Skip to Main Content
<< Back | Return to Main COMAR Search Page

6 records match your request.

FileAbstract
31.10.39.00.htm 31.10.39.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 39 Utilization Review of Treatment for Autism and Autism Spectrum Disorders Authority: Insurance Article, §2-109(a)1) and 15-835, Annotated Code of Maryland Ch. 294, §2, Acts of 2012
31.10.39.01.htm 31.10.39.01. 01 Scope.. This chapter establishes the manner in which carriers and private review agents acting on behalf of carriers may apply utilization review criteria and impose documentation requirements regarding the treatment of children diagnosed with autism or autism spectrum disorders, when covered under a habilitative services benefit under a health benefit plan.
31.10.39.02.htm 31.10.39.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Applied behavior analysis” means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.2) “Behavioral health tre
31.10.39.03.htm 31.10.39.03. 03 Utilization Review Criteria for Treatment of Autism and Autism Spectrum Disorders.. A. The utilization review criteria of a carrier or private review agent acting on behalf of a carrier to determine medical necessity or appropriateness may not be more restrictive for habilitative services for the treatment of autism and autism spectrum disorders than the criteria listed in this regulation.B. The carrier’s criteria for habilitative services shall include criteria
31.10.39.04.htm 31.10.39.04. 04 Coverage for Habilitative Services.. Coverage required under this chapter may be subject to limitations in a health benefit plan relating to coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, case management provisions, and co-payments, co-insurance, and deductible amounts.
31.10.39.9999.htm 31.10.39.9999. Administrative History Effective date: March 17, 2014 (41:5 Md. R. 348).
<< Back | Return to Main COMAR Search Page