To configure Maryland Medicaid ABA telehealth and claim controls, apply the current ABA transmittal to each service and authorization period. For 97155, 97156, and 97157, track the required in-person and telehealth mix, clinical readiness, provider authority, authorization, documentation, and GT modifier. The provider manual, later transmittal, and live telehealth page must be read together by service date.

Define a Maryland telehealth release

Gaspard treats telehealth as a service-date configuration. One row identifies the member, benefit or plan, covered service, billing and rendering providers, supervisor when applicable, member and practitioner locations, modality, authorization, clinical decision, access supports, platform, note, claim rule, and emergency plan. The row cannot inherit a prior session's location or payer evidence without a current check.

Read the current Maryland Medicaid authority

ABA Transmittal 9 states that, effective April 1, 2026, 97155, 97156, and 97157 may no longer be delivered entirely through telehealth. At least 25 percent must be in person and up to 75 percent may be telehealth. It also requires GT for two-way HIPAA-compliant audio-visual delivery. Gaspard tracks the mix by the unit and period the governing source defines.

Separate program coverage from payer routing

The ABA Provider Manual effective February 1, 2026 requires a Telehealth Readiness Checklist in treatment plans requesting remote 97155, 97156, or 97157. The ABA program page and telehealth page route providers to current material. Gaspard gives later service-specific instructions precedence for affected dates and records any unresolved conflict.

Use one release gate for every required fact

Gaspard requires eligible service; compliant in-person and telehealth mix; readiness checklist; qualified provider; member and practitioner locations; client choice; consent and assent when applicable; clinical fit; access; authorization; two-way audio-video; complete note; GT and current place-of-service instruction; and emergency plan. A failed gate holds the session or claim at the point affected. The register shows the source, owner, checked time, effective period, exception path, and next action. It never collapses clinical, legal, payer, technical, and claim facts into one green telehealth flag.

Keep the clinical decision with a qualified clinician

Gaspard routes case-specific modality, risk, treatment, supervision, and clinical-fit decisions to an appropriately qualified clinician. Operations can verify evidence, schedule, and surface conflicts. Software can check fields and deadlines. Neither operations nor software changes a goal, dosage, risk control, or treatment rationale to satisfy a payer rule.

Verify location at every encounter

The member and practitioner locations can change between sessions. Gaspard asks for the member's physical location at check-in and records the practitioner's physical location from the responsible professional. Those facts drive licensure, payer, emergency, privacy, and place-of-service analysis. A home address, office profile, device setting, or prior visit cannot silently substitute.

Preserve choice, consent, assent and communication

Gaspard gives the person an understandable choice when the governing source allows it and records required consent from the person legally authorized to provide it. Assent is monitored when applicable. Speech, AAC, sign, gesture, writing, interpreters, captions, and other effective forms remain available. The person can request a pause or another supported setting without losing basic communication access.

Decide whether the session can work remotely

A qualified clinician reviews the purpose, response forms, observation needs, prompting, caregiver role, safety, privacy, environment, technology, fatigue, and alternatives. Gaspard identifies which components need direct observation or in-person care and when to switch. Convenience, staffing pressure, distance, or payer approval cannot supply evidence that the modality fits the person and task.

Build technical and emergency readiness

Gaspard tests the approved platform, audio, video when required, device power, bandwidth, camera view, communication system, backup contact, privacy, and outage route. The record names the person's physical location, local emergency contact, responsible adult when applicable, nearest response route, and stop condition. Staff pause when a connection failure prevents safe or meaningful care.

Match authorization and documentation

Gaspard compares the authorized service, provider, setting, modality, dates, units, and stated conditions with the planned encounter. The note records actual locations, modality, start and stop time when required, participants, accessible communication, interventions, responses, interruptions, supervision, and clinically relevant outcome. It represents what happened instead of what the template expected.

Release the claim from completed evidence

Gaspard derives code, units, modifier, place of service, rendering and billing identities, location, authorization reference, and payer route from verified records and current instructions. A telehealth flag cannot create coverage or repair a missing note. Claim acceptance, clean-claim status, adjudication, remittance, and payment remain later states with their own evidence.

Work through Gaspard's fictional cohort

Gaspard locks 20 fictional Baltimore service periods for 97155, 97156, and 97157. Twelve initially contain current sources, a compliant mix, readiness checklist, provider authority, locations, choice, clinical fit, access, authorization, note, GT, place of service, and emergency plan. Two are planned at 100 percent telehealth, one checklist is missing, one authorization names in-person care only, one note omits modality, one uses audio only, and two use an older billing setup. Six repair. Two remain held. The example is synthetic. It tests release and denominator logic and establishes no coverage, authorization, clinical, legal, privacy, licensure, claim, or payment conclusion for a real person or practice.

Calculate Gaspard's measures

Maryland ABA telehealth readiness is 12 of 20, or 60.0%. After repairs, eighteen periods are ready for release, or 18 of 20, or 90.0%. Report holds by coverage, authority, location, choice, consent, assent, access, clinical fit, technology, authorization, documentation, claim, and emergency reason. Preserve counts alongside percentages and age every unresolved item from its defined start event. Never drop a failed or pending item simply because it did not reach billing.

Address the main Maryland failure mode

The April 2026 transmittal changed the allowable remote mix and superseded earlier continuation guidance. Gaspard versions every calculation by service, authorization period, and effective date. He does not average unrelated clients or services together, and he keeps units already rendered separate from future scheduled units.

Test Gaspard's controls

Gaspard tests 97155, 97156, 97157, 100 percent remote plan, compliant 75 percent remote plan, missing checklist, audio-only request, old modifier setup, place-of-service conflict, and authorization mismatch. Each scenario records the starting facts, expected action, source, observed result, owner, correction, retest, and disposition. A platform connection passes only a connection test. It cannot prove coverage, clinical fit, authorization, documentation, or payment.

Run independent acceptance

Gaspard gives an independent reviewer the locked cohort, sources, member and practitioner locations, provider records, authorizations, clinical decisions, access plans, consent and assent evidence, platform results, notes, claims, and payer responses. The reviewer reproduces one release and one hold. A changed cohort, hidden failure, unsupported rule, or unexplained calculation fails acceptance.

Maintain the Maryland ABA telehealth mix and claim register

Gaspard reviews sources monthly and after program, plan, law, rule, manual, code, modifier, place-of-service, form, platform, authorization, contract, or contact changes. Each source keeps an owner, effective and checked dates, scope, supersession, and next review. This Maryland page remains draft and noindex until every named expert review finishes.

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