37.34.1961 MEDICAID AND COMMUNITY SERVICES CHILDREN'S AUTISM PROGRAM 0667: INDIVIDUAL GOODS AND SERVICES, REQUIREMENTS
(1) Items covered through individual goods and services must meet the following requirements:
(a) the item or service is designed to meet the child's functional, medical, or social needs and advance the desired outcomes in the plan of care;
(b) the item or service is not prohibited by federal or state statutes or regulations;
(c) the item or service is not available through another source;
(d) the service does not include experimental goods or services; and
(e) one or more of the following additional criteria are met:
(i) the item or service would increase the child's functioning related to the disability;
(ii) the item or service would increase the child's safety in the home environment; or
(iii) the item or service would increase independence from other Medicaid services.
(2) Recreational activities provided through individual goods and services may be covered only to the degree that they are not diversional in nature and are included in a planning objective related to a specific therapeutic goal.
(3) Individual goods and services are reimbursable only if:
(a) individual goods and services must be approved by the planning team prior to purchase; and
(b) goods and services purchased on behalf of the child by nonemployees acting on behalf of the child are reimbursable only if receipts for such purchases are submitted to the agency that has a contract with the department.
(4) The department assures that services, goods, or supports provided for through this definition are not available through the Individuals with Disabilities Education Act (IDEA) or Section 110 of the Rehabilitation Act or available through any other public funding mechanism.
(5) Individual goods and services is considered an ancillary service. The sum of all ancillary service costs may not exceed $4,000 annually. Individual goods and services projected to exceed an annual aggregate amount of $2,000 require approval by the program regional manager.