Behavior Analysis and Distance Supervision in Virginia

There have been a lot of questions lately about distance supervision.

According to the Board of Medicine, supervision of LABAs, students, and unlicensed persons (typically RBTs, which are not formally recognized by the Board of Medicine) must be “live” and “person-to-person” but not “in person.” Therefore, it is acceptable to supervise via video as long as it is HIPAA compliant, synchronous (not recorded earlier), and the supervisor can see the supervisee and the client.  Of course, it is necessary that anyone practicing (including supervising) behavior analysis in Virginia MUST be licensed by the Board of Medicine.

Whether it is allowable by law is a different question than whether it is reimbursable. Check with your private insurers to see what supervision practices they cover. With regard to Medicaid:

DMAS defers to the appropriate DHP regulatory board for clinical supervision requirements. Licensed providers should contact their appropriate regulatory board for guidance on whether clinical supervision can be provided remotely.

Within the CMHRS Manual, Behavioral Therapy supplement (08/22/2018), on Page 15 DMAS specifies that clinical supervision shall be required for Medicaid reimbursement of Behavioral Therapy services rendered by a LABA, LMHP-R, LMHP-RP, or LMHP-S. Clinical supervision must be consistent with the scope of practice as described by the applicable Virginia Department of Health Professions (DHP) regulatory board. Supervision of unlicensed staff shall occur at least weekly by the licensed supervisor. As documented in the individual’s medical record, supervision shall include a review of progress notes and data and dialogue with supervised staff about the individual’s progress and effectiveness of the ISP. Supervision shall be documented by, at a minimum, the contemporaneously dated signature of the licensed supervisor. Supervision time is permitted to be billed simultaneously with direct care staff billing.

Assessments and review of the ISP must be conducted face to face by the LMHP, LMHP-R, LMHP-RP, LMHP-S, LBA or LABA.

Within the CMHRS Manual, Behavioral Therapy supplement (08/22/2018), on Page 12, assessments must be done face-to-face with both the child and family prior to starting services. Assessments must be updated at least annually. The manual further specifies on Page 21, documentation of the review of the ISP and supervision with the family conducted face to face at a minimum of once every three months to observe the child and family interaction, review clinical data and adjust the ISP as necessary;

Please email admin@virginiaaba.org if you have any questions. You are also welcome to email cccpluscmhrs@dmas.virginia.gov with specific questions about delivering Behavioral Therapy Services covered by Medicaid.

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