"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.
