Rulemaking re: Medicaid coverage for ABA

[Guest guest]

This is not something I personally will be following, but:

If you are thinking about/hoping to access ABA through state plan medicaid (not the waiver), this is a process you should be monitoring. This rulemaking process will establish the criteria to rule in or rule out coverage of ABA by Medicaid. See from the notice below:

It (the new rule) provides guidelines which are to be used when making a coverage determination of a new drug, device, medical or therapeutic treatment or procedure, including services such as applied behavior analysis. The rule includes the types of data referenced in the decision making process and names the person(s) qualified to make the final coverage determination.

(be careful not to be mislead by terminology such as "generally accepted professional medical standards"....State Plan Medicaid can and does establish through rulemaking "medical necessity" and what data they look to in order to determine medical necessity.)

Notice of Development of Rulemaking (release date 6/15/2012)

AGENCY FOR HEALTH CARE ADMINISTRATIONMedicaid

RULE NO.: RULE TITLE:59G-1.035: Determining Generally Accepted Professional Medical StandardsPURPOSE AND EFFECT: Subparagraph 59G-1.010(166)(a)3., Florida Administrative Code (F.A.C.) provides that medical necessity must be consistent with generally accepted professional medical standards, as determined by the Medicaid program, and not by experimental or investigational standards as defined in subsection 59G-1.010(84), F.A.C. This rule specifies the Medicaid program’s process for determining the circumstances under which a drug, device, medical or therapeutic treatment, or procedure is consistent with generally accepted professional medical practice and standards. It provides guidelines which are to be used when making a coverage determination of a new drug, device, medical or therapeutic treatment or procedure, including services such as applied behavior analysis. The rule includes the types of data referenced in the decision making process and names the person(s) qualified to make the final coverage determination.SUBJECT AREA TO BE ADDRESSED: Determining Generally Accepted Professional Medical Standards.An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-1.035, F.A.C., will have as provided for under Sections 120.54 and 120.541, F.S.RULEMAKING AUTHORITY: 409.919 FS.LAW IMPLEMENTED: 409.902, 409.905, 409.912, 409.913 FS.IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:DATE AND TIME: Monday, July 9, 2012, 2:30 p.m. – 4:30 p.m.PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, Florida 32308-5407Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Ronique Hall at the Bureau of Medicaid Services, (850)412-4281. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Ronique Hall, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: (850)412-4281, e-mail: ronique.hall@...THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS NOT AVAILABLE.