Become a Therapeutic Consultation Provider

Want to help the many individuals who are currently have DD and ID Waivers?  LBAs and LABAs can do this through Therapeutic Consultation.  These individuals are generally adults, but may be children and adolescents as well.

According to the manual (emphasis added): “Therapeutic Consultation provides expertise, training, and technical assistance in any of the following specialty areas to assist family members, caregivers, and other service providers in supporting the individual. The specialty areas are: a. Psychology; b. Social Work; c. Therapeutic Recreation; d. Speech and Language Therapy; e. Occupational Therapy; f. Physical Therapy; g. Rehabilitation Engineering; h. Psychiatry; i. Psychiatric Clinical Nursing. and j. Behavioral Consultation”

The currently allowable activities are:

  1. Interviewing the individual, family members, caregivers, and relevant others to identify issues to be addressed and desired outcomes of consultation;
  2. Observing the individual in daily activities and natural environments and observing and assessing the current interventions, support strategies, or assistive devices being used with the individual;
  3. Assessing the individual’s need for an assistive device for a modification or adjustment of an assistive device, or both, in the environment or service, including reviewing documentation and evaluating the efficacy of assistive devices and interventions identified in the therapeutic consultation plan;
  4. Developing data collection mechanisms and collecting baseline data as appropriate for the type of consultation service provided;
  5. Designing a written therapeutic consultation plan detailing the interventions, environmental adaptations, and support strategies to address the identified issues and desired outcomes, including recommendations related to specific devices, technology, or adaptation of other training programs or activities. The plan may recommend training relevant persons to better support the individual simply by observing the individual’s environment, daily routines, and personal interactions;
  6. Demonstrating (i) specialized, therapeutic interventions; (ii) individualized supports; or (iii) assistive devices;
  7. Training family/caregivers and other relevant persons to assist the individual in using an assistive device; to implement specialized, therapeutic interventions; or to adjust currently utilized support techniques;
  8. Intervening directly, by behavioral consultants, with the individual and demonstrating to family/caregivers or staff such interventions. Such intervention modalities shall relate to the individual’s identified behavioral needs as detailed in established specific goals and procedures set out in the ISP; and
  9. Consulting related to person centered therapeutic outcomes, in person or over the phone.

How do you become a Therapeutic Consultation provider with DBHDS?

  1. First, create a login at https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/WebRegistration.
  2. Click on the Provider Enrollment tab (upper right) and begin an application. Choose Developmental Disability Waiver.  Note the phone number at the top of the screen (888-829-5373) and contact them if you have any specific questions.  You may also email VABA at admin@virginiaaba.org with any questions.
  3. The questions should be self-explanatory. You will need to enter your NPI number.  If you do not have one, you can apply for one using your license here: https://nppes.cms.hhs.gov/NPPES/Welcome.do
  4. Make sure that your name matches your NPI. If you are using an individual NPI number, you should use an individual name and social security number, not a company name and TIN.
  5. When asked about the service you wish to provide, choose “Therapeutic Consultation.”  If you already provide other waiver services, check those services as well – even though you were previously approved, because the system will reset.

Congratulations!  It’s that easy!  But it may take a month or so to become approved.

Once approved, work with your local CSB to get cases.  You will need to use WAMS for authorizations and to add in your service plan.  WAMS is not a very intuitive system, although there is a user guide.  To set up a login, call the Support Line: 844-4-VA-WaMS (844-482-9267).

DBHDS has issued a guidance document on writing goals for ISPs for those with the DD waiver.  This applies to Therapeutic Consultation and any other DBHDS licensed service for waiver recipients.

To learn more about the service, read the manual by going to “Provider Resources” and choosing the “Individual and Family Developmental Disabilities Waiver Services” manual.  For specific information on Therapeutic Consultation, see Chapter IV Covered Services and Limitations.  But there is important info in the rest of the manual as well, especially with regard to billing.

The code for this service is 97139 and is billed per hour at the following rates: those in Northern Virginia – $92.85/hour; those in the rest of the state – $87.75/hour.  To bill you use the same Medicaid portal where you registered and click on the Claims heading.

For a good Web site that has general information on the DD waiver, go to http://www.mylifemycommunityvirginia.org/.

For information on the autism and behavioral competencies, click here.

Finally for more information, log into our member page and see the Webinar on this subject (from Sept 2020)

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