Over-arching Comments:
Throughout the regulations, there are multiple references to disability specific chapters regarding requirements. As these chapters do not yet exist, it is hard to effectively evaluate in relation to these regulations. A full review of comments is not possible if the reference is made to the disability specific chapters and not being able to read them to obtain full context.
There are definitions removed from proposed regulations that we are unable to determine if they will be included in the disability specific chapter or if being removed altogether which will impact practice.
If duplications with performance contract remain in licensing regulations for the purpose of increasing structure for private providers, then we advocate removing redundant requirements in the performance contract.
The increase in administrative burden to meet the letter of these proposed regulations is substantial. In general, it would seem that setting the expectation for Licensing Specialists to review program descriptions, (a sample of) policies, during annual site visits would be more efficient for both OL and providers – vs. frequent submission of documents to OL.
Regulations feel like they are micro managing and becoming prescriptive as to specifying exactly where information should be documented
Any reference to “Substance Abuse” should be changed to “Substance Use Disorders” for consistency in terminology.
Suggesting the regulations move to become gender neutral as positions could be filled by a male or female by using gender neutral pronouns.
Department guidance documents are not regulations. While they may be best practice, regulations should document the requirements. There is not the opportunity to provide comment or follow the adoption process with guidance documents.
Multiple sections reference competency testing. This needs to be further defined including specification of expectations around this term.
106-20: Definitions
Definitions should be consistent across licensing, DMAS, and core taxonomy definitions to ensure the ability to comply with each of these entities.
Adding “and desires” to the definition of case management services potentially broadens the scope of support coordination and stretches limited resources. The service should be based on individual’s needs.
Add definition of “Behavioral Health”, allowing for recognition of co-occurring MH/SU disorders and adjustment of license types. Regulations and expectations should be consistent across behavioral health services.
Change the proposed definition of “Comprehensive assessment” to “means a comprehensive and written assessment used in lieu of, or updates and finalizes the initial assessment. This removes the requirement to complete a separate initial assessment for providers who provide the Comprehensive assessment at initial assessment.
“Crisis Stabilization”- Change “…individuals may ‘be maintained’ in the community” to ‘be supported’.
“Direct Care Position”-Clarification requested. Is this defining the role of a supervisor of direct care positions is also considered a direct care position?
“Full time employee” or “employee” means an employee employed on average at least 30 hours of service per week, or 130 hours of service per month. Remove the second “employee” as this is seems to state that only employees who work those hours are considered to be an “employee”.
“Intensive Outpatient Service”- This definition does not match DMAS definition of minimum 3 hours per day. The proposed regulation adds “shall” include multiple group therapy sessions during the week, individual and family therapy, individual monitoring, and case management. The word shall seems to require the provision of each and all of these. Family therapy should be a choice and case management is a separate service, including as defined in the DMAS ARTS manual.
“Medication Error” definition is removed. What is the impact? Do we not have to investigate these as neglect?
“Outpatient services” definition “shall not include practitioners who hold a “licensed issued by a health regulatory board of DHP” or “who are exempt from licensing pursuant to” This reads as if licensed staff of excluded from providing outpatient services.
“Partial Hospitalization”- DMAS does not specify that these services must be medically-directed. Remove “medically-directed” from proposed regulations.
“QDDP”, “QMHP”, “QMHP-A”, “QMHP-C”, “QMHP-E”, “QPPMH”- These definitions are removed from the proposed regulations. Is it intended that they will be included in the disability-specific chapters? It is difficult to evaluate the appropriateness of the removal of these definitions without the subsequent chapters.
“Residential crisis stabilization”- Why is this definition removed? Will it be included in disability specific chapter? Would this cross disabilities?
“Serious Incident”- Remove/reconsider the inclusion of “uplanned psychiatric hospitalizations” as this is part of the support/services provided by the CSB. Is removal of Level III, item 3 intentional?
Remove “gero-psychiatric residential services” from “Services” definition to ensure it matches list under 1014.
106-30 Licensing Requirements
C. A license addendum shall:
Remove “normal business hours” from the requirement. This reduces the flexibility of service providers to change hours and increases administrative burden on both providers and office of licensing.
106-60 Inspection Requirements
Would the Office of Licensure support organizations that are accredited by CARF (or National Accreditation Organization) by waiving the annual reviews and move to either a triennial review or on an “as warranted” basis.
F. “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. “ Request to remove this wording. Requiring records within a time frame seems to exceed the scope of regulations. This may not always be possible in rural locations due to travel, larger organizations, or volume/extent of records requested, etc.
106-70- Renewals
F. Failure to submit a completed renewal application prior to the expiration of the provider’s current license shall result in the closure of the license. The department shall notify the provider in writing that the current license is closed and that any future interest in licensure will require the submission of an initial application. Comment: Can there be a warning for a provider before the closure of the license? Having a step in between seems to be a more efficient process. Further, in the past lapsed renewal was given grace.
106-80- Changes to licenses and notifications to the department
Draft Reg: A. A provider shall submit a written service modification application and all attachments required by this chapter at least 45 business days in advance of a proposed modification to its license. The modification may address Changes to the following characteristics require a service modification application: Modification to service descriptions; The provider’s normal business hours;
Comment: Requiring a licensed program to submit a service modification when modifying its service descriptions and hours is burdensome for services provider, removes the flexibility to respond to needs in a timely basis. Requesting this is removed.
Requesting modification application for the modification to service description does not reflect the ebb and flow of business practices. Perhaps review of a program description by Licensing Specialist when conducting the annual service review would help notify OL of changes without additional burden to both providers and OL by submitting this degree of Service Mods.
7/10/19 Memo regarding Service Modifications allows Licensing Specialists 60 business days to conduct site reviews from the time a completed service modification packet is completed. In essence, this changes the timeframe for providers to submit a Service Modification 60 days in advance of a desired start date. Recommend regulation match the intended practice (or that the guidance document be revised to match the regulation).
“Any changes that cause a provider to be unable to provide services to any individual for a significant period of time”. Too prescriptive, consider revision.
106-90- Variances
Draft Reg 2. The request shall demonstrate that complying with the regulation would be a hardship unique to the provider, that is not purely financial in nature, and that the variance will not jeopardize the health, safety, or welfare of individuals. Comment: The increase in regulatory requirements does come with a cost to organizations. It is requested that the department study the financial impacts on organizations as regulations increase to provide financial assistance to providers to meet the increase in administrative and quality assurance requirements.
106-110- Compliance
Draft reg: 3. All applicable federal, state, or local laws, and regulations and all applicable department guidance including: Comment: Department guidance documents are not regulations and should not be added to the regulatory requirements. There is not an opportunity to give feedback on guidance documents as in draft regulation. They may be best practices, but providers may not have the ability to implement the guidance documents as written. An example is the guidance document on how to complete a root cause analysis.
106-120 Corrective Action Plan:
Regulation does not specify timeframe for Licensing Specialist to return the approved CAP or notify if not approved. Experiences have ranged from 1 business day to several months. Recommend adding this information (with 15 business days as the suggested timeline). Lengthy delays in responses put provider in difficult position regarding whether or not to move forward. Recently, Licensing Specialist has required that the person responsible for monitoring an action step be named (by role) in the CAP. If this is to be a routine expectation, then add to the regulation
106-170 Informal Hearings
Draft Reg: 1. “Reasonable” notice of the informal hearing, which shall include contact information consisting of the name, telephone number and government email address of the person designated by the department to answer questions or otherwise assist a named party; Comment: Requesting time frames are placed in the informal hearings such as within 15 days of receipt. Regulations should have clear time frames for providers and for the Office of Licensure. Time frames should be added to each step so the provider knows the time commitment to an appeal process and knows what to expect. Each provider should experience the informal hearings the same way such as in the Human Rights hearing processes. Timeframes should occur in both departments, not just Human Rights.
106-180 Governance
Under the terms of the Core Services Taxonomy with DHBDS, CSBs have four options for how to be structured. How does this effect boards that are part of a government agency in which the County provides this level of oversight and more? Requiring a specific standing committee is prescriptive and may not be effective if the board does not have this level of expertise in their volunteers. Recommend this section be rephrased to ensure in alignment for CSBs. CSB board members are volunteers, they are not paid positions that you can find someone with the proposed distinct expertise. Further, should not have requirement to submit personal, home addresses of Board members who are not employees.
106-190 Organizational Structure:
A. written policy that describe the organizational structure including lines of authority, responsibility, communication, and staff assignment. Comment: If the organizational chart has names and shows the lines of authority it should meet this requirement.
106-200 Executive Director or Administrator
Remove list of degrees as not exhaustive with a preference for level of education and combination of experience.
106-220 Liabilities and Insurance
Draft Regs B. Additional protections from risks of liability may be required and enumerated within disability specific licensing chapters and department guidance. Comments: Remove reference to department guidance.
106-230 Confidentiality of Records
106-240 Criminal Background and Registry Checks
Draft Regs 2. Define direct supervision. Does this mean the individual cannot be out of sight of supervisor? Registry checks take extended time to complete and this would complicate onboarding.
Draft Regs 3. The provider shall have a policy related to the periodic performance of criminal history background checks of employees and contractors after the initial check performed pursuant to 12VAC35-106-240(A)(1). The policy shall require that the provider conduct background checks on a minimum of 20% of all existing employees annually. Comments: Suggest the regulations state the provider has a policy and that the regulations do not dictate an annual percentage.