| (a) Providers of ABA services include:
(1) LBAs who:
(A) practice within the LBA's state scope of practice
and licensure requirements, meet all relevant provider qualifications,
and comply with all applicable law, rules, and requirements under
this subchapter;
(B) are currently enrolled in Texas Medicaid through
TMHP;
(C) for claims submission purposes, serve as the Medicaid
enrolled rendering provider for all ABA evaluation, treatment, and
supervision services, including those ABA services rendered under
the LBA's supervision by an LaBA or a BT, as applicable, where the
rendering provider for the specific service, which may be the LBA,
LaBA, or BT, may or must, as applicable, be indicated on the claim
with an appropriate Medicaid modifier; and
(D) may provide the following Medicaid reimbursable
ABA services when authorized:
(i) ABA evaluation and treatment services to the child;
(ii) education and training services to the LAR, parent,
or caregiver, as applicable;
(iii) supervision services for the LaBA or BT, as applicable,
to whom the LBA has delegated service delivery; and
(iv) required participation in ABA-related interdisciplinary
team meetings, if utilized.
(2) LaBAs who:
(A) practice within the LaBA's state scope of practice
and licensure requirements, meet all relevant provider qualifications
and comply with all applicable law, rules, and requirements under
this subchapter; and
(B) are not Medicaid enrolled but rather render in-person
ABA treatment services, parent or caregiver education and training
services, or supervision services for a BT, under the supervision
of the enrolled LBA.
(3) BTs who:
(A) are currently fully registered or certified as
a BT under this subchapter and meet all other relevant provider qualifications;
(B) practice in accordance with their national certification
or registration requirements and as directed by the supervising LBA
or LaBA, to ensure compliance with all applicable law, rules, and
requirements under this subchapter; and
(C) are not Medicaid enrolled but rather render in-person
ABA treatment services under the supervision of the enrolled LBA or
the LaBA.
(4) Licensed professionals who:
(A) are described in the Autism Section in the TMPPM
as eligible licensed professionals for participation in ABA-related
interdisciplinary team meetings, other than LBAs; and
(B) participate in Medicaid reimbursable ABA-related
interdisciplinary team meetings to coordinate care for the child when
eligible.
(b) Providers of ABA services must comply with:
(1) all applicable state and federal law or rule, such
as:
(A) Title XIX of the Social Security Act (42 U.S.C. §1396
et seq.) (relating to Grants to States for Medical Assistance Programs);
(B) 42 CFR §440.40(b) (relating to EPSDT) and §§441.50
- 441.62 (relating to Early and Periodic Screening, Diagnosis, and
Treatment (EPSDT) of Individuals Under Age 21);
(C) Texas Human Resources Code Chapter 32 (relating
to Medical Assistance Program);
(D) Texas Government Code Chapter 531 (relating to
Health and Human Services Commission);
(E) Chapter 352 of this title (relating to Medicaid
and Children's Health Insurance Program Provider Enrollment);
(F) Chapter 353 of this title (relating to Medicaid
Managed Care);
(G) Chapter 354 of this title (relating to Medicaid
Health Services);
(H) Chapter 363 of this title (relating to Texas Health
Steps Comprehensive Care Program); and
(I) 25 TAC Chapter 33 (relating to Early and Periodic
Screening, Diagnosis, and Treatment);
(2) the Texas Medicaid Provider Agreement, as applicable;
(3) the NCCI;
(4) the current TMPPM, including:
(A) all published updates, including updates made available
through bulletins, banners, or other means, and any revisions of published
updates;
(B) all published handbooks, standards, and guidelines;
and
(C) the specific ABA service requirements in this subchapter
and the Autism Section in the TMPPM;
(5) Texas Family Code Chapter 261 (relating to Investigation
of Report of Child Abuse or Neglect); and
(6) retrospective reviews, which include reviews of
providers and provider locations, activities, and records to confirm
compliance with all applicable law or rule, and other applicable requirements
under this subchapter.
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