Sec. 10.09.28.01. Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) Applied Behavior Analysis (ABA).

(a) "Applied behavior analysis (ABA)" means the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvements in human behavior.

(b) "Applied behavior analysis (ABA)" includes the direct observations, measurement, and functional analysis of the relations between environment and behavior.

(2) "ABA program" means an association, partnership, corporation, or unincorporated group that includes:

(a) A licensed psychologist, a licensed BCBA-D, or a licensed BCBA; and

(b) A BCaBA or an RBT.

(3) "Autism spectrum disorder (ASD)" means a group of developmental disorders:

(a) Characterized by persistent deficits in social communication and social interaction across multiple contexts;

(b) Characterized by restricted, repetitive patterns of behavior, interests, or activities; and

(c) Whose symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

(4) "Behavior Analyst Certification Board (BACB)" means the Board accredited by the National Commission for Certifying Agencies that credentials and certifies a BCBA-D, BCBA, or BCaBA, or registers an RBT.

(5) "Board certified assistant behavior analyst (BCaBA)" means a paraprofessional who:

(a) Delivers ABA treatments that are provided to participants with ASD under the supervision of:

(i) A licensed psychologist;

(ii) A licensed BCBA-D; or

(iii) A licensed BCBA; and

(b) Obtained a BACB certification.

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

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

(b) Obtained a BACB certification.

(7) "Board certified behavior analyst-doctoral (BCBA-D)" means a licensed professional who:

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

(b) Obtained a BACB certification with a doctoral-level credential.

(8) "Caregiver" means a willing and able individual who is trained in providing care to the participant.

(9) "Comprehensive diagnostic evaluation" means a direct observation of the participant and interviews with the participant’s parent or caregiver performed by a qualified health care professional with the help of validated instruments.

(10) "Custodial care" means care that is provided:

(a) To assist in the activities of daily living, such as bathing, dressing, eating, and maintaining personal hygiene;

(b) For maintaining the participant’s safety; and

(c) By individuals without professional skills or training.

(11) "Department" means the Maryland Department of Health.

(12) "Designee" means the entity designated by the Department to manage the public behavioral health system on behalf of the Department.

(13) “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) "Early and periodic screening, diagnosis, and treatment (EPSDT)" means the provision, to individuals younger than 21 years old, of preventive health care pursuant to 42 CFR §441.50 et seq., as amended, and other health care services, diagnostic services, and treatment services that are necessary to correct or ameliorate defects, physical and mental illnesses, and conditions discovered by EPSDT screening services.

(15) "Family" means an adult who:

(a) Lives with or provides care to the participant; and

(b) Is not paid to provide the care.

(16) "HIPAA" means the Health Insurance Portability and Accountability Act, a federal law enacted on August 21, 1996, whose purpose is to improve the efficiency and effectiveness of the health care system by standardizing the electronic exchange of administrative and financial data, provide security requirements for transmitted information, and protect the privacy of identifiable health information.

(17) "Individualized education program (IEP)" means a written description of special education and related services to be implemented to meet the individual needs of a child pursuant to COMAR 13A.05.01.03B and 13A.05.01.09.

(18) "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 pursuant to COMAR 13A.13.01.03B.

(19) "Intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF-IID)" means an institution licensed by the Department under COMAR 10.07.20 that provides health-related services or health rehabilitative services for individuals with intellectual disabilities or related conditions.

(20) Maladaptive Behavior.

(a) "Maladaptive behavior" means behavior that interferes with the participant’s activities of daily living or ability to adjust or participate in particular settings.

(b) "Maladaptive behavior" includes behaviors such as self-injurious behavior, aggression, tantrums, stereotypies, and rituals.

(21) "Maryland Medical Assistance Program" means a program of comprehensive medical and other health-related care for indigent and medically indigent individuals, jointly financed by the federal and state governments and administered by states under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq., as amended.

(22) "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 for the convenience of the participant, family, or provider.

(23) "Medicare" means the insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq., as amended.

(24) "Parent" means the adult representative of a participant and includes:

(a) A biological or adoptive parent;

(b) A legal guardian;

(c) An individual acting in the place of a parent, such as a grandparent or stepparent with whom the participant lives, including those relatives or stepparents who are foster parents;

(d) An individual appointed as the parent surrogate in accordance with Education Article, §8-412, Annotated Code of Maryland, for matters within the scope of the Individuals with Disabilities Education Act; or

(e) Another individual responsible for a participant’s welfare.

(25) "Participant" means an eligible individual who is enrolled in the Program.

(26) "Plan for generalization" means a component of the treatment plan whose goal is the expansion of a participant's performance ability beyond the initial conditions set for acquisition of a skill that can occur across people, places, and materials used for teaching.

(27) "Preauthorized" means the approval required from the Department, or its designee, before a provider renders services in order to receive reimbursement for services.

(28) "Program" means the Maryland Medical Assistance Program.

(29) "Provider" means a person certified to provide ABA services to participants and who, through appropriate agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

(30) "Psychologist" means an individual who is:

(a) Licensed and legally authorized to practice psychology under Health Occupations Article, Title 18, Annotated Code of Maryland; or

(b) Licensed and legally authorized to practice psychology in the state where the service is rendered.

(31) "Qualified health care professional" means a developmental pediatrician, pediatrician, pediatric neurologist, child psychiatrist, clinical psychologist, neuropsychologist, or a nurse practitioner with training and experience to diagnose ASD.

(32) "Registered behavior technician (RBT)" means a paraprofessional who delivers ABA services that are provided to participants with ASD under the supervision of:

(a) A licensed psychologist;

(b) A licensed BCBA-D; or

(c) A licensed BCBA.

(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 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) "Treatment plan" means an individualized written plan for ABA services which includes the components specified in Regulation .03 of this chapter.