Ethical and uniform practice of behavioral therapy should absolutely be of utmost concern for all our practitioners. So should be the individualized, quality care of the clients we are serving. One of my primary concerns after reading the proposed regulations is that we are moving toward a more “cookie-cutter” style of treatment-planning, with a higher expectation to provide the same quality of services that we currently are providing when given more leeway to appropriately serve our clients. Home-based behavioral therapy is often serving the most severe, remote, and isolated cases, who cannot access services in other ways due to concerns with safety (because of severity of interfering behaviors) or means (we often are serving clients who have no access to WiFi, reliable transportation, and who are unsure where their next meals are coming from, etc). These cases require more intentional and frequent treatment planning and updates, observation, data review, supervision, and care coordination to achieve positive outcomes - all activities that are necessary and of course required through these proposed regulations but are also not accounted for in the billing codes - at least not at the extent to which they will be necessary to provide appropriate services to these clients while considering their unique and complex environmental situations. How do you propose we provide quality services for these most-severely impacted cases if we as licensed practitioners are not being supported to do so? This will surely lead to less individualized treatment planning, that does not fit a client/family’s specific needs, and less effective behavior change overall, and thus ultimately higher costs for the state long term to care for that individual when that child’s needs for behavior therapy have not been met in their youth.

Also, I have been a practicing LABA in clinic and home-based services for nearly a decade, and have endured multiple changes to the DMAS regulations. While the iterations of these regulations over the years have always been a difficult transition for BCaBAs/LABAs, never have they appeared to be in direct opposition to the BACB, as these proposed regulations appear to be. My years of training and experience, paired with my degree, license-specific certification education, and fieldwork experience hours have consistently solidified to the BACB – my field’s certification board – my proficiency and ability to treatment plan, train parents and caregivers, and supervise unlicensed staff, so long as I am meeting my own necessary supervision requirements under a licensed LBA. These proposed regulations suggest that this is all insufficient and are in direct contradiction to the requirements set forth by the BACB itself. Please reference the most recent task list for BCaBA/LABAs: https://www.bacb.com/wp-content/uploads/2020/05/170113-BCBA-BCaBA-task-list-5th-ed-.pdf

It is my understanding that neighboring states, such as Maryland, have added some provisions for supervision and treatment planning for each client. These are crucial activities for the ethical, individualized, and quality implementation of our science to promote behavior change for our most severely impacted clients. And isn’t that what we’re all trying to achieve here?