The Virginia Office for Protection and Advocacy frequently represents parents and children in their quest for behavioral therapy services (including Applied Behavior Analysis (ABA)) through Medicaid’s EPSDT program.  Our office is hopeful that new regulations will make it easier for our clients to find appropriate behavioral therapy services.  To that end, we offer the following two comments as suggestions for the content of the proposed regulations, based on our office’s experiences with requests for behavioral therapy services for children.

First, the new regulations should ensure appropriate licensure and certification of providers of behavioral therapy services to children.  Recently, the Commonwealth of Virginia began licensing Board Certified Behavior Analysts (BCBAs).  Identification and enrollment of those newly licensed BCBAs as providers will help ensure ABA services are appropriate, available, and standardized.  Of course, other qualified providers should be authorized to provide other behavioral therapy services.

Second, the regulations should include a mechanism for an evaluation or development of a plan of care before the provider requests service approval through the Letter of Medical Necessity process, to ensure the child’s behavioral therapy needs are appropriately addressed.