Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
 
Board
Board of Medical Assistance Services
 
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5/5/22  8:25 am
Commenter: Anonymous

Suggestion for Community Stabilization Length of Stay
 

Please consider the clinical impact of reducing Community Stabilization to a 3 day admission. If the initial registration is 3 days, it is setting a standard expectation that service delivery can often be accomplished successfully within 3 days. With the revised eligibility criteria, it is unlikely most individuals who meet service criteria will be able to have needs met within 3 days. A warm handoff will be extremely challenging and rare. Individuals entering service over the weekend will be especially disadvantaged due to the limited opportunities to coordinate care outside of normal business hours. Their admissions will be ineffective, as it is unlikely MCOs would consider a weekend admission sufficient clinical rationale for a continued stay. 

 
The original assumptions for this service from the 2019 Mercer study were that it would be a 30 day service with units used heavily in the first week and minimally throughout the rest of the month. The draft service descriptions from DMAS in January 2020 continued this same assumption of a 30 day service. However, when the final DMAS manual was released, the initial registration period became only 7 days. This opened the door for overutilization of the service in which clients have multiple admissions per month instead of working to stabilize over a 30 day period. Disjointed admissions with numerous providers is expensive for the state and counterproductive to the intended definition of the service. It is therefore understandable that some adjustments need to be made to ensure the service is being appropriately utilized. However, why not resort back to the original assumption of a 30 day admission for around 30 total hours (120 units)? This would allow for the service to function more like a bridge to aftercare and would serve the same purpose of eliminating crisis cycling without negatively impacting individuals who truly need more than 3 days to stabilize and be linked to resources. The current proposed change of a 3 day admission makes a 30 day stay almost impossible, as it would likely require many continued stay requests to be approved. That effectively abandons the intended service model. It seems there is a way to accomplish the goals of preventing overutilization while also maintaining the service in a manner it was originally intended to be provided. 
 
CommentID: 121910