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The General Court of the State of Massachusetts is currently entertaining two licensing measures which would regulate practitioners and the practice of applied behavior analysis within the state.
H.B. 181 and S.B. 47, would impose criminal penalties on anyone practicing ABA without a license. These bills establish two levels of practitioner, at the doctorate and master’s levels, and define the scope of practice of ABA to include conducting ABA-based therapy, as well as planning and supervision services. Bill Histories show that both H.B.181 and S.47 are currently in the Joint Committee on Consumer Protection and Professional Licensure
H.B. 181: An Act relative to the licensure of applied behavior analysts.
and
S. 47: An Act relative to the licensure of applied behavior analysts. would create the professional titles of,
- “Licensed Independent Applied Behavior Analyst (LIABA)”, an individual who by training and experience meets the requirements for licensing by the board and is duly licensed to practice independent applied behavior analysis., and
- "Licensed Applied Behavior Analyst (LABA)", an individual who by training and experience meets the requirements for licensing by the board and is duly licensed to practice applied behavior analysis.
as well as create a nine member separate professional licensing board - seven members to be drawn from the Licensed Applied Behavior Analysts of both levels and two members would be selected as representatives of the public.
Both bills describe in some detail the proposed operations, powers and duties of the licensing board, defines the scope of practice of applied behavior analysis, the qualifications and requirements of those applying for a license - which initially includes receipt of certification by the Behavior Analyst Certification Board, supervision competencies, responsibility to clients and colleagues, safeguards and penalties.
The bills state that the measures would not prevent specified members of other professions from doing work of an applied behavior analytic nature consistent with standards of their professions, but that they cannot present themselves to the public implying that they are applied behavior analysts or are licensed to practice applied behavior analysis.
In relation to special education the Massachusetts Department of Education would develop standards and implement policy necessary to include the profession of applied behavior analysis as a "related service provider".
For more information
General Court of the Commonwealth of Massachusetts
© 2010 Regina G. Claypool-Frey
Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.
On Sunday, March 21, 2010 the U.S. House of Representatives passed by a vote of 219 to 212,
H.R. 3590 Patient Protection and Affordable Care Act which is the Senate version of health care reform that was originally passed by the Senate on December 24, 2009. H.R. 3590 is scheduled to be signed into law by President Obama on March 23, 2010 at 11:15 AM EDT.
Within minutes of the passage of H.R. 3590, the House also passed by a vote of 220 to 211 a reconciliation bill,
H.R. 4872, Reconciliation Act of 2010 which encompasses amendments to H.R. 3590 proposed by the House. The U.S. Senate still has to deliberate and approve H.R. 4872; it is required to commence those deliberations after H.R. 3590 is enacted into law by the President's signature, to allot at least 20 hours of debate to the matter, and due to technicalities the reconciliation bill requires only a simple majority for passage. The Senate calendar shows deliberation on H.R. 4872 commencing Tuesday, March 23, 2010 at 2:15PM EDT, although it is possible that could change.
H.R. 3590 does include a behavioral health provision for mental health and substance abuse treatment, however behavior analysts are not listed among those providers explicitly identified for reimbursement as part of a treatment team. It has also been noted by Autism Votes that the behavioral health clauses as enacted do not have sufficient reach to benefit more than a relative minority of families seeking ABA services, since this coverage is not required for all plans excepting,
(1) plans offered by state-based exchanges, through which individuals and small businesses can purchase coverage; and
(2) plans offered in the individual and small group markets outside the exchange.
The Arc struck a more optimistic note in changes that it sees as improvements in coverages, benefits and Long-Term Supports for those with developmental disabilities.
The reconciliation act, H.R. 4872 makes additional specification for covered professionals, under,
TITLE K--PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE
Sec. 1308. Coverage of marriage and family therapist services and mental health counselor services.
National Public Radio has produced a report outlining what would be "immediate" impacts vs. those which would be coming online in several years time, such as the 2014 requirement for all the requirement that all Americans acquire health insurance or face a fine. Another NPR story describes potential state Attorney General challenges to the legislation on the grounds that penalties for not having individual coverage and state requirements under the mandate are unconstitutional.
News reports and analysis will undoubtedly continue over the coming days clarifying the relative strengths and weaknesses of the enacted legislation, with some dependency on the outcome of the Senate actions yet to occur on H.R. 4872.
News and reports of interest
Obama to sign health care reform into law, then promote it on the road
CNN
March 23, 2010 -- Updated 0736 GMT (1536 HKT)
After Obama signs health care reform bill, why mess with reconciliation?
The Christian Science Monitor
March 23, 2010
States Opposed To Insurance Mandate Prepare Lawsuits
Scott Hensley
National Public Radio health Blog
March 22, 2010 3:15PM
The Arc Applauds House Passage of Health Care Reform Legislation
3/22/2010
Washington, D.C. (March 22, 2010) - Press Release
Describes changes that The Arc sees as positive in coverages, benefits and Long-Term Services and Supports for those with developmental disabilities
U.S. House Passes Health Care Reform Bill Containing Provision For Autism Insurance Reform
Autism Votes
Autism Votes describes coverage gaps for those with autism, even given some behavioral health coverage in the legislation and the need to continue advocacy at the state and Federal level.
What Are The Immediate Effects Of Health Bill Passing?
Julie Appleby and Kate Steadman
March 21, 2010
© 2010 Regina G. Claypool-Frey
Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.
A news report states that two bills have been reported favorably from the Massachusetts Joint Committee on Children, Families and Persons with Disabilities and are now headed to the Massachusetts Senate.
The bills are,
S. 45: An Act relative to Level IV Treatment Interventions,
and a companion bill,
S. 46: An Act Creating a Special Commission on Behavior Modification
S. 45 would classify and define detailed oversight of Level IV treatment interventions (those utilizing aversives as a last resort for dangerous or self-destructive behaviors which have failed to be resolved under less intrusive interventions) in facilities receiving public funding,
- at the state level by a statewide committee of specific composition,
- at a facility level by a facility peer-review committee of specific composition, and would require
- direct supervision and physical presence as specified in the bill.
Standards of procedures, safeguards, required documentations, competencies of the committees and supervisors, and scope of use are defined in S.45.
S. 46 would establish a special commission to investigate and make legislative recommendation on the adequacy and effectiveness of laws and and regulations governing use of behavior modification techniques, including aversive procedures and the principles of applied behavior analysis across all public or private agencies in Massachusetts receiving public funding, including state agencies and contracted providers.
After its investigation, the commission would develop and recommend a unified set of standards for the use of behavior modification procedures in all agencies and programs licensed, funded and/or regulated in Massachusetts. The standards would include the minimum qualifications for staff involved in the development and direct implementation of aversive procedures and the review and monitoring requirements for such interventions. The commission is also required file a report the results of the investigation and recommendations with the clerks of the Massachusetts Senate and House of Representatives by a specified date.
The composition of the commission would be the following state officers or designees:
Governor, Senate President, Speaker of the House, Senate and House Chairs of the Joint Committee on Children and Families, the Chief Justice of the Probate and Family Court. the Commissioner of the Department of Developmental Services, the Commissioner of the Department Mental Health , the Commissioner of the Department of Early Education and Care, the Commissioner of the Department of Elementary and Secondary Education, the Commissioner of the Department of Children and Families, the Commissioner of the 26 Department of Youth Services, the Executive Director of the Disabled Persons Protection Commission, the Chairman of the Governor’s Commission on Mental Retardation, the Executive Director of the Massachusetts Psychological Association, and a Licensed Applied Behavior Analyst or Certified Behavior Analyst to be appointed by the Governor. The Governor would also appoint at least one disability advocate and one service provider whose agency conducts behavioral intervention programming.
For further information
Two shock therapy bills headed to Senate
GateHouse News Service
Posted Mar 16, 2010 @ 09:00 AM
General Court of the State of Massachusetts
© 2010 Regina G. Claypool-Frey
Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.
Below is a press release from the U.S. Department of Justice announcing a request for a preliminary injunction against the Conway Human Development Center in Conway, AR. The filing, besides its own stated merits, provides a case study on several grounds: the nature of the points made in the DOJ's filing and prior discovery; the background of lack of appropriate training in and application of behavioral assessment and intervention for both behavior management and re/habilitative purposes; allegations of violation of FAPE/IDEA; what constitutes appropriate standards of care and ethical professional practice; the discussion of Federal statute and prior case law in application of certain techniques, monitoring and community-based care. Links in this post were added to press release text to simplify access to primary documents referenced.
-----------------------------
" Department of Justice
Office of Public Affairs FOR IMMEDIATE RELEASE Tuesday, March 9, 2010 Justice Department Files for Immediate Relief Regarding Conditions at Conway Human Development Center, in Conway, Arkansas
The Justice Department today asked the Federal District Court for the Eastern District of Arkansas to take immediate action to prevent children from being admitted to the Conway Human Development Center(CHDC) in Conway, Ark. The department’s motion for preliminary injunction aims to prevent the segregation of children with developmental disabilities in dangerous conditions and to address accusations of imminent and serious threats to the safety of the facility’s more than 500 current residents.
In January 2009, the Justice Department filed a complaint against the State of Arkansas to enforce the federal requirement that individuals with disabilities be served in the most integrated settings appropriate, and to remedy unconstitutional conditions at CHDC. Information collected through discovery since the filing of the complaint has led the department to conclude that residents face increasing and grave risk of harm with each day that deficiencies are ignored, and that Arkansas fails to serve individuals in the most integrated setting appropriate to the residents’ needs.
The United States has concluded that children at the facility are particularly vulnerable given allegations that CHDC residents are subjected to dangerous medication mismanagement and harmful, unnecessary restraints. In recent years, at least three CHDC residents have died, suffered possible permanent organ damage or been at risk of hemorrhaging to death because of psychotropic medication mismanagement. CHDC also continues to utilize 41 different forms of mechanical restraints on both children and adults, including straitjackets, restraint chairs and papoose boards - practices that have been largely barred from other facilities for years.
"The State has a responsibility to ensure the safety of individuals who reside in state-run facilities, and we must act swiftly when the state does not live up to that responsibility," said Thomas E. Perez, Assistant Attorney General in charge of the Civil Rights Division. "Individuals with developmental disabilities have the right to live in the most integrated setting appropriate to their needs, and states must take swift action to ensure that all individuals are accorded these basic rights." In addition to barring inappropriate restraints and requiring safeguards to prevent dangerous medication practices, the motion seeks to require that the state remove barriers to the provision of supports and services in the community, so that individuals with disabilities, including the approximately 50 children at CHDC, are not forced to choose between an unsafe institution and the denial of necessary services in a more integrated setting.
Between June 1, 2007, and Oct. 1, 2009, a CHDC resident was more likely to die than be discharged to a more integrated setting. On average, CHDC residents die at the age of 46.5 years, compared with the average age of 72 years for other individuals with developmental disabilities living in institutional settings. The number of individuals with developmental disabilities who are waiting to receive community-based services is on the rise in Arkansas, with over 1,300 currently waiting to receive services through the Centers for Medicaid and Medicare Services Alternative Community Services waiver program, with an average wait time of approximately two and a half years.
The Civil Rights Division is authorized to conduct investigations under the Civil Rights of Institutionalized Persons Act (CRIPA) and the Americans with Disabilities Act of 1990 (ADA). CRIPA authorizes the Attorney General to investigate conditions of confinement in certain institutions owned or operated by, or on behalf of, state and local governments. In addition to residential facilities serving persons with developmental disabilities, these institutions include psychiatric hospitals, nursing homes, jails, prisons and juvenile correctional facilities. The ADA authorizes the Attorney General to investigate whether a state is serving individuals in the most integrated settings appropriate to their needs. Please visit http://www.justice.gov/crt to learn more about CRIPA, the ADA and other laws enforced by the Justice Department’s Civil Rights Division. 10-242 Attorney General"
----------------------------- For reference, further reading
Selected briefs
Civil Rights of Institutionalized Persons Act Briefs
Developmental Disability and Mental Retardation Facilities Complaints - United States v. State of Arkansas (Conway Human Development Center)
United States v. State of Arkansas; The Honorable Mike Beebe; John M. Selig; James C. Green, Ph.D.; Calvin Price
Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services
© 2010 Regina G. Claypool-Frey
Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.
On February 16, 2010, the Wisconsin Office of the Commissioner of Insurance Autism Treatment Working Group, the group charged with developing regulations from the statute, Section 632.895 (12m), Wis. Stat., held a meeting to discuss agenda items including,
- Review of Comments received at December 2nd (2009) hearing.
- Coverage amount required by insurers when a previous insurer has already provided autism treatment services as required under the mandate.
- Discussion on training/supervisory requirements the rule places on Speech Language Pathologists and Occupational Therapists.
- Legislation to include coverage for services provided by Board Certified Behavioral Analysts (BCBAs).
Currently the regulations are of an emergency and interim basis. It was noted on the audio minutes of the meeting that one more extension is allowed by law before working rules are required to be completed.
The audio minutes of the meeting stated that the December (2009) public comment to rulemaking period resulted in many responses requesting that BCBAs to be approved as providers, and questions about the interaction of the insurance mandate with the existing Children's Long-Term Support Home and Community-Based Medicaid Waivers (CLTS Waivers).
A large portion of the meeting centered around the relationship of intensive vs. nonintensive service, behavioral vs. nonbehavioral services, and the requirements of providers identified in the bill to provide intensive services at the competencies specified in the statute. It was noted that there may be an insufficiency of providers with training to provide intensive behavioral therapy within the scope of practice of current license, and that some licensed providers had reservations about being supervised by other licensed providers from outside of their professional area. Some discussion ensued on the complementary relationship of behavioral therapists, SLPs and OTs in a therapeutic team.
The audio transcript is informative and educational the process and deliberation brought to bear in the development of regulation resulting from passage of statute, the balancing act of meeting conditions of law as well as the needs of the client and professional constituencies and, in this situation, the input resulting from the public hearing of the interim regulations.
Unfortunately the transcript suspended at the point where there was to be a discussion of regarding the introduction of legislation to amend the statute to include Board Certified Behavior Analysts as authorized providers, but the inclusion of this as an agenda item, as well as the comments about the public response is suggestive that such a development is possible in the near future.
The agenda for the February 16, 2010 meeting suggests that the next meeting of the Working Group will occur in April, 2010.
For more information
Wisconsin Office of the Commissioner of Insurance Autism Treatment Working Group
Memo from the Office of the Commissioner of Insurance dated 22 September 2009
Section 632.895 (12m), Wis. Stat. (12m) TREATMENT FOR AUTISM SPECTRUM DISORDERS.
OCI FREQUENTLY ASKED QUESTIONS ON MANDATED COVERAGE FOR AUTISM SERVICES
"This FAQ is presented for informational purposes only. It does not carry the full force and effect of the law."
Document links to statute and emergency rule.
Frequently Asked Questions About How The Autism Insurance Mandate Affects Children Participating in the CLTS Waivers
WISCONSIN: Frequently Asked Questions About the Autism Insurance Reform Law
Autism Votes
WI Autism Insurance - Updates from Elvis Sightings blog
Blog of a parent who is tracking these events in Wisconsin
'Huge hole' in Wisconsin's autism coverage mandate
Wisconsin State Journal
By MATTHEW DeFOUR mdefour@madison.com 608-252-6144 | Posted: Sunday, November 29, 2009 5:50 pm
© 2010 Regina G. Claypool-Frey
Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.
The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury on January 29, 2010 issued the awaited interim final rules [ http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf ] resulting from passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The notice/press release below outlines changes resulting from the passage of MHPAEA, and requests comment during a comment period of 90 days on certain areas of the interim final rules. While the notice/press release is retained in full, some areas have been highlighted and bulleted to emphasize important areas of the law's requirements, areas that comment are being requested for, how to submit comments on the MHPEA interim rules, and how to request materials in an alternative accessible format. ---------------------------------------- Paul Wellstone, Pete Domenici Parity Act prohibits discriminationWASHINGTON, Jan. 29 /PRNewswire-USNewswire/ -- The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury today jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders. "Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," said U.S. Secretary of Labor Hilda L. Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That is not just sound policy, it's the right thing to do."
"The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care," said Secretary of Health and Human Services Kathleen Sebelius. "I applaud the longstanding and bipartisan effort that made these important new protections possible."
"Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment," said Deputy Treasury Secretary Neal Wolin. "These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need." The new rules prohibit group health insurance plans — typically offered by employers — from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits. The new law requires that - any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.
- These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits.
- For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits. They must be calculated as one limit.
- MHPAEA applies to employers with 50 or more workers whose group health plans choose to offer mental health or substance use disorder benefits.
- The new rules are effective for plan years beginning on or after July 1, 2010.
The Wellstone-Domenici Act is named for two dominant figures in the quest for equal treatment of benefits. The late Sen. Paul Wellstone, D-Minn., who was a vocal advocate for parity throughout his Senate career, sponsored the ultimately successful full parity act. He was joined by former Sen. Pete Domenici, R-N.M., who first introduced legislation to require parity in 1992. Champions of the legislation also included the bipartisan team of Rep. Patrick Kennedy, D-R.I., and former Rep. Jim Ramstad, R-Minn. The issue of parity dates back more than 40 years to President John F. Kennedy, and also was supported by President Clinton and the late Sen. Edward Kennedy. The released interim final rules released today were developed based on the departments' review of more than 400 public comments on how the parity rule should be written. Comments on the interim final rules are still being solicited. - Sections where further comments are being specifically sought include so-called "non quantitative" treatment limits such as those that pertain to the
- scope and duration of covered benefits,
- how covered drugs are determined (formularies) and
- the coverage of step-therapies.
- Comments are also being specifically requested on the regulation's section on "scope of benefits" or continuum of care.
Comments on the interim final regulation are due 90 days after the publication date. Comments may be emailed to the federal rulemaking portal at http://www.regulations.gov. - Comments directed to HHS should include the file code CMS-4140-IFC.
- Comments to the Department of Labor should be identified by RIN 1210-AB30.
- Comments to the Treasury's Internal Revenue Service should be identified by REG-120692-09.
- Comments may be sent to any of the three departments and will be shared with the other departments.
- Please do not submit duplicates.
U.S. Department of Labor releases are accessible on the Internet at http://www.dol.gov. The information in this news release will be made available in alternate format (large print, Braille, audio tape or disc) from the COAST office upon request. Please specify which news release when placing your request at 202-693-7828 or TTY 202-693-7755. The Labor Department is committed to providing America's employers and employees with easy access to understandable information on how to comply with its laws and regulations. For more information, please visit http://www.dol.gov/compliance. SOURCE U.S. Department of Labor RELATED LINKS http://www.dol.gov------------------------------------ For more information:Federal Register: Tuesday, February 2, 2010Part IV: Department of the Treasury, Internal Revenue Service, 26 CFR Part 54 Department of Labor, Employee Benefits Security Administration, 29 CFR Part 2590 Department of Health and Human Services, Centers for Medicare & Medicaid Services, 45 CFR Part 146 Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Final Rule http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdfGood summary article of the rules release, application and comment submission Registration required to access. Interim rule issued on mental health parityModernHealthcare.com
By Jessica Zigmond
Posted: January 29, 2010 - 5:59 am ET© 2010 Regina G. Claypool-Frey
Disclaimer: This blog publishes news and announcements only as a service to interested persons, the posts are the responsibility of the individual author, and unless otherwise noted do not constitute nor claim to represent the official position of ABA International, its officers or associated entities. This blog makes no representation as to the accuracy of the report and readers are strongly encouraged to consult and reference the primary sources noted.
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