Thank you for the opportunity to provide public comment on these regulations.  As the Public Policy Committee for the Virginia Association for Behavior Analysis, we have the following comments.  We have confined them to 12VAC30-122-550, as Therapeutic Consultation Service is the primary service delivered by behavior analysts with respect to the waiver.

 

First off and most importantly, we implore DMAS and DBHDS to change the unit from one hour to 15 minutes.  From our interactions with providers, most providers at one point spend less than an hour with an individual or caregiver in one session, or go over the hour unit, but not by a full hour.  The regulations do not specify how we should bill in these situations.  The convention, as we understand it, is to add the minutes together at the end of the month, and if the extra minutes go over 30 and under 1:30, we are to bill that portion as an hour.  We find this inefficient and detrimental to either the provider or payor.  With other services that we provide, the billing unit is 15 minutes, and the rounding rules are normalized.  Especially with the advent of telephonic and telehealth services, the service unit of one hour is inappropriate and a service unit of 15 minutes would lead to more accuracy and less confusion in billing. 

 

We note that Therapeutic Consultation is currently only available for those with the Community Living Waiver or Family and Individual Supports Waiver.  We request that the service be added to the Building Independence waiver to allow those individuals to increase their independence through behavioral consultation.

 

We want to thank you for identifying the good work we have been able to do via telephonic and telehealth means over the past year and feel that the continuation in B2i is appropriate and beneficial to the individuals receiving this service.

 

In C3, written preparation is listed as an in-kind service, but is not defined.  Designing a written plan is an allowable service and there is confusion about the difference between the two.  A specific definition would be helpful.

 

In E1a, the regulations state that a completed copy of the SIS should be kept in the individual’s record.  However, we do not conduct this assessment and it is rarely shared with Therapeutic Consultation providers.  Thus we request that this item be struck.

 

In E1c1ix, we request the words “when indicated” be struck. Behavior analytic research has proven that consequence interventions are one of the most key elements of a plan.  Behaviors are maintained by consequences and antecedent interventions alone will not change a behavior.  Consequence is not synonymous with punishment.  Operant learning and increasing prosocial behaviors and new skills through reinforcement are one of the most fundamental and important parts of a behavior plan.

 

With respect to E1c1xi, while it's not uncommon for behavior analysts to proffer recommendations about other services, we are concerned that this point reflects a misunderstanding that behavior analysts are somehow also doing case management, and perhaps more important and germane to this exact section, that the behavior plan itself is not typically the suitable or customary vehicle for providing such recommendations. By requiring them in the plan, it imposes a standard that should be addressed adjacent to the plans rather than embedded within them. 

 

Finally, In E1e, the instructions on when to create a quarterly report are confusing. Other regulations lead us to believe that a Therapeutic Consultation provider’s quarterly reports should align with the ISP.  But what if Therapeutic Consultation services are authorized at a different point in the year?  If the Annual ISP is created in January, and Therapeutic Consultation services begin in February, is a quarterly report written in April (to coincide with the ISP), May (to coincide with the direction to produce a quarterly report after three months of service), or July (to exceed three months and coincide with the ISP).  Please provide specific guidance.

 

Once again, we thank you for the opportunity to comment on these regulations.