| (a) This subsection describes ABA services and Requirements
for providing ABA services.
(1) ABA services under this subchapter may be available
only when the documentation of the diagnosis of ASD, or re-evaluation
of the diagnosis:
(A) identifies current ASD symptoms and symptom severity
level using the DSM, as determined by a qualified medical or health
care professional under the Autism Section of the TMPPM, including
a member of an interdisciplinary diagnostic team who is authorized
by licensure to use the DSM;
(B) includes data from use and interpretation of an
additional ASD diagnostic tool or tools, as clinically and age appropriate,
as determined by a qualified medical or health care professional under
the Autism Section of the TMPPM, including a member of an interdisciplinary
diagnostic team who is authorized by licensure to use the ASD diagnostic
tool or tools;
(C) includes a determination that the diagnosis of
ASD is clinically appropriate, made by a qualified medical or health
care professional, or a PCP or other physician working in collaboration
with an authorized interdisciplinary diagnostic team under this subchapter
and the Autism Section of the TMPPM, and confirms that the analysis
of all elements of a comprehensive diagnostic evaluation at a minimum
is the basis for the determination;
(D) is current (within three years of the request for
ABA services) to provide timely age- and developmentally-appropriate
information;
(E) includes all additional required items for the
documentation of the diagnosis in the Autism Section in the TMPPM;
and
(F) may facilitate delivery of holistic health care
services for the child.
(2) The ABA services of the LBA and the supervised
LaBA or BT must:
(A) focus on:
(i) treating behavior difficulties related to the core
symptoms of ASD; and
(ii) shaping behavior patterns through environmental
adaptations and consistent reinforcement and consequences across the
child's natural settings and situations;
(B) effect meaningful behavior change related to the
core symptoms of ASD (to be meaningful, the behavior change must be
durable and generalizable, in socially significant behaviors, which
affect health, safety, or independence, in everyday settings); and
(C) maintain behavior change and prevent regression
as medically necessary.
(3) ABA evaluation, treatment, and supervision service
planning, design, and delivery must:
(A) be:
(i) based on authorized ABA services, per the order,
referral, or prescription for ABA evaluation or treatment services;
(ii) person-centered;
(iii) family-centered;
(iv) evidence-based;
(v) trauma informed;
(vi) informed by co-morbid conditions of the child
and their intersection with ABA services, understanding that co-morbid
conditions may mimic or exacerbate ASD symptoms;
(vii) provided in the primary language of the child,
or those who are closest to the child, as applicable, when required
for effective communication and service delivery;
(viii) in compliance with all applicable law or rule
and additional requirements for Medicaid reimbursable ABA services,
including when these requirements are more restrictive than state
scope of practice or licensing requirements for LBAs and LaBAs, or
certification or registration entity requirements for BTs, as applicable;
and
(ix) ethical;
(B) use functional goals, for meaningful behavior change,
that are specific, measurable, and realistically attainable;
(C) involve the LBA routinely assessing progress in
implementing the ABA treatment plan and achieving goals, based on
measurable treatment data, and amending the treatment plan, as appropriate;
(D) involve the LBA routinely assessing and amending
the formal ABA supervision documentation, as appropriate, including
specifying:
(i) the available LaBA or BT who may provide supervised
ABA services under the treatment plan;
(ii) the ABA services delegated to the supervised LaBA
or BT; and
(iii) the current supervisory instructions for the
LaBA or BT based on the initial or modified treatment plan, to ensure
provision and facilitation of clinically appropriate and effective
ABA services by the LaBA or BT;
(E) only allow an LaBA or a BT to provide in-person
ABA services; and
(F) include participation by the LAR, parent, or caregiver,
as applicable, in parent or caregiver education and training sessions,
in a frequency and duration agreed to by the LAR, parent, or caregiver.
The LAR, parent, or caregiver determines the appropriateness and what
is realistic for the individual circumstances, unless an exception
from participation in parent or caregiver education and training services
is made in the service authorization process, conforming to the Autism
Section in the TMPPM, where:
(i) the treatment plan for ABA services must contain
goals specific to LAR, parent, or caregiver education and training
unless exempted, and the progress towards the goals for LAR, parent,
or caregiver education and training must be considered when evaluating
ABA services; and
(ii) it is expected that the participation of the LAR,
parent, or caregiver in education and training sessions may result
in their delivery of the ABA services outside of Medicaid reimbursable
ABA service delivery sessions and contribute to durability and generalizability
of meaningful behavior change.
(b) Medicaid medically necessary ABA services for ASD
are one of a comprehensive array of potentially available Medicaid
medically necessary services and treatment methodologies for children
with ASD.
(1) Other potential medically necessary services or
covered treatment methodologies for ASD may include:
(A) nutrition services provided by an LD;
(B) outpatient behavioral health services, including
a history of trauma related to ASD;
(C) physician services, including medication management;
(D) speech-language pathology or ST services;
(E) OT services;
(F) PT services;
(G) other evidence-based forms of behavioral therapy;
(H) service coordination or service management services;
and
(I) any other medically necessary services or treatment
methodologies which meet Medicaid requirements to treat ASD.
(2) Use of ABA services in no way precludes the child
from participating in other medically necessary services, treatments,
and interventions for ASD.
(c) When providing ABA services to a child, a provider
of ABA services must not:
(1) cause harm to or be exploitative of the child,
or to those who are closest to the child, as applicable;
(2) include the use of aversive interventions, including
the use of pain, discomfort, social humiliation, or seclusion; or
(3) involve use of physical restraints, except to the
extent described in the Autism Section in the TMPPM.
(d) LBAs and LaBAs may allow a BT to be referred to
as a behavior technician (BT), a Registered Behavior Technician (RBT),
a Board Certified Autism Technician (BCAT), an Applied Behavior Analysis
Technician (ABAT), or a similar term but must prohibit the BT from:
(1) using a title, being called or referred to as,
or referring to oneself as a "therapist" in interactions with:
(A) the child;
(B) those who are closest to the child; and
(C) other professionals who serve the child who provide
any service other than ABA; and
(2) conducting any part of the initial evaluation;
creating or amending any part of the treatment plan; and interpreting
the treatment plan to any of the individuals as detailed in this paragraph.
|
