Iowa Administrative Code › Agency 441 - Human Services Department › Title III - Mental Health › Chapter 22 - Autism Support Program › Rule 441-22.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Administrator "
means the entity selected
				  by the department through a request for proposal process or other contractual
				  arrangement to administer the autism support program.
"Applicant"
means an individual on whose
				  behalf an application has been submitted but who has not been identified as an
				  eligible individual, or an individual who has received a denial of eligibility
				  for the program.
"Appliedbehavioral analysis"
or
"ABA
				  "
means the same as defined in Iowa Code section
				  225D.1.
"Autism"
means autism spectrum disorders as
				  defined in Iowa Code section
				  514C.28.
"Autism service provider"
means a person
				  providing applied behavioral analysis, who meets both of the following
				  criteria:
1. The person:
* Is certified as a behavior analyst by the Behavior Analyst
				  Certification Board, is a psychologist licensed under Iowa Code chapter 154B,
				  or is a psychiatrist licensed under Iowa Code chapter 148; or
* Is a board-certified assistant behavior analyst who
				  performs duties, identified by and based on the standards of the Behavior
				  Analyst Certification Board, under the supervision of a board-certified
				  behavior analyst.
2. Is approved as a member of the provider network by the
				  department.
"Autism support fund"
or
"fund"
means the autism support fund created in Iowa Code
				  section
				  225D.2.
"Autism support program"
or
"program"
means the program created in Iowa Code section
				  225D.2 to provide funding for applied behavioral analysis and care coordination
				  for eligible individuals with a diagnosis of autism.
"Clinically relevant"
means medically
				  necessary and resulting in the development, maintenance, or restoration, to the
				  maximum extent practicable, of the functioning of an individual.
"Department"
means the department of human
				  services.
"Diagnostic assessment of autism"
means
				  medically necessary assessment, evaluations, or tests performed by a licensed
				  child psychiatrist, developmental pediatrician, or clinical
				  psychologist.
"Eligible individual"
means a child less
				  than 14 years of age who has been diagnosed with autism based on a diagnostic
				  assessment of autism, is not otherwise eligible for coverage for applied
				  behavioral analysis treatment or applied behavior analysis treatment under the
				  medical assistance program, Iowa Code section
				  514C.28,
				  Iowa Code section 514C.31, or private insurance coverage, and whose household
				  income does not exceed 500 percent of the federal poverty level.
"Federalpoverty level"
means the most
				  recently revised poverty income guidelines published by the United States
				  Department of Health and Human Services.
"Household income "
means household income,
				  reported on the tax return on which the eligible individual is claimed as a
				  dependent, as determined using the modified adjusted gross income methodology
				  pursuant to Section 2002 of the federal Patient Protection and Affordable Care
				  Act, Pub. L.No.
				  111-148. If the eligible individual's parents live
				  together and file separate tax returns, the income reported on both parents'
				  tax returns must be combined.
"Household size"
means the total number of
				  personal and dependent exemptions claimed on the tax return on which the
				  eligible individual is claimed as a dependent plus any child under the age of
				  19 living in the household who is claimed for tax purposes by a noncustodial
				  parent through a release of claim to exemption by the custodial parent.
"Integratedhealth home"
means the same as
				  defined in 441-subrule 78.53(1).
"Maximum amount of treatment"
means a
				  maximum of 24 months of applied behavioral analysis funded by the autism
				  support program. Months of service are not required to be consecutive.
"Maximum annual benefit"
means a maximum
				  annual benefit amount of $3 6,000 per year for autism support program services
				  for an eligible individual. For the purposes of this program, the annual
				  benefit is calculated by using as a starting date the date the first service is
				  reimbursed by the program and an ending date 12 months from the starting date.
				  Expenditures included in the calculation of the maximum annual benefit include
				  reimbursements to autism service providers for provision of applied behavioral
				  analysis and reimbursements to integrated health homes for costs of care
				  coordination. Cost-sharing paid by the eligible individual is not included in
				  the calculation of the individual's annual benefit.
"Medical assistance"
or
"Medicaid"
means assistance provided under the medical
				  assistance program pursuant to Iowa Code chapter 249A and Title XIX of the
				  Social Security Act.
"Month of service"
means any month in which
				  an individual receives at least one billable unit of applied behavioral
				  analysis service funded by the autism support program.
"Provider network"
means a network of autism
				  service providers approved by the department to provide services to eligible
				  individuals through the autism support program.
"Regional autism assistance program "
or
"RAP"
means the regional autism assistance program created
				  in Iowa Code section
				  256.35.
"Treatment plan"
means a plan for the
				  treatment of autism developed by a licensed physician or licensed psychologist
				  pursuant to a comprehensive evaluation or reevaluation performed in
				  consultation with the patient and the patient's
				  representative.