Revisions to licensure rules and regulations that may adversely directly impact service delivery to at-risk youth include the following:

1. 12VAC35-105-20, Definitions, “Qualified Mental Health Professional (QMHP)”.  The revision includes only the QMHP working in a PACT or ICT.  The definition is not clear as to whether QMHPs can work in intensive in-home and mental health community support services.  The revision should also include, at a minimum, the QMHP working in intensive in-home and mental health community support services.
2. 12VAC35-105-590. Supervision guidelines (Provider staffing plan C9) for Intensive-In Home Services are more stringent than those required for comparable state reimbursed services. We recommend that C9 be REPEALED. Providers should be charged with the responsibility of ensuring supervision is appropriate to the services provided.  Supervision and employee licensing costs are significant expenses for any home-based provider.  Micro-management in this area will drive related costs up even higher.  If the decision is to leave C9 as is, providers should be given clear-cut guidelines for ‘grandfathering,’ without penalty, current supervisors who do not meet the new criteria. 
3. In general, DBDHS and DMAS regulations do not match, continuing to leaving providers caught in the ‘gray areas.’ 
4. Licensing has issued “Guidelines” for intensive in-home providers that call for a restriction on the number of cases (no more than five) a worker may be assigned at one time.  Many providers use a team approach to intensive in-home counseling.  Restricting the number of cases would mean that providers would have to change their approach to one person per case so that employees who are considered full-time are not penalized for using the team approach.  In other words, currently, a staff member might work on eight cases with a team member and work three to five hours per case per week; this would bring their total hours to approximately 24 to 40 hours per week.  An employee working five FAPT funded cases would only be able to average approximately 30 hours per week maximum under the new guidelines.  Full time employees generally work from 35 to 37.5 hours per week in the in-home profession.  Most providers have a cap on the number of hours their employees are allowed to work due to the high rate of burn-out in the profession.  Providers should be held responsible to ensure that employees are not overloaded with cases so that the consumers receive the highest quality of care.
5. Providers recently received notice of a training in May from DBHDS on evidence based practices which is yet another cost to providers, in addition to the increased supervision costs, etc.  Members of VAFP are committed to the utilization of best practices to ensure quality services.