This memo was released in July of 2025.  

Please keep in mind that rates will change from time to time. If you are not sure, go to  www.dmas.virginia.gov, click on the provider drop down menu, then click on rates and rate setting. Scroll down to the bottom and click on the most resent state fiscal year developmental disability waiver rates. Search for Therapeutic Consultation, Therapist/Behavior Analysts/Rehab. Engineers 97139 code to find the rates.

Therapeutic consultation service is covered in the Family and Individual Support and Community Living waivers. To qualify for therapeutic consultation service, the individual must have a documented need for consultation. This means that the ISP cannot be implemented effectively and efficiently unless this form of therapeutic consultation is authorized and provided. The need for this service must be based on the individual’s ISP and clinically necessary to the individual. Therapeutic consultation service may be provided in individuals’ homes, day support programs, and in other community settings, where they will facilitate implementation of individuals’ desired outcomes as identified in their ISP.

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, over the phone, or via video feed in accordance with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).

Therapeutic consultation may not be billed solely for purposes of monitoring the individual, nor for direct and ongoing therapy. Therapeutic Consultation for Speech, OT, and PT cannot be billed for the purpose of initial evaluations/assessments as this is covered under the State Option Plan.

Other than behavioral consultation, therapeutic consultation service may not include direct therapy provided to individuals enrolled in the waiver and may 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 staff in the presence of the individual.

For specific allowable activities and service limitations please review 12VAC30-122-550 Therapeutic consultation service

Before a telemedicine option is requested and/or authorized for an individual, the individual’s support team should assess and document the individual’s ability to be supported effectively via telemedicine. Justification for telemedicine being an appropriate service delivery modality is to be included in the individual’s person centered Individual Support Plan (ISP). 

Read more at the links below:

DD Waiver Telemedicine Information

Telemedicine Attestation

• For all services other than behavior consultation, ensure the service is consultative in nature. For example, hours requested for speech consultation, occupational therapy consultation, physical therapy consultation, recreation consultation, psychology consultation, and rehabilitation consultation are appropriate for a consultative need and are not direct therapy. Include in the justification that the services do not duplicate other services already provided.

• If speech consultation, occupational therapy consultation, physical therapy consultation, recreation consultation, psychology consultation, or rehabilitation consultation services are not consultative in nature, the State Plan option should be explored. Service Authorization request should include explanation of exploration and exhaustion, along with detail as to how or why therapeutic consultation for these services is the appropriate option through waiver.

• Incorporate the service need within the ISP, service authorization justification, and the benefits of the service to the individual.

• For behavior consultation: if the individual is 21 years or younger and direct therapy is included as a part of the service authorization request, identify in the justification if behavioral therapy (e.g., ABA) has been explored through State Plan option for Medical Assistance / EPSDT, along with the outcome. If the service is solely consultative with no direct therapy requested for an individual aged 21 or younger, exploring State Plan option / EPSDT does not need to be provided in the justification. If the individual is over 21 years of age, exploring State Plan option does not need to be provided in the justification, regardless of whether direct therapy is included in the service request or not.

How do you become a Therapeutic Consultation provider with DBHDS?

DBHDS has developed a training series on Navigating Therapeutic Behavioral Consultation for New Providers.  The following three-part video series and associated task analysis offers an overview to new providers to assist with provider enrollment, using WaMS, getting started with the service, and understanding the quality assurance and human rights expectations. 

• Part 1: Becoming a Therapeutic Behavioral Consultation Provider
  • Part 1 slide deck
• Part 2: Getting Started
  • Part 2 slide deck
• Part 3: Regulations and Guidelines
  • Part 3 slide deck
• Therapeutic Behavioral Consultation: Provider Enrollment Task Analysis

Visit the DBHDS Behavioral Services website for more information and resources.

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

Are you interested in providing services to waiver recipients through Therapeutic Behavioral Consultation?  Are you already doing so and would like some help?

DBHDS has provided several trainings related to Therapeutic Consultation. Click on the links below to access the training: 

• Part 1: Becoming a Therapeutic Behavioral Consultation Provider
  • Part 1 slide deck
• Part 2: Getting Started
  • Part 2 slide deck
• Part 3: Regulations and Guidelines
  • Part 3 slide deck
• Therapeutic Behavioral Consultation: Provider Enrollment Task Analysis

Skill-Based Treatment This training overviews the Skill-Based Treatment package along with variations of the process and troubleshooting; the training is an extension of the Practical Functional Assessment training below.  Slide deck available here. 

Introduction to the Practical Functional Assessment This training provides an overview of functional analysis procedures, with specific introductory information on the Practical Functional Assessment. Asynchronous continuing education certificate is not available for this training.  Slide deck for the training is available here.  

BSPARI Review Updates, September 2024 This video outlines the revise and resubmit process for BSPARIs not in adherence with the DBHDS/DMAS Practice Guidelines for Behavior Support Plans that began in October 2024. Behavior programs that are not in adherence are to be revised and resubmitted to DBHDS. The Q&A from this webinar is available here.  

Quality Reviews in Therapeutic Behavioral Consultation, November 2023 This training outlines the BSPARI and related feedback sessions, trend results of reviews, and on-target examples and resources, as of 11/2023.

BSPARI Trends, August 2022 This training outlines the purpose and nature of the BSPARI and related feedback sessions, trend results of reviews, and on-target examples and resources, as of 8/2022.

Introduction to Functional Behavior Assessment Training from West Virginia University on basics of functional behavior assessment (FBA).  

Advanced Functional Behavior Assessment Training from West Virginia University on advanced FBA.

Behavioral Skills Training  West Virginia University presents an overview on behavioral skills training. 

Advanced Behavior Support Planning Training from West Virginia University on advanced behavior support planning. 

Graphical Displays and Analysis: Plotting without Deception Part 1 The first part of a training from University of Cincinnati on graphing and analysis.  

Graphical Displays and Analysis: Plotting without Deception Part 2 The second part of a training from University of Cincinnati on graphing and analysis. 

Jump-Start Materials: (complete these fillable forms, and send as attachments)

• Assignment of Award – 6/13/25
• Application – 6/13/25
• Funding Program Information – 3/17/25
• Jump-Start Budget Form – 6/13/25

Effective 11/01/2018, LBAs have been added to the list of people who can conduct and assessment that would allow restraint or time out to be in a behavioral treatment plan.  Please note that plans that include restraint or time out must be submitted to an IRC (independent review committee) prior to implementation.  If you need help finding one of these or want to start your own, please contact VABA at admin@virginiaaba.org

Here is a link to the information on Town Hall

Below is the code language.  These regulations apply to those receiving services from providers licensed, funded, or operated by DBHDS (the Department of Behavioral Health and Developmental Services).

12VAC35-115-105. Behavioral treatment plans.

A. A behavioral treatment plan is used to assist an individual to improve participation in normal activities and conditions of everyday living, reduce challenging behaviors, alleviate symptoms of psychopathology, and maintain a safe and orderly environment.

B. Providers may use individualized restrictions such as restraint or time out in a behavioral treatment plan to address challenging behaviors that present an immediate danger to the individual or others, but only after a licensed professional or licensed behavior analyst has conducted a detailed and systematic assessment of the behavior and the situations in which the behavior occurs. Providers shall document in the individual’s services record that the lack of success or probable success of less restrictive procedures attempted or considered, and the risks associated with not treating the behavior, are greater than any risks associated with the use of the proposed restrictions.

C. Providers shall develop any behavioral treatment plan according to their policies and procedures, which shall ensure that:

1. Behavioral treatment plans are initiated, developed, carried out, and monitored by professionals who are qualified by expertise, training, education, or credentials to do so;

2. Behavioral treatment plans include nonrestrictive procedures and environmental modifications that address the targeted behavior; and

3. Behavioral treatment plans involving the use of restraint or timeout are submitted to an independent review committee, prior to implementation, for review and approval of the technical adequacy of the plan and data collection procedures.

D. In addition to any other requirements of 42 CFR 483.440(f)(3), providers that are intermediate care facilities for individuals with intellectual disabilities shall submit any behavioral treatment plan that involves the use of restraint or time out, and its independent review committee approval, to the SCC under 42 CFR 483.440(f)(3) for the SCC’s approval prior to implementation.

E. Providers other than intermediate care facilities for individuals with intellectual disabilities shall submit any behavioral treatment plan that involves the use of restraint or time out, and its independent review committee approval, to the LHRC, which shall determine whether the plan is in accordance with this chapter prior to implementation.

F. If either the LHRC or SCC finds that the behavioral treatment plan violates the rights of the individual or is not being implemented in accordance with this chapter, the LHRC or SCC shall notify the director and provide recommendations regarding the proposed plan.

G. Behavioral treatment plans involving the use of restraint or time out shall be reviewed quarterly by the independent review committee and the LHRC or SCC to determine if the use of restraint has resulted in improvements in functioning of the individual.

H. Providers shall not use seclusion in a behavioral treatment plan.

There are five regions for OHR.  Click the link to see where your area resides.

Note that BCBAs and BCaBAs actually do not fall under the current regulations since we are not licensed by DBHDS, but we work with providers who do.  Therefore, following these regulations are more of a best practice than a requirement.

The Department’s Office of Human Rights, established in 1978, has as its basis the Rules and Regulations to assure the rights of individuals receiving services from providers licensed, funded, or operated by DBHDS.  The Regulations outline the Department’s responsibility for assuring the protection of the rights of consumers in facilities and programs operated funded and licensed by DBHDS.

However, in 2017, Licensed Behavior Analysts were added to the list of professionals who can review a plan that includes time out or restraint.  See this link for more information.

DBHDS has a training designed specifically with behaviorists in mind. The training includes review of the Behavior Treatment Plans, Use of Restraint and Time-Out as it pertains to the HRR and licensed provider expectations. I linked it here: Overview-for-Professionals_Final.web_.pdf

Some tips:

When working with providers, make sure to pull back on the behavior analytic language to better communicate.  Especially be sure to translate acronyms

LHRC – Local Human Rights Committees: These committees look at provider plans in their area to be sure that the rights of the individual receiving services are being maintained.  A BCBA may be called upon to review such plans.  Or it may be necessary for a BCBA to have his/her plan reviewed by the committee.  Questions will not be about the clinical aspects of the plan, just the process.

Informed Consent – note that there is a sample in WAMS for providers of DBHDS services (such as Therapeutic Consultation)

Any Restrictions must be put in writing.  The behavior plan must be reviewed if it includes references to restraint or time-out.  Note that an IRC (internal review committee) would do a clinical review and the LHRC would do a process review.

The OHR defines restriction and restraint differently.  Restraint may only be applied if there is imminent harm.  Restraint must not be used for non-compliance, even if it is a non-negotiable task (something the individual is required to do, such as take their medicine).  The best practice for a restraint is to immediately release when there is no longer imminent harm.  OHR has specific forms to be used for restraints and restrictions.

It is important that behavior plans clearly define for providers (such as group home workers or day support workers) what tasks are non-negotiable.  In addition, if the provider will need to touch the individual for any reason, that should be defined as well.

BCBAs should also clearly document training to make sure direct service providers are not taking direction too far.  Make sure to know the physical intervention (Safety Care, MANDT, etc.) that the provider is using so that you can use that terminology in the plan.  Best practice is simply to refer back to the agency policy and not be specific.

Time out must also be clearly defined if not using the specified regulations definition.

Virginia requires that Medicaid Providers (Therapeutic Consultation and ABA for Medicaid) verify each month that they are not in the exclusions database.  This database is of providers, not organizations, so if you have several providers, you’ll need to verify for all.  Here is the link: https://exclusions.oig.hhs.gov/

Enter the name and then print/save as pdf the verification.  If you have a similar name to someone with an issue, there is a SSN option.

When addressing Identified Risks or Potential Risks included in the Individual Support Plan (ISP) Part V, therapeutic consultation clinicians should approach each risk as if it were occurring in their presence. This perspective helps ensure a clear, practical and effective response is outlined for each situation. All risks identified through the Shared Planning process in Part III must be addressed by all providers in Part V. Routine Supports is addressed on Page 5 of this document.

Click here to read more!