Read this first: RightCare — Baylor Scott & White Health Plan’s STAR Medicaid product for the Central Texas Medicaid Rural Service Area (MRSA Central) — exited the Texas Medicaid managed care program on August 31, 2026; the plan’s own site now says “RightCare exited the Texas Medicaid Managed Care Program on Aug. 31, 2026,” and its sister brand FirstCare Health Plans exited the same day. TMHP: “Effective September 1, 2026, Baylor Scott & White and FirstCare health plans no longer participate in Texas Medicaid managed care programs,” claims with a date of service on or after September 1, 2026 are rejected, and “Providers have 95 days to submit their claims with a DOS on or before August 31, 2026.” A family presenting with a RightCare STAR card now has a different STAR MCO; verify the current plan in TexMedConnect or with TMHP before any intake. The ABA rules below describe how RightCare handled dates of service through August 31, 2026.
TMHP’s July 17, 2026 announcement said Baylor Scott & White (MRSA Central) and FirstCare Health Plans (MRSA West/Lubbock) would end participation in Texas Medicaid managed care, with August 31, 2026 the last date of service TMHP accepts; claims with a date of service on or after September 1, 2026 are rejected. That notice first gave providers 24 months to submit claims for earlier dates of service, but TMHP’s September 2, 2026 update replaced it: “Providers have 95 days to submit their claims with a DOS on or before August 31, 2026” — so a claim for August 31, 2026 is due by early December 2026. RightCare’s site now reads “RightCare exited the Texas Medicaid Managed Care Program on Aug. 31, 2026.” HHSC ran turnover plans to move members to their newly selected plans; questions go to the TMHP Contact Center at 800-925-9126.[2][3][1]
RightCare's own Medicaid/CHIP Prior Authorization Codes list (effective 7/1/2026) confirms PA-required ABA codes 97151, 97153, 97154, 97155, 97156, 97158, and 99366 — each showing a PA-requirement effective date of 1/3/2020 — with 97152 and 97157 absent from the list, matching the TMHP statewide THSteps-CCP Autism Services code set exactly. Requests submit through the RightCare Self-Service Portal or by fax to the Medical Management line. The plan's separate clinical policy, Medical Coverage Policy 206 ("Autism Spectrum Disorder," effective 7/1/2026), explicitly defers to the TMPPM first: "For Medicaid plans, please confirm coverage as outlined in the Texas Medicaid Provider Procedures Manual (TMPPM). If there are no applicable criteria to guide medical necessity decision making in the TMPPM, use the criteria set forth below." Note that Policy 206's own CPT code table (which lists 97152, 97157, 0362T, and 0373T alongside the others) is the plan's general/commercial-oriented table, not the operative Medicaid PA gate — the PA code list above is what actually governs a Medicaid claim, and it matches the narrower TMHP set. We could not confirm a RightCare-specific authorization-period length (e.g., a 90-day or 6-month cycle) beyond the general TMPPM baseline — treat auth-period length as inherited from the state rules and confirm any RightCare-specific timing with the plan directly.[4][5]
RightCare runs behavioral health administration itself, under the branded units "RightCare Behavioral Health Management" and "RightCare Behavioral Health Disease and Case Management" (phone 1-855-395-9652, fax 1-844-436-8779) — no third-party BH vendor (no Cenpatico, Beacon, Magellan, Carelon, or Optum) appears anywhere in the plan's current provider manual or PA materials. That BH line is distinct from the medical Prior Authorization/Medical Management line (1-855-691-7947, fax 1-512-383-8703 or 1-800-292-1349) — we could not confirm from published materials which channel ABA codes route through specifically, since the PA list groups 97151–97158/99366 alongside general PT/OT/rehab codes; confirm the correct submission channel with RightCare before your first request. General Provider Relations runs at 1-855-TX-RIGHT (1-855-897-4448).[6]
RightCare's own 2025/2026 network materials list a 30-county MRSA Central service area: Bell, Blanco, Bosque, Brazos, Burleson, Colorado, Comanche, Coryell, Erath, Falls, Fayette, Freestone, Gillespie, Gonzales, Grimes, Hamilton, Hill, Jackson, Lampasas, Lavaca, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, and Washington. A separate internal document from a different Texas MCO listing MRSA Central for its own STAR Kids product adds a 31st county (DeWitt) not on RightCare's own list — we could not resolve this discrepancy and flag DeWitt as unconfirmed for RightCare specifically rather than asserting it either way. No RightCare-specific ABA fee schedule was found; the plan's own provider manual states reimbursement follows the Medicaid fee schedule "when available" — meaning the TMHP statewide Autism Services fee schedule (PRCR615C) already covered in our Texas Medicaid guide is the reference point, not a RightCare-negotiated rate.[7][6]
Follows the Texas Medicaid rule — Baylor Scott & White's own provider documents that we checked (October 2026) set no change-of-provider rule of their 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).[10][11]
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). Baylor Scott & White does not publish whether its ABA network is open, so ask its provider relations team.[10][11]
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.[13][11][6]
RightCare’s 2026 manual: "Providers must submit claims within 95 days of the rendering of service, or within 95 days of settlement with the primary carrier in a Coordination of Benefits case."[13][11][6]
The questions that decide whether a family can start with RightCare from Scott and White Health Plan (dba Baylor Scott & White 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. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exited Texas Medicaid on 8/31/2026.[10][4][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. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exited Texas Medicaid on 8/31/2026.[10][4][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). Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exited Texas Medicaid on 8/31/2026.[10][4][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. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exited Texas Medicaid on 8/31/2026.[10][4][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. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exited Texas Medicaid on 8/31/2026.[10][4][5][9]
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. Medical Coverage Policy 206 states it directly: for Medicaid plans, confirm coverage as outlined in the TMPPM, and use Policy 206's own criteria only where the TMPPM is silent. The plan exited Texas Medicaid on 8/31/2026.[10][4][5]
"RightCare Medical Management processes prior authorization requests within 3 business days after receipt of a completed request" — the same language appears for behavioral health — and inpatient or concurrent requests "within one business day after receipt of a completed request." Lead time is a requirement, not a suggestion: "the requesting/performing provider must contact RightCare Medical Management at least 3 business days before the requested services are provided. Failure to timely request prior authorization may result in denial," and RightCare "does not process requests for retro-authorization." No ABA-specific reauthorization lead time is published.[6][14]
"If a RightCare member has insurance other than Medicaid, the other insurance becomes the primary carrier and claims should be submitted to that primary carrier first," then filed with RightCare with the EOB attached "within 95 days of settlement with the primary carrier." Authorization still applies when RightCare pays second: "RightCare's authorization procedures must be followed to receive payment." The manual's exceptions to billing the other insurer first are "Texas Health Steps exams and family planning services" — not ABA.[6][15]
Coverage decides whether RightCare from Scott and White Health Plan (dba Baylor Scott & White 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.[10][4][5][8]
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.[10][4][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. No RightCare-specific authorization-period length could be confirmed beyond the TMPPM baseline.[4][10]
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.[10][4][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.[10][4][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.[10][4][5]
No. RightCare exited Texas Medicaid managed care on August 31, 2026. Claims for dates of service on or after September 1, 2026 are rejected, and TMHP’s September 2, 2026 update gives providers 95 days to submit claims for dates of service on or before August 31, 2026.
It did, for dates of service through August 31, 2026 — PA-required codes 97151, 97153, 97154, 97155, 97156, 97158 and 99366, matching the statewide TMHP code set, with criteria deferring to the TMPPM. The plan has since exited Texas Medicaid.
No — RightCare administers behavioral health in-house through its own "RightCare Behavioral Health Management" unit, not a third-party vendor like Magellan or Carelon.
HHSC moved members to their newly selected plans at the 8/31/2026 exit. A new Texas Medicaid MCO must continue an existing authorization it is told about for up to 90 days, or until it ends or the new plan decides; confirm the family’s current plan with TMHP’s Contact Center (800-925-9126).
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, and RightCare’s own manual states the same deadline. 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.
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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