UPDATE on Autism Insurance Reform (1.17.2012)

June Update

Virginia required a license for Board Certified Behavior Analysts (BCBAs) and Board Certified Assistant Behavior Analysts (BCaBAs) to practice Applied Behavior Analysis (ABA) in Virginia.

The process for developing the regulations included a Working Group of 3 BCBAs and a BCaBA as well as a consumer and two doctors. The Working Group met 3 times to develop draft regulations.

The original proposed draft regulations which staff introduced to the group were amended by the Working Group. The original proposed draft was not acceptable to the Working Group because it would have prevented unlicensed but supervised individuals from delivering ABA services. The working group listened to input from the public and BCBA professionals. They drastically changed the regulations to ensure the continued right to practice and supervise in Virginia. They amended the regulations and among other things, tied the licensure and renewal to the national certification board, the Behavior Analysts Certification Board (BACB). Equally as important and pivotal for the profession, they restored the supervision of trained, unlicensed individuals by BCBAs and BCaBAs.

These draft regulations were then presented to the full Board of Medicine on Thursday, June 21, 2012. The Board of Medicine ignored the Working Group proposed regulations, the public comment of the professionals, providers and family members and reverted to the staff’s original draft of the regulations, which was not voted on or approved of by the Working Group.

At this time, the proposed regulations from the Board of Medicine would not allow unlicensed but supervised therapists to deliver ABA in Virginia which would shut down the current services to children on the autism spectrum in Virginia.

This has sweeping implications for schools, Tricare beneficiaries, service providers, DMAS and anyone that uses unlicensed but supervised behavior therapists to provide ABA therapy. ABA therapy for children with autism is typically provided by trained behavior therapists or para-professionals under the supervision of licensed therapists. This service model is accepted by the federal government, the Tricare military insurance program, and the majority of commercial insurance carriers in almost 30 states around the nation.

  • There are currently about 300 licensed BCBA therapists in Virginia.
  • There are about 20,000 children with autism in Virginia.
  • A direct-care therapist can service roughly 3-4 children per week.
  • Assuming the above figures, Virginia would have to have 6,000 therapists to meet the existing need.

We are very concerned about the BOM’s lack of consideration for the Working Group’s recommendations for the regulations that will govern the BCBA and BCaBA profession.

We are especially concerned because the regulations say that unlicensed people who are supervised by licensed behavior analysts cannot practice ABA. The definition of ABA covers all things that both certified and non certified individuals would do. The current wording would prohibit students in VA from completing fieldwork to become board certified and it would also prohibit certified behavior analysts from training others to implement behavior analytic techniques. But most concerning of all is the fact that thousands of children with a diagnosis of autism in Virginia and countless others that receive behavior analytic services stand to lose care they are already receiving, or will be denied care they need.

There are several more steps through which these proposed regulations need to go. Ultimately they will end up with the Governor for his approval. Stay connected with the Virginia Autism Project on Facebook https://www.facebook.com/VirginiaAutismProject and Twitter @VaAutismProject. JOIN OUR MAILING LIST and tell other BCBA and BCaBA professionals to contact Megan Miller, M.S. BCBA at millermegan.mm@gmail.com

We have a lot of work yet to do- but we won’t back down!

February 8, 2012

Governor McDonnell signed HB 1106 into law on February 7. The Virginia Autism Project would like everyone to thank the Governor and their Legislators!

Click here to send Governor McDonnell a Thank You Note!

Remind him HB 1106 is the technical fix for the autism law so that families may access benefits provided by insurance for ABA therapy after a license for BCBAs is in place.

Thank Delegate Greason: DelTGreason@house.virginia.gov

You can find out who your legislators are at Richmond Sunlight and then contact them to thank them for their support.

With much appreciation for everyone’s hard work!

Thank Autism Speaks!

Judith Ursitti Judith.Ursitti@autismspeaks.org

Lorri Unumb lorri.unumb@autismspeaks.org

Thank our Lobbyists!

Angie Bezik abezik@principle-advantage.com

Anne Flandermeyer annflan@principle-advantage.com

January 31, 2012 Status Update:

HB 1106 passed out of the Senate Monday with a resounding 40-0 vote.

The families and providers in the Gallery were recognized by Senator Janet Howell as she introduced the bill. Although it was initially voted on in the Uncontested Calendar, a technical malfunction required a separate vote.

The next step is to await the Governor’s signature!

Please take a minute to thank your Senator for voting for HB 1106:

Richmond Sunlight allows you to identify your Senator and contact them via email.

Thank You Everyone!

January 28, 2012 Status Update:

HB 1106 flew out of Senate Education and Health Committee unanimously. The Senate waived the first reading of the bill and the Second reading was Friday. On Monday, January 30, 2012, HB 1106 will be on the uncontested calendar and hopefully the Senate will pass the measure with little or no fanfare.

Senator Janet Howell is ready to defend the bill if someone raises any questions and she conformed her bill to the House bill.

After the bill passes the Senate, it goes to the Governor for his signature and the 280 day clock will start running.

January 17, 2012 Status Update:

Huge accomplishment today (one of many more to go).

HB 1106 as introduced was amended after discussions with the Governor’s staff and the insurance industry. KEY provisions of the amended draft as agreed:

  • Emergency Clause: Regulations within 280 days.
  • A Working Group rather than an Advisory Board: made up of 3 BCBAs who have been practicing at least 3 years; one BCaBA practicing at least 3 years, one consumer or family member and no more than 2 others that the Board of Medicine may deem it necessary to appoint.
  • This Working Group will draft regulations to regulate BCBAs, BCaBAs and the supervision of unlicensed individuals providing ABA.

HB 1106 was passed out of the House Health, Welfare and Institutions committee on Tuesday, January 17, 2012 with a 21-0 vote.

Wednesday, Thursday and Friday the bill will be on the Floor of the House of Delegates for First Reading, Second Reading (debate) and Third Reading (vote).

We are very grateful to Delegate Greason and the members of the House Health, Welfare and Institutions committee for their support of children with a diagnosis of autism and their families.


  • Thank the members of the committee for their “yes” vote.
  • Contact all the Delegates and be present on Thursday for the debate and Friday for the VOTE!

WE must have 80 votes to keep our emergency clause and regulations within 280 days. Keep pushing!!


The bill that passed in the Virginia 2011 legislative session required insurance coverage of treatment and therapy including Applied Behavior Analysis, (ABA) for children ages 2-6 on the Autism Spectrum.

At the last minute the Governor added an amendment to our bill, which has delayed the implementation of the ABA coverage.

The Governor’s amendment to license Board Certified Behavior Analysts (BCBAs) in Virginia was determined by the Attorney General’s office to be inadequate to authorize the Board of Medicine to write the regulations to govern the licensure. Thus, under the current law the way it is written, it is impossible to have ABA reimbursed by insurance.

The law had a mandate that the insurance companies prepare to provide coverage on January 1, 2012. The key therapy (ABA) will not be covered and families are once again facing out of pocket expenses that they cannot hope to afford.

Insurance companies have built the cost of covering this therapy, as mandated by the bill, into their premiums for the 2012 policy year. They are pocketing that amount without having to pay for the therapy.

The 2012 legislative session has to FIX the law with language that will either authorize the Board of Medicine to act to promulgate regulations to license BCBAs in Virginia or altogether remove the licensure provision from the bill.

The Virginia Autism Project is coordinating efforts with our Patrons to properly implement this law.

Next Steps:

January 11, 2012 First day of Legislative Session

  • Stay Tuned for Autism Legislative Day plans (date to be announced)
  • Delegate Tag Greason and Senator Janet Howell are each introducing bills to fix the technical issues presented by the Governor’s amendment to our bill in the last session.
  • BCBAs, BCaBAs, Providers and Families: JOIN OUR MAILIING LIST and receive ACTION NOTICES
  • DONATE to the Virginia Autism Project to help us pay for expenses to implement the law.

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