Section 441.22.5. Initial service authorization and renewal of service authorization.

         22.5(1) All services reimbursed through the program shall be prior-authorized by the administrator.

         22.5(2) An autism service provider shall submit an initial treatment plan to the administrator specifying a plan of treatment for a period of no more than six months. The initial treatment plan shall specify the amount of units of applied behavioral analysis services requested for the eligible individual and include a baseline standardized assessment score.

         22.5(3) Family engagement and participation are required for participation in the autism support program. Treatment plans shall identify specific activities and responsibilities of parents or guardians in the treatment plan.

         22.5(4) The treatment plan shall reflect the autism service provider’s engagement with the school in which the eligible individual is enrolled. Treatment plans shall identify specific actions taken by the autism service provider to engage the eligible individual’s school and the results of such actions.

         22.5(5) The treatment plan may include services provided by staff with a minimum of a bachelor’s degree in a human services or education field, working under the supervision of an autism service provider who is board-certified as a behavior analyst. The treatment plan shall identify which services shall be provided directly by the board-certified behavior analyst and which services shall be provided by staff under the supervision of a board-certified behavior analyst.

         22.5(6) For renewal or modification of service authorizations, the autism service provider shall submit an updated plan of treatment with a request for the number of units of applied behavioral analysis the provider believes is medically necessary to address the eligible individual’s ongoing treatment needs. The autism service provider shall also provide evidence of the eligible individual’s progress on identified treatment goals. The administrator shall consider the eligible individual’s updated standardized assessment score along with other clinical information when reviewing requests for renewal or modification of service authorizations. Ongoing service authorization requests shall not exceed six months in duration.

         22.5(7) The administrator shall provide approval, request for modification, or denial within five business days of receipt of all service authorization requests.

[ ARC 1329C , IAB 2/19/14, effective 4/1/14;    ARC 2816C , IAB 11/23/16, effective 1/1/17]