Title of Regulation: 12VAC35-220. Certification Requirements for Early Intervention Professionals and Early Intervention Specialists (amending 12VAC35-220-10, 12VAC35-220-30, 12VAC35-220-50, 12VAC35-220-80, 12VAC35-220-90; adding 12VAC35-220-35).

Statutory Authority: § 2.2-5304 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: August 28, 2013.

Effective Date: September 12, 2013.

Agency Contact: Catherine Hancock, Part C Administrator, Department of Behavioral Health and Developmental Services, 1220 Bank Street, Richmond, VA 23218-1797, telephone (804) 371-6592, FAX (804) 371-7959, or email catherine.hancock@dbhds.virginia.gov.

Basis: Section 2.2-5304 of the Code of Virginia authorizes the Board of Behavioral Health and Developmental Services to promulgate regulations and adopt the policies and procedures as necessary to implement an early intervention services system. Chapter 890 of the 2011 Acts of Assembly (Budget Bill Item 304 Q) requires the Department of Behavioral Health and Developmental Services, in consultation with the Department of Medical Assistance Services, to promulgate regulations to certify early intervention case managers to provide case management services to Medicaid and FAMIS children enrolled in early intervention services provided under Part C of the Individuals with Disabilities Education Act (IDEA) of 2004.

Purpose: These regulations provide specific requirements for certification of early intervention case managers under Virginia's early intervention services system, as required by Public Law 108-446 and the standards established in 42 CFR 431.51. Section 2.2-5304 of the Code of Virginia designates the department as the state lead agency responsible for implementing Virginia's early intervention services system and ensuring compliance with the applicable federal requirements. The goal of these regulations is to ensure the competence of early intervention case managers under the authority granted to the lead agency. The regulations also provide the basis for the department to certify qualified individuals to coordinate the early intervention services and supports provided to children and their families and allow these individuals to receive reimbursement for the coordination services provided under the Medicaid State Plan § 1902a (42 USC § 1396a). The department consulted with the public, providers, and other state agencies, including the Department of Medical Assistance Services, in developing these regulations.

Rationale for Using Fast-Track Process: The regulations (i) provide practitioners the opportunity to qualify for Medicaid reimbursement and (ii) reflect federal and state requirements. Nearly 390 individuals have been certified as early intervention case managers under emergency regulations that became effective February 1, 2012. The Virginia Interagency Coordinating Council supports adoption of permanent regulations.

Adoption of permanent regulations will permit individuals providing care coordination for the early intervention service system to pursue certification and allow currently certified early intervention case managers to continue receiving reimbursement for services performed and to accumulate the additional educational credentials required for certification renewal.

Substance: The substantive provisions of the regulation include:

1. A definition of early intervention case management and a requirement for specified providers of this service under the Medicaid State Plan to be certified by the department;

2. Specific criteria for practitioners to be certified as early intervention case managers;

3. Application process requirements for initial certification, recertification, and the restoration of an expired certification; and

4. Processes for practitioners to seek reconsideration of a decision to deny certification.

Issues: This action poses no disadvantages to the public or the Commonwealth. These regulations establish a certification process for early intervention case managers that assures individuals completing the certification process are appropriately and adequately prepared and trained to coordinate services to infant and toddlers with disabilities. The regulations establish the criteria for maintenance of the certification, which allows practitioners to seek reimbursement for services rendered.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to Virginia Code 2.2-5304 and Chapter 890 of the 2011 Virginia Acts of Assembly (Budget Bill Item 304#Q), the State Board of Behavioral Health and Developmental Services (Board) proposes to establish the certification requirements for early intervention case managers.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. The current emergency regulations governing the certification requirements of early intervention case managers have been in effect since February 1, 2012. As of July 2012, 389 professionals have been certified as early intervention case managers with no identified regulatory problems. The Board proposes no changes to the emergency regulations that are currently in force.

The regulations provide practitioners the opportunity to qualify for Medicaid reimbursement and reflect federal and state requirements. The proposed regulations help provide funding for services for children age three and younger by establishing reasonable certification requirements. Thus, the proposed regulations produce a net benefit.

Businesses and Entities Affected. The proposed amendments affect the approximately 70 small businesses that provide early intervention services in the Commonwealth, as well as the children and families for whom they provide services.

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendments may positively affect employment at the approximately 70 small businesses that provide early intervention services in the Commonwealth.

Effects on the Use and Value of Private Property. The proposed amendments may moderately increase the value of the approximately 70 small businesses that provide early intervention services in the Commonwealth.

Small Businesses: Costs and Other Effects. The proposed amendments do not add costs for small businesses.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed amendments do not adversely affect small businesses.

Real Estate Development Costs. The proposed amendments will not affect real estate development costs.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses,§ 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The agency concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

Pursuant to Item 304 Q of Chapter 890 of the 2011 Acts of Assembly, these regulations establish requirements for the certification of early intervention case managers who may provide early intervention services and support to children and their families under the federal Part C program.

CHAPTER 220
CERTIFICATION REQUIREMENTS FOR EARLY INTERVENTION PROFESSIONALS AND, EARLY INTERVENTION SPECIALISTS, AND EARLY INTERVENTION CASE MANAGERS

12VAC35-220-10. Authority and applicability.

A. Pursuant to § 2.2-5304 of the Code of Virginia, the Governor has designated the Department of Behavioral Health and Developmental Services as the state lead agency responsible for implementing the Virginia early intervention services system and ensuring compliance with federal requirements. These regulations are necessary to ensure the competence for early intervention services system practitioners under the authority granted to the lead agency.

B. Individual providers of early intervention services under the Medicaid State Plan must be certified by the Department of Behavioral Health and Developmental Services as qualified to provide certain early intervention professionals or early intervention specialists services. These regulations provide certification requirements for these early intervention professionals and early intervention specialists providers.

12VAC35-220-30. Certification required for the provision of early intervention services professionals and early intervention specialists.

A. Individual practitioners of early intervention services, with the exception of physicians, audiologists, and registered dietitians, shall be certified by the department as early intervention professionals or early intervention specialists.

B. Certified early intervention professionals shall have expertise in a discipline trained to enhance the development of children with a disability, as evidenced by state licensure, including application for state licensure if the discipline authorizes practice in Virginia while the application is pending and the individual practitioner meets all applicable requirements for such practice; state endorsement; or certification by a national professional organization. Qualified personnel in the following disciplines may seek certification from the department as early intervention professionals:

1. Counselors:

a. Licensed professional counselors licensed by the Virginia Board of Counseling; and

b. School counselors (Pre K - 12) endorsed by the Virginia Board of Education;

2. Educators:

a. Educators licensed by the Virginia Board of Education with endorsement in Special Education - Early Childhood (Birth - 5);

b. Educators licensed by the Virginia Board of Education with endorsement in Early/Primary Education (Pre K - 3);

c. Educators licensed by the Virginia Board of Education with endorsement in Career and Technical Education - Family and Consumer Services;

d. Educators licensed by the Virginia Board of Education with endorsement in Special Education - Hearing Impairments (Pre K - 12);

e. Educators licensed by the Virginia Board of Education with endorsement in Special Education - Visual Impairments (Pre K - 12); and

f. Educators with a technical professional license issued by the Virginia Board of Education in Career and Technical Education - Family and Consumer Sciences;

3. Family and consumer science professionals certified through the American Association of Family and Consumer Sciences (AAFCS). Individuals certified by the AAFCS after June 30, 2009, shall meet certification requirements in family and consumer sciences - human development and family studies;

4. Marriage and family therapists licensed by the Virginia Board of Counseling;

5. Music therapists certified by the Certification Board for Music Therapists (CBMT);

6. Nurses:

a. Nurse practitioners licensed by the Virginia Board of Nursing; and

b. Registered nurses licensed by the Virginia Board of Nursing;

7. Occupational therapists licensed by the Virginia Board of Medicine;

8. Orientation and mobility specialists certified by the National Blindness Professional Certification Board as a National Orientation and Mobility Certificant (NOMC) or certified by the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP) as a Certified Orientation and Mobility Specialist (COMS);

9. Physical therapists licensed by the Virginia Board of Physical Therapy;

10. Psychologists:

a. Applied psychologists licensed by the Virginia Board of Psychology;

b. Clinical psychologists licensed by the Virginia Board of Psychology; and

c. School psychologists licensed by the Virginia State Board of Education with an endorsement in school psychology;

11. Social workers:

a. Licensed clinical social workers licensed by the Virginia Board of Social Work; and

b. School social workers licensed by the Virginia State Board of Education with an endorsement as a school social worker;

12. Speech-language pathologists licensed by the Virginia Board of Audiology and Speech-Language Pathology; and

13. Therapeutic recreation specialists certified by the National Council on Therapeutic Recreation.

C. Certified early intervention specialists shall hold a minimum of a high school diploma or general equivalency diploma. Qualified personnel in the following disciplines may seek certification from the department as early intervention specialists:

1. Early intervention assistants whose qualifications have been approved by the Department of Behavioral Health and Developmental Services;

2. Licensed social workers licensed by the Virginia Board of Social Work;

3. Nurses:

a. Certified nurse aides certified by the Virginia Board of Nursing; and

b. Licensed practical nurses licensed by the Virginia Board of Nursing;

4. Occupational therapy assistants licensed by the Virginia Board of Medicine; and

5. Physical therapy assistants licensed by the Virginia Board of Physical Therapy.

D. Certified early intervention professionals and certified early intervention specialists shall demonstrate knowledge of early intervention principles and practices, including infant and toddler development, family-centered practice and multidisciplinary team practice, by successful completion of the early intervention principles and practices online training modules administered by the department. A score of at least 80% accuracy on each module's competency test shall be required for successful completion.

12VAC35-220-35. Certification required for early intervention case managers.

A. Individual practitioners of case management services who provide service coordination to children enrolled in early intervention services shall be certified by the department as early intervention case managers.

B. Certified early intervention case managers shall hold:

1. A minimum of a bachelor's degree in any of the following fields:

a. Allied health, including rehabilitation counseling, recreation therapy, occupational therapy, physical therapy, or speech or language pathology;

b. Child and family studies;

c. Counseling;

d. Early childhood;

e. Early childhood growth and development;

f. Early childhood special education;

g. Human development;

h. Human services;

i. Nursing;

j. Psychology;

k. Public health;

l. Social work;

m. Special education - hearing impairments;

n. Special education - visual impairments; or

o. Other related field or interdisciplinary studies approved by the department;

2. An associate degree in a related field such as occupational therapy assistant, physical therapy assistant, or nursing; or

3. A high school diploma or general equivalency diploma, or an undergraduate degree in an unrelated field, plus three years experience coordinating direct services to children and families and implementing individual service plans. Direct services address issues related to developmental and physical disabilities, behavioral health or educational needs, or medical conditions. Experience may include supervised internships, practicums, or other field placements.

C. Qualified persons shall demonstrate:

1. Expertise in the provision of case management services, as evidenced by successful completion of training approved by the department. A score of at least 80% accuracy on the training competency test or tests shall be required for successful completion.

2. Knowledge of early intervention principles and practices, including infant and toddler development and family-centered practice and multidisciplinary team practice, as evidenced by successful completion of the early intervention principles and practices online training modules administered by the department. A score of at least 80% accuracy on each module's competency test shall be required for successful completion.

12VAC35-220-50. Initial certification and recertification processes.

A. Initial certification. To apply for initial certification as an early intervention professional or, early intervention specialist, or early intervention case manager, practitioners shall:

1. Obtain the designated early intervention certification application package from the department; and

2. Submit a completed and signed application package to the department with:

a. A signed assurance that the practitioner will comply with all federal and state early intervention requirements;

b. Documentation of the practitioner's educational credentials, professional certification, licensing, endorsement, or other qualification for the practice of his profession in the Commonwealth of Virginia; and

c. Documentation of the practitioner's successful completion of the early intervention principles and practices training administered required by the department.

Any initial certification granted to individuals who have made application for state licensure and are awaiting licensure shall be valid only as long as that individual meets the requirements of their discipline to practice in Virginia.

B. Three-year recertification. At least 30 days prior to the expiration of the practitioner's certification period, the certified early intervention professionals and certified early intervention specialists practitioner shall submit an application for recertification to the department. This application shall include:

1. Documentation of the practitioner's continuing professional certification, licensing, endorsement, or other qualification for the practice of his profession in the Commonwealth of Virginia, and

2. Documentation that the practitioner has successfully completed at least 30 hours of continuing learning activities during the three-year certification period. The continuing learning activities shall address one or more of the following: (i) evidenced-based practices in early intervention services; (ii) changes in federal or state law, regulations, or practice requirements; (iii) topics identified on a personal development plan; and (iv) training needed for new responsibilities relating to early intervention services; and (v) training required by the department. For each continuing learning activity, documentation shall include a description of the activity and sponsoring organization, if applicable; the date or dates of training; the number of hours; and a copy of a certificate or verification of attendance, if applicable.

12VAC35-220-80. Restoration of expired certifications.

A. The department shall notify practitioners in writing of the date their certification as an early intervention professional or early intervention specialist expired and that the practitioner has been placed on inactive status in the practitioner database maintained by the department.

B. Practitioners whose certification as early intervention professionals or early intervention specialists has expired may apply to the department for restoration of their certifications.

C. The department may restore certification for practitioners as early intervention professionals or early intervention specialists under the following conditions:

1. The individual's certification has been lapsed for a period of less than one year; and

2. The certification:

a. Has lapsed because the practitioner failed to complete the three-year recertification requirements and the individual provides documentation to the department demonstrating (i) he is currently qualified for the practice of his discipline or profession in the Commonwealth of Virginia, and (ii) he has completed at least 30 hours of training addressing one or more of the topics specified in 12VAC35-220-50 B 2; or

b. Has lapsed because the practitioner's discipline or profession-specific qualification expired and the practitioner documents that he now holds a current license, certification, endorsement, or other qualification for the practice of his discipline or profession in the Commonwealth of Virginia.

D. The department shall provide written notice of the decision on reinstatement of the practitioner's certification within 30 days of the receipt of a completed request and required documentation.

E. Upon restoration of the practitioner's certification as an early intervention professional or early intervention specialist, the department shall reinstate the individual's active status in the practitioner database maintained by the department.

12VAC35-220-90. Termination of early intervention professional or early intervention specialist certification.

A. The department shall terminate a practitioner's certification as an early intervention professional or early intervention specialist under the following circumstances:

1. The practitioner's discipline-specific license, certification, or endorsement has been suspended or terminated;

2. The practitioner, after a year, fails to comply with the recertification requirements set forth in these regulations; or

3. The practitioner fails to comply with his signed assurance that he will comply with all federal and state early intervention requirements.

B. The department shall notify the practitioner in writing of the date of and reason for termination and that the practitioner has been removed from the practitioner database maintained by the department.