Md. Code Regs. 10.09.28.06

Current through Register Vol. 51, No. 19, September 20, 2024

Section 10.09.28.06 - Payment Procedures

A. The provider shall follow all procedures in accordance with COMAR 10.09.36.

B. The Program shall provide fee-for-service reimbursement for covered ABA services to the following ABA providers who meet the conditions for participation set forth in Regulation .02 of this chapter:

(1) ABA program;

(2) Individual licensed psychologist; and

(3) Individual LBA.

C. Reimbursement for ABA services may not be made directly to a BCaBA, RBT, or BT rendering ABA services.

D. Reimbursement for ABA services may not be made to, or on behalf of services rendered by, the participant's parent or caregiver.

E. The Program shall pay for covered services:

(1) At the lesser of the provider's customary charge to the general public unless the services are free to the individuals not covered by Medicaid; or

(2) In accordance with COMAR 10.09.36.06.

F. For dates of service from November 1, 2021 through June 30, 2022, reimbursement for ABA services covered under this chapter is as follows:

(1) Behavior identification assessment at a rate of $31.20 per 15 minutes;

(2) Behavior identification assessment follow-up at a rate of $15.60 per 15 minutes;

(3) Exposure behavior identification supporting assessment at a rate of $42.55 per 15 minutes;

(4) Adaptive exposure behavior treatment with protocol modification at a rate of $42.55 per 15 minutes;

(5) Group adaptive behavior treatment by protocol at a rate of:

(a) $8.51 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

(b) $6.81 per 15 minutes, per participant, when provided by a BCaBA; and

(c) $5.67 per 15 minutes, per participant, when provided by an RBT;

(6) Adaptive behavior treatment with protocol modification at a rate of $31.20 per 15 minutes;

(7) Multiple-family group adaptive behavior treatment guidance at a rate of $10.50 per 15 minutes per family;

(8) Family adaptive behavior treatment guidance with the participant present at a rate of:

(a) $31.20 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $17.02 per 15 minutes when provided by a BCaBA;

(9) Family adaptive behavior treatment guidance without the participant present at a rate of:

(a) $17.02 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $9.93 per 15 minutes when provided by a BCaBA;

(10) Behavior identification reassessment at a rate of $31.20 per 15 minutes;

(11) Group adaptive treatment with protocol modification at a rate of $8.51 per 15 minutes per participant;

(12) Adaptive behavior treatment direction at a rate of $31.20 per 15 minutes;

(13) Adaptive behavior treatment by protocol at a rate of:

(a) $19.86 per 15 minutes when provided by a licensed psychologist or an LBA;

(b) $17.02 per 15 minutes when provided by a BCaBA; and

(c) $15.60 per 15 minutes when provided by an RBT; and

(14) Adaptive behavior treatment planning:

(a) At a rate of $31.20 per 15 minutes; and

(b) For a maximum of 4 hours per month.

G. Effective July 1, 2022, reimbursement for ABA services covered under this chapter is as follows:

(1) Behavior identification assessment at a rate of $33.46 per 15 minutes;

(2) Behavior identification assessment follow-up at a rate of $16.73 per 15 minutes;

(3) Exposure behavior identification supporting assessment at a rate of $45.63 per 15 minutes;

(4) Adaptive exposure behavior treatment with protocol modification at a rate of $45.63 per 15 minutes;

(5) Group adaptive behavior treatment by protocol at a rate of:

(a) $9.13 per 15 minutes, per participant, when provided by a licensed psychologist or an LBA;

(b) $7.30 per 15 minutes, per participant, when provided by a BCaBA; and

(c) $6.08 per 15 minutes, per participant, when provided by an RBT or BT;

(6) Adaptive behavior treatment with protocol modification at a rate of $33.46 per 15 minutes;

(7) Multiple-family group adaptive behavior treatment guidance at a rate of $11.26 per 15 minutes per family;

(8) Family adaptive behavior treatment guidance with the participant present at a rate of:

(a) $33.46 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $18.25 per 15 minutes when provided by a BCaBA;

(9) Family adaptive behavior treatment guidance without the participant present at a rate of:

(a) $18.25 per 15 minutes when provided by a licensed psychologist or an LBA; and

(b) $10.65 per 15 minutes when provided by a BCaBA;

(10) Behavior identification reassessment at a rate of $33.46 per 15 minutes;

(11) Group adaptive treatment with protocol modification at a rate of $9.13 per 15 minutes per participant;

(12) Adaptive behavior treatment direction at a rate of $33.46 per 15 minutes;

(13) Adaptive behavior treatment by protocol at a rate of:

(a) $21.30 per 15 minutes when provided by a licensed psychologist or an LBA;

(b) $18.25 per 15 minutes when provided by a BCaBA; and

(c) $16.73 per 15 minutes when provided by an RBT or BT; and

(14) Adaptive behavior treatment planning:

(a) At a rate of $33.46 per 15 minutes; and

(b) For a maximum of 4 hours per month.

Md. Code Regs. 10.09.28.06

Regulations .06 adopted effective 43:22 Md. R. 1218, eff. 11/7/2016; amended effective 45:5 Md. R. 285, eff. 3/12/2018; amended effective 46:12 Md. R. 541, eff. 6/17/2019; amended effective 49:25 Md. R.1041-1070, eff. 12/12/2022; amended effective 50:24 Md. R. 1041, eff. 12/11/2023