Md. Code Regs. 31.10.39.02

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.10.39.02 - Definitions

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

B. Terms Defined.

(1) "Applied behavior analysis" means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.

(2) "Behavioral health treatment" means professional counseling and treatment programs, including applied behavior analysis, that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual.

(3) "Carrier" means an insurer, a nonprofit health service plan, or a health maintenance organization.

(4) "Child" means an individual who is:

(a) Younger than 19 years of age; and

(b) Diagnosed with autism or autism spectrum disorder.

(5) "Commissioner" means the Maryland Insurance Commissioner.

(6) "Habilitative services" has the meaning stated in Insurance Article, § 15-835, Annotated Code of Maryland.

(7) "Health benefit plan" has the meaning stated in Insurance Article, § 15-1301, Annotated Code of Maryland.

(8) "Health maintenance organization" has the meaning stated in Health-General Article, §19-701, Annotated Code of Maryland.

(9) "Insurer" has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(10) "Nonprofit health service plan" means a person who has received a certificate of authority from the Commissioner to act as a nonprofit health service plan in the State.

(11) "Private review agent" has the meaning stated in Insurance Article, § 15-10 B-01, Annotated Code of Maryland.

(12) Psychological Care.

(a) "Psychological care" means direct or consultative services provided by a psychologist licensed in the state in which the services are provided or by a social worker licensed in the state in which in which the services are provided.

(b) "Psychological care" includes psychotherapy.

(13) "Therapeutic care" means services provided by a speech-language pathologist, occupational therapist, or physical therapist licensed in the state in which the services are provided.

(14) "Utilization review" has the meaning stated in Insurance Article, § 15-10 B-01, Annotated Code of Maryland.

Md. Code Regs. 31.10.39.02

Effective date: 41:5 Md. R. 348, eff.3/17/2014