PDFWAC 182-531A-0400

Applied behavior analysis (ABA)—Client eligibility.

To be eligible for applied behavior analysis (ABA) services, a client must:
(1) Be covered under Washington apple health (WAH);
(2) Provide documentation created by a COE clinician that:
(a) Establishes the presence of functional impairment; delay in communication, behavior, or social interaction; or repetitive or stereotyped behavior;
(b) Establishes that the client's impairment, delay, or behaviors adversely affect development or communication, or both, such that:
(i) The client cannot adequately participate in home, school, or community activities because the behavior or skill deficit interferes with these activities; or
(ii) The client's behavior endangers the client or another person, or impedes access to home and community activities; and
(c) An agency-recognized center of excellence (COE) clinician has confirmed that:
(i) The client meets all requirements in (a) and (b) of this subsection;
(ii) The client has a qualifying diagnosis;
(A) Autism spectrum disorder; or
(B) Developmental/intellectual disability;
(iii) There is a reasonable expectation the requested services will result in measurable improvement in either the client's behavior, skills, or both; and
(iv) Either:
(A) Less intrusive or less intensive behavioral interventions have been tried and have not been successful; or
(B) No equally effective and substantially less costly alternative is available for reducing interfering behaviors, increasing prosocial skills and behaviors, or maintaining desired behaviors.
[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-0400, filed 3/29/22, effective 4/29/22. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 14-24-083, § 182-531A-0400, filed 12/1/14, effective 1/1/15.]