<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.28.04" title_num="10" subtitle_num="09" chapter_num="28" heading="Covered Services.">
  <paragraph num="A.">
    <text>The Program covers the ABA services set forth in §B of this regulation when the services are:</text>
    <paragraph num="(1)">
      <text>Medically necessary;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Preauthorized by the Program or its designee;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Delivered in accordance with the participant's treatment plan; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Supported by documentation of consent to treatment from the participant or the participant’s parent or guardian.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Program covers the following ABA services:</text>
    <paragraph num="(1)">
      <text>An ABA assessment, which is a behavior identification assessment that:</text>
      <paragraph num="(a)">
        <text>Is administered in person with a participant and the participant's parent or caregiver by:</text>
        <paragraph num="(i)">
          <text>A licensed psychologist; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An LBA;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Addresses the behavioral needs for ABA services; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Includes:</text>
        <paragraph num="(i)">
          <text>An interview, direct observation, record review, data collection, and analysis;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An assessment of the participant's current level of functioning, skills deficits, and maladaptive behaviors using validated instruments;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Analysis of past data;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Scoring and interpreting the assessment;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Preparing the treatment plan and report; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Discussion of the findings;</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A behavior identification supporting assessment which is a follow-up assessment that is administered:</text>
      <paragraph num="(a)">
        <text>In person, by an RBT, BT, or BCaBA, with a participant present; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Under the direction of a licensed psychologist or an LBA;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>An exposure behavior identification supporting assessment which is a follow-up assessment that:</text>
      <paragraph num="(a)">
        <text>Is conducted on a participant with specific, severe destructive behaviors in a structured, safe environment;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is administered in person by a licensed psychologist or an LBA with the assistance of two or more BCaBAs, RBTs, or BTs;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Exposes the participant to a customized series of social and environmental conditions associated with the destructive behaviors; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Uses structured testing to examine events, cues, responses, and consequences associated with the behaviors;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>An adaptive behavior treatment with protocol modification which is an in-person service that:</text>
      <paragraph num="(a)">
        <text>Is conducted on a participant with specific, severe destructive behaviors in an environment that is:</text>
        <paragraph num="(i)">
          <text>Customized;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Structured; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Safe;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Is administered in-person by a licensed psychologist or an LBA with the assistance of two or more BCaBAs, RBTs, or BTs;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Includes in-person direction of two or more technicians eliciting behavioral effects or exposing the participant to specific environmental conditions and treatment; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Refines and modifies ineffective components of the treatment;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Group adaptive behavior treatment by protocol which is an in-person service provided to a group of two or more participants by:</text>
      <paragraph num="(a)">
        <text>A licensed psychologist;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An LBA; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A BCaBA, RBT, or BT under the direction of a licensed psychologist or an LBA utilizing a behavioral intervention protocol designed in advance by the psychologist or an LBA who may or may not provide in-person direction of a technician during the treatment;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Multiple-family group adaptive behavior treatment guidance that:</text>
      <paragraph num="(a)">
        <text>Is provided in person with parents or caregivers of multiple participants without the presence of the participants by:</text>
        <paragraph num="(i)">
          <text>A licensed psychologist; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An LBA;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Identifies maladaptive behaviors and skills deficits;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Instructs parents or caregivers on how to utilize ABA treatments to reduce maladaptive behaviors and skill deficits; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Is performed in person for at least 25 percent of the session time each month;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Family adaptive behavior treatment guidance which:</text>
      <paragraph num="(a)">
        <text>Is provided in person or remotely with a participant’s parent or caregiver, with or without the presence of the participant by:</text>
        <paragraph num="(i)">
          <text>A licensed psychologist;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An LBA; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>A BCaBA;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Identifies maladaptive behaviors and skills deficits;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Instructs the parent or caregiver on how to utilize ABA strategies to reduce maladaptive behaviors and skill deficits; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Is performed in person for at least 25 percent of the session time each month;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(8)">
      <text>A behavior identification reassessment which is a follow-up assessment that:</text>
      <paragraph num="(a)">
        <text>Is performed in person with a participant and a participant's parent or caregiver every 180 days by:</text>
        <paragraph num="(i)">
          <text>A licensed psychologist; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An LBA;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Evaluates the progress toward each behavior treatment goal using objective, quantifiable measures and includes the results of validated instruments;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Includes a revision of the treatment plan based on progress; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Includes a clinical recommendation as to whether ABA services continue to be medically necessary;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Group adaptive behavior treatment with protocol modification which is a service that is:</text>
      <paragraph num="(a)">
        <text>Provided in person to multiple participants by:</text>
        <paragraph num="(i)">
          <text>A licensed psychologist; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An LBA;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Focused on social skills training; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Aimed at identifying and targeting individual participants social deficits and maladaptive behaviors;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>Adaptive behavior treatment direction of a technician which is the clinical direction and oversight of a BCaBA, RBT, or a BT by a licensed psychologist or an LBA that:</text>
      <paragraph num="(a)">
        <text>Requires the licensed psychologist or the LBA to directly or remotely observe the BCaBA, RBT, or BT administering ABA services to the participant, group of participants, parent, or caregiver;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Is performed on an ongoing basis, equal to at least 10 percent of the amount of hours that the BCaBA, RBT, or BT is providing direct ABA services to the participant, or group of participants; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Is performed in person for at least 25 percent of the session time each month;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>Adaptive behavior treatment by protocol which is an in-person service provided to a participant by:</text>
      <paragraph num="(a)">
        <text>A licensed psychologist or an LBA; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A BCaBA, RBT, or BT under the direction of a licensed psychologist or an LBA utilizing a behavioral intervention designed in advance by the licensed psychologist or an LBA, who may or may not provide in-person or remote direction during the treatment; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>Adaptive behavior treatment planning which is an ongoing indirect service that:</text>
      <paragraph num="(a)">
        <text>Is performed by a licensed psychologist or an LBA; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Includes:</text>
        <paragraph num="(i)">
          <text>Development and revision of the treatment plan and goals;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Data analysis; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Real-time, direct communication and coordination with the participant's other service providers.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>ABA services shall only be provided by a licensed psychologist, LBA, BCaBA, RBT, or BT.</text>
  </paragraph>
  <paragraph num="D.">
    <text>ABA services shall be initially preauthorized for a period not to exceed 180 days.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Additional preauthorization beyond the initial preauthorization shall be requested every 180 days, in advance of the expiration of the previous preauthorization.</text>
  </paragraph>
  <paragraph num="F.">
    <text>The provider shall maintain documentation of each service delivered under the participant's treatment plan, which, at a minimum, includes:</text>
    <paragraph num="(1)">
      <text>The location, date, start time, and end time of the service;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A brief description of the service provided, including reference to the treatment plan;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A description of the participant's behaviors or symptoms in measurable terms;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A description of the participant’s parent or caregiver’s participation in the ABA treatment sessions, including the parent or the caregiver’s name and relationship to the participant, date, and time of participation or notification of the participant’s parent or caregiver’s consent to be absent; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A legible signature, along with the printed or typed name of the individual providing care, with the appropriate title.</text>
    </paragraph>
  </paragraph>
</regulation>