Md. Code Regs. 10.09.34.03

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.34.03 - 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 and reassessment that includes:

(a) Development of a behavioral plan with the participant and parent, guardian, or individual who customarily provides care which specifically:

(i) Identifies the target behaviors or symptoms that are placing the current living arrangement at risk or presenting a barrier to transition to a less restrictive living arrangement;

(ii) Defines specific interventions to be used to resolve the behaviors or symptoms, including how a therapeutic aide will implement therapeutic behavioral services;

(iii) Defines outcome measures that can be used to demonstrate the decreasing frequency of targeted behaviors;

(iv) Defines alternative behaviors;

(v) Defines the clinically accepted techniques for behavior change, including where, when, and the frequency of the techniques to be used and the risks and benefits of each;

(vi) Details the strategies and skills for the participant and parent, guardian, or individual who customarily provides cares to provide continuity of care when therapeutic behavioral services are discontinued;

(vii) Details emergency procedures to be implemented when the participant exhibits behaviors that pose harm to self or others;

(viii) Contains written informed consent before implementation, of the parent or legal guardian, or if the participant is 18 years old or older, written informed consent of the participant; and

(ix) Identifies the level or type of licensed healthcare professional responsible for monitoring the behavioral plan; and

(b) Determination if therapeutic behavioral services are needed;

(2) Therapeutic behavioral services that:

(a) Provide one-to-one intervention for a specified period of time at the appropriate site in accordance with the behavioral plan; and

(b) May include, but are not limited to:

(i) Assisting the participant to engage in or remain engaged in appropriate activities;

(ii) Minimizing the participant's impulsive behavior;

(iii) Providing immediate behavioral reinforcements;

(iv) Providing time structuring activities; and

(v) Collaboration with and support for parent, guardian, or individual who customarily provides care in the effort to provide ongoing behavioral support.

Md. Code Regs. 10.09.34.03

Regulation .03 amended effective 49:25 Md. R.1041-1070, eff. 12/12/2022