Sec. 10.09.34.03. Covered Services

A. The Program covers the services listed in this chapter when the services are:

(1) Diagnosed, identified, and prescribed by an EPSDT provider to be medically necessary;

(2) Preauthorized by the Department or its designee; and

(3) Delivered in accordance with the behavioral plan.

B. The following services are covered:

(1) Therapeutic behavioral assessment that includes:

(a) Development of a behavioral plan with the recipient and parent, guardian, or individual who customarily provides care which specifically:

(i) Identifies the target behaviors or symptoms that are placing the current living arrangement at risk or presenting a barrier to transition to a less restrictive living arrangement;

(ii) Defines specific interventions to be used to resolve the behaviors or symptoms, including how a therapeutic aide will implement therapeutic behavioral services;

(iii) Defines outcome measures that can be used to demonstrate the decreasing frequency of targeted behaviors;

(iv) Defines alternative behaviors;

(v) Defines the clinically accepted techniques for behavior change, including where, when, and the frequency of the techniques to be used and the risks and benefits of each;

(vi) Details the strategies and skills for the recipient and parent, guardian, or individual who customarily provides cares to provide continuity of care when therapeutic behavioral services are discontinued;

(vii) Details emergency procedures to be implemented when the recipient exhibits behaviors that pose harm to self or others;

(viii) Contains written informed consent before implementation, of the parent or legal guardian, or if the recipient is 18 years old or older, written informed consent of the recipient; and

(ix) Identifies the level or type of licensed healthcare professional responsible for monitoring the behavioral plan; and

(b) Determination if therapeutic behavioral services are needed;

(2) Therapeutic behavioral services that:

(a) Provide one-to-one intervention for a specified period of time at the appropriate site in accordance with the behavioral plan; and

(b) May include, but are not limited to:

(i) Assisting the recipient to engage in or remain engaged in appropriate activities;

(ii) Minimizing the recipient's impulsive behavior;

(iii) Providing immediate behavioral reinforcements;

(iv) Providing time structuring activities; and

(v) Collaboration with and support for parent, guardian, or individual who customarily provides care in the effort to provide ongoing behavioral support.