WSR 14-06-094 PERMANENT RULES DEPARTMENT OF SOCIAL AND HEALTH SERVICES (Aging and Disability Services) (Behavioral Health and Service Integration Administration) [Filed March 4, 2014, 4:43 p.m., effective April 4, 2014] Effective Date of Rule: Thirty-one days after filing.
Purpose: The department repealed WAC 388-865-0469 Applied behavior analysis (ABA) services, filed on May 29, 2013, under WSR 13-12-026, and replaced it with WAC 388-877A-0370 Recovery support services requiring program-specific certification—Applied behavior analysis (ABA) services. This rule contains the licensure, certification, and staffing requirements for agencies providing ABA services to assist children with autism spectrum disorders. WAC 388-865-0400, 388-865-0405, 388-865-0420, 388-865-0425, and 388-865-0460 are also being repealed because the requirements in these sections are now included in chapters 388-877 and 388-877A WAC. The new rule ensures the continued implementation of the requirements of a settlement agreement resulting from Washington Autism Alliance and Advocacy, et al. v. Douglas Porter, U.S. District Court, Western District of Washington, Case No. 2:12-cv-0072-RAJ. The rule also ensures the continued provision of minimum standards for agencies to obtain and maintain licensure from DSHS so that licensed agencies may contract with HCA to deliver ABA services to eligible individuals. HCA has adopted rules in Title 182 WAC to implement this settlement agreement.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-865-0400, 388-865-0405, 388-865-0420, 388-865-0425, 388-865-0460, and 388-865-0469.
Other Authority: Washington Autism Alliance and Advocacy, et al. v. Douglas Porter, U.S. District Court, Western District of Washington, Case No. 2:12-cv-00742-RAJ.
Adopted under notice filed as WSR 14-01-106 on December 18, 2013.
Changes Other than Editing from Proposed to Adopted Version: WAC 388-877A-0370 (1)(a) Assist children for which there is evidence ABA is effective ABA services have been determined to be medically necessary; WAC 388-877A-0370 (1)(b)(v) Vocational; and or; WAC 388-877A-0370 (3)(g)(i) Referrals to and assessments by Centers of Excellence (COE) for evaluations and orders to be performed by healthcare professionals licensed under chapters 18.71, 18.71A, 18.79, and 18.83 RCW; WAC 388-877A-0370 (4)(c) Be comprehensive and incorporate document treatment being; WAC 388-877A-0370 (7)(a) Supervises the therapy assistant: (i) For a minimum of five percent of the total direct care provided by the therapy assistant per week (for example, one hour of direct supervision per twenty hours of direct care): and (ii) iIn accordance; WAC 388-877A-0370 (7)(e) Meets at least […] makes changes accordingly to the ABA therapy treatment plan as indicated by the individual's progress and/or response.
A final cost-benefit analysis is available by contacting Kathy Sayre, 4500 10th Avenue S.E., Lacey, WA 98503, phone (360) 725-1342, fax (360) 725-2280, e-mail kathy.sayre@dshs.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 6.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 6.
Date Adopted: February 27, 2014.
Katherine I. Vasquez
Rules Manager
NEW SECTION
WAC 388-877A-0370 Recovery support services requiring program-specific certification—Applied behavior analysis (ABA) services.
Applied behavior analysis (ABA) services are a recovery support service that requires program-specific certification by the department's division of behavioral health and recovery.
(1) ABA services:
(a) Assist children and their families to improve the core symptoms associated with autism spectrum disorders or other developmental disabilities for which ABA services have been determined to be medically necessary; and
(b) Support learning, skill development, and assistance in any one or more of the following areas or domains:
(i) Social;
(ii) Behavior;
(iii) Adaptive;
(iv) Motor;
(v) Vocational; or
(vi) Cognitive.
(2) An agency providing ABA services must meet the:
(a) General requirements in chapter 388-877 WAC for behavioral health services administrative requirements;
(b) General requirements in WAC 388-877A-0300 for recovery support services requiring program-specific certification;
(c) Specific agency staff requirements in WAC 388-877A-0310; and
(d) Specific clinical record content and documentation requirements in WAC 388-877-640 and 388-877A-0320.
(3) The health care authority (HCA) administers rules in chapter 182-531 WAC for ABA services requirements. The rules in chapter 182-531 WAC include:
(a) Definitions that apply to ABA services;
(b) Program and clinical eligibility requirements;
(c) Prior authorization and recertification requirements;
(d) Specific ABA provider requirements;
(e) Covered and noncovered services;
(f) Billing requirements; and
(g) Requirements for:
(i) Referrals to and assessments by Centers of Excellence (COE) for evaluations and orders; and
(ii) ABA assessments and individualized ABA therapy treatment plans.
(4) The ABA therapy treatment plan must:
(a) Be developed and maintained by a lead behavior analysis therapist (LBAT) (see (5) of this section);
(b) Identify the services to be delivered by the LBAT and the therapy assistant, if the agency employs a therapy assistant (see (6) and (7) of this section);
(c) Be comprehensive and document treatment being provided by other health care professionals; and
(d) Document how all treatment will be coordinated, as applicable, with other members of the health care team.
(5) An agency must employ a lead behavior analysis therapist (LBAT).
(a) To qualify as an LBAT, an individual must meet the professional requirements in chapter 182-531 WAC.
(b) The agency must ensure the LBAT meets other applicable requirements in chapter 182-531 WAC.
(6) An agency may choose to employ a therapy assistant.
(a) To qualify as a therapy assistant, an individual must meet the professional requirements in chapter 182-531 WAC.
(b) The agency must ensure the therapy assistant meets other applicable requirements in chapter 182-531 WAC.
(7) If the agency employs a therapy assistant(s), the agency must ensure the LBAT:
(a) Supervises the therapy assistant:
(i) For a minimum of five percent of the total direct care provided by the therapy assistant per week (for example, one hour of direct supervision per twenty hours of direct care); and
(ii) In accordance with agency policies and procedures.
(b) Meets the requirements in this section;
(c) Completes a review of an individual's ABA therapy treatment plan with the therapy assistant before services are provided;
(d) Assures the therapy assistant delivers services according to the individual's ABA therapy treatment plan; and
(e) Meets at least every two weeks with the therapy assistant and documents review of the individual's progress and/or response to the treatment, and makes changes to the ABA therapy treatment plan as indicated by the individual's progress and/or response.
(8) To maintain department program-specific certification to provide ABA services, an agency must continue to ensure the requirements in this section are met.
REPEALER
The following sections of the Washington Administrative Code are repealed:
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