Nevada § 422.2719 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to fetal alcohol spectrum disorders

§ 422.2719. State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to fetal alcohol spectrum disorders

1. The Director shall include in the State Plan for Medicaid a requirement that the

State pay the nonfederal share of expenditures incurred for screening for and diagnosis

of fetal alcohol spectrum disorders and for treatment of fetal alcohol spectrum disorders

to persons under the age of 19 years or, if enrolled in high school, until the person

reaches the age of 21 years. 2. A managed care organization, including a health maintenance organization, that

provides health care services to recipients of Medicaid under the State Plan for Medicaid

or the Children's Health Insurance Program pursuant to a contract with the Division,

which provides coverage for outpatient care shall not require a longer waiting period

for coverage for outpatient care related to fetal alcohol spectrum disorders than

is required for other outpatient care covered by the plan. 3. A managed care organization shall cover medically necessary treatment of a fetal

alcohol spectrum disorder. 4. Treatment of a fetal alcohol spectrum disorder must be identified in a treatment

plan and must include medically necessary habilitative or rehabilitative care, prescription

care, psychiatric care, psychological care, behavioral therapy or therapeutic care

that is: (a) Prescribed for a person diagnosed with a fetal alcohol spectrum disorder by a

licensed physician or licensed psychologist; and (b) Provided for a person diagnosed with a fetal alcohol spectrum disorder by a licensed

physician, licensed psychologist, licensed behavior analyst or other provider that

is supervised by the licensed physician, psychologist or behavior analyst. A managed care organization may request a copy of and review a treatment plan created

pursuant to this subsection. 5. Nothing in this section shall be construed as requiring a managed care organization

to provide reimbursement to a school for services delivered through school services. 6. As used in this section: (a) “ Applied behavior analysis ” means the design, implementation and evaluation of environmental modifications using

behavioral stimuli and consequences to produce socially significant improvement in

human behavior, including, without limitation, the use of direct observation, measurement

and functional analysis of the relations between environment and behavior. (b) “ Behavioral therapy ” means any interactive therapy derived from evidence-based research, including, without

limitation, discrete trial training, early intensive behavioral intervention, intensive

intervention programs, pivotal response training and verbal behavior provided by a

licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst

or registered behavior technician. (c) “ Evidence-based research ” means research that applies rigorous, systematic and objective procedures to obtain

valid knowledge relevant to fetal alcohol spectrum disorders. (d) “ Fetal alcohol spectrum disorder ” has the meaning ascribed to it in NRS 432B.0655 . (e) “ Habilitative or rehabilitative care ” means counseling, guidance and professional services and treatment programs, including,

without limitation, applied behavior analysis, that are necessary to develop, maintain

and restore, to the maximum extent practicable, the functioning of a person. (f) “ Health maintenance organization ” has the meaning ascribed to it in NRS 695C.030 . (g) “ Licensed assistant behavior analyst ” has the meaning ascribed to the term “assistant behavior analyst” in NRS 641D.020 . (h) “ Licensed behavior analyst ” has the meaning ascribed to the term “behavior analyst” in NRS 641D.030 . (i) “ Managed care organization ” has the meaning ascribed to it in NRS 695G.050 . (j) “ Medically necessary ” means health care services or products that a prudent physician or psychologist

would provide to a patient to prevent, diagnose or treat an illness, injury or disease,

or any symptoms thereof, that are necessary and which are: (1) Provided in accordance with generally accepted standards of medical practice; (2) Clinically appropriate for the type, frequency, extent, location and duration; (3) Not primarily provided for the convenience of the patient, physician, psychologist

or other provider of health care; (4) Required to improve a specific health condition of the patient or to preserve

the existing state of health of the patient; and (5) The most clinically appropriate level of health care that may be safely provided

to the patient. (k) “ Prescription care ” means medications prescribed by a licensed physician and any health-related services

deemed medically necessary to determine the need or effectiveness of the medications. (l) “ Psychiatric care ” means direct or consultative services provided by a psychiatrist licensed in the

state in which the psychiatrist practices. (m) “ Psychological care ” means direct or consultative services provided by a psychologist licensed in the

state in which the psychologist practices. (n) “ Registered behavior technician ” has the meaning ascribed to it in NRS 641D.100 . (o) “ Screening for and diagnosis of fetal alcohol spectrum disorders ” means medically appropriate assessments, evaluations or tests to screen and diagnose

whether a person has a fetal alcohol spectrum disorder. (p) “ Therapeutic care ” means services provided by licensed or certified speech-language pathologists, occupational

therapists and physical therapists. (q) “ Treatment plan ” means a plan to treat a fetal alcohol spectrum disorder that is prescribed by a

licensed physician or licensed psychologist and may be developed pursuant to a comprehensive

evaluation in coordination with a licensed behavior analyst.