In light of recent developments in Virginia's mental health system, The disAbility Law Center of Virginia urges the Department of Medical Assistance Services to rescind the proposed emergency regulatory changes implemented on December 1, 2013. The changes will result in higher mental health costs without any appreciable benefit and in fact will almost certainly have a negative impact on adults and children trying to access mental health services in Virginia.

Reduced Access to Services

Under the proposed changes, before an individual can access Mental Health skill-building services, the individual must first undergo very specific psychiatric services. See12 VAC226(B)(6)(b)(3) (adults); 12 VAC226(B)(6)(c)(4) (minors). This list includes only the most restrictive services including: hospitalization, residential crisis services, a temporary detention order, intensive community treatment or program of assertive community treatment services.

Many individuals with mental illness require skill-building services to avoid restrictive psychiatric services. The regulations essentially require an individual to decompensate to prove the need for the skill-building services. This is neither an appropriate nor efficient treatment course. We recommend deletion of this requirement.

Another disturbing addition is the requirement of stringent documentation requirements found in building services. dLCV has already received reports that at least two individuals have already been denied these services because of this problem in recent weeks.

The new changes also require the client to have had a prescription for an anti-psychotic, mood stabilizing or anti-depressant medication to be eligible for the skill-building services. See 12 VACB)(6)(b)(4) (adults); 12 VAC226(B)(6)(c)(5) (minors). This, too, is a needless barrier to services.

building services. In addition, many individuals with mental illness have no way to access or afford medication. Clinical necessity and functional criteria coupled with a diagnosis should suffice as sufficient criteria. dLCV recommends deletion of the medication requirement.

Mental Health skill-building services are also critical to both adults and children with mental illness. However, under the new regulations, if an individual is under the age of 21 and lives with a parent, they will not qualify for skill-building services. See 12 VAC-30-50-226(B)(6)(c)(1)There is no justification in science of law for denying these services to someone under the age of 21 or making them available only to young people who move out of their parents' homes. We request that you eliminate this distinction as it very clearly creates a wall to service delivery for many young people in need of these services.

The regulations also require an 'Axis-1 diagnosis' in revisions to 12 VAC-30-50-226(B)(6)(b)(1) (adults) and 12 VAC226 (B)(6)(c)(2) (minors). Because the current version of the DSM, DSM-V published in May 2013, abolishes the Axis system this requirement should be eliminated.

Overall Impact on Proposed Regulations

The disAbilitydiagnose, assigning a more restrictive label than is clinically justified.

The new regulations could also create a large unanticipated effect on patients in state hospitals as well. Because of the difference in definitions, community services like skill-building will not be available to all who need them upon discharge. The regulations underscore the fundamental imbalance of Virginia's system of care for persons with mental illness. Virginia uses a broad definition of mental illness to keep people within state hospitals and commit people to state hospitals, yet proposes very limited definition to receive community services. In a state that is already strongly biased towards institutional care, these regulations will only contribute further to the bias.

Conclusion

The disAbility Law Center of Virginia urges DMAS to withdraw the proposed regulations. The effect of the emergency regulations is very likely to be a higher number of people committed to a state hospital needlessly, many of whom could receive services in the community. This will undermine the mandate that individuals with disabilities receive services in the least restrictive environment and will likely ultimately result in increased costs for the Commonwealth.