Virginia Regulatory Town Hall
Department of Behavioral Health and Developmental Services
State Board of Behavioral Health and Developmental Services
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10/28/19  3:16 pm
Commenter: Mount Rogers CS

comments questions about proposed changes to licensing regs

106-20 Definitions

Admission Date—our EHR doesn’t seem to support adherence to this.. Does this contradict CCS3 reporting requirements? How does this impact the dashboard measures?  How does this then impact throughout the rest of the requirements, i.e. due date for quarterlies and annuals? Does this align with Medicaid/DMAS regs?


“Comprehensive Assessment”—we want to clarify that many Boards do not do an initial assessment, this changed largely in relation to Same Day Access.  Does including a definition of “initial assessment” contradict the expectations of the SDA model and completing a comprehensive assessment?  We also want to highlight that the comprehensive assessment in the SDA process takes longer than an hour.  Most individuals have to sit through a process that takes 2+ hours due to the increasing requirements for the assessment as well as the financial/administrative part of admission.


Do Boards offer non-residential/ambulatory crisis stab 24/7?  Reimbursement is only allowed for up to 23 hours, and funding is not sufficient for 7 days a week.


Emergency Services/Crisis Intervention—“in the home”—will this be reliant on “as funding for Mobile Crisis and safety allows”?


“Full-time Employee”—is this consistent with Labor Laws?  We’re curious why is this included in licensing regs?


“Initial assessment” definition has additional language that indicates, “An assessment is not a service”.  Can this be clarified more… for example, DMAS allows CM to get to know the individual’s needs and glean info from outside provides for up to 30 days. Plus, does admission through SDA equal the beginning of the service?  If so, this contradicts the assertion that an assessment is not a service. Also, DMAS’ CNA process was developed to streamline the admission and assessment process, but this further complicates how to satisfy licensing regs. The COV defines assessment as the provision of a behavioral health service 12VAC 30-50-226.


“Intensive outpatient service,” added “shall”-- “Intensive outpatient services shall include multiple group therapy sessions during the week, individual and family therapy, individual monitoring, and case management.”  Concerned intensive outpatient now shall include family therapy and case management.  Family therapy should be a choice and case management is a separate service, including as defined in the DMAS ARTS manual.


“IOP” def. does not seem to match DMAS def. of minimum of 3 hours per day.


Outpatient services definition “shall not include practitioners who hold a licensed issued by a health regulatory board of the Department of Health Professions” or who are exempt from licensing pursuant to…” This reads as if licensed staff are excluded from providing outpatient services.


PACT definition of 10 FTEs—this doesn’t align with discussions in MH redesign (to have varying staffing patterns in PACT to reflect the individuals served).


Page 14—under “Serious Incidents” definition, Level II now states “an emergency room visit,” whereas the emergency regs stated “an emergency room visit in lieu of primary care”—this will revert back to DBHDS receiving hundreds of unnecessary Level II reports again.

Also, #3 (in Emergency regs) of Level IIIs is missing (permanent injury)


106-40 Applications

#A.2 the language of operating expenses is inconsistent with our performance contracts.


#B.5—please clarify what they mean for “nonresidential services”.  Do we have a cap on the number of people we can serve in Outpatient services?


106-50 License Types

Pg. 21 F: “No provider shall be issued multiple licenses for the same service.” Please clarify that this mean a new number for a license for the overall entity/agency; not that we no longer have to apply to add locations for the same service (which results in multiple addendums being issued).


106-60 Inspection Requirements

Added language, “Any records or information requested by department staff in order to conduct the onsite review shall be available to department staff within one hour of the request for such information”.  Is this reasonable for large organizations?


Does any regulation define how long DBHDS has to respond once a request for modifications to a provider’s license is submitted?


106-250 Full-time and Part-time employee records

Does this match EEO requirements?


#A.3 Please clarify what is meant by including history of population served.


(A)(5 &6)Note addition of three references supporting the KSAs of the job description or documented efforts to obtain them.  What documents reasonable efforts?  Shouldn’t these two be combined? We don’t require 3 references for internal hires. Is confirming dates of employment enough (which is often all that a previous employer will disclose)?


106-260 Contracted Employees

This section appears open-ended. For example, the way this is written, it could include vendors, like cleaning services or accounting services.  Should the definition be clarified to reflect contractors who are licensed under this regulation?


106-300 Employee Training

#A. Is this meant to broaden what providers do with retraining, based on provider-specific  needs?  Or is it an unfunded mandate because it will require more administrative functions with no additional funding or increases in reimbursement rates to cover increased administrative functions.


(B)(1) Within 7 days requiring –  “basic orientation” This will create a significant delay in beginning orientation to the job (under supervision) because many staff can job-shadow to learn how to do their job and serve individuals while waiting for the next orientation sessions to begin.  This also will cause delay in service provision. This will mean that we can only hire on one date every month.  In relation to medication administration training—this training take 5 business days.  Staff can work in a group home, but not administer meds.  Seven business days is not reasonable.

Also, please clarify that all administrative-only staff will be required to have CPR?  This is costly and retracts from maintaining operations.


 (B)(4) All new employees, contractors, volunteers and students shall be supervised until completing all orientation and training required…. What does “supervision” mean specifically?  Does this mean they cannot be alone with individuals until completing the requirements?


Personnel files: our personnel files are paper, but our trainings are documented electronically in an electronic system designed for tracking our training compliance.  Would we revert back to paper files for this, while we’re trying to become all digital?


106-310 Notification of Policy Changes

How will we be notifying DBHDS of every procedure change we make throughout the month/year?


106-320 TB Screening

“Prior to”: This creates a barrier and delay of service provision.  In our rural area, we can’t walk-in and get a TB screening in our health department at any time.  They are able to schedule appointments, some only on one day a week.


106-330 Performance Evaluation

Personnel files: our personnel files are paper, but we are moving to digital performance evaluations this fiscal year, documented in an electronic system designed for tracking our performance evaluation compliance.  Would we revert back to paper files for this, while we’re trying to become all digital?


106-460 Discharges

Added (F)(2) in the written discharge summary, “Description of the individual’s or authorized representative’s participation in discharge planning and documentation of informed choice by the individual or his authorized representative as applicable in the decision to and palling for the discharge.”  What does this look like? How does this apply to situations in which an individual voluntarily doesn’t return, despite efforts to re-engage?


106-480 Policies

Traffic pattern for drop off and pick up—Please clarify this.  We don’t really have a need for a policy on traffic patterns in our rural areas. This also relates to 106-710 Traffic Patterns


106-490 Emergency Medical Information

#A.6 and A.9-- Requiring identifying and maintaining Medical protocols and pregnancy and delivery information are excessive for community-based, non-residential services.  We are not medical providers beyond primary-case screening and monitoring. We believe that our EHR may not support this kind of detail (such as medical protocols being included for those who have a medical protocol or several).


106-550 Privacy

Request clarification of 550 – 5 – is the intent for the policy to prohibit staff members from receiving visitors while at work in any manner?  Please clarify if this applies to certain services like residential services or all services. This appears to be over-reaching and will overrule provider procedures on Employee Conduct and Confidentiality that are specific to each provider’s working environments (which is what HIPAA requires).


106-580 Risk Management

Please clarify: 30 Calendar days or business days?


106-720 Lighting

Please clarify if this is referring to all types of sites or just residential sites.


106-760 Laundry Areas

Will these modifications to existing facilities (approved by local inspectors) be funded?


106-810 Emergency Preparedness and Response Plan

For a 24-hour phone line—if cell service was knocked out, do you consider a fax line a land line? With today’s technology, many people no longer have land lines


CommentID: 76678