App D: Page 37: Service limitations: “Services that are provided in the absence of the youth or a parent or other authorized caregiver identified in the ISP.”
ABA Treatment planning is a critical component of supporting clients in modifying socially significant behaviors. In the presence of the youth or parent/authorized caregiver, the LBA/LMHP provides training, supports interventions, and ensures protocol application and treatment integrity by technicians. When cases of severe maladaptive behavior occur during a program modification ABA service; the LBA/LMHP will not be able to adequately modify programs, create written protocols, or coordinate with other providers as their expertise will be need in directing the ABA team to appropriately support the client. These essential duties will need to be performed in the absence of the youth or parent/authorized caregiver to best support the youth. I advocate to make analysis of data, ISP revisions, development of new skill acquisition targets, and development of behavior intervention plans by BCBAs billable when a client is not physically present.
App D: Page 36: “Supervision of unlicensed staff shall occur at least weekly by the licensed supervisor”
Requiring a frequency of visits per week rather than a percentage per month could be detrimental to the supervisors scheduling ability to meet the needs of their clients.
Examples of when weekly supervision may not be needed: When an experienced behavior technician is working with a client, when a behavior technician whom is training to become a BCBA and requires 5% supervision regardless of frequency of visits is meeting that supervision requirement, or the client only receives services once per week (in which case supervision percentages would be exceeding recommendations from the BACB and ultimately using more units than medically necessary).
Examples of when more supervision may be needed more than once per week: A less experienced behavior technician may require more support, a client may engage in high frequencies of dangerous behaviors, or if a substitute RBT is covering a session for a client and is new to the team.
A percentage of time licensed staff supervise unlicensed staff per month (5%-20%) would be a more suitable requirement than a weekly frequency as different cases have different needs.
APP D: Page 37: “Group treatment should include no more than 3 youth”
This prevents generalization from therapy settings to natural environments (community sports programs, summer camps, schools, etc).As clients gain skills, they must be able to apply them in socially significant environments with realistic factors. This is not possible to do with only 3 children. A maximum of 10 youth would be more suitable.
APP D: Page 45-47: “Services in the chart below must be provided by a LBA or LMHP acting within their scope of practice”
A Board Certified Assistant Behavior Analyst is recognised by the Commonwealth of Virginia Board of Medicine. There are eligibility requirements to be under the mentorship and supervision of a LBA while practicing as an LABA. Therefore, a Licensed Assistant Behavior Analyst (LABA) should also be considered eligible to provide the services a LBA can provide.
97155 (protocol modification) code allows for simultaneous direction of technician - can this code and the 97153 (treatment by protocol) be billed concurrently?