Sec. 10.09.28.03. Participant Eligibility

A. A participant shall meet the eligibility conditions set forth in §B of this regulation.

B. To qualify for ABA services, a participant shall:

(1) Be younger than 21 years old;

(2) Live in the community;

(3) Be diagnosed with an ASD by a qualified health care professional and referred for ABA services;

(4) Exhibit the presence of maladaptive behavior or developmental skills deficits that significantly interferes with home, school, or community activities;

(5) Be medically stable and not require 24-hour medical or nursing monitoring or procedures provided in a hospital or an ICF-IID;

(6) Have a comprehensive diagnostic evaluation by a qualified health care professional;

(7) Have a prescription for ABA services ordered by a qualified health care professional; and

(8) Have a completed ABA treatment plan that shall:

(a) Be participant-centered and family-centered, culturally competent, and based on individualized goals;

(b) Consider the participant’s age, school attendance requirements, and other daily activities;

(c) Be developed by:

(i) A licensed psychologist;

(ii) A licensed BCBA-D; or

(iii) A licensed BCBA;

(d) Ensure that the interventions are consistent with ABA techniques;

(e) Delineate both the frequency of baseline targeted behaviors and the behavior intervention plan to address the behaviors;

(f) Identify long-term goals, short-term goals, and objectives that:

(i) Are behaviorally defined;

(ii) Are customized to the participant;

(iii) Are measurable; and

(iv) Are based upon clinical observations;

(g) Identify the methods that will be used to measure achievement of behavior goals, objectives, and estimated timeframes;

(h) Identify the schedule of services planned, including number of hours per week and the providers responsible for delivering the services;

(i) Include:

(i) Care coordination involving the participant’s parent or caregiver and other professionals as applicable;

(ii) Support and training of the participant’s parent or caregiver;

(iii) A plan for generalization; and

(iv) Measurable discharge criteria.