Hello, my name is Eli Newcomb and I am a behavior analyst who oversees the provision of a number of behavioral services. There are some areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts. Often behavioral therapy run by non-licensed individuals looks more like counseling or behavior modification and not the more specific discipline and practice of ABA. It is confusing to group multiple and different professions as one, and the distinction is necessary, as ABA has been a well-established discipline for nearly a half century. 

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual. This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual. ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting. The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am a Board Certified and Virginia Licensed Behavior Analyst working with families throughout the Northern Virginia area.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

David Mittermaier, M.A., BCBA, LBA
Owner
Capital ABA, LLC

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am a Board Certified Behavior Analyst and Licensed Behavior Analyst in Virginia.  I am a current Medicaid provider and manage a team of providers.  EPSDT Behavior Therapy coverage is utilized by many of our past and current patients. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Hello,

Thank you for allowing the opportunity for comments so that community providers may help improve the quality and access of services for individuals in our commonwealth. To better assist individuals and families in building skills to support behavior and skill deficits in at-risk eligible populations, I would like to highlight the following:

While ABA therapy is a behavioral therapy, all behavioral therapy is not ABA. Individuals and organizations searching for appropriate services may confuse these, and since the standard of practice differs between ABA and behavior therapies, the distinction between the two fields is necessary to ensure the correct application of services.

ABA includes generalization in treatment, meaning that when done correctly, it is a "real life" intervention. This occurs across settings, and should not be limited to just the home setting. Social skills and behavioral strategies taught in the home should also be able to be practiced out in the community with others, in the natural environment. Sometimes a controlled setting such as a center is most helpful, to establish skills first. Limiting the locations available for services limits progress for the individual.

ABA is always individualized, but with clinical oversight by an LBA, there are many times when group treatment could be beneficial as well. Individuals that require peers to practice skills are not able to routinely get access to each other with the current regulations in place as written.

"Sessions for family support" may be considered vague, and as EPSDT mandates parent training (a "support" for families), this sometimes occurs without the client present to allow the parent to practice strategies in the treatment plan before implementation by the family.

Many individuals eligible for EPSDT services may benefit from an interdisciplinary approach, such as those who have a developmental diagnosis and co-morbid PTSD or other trauma, or a co-morbid mental illness. This population currently has to choose whether he/she gets treatment for skill deficits, or the co-morbid disorder, which often goes back and forth, making it unlikely that the individual will ever demonstrate enough progress to be eligible for discharge. Making both services available could help shorten the length of treatment for these individuals significantly.

Many individuals who would benefit from ABA services are not eligible due to age. Please consider extending coverage past age 22 years old to assist those who have fewer service options available to him/her.

Thank you for taking time to consider my comments. 

Sincerely, 

Hannah Robicheau, M. Ed., BCBA VA-LBA

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am Barry Chlebnikow Ed.D., Director of Education at the Virginia Institute of Autism.  Over the past 40 years I have served children in public and private schools as a classroom teacher and school leader.

There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Hello, my name is Ethan Long and I am the Executive Director of the Virginia Institute of Autism. The Virginia Institute of Autism is a nonprofit organization devoted to helping children, adults, and famlies overcome the challenges of autism. We utilize evidence-based interventions based on the principals of applied behavior analysis to serve approximately 200 families per week. There are some areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts. Often behavioral therapy run by non-licensed individuals looks more like counseling or behavior modification and not the more specific discipline and practice of ABA. It is confusing to group multiple and different professions as one, and the distinction is necessary, as ABA has been a well-established discipline for nearly a half century. 

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual. This may be a clinic, the community, a social group, or the home, or  any other place that meets the needs of the individual.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting. The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the Individual Service Plan. 

Thank you for the opportunity to comment. Ethan Long

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  My name is Matthew Osborne, and I am a Licensed Behavior Analyst (#0133000366) who provides ABA therapy to children and adults diagnosed with ASD. The proposed changes will significantly impact both the quality and the availability of ABA therapy for individuals diagnosed with autism who have met medical necessity to receive ABA therapy. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Sincerely, 
Matthew

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am Megan Valentine, BCBA LBA and I am the Regional Director of ABA Therapy program in Northern Virginia.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

4. ABA therapy does not end at age 21. For most, if not all of our clients, need us more than ever after age 21. There is continued need to treat developmenatal delays that impact a persons ability to live a more independent and meaningful life well into their adult years. And with the wait list for access to Medicaid Waviers, many individuals do not get the help and support they need until they are well into their late teens or early 20s. We are losing an entire group of individuals that could benefit from ABA services due to the long DD wait list and then compounded by the age restriction of under 21. I urge you to please look into increasing the age to 22 and over to maximize the benefit of services to adults. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment. 

Megan Valentine, BCBA, LBA

Compass Counseling Services of NOVA

Regional Clinical Director

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am [fill in personal information about why this is important to you – your credentials, your Medicaid provider status, etc.].  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am Nikia Dower, MS, CCC-SLP/L, BCBA, LBA.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am a licensed behavior analyst, and I work with teenagers and young adults with Autism and related disabilities in the school setting. Several of my students need additional services outside of the school day in order to reach their goals and improve their quality of life. The EPSDT waiver is a major factor in which services they can access. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to commment on the proposed changes.  I am a PhD-level Board Certified Behavior Analyst and Director of Clinical Services for our Agency.  I am proud that we provide center-based, in-home, and community-based Applied Behavior Analysis services.  

A few notes on ways in which changes to the way EPSDT covers ABA are suggested for your review: 

1. ABA and  Behavioral therapy are NOT the same.  Thus, they should be seperate treatments and ABA should be guided by the DHP regulations, which governs behavior analysts.  The certification overseen by the DHP ensures that the national requirements by the Behavior Analyst Certification Board function as a minimum standard and protects the practioner and consumer.  It is inappropritae to lump professions together both because of the obvious differences in certification requirementsand and it would cause confusion to the consumer, as well.

2. The location of services should be determined by the professional, i.e., the BCaBA/BCBA/BCBA-D.  For some individuals, that might be in the home, the community, a center or a combination thereof.  However, an important consideration is the licensure of center-based services, which is not currently available. 

3.  Similarly, ABA can be provided individually or in small groups, and that determination should be made, also, by the professional.  

Revising regulations is a tedious process.  Thank you for taking the time to review my comments.  

Katie Topham, PhD, BCBA-D, LBA

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  My name is Jamie Bass and I'm a BCBA and LBA who provides ABA therapy to adolescents and young adults with developmental disabiltiies. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. This is especially important to the individuals I serve, as they could benefit from social skills training in a group setting rather than 1:1. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am Tiffanie Johnson, and I am a BCBA and LBA who works with individuals of all ages. Our company currently provides center-based, in-home, and community-based Applied Behavior Analysis services.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on the proposed regulation changes.

• There is a very big difference between ABA as provided by a someone with training, certification and licensing in this specific field and someone doing behavior therapy who has training in counseling for a wide range of issues. The Commonwealth of Virginia recognizes the expertise in ABA as provided by Board Certified Behavior Analysts and has licensed them to do this. To entrust this to providers with less knowledge and experience is to do a disservice to a very fragile population.
• ABA is typically provided within the home setting when that is where most of the individual's time is spent, but then expands out to the community where we hope that individual will be able to interact for the rest of his/her life. Occasionally we need to address some issues outside of the home in an environment which is more conducive to learning and then generalize that learning back to the home and community.
• ABA is also typically provided in a one-to-one setting as an individual is learning new skills, which are then generalized to a setting in which they can access other people. Some of the training should be in a group setting with the amount of support needed to be successful.

 

Thank you for the opportunity to comment on EPSDT changes that concern behavior therapy.  I am Julie Barndt, BCBA, LBA and provide behavior analytic services for children and adolescents with autism. My practice accepts all payor types including Medicaid.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy are not the same treatments and  properly separated. ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time. Due to significance of social deficits that are part of an autism diagnoses, it is essential to treat social deficits in the context of behavior analytic therapy which can only be done in situations in which social interactions with peers is likely. Often times parents are not able to provide social opportunities for their child in their home.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. It is important that children with all levels of need are able to access behavior analytic therapy that is helpful to them and this includes individuals who may only need assistance in social interactions and don’t necessarily require the intensity of a 1:1 intervention. 

Overall, necessary changes should be made so that an appropriate person-centered approach can be utilized as deemed necessary by the licensed clinical professional.

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment. 

My name is Byron Wine and I am VP of Operations at the Faison Center in Richmond. The Faison Center consists of a school, adult day program, residential program, and behavioral health clinic that serves approximately 250 individuals per day. I would recommend a few changes to the way EPSDT covers Applied Behavior Analysis (ABA).

ABA and Behavioral Therapy are not interchangeable terms and ABA should be guided by the DHP regulations governing behavior analysts. Behavior therapy is a nebulous term used by several different licensed and unlicensed professionals. To a lay audience though these terms sound alike and can lead to confusion.

ABA often takes place where the client is having difficulties. As such, ABA should not be limited by location, but the services should be provided in the location that is determined most appropriate by the behavior analyst. 

ABA may be delivered individually or to groups of clients. The behavior analysts should be able to decide, from a comprehensive assessment of the presenting problem, if one-to-one or group therapy is most appropriate.

Thank you, Byron Wine

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am a licensed behavior analyst and the agency that I work for serves a wide range of clients in school, clinic, and community settings.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

Thank you for the hard work that has gone into revising these regulations, I appreciate the opportunity to comment.

 

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am a Board Certified Behavior Analyst, Licensed Behavior Analyst, and provide services as a behavior analyst to Medicaid Beneficiaries  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Autumn Keener, M.Ed., BCBA, LBA

Thank you for your dedication to revising the regulations. I am a licensed behavior analyst at The Faison Center where we provide services to individuals across the lifespan. I would like to comment on the EPSDT changes that concern how the EPSDT is covering Applied Behavior Analysis services.

First, ABA and Behavioral Therapy are two separate treatments. ABA is guided by the Virginia Department of Health Professions regulations governing behavior analysts. Behavioral Therapy and ABA are distinct and should not be lumped together. Second, the provision of ABA should not be limited by location. Services should be person-centered and therefore occur in the setting most appropriate to the needs of the individual. These locations may include a clinic, center, community, home, social group or any other place where the behavior of interest may occur. Last, ABA is provided in 1:1 and group settings. As above, a person-centered approach requires that the services be provided according to the needs of the individual. Therefore, if a group setting may be the most appropriate, then it should be permitted. 

Thank you again for your efforts in revising these regulations and for your attention to this comment. 

 

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am Danielle Damico and I am a BCaBA at Youth and Family Services The ASSET Program.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am Matthew White and am a Licensed Assistant Behavior Analyst and have been working in EPSDT services for the past 6 years.  I have been impressed by the previous changes that have happened under EPSDT in the past as I have found them to be beneficial for the treatment of our clients.  The addition of the Board of Medicine regulations have assisted in improving services provided as well.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.
2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, the home, or other place that is most conducive to learning. Generalization programs will allow providers to teach acquired skills back into the home and community.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.
3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP

I appreciate the dedicated work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

There is irreparable harm being done to clients with autism in treating this condition with EPSDT modalities.  We have experienced clients treated with Behavioral Therapy modalities (EPSDT counseling) who's previous provider has not been properly trained (or no training) in Applied Behavior Analysis and damaged the progess of the client.  ABA and EPSDT should be separated and ABA treatment provided under DHP guidelines for this client group. 

 

Type over this text and enter your comments here. You are limited to approximately 3000

Thank you for the opportunity to comment on EPSDT changes that concern behavior. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.
2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, the home, or other place that is most conducive to learning. Generalization programs will allow providers to teach acquired skills back into the home and community.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.
3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP

I appreciate the dedicated work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.
2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, the home, or other place that is most conducive to learning. Generalization programs will allow providers to teach acquired skills back into the home and community.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.
3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP

I appreciate the dedicated work that has gone into revising these regulations and thank you, again, for the opportunity to comment

Thank you for the opportunity to comment on EPSDT changes that concern behavior. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.
2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, the home, or other place that is most conducive to learning. Generalization programs will allow providers to teach acquired skills back into the home and community.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.
3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP

I appreciate the dedicated work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.
2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, the home, or other place that is most conducive to learning. Generalization programs will allow providers to teach acquired skills back into the home and community.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.
3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP

I appreciate the dedicated work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.
2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, the home, or other place that is most conducive to learning. Generalization programs will allow providers to teach acquired skills back into the home and community.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.
3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP

I appreciate the dedicated work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.
2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, the home, or other place that is most conducive to learning. Generalization programs will allow providers to teach acquired skills back into the home and community.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.
3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP

I appreciate the dedicated work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

Thank you for the opportunity to comment on EPSDT changes that concern behavior.  I am Dylan Markham, Program Supervisor for our Staunton office, which provides in-home ABA services.  There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA):

1. Differentiating between ABA and Behavioral Therapy is vital and ABA should be solely guided by the DHP regulations governing behavior analysts.  Behavioral therapy run by non-LBAs may look more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

2. ABA should not be limited by location; the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

A. Dylan Markham, MA, BCBA, LBA

Compass Counseling Services of VA

Connections Program Supervisor

 

Thank you for this opportunity to post comments on EPSDT Behavior Therapy:

1. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  Limiting location also limits the ability to bill DMAS/Magellan as a secondary payer, as the insurance mandate requires private insurance to cover ABA services.  Private insurance does not limit services by location.  

2. ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.  It is this analyst's professional opinion that DBHDS is the appropriate licensing agency, as was previously done.  DBHDS licensed ABA Outpatient facilities in the past; they ensured that appropriate codes for the facility were met (i.e. water temperature checks, emergency exits, emergency exit plans, fire safety plans and checklists completed), staffing regulations and backgrounds checks and licensces were met, and policies and procedures for health and safety and incident reporting were in place.  DOH is not the appropriate agency as we do not fit into "daycare facilities" and cannot meet those regulations while meeting insurance requirements.

3. In order to facilitate secondary claims, T codes would be beneficial.  Most private insurances are using T codes for authorizations and billing of claims.  It is difficult to process secondary claims through DMASMagellan when the primary payer is using T codes.

4. Almost all other medically necessary services can obtain an authorization through their primary insurance and then simply submit secondary billing to their secondary insurer.  With the current set up, there has to be two independent assessments and authorizations.  This is a duplication of our time and is costly to DMAS/Magellan.  It would be very helpful if Medicaid/Magellan would accept the primary insurances' authorization and we simply bill DMAS/Magellan as secondary without obtaining a second authorization.

5.  ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

6. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate this amazing opportunity to offer public comment and appreciate everything that you do for our community each day!!  Thank you so much, Lissa D. Hoprich, MA, BCBA, LBA

The opportunity to comment on the EPSDT Behavior Therapy townhall is greatly appreciated.

Please consider the following:

- Limiting ABA to the home severely limits the efficacy of the service. Services should be provided in the location that is most appropriate to the needs of the individual. This may be a clinic, community, social group, or other place that meets the needs of the individual.
- ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.

 

- ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP.

- ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

Clarification is needed regarding the following found in the proposal:

- The statement about a service specific provider intake being done face to face with the individual and guardian- obviously the individual should be part of the assessment, but conducting an interview alone with the guardian is also vital to the assessment process. This wording could be construed by Quality Assurance divisions as not allowing for this to occur.
- Completing an intake every 3 months- Quarterly reviews assess progress and the need to make changes to the treatment plan. This process includes a review of services and behaviors. What is the additional benefit of completing an entire intake instead?
- Section 8a references a “screening to identify physical, mental, or developmental conditions”. Is this referencing the DMAS 355 form? If not, clarification is needed.
- Section 8d states that family support and education are not allowable. Clarification as to the meaning of this language is needed as a major focus of the service is teaching and modeling for caregivers.

Section 11c references 2 areas of clarification:

i.“Documentation shall include activities provided, length of services provided, the individual’s reaction to that day’s activity . . . “- This last point regarding the individual’s reaction seems to move from the data driven model of ABA to a more subjective framework. An individual’s reaction is seen through the behaviors observed and data produced. The last point listed seems to open the door to statements such as “he enjoyed the activity, he became frustrated with the activity, etc.” which are not objective measures.

ii.“Documentation shall be prepared to clearly demonstrate efficacy using baseline and service-related data that shows clinical progress and generalization for the child and family members toward the therapy goals as defined in the service plan.”- Service plans are developed after a baseline is established. This wording does not provide for such time and staff obtaining baseline data in preparation of the plan would be documenting their efforts, but would not yet have a service plan to document against. 

Emily McClellan, Regulatory Supervisor

Policy Division, DMAS

600 E. Broad Street, Suite 1300

Richmond, VA 23219

 

Dear Ms. McClellan

 

The disAbility Law Center of Virginia (dLCV), Virginia’s designated protection and advocacy system for individuals with disabilities, appreciates the opportunity to comment on the action to define the parameters of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Behavioral Therapy Services.  We have a few concerns we hope that you can address.

Our first concern relates to Intensive in-home services (IIH).  We believe that the language gives the impression that the service is limited in ways that you do not intend.   In 12VAC30-50-130 (B)(b) you state that ‘(1) These services shall be limited annually to 26 weeks.’ As you are aware, while federal law allows states to limit services under EPSDT, medical necessity must be individualized and services must still be provided if determined to be medically necessary for an individual child.

The regulations acknowledge this in 12VAC30-50-130 (B)(6)(3) where you state:  ‘d. Service limits may be exceeded based on medical necessity for individuals eligible for EPSDT.’

The same issue arises in In 12VAC30-50-130 (B)(c) where you state: ‘c. Therapeutic day treatment (TDT) shall be provided two or more hours per day in order to provide therapeutic interventions. Day treatment programs, limited annually to 780 units.’

dLCV recommends adding ‘Service limits may be exceeded based on medical necessity for individuals eligible for EPSDT’ directly to the language of both the IIH and TDT sections, to minimize confusion

Our final concern relates to the new section 12VAC30-50-130 (B)(8) which defines behavioral therapy services. The section states: ‘c. These services shall be provided in settings that are natural or normal for a child or adolescent without a disability, such as his home, unless there is justification in the ISP, which has been authorized for reimbursement, to include service settings that promote a generalization of behaviors across different settings to maintain the targeted functioning outside of the treatment setting in the patient's residence and the larger community within which the individual resides.’

dLCV worked with children need behavioral therapy to return to a home or community setting. We have learned that children can’t get funding for the full amount recommended and are unable to request the additional amount through EPSDT because a child is in a residential placement.

The new language in 12VAC30-50-130 (B)(8) seems to suggest that behavioral therapy coverage outside of the home is possible, but our recent experience seems to indicate that is not always the case. dLCV requests clarification on this important issue.

dLCV appreciates the opportunity to comment on this important action and we look forward to your response on this matter. 

 

Sincerely,

 

Colleen Miller

Executive Director

Thank you for the opportunity to comment on EPSDT changes that concern behavior. I am a licensed behavior analyst and provide behavioral services to individuals diagnosed with ADD and other disorders. There are three areas where I think changes should be made to the way EPSDT covers Applied Behavior Analysis (ABA): 1. ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts. Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA. It is confusing to lump the professions together, and the distinction is necessary. 2. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual. This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual. ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time. 3. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting. The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. I appreciate the hard work that has gone into revising these regulations and thank you, again, for the opportunity to comment.

In regards to proposed regulation change H7 that specifies that "Clinical supervison shall occur at least weekly..." I am concerned that this change unintentionally usurps both the role of the Board of Medicine to set supervision standards and the judgement of the Licensed Behavior Analyst to set supervision requirements on a case by case basis.  In addition I am concerned that the unintended consequences of this rule change would be that fewer children would be served.  Why not just align the supervision rule with the current Board of Medicine standard?