# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 56 — Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder

#### Regulation .14-1 Covered Services — Intensive Therapeutic Integration Services.

*COMAR 10.09.56.14-1*

A. Intensive therapeutic integration services under this regulation:

  (1) Are provided at a nonresidential setting separate from the home or facility where the participant lives;

  (2) Shall have an on-site direct care worker for every participant receiving one-to-one interventions for intensive therapeutic integration;

  (3) Shall include expressive therapies and therapeutic recreational activities;

  (4) Shall include the development of socialization skills, enhancement of self-esteem, and behavior management;

  (5) Are for participants who require one-to-one interventions and also have problems with socialization, isolation, hyperactivity, impulse control, and behavioral or other related disorders;

  (6) Are not solely educational or recreational in nature, but have a therapeutic habilitative orientation, as evidenced in written progress notes;

  (7) Shall be culturally competent and congruent with the participant’s cultural norms;

  (8) Shall assure coordination with the participant’s other service providers, service coordinator, and multidisciplinary team;

  (9) Shall be based on the participant’s individualized written treatment plan that identifies goals of the specific therapeutic activities provided;

  (10) Shall provide:

    (a) General therapeutic and therapeutic recreational services;

    (b) Behavioral management;

    (c) Planning for crises with the participant during a session;

    (d) Socialization groups; and

    (e) One or more of art, music, dance, or activity therapies, as appropriate for participants;

  (11) Shall have a supervisor who has been trained in accordance with Regulation .04E(3) of this chapter that:

    (a) Trains and provides ongoing supervision to the direct care worker rendering therapeutic integration services;

    (b) Supervises the direct care worker when crisis intervention services are rendered to evaluate the nature of the crisis and intervenes to reduce the likelihood of reoccurrence;

    (c) Plans and regularly reviews the participant’s therapeutic activities and behavior plan;

    (d) Meets regularly with the participant and family and observes the participant in the community setting;

    (e) Develops intervention on an individualized basis and identifies the interventions on an individualized treatment plan; and

    (f) Identifies, in the treatment plan, the goals and tasks that the intensive therapeutic integration direct care worker is implementing; and

  (12) Shall, when transportation is provided:

    (a) Have individualized goals for transportation for the participant on the participant’s treatment plan; and

    (b) Document the start and stop times transportation is provided for each day that a participant is transported.

B. For dates of service before July 1, 2023, a unit of service is a 30-minute increment of service rendered to a participant by a qualified provider in the community setting.

C. For dates of service on or after July 1, 2023, a unit of service is a 15-minute increment of service rendered to a participant by a qualified provider in the community setting.