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10.09.28.00.htm 10.09.28.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 28 Applied Behavior Analysis Services Authority: State Government Article, §2-104(b) 2-105(b) and 15-103, Annotated Code of Maryland
10.09.28.01.htm 10.09.28.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) Applied Behavior Analysis (ABA). a) "Applied behavior analysis (ABA) means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvements in human behavior.b) "Applied behavior analysis (ABA) includes the direct observations, measurement, and functional an
10.09.28.02.htm 10.09.28.02. 02 Provider Qualifications and Conditions for Participation.. A. A provider shall meet all conditions for participation as set forth in COMAR 10.09.36.03.. B. An ABA provider shall be licensed, certified, or otherwise legally authorized to provide ABA services in the jurisdiction in which the services are provided.C. An ABA provider may not have current sanctions or current disciplinary actions imposed by:. 1) The jurisdictional licensing or certification authority;.
10.09.28.03.htm 10.09.28.03. 03 Participant Eligibility.. A. A participant shall meet the eligibility conditions set forth in §B of this regulation.. B. To qualify for ABA services, a participant shall:. 1) Be younger than 21 years old;. 2) Live in the community;. 3) Be diagnosed with an ASD by a qualified health care professional and referred for ABA services;. 4) Exhibit the presence of maladaptive behavior or developmental skills deficits that significantly interferes with home, school, or community activit
10.09.28.04.htm 10.09.28.04. 04 Covered Services.. A. The Program covers the ABA services set forth in §B of this regulation when the services are:. 1) Medically necessary;. 2) Preauthorized by the Program or its designee; and. 3) Delivered in accordance with the participant’s treatment plan.. B. The Program covers the following ABA services:. 1) ABA assessment, which is a comprehensive behavior assessment that:. a) Is performed face-to-face with a participant and the participant’s parent or caregiver by:.
10.09.28.05.htm 10.09.28.05. 05 Limitations.. A. ABA services are only available to participants under the EPSDT program.. B. ABA services shall be delivered in a home or community setting, including a clinic.. C. The provider may not bill the Program for:. 1) Services that are:. a) Provided in:. i) A hospital;. ii) An institution for mental disease;. iii) An ICF-IID;. iv) A crisis residential program;. v) A residential treatment center;. vi) A 24-hour, 365-day residential program funded
10.09.28.06.htm 10.09.28.06. 06 Payment Procedures.. A. The Program shall provide fee-for-service reimbursement for covered ABA services to the following ABA providers who meet the conditions for participation set forth in Regulation .02 of this chapter:1) ABA program;. 2) Individual psychologist;. 3) Individual BCBA-D; and. 4) Individual BCBA.. B. Reimbursement for ABA services may not be made directly to a BCaBA or RBT rendering ABA services.. C. Reimbursement for ABA services may not be made
10.09.28.07.htm 10.09.28.07. 07 Recovery and Reimbursement.. Recovery and reimbursement are as set forth in COMAR 10.09.36.07..
10.09.28.08.htm 10.09.28.08. 08 Cause for Suspension or Removal and Imposition of Sanctions.. Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.
10.09.28.09.htm 10.09.28.09. 09 Appeals Procedures.. Appeal procedures are as set forth in COMAR 10.09.36.09..
10.09.28.10.htm 10.09.28.10. 10 Interpretive Regulation.. This chapter shall be interpreted as set forth in COMAR 10.09.36.10..
10.09.28.9999.htm 10.09.28.9999. Administrative History Effective date: November 7, 2016 (43:22 Md. R. 1218).
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