Molina Healthcare of Texas runs STAR, STAR+PLUS, and CHIP — with a book that includes the Cigna Texas Medicaid (STAR+PLUS) membership Molina acquired in 2021. For ABA purposes, keep the programs straight: STAR+PLUS is the adult program, so pediatric ABA volume rides on Molina STAR. Like every Texas MCO, Molina delivers the statewide Autism Services benefit on TMPPM criteria; we found no evidence of distinct Molina ABA criteria. The caveat shaping this guide: Molina's Texas PA guide PDFs are served behind bot protection, so plan-specific PA details below are flagged for manual confirmation rather than asserted.
Molina members get the same benefit as everyone else in Texas Medicaid: PA on the 97151 evaluation with signed prescriber referral and a 3-year-recent ASD diagnosis, the 90/90/180 treatment cadence (no prescriber signature on the 90-day extension since April 2025), the 8-hour daily cap, credential modifiers, and the in-person requirement for BT/LaBA-delivered direct treatment. Build the clinical package to the TMPPM and it travels to Molina intact. One Molina-specific rule surfaced in its PA guidance: out-of-network requests require authorization regardless of the service — relevant while credentialing is in flight.[1][2]
Molina directs providers to its Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool for code-level PA handling, and its current-year "MHT Prior Authorization Guide" PDF is the document of record — but those files sit behind bot protection, so we could not verify their ABA specifics for this guide. Before your first Molina submission: download the current PA guide from molinahealthcare.com manually, run the ABA codes (97151–97158, 99366) through the look-up tool, and confirm the submission channel (Molina plans typically use Availity or the Molina Provider Portal, but confirm for Texas ABA specifically). Note also which program the child is on: a family that says "Molina" after the Cigna transition may be a STAR+PLUS adult — not an ABA case profile.[3][2]
The Texas Medicaid rule — Molina's own provider documents could not be retrieved to check for a plan-specific rule, so confirm with the plan. 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).[1][5]
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). Molina does not publish whether its ABA network is open, so ask its provider relations team.[1][5]
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.[7][5]
The questions that decide whether a family can start with Molina Healthcare of Texas, and what they have to bring. Each maps onto something intake should ask on the first call.
Molina's 2026 manual: "For a standard authorization request, Molina makes the determination and provides notification within three (3) calendar days for CHIP and three (3) business days for Medicaid"; non-urgent pre-service decisions for STAR run "Within 3 business days after receipt of request." Expedited: "as promptly as the member's health requires and no later than seventy-two (72) hours after we receive the initial request," and "Supporting documentation is required to justify the expedited request" — the PA guide adds that requests outside the urgent definition "will be handled as routine or non-urgent." A request to extend an ongoing course of ambulatory treatment counts as concurrent review, decided "Within 24 clock hours of receipt of request" when urgent. ABA is on Molina's PA list; the manual sets no ABA reauthorization lead time and no incomplete-request timeline of its own, so the state process applies (1 TAC § 353.425).[8][3][9][10]
"Medicaid is the payer of last resort. Private and governmental carriers must be billed prior to billing Molina." After the other coverage pays or denies, submit to Molina with the primary's remittance advice — "A copy of the remittance advice from the primary payer must accompany the claim or the claim will be denied" — "within 95 calendar days after final determination by the primary payer." If the primary paid more than Molina's contracted allowable, the claim is paid in full at zero. The manual does not say whether Molina's own ABA PA is still needed when Molina pays second — request it.[8][11]
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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). No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
Coverage decides whether Molina Healthcare 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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. TMPPM: “If services billed exceed the limitations outlined in this section, the claim will be denied, and may be appealed,” so the cap is a claim edit as well as an authorization limit. Authorization periods are two consecutive 90-day terms then recertifications of up to 180 days. Molina’s 2025 Texas PA guide lists ABA for autism among the services needing PA and sets no unit rule of its own; its provider manual and code matrix could not be read, so plan-level claim edits are unchecked.[1][3]
Blocked on: Molina Healthcare of Texas provider manual and its Behavioral Health PA code matrix (molinahealthcare.com serves a bot wall) — or Molina provider services, for any unit edit beyond the TMPPM cap.
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. No distinct Molina Texas ABA criteria surfaced, but its own PA documents could not be read, so plan-level deviation could not be ruled out.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
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. One Molina-specific rule is confirmed from its PA guidance: out-of-network requests require authorization regardless of the service, which matters while credentialing is in flight.[1][2]
Blocked on: Molina's Texas Behavioral Health and Medical Prior Authorization Code Matrix / Look-Up Tool and the current MHT Prior Authorization Guide, both served behind bot protection — download them manually from molinahealthcare.com.
Yes — the statewide THSteps-CCP Autism Services benefit on TMPPM criteria, with PA on evaluation and treatment. Pediatric ABA members sit on Molina STAR; STAR+PLUS is the adult program and CHIP is excluded.
We found no evidence of distinct criteria — Texas MCOs must apply the TMPPM. Plan clinically to the state baseline, and confirm code-level PA handling in Molina's PA Code Matrix / Look-Up Tool since its PA guide PDFs are not reliably accessible online.
Molina acquired Cigna's Texas Medicaid (STAR+PLUS) business in 2021 — those are adult-program members. A "Cigna Medicaid" mention in Texas today means Molina.
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.
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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