Diagnostic assessment must find ASD [625.2(a)]

Diagnostic assessment must be done by:
physician,
licensed psychologist,
licensed physician assistant; or
certified registered nurse practitioner  [625.2(f)(5)]
Treatment must be prescribed or ordered by
licensed physician,
licensed physician’s assistant,
licensed psychologist,
licensed clinical social worker; or
certified registered nurse [635.2.(f)(14)(i)]

Treatment must be in the treatment plan [635.2(f)(14)]

Treatment plan must be
Developed by a licensed physician or licensed psychologist
“Pursuant to an comprehensive evaluation or reevaluation”
“consistent with the most recent clinical report of recommendations of the American Academy of Pediatrics”  [635.2(f)(15)]

Treatment must fit one of the categories of covered services [625.2(f)(14)]

Pharmacy [625.2(f)(9)]
Psychiatry  [625.2(f)(10)]
Psychology [625.2(f)(11)]
Rehabilitation [625.2(f)(12)-
including ABA  [625.2(f)(1)]
Therapies  [635.2(f)(13)]
Speech/language
Occupational therapy
Physical therapy
Treatment must be medically necessary [625.2(f)(14)]
No definition of medical necessity in Act but-
“prevent loss of attained skill or function” is part of definition of both rehabilitative care [625.2(f)(12)] & ABA [625.2(f)(1)] so it appears that prevention of loss of attained skill or function must be part of the medical necessity criteria for rehabilitative care & ABA.
Treatment must be provided by:
an “autism service provider” or
“person, entity or group that works under the direction of an autism service provider” [635.2(f)(14)(ii)&(iii), p.10]
“autism service provider” is “person, entity or group providing treatment of ASD” who is
Licensed or certified [635.2(f)(2)]
Presumably any of the people listed in 635.2(f)(14)(i) +
“behavior specialist” [635.2.(f)(4)]
Licensure/certification set out at 635.2(g)
Persons meeting the statutory requirements are covered without licensure/certification for 1 year from promulgation of licensure/ certification regulations or July 9, 2011, whichever is later. [635.2(l)]
Or enrolled in Medical Assistance
on or before 7/9/08 [635.2(f)(2)] and
agrees to “the payment levels, terms & conditions applicable to the insurer’s other participating providers for such service.” [635.2(h)]
While the Act doesn’t specifically mention this, under common insurance policies and under Medical Assistance, the treatment provider will also have to be enrolled in the child’s insurance plan unless the plan has authorized coverage by a “non-par” provider.