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TITLE 1 - ADMINISTRATION
PART 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354 - MEDICAID HEALTH SERVICES
SUBCHAPTER P - AUTISM SERVICES
SECTION/RULE ยง354.5003 - Definitions
Chapter Review Date 11/08/2024

The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.(1) ABA--Applied behavior analysis. The practice of applying the principles of learning and behavior, specifically about how behavior affects, and is affected by, past and current environmental events in conjunction with biological variables to improve the human condition through behavior change that is based on current, evidence-based, specialized principles, and delivered by a qualified professional under this subchapter.(2) APRN--Advanced practice registered nurse. A person who:(A) is currently licensed without restriction as an advanced practice registered nurse by the Texas Board of Nursing under Texas Occupations Code (TOC), Chapter 301 (relating to Nurses); and(B) practices under a current, executed prescriptive authority agreement with a qualified physician in accordance with TOC, Chapter 157, Subchapter B (relating to Delegation to Advanced Practice Registered Nurses and Physician Assistants).(3) ASD--Autism spectrum disorder. Is a condition included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is characterized by restricted, repetitive patterns of behavior, interests, or activities and deficits in social communication and social interaction, with onset of symptoms occurring in early childhood.(4) Authorized primary care provider--Includes a qualified physician, acting as the primary care physician (PCP), or a qualified physician assistant (PA) or APRN, acting as the primary care provider.(5) Autism--Autism spectrum disorder.(6) Autism Section--Medicaid Autism Services section. The section in the Children's Services Handbook in the TMPPM that:(A) addresses authorization to provide ABA to treat ASD and coverage of ABA services;(B) covers ABA services to the extent required by EPSDT; and(C) covers coordination of a comprehensive array of services to treat ASD.(7) BT--Behavior technician. A person who is currently fully registered or certified without restriction as one of the following:(A) Registered Behavior Technician (RBT);(B) Board Certified Autism Technician (BCAT); or(C) Applied Behavior Analysis Technician (ABAT).(8) CFR--Code of Federal Regulations.(9) Child--A child is an individual who is under 21 years of age who is Medicaid enrolled and who is eligible for ABA services under this subchapter and the Autism Section in the Children's Handbook in the Texas Medicaid Provider Procedures Manual (TMPPM).(10) Children's Handbook--The Children's Services Handbook in the TMPPM.(11) Co-morbid condition--A child who has a co-morbid condition with ASD has a physical, mental, or behavioral health condition, which may include a history of trauma, where diagnosis, symptoms, or treatment of the co-morbid condition occur at the same time as ASD.(12) Comprehensive diagnostic evaluation--The medical standard of practice for the evaluation process and elements used by a qualified medical or health care professional to make an ASD diagnosis. The qualified medical or health care professional must either meet minimum requirements in the Autism Section in the Children's Handbook in the TMPPM to make a diagnosis of ASD, or be a PCP or other physician, working in consultation with an interdisciplinary diagnostic team that meets minimum requirements in the Autism Section in the TMPPM, to decide whether an ASD diagnosis is clinically appropriate for a child.(13) DSM--Diagnostic and Statistical Manual for Mental Disorders. The current edition of the publication of the American Psychiatric Association, which is used by a qualified medical or health care provider in the evaluation and diagnosis of mental and behavioral health illnesses and conditions.(14) Durable--Able to exist for a long time without significant deterioration in quality or value; not occurring only during ABA services or a temporary period thereafter.(15) EPSDT--Early and Periodic Screening, Diagnosis, and Treatment. The federally mandated Early and Periodic Screening, Diagnosis, and Treatment program defined in Texas Administrative Code (TAC)