Chapter 50. EPSDT School Health-Related Services or Health-Related Early Intervention Services
Regulation .01 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Audiological evaluation” means identification, evaluation, and treatment of auditory impairments necessary to develop and implement an IFSP or an IEP pursuant to COMAR 13A.13.01.03B and 13A.05.01.03B.
(2)
“Audiologist” means an individual licensed by the Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech Language Pathologists to practice audiology in Maryland.
(3)
“Audiology service” means treatment of auditory impairments necessary to develop and implement an IFSP or an IEP pursuant to COMAR 13A.13.01.03B and 13A.05.01.03B.
(4)
“Dietitian-Nutritionist” means an individual who is licensed as a dietitian-nutritionist by the Maryland State Board of Dietetic Practice to practice dietetics in Maryland.
(5)
“Aversive technique” means the use of painful or noxious stimuli to the body, which is intrusive to the individual's physical, mental, or emotional well-being, used to terminate challenging or maladaptive behavior.
(6)
“Child's family” means those individuals with whom a participant resides, who are responsible for the participant, and who are the primary nurturing caregivers.
(7)
“Crisis intervention services” means the therapeutic response that provides immediate care or referral for an individual with an urgent mental health need.
(8)
“Department” means the Maryland Department of Health as defined in COMAR 10.09.36.01.
(9)
“Early intervention services (EIS)” means services which are consistent with COMAR 13A.13.01.03B.
(10)
“Individualized education program (IEP)” means a written description of special education and related services developed by an IEP team to be implemented to meet the individual needs of a child pursuant to COMAR 13A.05.01.03B and 13A.05.01.09.
(11)
“IEP team” means a group convened and conducted by a provider to develop a participant’s IEP, which is composed of a child’s parent or parents, the child’s teacher, and relevant service providers as indicated in COMAR 13A.05.01.03B and 13A.05.01.07.
(12)
“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 developed by an IFSP team pursuant to COMAR 13A.13.01.03B.
(13)
“IFSP team” means a group convened and conducted by a provider to develop a participant’s IFSP, which is composed of a child’s parent or parents, the child’s service coordinator, and relevant service providers as indicated in COMAR 13A.13.01.06.
(14)
“Infants and toddlers with disabilities” means children from birth to the beginning of the school year following the child’s 4th birthday who are eligible for early intervention services, as described in COMAR 13A.13.01.03B and documented by appropriate licensed personnel as defined in COMAR 13A.13.01.03B.
(15)
“Jurisdiction” means a state or the District of Columbia.
(16)
“Local School System (LSS)” means any of the 24 public school systems in Maryland responsible for providing public elementary or secondary education.
(17)
“Local lead agency” means the agency designated by the local governing authority in each county and Baltimore City to administer the interagency system of early intervention services under the direction of the State Department of Education in accordance with Education Article, §8-416, Annotated Code of Maryland.
(18)
“Maladaptive behavior” means behavior that is:
(a)
Harmful to oneself or others;
(b)
Developmentally inappropriate; and
(c)
Disruptive or dangerous.
(19)
“Maryland State Department of Education” has the meaning stated in COMAR 13A.01.03.
(20)
“Medical Assistance Program” has the meaning stated in COMAR 10.09.36.01.
(21)
“Mental health professional” has the meaning stated in COMAR 10.21.17.02B.
(22)
“Nurse” means an individual who is licensed to practice as a registered nurse (RN) or licensed practical nurse (LPN) in the jurisdiction in which services are provided.
(23)
“Nursing care plan” means a plan developed by a registered nurse that identifies the patient’s diagnoses and needs, the goals to be achieved, and the interventions required to meet the patient’s medical condition as defined in COMAR 10.09.53.01B.
(24)
Nursing Services.
(a)
“Nursing services” means skilled nursing services performed by a licensed nurse for a participant, which are necessary for the participant to benefit from educational or early intervention services pursuant to COMAR 13A.05.01.03B and 13A.13.01.03B.
(b)
“Nursing services” includes an initial assessment.
(c)
“Nursing services” does not include:
(i)
Routine assessments of recipients whose medical condition is stable, unless the assessment leads to an intervention or change in the nursing care plan;
(ii)
Administration of medications;
(iii)
Supervision of interventions which the child is able to perform independently;
(iv)
Health screens;
(v)
Health education, except one-on-one training regarding self-management of the child's medical condition;
(vi)
First aid interventions;
(vii)
Services not directly related to the nursing care plan; and
(viii)
Services not deemed medically necessary at the initial assessment or the most recent nursing care plan review.
(25)
Nutrition Services.
(a)
“Nutrition services” means services delivered by a licensed dietitian nutritionist.
(b)
“Nutrition services” includes:
(i)
Nutrition assessments and evaluations;
(ii)
Developing and monitoring appropriate plans to address the nutritional needs of eligible children; and
(iii)
Making referrals to appropriate community resources to carry out nutrition goals in an IFSP pursuant to COMAR 13A.13.01.03B.
(26)
“Occupational therapist” means an individual licensed by the Maryland State Board of Occupational Therapy Practice to practice occupational therapy in Maryland.
(27)
“Occupational therapy assistant” means an individual licensed by the Maryland State Board of Occupational Therapy Practice to practice limited occupational therapy in Maryland.
(28)
“Occupational therapy services” means occupational therapy evaluations or treatments delivered by a licensed occupational therapist, or treatments delivered by a licensed occupational therapy assistant, which are necessary to develop and implement an IEP or an IFSP pursuant to COMAR 13A.05.01.03B and 13A.13.01.03B.
(29)
“Parent” means the parent of a child and includes:
(a)
A biological or adoptive parent;
(b)
A legal guardian;
(c)
Another person responsible for a child's welfare; or
(d)
A parent surrogate for those cases when:
(i)
A public agency, after reasonable efforts, cannot discover the whereabouts of a biological or adoptive parent,
(ii)
An individual cannot be identified with responsibility for a child's welfare, or
(iii)
A child is a ward of the State.
(30)
“Participant” means a Medical Assistance recipient who is eligible for and receives school-based health-related services.
(31)
“Physical therapist” means an individual licensed by the Maryland Board of Physical Therapy Examiners to practice physical therapy in Maryland.
(32)
“Physical therapist assistant” means an individual licensed by the Maryland Board of Physical Therapy Examiners to practice limited physical therapy in Maryland.
(33)
“Physical therapy services” means physical therapy evaluations or treatments, delivered by a licensed physical therapist, or treatments delivered by a licensed physical therapy assistant, which are necessary to develop and implement an IEP or an IFSP pursuant to COMAR 13A.05.01.03B and 13A.13.01.03B.
(34)
“Program” means the Medical Assistance Program as defined in COMAR 10.09.36.01.
(35)
“Provider” means a local school system, local lead agency, State-operated education agency, or State-supported education agency which meets the conditions for participation as defined in Regulation .03 of this chapter to provide school-based health-related services.
(36)
“Psychological services” means the delivery of services by a qualified licensed mental health professional, including administering psychological and developmental tests and other assessment procedures, interpreting assessment results, obtaining, integrating, and interpreting information about child behavior and child and family conditions related to learning, mental health, and development, and planning and managing a program of psychological services including psychological counseling for children and families.
(37)
“Rehabilitative service” means the medical or remedial service recommended by a licensed physician or authorized practitioner under Health Occupations Article, Annotated Code of Maryland within the scope of the practice under §B(36) of this regulation, for the reduction of maladaptive behavior and restoration of a recipient to the best possible functional level.
(38)
“School psychologist” means an individual certified by the Maryland State Department of Education to provide psychological services in a school-based setting.
(39)
“Special health needs” means those temporary or long-term health problems arising from physical, emotional, or social factors, or any combination of these.
(40)
“Speech-language pathologist” means an individual licensed by the State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists to practice speech language pathology in Maryland.
(41)
“Speech-language pathology assistant” means an individual licensed by the State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists to assist in the practice of speech language pathology in Maryland.
(42)
“Speech-language pathology” means speech language evaluations, diagnoses or treatments delivered by a licensed speech-language pathologist, or treatments delivered by a licensed speech-language pathology assistant, which are necessary to develop and implement an IEP or an IFSP pursuant to COMAR 13A.05.01.03B and 13A.13.01.03B.
(43)
“Therapeutic behavioral aide” means an individual who has been trained to implement a behavior plan as specified in the IEP or IFSP under the supervision of a licensed physician or authorized practitioner pursuant to Health Occupations Article, Annotated Code of Maryland.
(44)
“Therapeutic behavioral service” means a one-to-one individualized rehabilitative service, rendered by a therapeutic behavioral aide, using appropriate methods of preventing or decreasing maladaptive behaviors for a Medicaid recipient who is eligible for and receives health-related services in an IEP or health-related early intervention services in an IFSP.
Regulation .02 Licensure and Certification.LinkCopy Citation
A.
A provider shall ensure that the provider's employees who render school health-related services meet the licensure or certification requirements for their profession, as specified in §B of this regulation.
B.
A professional employed by a provider shall have the following qualifications:
(1)
An audiologist shall be licensed to practice in the jurisdiction in which services are provided;
(2)
A professional counselor shall be licensed to practice in accordance with Health Occupations Article, Title 17, Annotated Code of Maryland, in the jurisdiction in which services are provided;
(3)
A nurse shall be a registered nurse or a practical nurse licensed to practice in the jurisdiction in which services are provided:
(4)
A nurse psychotherapist shall be licensed to practice in the jurisdiction in which services are provided;
(5)
A dietitian-nutritionist shall be licensed to practice in the jurisdiction in which services are provided;
(6)
An occupational therapist shall be licensed to practice in the jurisdiction in which services are provided;
(7)
An occupational therapy assistant shall be licensed to practice in the jurisdiction in which services are provided under the direction of a licensed occupational therapist;
(8)
A physical therapist shall be licensed to practice in the jurisdiction in which services are provided;
(9)
A physical therapy assistant shall be licensed to practice in the jurisdiction in which services are provided under the direction of a licensed physical therapist;
(10)
A psychiatrist shall be a physician licensed to practice in the jurisdiction in which services are provided who is certified by the American Board of Psychiatry and Neurology or who has completed the minimum educational and training requirements to take the Board examination;
(11)
A psychologist shall be licensed to practice in the jurisdiction in which services are provided;
(12)
A school psychologist shall be certified in accordance with COMAR 13A.12.04.09 to practice in the jurisdiction in which services are provided;
(13)
A social worker shall be licensed as:
(a)
A master social worker in accordance with COMAR 10.42.01.04 to practice in the jurisdiction in which services are provided;
(b)
A certified social worker in accordance with COMAR 10.42.01.04 to practice in the jurisdiction in which services are provided; or
(c)
A certified social worker-clinical in accordance with COMAR 10.42.01.04 to practice in the jurisdiction in which services are provided;
(14)
A speech language pathologist shall be licensed to practice in the jurisdiction in which services are provided;
(15)
A speech language pathology assistant shall be licensed to practice in the jurisdiction in which services are provided under the supervision of a licensed speech language pathologist; and
(16)
A therapeutic behavioral provider shall be approved by the Department in accordance with COMAR 10.09.50.05A.
Regulation .03 Conditions for Participation.LinkCopy Citation
A.
General requirements for participation in EPSDT school health-related or health-related early intervention services are that a:
(1)
Provider shall:
(a)
Meet all the requirements for participation in the Program as set forth in COMAR 10.09.36.03; and
(b)
Collaborate in the provision of covered services with local health departments in accordance with Education Article, §7-401, Annotated Code of Maryland; and
(2)
Therapeutic behavioral aide shall be:
(a)
Trained in the principles of behavioral management and appropriate methods of preventing or decreasing maladaptive behaviors relevant to the recipient's behavioral needs; and
(b)
Supervised by a licensed physician or an authorized practitioner under Health Occupations Article, Annotated Code of Maryland.
B.
Specific requirements for participation in the Program require that the provider maintain adequate documentation of all services provided, which at a minimum, includes:
(1)
The location, date, start, and end time of the service;
(2)
A brief description of the service; and
(3)
A legible signature, along with the printed or typed name of the individual providing care, with the appropriate title.
Regulation .04 Covered Services.LinkCopy Citation
A.
The Program covers the services listed in §B and C of this regulation when the services are:
(1)
Necessary to identify the need for a health-related service or health-related early intervention service;
(2)
Necessary to:
(a)
Prevent disease, disability, and other health conditions or their progression; and
(b)
Promote physical and mental health and efficiency;
(3)
Necessary for the maximum reduction of physical or mental disability and restoration of a participant to the participant's best possible functional level; and;
(4)
Rendered in accordance with accepted professional standards.
B.
The following services are covered under this chapter when delivered in accordance with an IEP or an IFSP, which is developed at the time of referral for health-related services or health-related early intervention services:
(1)
Audiology services, which include the identification, evaluation, and treatment of auditory impairments;
(2)
Nursing services, which:
(a)
Are related to an identified health problem;
(b)
Except for nursing assessments, are ordered by a licensed prescriber;
(c)
Are indicated in the nursing care plan, which is reviewed at least every 60 days and more frequently when the child's medical condition changes; and
(d)
Require the judgment, knowledge, and skills of a licensed nurse;
(3)
Nutrition services which include conducting assessments of nutritional history and dietary intake and developing and monitoring appropriate plans to address a participant’s nutritional needs;
(4)
Occupational therapy services, which include any screening, evaluations, or treatments necessary to implement a program of activities, with the goal to develop or maintain the adaptive skills necessary to achieve a participant’s adequate and appropriate physical and mental functioning;
(5)
Physical therapy services, which include screening and evaluations necessary to determine a participant’s level of functioning, as well as any treatment, which may use therapeutic exercises for the purpose of preventing, restoring, or alleviating a movement dysfunction and related functional problems;
(6)
Psychological services, which include the evaluation, diagnosis, and treatment of emotional or behavioral problems in order for a participant to benefit from an educational or early intervention program including the counseling of parents and parent training when the participant is present;
(7)
Speech-language pathology services, which include, diagnosis, evaluation, or treatment; and
(8)
Therapeutic behavioral services which:
(a)
Includes one-to-one services by a trained therapeutic behavior aide; and
(b)
Is supervised by a licensed physician or authorized practitioner under Health Occupations Article, Annotated Code of Maryland.
C.
Psychological services, as described in §B(6) of this regulation, are covered under this chapter even if the services are not delivered in accordance with an IEP or an IFSP.
Regulation .05 Limitations.LinkCopy Citation
A.
To participate in the Program as a provider of health-related services or health-related early intervention services, the provider shall be a local school system, a local lead agency, a State-operated education agency, or State-supported education agency.
B.
Health-related services or health-related early intervention services outlined in the IEP or the IFSP shall be approved by the IEP or IFSP team for continued treatment.
C.
Therapeutic behavioral services may only be provided if:
(1)
Preauthorized through the IEP or IFSP process and directly related to the IEP or IFSP;
(2)
Services are not custodial;
(3)
Services are considered medically necessary by the IEP or IFSP team, which develops the recipient’s IEP or IFSP;
(4)
Delivered in the recipient's home, school, or other setting if normal activities are disrupted;
(5)
The therapeutic behavioral aide is not a member of the recipient's immediate family or an individual who ordinarily resides in the recipient's home; and
(6)
The recipient has:
(a)
Maladaptive behavior;
(b)
Warrants a behavioral plan;
(c)
Behavior that is deviant from developmentally appropriate behavior for the individual’s chronological age as determined by the IEP or IFSP team;
(d)
A behavior plan that does not include aversive techniques, restraints, and seclusion, or any of these; and
(e)
No insurance coverage for therapeutic behavior services when compensated as an individual service covered by another third party insurance or part of a package of benefits covered by either another third party insurance or another public agency.
Regulation .06 Preauthorization.LinkCopy Citation
A.
Therapeutic behavioral services shall be preauthorized through the IEP or IFSP process.
B.
Psychological services that are not delivered in accordance with an IEP or IFSP shall be preauthorized by the Administrative Services Organization in accordance with COMAR 10.09.59.08.
Regulation .07 Payment Procedures.LinkCopy Citation
A.
Request for Payment.
(1)
An approved provider shall submit a request for payment of services rendered and completed under this chapter as set forth in COMAR 10.09.36.04. The Department reserves the right to return to the provider, before payment, all payment requests not properly prepared or submitted.
(2)
A provider shall submit a request for payment as set forth in COMAR 10.09.36.04A. The completed form shall indicate the:
(a)
Date or dates of service;
(b)
Participant's name and Medical Assistance number;
(c)
Provider's name, location, and provider number; and
(d)
Nature, unit or units, and procedure code or codes of covered services provided.
B.
Providers may not bill the Program for:
(1)
Services not rendered in person, unless the services are provided in compliance with COMAR 10.09.49 and any guidance issued by the Department:
(2)
Completion of forms or reports;
(3)
Broken or missed appointments;
(4)
Services which duplicate a service that a recipient is receiving under another medical care program.
C.
The Program may not make direct payment to a participant.
D.
Billing time limitations for services covered under this chapter are the same as those set forth in COMAR 10.09.36.06.
E.
Reimbursement for health-related services and health-related early intervention services is contained in COMAR 10.09.02.07D. The State portion of reimbursement is provided by the Maryland State Department of Education.
F.
Psychological services not delivered in accordance with an IEP or IFSP are reimbursable when they are:
(1)
Rendered by a school psychologist or school social worker that:
(a)
Meets the qualifications of this chapter; and
(b)
Is enrolled with the Medicaid Program in accordance with COMAR 10.09.36; and
(2)
Billed by a local education agency in accordance with COMAR 10.09.59.09.
Regulation .08 Recovery and Reimbursement.LinkCopy Citation
Recovery and reimbursement is as set forth in COMAR 10.09.36.07.
Regulation .09 Cause for Suspension or Removal and Imposition of Sanctions.LinkCopy Citation
Cause for suspension or removal and imposition of sanctions is as set forth in COMAR 10.09.36.08.
Regulation .10 Appeal Procedures.LinkCopy Citation
Appeal procedures are set forth in COMAR 10.09.36.09.
Regulation .11 Interpretive Regulation.LinkCopy Citation
Interpretive regulations are set forth in COMAR 10.09.36.10.
Chapter annotations
Authority: Health-General Article, §§2-104(b), 15-103, and 15-124, Annotated Code of Maryland
History: Effective date:
History: Regulations .01—.10 adopted as an emergency provision effective February 2, 1993 (20:4 Md. R. 369); adopted permanently effective June 1, 1993 (20:10 Md. R. 852)
History: Regulations .01—.04 and .06 amended as an emergency provision effective September 19, 1997 (24:21 Md. R. 1445); amended permanently effective December 29, 1997 (24:26 Md. R. 1759)
History: Regulations .01, .02, .04, and .05 amended effective June 25, 2001 (28:12 Md. R. 1106)
History: Regulations .01B, .02B, and .04—.06 amended as an emergency provision effective September 2, 1994 (21:20 Md. R. 1729); amended permanently effective December 19, 1994 (21:25 Md. R. 2105)
History: Regulation .05B amended as an emergency provision effective July 1, 1996 (23:15 Md. R. 1083); amended permanently effective November 4, 1996 (23:22 Md. R. 1497)
History: Chapter revised as an emergency provision effective December 17, 2002 (30:1 Md. R. 22); emergency status extended at 30:14 Md. R. 933; revised permanently effective August 4, 2003 (30:15 Md. R. 991)
History: Regulation .01B amended effective March 14, 2016 (43:5 Md. R. 386); May 12, 2025 (52:9 Md. R. 405)
History: Regulation .02 amended effective May 12, 2025 (52:9 Md. R. 405)
History: Regulation .02B amended effective March 14, 2016 (43:5 Md. R. 386)
History: Regulation .03 amended effective March 14, 2016 (43:5 Md. R. 386)
History: Regulation .03A amended effective May 12, 2025 (52:9 Md. R. 405)
History: Regulation .04 amended effective March 14, 2016 (43:5 Md. R. 386)
History: Regulation .04A, B amended effective May 12, 2025 (52:9 Md. R. 405)
History: Regulation .04C adopted effective May 12, 2025 (52:9 Md. R. 405)
History: Regulation .05 amended effective March 14, 2016 (43:5 Md. R. 386)
History: Regulation .05C amended effective May 12, 2025 (52:9 Md. R. 405)
History: Regulation .06 amended effective May 12, 2025 (52:9 Md. R. 405)
History: Regulation .07B amended effective September 26, 2016 (43:19 Md. R. 1072); April 4, 2022 (49:7 Md. R. 466)
History: Regulation .07E, F amended effective November 14, 2011 (38:23 Md. R. 1421)
History: Regulation .07E amended effective March 14, 2016 (43:5 Md. R. 386); February 27, 2017 (44:4 Md. R. 252)
History: Regulation .07F repealed effective March 14, 2016 (43:5 Md. R. 386)
History: Regulation .07F adopted effective May 12, 2025 (52:9 Md. R. 405)