To Whom It May Concern:

The Virginia Autism Project (VAP) and Autism Speaks (AS) submit the following comments on the Emergency Regulations Governing the Practice of Behavior Analysis.  (18VAC 85-150-10 et seq, effective dates September 19, 2012 to September 18, 2013).

First, VAP and AS would like to thank the members of the Working Group and the  Board of Medicine for their methodical and careful consideration of the profession of Board Certified Behavior Analysts (BCBA® ) and Board Certified Assistant Behavior Analysts (BCaBA® )

The report that we have received from BCBAs in the Commonwealth of Virginia, is that the licensure application process is straight forward and efficient.  Thank you for the continued professionalism and attention to detail everyone has demonstrated in this difficult process.

Second, we present the following comments for deliberation:

• Section 18VAC85-150-130.  Supervision of unlicensed personnel.

This section has concerned many in the practice of behavior analysis.  The law defines the practice of behavior analysis to mean “the design, implementation, and evaluation of environmental modifications, using behavior stimuli and consequences, to produce socially significant improvement in human behavior; including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.”

“The formal training of professionals certified by the Behavior Analyst Certification Board, Inc. (BACB) is similar to that of other medical and behavioral health professionals. That is, they are initially trained within academia and then begin working in a supervised clinical setting with clients. As they gradually demonstrate the competencies necessary to manage complex clinical problems across a variety of clients and medical environments, they become independent practitioners. In summary, Behavior Analysts undergo a rigorous course of training and education and have an “internship” period in which they begin by working under the direct supervision of an experienced Behavior Analyst. “[1]

“The use of carefully trained and well-supervised Behavioral Technicians* [*unlicensed professional and/or students training to become licensed professional] is a common practice in ABA treatment.  The use of Behavioral Technicians enables health plans and insurers ensure that they maintain adequate provider networks and deliver medically necessary treatment in a way that manages costs.   The use of Behavioral Technicians produces more cost-effective levels of service for the dura­tion of treatment because it allows the Behavior Analyst to manage more cases/hours of direct treatment.  The use of the tiered service delivery model permits sufficient expertise to be delivered to each case at the level needed to reach treatment goals. This is critical as the level of supervision required may need to shift rapidly in response to rapid client progress or demonstrated need.   Tiered service delivery models can help ensure that treatment is delivered to families in hard to access rural and urban areas as well as families who have complex needs.”[2]

VAP and AS have been assured that the language of 18VAC85-150-130 will not endanger the use of supervised unlicensed individuals or students training to become licensed professionals in the implementation of Behavior Treatment Plans.  

Finally, as we go forward with implementation of Virginia’s insurance mandate and then the subsequent filings for reimbursement from insurance providers, it will be important to monitor this section on the supervision of unlicensed personnel.  If for any reason it is used as a tool to deny reimbursement for behavior analysis to families, the Board of Medicine must act swiftly to clarify the intent of the regulations to follow the medical model of billing for the services performed under the larger umbrella of the licensed professional.

Respectfully submitted,

Teresa L. Champion,

President,

Virginia Autism Project

teechamp@gmail.com

Judith Ursitti,

Director, State Government Affairs

Autism Speaks

Judith.Ursitti@autismspeaks.org