The medicaid agency pays for ABA services when the services are:

1. (1) Covered;
2. (2) Medically necessary;
3. (3) Within the scope of the eligible client's medical care program;
4. (4) Provided to clients who meet the criteria in WAC 182-531A-0400;
5. (5) Within currently accepted standards of evidence-based clinical practice;
6. (6) Not duplicative of ABA services paid for by other state agencies using medicaid funds;
7. (7) Completed in the stages described in this chapter;
8. (8) Provided by qualified health care professionals, as described in this chapter;
9. (9) Authorized, as required within this chapter, chapters 182-501 and 182-502 WAC, and the agency's Applied Behavior Analysis Provider Guide; and
10. (10) Billed according to this chapter, chapters 182-501 and 182-502 WAC, and the agency's Applied Behavior Analysis Provider Guide.

[Statutory Authority: RCW 41.05.021, 41.05.160, and Thurston County Superior Court in J.C. and H.S. v. Washington State Health Care Authority, no. 20-2-01813-34. WSR 22-08-035, § 182-531A-0300, filed 3/29/22, effective 4/29/22. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 14-24-083, § 182-531A-0300, filed 12/1/14, effective 1/1/15.]