I appreciate the opportunity to share our perspective on the proposed revisions to Virginia Medicaid’s ABA policy. I recognize the importance of responsible oversight, clear clinical standards, and appropriate utilization of Medicaid services. However, these goals must be balanced with the realities families and providers face, including diagnostic waitlists, workforce shortages, geographic limitations, and the need to preserve continuity of care.

• The requirement for an in-person comprehensive diagnostic evaluation (CDE) is a great concern. Virginia already has communities where families struggle to locate qualified diagnosing professionals. Requiring an in-person evaluation in every circumstance does not create more diagnosing providers. It simply makes an already scarce resource harder to access. DMAS should establish a clear exception allowing an appropriate telehealth diagnostic evaluation when an in-person provider is not reasonably available, with safeguards and criteria established by DMAS.
• The same principle should apply to initial ABA assessments. Virginia Medicaid currently requires initial assessments to be conducted in person. When no qualified BCBA or other permitted clinician is reasonably available in the member’s area, telehealth should be an available exception rather than leaving the child without a pathway to treatment.
• Evidence-based diagnostic tools should be specified as examples, not an exclusive list. This language will allow diagnosing providers to use the tools according to individuals' needs.
• The 20-hour weekly limit also requires careful implementation. The General Assembly’s language itself provides that the 20-hour limit may be exceeded based on documented medical necessity under EPSDT. DMAS should therefore implement 20 hours as a threshold for additional clinical review, not as a practical ceiling on care. When a child’s clinical circumstances support more intensive treatment, there must be a clear, reasonable, and meaningful process for obtaining those medically necessary hours.
• DMAS should also provide continuity protections for members already receiving ABA services under a provisional or other diagnosis previously accepted by the program. Changes in eligibility criteria should not abruptly interrupt established treatment. Existing members should have a reasonable transition pathway that allows treatment to continue while updated diagnostic requirements are satisfied. DMAS should also provide sufficient advance notice of the policy’s effective date so providers and families have a meaningful opportunity to obtain any newly required diagnostic evaluations and documentation without disrupting ongoing care.
• DMAS should remove the 31-consecutive-day discharge requirement. A lapse in services should not automatically trigger discharge and require a new assessment, ISP, and authorization before treatment can resume. Instead, providers should be permitted to add an addendum to the existing treatment plan documenting the reason for the lapse and obtain Care Manager approval to determine whether a new assessment and service authorization are necessary.

Virginia’s children should not have to be less complex, live closer to a provider, or require fewer hours of care for the system to work for them. The policy should be built around the realities of the children Medicaid serves, not require those children to fit within its limitations.

Thank you.