The proposed draft regulations may negatively impact clients who are exclusively receiving in-home services through the following two proposed changes:

• Eliminating supervision of unlicensed staff without the client present as a billable activity
• Eliminating treatment planning as a billable activity

Supervision without the client present is necessary for in-home work. Each family served brings unique challenges, requiring extensive supervision that should not be limited to time spent with the client. The requirement for supervision to be completed in the presence of the client may lead to the choice of the following: placing the client/family in an uncomfortable situation in which their dignity is not protected or specific and necessary treatment decisions going undiscussed in a timely manner between licensed and unlicensed staff.  Please consider allowing supervision of unlicensed staff without the client/family present as a billable activity.

As mentioned, working in-home brings unique challenges. These challenges require ongoing oversight and data analysis and frequent changes to treatment plans.  These are necessary components of an LBA’s ability to effectively target adaptive and challenging behavior that cannot be solely completed in the presence of a client.  Exclusion of treatment planning as a billable activity may lead to less individualized treatment and less effective treatment.  Please consider allowing treatment planning and data analysis as a billable activity.

Home-based services are essential in providing quality behavior analytic services. Unintended consequences of the proposed regulation changes may impact the benefits of home-based services: 

• Generalization of skills
• Caregiver training
• Working in the most natural setting
• Providing services to those who cannot access a clinic or other specialized centers.

Please consider allowing ongoing treatment planning, data review, and supervision as billable activities.