Peaceable Life Therapeutic Services, Inc. Response to DD-Waiver Proposed Permanent Regulations

 

Peaceable Life Therapeutic Services, Inc. provides Therapeutic Behavioral Consultation Services and would like to submit the following comments in response to the DD Waiver Open Comment.  For any questions related to this document, you may contact: 

Meneika Keith, Family Sharing, Inc., mkeith.peaceablelife@gmail.com, 540-414-4561

 

550 – Therapeutic consultation

·         B.2.i - Support Dr. Walker’s comments as follows:

Recommended Change #1:  In Section C. 3., "telephone communication" should be deleted from the list of in-kind activities that cannot be billed.
 

Reason for Change: Telephone communication is considered an allowable activity in B. i.

Recommended Change #2:  In Section B. i., the phrase "or via video conferencing" should be added at the end. 

Reason for Change: The would clarify that video conferencing is an allowable activity in the provision of Therapeutic Consultation services. Allowing video conferencing might increase the availability of Therapeutic Consultation services, especially in rural areas.

Recommended Change #3:  All of C. 4. ("Therapeutic consultation shall not be billed solely for purposes of monitoring the individual") should be deleted.

Reason for Change:  Page 79 of the December 2018 DOJ Monitor's report states "... of those who did have BSPs, half were not supervised by qualified behavior clinicians." The current language in the regulations suggests that monitoring of an ongoing Behavioral Support Plan (BSP) is not an allowable activity. In fact, ongoing monitoring (that is, supervision by a qualified clinician) of an individual's progress is essential if the plan is to be successful. The language in C.4. suggests that this monitoring is not permitted. 
 

·         C.3- Strike “written preparation and telephone communication”
 

·         INTERPRETATION OF BILLING CODES FOR TC:  Peaceable Life Therapeutic Services, Inc. would like to advocate that LPCs and LCSWs who are endorsed to provide Positive Behavioral Supports are able to bill at the highest rate along with “Therapist and BCBAs” as follows: 

97139 Therapeutic Consultation, Therapists/Behavior Analysts/Rehab. Engineers

LPCs and LCSWs who provide Therapeutic Consultation for behavior supports are told that we have to bill under 97530 as "other" because we are not what is meant by "Therapists" under 97139.  Licensed Professional Counselors are required to complete 4000 supervised clinical hours with 200 direct supervision hours LPC.  Likewise, LCSWs are required to complete 3000 supervised clinical hours with 100 direct supervision hours under a current LCSW.  In addition to being able to provide interventions for behavioral challenges and address behavioral emergencies, LPCs and LCSWs will be able to diagnose mental health disorders, write and implement treatment plans, make referrals, and recommend hospitalization.  By comparison, BCBA’s require 1500 clinical hours made up of 2 week supervisory periods with 1 supervisor contact per period – 5% of hours must be supervised.  Many of the individuals we are servicing with behavioral consultation needs have dual diagnoses of developmental disabilities and mental health disorders that impact their behaviors.  LPCs and LCSWs who are endorsed to provide behavioral consultation are uniquely qualified to support these highly complex behavioral needs and should be able to bill accordingly.

·         I am advocating for LPCs and LCSWs to be able to bill at the 97139 rate for Therapeutic Behavioral Consultation

 

 

In addition, we support the comments from the VaSRPG and the DD Waiver Committee and would also like to highlight the following comments:

 

 

20 – Definitions

·         Positive Behavior Supports – use the definition of the American Association for Positive Behavior Supports and delete the language provided [This will bring the service in line with the national standard]

·         Progress Note – We support this definition as written and object to the variations contained in the Provider Requirement sections of the several service descriptions.

·         QDDP – add a reference to all sections in this regulation which permit “QDDP” for the purposes of developing service plans and/or the supervision of staff to be defined in accordance with 12VAC35-105.590.7; while it is not necessary for the purposes of the definition, it will add clarity to the regulations.

7. Supervision of mental retardation (intellectual disability) developmental services shall be provided by a person with at least one year of documented experience working directly with individuals who have mental retardation (intellectual disability) or other developmental disabilities and holds at least a bachelor's degree in a human services field such as sociology, social work, special education, rehabilitation counseling, nursing, or psychology. Experience may be substituted for the education requirement

VaSRPG would also like to highlight the sentence that states “Experience may be substituted for the education requirement” which has historically been defined as 5 years of documented experience working directly with individuals who have ID/DD.  We continue to support this, as many qualified staff with degrees in non-human services fields find that they are skilled and committed to working in this field and should be given the opportunity for advancement with experience within the service structure. 
 

·         Service Authorizations- Strike the word “medically” [While we understand the Medicaid standard of “medical necessity” for payment, it implies that services must have a physician’s order and not be developed by the Person-Centered planning process]

 

120 – Provider requirements

·         A.5.- Strike “medically necessary services and supplies” and add “services and supports”

·         A.6.- Strike “supplies” and add “supports”

·         A.10.d- Strike “Such documentation shall be written on the date of service delivery.” [This is not in keeping with the definition of Progress Note]

·         A.10.d- Strike “medical” in the first sentence

·         A.10.f- Add “if applicable” within the parenthetical phrase “including specific timeframe”

·          

200 – Supports Intensity Scale® requirements

·         A.1- Delete “to 72” and add “or older” after “years of age.”  [If the SIS is only validated to age 72 then language should be added to automatically assign all individuals age 72 or older to Level 5, Tier 4; the text (Appendix D-1) from the most recent Waiver Application is:

“To assess other support needs, each individual 22 years of age and older has the Supports Intensity Scale® (SIS®) completed every four years or when the individual's needs change significantly.

·         A.2.a - Change “three” to “four” to stay consistent with the CL application

VaSRPG supports changing from “three” to “four” with provision to allow providers to appeal results as noted under this section “E”
 

·         D - Strike entre paragraph

·         Add a new D – “Requires that the results of the SIS be provided within 10 days of scoring in an understandable format and that the support coordinator be required to explain the results and implications of the SIS score and avenues of appeal.”

·         Add a new E.- “An automatic, independent review of the SIS administration process and results when an individual’s SIS Score changes despite a lack of change in their health or other circumstances, upon request.”

Additionally add to E. Allow for providers of services to request an automatic, independent review of the SIS results when results do not align with their support needs.

 

370 – Environmental modifications

·         C.6.- We recommend that an exception process be put into place for the uncommon circumstance in which the expansion of square footage to the home (which is prohibited) is an incidental result of a modification that will enable the individual to remain in the home, e.g., a larger, accessible bathroom. Limits could be put into place for how much additional square footage would be allowable in an exceptions process.
 

·         Allow individuals in Sponsored Residential homes to access environmental modifications in their Sponsored Residential location when there are changing needs requiring such funding. 

 

 

390 – Group home residential

·         E.1.c- Change “at least a daily note” to “a Progress Note” [This makes it consistent with other requirements]

·         Move C.3 under letter D [It is under this section in other service descriptions]

 

460 – Personal assistance

·         A.4- Change to “all waivers”

·         B.4.e. correct spelling of “activities”

·         C.7.a & b.- Strike all references to “Companion”  and replace with “Personal Assistance”

 

530 – Sponsored residential

·         E.1.c.- Strike “confirming the amount of the individual’s time in service and”

·         E.1.c.- End of second sentence strike “at least a daily note” add “in a progress note” [This makes documentation consistent]