Aetna Better Health of Texas serves STAR, STAR Kids, and CHIP in the Bexar and Tarrant service areas — putting it alongside UnitedHealthcare in the DFW/Tarrant STAR Kids market. Like every Texas MCO, it delivers the statewide THSteps-CCP Autism Services benefit and must apply the TMPPM medical-necessity criteria. An honesty note that shapes this guide: Aetna Better Health's Texas provider manual and PA pages block automated retrieval, and we found no distinct TX ABA clinical policy in public sources — so this page gives you the state baseline that verifiably governs, and flags exactly which plan-level mechanics to confirm with the plan before your first submission.
Every fact on the Texas Medicaid guide applies to Aetna Better Health members: PA required on the 97151 evaluation (24-unit cap) with a signed prescriber referral and an ASD diagnosis made or reconfirmed within 3 years; treatment authorized in two 90-day periods then 180-day recertifications, with the prescriber signature no longer required on the 90-day extension since April 1, 2025; the 8-hour daily direct-treatment cap; the HO/HN/HM credential modifiers; and the telehealth ban on BT/LaBA-delivered direct treatment. Build your clinical package to that baseline and it will be substantively correct regardless of Aetna's intake mechanics.[3][4]
The plan’s 2025–2026 provider manual (published August 2026) has no ABA section, so the clinical rules are the TMPPM’s. Its general prior-authorization process: complete the Texas Universal Authorization Form, fax acute-care requests to the Prior Authorization department at 1-866-835-9589 with supporting clinical information, and allow at least 3 business days; the current list of services and codes that need PA is in the online tool at medicaidportal.aetna.com/propat. A request for something that does not need PA comes back “PA not required,” which “does not mean that service is approved.” Claim appeals are filed through Availity. Before your first case, confirm with provider relations that the plan accepts your ABA packet on that form.[5][6]
The Texas Medicaid rule — Aetna Better Health’s 2025–2026 provider manual has no ABA section of its own. A family that moves to a new ABA provider outside the current group needs a new authorization request with all the documentation of an initial evaluation, plus a change-of-therapy-provider letter signed by the responsible adult giving the date therapy ended (or the last date of service) and the names of both providers (TMPPM § 2.3.9). A move to another provider within the same group keeps the same evaluation, plan of care and authorization period. If the child changes health plans, "Health plan prior authorizations do not automatically transfer," but the new MCO must continue an existing authorization it is told about, at the same amount, duration and scope, until the earliest of 90 days, the end of the authorization, or its own new decision (Managed Care Handbook § 2.8).[3][8]
Joining the network: a provider must be enrolled in Texas Medicaid before an MCO can enroll it; "Individual MCOs and DMOs have their own guidelines for contracting providers," and Medicaid enrollment "does not guarantee that an MCO or DMO will contract enroll or credential a particular provider." All Medicaid MCOs credential through the Texas Association of Health Plans' contracted credentialing verification organization (Handbook § 2.2.1). Aetna Better Health does not publish whether its ABA network is open, so ask its provider relations team.[3][8]
HHSC sets the claim clocks for every Texas Medicaid MCO in its Uniform Managed Care Claims Manual: a provider must file a claim with the MCO "within 95 Days from the date of service," and the MCO must deny a claim it does not receive in that window unless an exception applies (wrong plan, other insurance, newborns, newly enrolled providers). The MCO must tell the provider it "has 120 Days from the date of disposition to appeal the Claim," and must adjudicate an appealed claim within 30 days. Its performance standard is to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days, with every claim finalized within 24 months of the date of service. When another insurer is billed first, the claim “must be refiled and received by the MCO within 95 Days from the date of disposition by the other insurance resource.” HHSC sets no weekly submission cutoff or check-run day; each MCO runs its own payment cycle. The TMPPM Managed Care Handbook repeats the 95-day rule and sends appeals to the MCO first, then to HHSC as a complaint.[2][8][5]
The plan’s own manual (2025–2026) restates the 95 days and adds its terms: “If a claim is not received by Aetna Better Health within 95 days, the claim will be denied unless excepted,” and with other insurance the 95 days run from the primary carrier’s EOB. On payment it says both that participating providers “shall be paid … no later than 30 working days after receipt of a completed clean claim” and that the plan pays interest “at an 18 percent annual rate, calculated daily,” on any clean claim left un-adjudicated past the 30-day deadline; it notifies the provider within 30 days if a claim is not clean. Claim appeals go through Availity, and EFT/ERA enrolment runs through ECHO. No weekly submission cutoff or check-run day is published.[2][8][5]
The questions that decide whether a family can start with Aetna Better Health of Texas, 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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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). Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[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. The plan manual’s general telemedicine passage (patient-site presenters; “A patient’s private home is not an established home site”) defers to “the state’s rules for Medicaid services,” and the TMPPM says its ABA remote-delivery rules “supersede that of the Telecommunication Services Handbook.” Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged. TMPPM’s Telecommunication Services Handbook makes modifier 95 the telehealth marker and sets no telehealth place-of-service code.[1][3][5]
Aetna Better Health of Texas’s 2025–2026 manual: complete the Texas Universal Authorization Form, fax it to the Prior Authorization department at 1-866-835-9589 with the clinical support, and “Allow at least 3 business days for a response if medically appropriate”; urgent requests for non-urgent services run on the routine clock, and the current PA code list is in the online tool at medicaidportal.aetna.com/propat. Concurrent review decisions are made within one business day. The statute sets the same ceiling for every Texas Medicaid MCO: a nonhospitalized PA must be decided “within three business days after the organization receives the request” (Tex. Gov’t Code § 540.0303), and an incomplete request follows 1 TAC § 353.425. No ABA reauthorization lead time is published; the TMPPM cadence (two 90-day periods, then 180-day recertifications) applies.[5][10][11][3]
Medicaid pays last: bill the commercial plan first. Aetna Better Health of Texas’s 2025–2026 manual: “Providers must submit claims within 95 days of the rendering of service, or within 95 days of the primary carrier’s EOB in the Coordination of Benefits (COB) case, to include Medicare for Dual Eligible STAR Kids Members.” The manual does not say whether the plan waives its own ABA prior authorization when it pays second, so get the Texas Medicaid PA as well.[5][12]
Ask the plan: Aetna Better Health of Texas provider services (number on the member card) — ask whether ABA needs the plan’s PA when a commercial plan is primary.
Coverage decides whether Aetna Better Health of Texas 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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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. TMPPM: “If services billed exceed the limitations outlined in this section, the claim will be denied, and may be appealed” — so the cap is enforced on the claim, not only on the authorization. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
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. Aetna Better Health of Texas’s 2025–2026 provider manual (published August 2026) has no ABA section and adds no rule of its own, so the state rule applies unchanged.[3][5]
Yes — as a Texas Medicaid MCO it delivers the statewide THSteps-CCP Autism Services benefit under TMPPM criteria: PA on evaluation and treatment, ages 0–20, 3-year dx recency. CHIP members are excluded.
No. Its 2025–2026 provider manual has no ABA section, and Texas MCOs must apply the TMPPM criteria, so plan clinically against the state baseline.
The plan’s manual routes prior authorization on the Texas Universal Authorization Form, faxed to 1-866-835-9589 with the clinical documentation; allow at least 3 business days. Check the online PA tool (medicaidportal.aetna.com/propat) for the current code list, and confirm with provider relations that your ABA packet is complete.
A new ABA provider outside the current group must file a new authorization with initial-evaluation documentation and a change-of-provider letter signed by the responsible adult (TMPPM § 2.3.9). A new health plan must continue an existing authorization for up to 90 days, or until it ends or the new plan decides.
It does not publish an open or closed status. Enroll in Texas Medicaid first, then apply to the plan; Medicaid enrollment does not guarantee an MCO contract. Ask provider relations.
Ninety-five days from the date of service. HHSC’s Uniform Managed Care Claims Manual sets it for every Texas Medicaid MCO. Claim appeals get 120 days from the disposition date.
HHSC requires every Texas Medicaid MCO to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days. The plan’s manual pays 18 percent annual interest on clean claims left un-adjudicated past 30 days. No weekly cutoff or check-run day is published.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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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