The following words and terms, when used in this subchapter,
have the following meanings unless the context clearly indicates otherwise.
(1) ABA--Applied behavior analysis. The practice of
applying the principles of learning and behavior, specifically about
how behavior affects, and is affected by, past and current environmental
events in conjunction with biological variables to improve the human
condition through behavior change that is based on current, evidence-based,
specialized principles, and delivered by a qualified professional
under this subchapter.
(2) APRN--Advanced practice registered nurse. A person
who:
(A) is currently licensed without restriction as an
advanced practice registered nurse by the Texas Board of Nursing under
Texas Occupations Code (TOC), Chapter 301 (relating to Nurses); and
(B) practices under a current, executed prescriptive
authority agreement with a qualified physician in accordance with
TOC, Chapter 157, Subchapter B (relating to Delegation to Advanced
Practice Registered Nurses and Physician Assistants).
(3) ASD--Autism spectrum disorder. Is a condition included
in the Diagnostic and Statistical Manual of Mental Disorders (DSM),
which is characterized by restricted, repetitive patterns of behavior,
interests, or activities and deficits in social communication and
social interaction, with onset of symptoms occurring in early childhood.
(4) Authorized primary care provider--Includes a qualified
physician, acting as the primary care physician (PCP), or a qualified
physician assistant (PA) or APRN, acting as the primary care provider.
(5) Autism--Autism spectrum disorder.
(6) Autism Section--Medicaid Autism Services section.
The section in the Children's Services Handbook in the TMPPM that:
(A) addresses authorization to provide ABA to treat
ASD and coverage of ABA services;
(B) covers ABA services to the extent required by EPSDT;
and
(C) covers coordination of a comprehensive array of
services to treat ASD.
(7) BT--Behavior technician. A person who is currently
fully registered or certified without restriction as one of the following:
(A) Registered Behavior Technician (RBT);
(B) Board Certified Autism Technician (BCAT); or
(C) Applied Behavior Analysis Technician (ABAT).
(8) CFR--Code of Federal Regulations.
(9) Child--A child is an individual who is under 21
years of age who is Medicaid enrolled and who is eligible for ABA
services under this subchapter and the Autism Section in the Children's
Handbook in the Texas Medicaid Provider Procedures Manual (TMPPM).
(10) Children's Handbook--The Children's Services Handbook
in the TMPPM.
(11) Co-morbid condition--A child who has a co-morbid
condition with ASD has a physical, mental, or behavioral health condition,
which may include a history of trauma, where diagnosis, symptoms,
or treatment of the co-morbid condition occur at the same time as
ASD.
(12) Comprehensive diagnostic evaluation--The medical
standard of practice for the evaluation process and elements used
by a qualified medical or health care professional to make an ASD
diagnosis. The qualified medical or health care professional must
either meet minimum requirements in the Autism Section in the Children's
Handbook in the TMPPM to make a diagnosis of ASD, or be a PCP or other
physician, working in consultation with an interdisciplinary diagnostic
team that meets minimum requirements in the Autism Section in the
TMPPM, to decide whether an ASD diagnosis is clinically appropriate
for a child.
(13) DSM--Diagnostic and Statistical Manual for Mental
Disorders. The current edition of the publication of the American
Psychiatric Association, which is used by a qualified medical or health
care provider in the evaluation and diagnosis of mental and behavioral
health illnesses and conditions.
(14) Durable--Able to exist for a long time without
significant deterioration in quality or value; not occurring only
during ABA services or a temporary period thereafter.
(15) EPSDT--Early and Periodic Screening, Diagnosis,
and Treatment. The federally mandated Early and Periodic Screening,
Diagnosis, and Treatment program defined in Texas Administrative Code
(TAC) Title 25, Chapter 33 (relating to Early and Periodic Screening,
Diagnosis, and Treatment). The State of Texas has adopted the name
Texas Health Steps (THSteps) for its EPSDT program.
(16) EPSDT-CCP--Early and Periodic Screening, Diagnosis,
and Treatment-Comprehensive Care Program. A program described in Chapter
363 of this title (relating to Texas Health Steps Comprehensive Care
Program).
(17) Evidence-based ABA services--ABA services for
ASD which are consistently delivered based on rigorous and reliable
clinical research outcomes that are widely recognized as effective
by medical professionals.
(18) Family-centered--An approach to service delivery
that uses a set of values, attitudes, and practices for working with
children, which assures the health and well-being of the child and
the people closest to the child, including the legally authorized
representative (LAR), parent, caregiver, or other appropriate person,
as applicable, through a respectful family-professional partnership,
which honors the strengths, cultures, traditions, and expertise that
everyone brings to this relationship.
(19) Generalizable--Able to be applied across the child's
natural settings and not be limited to the specific locations where
the ABA services are delivered.
(20) HHSC--The Texas Health and Human Services Commission.
The single state agency charged with administration and oversight
of the Texas Medicaid program, or its designee.
(21) In-person--Within the physical presence of another
person. In-person does not include interacting with a member via a
telemedicine or telehealth service.
(22) LaBA--Licensed assistant behavior analyst. A person
who is currently licensed without restriction as a licensed assistant
behavior analyst by the Texas Department of Licensing and Regulation
(TDLR) under TOC, Chapter 506 (relating to Behavior Analysts), and
16 TAC Chapter 121 (relating to Behavior Analyst) and provides ABA
services in accordance with state scope of practice and licensing
requirements.
(23) LAR--Legally authorized representative. A person
who is authorized by law to act on behalf of an individual regarding
a matter described in this chapter, and may, depending on the circumstances,
include a parent, caregiver, guardian, or managing conservator of
a minor, or the guardian of an adult, or a representative designated
pursuant to 42 CFR §435.923 (relating to Authorized Representatives).
(24) LBA--Licensed behavior analyst. A person who is
currently licensed without restriction as a licensed behavior analyst
by TDLR under TOC, Chapter 506, and 16 TAC Chapter 121, and provides
ABA services in accordance with state scope of practice and licensing
requirements.
(25) LD--Licensed dietitian. A person who is currently
licensed without restriction as a licensed dietitian by TDLR under
TOC, Chapter 701 (relating to Dietitians).
(26) Medicaid--The medical assistance program authorized
and funded pursuant to Title XIX of the Social Security Act (Title
42, United States Code (U.S.C.), 1396 et seq.) (relating to Grants
to States for Medical Assistance Programs) and administered in Texas
by HHSC.
(27) Medically necessary--This term has the meaning
set forth in §353.2 of this title (relating to Definitions).
(28) NCCI--National Correct Coding Initiative. The
initiative of the Centers for Medicare & Medicaid Services for
using the Current Procedural Terminology codes of the American Medical
Association to promote national correct coding methodologies and to
control improper coding.
(29) Nutrition services--Medicaid covered nutrition
services provided by an LD.
(30) ORP--Ordering, referring, or prescribing physician.
The ORP, including an authorized primary care provider, may request
prior authorization, or authorization, as applicable, for a specific
amount, duration, and scope of ABA services for a child, including
Medicaid ABA evaluation, treatment, and ABA-related interdisciplinary
team meeting services to treat ASD, and the ORP may receive formal
authorization for a specific amount, duration, and scope of ABA services
for a child.
(31) OT--Occupational therapy. OT is the discipline
and services of occupational therapy, where the services are regulated
by the Executive Council of Physical Therapy and Occupational Therapy
Examiners, Texas Board of Occupational Therapy Examiners, under TOC,
Chapter 454 (relating to Occupational Therapists).
(32) PA--Physician assistant. A person who:
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