To those it concerns,

I would like to address concerns I have with the most recent CPT billing code proposals and outline some of the damage it could do the relatively new field of Applied Behavior Analysis. A field founded on evidence-based interventions which serves a rapidly expanding population of individuals with a broad range of needs.

I am an active Board Certified Behavior Analyst (BCBA) licensed by the Virginia Department of Health Professionals. I work alongside a statewide team of BCBAs/LBAs and BCaBAs/LABAs with two BCaBAs/LABAs working directly with me in our Richmond location. I have provided ABA services to families across the state of Virginia for the past 6 years from Buckingham County, to Gloucester, to Tappahannock, to Petersburg, and my hometown of Richmond City.

Becoming either a licensed behavior analyst or licensed assistant behavior analyst in the state of Virginia requires candidates to engage in an extensive and rigorous process including coursework, 1,500 or more supervised experience hours practicing under a credentialed BCBA, and then pass the BCBA or BCaBA exam before applying with the earned credentials and becoming licensed. All these elements are the products of multiple boards and bodies of professionals from the field and related fields. Groups like the Association of Behavior Analysis International and their chapters support the development and verification of the very coursework which is required for becoming a behavior analyst or assistant behavior analyst. The Behavior Analytic Certification Board (BACB) outlines the content certified clinicians are expected to know and embody in their practice, creates the examination provides guidance for determining the scope of practice of behavior analytic service providers. The Department of Health Professionals at the Virginia Board of Medicine licenses those who are able to demonstrate that they meet and maintain the required qualifications.

I have grown accustomed to adapting and transforming the way I practice this service in accordance with the ever-developing research and guidance provided by the organizations that govern the field. However, after reviewing the most recent edition of the billing code proposal for ABA services, I found that it includes problematic language that, if implemented as written in the draft, will likely have far-reaching consequences for the practitioners and families it serves. The language within the draft indicates that certain services will no longer be able to be funded if provided by many of my licensed colleagues. I believe that these changes, if enacted, will result in a wide array of consequences which affect my ability and that of my colleagues to provide the evidence-based, high-quality services to our clients. Given my experience and the credentials I have in the field of ABA, I feel it is my role to present why it is so imperative that these proposed changes be considered with more scrutiny due to the threat they pose to the continued success ABA services provide in the communities they serve.

Based on my understanding of the draft, the proposed change that presents the most dramatic threat is the addition of the qualifying descriptions which appears to exclude Licensed Assistant Behavior Analysts (LABAs) from being able to provide the services with the CPT codes of 97151, 97155, 97156, 97157, and 97158 even if they are supervised by a Licensed Behavior Analyst. Presented below is an abridged list of the possible harm that making this change might do.

1. The immediate impact of a change like the one listed above would certainly be felt by the current LBAs and LABAs. The application of behavior analytic principles to address and improve the behavioral and mental wellbeing of the individuals we served requires a commitment to provide diligent and routine attention to each client they agree to serve. If we shift towards limiting the roles certain practitioners can complete, then these roles will fall on the remaining individuals who are able to be compensated for these services. This could increase the burden on LBAs by immediately increasing the services they must complete without the assistance of the LABAs who they depend on within a team-based, tiered approach to service delivery.
2. The effect of the proposal on those who are currently receiving or who are candidates for ABA services would also be vast. While not representative of all the diagnoses addressed by ABA practitioners, a great deal of the clients served have been diagnosed with Autism Spectrum Disorder and the population of individuals with this diagnosis or similar diagnoses has swelled exponentially since its identification and classification. The current waitlist for individuals seeking access to ABA services is extensive and this change will likely result in its expansion. Further reducing the accessibility of these services by decreasing the individuals able to provide essential services and consequently increasing the burden on the remaining clinicians would most likely only serve to delay these individuals and families from benefiting from these time-sensitive interventions.
3. Lastly, the governing bodies have outlined the ethical, procedural, and scientific guidelines for how practitioners in the field of ABA should shape their service delivery. The existing and past publications of the billing code literature also refers to these groups as the ones who should be considered responsible for defining the scope of an ABA clinician. This proposal would mean that a funding source would be assuming a position where it also determines the clinical scope of credentialed and licensed practitioners.

The language and execution of this contract should be the product of a collaboration. The current proposal for the soon-to-be-implemented codes does not meet that standard. Additionally, Given the trajectory of an ever-expanding need, it seems short-sighted to limit the number of individuals able to address it. Especially when considering that those willing to do so are extensively trained and regularly supervised, well-educated, have passed an examination (which is notoriously difficult), and have become certified by the Behavior Analytic Certification Board and licensed by the Virginia Board of Medicine. It is my opinion that this proposal undermines the certification and licensing boards which govern the practice of ABA in Virginia by beginning to redefine the scope of practice for its professionals, creates the conditions for licensed professionals to be overburdened and threatens the quality of service their teams are able to provide given the current and growing needs, and would likely only serve to exacerbate the already difficult experience individuals seeking services currently endure.

Thank you,

Christopher R. DuVall, MEd, BCBA, LBA