Public Hearing about Proposed #Medicaid #ABA Rule: Sept 10
Family Voices Indiana shares this opportunity to attend a public hearing about a proposed rule for ABA under Medicaid.
Notice of Public Hearing
Under IC 4-22-2-24, notice is hereby given that on September 10, 2015, at 1:00 p.m., at the
Indiana Government Center South, 402 West Washington Street, Conference Center Room 14,
Indianapolis, Indiana, the Office of the Secretary of Family and Social Services will hold a public hearing on a proposed rule which amends 405 IAC 5-22-1 to update the definitions of certain categories of necessary services; amends 405 IAC 5-22-6, 405 IAC 5-22-8, and 405 IAC 5-22-10 to make changes to coverage requirements for medically necessary occupational therapy services, physical therapy services, respiratory therapy services, and speech and pathology services for individuals under 21 years of age; amends 405 IAC 5-22-11 to update the licensure and supervision requirements for occupational therapy assistants in accordance with IC 25-23.5-1-6 and IC 25-23.5-3; and adds 405 IAC 5-22-12 to add applied behavioral analysis therapy services as a reimbursable component.
Pursuant to IC 4-22-2-24(d)(3), the Indiana Family and Social Services Administration’s (FSSA)
has determined that the proposed rule will impose requirements and may impose costs on regulated entities affected by the proposed rule. Regulated entities will be required to comply with licensure and supervision requirements for occupational therapy assistants as required by law under IC 25-23.5-3 and
IC 25-23.5-1-6. The proposed rule also adds ABA therapy services, which serve a public need by
promoting health. Regulated entities that want to provide ABA therapy services will be required to
comply with Medicaid regulations regarding Medicaid providers.
All parties interested in the proposed rule are invited to attend the public hearing and to offer
public comments.
In lieu of attendance at the public hearing, written comments may be sent to: FSSA,
Attention: Kim Crawford, 402 W. Washington St., Room W451, Indianapolis, IN 46204.
COMMENT RE: "LSA Document #14-337, Nursing Therapies and ABA Rule".
Copies of the proposed rule and this notice are now available on the Family Social Services
Administration website at: http://www.in.gov/fssa/4543.htm
Copies of the proposed rule and this notice are now available and may be inspected by
contacting the director of the local county Division of Family Resources office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W451, Indianapolis, Indiana.
Copies of the proposed rule are now on file at the Indiana Government Center South, 402 West
Washington Street, Room W451 and Legislative Services Agency, 100 North Senate Avenue, Room N201, Indianapolis, Indiana and are open for public inspection.
Here is proposed language about ABA:
SECTION 6. 405 IAC 5-22-12 IS ADDED TO READ AS FOLLOWS:
405 IAC 5-22-12 Applied behavior analysis therapy services
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 12. (a) ABA therapy services shall be available to an individual who:
(1) is eligible for Medicaid services;
(2) is three (3) years of age up to and including twenty (20) years of age;
(3) has been diagnosed as having Autism Spectrum Disorder by a qualified
provider; and
(4) has a completed diagnostic evaluation. A qualified provider, when completing
such evaluation, shall:
(i) utilize a standardized assessment tool approved by the office; and
(ii) include a recommended treatment referral for ABA services, including
projected length of treatment.
(b) The following providers may provide ABA therapy services:
(1) A licensed or board certified behavior analyst.
(2) A provider holding a BCBA or BCaBA under the supervision of a health service
provider in psychology or a licensed psychologist holding a BDBA-D.
(3) a credentialed registered behavior technician under the supervision of a health
service provider in psychology or licensed psychologist holding a BCBA-D. Services
provided by a registered behavior technician will be reimbursed at seventy-five
percent (75%) of the rate on file.
(c) A provider described in subsection (c) shall develop a treatment plan for each
recipient eligible for services under this section. The treatment plan shall be based criteria
such as the individual’s:
(1) needs;
(2) age;
(3) school attendance; and
(4) other daily activities as documented in the treatment plan not otherwise excluded
from coverage under subsection (g).
(d) All covered ABA therapy services shall be subject to prior authorization. A
provider shall abide by the prior authorization requirements under 405 IAC 5-3, with the
exception that a BCBA may also submit a prior authorization request to the office for
review and approval. Each prior authorization request shall include, at a minimum, the
following:
(1) the individual’s treatment plan and supporting documentation;
(2) the number of therapy hours requested and supporting documentation; and
(3) other documentation as requested by the office.
(e) Prior approval for the initial course of treatment may be approved for up to
three (3) months. In order to continue providing ABA therapy services, a provider shall
submit a new prior authorization request and receive approval. The prior authorization
request shall include an updated treatment plan along with the documentation specified in
subsection (d)(2)-(3).
(f) ABA therapy services shall only be available to a recipient for a period of 3 years
and shall not exceed a period of 40 hours per week. The office shall not approve any prior
authorization request that provides ABA services for a period longer than the following:
(1) For an individual three (3) years of age up to and including twelve (12) years of
age, six (6) months
(2) For an individual thirteen (13) years of age up to and including twenty (20) years
of age, three (3) months.
(g) Coverage under this section shall not be available for services that:
(1) Focus solely on recreational outcomes.
(2) Focus solely on educational outcomes.
(3) Are rendered when measurable functional improvement is not expected or
documented.
(4) Are duplicative, such as services rendered under an individualized educational
plan.
(5) Are provided by a registered behavior technician in the home or school settings.
(Office of the Secretary of Family and Social Services; 405 IAC 5-22-12; filed
Notice of Public Hearing
Under IC 4-22-2-24, notice is hereby given that on September 10, 2015, at 1:00 p.m., at the
Indiana Government Center South, 402 West Washington Street, Conference Center Room 14,
Indianapolis, Indiana, the Office of the Secretary of Family and Social Services will hold a public hearing on a proposed rule which amends 405 IAC 5-22-1 to update the definitions of certain categories of necessary services; amends 405 IAC 5-22-6, 405 IAC 5-22-8, and 405 IAC 5-22-10 to make changes to coverage requirements for medically necessary occupational therapy services, physical therapy services, respiratory therapy services, and speech and pathology services for individuals under 21 years of age; amends 405 IAC 5-22-11 to update the licensure and supervision requirements for occupational therapy assistants in accordance with IC 25-23.5-1-6 and IC 25-23.5-3; and adds 405 IAC 5-22-12 to add applied behavioral analysis therapy services as a reimbursable component.
Pursuant to IC 4-22-2-24(d)(3), the Indiana Family and Social Services Administration’s (FSSA)
has determined that the proposed rule will impose requirements and may impose costs on regulated entities affected by the proposed rule. Regulated entities will be required to comply with licensure and supervision requirements for occupational therapy assistants as required by law under IC 25-23.5-3 and
IC 25-23.5-1-6. The proposed rule also adds ABA therapy services, which serve a public need by
promoting health. Regulated entities that want to provide ABA therapy services will be required to
comply with Medicaid regulations regarding Medicaid providers.
All parties interested in the proposed rule are invited to attend the public hearing and to offer
public comments.
In lieu of attendance at the public hearing, written comments may be sent to: FSSA,
Attention: Kim Crawford, 402 W. Washington St., Room W451, Indianapolis, IN 46204.
COMMENT RE: "LSA Document #14-337, Nursing Therapies and ABA Rule".
Copies of the proposed rule and this notice are now available on the Family Social Services
Administration website at: http://www.in.gov/fssa/4543.htm
Copies of the proposed rule and this notice are now available and may be inspected by
contacting the director of the local county Division of Family Resources office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W451, Indianapolis, Indiana.
Copies of the proposed rule are now on file at the Indiana Government Center South, 402 West
Washington Street, Room W451 and Legislative Services Agency, 100 North Senate Avenue, Room N201, Indianapolis, Indiana and are open for public inspection.
Here is proposed language about ABA:
SECTION 6. 405 IAC 5-22-12 IS ADDED TO READ AS FOLLOWS:
405 IAC 5-22-12 Applied behavior analysis therapy services
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 12. (a) ABA therapy services shall be available to an individual who:
(1) is eligible for Medicaid services;
(2) is three (3) years of age up to and including twenty (20) years of age;
(3) has been diagnosed as having Autism Spectrum Disorder by a qualified
provider; and
(4) has a completed diagnostic evaluation. A qualified provider, when completing
such evaluation, shall:
(i) utilize a standardized assessment tool approved by the office; and
(ii) include a recommended treatment referral for ABA services, including
projected length of treatment.
(b) The following providers may provide ABA therapy services:
(1) A licensed or board certified behavior analyst.
(2) A provider holding a BCBA or BCaBA under the supervision of a health service
provider in psychology or a licensed psychologist holding a BDBA-D.
(3) a credentialed registered behavior technician under the supervision of a health
service provider in psychology or licensed psychologist holding a BCBA-D. Services
provided by a registered behavior technician will be reimbursed at seventy-five
percent (75%) of the rate on file.
(c) A provider described in subsection (c) shall develop a treatment plan for each
recipient eligible for services under this section. The treatment plan shall be based criteria
such as the individual’s:
(1) needs;
(2) age;
(3) school attendance; and
(4) other daily activities as documented in the treatment plan not otherwise excluded
from coverage under subsection (g).
(d) All covered ABA therapy services shall be subject to prior authorization. A
provider shall abide by the prior authorization requirements under 405 IAC 5-3, with the
exception that a BCBA may also submit a prior authorization request to the office for
review and approval. Each prior authorization request shall include, at a minimum, the
following:
(1) the individual’s treatment plan and supporting documentation;
(2) the number of therapy hours requested and supporting documentation; and
(3) other documentation as requested by the office.
(e) Prior approval for the initial course of treatment may be approved for up to
three (3) months. In order to continue providing ABA therapy services, a provider shall
submit a new prior authorization request and receive approval. The prior authorization
request shall include an updated treatment plan along with the documentation specified in
subsection (d)(2)-(3).
(f) ABA therapy services shall only be available to a recipient for a period of 3 years
and shall not exceed a period of 40 hours per week. The office shall not approve any prior
authorization request that provides ABA services for a period longer than the following:
(1) For an individual three (3) years of age up to and including twelve (12) years of
age, six (6) months
(2) For an individual thirteen (13) years of age up to and including twenty (20) years
of age, three (3) months.
(g) Coverage under this section shall not be available for services that:
(1) Focus solely on recreational outcomes.
(2) Focus solely on educational outcomes.
(3) Are rendered when measurable functional improvement is not expected or
documented.
(4) Are duplicative, such as services rendered under an individualized educational
plan.
(5) Are provided by a registered behavior technician in the home or school settings.
(Office of the Secretary of Family and Social Services; 405 IAC 5-22-12; filed
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