<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.28.05" title_num="10" subtitle_num="09" chapter_num="28" heading="Limitations.">
  <paragraph num="A.">
    <text>ABA services are only available to participants under the EPSDT program.</text>
  </paragraph>
  <paragraph num="B.">
    <text>ABA services shall be delivered in a home or community setting, including a clinic, when medically necessary.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The provider may not bill the Program for:</text>
    <paragraph num="(1)">
      <text>Services that are:</text>
      <paragraph num="(a)">
        <text>Provided in:</text>
        <paragraph num="(i)">
          <text>A hospital;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An institution for mental disease;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>An ICF-IID;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>A crisis residential program;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>A residential treatment center;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>A 24-hour, 365-day residential program funded with federal, State, or local government funds; or</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Nonconventional settings, including but not limited to resorts, spas, and camps;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Rendered when measurable functional improvement or continued clinical benefit is not met, and treatment is not deemed necessary;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Not preauthorized by the Department or its designee;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Beyond the provider's scope of practice;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Rendered but not documented in accordance to Regulation .04 of this chapter;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Rendered by mail or telephone;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Services whose purpose is vocationally based or recreationally based;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Respite services;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Custodial care;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Completion of forms and reports;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Broken or missed appointments;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Travel to and from site of service; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Services which duplicate a service that a participant is receiving under another medical care program.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The participant’s parent or caregiver shall be trained to reinforce ABA services for the participant in a clinically effective manner.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Services shall be discontinued if no longer medically necessary because:</text>
    <paragraph num="(1)">
      <text>Long-term treatment goals and objectives are achieved; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Participant is not demonstrating progress towards treatment goals and objectives and measurable functional improvement is no longer expected.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The provider shall obtain approval by the Department or its designee for remote supervision.</text>
  </paragraph>
</regulation>