# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 34 — Therapeutic Behavioral Services

#### Regulation .03 Covered Services.

*COMAR 10.09.34.03*

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.