Current through Register Vol.. 38, No. 17, April 11, 2022
Service description. Therapeutic
consultation service means professional consultation provided by members of
psychology, social work, rehabilitation engineering, behavior
analysis/consultation, speech-language pathology therapy, occupational therapy,
psychiatry, psychiatric clinical nursing, therapeutic recreation, or physical
therapy disciplines that are designed to assist individuals, parents,
guardians, family members, and any other providers of support services with
implementing the individual support plan. This service shall provide
assessments, development of a therapeutic consultation support plan, and
teaching in any of these designated specialty areas to assist family members,
caregivers, and other providers in supporting the individual enrolled in the
waiver. The individual's therapeutic consultation service support plan shall
clearly reflect the individual's needs, as documented in the assessment
information, for specialized consultation provided to family/caregivers and
providers. Therapeutic consultation service shall be covered in the FIS and CL
A therapeutic consultation service support plan is the report
of recommendations resulting from a therapeutic consultation that is developed
by the professional consultant after he spends time with the individual to
determine the individual's needs in his area of expertise.
Criteria and allowable activities.
1. To qualify for therapeutic consultation
service, the individual shall have a documented need for consultation.
Documented need shall indicate that the ISP cannot be implemented effectively
and efficiently without such consultation as provided by this covered service
and approved through service authorization. The need for this service shall be
based on the individual's ISP and shall be provided to an individual for whom
specialized consultation is clinically necessary. Therapeutic consultation
service may be provided in individuals' homes and in appropriate community
settings, such as licensed or approved homes or day support programs, as long
as they are intended to facilitate implementation of individuals' desired
outcomes as identified in their ISP.
Allowable activities for this service
a. Interviewing the individual,
family members, caregivers, and relevant others to identify issues to be
addressed and desired outcomes of consultation;
b. 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
c. 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;
d. Developing data collection mechanisms and
collecting baseline data as appropriate for the type of consultation service
e. Designing a written
therapeutic consultation plan or a behavioral support 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;
f. Demonstrating (i) specialized, therapeutic
interventions; (ii) individualized supports; or (iii) assistive
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;
h. 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
i. Consulting related to person centered
therapeutic outcomes, in person , over the phone, or via video feed consistent
with in accordance with the requirements of the Health Insurance Portability
and Accountability Act (HIPAA).
Service units and limits.
1. The unit of service shall be one
2. The services shall be
explicitly detailed in the plan for supports.
3. Travel time and written preparation shall
be considered as in-kind expenses within therapeutic consultation service and
shall not be reimbursed as separate items.
4. Therapeutic consultation shall not be
billed solely for purposes of monitoring the individual.
a. Only behavioral consultation in the
therapeutic consultation service may be offered in the absence of any other
b. Initial requests
for behavioral consultation may not be authorized for more than 180
c. Behavioral support plans
will be submitted with subsequent authorizations as well as baseline data for
the initial request after assessment and then an annual summary of quarterly
data for re-renewals.
6. Other than behavioral consultation,
therapeutic consultation service shall not include direct therapy provided to
individuals enrolled in the waiver and shall not duplicate the activities of
other services that are available to the individual through the State Plan for
Medical Assistance. Behavior consultation may include direct behavioral
interventions and demonstration of such interventions to family members or
requirements. Professionals rendering therapeutic consultation service,
including behavior consultation, shall meet all applicable state licensure or
consultation shall only be provided by (i) a licensed behavior analyst or a
licensed assistant behavior analyst or (ii) a positive behavior supports
facilitator endorsed by a recognized positive behavior supports organization or
who meets the criteria for psychology consultation.
Psychology consultation shall only be
provided by the following individuals licensed in the Commonwealth of Virginia:
(i) a psychologist,
(ii) a licensed professional counselor,
(iii) a licensed clinical social
(iv) a psychiatric clinical
nurse specialist, or
consultation shall only be provided by a speech-language pathologist who is
licensed by the Commonwealth of Virginia.
4. Occupational therapy consultation shall
only be provided by an occupational therapist who is licensed by the
Commonwealth of Virginia.
Physical therapy consultation shall only be provided by a physical therapist
who is licensed by the Commonwealth of Virginia.
6. Therapeutic recreation consultation shall
only be provided by a therapeutic recreation specialist who is certified by the
National Council for Therapeutic Recreation Certification.
7. Rehabilitation consultation shall only be
provided by a rehabilitation engineer or certified rehabilitation
documentation and requirements.
shall include signed and dated documentation of the following in each
A copy of the
completed age-appropriate assessment as detailed in 12VAC30-122-200
The provider's plan for supports per
requirements detailed in 12VAC30-122-120
A written therapeutic consultation support
plan detailing the recommended interventions or support strategies for
providers and family/caregivers to better support the individual enrolled in
the waiver in the service.
support plans will contain the following information, at a minimum:
(i) demographic information,
(ii) person-centered information,
(iii) history and rationale,
(iv) functional behavior assessment,
(v) behaviors targeted for
functions of behavior,
proactive strategies and antecedent interventions,
(viii) replacement behaviors and behaviors
targeted for increase;
consequence interventions (when indicated),
(x) safety and crisis guidelines (when
(xi) any additional
recommendations (linkages, etc.), and
(xii) appropriate signatures and plan for
Documentation of who was trained on the plan and when and where should be
maintained and a plan for ongoing training should be determined.
d. Ongoing progress note
documentation of rendered consultative service that may be in the form of
contact-by-contact or monthly notes that must be contemporaneously signed and
dated, that identify each contact including location and recipient of training
activities, the amount of time spent on the activity, what was accomplished,
and the professional who made the contact and rendered the service.
If the consultation service extends three
months or longer, written quarterly reviews that are completed by the provider
and forwarded to the support coordinator. If the consultation service extends
beyond one year or when there are changes to the plan for supports, the plan
for supports shall be reviewed by the provider with the individual,
individual's family/caregiver, as appropriate, and the support coordinator and
shall be submitted to the support coordinator for service authorization, as
(1) For behavioral therapeutic
consultation, the quarterly review shall include graphed data and a summary of
(2) For behavioral
therapeutic consultation, the annual review shall include graphed or tabled
data that is trended across the first three quarters.
f. All correspondence to the individual and
the individual's family/caregiver, as appropriate, the support coordinator,
DMAS, and DBHDS.
progress note documentation of contacts made with the individual's
family/caregiver, physicians, providers, and all professionals concerning the
signed and dated final disposition summary that is forwarded to the support
coordinator within 30 days following the end of this service and that includes:
(1) Strategies utilized;
(2) Objectives met;
(3) Unresolved issues; and
(4) Consultant recommendations.
documentation shall support all claims submitted for DMAS reimbursement. Claims
for payment that are not supported by supporting documentation shall be subject
to recovery by DMAS or its designee as a result of utilization reviews or