1. A. ABA services are only available to participants under the EPSDT program.
2. B. ABA services shall be delivered in a home or community setting, including a clinic, when medically necessary.

3. C. The provider may not bill the Program for:

   1. (1) Services that are:

      1. (a) Provided in:

         1. (i) A hospital;
         2. (ii) An institution for mental disease;
         3. (iii) An ICF-IID;
         4. (iv) A crisis residential program;
         5. (v) A residential treatment center;
         6. (vi) A 24-hour, 365-day residential program funded with federal, State, or local government funds; or
         7. (vii) Nonconventional settings, including but not limited to resorts, spas, and camps;
      2. (b) Rendered when measurable functional improvement or continued clinical benefit is not met, and treatment is not deemed necessary;
      3. (c) Not preauthorized by the Department or its designee;
      4. (d) Beyond the provider's scope of practice;
      5. (e) Rendered but not documented in accordance to Regulation .04 of this chapter;
      6. (f) Rendered by mail or telephone;
   2. (2) Services whose purpose is vocationally based or recreationally based;
   3. (3) Respite services;
   4. (4) Custodial care;
   5. (5) Completion of forms and reports;
   6. (6) Broken or missed appointments;
   7. (7) Travel to and from site of service; and
   8. (8) Services which duplicate a service that a participant is receiving under another medical care program.
4. D. The participant’s parent or caregiver shall be trained to reinforce ABA services for the participant in a clinically effective manner.

5. E. Services shall be discontinued if no longer medically necessary because:

   1. (1) Long-term treatment goals and objectives are achieved; or
   2. (2) Participant is not demonstrating progress towards treatment goals and objectives and measurable functional improvement is no longer expected.
6. F. The provider shall obtain approval by the Department or its designee for remote supervision.

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

Effective date: November 7, 2016 (43:22 Md. R. 1218)

Regulation .01B amended effective March 12, 2018 (45:5 Md. R. 285); June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049); December 11, 2023 (50:24 Md. R. 1041)

Regulation .02A amended effective December 12, 2022 (49:25 Md. R. 1049)

Regulation .02H, I amended effective June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049)

Regulation .02J adopted effective December 11, 2023 (50:24 Md. R. 1041)

Regulation .03B amended effective June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049)

Regulation .04 amended effective December 12, 2022 (49:25 Md. R. 1049)

Regulation .04B amended effective March 12, 2018 (45:5 Md. R. 285); June 17, 2019 (46:12 Md. R. 542); December 11, 2025 (52:24 Md. R. 1197

Regulation .04B, C amended effective December 11, 2023 (50:24 Md. R. 1041)

Regulation .05B, C amended effective March 12, 2018 (45:5 Md. R. 285)

Regulation .05D amended effective December 12, 2022 (49:25 Md. R. 1049)

Regulation .05F adopted effective March 12, 2018 (45:5 Md. R. 285)

Regulation .06 amended effective March 12, 2018 (45:5 Md. R. 285); December 11, 2023 (50:24 Md. R. 1041); December 11, 2025 (52:24 Md. R. 1197)

Regulation .06B amended effective December 12, 2022 (49:25 Md. R. 1049)

Regulation .06F amended effective June 17, 2019 (46:12 Md. R. 542); December 12, 2022 (49:25 Md. R. 1049)

Regulation .06G adopted effective December 12, 2022 (49:25 Md. R. 1049)