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10.09.34.00.htm 10.09.34.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 34 Therapeutic Behavioral Services Authority: Health-General Article, ยง2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.34.01.htm 10.09.34.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Behavioral plan" means an individualized written plan for therapeutic behavioral services which includes the components specified in Regulation .03B(1) of this chapter.2) "Department" means the Department of Health and Mental Hygiene, the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C.
10.09.34.02.htm 10.09.34.02. 02 Conditions for Provider Participation.. A. A therapeutic behavioral service provider shall:. 1) Ensure that therapeutic behavioral aides are trained and supervised in:. a) Principles of behavior change and childhood development;. b) Clinically accepted techniques for decreasing or eliminating maladaptive behaviors;. c) Implementing a behavioral plan;. d) Identifying the needs and characteristics of the recipient; and. e) Documenting interventions and outcomes;.
10.09.34.03.htm 10.09.34.03. 03 Covered Services.. A. The Program covers the services listed in this chapter when the services are:. 1) Diagnosed, identified, and prescribed by an EPSDT provider to be medically necessary;. 2) Preauthorized by the Department or its designee; and. 3) Delivered in accordance with the behavioral plan.. B. The following services are covered:. 1) Therapeutic behavioral assessment that includes:. a) Development of a behavioral plan with the recipient and parent, guardian
10.09.34.04.htm 10.09.34.04. 04 Limitations.. A. To be eligible for therapeutic behavioral services the:. 1) Recipient shall be younger than 21 years old and enrolled in the Program;. 2) Recipient shall be assessed as having behaviors or symptoms related to a mental health diagnosis that places the individual's current living arrangement at risk and creates a risk for a more restrictive placement, or prevents transition to a less restrictive placement;
10.09.34.05.htm 10.09.34.05. 05 Preauthorization.. A. The Department or its designee shall require preauthorization for therapeutic behavioral services.B. The initial authorization shall be given for not more than 60 calendar days.. C. Additional authorization beyond the initial authorization shall be requested at a minimum, every 60 days and in advance of the expiration of the previous authorization.D. Authorization may only be given if the therapeutic behavioral service continues to be effective a
10.09.34.06.htm 10.09.34.06. 06 Payment Procedures.. A. Request for payment of services shall be submitted in accordance with COMAR 10.09.36.04.. B. Billing time limitations for claims submitted pursuant to this chapter as set forth in COMAR 10.09.36.06.C. Reimbursement for services covered under this chapter is as follows:. 1) Initial therapeutic assessment at a rate of $26.91 per 15 minutes, with a maximum of 60 minutes;.
10.09.34.07.htm 10.09.34.07. 07 Recovery and Reimbursement.. Recovery and reimbursement shall be as set forth in COMAR 10.09.36.07..
10.09.34.08.htm 10.09.34.08. 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.
10.09.34.09.htm 10.09.34.09. 09 Appeal Procedures.. Appeals procedures shall be as set forth in accordance with COMAR 10.09.36.09..
10.09.34.10.htm 10.09.34.10. 10 Interpretive Regulation.. This chapter shall be interpreted as set forth in COMAR 10.09.36.10..
10.09.34.9999.htm 10.09.34.9999. Administrative History Effective date: November 24, 2005 (32:23 Md. R. 1827). Regulation .01B amended effective May 2, 2011 (38:9 Md. R. 552). Regulation .02A amended effective February 15, 2016 (43:3 Md. R. 273). Regulation .04D amended effective July 4, 2016 (43:13 Md. R. 712). Regulation .06C amended effective February 15, 2016 (43:3 Md. R. 273).
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