<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.34.04" title_num="10" subtitle_num="09" chapter_num="34" heading="Limitations.">
  <paragraph num="A.">
    <text>To be eligible for therapeutic behavioral services the:</text>
    <paragraph num="(1)">
      <text>Participant shall be younger than 21 years old and enrolled in the Program;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Participant shall be assessed as having behaviors or symptoms related to a mental health diagnosis that places the individual's current living arrangement at risk and creates a risk for a more restrictive placement, or prevents transition to a less restrictive placement;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Participant’s behaviors or symptoms shall be safely and effectively treated in the community; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Participant’s parent, guardian, or individual who customarily provides care shall be present during the provision of all therapeutic behavioral services to participate in the behavioral plan, unless there are clinical goals specifically addressed in the behavior plan that need to be achieved requiring that the parent, guardian, or individual who customarily provides care not be present.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Therapeutic behavioral services shall meet the definition of rehabilitation services.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Therapeutic behavioral services shall be:</text>
    <paragraph num="(1)">
      <text>Decreased proportionally when indicated by the participant’s progress;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Discontinued when the targeted outcomes have been reached; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Reassessed for new targeted outcomes if progress on the current outcomes is not being achieved.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>A therapeutic behavioral service 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>An intermediate care facility;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An institution for mental disease;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>A hospital; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>A crisis residential program;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Habilitative, custodial, or activities of daily living;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Not authorized by the Department or its designee;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Provided by a therapeutic behavioral aide who is a member of the participant’s immediate family or who resides in the participant’s home;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Not medically necessary;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Beyond the provider's scope of practice;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Not performed under the supervision of a licensed health care provider;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Rendered but not appropriately documented;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Part of another service paid for by the State; or</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Rendered by mail, telephone, or otherwise not one-to-one, in person;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Services that duplicate the care and custody provided by another State agency pursuant to a court order or a voluntary placement agreement;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Respite services;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Seclusion or restrictive techniques;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Completion of forms or reports;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Broken or missed appointments; or</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Travel to and from site of service.</text>
    </paragraph>
  </paragraph>
</regulation>