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    PROPOSAL

    Maryland Register

    Issue Date:  January 18, 2019

    Volume 46 • Issue 2 • Page 59-61

    Title 10 
    MARYLAND DEPARTMENT OF HEALTH

    Subtitle 09 MEDICAL CARE PROGRAMS

    10.09.28 Applied Behavior Analysis Services

    Authority: Health-General Article, §§2-104(b), 2-105(b), 15-103, and 15-105, Annotated Code of Maryland

    Notice of Proposed Action

    [19-017-P]

    The Secretary of Health proposes to amend Regulations .01—.04 and .06 under COMAR 10.09.28 Applied Behavior Analysis Services.

    Statement of Purpose

    The purpose of this action is to update the definitions, service descriptions, and rates associated with Applied Behavioral Analysis (ABA) Services. The American Medical Association (AMA) published the code revisions, which will go into effect January 1, 2019.

    Comparison to Federal Standards

    There is no corresponding federal standard to this proposed action.

    Estimate of Economic Impact

    The proposed action has no economic impact.

    Economic Impact on Small Businesses

    The proposed action has minimal or no economic impact on small businesses.

    Impact on Individuals with Disabilities

    The proposed action has no impact on individuals with disabilities.

    Opportunity for Public Comment

    Comments may be sent to Jake Whitaker, Acting Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through February 19, 2019. A public hearing has not been scheduled.

    .01 Definitions.

    A. (text unchanged)

    B. Terms Defined.

    (1)—(5) (text unchanged)

    (6) “Board certified behavior analyst (BCBA)” means a licensed professional who:

    (a) Renders and [supervises] provides direction for ABA services that are provided to participants with ASD; and

    (b) (text unchanged)

    (7) “Board certified behavior analyst-doctoral (BCBA-D)” [is] means a licensed professional who:

    (a) Renders and [supervises] provides direction for ABA treatments that are provided to participants with ASD; and

    (b) (text unchanged)

    (8)—(12) (text unchanged)

    (13) “[Direct supervision] Direction of a technician” means the in-person monitoring of a BCaBA or an RBT, performed by [a licensed psychologist,] a licensed BCBA-D[,] or a licensed BCBA.

    (14)—(32) (text unchanged)

    (33) “Remote access technology” means the use of HIPAA compliant technological methods to provide auditory and visual connection between [a licensed psychologist,] a licensed BCBA-D[,] or a licensed BCBA, who is not directly present, and a BCaBA or an RBT when services are being provided at the participant’s home.

    (34) “Remote [supervision] direction of a technician” means the monitoring of a BCaBA or an RBT, performed via remote access technology by [a licensed psychologist,] a licensed BCBA-D[,] or a licensed BCBA.

    (35) (text unchanged)

    .02 Provider Qualifications and Conditions for Participation.

    A.—G. (text unchanged)

    H. A BCaBA provider who renders ABA services shall:

    (1) (text unchanged)

    (2) Work under the [supervisiondirection of:

    [(a) A licensed psychologist;]

    [(b)(a)[(c)(b) (text unchanged)

    (3) (text unchanged)

    I. An RBT provider who renders ABA services shall:

    (1)—(3) (text unchanged)

    (4) Work under the [supervision] direction of:

    [(a) A licensed psychologist;]

    [(b)] —[(c)(b) (text unchanged)

    (5) (text unchanged)

    .03 Participant Eligibility.

    A. (text unchanged)

    B. To qualify for ABA services, a participant shall:

    (1)—(7) text unchanged)

    (8) Have a completed ABA treatment plan that shall:

    (a)—(e) (text unchanged)

    (f) Identify long-term goals, short-term goals, and objectives that:

    (i) (text unchanged)

    (ii) Are [specific and tailored] customized to the participant;

    (iii)—(iv) (text unchanged)

    (g)—(i) (text unchanged)

    .04 Covered Services.

    A. (text unchanged)

    B. The Program covers the following ABA services:

    (1) An ABA assessment, which is a [comprehensive] behavior identification assessment that:

    (a) Is [performedadministered in person with a participant and the participant’s parent or caregiver by:

    (i)—(iii) (text unchanged)

    (b) Addresses the behavioral needs for ABA services; and

    (c) Includes [an]:

    (i) An interview, direct observation, record review, data collection, and analysis;

    [(d)] (ii) [IncludesAn assessment of the participant’s current level of functioning, skills deficits, and maladaptive behaviors using validated instruments; [and]

    (iii) Analysis of past data;

    (iv) Scoring and interpreting the assessment;

    (v) Preparing the treatment plan and report; and

    (vi) Discussion of the findings;

    [(e) Develops a treatment plan;]

    (2) A behavior identification supporting assessment which is a follow-up assessment that is administered:

    (a) In person, by an RBT or BCaBA, with a participant present; and

    (b) Under the direction of a licensed BCBA-D or a licensed BCBA;

    [(2)] (3) [ABA exposure] An exposure behavior identification supporting assessment which is a follow-up assessment that:

    (a) (text unchanged)

    (b) Is [providedadministered in person by [a licensed psychologist,] a licensed BCBA-D[,] or a licensed BCBA, with the assistance of [one] twoor more BCaBAs or RBTs;

    (c) Exposes the participant to a customized series of social and environmental conditions associated with the destructive behaviors; and

    (d) (text unchanged)

    [(3)(4) [ABA exposure modified treatmentAn adaptive behavior treatment with protocol modification which is an in-person service that:

    (a) Is conducted on a participant with specific, severe destructive behaviors in [a structured, safe environment] an environment that is:

    (i) Customized;

    (ii) Structured; and

    (iii) Safe;

    (b) Is [provided] administered in person by [a licensed psychologist,] a licensed BCBA-D[,] or a licensed BCBA, with the assistance of two or more BCaBAs or RBTs;

    (c) Includes [direct or remote supervision of the BCaBAs or RBTs] in-person direction of two or more technicians eliciting behavioral effects or exposing the participant to specific environmental conditions and treatment; and

    (d) (text unchanged)

    [(4)] (5) [ABA group treatmentGroup adaptive behavior treatment by protocol which is an in-person service provided to a group of two or more participants by:

    (a) (text unchanged)

    (b) A BCaBA or an RBT under the direction of [a licensed psychologist,] a licensed BCBA-D[,] or a licensed BCBA, utilizing a behavioral intervention protocol designed in advance by [the  psychologist,] the BCBA-D[,] or the BCBA, who may or may not provide [direct or remote supervisionin-person direction of a technician during the treatment;

    [(5) ABA modified treatment which is an in-person service provided to a participant by a licensed psychologist, a licensed BCBA-D, or a licensed BCBA who:

    (a) Resolves one or more problems with the treatment; and

    (b) May simultaneously instruct the BCaBA, RBT, or participant’s parent or caregiver in administering the modified treatment;]

    (6) [ABA multiple-family group training which isMultiple-family group adaptive behavior treatment guidance that:

    (a)—(c) (text unchanged)

    (7) [ABA parent trainingFamily adaptive behavior treatment guidance which [is behavior treatment guidance that]:

    (a)—(b) (text unchanged)

    (c) Instructs the parent or caregiver on how to utilize ABA [treatmentsstrategies to reduce maladaptive behaviors and skill deficits;

    (8) [ABAA behavior identification reassessment which is a follow-up assessment that:

    (a)—(d) (text unchanged)

    (9) [ABA social skills group] Group adaptive behavior treatment with protocol modification which is a service that is:

    (a)—(c) (text unchanged)

    (10) [ABA supervisionAdaptive behavior treatment direction of a technician which is [athe clinical direction and oversight of a BCaBA or an RBT by [a licensed psychologist,] a licensed BCBA-D[,] or a licensed BCBA that:

    (a) Requires [the psychologist,] the BCBA-D[,] or the BCBA to directly or remotely observe the BCaBA or the RBT administering ABA services to the participant, group of participants, parent, or caregiver;

    (b)—(c) (text unchanged)

    (11) [ABA treatmentAdaptive behavior treatment by protocol which is an in-person service provided to a participant by:

    (a) (text unchanged)

    (b) A BCaBA or an RBT under the direction of [a licensed psychologist,] a licensed BCBA D[,] or a licensed BCBA utilizing a behavioral intervention designed in advance by [the a psychologist,] the BCBA-D[,] or the BCBA, who may or may not provide [direct or remote supervision] in-person or remote direction during the treatment; and

    (12) [ABAAdaptive behavior treatment planning which is an ongoing indirect service that:

    (a)—(b) (text unchanged)

    C.—F. (text unchanged)

    .06 Payment Procedures.

    A.—E. (text unchanged)

    F. [ReimbursementEffective January 1, 2019, reimbursement for ABA services covered under this chapter is as follows:

    (1) [ABA assessment] Behavior identification assessment at a rate of [$220$27.50 per 15 minutes;

    (2) Behavior identification assessment follow-up at a rate of $13.75 per 15 minutes;

    [(2)] (3) [ABA exposure] Exposure behavior identification supporting assessment at a rate of [$75$37.50 per [3015 minutes;

    [(3)(4) [ABA exposure modified treatment] Adaptive exposure behavior treatment with protocol modification at a rate of[:

    (a) $150 for the first 60 minutes; and

    (b) $75 per additional 30 minutes;$37.50 per 15 minutes;

    [(4)] (5) [ABA group treatment] Group adaptive behavior treatment by protocol at a rate of:

    (a) [$15$7.50 per [3015 minutes, per participant, when provided by a psychologist, BCBA-D, or BCBA;

    (b) [$12$6 per [3015 minutes, per participant, when provided by a BCaBA; and

    (c) [$10$5 per [3015 minutes, per participant, when provided by an RBT;

    [(5)] (6) [ABA modified treatmentAdaptive behavior treatment with protocol modification at a rate of [$55$27.50 per [3015 minutes;

    [(6)] (7) [ABA multiple-family group training] Multiple-family group adaptive behavior treatment guidance at a rate of [$37$9.25 per 15 minutes per family;

    [(7)] (8) [ABA parent trainingFamily adaptive behavior treatment guidance with the participant present at a rate of:

    (a) [$55$27.50 per [3015 minutes when provided by a psychologist, BCBA-D, or BCBA; and

    (b) [$30$15 per [3015 minutes when provided by a BCaBA;

    [(8)] (9) [ABA parent trainingFamily adaptive behavior treatment guidance without the participant present at a rate of:

    (a) [$60$15 per 15 minutes when provided by a psychologist, a BCBA-D, or a BCBA; and

    (b) [$35$8.75 per 15 minutes when provided by a BCaBA;

    [(9)] (10) [ABABehavior identification reassessment at a rate of [$55$27.50 per [3015 minutes;

    [(10)] (11) [ABA social skills groupGroup adaptive treatment with protocol modification at a rate of [$30$7.50 per 15 minutes per participant;

    [(11)(12) [ABA supervisionAdaptive behavior treatment direction at a rate of [$55$27.50 per [3015 minutes;

    [(12)] (13) [ABA treatmentAdaptive behavior treatment by protocol at a rate of:

    (a) [$35$17.50 per [3015 minutes when provided by a psychologist, BCBA-D, or BCBA;

    (b) [$30$15 per [3015 minutes when provided by a BCaBA; and

    (c) [$27.50$13.75 per [3015 minutes when provided by an RBT; and

    [(13)(14) [ABAAdaptive behavior treatment planning:

    (a) At a rate of [$55$27.50 per [30] 15 minutes; and

    (b) (text unchanged)

    ROBERT R. NEALL
    Secretary of Health

     ​