ARC 0128D

ARC 0128D

HUMAN SERVICES DEPARTMENT[441]

Notice of Intended Action

Proposing rulemaking related to autism support program
and providing an opportunity for public comment

    The Department of Health and Human Services hereby proposes to rescind Chapter 22, “Autism Support Program,” Iowa Administrative Code, and to adopt a new Chapter 22 with the same title.

Legal Authority for Rulemaking

    This rulemaking is proposed under the authority provided in Iowa Code section 225D.2.

State or Federal Law Implemented

    This rulemaking implements, in whole or in part, Iowa Code chapter 225D.

Purpose and Summary

    These proposed rules provide definitions, provider qualifications, and appeal procedures related to the Autism Support Program created in Iowa Code chapter 225D. The purpose of the Autism Support Program is to provide funding for applied behavioral analysis services and care coordination for children with a diagnosis of autism who meet certain financial and clinical eligibility criteria.

        This proposed chapter underwent a Red Tape Review pursuant to Executive Order 10. As a result of the Department’s review, the Department removed restrictive terms, removed references to a program that is sunsetting, referred definitions back to the applicable Iowa Code section, and removed redundant language.

Regulatory Analysis

    A Regulatory Analysis for this rulemaking was published in the Iowa Administrative Bulletin on February 4, 2026. A public hearing was held on the following date(s):

     ?   February 24, 2026

Fiscal Impact

     This rulemaking has no fiscal impact to the State of Iowa.

Jobs Impact

    After analysis and review of this rulemaking, no impact on jobs has been found.

Waivers

    Any person who believes that the application of the discretionary provisions of this rulemaking would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to 441—Chapter 6.

Public Comment

     Any interested person may submit written or oral comments concerning this proposed rulemaking, which must be received by the Department no later than 4:30 p.m. on April 7, 2026. Comments should be directed to:

Public Hearing

     Public hearings at which persons may present their views orally or in writing will be held as follows:

    Persons who wish to make oral comments at a public hearing may be asked to state their names for the record and to confine their remarks to the subject of this proposed rulemaking.

     Any persons who intend to attend a public hearing and have special requirements, such as those related to hearing or mobility impairments, should contact the Department and advise of specific needs.

Review by Administrative Rules Review Committee

    The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rulemaking by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rulemaking at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

    The following rulemaking action is proposed:

    ITEM 1.  Rescind 441—Chapter 22 and adopt the following new chapter in lieu thereof:

TITLE III

MENTAL HEALTH

CHAPTER 22

AUTISM SUPPORT PROGRAM

441—22.1(225D) Definitions.

    “Administrator” means the entity selected by the department through a request for proposal process or other contractual arrangement to administer the autism support program.

    “Applicant” means an individual on whose behalf an application has been submitted but who has not been identified as an eligible individual or an individual who has received a denial of eligibility for the program.

    “Applied behavioral analysis” or “ABA” means the same as defined in Iowa Code section 225D.1.

    “Autism” means autism spectrum disorders as defined in Iowa Code section 514C.28.

    “Autism service provider” means the same as defined in Iowa Code section 225D.1.

    “Autism support fund” or “fund” means the autism support fund created in Iowa Code section 225D.2.

    “Autism support program” or “program” means the program created in Iowa Code section 225D.2 to provide funding for applied behavioral analysis and care coordination for eligible individuals with a diagnosis of autism.

    “Care coordination” means the coordination of services performed by the regional autism assistance program under Iowa Code section 256.35.

    “Clinically relevant” means the same as defined in Iowa Code section 225D.1.

    “Diagnostic assessment of autism” means the same as defined in Iowa Code section 225D.1.

    “Eligible individual” means the same as defined in Iowa Code section 225D.1.

    “Federal poverty level” or “FPL” means the same as defined in Iowa Code section 225D.1.

    “Household income” means household income, reported on the tax return on which the eligible individual is claimed as a dependent, as determined using the modified adjusted gross income methodology pursuant to Section 2002 of the federal Patient Protection and Affordable Care Act, Public Law 111-148 as amended to August 1, 2026. If the eligible individual’s parents live together and file separate tax returns, the income reported on both parents’ tax returns must be combined.

    “Household size” means the total number of personal and dependent exemptions claimed on the tax return on which the eligible individual is claimed as a dependent plus any child under the age of 19 living in the household who is claimed for tax purposes by a noncustodial parent through a release of claim to exemption by the custodial parent.

    “Maximum amount of treatment” means a maximum of 24 months of applied behavioral analysis funded by the autism support program. Months of service are not required to be consecutive.

    “Maximum annual benefit” means a maximum annual benefit amount of $36,000 per year for autism support program services for an eligible individual. For the purposes of this program, the annual benefit is calculated by using as a starting date the date the first service is reimbursed by the program and an ending date 12 months from the starting date. Expenditures included in the calculation of the maximum annual benefit include reimbursements to autism service providers for provision of applied behavioral analysis and reimbursements to integrated health homes for costs of care coordination. Cost-sharing paid by the eligible individual is not included in the calculation of the individual’s annual benefit.

    “Medical assistance” or “Medicaid” means assistance provided under the medical assistance program pursuant to Iowa Code chapter 249A and Title XIX of the Social Security Act as amended to August 1, 2026.

    “Month of service” means any month in which an individual receives at least one billable unit of applied behavioral analysis service funded by the autism support program.

    “Provider network” means a network of autism service providers approved by the department to provide services to eligible individuals through the autism support program.

    “Regional autism assistance program” or “RAP” means the program outlined in Iowa Code section 256.35.

    “Treatment plan” means the same as defined in Iowa Code section 225D.1.

441—22.2(225D) Eligibility and application requirements. To be determined eligible for funding for services through the autism support program, an individual must meet the following requirements:

    22.2(1) An individual shall submit an application to the department using a standardized application form available through the administrator’s and the department’s websites and from members of the provider network, RAP, and advocacy organizations.

    22.2(2) An applicant for autism program services shall be less than the age of 14 at the time of application for the program. Proof of age must be provided at the time of application. An individual who reaches the age of 14 prior to receipt of the maximum benefits of the program may continue to receive services from the program in accordance with the individual’s treatment plan, up to a maximum of 24 months of applied behavioral analysis treatment.

    22.2(3) An individual shall have a diagnosis of autism based on a diagnostic assessment of autism dated 24 months or less from the date of application for the program.

    22.2(4) An individual shall be determined ineligible for coverage of applied behavioral analysis services under the medical assistance program, Iowa Code section 514C.28 or 514C.31, or other private insurance coverage. Proof of insurance coverage and noneligibility for coverage for applied behavioral analysis shall be provided at the time of application and shall include a written denial of coverage or a benefits summary indicating that the applied behavioral analysis treatment or applied behavior analysis treatment is not a covered benefit for which the applicant is eligible under the Medicaid program, Iowa Code section 514C.28 or 514C.31, or other private insurance coverage.

    22.2(5) An individual shall have a household income equal to or less than 500 percent of the federal poverty level. Information needed to determine household income using modified adjusted gross income methodology shall be identified on the program application. Household size will be determined according to the standards in this chapter. The information shall be provided at the time of application.

    22.2(6) The department will provide to the parent or guardian a written notice of decision determining initial eligibility or denial within 30 calendar days of receipt of the application.

    22.2(7) The department will refer an applicant determined to be an eligible individual to care coordination services. The referral will occur within five business days of determination of eligibility for the program. Care coordination services will be provided by RAP. Care coordination is not required as a condition of receiving services through the autism support program.

    22.2(8) The department will provide information to an applicant determined to be an eligible individual regarding all available administrators. The eligible individual may choose any available administrator.

    22.2(9) The administrator shall maintain a list of individuals determined eligible for the program but unable to access services due to lack of available providers and shall work to connect eligible individuals on the list to network providers.

    22.2(10) The department will stop processing applications at the point where available funds are fully obligated for eligible individuals and additional eligible individuals would cause expenditures in excess of the funds available to the program. The department will maintain a waiting list of individuals denied access to the program due to lack of available funds. If additional funds become available, the department will contact individuals on the list in order of the earliest date and time of the receipt of the original application. The applicant will be allowed 30 calendar days to submit an updated application and any required information needed to determine eligibility. If the applicant does not submit required information, the applicant will be denied eligibility and removed from the waiting list maintained for individuals denied access to the program due to lack of funding. The age of the applicant at the time of the most recent application will be used when determining eligibility for the program.

441—22.3(225D) Cost-sharing requirements and graduated schedule of cost sharing.

    22.3(1) An individual with a household income equal to or greater than 200 percent of the federal poverty level, up to a maximum of 500 percent of the federal poverty level, will be subject to cost-sharing requirements. Cost sharing will be implemented incrementally up to a maximum of 15 percent of the costs of the services provided through the program for an individual with a household income equal to 500 percent of the federal poverty level. The following is a chart of the cost-sharing requirements:

    22.3(2) An individual may request an exemption from cost sharing due to financial hardship. To qualify for an exemption, an individual shall submit written documentation to the department that the individual or the individual’s family does not have the financial means to fulfill cost-sharing requirements.

    22.3(3) Criteria to determine financial hardship include but are not limited to a change in income, change in employment of the parent or guardian, additional medical expenditures, other family members’ health conditions, or other conditions that may affect the ability to fulfill cost-sharing requirements. The department will provide a written determination regarding eligibility for exemption from cost-sharing requirements. Eligibility for exemption from cost sharing expires at the end of the financial eligibility period.

441—22.4(225D) Review of financial eligibility, cost-sharing requirements, exemption from cost sharing, and disenrollment in the program.

    22.4(1) An eligible individual’s continued financial eligibility for the program, cost-sharing requirements, and exemption from cost sharing will be determined on an annual basis.

    22.4(2) The administrator shall request needed information from the eligible individual’s parent or guardian for redetermination of financial eligibility, cost-sharing requirements, and exemption from cost sharing at least 30 days prior to the expiration of the eligible individual’s eligibility period. The notice requesting information needed for renewal of eligibility shall include the ending date of eligibility for services.

    22.4(3) The department will provide a written notice of decision determining ongoing eligibility or denial within 15 calendar days of receipt of the continued financial eligibility documentation.

    22.4(4) If the signed application and verification of continuing eligibility are not received by the department by the last working day of the renewal month, the individual’s eligibility for the program will be terminated.

    22.4(5) Reasons for disenrollment in the autism support program include:

    a.  Death of the eligible individual.

    b.  The family no longer meets one or more of the eligibility criteria outlined in rule 441—22.2(225D).

    c.  The parent or legal guardian has failed to provide information required for redetermination of eligibility.

    d.  The eligible individual has failed to access authorized services for a period of three consecutive months and has not made arrangements with the autism service provider or administrator to access authorized services.

    e.  No funds are appropriated for the autism support program.

441—22.5(225D) Initial-service authorization and renewal-of-service authorization.

    22.5(1) All services reimbursed through the program shall be prior-authorized by the administrator.

    22.5(2) An autism service provider shall submit an initial treatment plan to the administrator specifying a plan of treatment for a period of no more than six months. The initial treatment plan shall specify the amount of units of applied behavioral analysis services requested for the eligible individual and include a baseline standardized assessment score.

    22.5(3) Family engagement and participation are required for participation in the autism support program. Treatment plans shall identify specific activities and responsibilities of parents or guardians in the treatment plan.

    22.5(4) The treatment plan shall reflect the autism service provider’s engagement with the school in which the eligible individual is enrolled. Treatment plans shall identify specific actions taken by the autism service provider to engage the eligible individual’s school and the results of such actions.

    22.5(5) The treatment plan may include services provided by staff with a minimum of a bachelor’s degree in a human services or education field, working under the supervision of an autism service provider who is board-certified as a behavior analyst. The treatment plan shall identify which services shall be provided directly by the board-certified behavior analyst and which services shall be provided by staff under the supervision of a board-certified behavior analyst.

    22.5(6) For renewal or modification of service authorizations, the autism service provider shall submit an updated plan of treatment with a request for the number of units of applied behavioral analysis the provider believes is medically necessary to address the eligible individual’s ongoing treatment needs. The autism service provider shall also provide evidence of the eligible individual’s progress on identified treatment goals. The administrator shall consider the eligible individual’s updated standardized assessment score along with other clinical information when reviewing requests for renewal or modification of service authorizations. Ongoing service authorization requests shall not exceed six months in duration.

    22.5(7) The administrator shall provide approval, request for modification, or denial within ten business days of receipt of all service authorization requests.

441—22.6(225D) Provider network. The administrator shall establish and maintain a network of department-approved autism service providers so that applied behavioral analysis services are available to eligible individuals statewide to the maximum extent possible.

    22.6(1) A provider shall be approved to participate in the autism support program provider network if the provider meets one of the following standards and is approved to provide applied behavioral analysis services through Medicaid:

    a.  The autism service provider is certified as a behavior analyst by the Iowa board of certification; or

    b.  The autism service provider is a psychologist licensed under Iowa Code chapter 154B; or

    c.  The autism service provider is a psychiatrist licensed under Iowa Code chapter 148.

    22.6(2) The administrator’s provider network shall accept the rate established by the department through the department’s contract with the administrator as payment in full for the services rendered and will not charge eligible individuals any additional fees for services rendered, except for those eligible individuals who are required to pay a portion of the cost of services due to cost-sharing requirements.

    22.6(3) The department is responsible for calculating the cost-sharing amount according to standards established in this chapter.

    22.6(4) The autism service provider is responsible for collecting the cost-sharing amount from the eligible individual and will only be reimbursed by the administrator for the balance of the service fee minus the amount of cost sharing.

441—22.7(225D) Financial management of the program.

    22.7(1) The department will:

    a.  Not take new applications for the program that would cause expenditures of the program to exceed the budgeted amount.

    b.  Limit expenditure of program funds to services for those individuals determined to be eligible individuals and for related administrative costs.

    c.  Allocate available funds for eligible individuals’ services in a manner that allows for funding for all eligible individuals’ services authorized by the administrator without exceeding the department’s funding limits.

    22.7(2) The administrator shall:

    a.  Limit annual expenditures for each eligible individual to the amount identified in Iowa Code section 225D.2(2)“a.”

    b.  Limit length of service through the program to the amount identified in Iowa Code section 225D.2(2)“b.”

    c.  Limit payment for applied behavioral analysis services to an hourly or equivalent quarter-hour unit rate that is equal to the contracted rate currently paid by Medicaid for applied behavioral analysis services.

    d.  Not provide financial compensation to RAP for care coordination services.

441—22.8(225D) Appeal. Notice of adverse action shall be given in accordance with 441—Chapter 16. The right to appeal shall be given in accordance with 441—Chapter 7.

These rules are intended to implement Iowa Code chapter 225D.