# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 28 — Applied Behavior Analysis Services

**Authority:** Health-General Article, §§2-104(b), 2-105(b), 15-103, and 15-105, Annotated Code of Maryland

**Administrative History:** Effective date: November 7, 2016 (43:22 Md. R. 1218)

**Administrative History:** Regulation .01B amended effective March 12, 2018 (45:5 Md. R. 285); June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049); December 11, 2023 (50:24 Md. R. 1041)

**Administrative History:** Regulation .02A amended effective December 12, 2022 (49:25 Md. R. 1049)

**Administrative History:** Regulation .02H, I amended effective June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049)

**Administrative History:** Regulation .02J adopted effective December 11, 2023 (50:24 Md. R. 1041)

**Administrative History:** Regulation .03B amended effective June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049)

**Administrative History:** Regulation .04 amended effective December 12, 2022 (49:25 Md. R. 1049)

**Administrative History:** Regulation .04B amended effective March 12, 2018 (45:5 Md. R. 285); June 17, 2019 (46:12 Md. R. 542); December 11, 2025 (52:24 Md. R. 1197

**Administrative History:** Regulation .04B, C amended effective December 11, 2023 (50:24 Md. R. 1041)

**Administrative History:** Regulation .05B, C amended effective March 12, 2018 (45:5 Md. R. 285)

**Administrative History:** Regulation .05D amended effective December 12, 2022 (49:25 Md. R. 1049)

**Administrative History:** Regulation .05F adopted effective March 12, 2018 (45:5 Md. R. 285)

**Administrative History:** Regulation .06 amended effective March 12, 2018 (45:5 Md. R. 285); December 11, 2023 (50:24 Md. R. 1041); December 11, 2025 (52:24 Md. R. 1197)

**Administrative History:** Regulation .06B amended effective December 12, 2022 (49:25 Md. R. 1049)

**Administrative History:** Regulation .06F amended effective June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049)

**Administrative History:** Regulation .06G adopted effective December 12, 2022 (49:25 Md. R. 1049)

#### Regulation .01 Definitions.

*COMAR 10.09.28.01*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) Applied Behavior Analysis (ABA).

    (a) “Applied behavior analysis (ABA)” means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvements in human behavior.

    (b) “Applied behavior analysis (ABA)” includes the direct observations, measurement, and functional analysis of the relations between environment and behavior.

  (2) “ABA program” means an association, partnership, corporation, or unincorporated group that includes:

    (a) A licensed psychologist or an LBA; and

    (b) A BCaBA, RBT, or a BT.

  (3) “Autism spectrum disorder (ASD)” means a group of developmental disorders:

    (a) Characterized by persistent deficits in social communication and social interaction across multiple contexts;

    (b) Characterized by restricted, repetitive patterns of behavior, interests, or activities; and

    (c) Whose symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

  (4) “Behavior Analyst Certification Board (BACB)” means the Board accredited by the National Commission for Certifying Agencies that credentials and certifies an LBA or BCaBA, or registers an RBT.

  (5) “Behavior technician (BT)” means a paraprofessional in the process of obtaining BACB certification who delivers ABA services that are provided to participants with ASD under the supervision of a licensed:

    (a) Psychologist;

    (b) BCBA-D; or

    (c) BCBA.

  (6) “Board certified assistant behavior analyst (BCaBA)” means a paraprofessional who:

    (a) Delivers ABA treatments that are provided to participants with ASD under the supervision of:

      (i) A licensed psychologist; or

      (ii) An LBA; and

    (b) Obtained a BACB certification.

  (7) “Board certified behavior analyst (BCBA)” means a licensed professional who:

    (a) Renders and provides direction for ABA services that are provided to participants with ASD; and

    (b) Obtained a BACB certification.

  (8) “Board certified behavior analyst-doctoral (BCBA-D)” means a licensed professional who:

    (a) Renders and provides direction for ABA treatments that are provided to participants with ASD; and

    (b) Obtained a BACB certification with a doctoral-level credential.

  (9) “Caregiver” means a willing and able individual who is trained in providing care to the participant.

  (10) “Comprehensive diagnostic evaluation” means an assessment performed by a qualified health care professional with the help of validated instruments, which includes:

    (a) A direct observation of the participant;

    (b) Interviews with the participant’s parent or caregiver;

    (c) Documentation of developmental history, psychosocial history, and current functioning across major domains of development; and

    (d) A confirmed diagnosis of Autism Spectrum Disorder (ASD).

  (11) “Custodial care” means care that is provided:

    (a) To assist in the activities of daily living, such as bathing, dressing, eating, and maintaining personal hygiene;

    (b) For maintaining the participant's safety; and

    (c) By individuals without professional skills or training.

  (12) “Department” means the Maryland Department of Health.

  (13) “Designee” means the entity designated by the Department to manage the public behavioral health system on behalf of the Department.

  (14) “Direction of a technician” means the in-person monitoring of a BCaBA, RBT, or BT, performed by a licensed psychologist or an LBA.

  (15) “Early and periodic screening, diagnosis, and treatment (EPSDT)” means the provision, to individuals younger than 21 years old, of preventive health care pursuant to 42 CFR §441.50 et seq., as amended, and other health care services, diagnostic services, and treatment services that are necessary to correct or ameliorate defects, physical and mental illnesses, and conditions discovered by EPSDT screening services.

  (16) “Family” means an adult who:

    (a) Lives with or provides care to the participant; and

    (b) Is not paid to provide the care.

  (17) “HIPAA” means the Health Insurance Portability and Accountability Act, a federal law enacted on August 21, 1996, whose purpose is to improve the efficiency and effectiveness of the health care system by standardizing the electronic exchange of administrative and financial data, provide security requirements for transmitted information, and protect the privacy of identifiable health information.

  (18) “Individualized education program (IEP)” means a written description of special education and related services to be implemented to meet the individual needs of a child pursuant to COMAR 13A.05.01.03B and 13A.05.01.09.

  (19) “Individualized family service plan (IFSP)” means a written plan for providing early intervention and other services to an eligible child and the child's family pursuant to COMAR 13A.13.01.03B.

  (20) “Intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF-IID)” means an institution licensed by the Department under COMAR 10.07.20 that provides health-related services or health rehabilitative services for individuals with intellectual disabilities or related conditions.

  (21) “Licensed behavior analyst (LBA)” means a licensed professional who is certified by the Behavior Analyst Certification Board (BACB) to be a:

    (a) BCBA; or

    (b) BCBA-D.

  (22) Maladaptive Behavior.

    (a) “Maladaptive behavior” means behavior that interferes with the participant's activities of daily living or ability to adjust or participate in particular settings.

    (b) “Maladaptive behavior” includes behaviors such as self-injurious behavior, aggression, tantrums, stereotypies, and rituals.

  (23) “Maryland Medical Assistance Program” means a program of comprehensive medical and other health-related care for indigent and medically indigent individuals, jointly financed by the federal and state governments and administered by states under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq., as amended.

  (24) “Medically necessary” means that the service or benefit is:

    (a) Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

    (b) Consistent with current accepted standards of good medical practice;

    (c) The most cost-efficient service that can be provided without sacrificing effectiveness or access to care; and

    (d) Not for the convenience of the participant, family, or provider.

  (25) “Medicare” means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq., as amended.

  (26) “Parent” means the adult representative of a participant and includes:

    (a) A biological or adoptive parent;

    (b) A legal guardian;

    (c) An individual acting in the place of a parent, such as a grandparent or stepparent with whom the participant lives, including those relatives or stepparents who are foster parents;

    (d) An individual appointed as the parent surrogate in accordance with Education Article, §8-412, Annotated Code of Maryland, for matters within the scope of the Individuals with Disabilities Education Act; or

    (e) Another individual responsible for a participant's welfare.

  (27) “Participant” means an eligible individual who is enrolled in the Program.

  (28) “Plan for generalization” means a component of the treatment plan whose goal is the expansion of a participant's performance ability beyond the initial conditions set for acquisition of a skill that can occur across people, places, and materials used for teaching.

  (29) “Preauthorized” means the approval required from the Department, or its designee, before a provider renders services in order to receive reimbursement for services.

  (30) “Program” means the Maryland Medical Assistance Program.

  (31) “Provider” means a person certified to provide ABA services to participants and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

  (32) “Psychologist” means an individual who is:

    (a) Licensed and legally authorized to practice psychology under Health Occupations Article, Title 18, Annotated Code of Maryland; or

    (b) Licensed and legally authorized to practice psychology in the state where the service is rendered.

  (33) “Qualified health care professional” means a developmental pediatrician, pediatrician, pediatric neurologist, child psychiatrist, clinical psychologist, neuropsychologist, or a nurse practitioner with training and experience to diagnose ASD.

  (34) “Registered behavior technician (RBT)” means a paraprofessional certified by the BACB who delivers ABA services that are provided to participants with ASD under the supervision of:

    (a) A licensed psychologist; or

    (b) An LBA.

  (35) “Remote access technology” means the use of HIPAA compliant technological methods to provide auditory and visual connection between a licensed psychologist or an LBA, who is not directly present, and a BCaBA, RBT, or BT when services are being provided at the participant’s home.

  (36) “Remote direction of a technician” means the monitoring of a BCaBA, RBT, or BT, who is physically with the participant, performed via synchronous two-way audio-visual remote access technology by a licensed psychologist or an LBA.

  (37) “Treatment plan” means an individualized written plan for ABA services which includes the components specified in Regulation .03 of this chapter..

#### Regulation .02 Provider Qualifications and Conditions for Participation.

*COMAR 10.09.28.02*

A. To participate in the Program, a provider shall:

  (1) Meet all conditions for participation as set forth in COMAR 10.09.36; and

  (2) If delivering services via telehealth, comply with COMAR 10.09.49 and any subregulatory guidance issued by the Department.

B. An ABA provider shall be licensed, certified, or otherwise legally authorized to provide ABA services in the jurisdiction in which the services are provided.

C. An ABA provider may not have current sanctions or current disciplinary actions imposed by:

  (1) The jurisdictional licensing or certification authority;

  (2) Medicare Program;

  (3) Maryland Medical Assistance Program; or

  (4) Other federally funded healthcare program.

D. An ABA provider shall have a completed Criminal Justice Information System's criminal background check.

E. A licensed psychologist who renders ABA services shall:

  (1) Be licensed by the Maryland Board of Examiners of Psychologists; and

  (2) Act within the licensee's scope of practice.

F. A BCBA-D provider who renders ABA services shall:

  (1) Be licensed by the Maryland Board of Professional Counselors and Therapists; and

  (2) Have a current certification of BCBA-D by the BACB.

G. A BCBA provider who renders ABA services shall:

  (1) Be licensed by the Maryland Board of Professional Counselors and Therapists; and

  (2) Have a current certification of BCBA by the BACB.

H. A BCaBA provider who renders ABA services shall:

  (1) Have a current certification of BCaBA by the BACB;

  (2) Work under the direction of:

    (a) A licensed psychologist; or

    (b) An LBA; and

  (3) Have the supervisory relationship documented in writing.

I. An RBT provider who renders ABA services shall:

  (1) Be 18 years old or older;

  (2) Be currently registered by the BACB;

  (3) Have a high school degree or national equivalent;

  (4) Work under the direction of:

    (a) A licensed psychologist; or

    (b) An LBA; and

  (5) Have the supervisory relationship documented in writing.

J. A BT provider who renders ABA services shall:

  (1) Be 18 years old or older;

  (2) Obtain BACB registration within 90 days of enrollment with Maryland Medicaid;

  (3) Have a high school degree or national equivalent;

  (4) Work under the direction of:

    (a) A licensed psychologist; or

    (b) An LBA; and

  (5) Have the supervisory relationship documented in writing.

#### Regulation .03 Participant Eligibility.

*COMAR 10.09.28.03*

A. A participant shall meet the eligibility conditions set forth in §B of this regulation.

B. To qualify for ABA services, a participant shall:

  (1) Be younger than 21 years old;

  (2) Live in the community;

  (3) Be diagnosed with an ASD by a qualified health care professional;

  (4) Exhibit the presence of maladaptive behavior or developmental skills deficits that significantly interferes with home, school, or community activities;

  (5) Be medically stable and not require 24-hour medical or nursing monitoring or procedures provided in a hospital or an ICF-IID;

  (6) Have a comprehensive diagnostic evaluation by a qualified health care professional;

  (7) Be referred for ABA services by a licensed health care professional; and

  (8) Have a completed ABA treatment plan that shall:

    (a) Be participant-centered and family-centered, culturally competent, and based on individualized goals;

    (b) Consider the participant's age, school attendance requirements, and other daily activities;

    (c) Be developed by:

      (i) A licensed psychologist; or

      (ii) An LBA;

    (d) Ensure that the interventions are consistent with ABA techniques;

    (e) Delineate both the frequency of baseline targeted behaviors and the behavior intervention plan to address the behaviors;

    (f) Identify long-term goals, short-term goals, and objectives that:

      (i) Are behaviorally defined;

      (ii) Are customized to the participant;

      (iii) Are measurable; and

      (iv) Are based upon clinical observations;

    (g) Identify the methods that will be used to measure achievement of behavior goals, objectives, and estimated timeframes;

    (h) Identify the schedule of services planned, including number of hours per week and the providers responsible for delivering the services;

    (i) Include:

      (i) Care coordination involving the participant's parent or caregiver and other professionals as applicable;

      (ii) Support and training of the participant's parent or caregiver;

      (iii) A plan for generalization; and

      (iv) Measurable discharge criteria.

#### Regulation .04 Covered Services.

*COMAR 10.09.28.04*

A. The Program covers the ABA services set forth in §B of this regulation when the services are:

  (1) Medically necessary;

  (2) Preauthorized by the Program or its designee;

  (3) Delivered in accordance with the participant's treatment plan; and

  (4) Supported by documentation of consent to treatment from the participant or the participant’s parent or guardian.

B. The Program covers the following ABA services:

  (1) An ABA assessment, which is a behavior identification assessment that:

    (a) Is administered in person with a participant and the participant's parent or caregiver by:

      (i) A licensed psychologist; or

      (ii) An LBA;

    (b) Addresses the behavioral needs for ABA services; and

    (c) Includes:

      (i) An interview, direct observation, record review, data collection, and analysis;

      (ii) An assessment of the participant's current level of functioning, skills deficits, and maladaptive behaviors using validated instruments;

      (iii) Analysis of past data;

      (iv) Scoring and interpreting the assessment;

      (v) Preparing the treatment plan and report; and

      (vi) Discussion of the findings;

  (2) A behavior identification supporting assessment which is a follow-up assessment that is administered:

    (a) In person, by an RBT, BT, or BCaBA, with a participant present; and

    (b) Under the direction of a licensed psychologist or an LBA;

  (3) An exposure behavior identification supporting assessment which is a follow-up assessment that:

    (a) Is conducted on a participant with specific, severe destructive behaviors in a structured, safe environment;

    (b) Is administered in person by a licensed psychologist or an LBA with the assistance of two or more BCaBAs, RBTs, or BTs;

    (c) Exposes the participant to a customized series of social and environmental conditions associated with the destructive behaviors; and

    (d) Uses structured testing to examine events, cues, responses, and consequences associated with the behaviors;

  (4) An adaptive behavior treatment with protocol modification which is an in-person service that:

    (a) Is conducted on a participant with specific, severe destructive behaviors in an environment that is:

      (i) Customized;

      (ii) Structured; and

      (iii) Safe;

    (b) Is administered in-person by a licensed psychologist or an LBA with the assistance of two or more BCaBAs, RBTs, or BTs;

    (c) Includes in-person direction of two or more technicians eliciting behavioral effects or exposing the participant to specific environmental conditions and treatment; and

    (d) Refines and modifies ineffective components of the treatment;

  (5) Group adaptive behavior treatment by protocol which is an in-person service provided to a group of two or more participants by:

    (a) A licensed psychologist;

    (b) An LBA; or

    (c) 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;

  (6) Multiple-family group adaptive behavior treatment guidance that:

    (a) Is provided in person with parents or caregivers of multiple participants without the presence of the participants by:

      (i) A licensed psychologist; or

      (ii) An LBA;

    (b) Identifies maladaptive behaviors and skills deficits;

    (c) Instructs parents or caregivers on how to utilize ABA treatments to reduce maladaptive behaviors and skill deficits; and

    (d) Is performed in person for at least 25 percent of the session time each month;

  (7) Family adaptive behavior treatment guidance which:

    (a) Is provided in person or remotely with a participant’s parent or caregiver, with or without the presence of the participant by:

      (i) A licensed psychologist;

      (ii) An LBA; or

      (iii) A BCaBA;

    (b) Identifies maladaptive behaviors and skills deficits;

    (c) Instructs the parent or caregiver on how to utilize ABA strategies to reduce maladaptive behaviors and skill deficits; and

    (d) Is performed in person for at least 25 percent of the session time each month;

  (8) A behavior identification reassessment which is a follow-up assessment that:

    (a) Is performed in person with a participant and a participant's parent or caregiver every 180 days by:

      (i) A licensed psychologist; or

      (ii) An LBA;

    (b) Evaluates the progress toward each behavior treatment goal using objective, quantifiable measures and includes the results of validated instruments;

    (c) Includes a revision of the treatment plan based on progress; and

    (d) Includes a clinical recommendation as to whether ABA services continue to be medically necessary;

  (9) Group adaptive behavior treatment with protocol modification which is a service that is:

    (a) Provided in person to multiple participants by:

      (i) A licensed psychologist; or

      (ii) An LBA;

    (b) Focused on social skills training; and

    (c) Aimed at identifying and targeting individual participants social deficits and maladaptive behaviors;

  (10) 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:

    (a) 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;

    (b) 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

    (c) Is performed in person for at least 25 percent of the session time each month;

  (11) Adaptive behavior treatment by protocol which is an in-person service provided to a participant by:

    (a) A licensed psychologist or an LBA; or

    (b) 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

  (12) Adaptive behavior treatment planning which is an ongoing indirect service that:

    (a) Is performed by a licensed psychologist or an LBA; and

    (b) Includes:

      (i) Development and revision of the treatment plan and goals;

      (ii) Data analysis; and

      (iii) Real-time, direct communication and coordination with the participant's other service providers.

C. ABA services shall only be provided by a licensed psychologist, LBA, BCaBA, RBT, or BT.

D. ABA services shall be initially preauthorized for a period not to exceed 180 days.

E. Additional preauthorization beyond the initial preauthorization shall be requested every 180 days, in advance of the expiration of the previous preauthorization.

F. The provider shall maintain documentation of each service delivered under the participant's treatment plan, which, at a minimum, includes:

  (1) The location, date, start time, and end time of the service;

  (2) A brief description of the service provided, including reference to the treatment plan;

  (3) A description of the participant's behaviors or symptoms in measurable terms;

  (4) 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

  (5) A legible signature, along with the printed or typed name of the individual providing care, with the appropriate title.

#### Regulation .05 Limitations.

*COMAR 10.09.28.05*

A. ABA services are only available to participants under the EPSDT program.

B. ABA services shall be delivered in a home or community setting, including a clinic, when medically necessary.

C. The provider may not bill the Program for:

  (1) Services that are:

    (a) Provided in:

      (i) A hospital;

      (ii) An institution for mental disease;

      (iii) An ICF-IID;

      (iv) A crisis residential program;

      (v) A residential treatment center;

      (vi) A 24-hour, 365-day residential program funded with federal, State, or local government funds; or

      (vii) Nonconventional settings, including but not limited to resorts, spas, and camps;

    (b) Rendered when measurable functional improvement or continued clinical benefit is not met, and treatment is not deemed necessary;

    (c) Not preauthorized by the Department or its designee;

    (d) Beyond the provider's scope of practice;

    (e) Rendered but not documented in accordance to Regulation .04 of this chapter;

    (f) Rendered by mail or telephone;

  (2) Services whose purpose is vocationally based or recreationally based;

  (3) Respite services;

  (4) Custodial care;

  (5) Completion of forms and reports;

  (6) Broken or missed appointments;

  (7) Travel to and from site of service; and

  (8) Services which duplicate a service that a participant is receiving under another medical care program.

D. The participant’s parent or caregiver shall be trained to reinforce ABA services for the participant in a clinically effective manner.

E. Services shall be discontinued if no longer medically necessary because:

  (1) Long-term treatment goals and objectives are achieved; or

  (2) Participant is not demonstrating progress towards treatment goals and objectives and measurable functional improvement is no longer expected.

F. The provider shall obtain approval by the Department or its designee for remote supervision.

#### Regulation .06 Payment Procedures.

*COMAR 10.09.28.06*

A. The provider shall follow all procedures in accordance with COMAR 10.09.36.

B. The Program shall provide fee-for-service reimbursement for covered ABA services to the following ABA providers who meet the conditions for participation set forth in Regulation .02 of this chapter:

  (1) ABA program;

  (2) Individual licensed psychologist; and

  (3) Individual LBA.

C. Reimbursement for ABA services may not be made directly to a BCaBA, RBT, or BT rendering ABA services.

D. Reimbursement for ABA services may not be made to, or on behalf of services rendered by, the participant's parent or caregiver.

E. The Program shall pay for covered services:

  (1) At the lesser of the provider's customary charge to the general public unless the services are free to the individuals not covered by Medicaid; or

  (2) In accordance with COMAR 10.09.36.06.

F. Effective July 1, 2022 through June 30, 2023, reimbursement for ABA services covered under this chapter is as follows:

  (1) Behavior identification assessment at a rate of $33.46 per 15 minutes;

  (2) Behavior identification assessment follow-up at a rate of $16.73 per 15 minutes;

  (3) Exposure behavior identification supporting assessment at a rate of $45.63 per 15 minutes;

  (4) Adaptive exposure behavior treatment with protocol modification at a rate of $45.63 per 15 minutes;

  (5) Group adaptive behavior treatment by protocol at a rate of:

    (a) $9.13 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

    (b) $7.30 per 15 minutes, per participant, when provided by a BCaBA; and

    (c) $6.08 per 15 minutes, per participant, when provided by an RBT or BT;

  (6) Adaptive behavior treatment with protocol modification at a rate of $33.46 per 15 minutes;

  (7) Multiple-family group adaptive behavior treatment guidance at a rate of $11.26 per 15 minutes per family;

  (8) Family adaptive behavior treatment guidance with the participant present at a rate of:

    (a) $33.46 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $18.25 per 15 minutes when provided by a BCaBA;

  (9) Family adaptive behavior treatment guidance without the participant present at a rate of:

    (a) $18.25 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $10.65 per 15 minutes when provided by a BCaBA;

  (10) Behavior identification reassessment at a rate of $33.46 per 15 minutes;

  (11) Group adaptive treatment with protocol modification at a rate of $9.13 per 15 minutes per participant;

  (12) Adaptive behavior treatment direction at a rate of $33.46 per 15 minutes;

  (13) Adaptive behavior treatment by protocol at a rate of:

    (a) $21.30 per 15 minutes when provided by a licensed psychologist or an LBA;

    (b) $18.25 per 15 minutes when provided by a BCaBA; and

    (c) $16.73 per 15 minutes when provided by an RBT or BT; and

  (14) Adaptive behavior treatment planning:

    (a) At a rate of $33.46 per 15 minutes; and

    (b) For a maximum of 4 hours per month.

G. Effective July 1, 2023 through December 31, 2023, reimbursement for ABA services covered under this chapter is as follows:

  (1) Behavior identification assessment at a rate of $34.46 per 15 minutes;

  (2) Behavior identification assessment follow-up at a rate of $17.23 per 15 minutes;

  (3) Exposure behavior identification supporting assessment at a rate of $47.00 per 15 minutes;

  (4) Adaptive exposure behavior treatment with protocol modification at a rate of $47.00 per 15 minutes;

  (5) Group adaptive behavior treatment by protocol at a rate of:

    (a) $9.40 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

    (b) $7.52 per 15 minutes, per participant, when provided by a BCaBA; and

    (c) $6.26 per 15 minutes, per participant, when provided by an RBT or BT;

  (6) Adaptive behavior treatment with protocol modification at a rate of $33.46 per 15 minutes;

  (7) Multiple-family group adaptive behavior treatment guidance at a rate of $11.60 per 15 minutes per family;

  (8) Family adaptive behavior treatment guidance with the participant present at a rate of:

    (a) $34.46 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $18.80 per 15 minutes when provided by a BCaBA;

  (9) Family adaptive behavior treatment guidance without the participant present at a rate of:

    (a) $18.80 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $10.97 per 15 minutes when provided by a BCaBA;

  (10) Behavior identification reassessment at a rate of $34.46 per 15 minutes;

  (11) Group adaptive treatment with protocol modification at a rate of $9.40 per 15 minutes per participant;

  (12) Adaptive behavior treatment direction at a rate of $34.46 per 15 minutes;

  (13) Adaptive behavior treatment by protocol at a rate of:

    (a) $21.94 per 15 minutes when provided by a licensed psychologist or an LBA;

    (b) $18.80 per 15 minutes when provided by a BCaBA; and

    (c) $17.23 per 15 minutes when provided by an RBT or BT; and

  (14) Adaptive behavior treatment planning:

    (a) At a rate of $34.46 per 15 minutes; and

    (b) For a maximum of 4 hours per month.

H. Effective January 1, 2024 through June 30, 2024, reimbursement for ABA services covered under this chapter is as follows:

  (1) Behavior identification assessment at a rate of $37.22 per 15 minutes;

  (2) Behavior identification assessment follow-up at a rate of $18.61 per 15 minutes;

  (3) Exposure behavior identification supporting assessment at a rate of $50.76 per 15 minutes;

  (4) Adaptive exposure behavior treatment with protocol modification at a rate of $50.76 per 15 minutes;

  (5) Group adaptive behavior treatment by protocol at a rate of:

    (a) $10.15 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

    (b) $8.12 per 15 minutes, per participant, when provided by a BCaBA; and

    (c) $6.76 per 15 minutes, per participant, when provided by an RBT or BT;

  (6) Adaptive behavior treatment with protocol modification at a rate of $37.22 per 15 minutes;

  (7) Multiple-family group adaptive behavior treatment guidance at a rate of $12.53 per 15 minutes per family;

  (8) Family adaptive behavior treatment guidance with the participant present at a rate of:

    (a) $37.22 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $20.30 per 15 minutes when provided by a BCaBA;

  (9) Family adaptive behavior treatment guidance without the participant present at a rate of:

    (a) $20.30 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $11.85 per 15 minutes when provided by a BCaBA;

  (10) Behavior identification reassessment at a rate of $37.22 per 15 minutes;

  (11) Group adaptive treatment with protocol modification at a rate of $10.15 per 15 minutes per participant;

  (12) Adaptive behavior treatment direction at a rate of $37.22 per 15 minutes;

  (13) Adaptive behavior treatment by protocol at a rate of:

    (a) $23.70 per 15 minutes when provided by a licensed psychologist or an LBA;

    (b) $20.30 per 15 minutes when provided by a BCaBA; and

    (c) $18.61 per 15 minutes when provided by an RBT or BT; and

  (14) Adaptive behavior treatment planning:

    (a) At a rate of $37.22 per 15 minutes; and

    (b) For a maximum of 4 hours per month.

I. Effective July 1, 2024, reimbursement for ABA services covered under this chapter is as follows:

  (1) Behavior identification assessment at a rate of $38.34 per 15 minutes;

  (2) Behavior identification assessment follow-up at a rate of $19.17 per 15 minutes;

  (3) Exposure behavior identification supporting assessment at a rate of $52.28 per 15 minutes;

  (4) Adaptive exposure behavior treatment with protocol modification at a rate of $52.28 per 15 minutes;

  (5) Group adaptive behavior treatment by protocol at a rate of:

    (a) $10.45 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

    (b) $8.36 per 15 minutes, per participant, when provided by a BCaBA; and

    (c) $6.96 per 15 minutes, per participant, when provided by an RBT or BT;

  (6) Adaptive behavior treatment with protocol modification at a rate of $38.34 per 15 minutes;

  (7) Multiple-family group adaptive behavior treatment guidance at a rate of $12.91 per 15 minutes per family;

  (8) Family adaptive behavior treatment guidance with the participant present at a rate of:

    (a) $38.34 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $20.91 per 15 minutes when provided by a BCaBA;

  (9) Family adaptive behavior treatment guidance without the participant present at a rate of:

    (a) $20.91 per 15 minutes when provided by a licensed psychologist or an LBA; and

    (b) $12.21 per 15 minutes when provided by a BCaBA;

  (10) Behavior identification reassessment at a rate of $38.34 per 15 minutes;

  (11) Group adaptive treatment with protocol modification at a rate of $10.45 per 15 minutes per participant;

  (12) Adaptive behavior treatment direction at a rate of $38.34 per 15 minutes;

  (13) Adaptive behavior treatment by protocol at a rate of:

    (a) $24.41 per 15 minutes when provided by a licensed psychologist or an LBA;

    (b) $20.91 per 15 minutes when provided by a BCaBA; and

    (c) $19.17 per 15 minutes when provided by an RBT or BT; and

  (14) Adaptive behavior treatment planning:

    (a) At a rate of $38.34 per 15 minutes; and

    (b) For a maximum of 4 hours per month.

#### Regulation .07 Recovery and Reimbursement.

*COMAR 10.09.28.07*

Recovery and reimbursement are as set forth in COMAR 10.09.36.07.

#### Regulation .08 Cause for Suspension or Removal and Imposition of Sanctions.

*COMAR 10.09.28.08*

Causes for suspension or removal and imposition of sanctions shall be as set forth in COMAR 10.09.36.08.

#### Regulation .09 Appeals Procedures.

*COMAR 10.09.28.09*

Appeal procedures are as set forth in COMAR 10.09.36.09.

#### Regulation .10 Interpretive Regulation.

*COMAR 10.09.28.10*

This chapter shall be interpreted as set forth in COMAR 10.09.36.10.