so every Texas foster-care child, statewide, routes ABA through Superior.
Superior announced the ABA benefit at its February 2022 launch with prior authorization required on every service code — 97151 for the evaluation, then 97153, 97154, 97155, 97156, 97158, and 99366 for treatment and team meetings — and its notices defer to the TMPPM for medical-necessity criteria, so the state's 3-year diagnosis recency, 90/90/180 cadence, and 8-hour daily cap all apply unchanged. Requests go through Superior's provider portal, with the plan's Prior Authorization Requirements page as the code-level reference. And the PA posture is stable: Superior's January 1, 2026 PA-removal list touched no ABA codes (the Medicaid removals were 36471, A6216, and A6218 only), so plan on full PA for the foreseeable future.[1][2][3]
If your practice serves children in foster care, Superior is unavoidable: STAR Health is administered by Superior alone, statewide. That makes Superior credentialing and PA fluency a de facto requirement for foster-care ABA anywhere in Texas — and it means intake should treat "foster care" as a routing answer, not just a demographic note. The clinical rules are the same TMPPM baseline; the population's documentation (medical consenters, caseworker involvement) is the added layer to plan for.[2]
The questions that decide whether a family can start with Superior HealthPlan (TX), 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.[4][2]
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.[4][2]
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).[4][2]
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.[4][2]
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.[4][2][6]
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.[4][2]
Superior "will respond to complete prior authorization requests within two Business Days for CHIP products, and within three Business Days for non-CHIP products" — three business days for STAR, STAR Kids and STAR Health, the same as the Texas statutory limit for nonhospitalized members (Tex. Gov't Code § 540.0303). "Urgent requests for services to be rendered within 72 hours may be submitted with reason for urgency indicated" and are decided within 72 hours. The clock runs on a complete request: an incomplete one is returned by fax listing what is missing, and "If the documentation/information is not provided within three Business Days from Superior's provider notification … the request may result in an adverse benefit determination." Lead time: "It is recommended that requests be submitted five Business Days prior to the desired start date." The manual lists ABA evaluation, treatment and "subsequent re-certifications" as PA-required but sets no ABA-specific recertification lead time.[7][8][9]
"Federal and state law require Medicaid (STAR/STAR+PLUS/STAR Kids/CHIP) be the payer of last resort." If the child has other insurance, "you must submit your claim to the primary insurance for consideration," then file with Superior attaching "a copy of the EOB, EOP or rejection letter from the other insurance" — without it the claim pends or denies. On authorization Superior is unusually specific: "An authorization is not required if an authorization from the primary insurance carrier indicating approval is received," but "If the other insurance carrier has denied and Superior is being asked to pay as primary for a service that requires an authorization, the provider will be required to request authorization prior to payment with Superior as primary" — so if the commercial plan may deny ABA, get Superior's PA in place before starting. STAR Health (foster care): "Superior does not actively pursue Coordination of Benefits (COB) for STAR Health members."[7][10]
Coverage decides whether Superior HealthPlan (TX) 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.[4][2][5]
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.[4][2]
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.[4][2]
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.[4][2]
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.[4][2]
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.[4][2]
Yes — the Texas Medicaid Autism Services benefit on TMPPM criteria, with prior authorization required on every ABA code, evaluation included, through Superior's provider portal.
No — Superior explicitly points providers to the TMPPM for diagnosis and clinical criteria and mirrors the state PA code list. What's Superior-specific is the portal, the PA-list mechanics, and the STAR Health foster-care line.
STAR Health, the Texas Medicaid program for children in foster care, is administered statewide by Superior alone — every foster-care ABA case routes through it.
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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