§ 225D.2 — Autism support program — fund

Iowa § 225D.2

• Jurisdiction: Iowa
• Title VI: HUMAN SERVICES
• Ch. 225D: AUTISM SUPPORT PROGRAM

Text

1. The department shall implement an autism support program beginning January 1,
2014, to provide payment for the provision of applied behavioral analysis treatment for
§225D.2, AUTISM SUPPORT PROGRAM 2
eligible individuals. The department shall adopt rules, including standards and guidelines
pursuant to chapter 17A to implement and administer the program. In adopting the
rules, standards, and guidelines for the program, the department shall consult with and
incorporate the recommendations of an expert panel convened by the regional autism
assistance program to provide expert opinion on clinically relevant practices and guidance
on program implementation and administration. The expert panel shall consist of families of
individuals with autism; educational, medical, and human services specialists, professionals,
and providers; and others with interest in or expertise related to autism. The program shall
be implemented and administered in a manner so that payment for services is available
throughout the state, including in rural and under-resourced areas.
2. At a minimum, the rules, standards, and guidelines for the program shall address all of
the following:
a. A maximum annual benefit amount for an eligible individual of thirty-six thousand
dollars.
b. A maximum of twenty-four months of applied behavioral analysis treatment.
c. Notwithstanding the age limitation for an eligible individual, a provision that if an
eligible individual reaches fourteen years of age prior to completion of the maximum
applied behavioral analysis treatment period specified in paragraph “b”, the individual may
complete such treatment in accordance with the individual’s treatment plan, not to exceed
the maximum treatment period.
d. A graduated schedule for cost-sharing by an eligible individual based on a percentage
of the total benefit amount expended for the eligible individual, annually. Cost-sharing
shall be applicable to eligible individuals with household incomes at or above two hundred
percent of the federal poverty level in incrementally increased amounts up to a maximum of
fifteen percent. The rules shall provide a financial hardship exemption from payment of the
cost-sharing based on criteria established by rule of the department.
e. Application, approval, compliance, and appeal processes for eligible individuals as
necessary to operate and manage the program.
f. Enrollment, renewal, and reimbursement of claims provisions for autism service
providers participating in the program.
g. A requirement of family engagement and participation as part of the eligible
individual’s treatment plan.
h. Arequirementthattheautismserviceprovidercoordinateinterventionswiththeschool
in which the eligible individual is enrolled.
i. A requirement that the administrator of the program utilize the regional autism
assistance program to coordinate interventions between eligible individuals and their
families receiving support through the autism support program with appropriate medical,
educational, and treatment providers, including integrated health homes. The regional
autism assistance program shall provide for family navigation and coordination and
integration of services through the statewide system of regional child health specialty
clinics, utilizing the community child health team model. As necessitated by the availability
of resources in the community where services are delivered, telehealth may be used
in delivering and coordinating interventions with appropriate providers. To the extent
available and accessible to an eligible individual, the eligible individual shall be enrolled in
an integrated health home that is an approved provider enrolled in the medical assistance
program. Health home services that are covered services under the medical assistance
program shall be reimbursed under the autism support program at rates consistent with
those established under the medical assistance program.
j. Requirementsrelatedtoreviewoftreatmentplans,whichmayrequirereviewonceevery
six months, subject to utilization review requirements established by rule. A more or less
frequent review may be agreed upon by the eligible individual and the licensed physician or
licensed psychologist developing the treatment plan.
k. Recognition of the results of a diagnostic assessment of autism as valid for a period of
not less than twelve months, unless a licensed physician or licensed psychologist determines
that a more frequent assessment is necessary.
l. Proof of eligibility for the autism support program that includes a written denial for
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coverage or a benefits summary indicating that applied behavioral analysis treatment or
applied behavior analysis treatment is not a covered benefit for which the applicant is
eligible, under the Medicaid program, section 514C.28, section 514C.31, or other private
insurance coverage.
3. Moneys in the autism support fund created under subsection 5 shall be expended only
for eligible individuals who are not eligible for coverage for applied behavioral analysis
treatment or applied behavior analysis treatment under the medical assistance program,
section 514C.28, section 514C.31, or other private insurance. Payment for applied behavioral
analysis treatment through the fund shall be limited to only applied behavioral analysis
treatment that is clinically relevant and only to the extent approved under the guidelines
established by rule of the department.
4. This section shall not be construed as granting an entitlement for any program, service,
or other support for eligible individuals. Any state obligation to provide a program, service,
or other support pursuant to this section is limited to the extent of the funds appropriated
for the purposes of the program. The department may establish a waiting list or terminate
participation of eligible individuals if the department determines that moneys in the autism
support fund are insufficient to cover future claims for reimbursement beyond ninety days.
5. a. An autism support fund is created in the state treasury under the authority of the
department. Moneys appropriated to and all other moneys specified for deposit in the fund
shall be deposited in the fund and used for the purposes of the program. Notwithstanding
section 12C.7, interest or earnings on moneys in the fund shall be credited to the fund.
Notwithstanding section 8.33, moneys credited to the fund that remain unexpended or
unobligated at the end of a fiscal year shall not revert to any other fund.
b. The department shall adopt rules pursuant to chapter 17A to administer the fund and
reimbursements made from the fund.
c. Moneys in the fund are appropriated to the department and shall be used by the
department for the purposes of the autism support program. The department shall be the
administrator of the fund for auditing purposes.
d. The department shall report on the program and fund pursuant to section 217.21.