I write to you today on behalf of The Council of Autism Service Providers (CASP) and our member organizations in Virginia which are serving children and adults diagnosed with autism spectrum disorder. CASP is a non-profit association of organizations committed to providing evidence-based care to individuals with autism. CASP represents the autism provider community to the nation at large, including government, payers, and the general public. We provide information and education and promote standards that enhance quality of care. Of particular interest to our members is the coverage of evidence-based care, including applied behavior analysis (ABA) for autistic individuals of all ages in both private health insurance plans as well as through Medicaid.

As a stakeholder who has worked in Virginia since 2008, I was part of the drafting process of Virginia’s autism insurance law[1] not only during its original passage but in every subsequent amendment. The statute read in its original form and in every amended form to date that:

Treatment for autism spectrum disorder" shall be identified in a treatment plan and includes the following care prescribed or ordered for an individual diagnosed with autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary: (i) behavioral health treatment, (ii) pharmacy care, (iii) psychiatric care, (iv) psychological care, (v) therapeutic care, and (vi) applied behavior analysis when provided or supervised by a board-certified behavior analyst who shall be licensed by the Board of Medicine. The prescribing practitioner shall be independent of the provider of applied behavior analysis.

This language specifically references that applied behavior analysis is provided or supervised by a board-certified behavior analyst. The legislative intent was to adhere to generally accepted standards^[2] of care specific to medically necessary applied behavior analysis for individuals diagnosed with an autism spectrum disorder. 

These standards  indicate that:

ABA is a specialized behavioral health treatment approach and most graduate or postgraduate training programs in psychology, counseling, social work, or other areas of clinical practice do not provide in-depth training in this discipline.

The formal training of professionals certified by the Behavior Analyst Certification Board (BACB) is similar to that of other medical and behavioral health professionals. That is, they are initially trained within academia and then begin working in a supervised clinical setting with clients. As they gradually demonstrate the competencies necessary to manage complex clinical problems across a variety of clients and medical environments, they become independent practitioners. In summary, Behavior Analysts undergo a rigorous course of training and education, including an “internship” period in which they work under the direct supervision of an experienced Behavior Analyst. 

The BACB is a nonprofit 501(c)(3) corporation established to meet professional credentialing needs identified by Behavior Analysts, governments, and consumers of behavior analysis services. The mission of the BACB is to protect consumers of behavior analysis services worldwide by systematically establishing, promoting, and disseminating professional standards. The BACB has established uniform content, standards, and criteria for the credentialing process that are designed to meet: 

• The legal standards established through state, national, and case law; 

• The accepted standards for certification programs; and 

• The “best practice” and ethical standards of the behavior analysis profession. 

The BCBA and BCaBA certification programs are currently accredited by the National Commission for Certifying Agencies (NCCA), the accreditation arm of the Institute for Credentialing Excellence. NCCA reviews and oversees all aspects related to ensuring the development and application of appropriate credentialing processes. 

Appropriate credentialing and certification are not only critical to the safety and well-being of consumers who are prescribed applied behavior analysis therapy by their licensed physician or psychologist, but also to the effectiveness of the intervention itself.

We strongly encourage you to continue to follow generally accepted standards of care and thus deny the petitioner's request to remove the specific requirement for BACB certification and accept certification from an entity that is nationally accredited to certify practitioners of behavior analysis.

Should you need additional information, please do not hesitate to contact me.

Sincerely,

Judith Ursitti

Vice President of Government Affairs