PDFWAC 182-531A-0900

Applied behavior analysis (ABA)—Covered services.

(1) The medicaid agency covers only the following applied behavior analysis (ABA) services, delivered in settings described in WAC 182-531A-0600, for eligible clients:
(a) The ABA assessments that determine the relationship between environmental events and the client's behaviors;
(b) The direct provision of ABA services by the therapy assistant (TA) or lead behavior analysis therapist (LBAT);
(c) Initial ABA assessment and development of a written, initial ABA therapy treatment plan, limited to one per year;
(d) Up to four additional ABA assessments and revisions of the initial ABA therapy treatment plan per year, if necessary to meet client's needs;
(e) One lifetime authorization of day treatment services. If a provider's request for covered services exceeds limitations in this section, the agency evaluates the request under WAC 182-501-0169.
(f) Supervision of the TA;
(g) Training and evaluation of family members or caregivers to carry out the approved ABA therapy treatment plans;
(h) Observation of the client's behavior to determine the effectiveness of the approved ABA therapy treatment plan; and
(i) On-site assistance in the event of a crisis.
(2) The agency covers the following services, which may be provided in conjunction with ABA services under other agency programs:
(a) Counseling;
(b) Dietician services;
(c) Interpreter services;
(d) Occupational therapy;
(e) Physical therapy;
(f) Speech and language therapy; and
(g) Transportation services.
(3) The agency does not pay for ABA services:
(a) That duplicate services provided in another setting; or
(b) That are provided by a family member.
(4) If a provider's request for covered services exceeds limitations in this section, the agency evaluates the request under WAC 182-501-0169.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-11-043, § 182-531A-0900, filed 5/9/24, effective 6/9/24. Statutory Authority: RCW 41.05.021, 41.05.160, and Thurston County Superior Court in J.C. and H.S. v. Washington State Health Care Authority, no. 20-2-01813-34. WSR 22-08-035, § 182-531A-0900, filed 3/29/22, effective 4/29/22. Statutory Authority: RCW 41.05.021, 41.05.160. WSR 15-19-121, § 182-531A-0900, filed 9/21/15, effective 10/22/15; WSR 14-24-083, § 182-531A-0900, filed 12/1/14, effective 1/1/15.]