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<regulation prefix="Regulation" num=".01" citation="COMAR 10.09.34.01" title_num="10" subtitle_num="09" chapter_num="34" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Behavioral plan” means an individualized written plan for therapeutic behavioral services which includes the components specified in Regulation .03B(1) of this chapter.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Department” means the Maryland Department of Health, the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396(a)—(v).</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) provider” means any health care provider acting within the scope of the provider's practice who:</text>
      <paragraph num="(a)">
        <text>Screens, evaluates, or identifies a condition; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Recommends treatment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>“Medically necessary” means that the service or benefit is:</text>
      <paragraph num="(a)">
        <text>Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Consistent with current accepted standards of good medical practice;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Not primarily for the convenience of the consumer, family, or provider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>“Participant” means an individual who is certified as eligible for and is receiving Medical Assistance benefits.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“Preauthorization” means the approval required from the Department, or its designee, before services may be rendered.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“Prescribed” means ordered in writing and signed by an EPSDT provider who has examined the participant and diagnosed the [recipient's] participant’s medical condition.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“Program” means the Maryland Medical Assistance Program.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Rehabilitative service” means a medical or remedial service prescribed by a licensed physician or authorized practitioner under Health Occupations Article, Annotated Code of Maryland, or the jurisdiction where services are rendered for:</text>
      <paragraph num="(a)">
        <text>Maximum reduction of physical or mental disability; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Restoration of a participant’s best possible functional level.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>“Therapeutic behavioral aide” means an individual who is:</text>
      <paragraph num="(a)">
        <text>A health care professional or a nonprofessional who is supervised by an individual who is licensed, certified, or otherwise legally authorized to provide mental health services independently in the state where the service is rendered;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Trained and supervised by a therapeutic behavioral service provider to implement a behavior plan; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Available on-site to provide one-to-one behavioral assistance and intervention to accomplish outcomes specified in the behavioral plan.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>“Therapeutic behavioral assessment” means a comprehensive assessment of a participant and, if applicable, a participant’s family that:</text>
      <paragraph num="(a)">
        <text>Is performed by a licensed or certified health care professional;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Addresses the medical and behavioral needs for therapeutic behavioral services;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Includes the risk of needing placement in a more restrictive living arrangement because of the behavior; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Includes development of a behavioral plan.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>“Therapeutic behavioral service” means an intensive, rehabilitative service that is documented in the written behavioral plan and is intended to:</text>
      <paragraph num="(a)">
        <text>Provide the participant with behavioral management skills to effectively manage the behaviors or symptoms that place the participant at risk for a higher level of care; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Restore the participant’s previously acquired behavior skills and enable the participant to develop appropriate behavior management skills.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(13)">
      <text>“Therapeutic behavioral service provider” means:</text>
      <paragraph num="(a)">
        <text>A Developmental Disabilities Administration provider meeting criteria set forth in COMAR 10.22.02;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An outpatient mental health clinic approved under COMAR 10.21.20;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A mental health mobile treatment unit meeting criteria set forth in COMAR 10.09.59; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A psychiatric rehabilitation program approved under COMAR 10.21.29.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>