Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.34 - Therapeutic Behavioral Services › Section 10.09.34.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Behavioral plan" means an individualized
				  written plan for therapeutic behavioral services which includes the components
				  specified in Regulation .03B(1) of this chapter.
(2) "Department" means the Department of
				  Health and Mental Hygiene, 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).
(3) "Early and Periodic Screening, Diagnosis,
				  and Treatment (EPSDT) provider" means any health care provider acting within
				  the scope of the provider's practice who:
(a)
				  Screens, evaluates, or identifies a condition; and
(b) Recommends treatment.
(4) "Medically necessary" means
				  that the service or benefit is:
(a) Directly
				  related to diagnostic, preventive, curative, palliative, rehabilitative, or
				  ameliorative treatment of an illness, injury, disability, or health
				  condition;
(b) Consistent with
				  current accepted standards of good medical practice;
(c) The most cost efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  consumer, family, or provider.
(5) "Participant" means an individual who is
				  certified as eligible for and is receiving Medical Assistance
				  benefits.
(6) "Preauthorization"
				  means the approval required from the Department, or its designee, before
				  services may be rendered.
(7)
				  "Prescribed" means ordered in writing and signed by an EPSDT provider who has
				  examined the participant and diagnosed the participant's medical
				  condition.
(8) "Program" means the
				  Maryland Medical Assistance Program.
(9) "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:
(a) Maximum reduction of physical or mental
				  disability; and
(b) Restoration of
				  a participant's best possible functional level.
(10) "Therapeutic behavioral aide" means an
				  individual who is:
(a) 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;
(b) Trained and supervised by a therapeutic
				  behavioral service provider to implement a behavior plan; and
(c) Available on-site to provide one-to-one
				  behavioral assistance and intervention to accomplish outcomes specified in the
				  behavioral plan.
(11)
				  "Therapeutic behavioral assessment" means a comprehensive assessment of a
				  participant and, if applicable, a participant's family that:
(a) Is performed by a licensed or certified
				  health care professional;
(b)
				  Addresses the medical and behavioral needs for therapeutic behavioral
				  services;
(c) Includes the risk of
				  needing placement in a more restrictive living arrangement because of the
				  behavior; and
(d) Includes
				  development of a behavioral plan.
(12) "Therapeutic behavioral service" means
				  an intensive, rehabilitative service that is documented in the written
				  behavioral plan and is intended to:
(a)
				  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
(b) Restore the
				  participant's previously acquired behavior skills and enable the participant to
				  develop appropriate behavior management skills.
(13) "Therapeutic behavioral service
				  provider" means:
(a) A Developmental
				  Disabilities Administration provider meeting criteria set forth in COMAR
				  10.22.02;
(b) An outpatient mental
				  health clinic approved under COMAR 10.21.20;
(c) A mental health mobile treatment unit
				  meeting criteria set forth in COMAR 10.09.59; or
(d) A psychiatric rehabilitation program
				  approved under COMAR 10.21.29.