Pg. 161-162 of 333, “This service shall provide expertise, training, and technical assistance in any of the following specialty areas to assist family members, caregivers, and other service providers in supporting the individual. Therapeutic consultation may not include direct therapy provided to waiver individuals other than Behavioral Consultation. Therapeutic consultation services may not duplicate the activities of other services available to the individual through the State Plan. In particular, the case manager must first access consultation from physical therapists, occupational therapists, speech and language therapists through the State Plan when State Plan services are available to an individual. Virginia attests that no duplication of therapeutic consultation in the waiver and EPSDT services will be permitted and will ensure that each child has access to all services to which he/she is entitled through EPSDT.”

The requirement for, “the case manager must first access consultation from physical therapists, occupational therapists, speech and language therapists through the State Plan” is a barrier to accessing this waiver service, which is not a medical service, and only provides, “expertise, training, and technical assistance”; not direct therapy. Yet, the individual has to have medical necessity for direct therapy; the provider has to be licensed to provide direct therapy; and the authorization process that would require waiver providers to enroll in MCOs to provide direct therapy is identical to that of direct therapy. If all these conditions exist, then the individual can get their needs met by medical services under the state plan.

Like all HCBS waiver services, access to TC should not require meeting a higher level of medical necessity than the HCBS waiver service provides. Remove the requirement to first access consultation from the State Plan.