The Virginia Association for Behavior Analysis (VABA) submits the following comments regarding the Three Waivers (ID, DD, DS) Redesign, specifically Therapeutic consultation service:

• In general, and throughout, when behavior precedes analysis, it should be “behavior” rather than “behavioral”
• We support the adding of telephone consultation to allowable activities and suggest that HIPAA-compliant video consultation be added as well.  However, later in the service limits, telephone consultation should be removed from the list of in-kind services.
• For therapeutic consultation, the unit of service should be 15 minutes rather than one hour.  This would invite less confusion on what to do if the service was provided for less or more than one hour.  If service unit remains one hour, it is paramount that the rounding rules are specifically spelled out for providers.
• Behavior analysts are listed incorrectly in the description of who should provide behavior consultation.  In Virginia, BCBAs and BCaBAs are licensed and the regulations should reflect that.  Board Certified Behavior Analyst ® and Board Certified Assistant Behavior Analyst ® are copyrighted terms and must be listed correctly and with the registration mark if used. 
• The SIS should not be included in the documentation necessary for the individual’s record.  The SIS assessment does not tend to inform the treatment plan and would be accessible through the case manager.  In addition, therapeutic consultation providers may not be invited to the SIS or may not treat the client at the time when the SIS is being administered as it is only administered tri-annually.
• There should be more guidelines for the support plan to set standards and protect the waiver recipient.  Each profession should have different guidelines for the plan.  Behavior Consultation Plans should include the following at a minimum:
• Target behaviors and definitions; includes both behaviors targeted for reduction and replacement behaviors
• Results of functional assessment, including function, type of assessment, dates, location, who participated, etc.
• Behavioral objectives
• Baseline data (could be from assessment)
• Data collection methods
• Clear description of treatment methods for behavior reduction and skill acquisition including antecedent and consequence procedures/protocols for each target behavior
• Functional reinforcer is identified for each behavior targeted for reduction
• Possible reinforcers (results from preference assessment) and schedule of reinforcement for replacement behaviors
• Generalization and maintenance strategies
• Medical contraindication
• Crisis management (what to do when individual is not responding to the behavior plan and is a danger to self and/or others)
• Criteria for discharge
• Benefits and risks associated with treatment and for not receiving treatment
• Signatures indicating consent from team members and from individual/legal guardian
• The quarterly reports are actually due three months after the person-centered planning meeting, regardless of when consultation service began.  The portion on the writing of the quarterly report should be written more clearly to let providers know that they need to follow the same schedule.  In addition, all quarterly reports must include data in the form of charts, graphs, or other measures that show that the plan is effective, or if ineffective, how the provider plans to change the service to make it effective.
• Finally, Therapeutic Consultation, especially behavioral therapeutic consultation, should be an available service for the Building Independence waiver as well.