§ 20-77-124 - Medicaid waiver for autism.
20-77-124. Medicaid waiver for autism.
(a) As used in this section:
(1) (A) "Intensive early intervention individualized therapy services" means intensive early intervention individualized therapy for a child with a pervasive developmental disorder, including without limitation:
(i) Behavioral therapies such as applied behavioral analysis and pivotal response training under the supervision of a behavior analyst who is board certified by the Behavior Analyst Certification Board;
(ii) Intensive speech therapy provided by a licensed speech therapist; and
(iii) Intensive occupational therapy provided by a licensed occupational therapist.
(B) Except as provided in subdivision (a)(1)(C) of this section, "intensive early intervention individualized therapy services" does not include coverage for services to treat developmental disorders of language, early onset psychosis, dementia, obsessive compulsive disorder, schizoid personality disorder, avoidant personality disorder, or reactive attachment disorder.
(C) If a child with a pervasive developmental disorder is diagnosed to have one (1) or more of the conditions listed in subdivision (a)(1)(B) of this section, intensive early intervention individualized therapy services includes coverage only for therapy necessary to treat the pervasive developmental disorder; and
(2) "Pervasive developmental disorders", commonly known as autism spectrum disorders, means a neurobiological condition characterized by severe deficits and pervasive impairment in multiple areas of development diagnosed by a team evaluation including at least a licensed physician, a licensed psychologist, and a licensed speech pathologist for an individual with a developmental disability as defined in 20-48-101, including without limitation:
(A) Asperger's disorder;
(B) Autism;
(C) Pervasive developmental disorder, not otherwise specified;
(D) Rett's disorder; and
(E) Childhood disintegrative disorder.
(b) (1) The Department of Human Services shall seek a Medicaid waiver from the Centers for Medicare & Medicaid Services to provide intensive early intervention individualized therapy services to any child who has been diagnosed with a pervasive developmental disorder.
(2) (A) The waiver shall be for children three (3) years of age through ten (10) years of age.
(B) No child shall participate in the Medicaid waiver under this section for more than three (3) years.
(C) The Medicaid waiver under this section shall not pay more than fifty thousand dollars ($50,000) annually per child.
(3) The waiver shall seek to develop skills of children in the areas of cognition, behavior, communication, and social interaction.
(c) The department shall apply for the Medicaid waiver under this section only as funding becomes available for that purpose.