WAC 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 . (5) For clients age 20 and younger, see the early periodic screening, diagnosis, and treatment (EPSDT) program described in chapter 182-534 WAC.