1 TAC § 354.5001. Purpose and Applicability, DIVISION 1. GENERAL PROVISIONS

(a) Applied behavior analysis (ABA) services for autism are covered through the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Medicaid enrolled children:

(1) who are under 21 years of age;

(2) who have a diagnosis of autism spectrum disorder (ASD); and

(3) for whom ABA services are medically necessary and clinically appropriate and effective.

(b) Providers of ABA services for autism under this subchapter include:

(1) licensed behavior analysts (LBAs);

(2) licensed assistant behavior analysts (LaBAs);

(3) behavior technicians (BTs); and

(4) licensed professionals, other than LBAs, as described in the medical policy in the Medicaid Autism Services section (Autism Section) in the Children's Services Handbook (Children's Handbook) in the Texas Medicaid Provider Procedures Manual (TMPPM), when they are eligible to and participate in Medicaid reimbursable ABA service-related interdisciplinary team meetings.

(c) This subchapter establishes requirements for providing ABA services to treat ASD and applies only to ABA services that are Medicaid reimbursable. Medicaid reimbursement of ABA services for ASD requires compliance with this subchapter, Medicaid, THSteps, any other applicable law or rule, the TMPPM, including the Autism Section, and the National Correct Coding Initiative.