The medicaid agency pays for ABA services when the services are:
(1) Covered;
(2) Medically necessary;
(3) Within the scope of the eligible client's medical care program;
(4) Provided to clients who meet the criteria in WAC
182-531A-0400;
(5) Within currently accepted standards of evidence-based clinical practice;
(6) Not duplicative of ABA services paid for by other state agencies using medicaid funds;
(7) Completed in the stages described in this chapter;
(8) Provided by qualified health care professionals, as described in this chapter;
(9) Authorized, as required within this chapter, chapters
182-501 and
182-502 WAC, and the agency's
Applied Behavior Analysis Provider Guide; and
(10) Billed according to this chapter, chapters
182-501 and
182-502 WAC, and the agency's
Applied Behavior Analysis Provider Guide.
[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-0300, filed 3/29/22, effective 4/29/22. Statutory Authority: RCW
41.05.021 and
41.05.160. WSR 14-24-083, § 182-531A-0300, filed 12/1/14, effective 1/1/15.]