Virginia Regulatory Town Hall
Department of Behavioral Health and Developmental Services
State Board of Behavioral Health and Developmental Services
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10/30/19  5:28 pm
Commenter: Tamara Starnes, Chief Clinical Officer, BRBH CSB

Comments draft regs pages 30-45

Page 30

1.The names, addresses and phone numbers of all owners, officers, directors, and financial investors …

-Home addresses and personal phone number of board members are personal and not subject to FOIA.  DBHDS regulations will further erode ability of providers to obtain quality volunteer board members if they must give up private information, especially given modern privacy concerns.


The agency must maintain and make available to employees, the organizational chart.  The chart has to indicate the authority, responsibilities, communication and staff assignment of employees.

                -recommend removing as these do not seem necessary for licensing and could change regularly


The ED or administrator section

  • Recommend removing section. Seems out of scope for licensure and more specific directing of business practices. Responsibility very  overarching, and 24/7 availability may not always be possible, however, can have designee

ED requirements. A master’s degree in social work, psychology, counseling, nursing, or administration and a combination of two years professional experience working with disability populations and in administration and supervision;

-Most EDs do not provide direct client services; therefore, do not see the need for educational requirements under licensing. Requirements of clinical degree for Executive Director does not ensure best candidate for the position. For some providers, it is more effective to have an Executive Director with good financial management skills, other business skills, fundraising skills, community partnership skills, or quality assurance skills, etc., particularly if the human services or clinical services skill set is met through other staff.  These narrow definitions will not ensure the best quality nor financial stability of providers.  Recommend removing


Page 31

 A.3:  Adds the budget information to the audit report. 

  • This could cause an increase in audit fees.

Item C: Provider shall have keep individual accounts separate. 

  • This is not fiscal best practice and serves to increase costs in the system.  Many excellent banks provide a single account with separate accounting of client's funds.  If the "individual account" requirement is enacted, providers will need to start charging clients their full payee fees in order to cover costs of separate bank accounts, thereby reducing funds for clients overall and not reflective of modern banking practices.

Item 106-220 A: adds contractors to be insured by the provider

  • Be requiring this, it is highly likely that providing the insurance will make the contractors not qualify to be contractors from the perspective of the IRS. IRS rules note practices that help delineate the different between employees and contractors, this appears to move across the line.

A. To protect the interests of individuals, employees and contractors, and the provider from risks of liability, there shall be indemnity coverage to include:

1. General liability;

2. Professional liability;

3. Commercial vehicular liability; and

4. Property damage

-Liability coverage - Providers should only be responsible for their and their employees liability.  Contractors are required to maintain their own.  If this is added, there will be less contracting occurring, as it will drive up provider costs. It also again confuses the difference in IRS definitions of employee versus contractor

-Note related to prior two comments:  All of these additional administrative requirements that drive up provider costs, without significant upward revision of Medicaid reimbursement or grant funding for services, will reduce overall service system ability to serve an underserved population.

Page 33

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.

- Creates Administrative and Financial burden as we have hundreds of employees. Will need further guidance on how the 20% is determined and recommend deleting or significantly reducing the percentage.


Full Time and Part Time employees-

- We utilize a 3rd party vendor for primary source verification of education history.  More reliable than transcripts.  Recommend add this as an option.


TB Testing

-Specify if assessment for TB is sufficient.  In recent years, there has been a shortage of serum needed to do TB testing, affecting ability to have all certified as TB free; rather assess and determine if warrant actual TB test. 


Evidence of a Virginia driver’s license and driving record by the Virginia Department of Motor Vehicles for employees transporting individuals;

-Staff may work in Virginia and live in another state, need to remove requirement for a Virginia license. Allow for driver’s licenses from other states; these are valid across the U.S.  People may relocate.  Undue barrier to employment to limit to VA and creates time lags in hiring.


Page 34

Three job-related references supporting the knowledge, skills, and abilities of the minimum qualifications according to the job description;

- This should be reduced to two.  Often difficult to get three which slows down the hiring process and results in loss of a qualified candidate.


Background Checks Results shall be placed within a file in accordance with 12VAC35-106 230 D within three business days of being received by the provider from the department.

- We do not use the Department for background checks.


A record of participation in employee development activities, including orientation, training, and the results of employee’s competency testing.


-What competency testing is being referred to here? Are they talking about Department mandated competency testing such as MH and DD Case Management? If so, should specific those specifically as all jobs do not require this.


Page 35

Qualifications of employees:

-B. don’t understand the reference addition in B.


C. supervisors must have education, training, and experience in working with individuals being served, including diagnosis and age, and in providing the services outlined in the service description.

-This is prohibitive of being able to grown new employees and a clinically skilled work force. Recommend removing. Many skills are transferable across ages and populations, “training” is vague and often not available formally, supervisory and management skills may be more important depending on position.


Page 36

Training Requirements: Required initial training: Within 7 business days following an employee or contractor’s start date

-Does this training apply to Admin staff as well or only individuals working directly with the person served. It is practically impossible to provide all trainings, including First Aid and CPR training within the first 7 days. Should not give a time frame but state that a person cannot work alone without becoming certified.  CPR, First Aid, Medication Administration, and Behavior intervention such as TO/CPI are among more difficult trainings to obtain.  Also, impact on employers when small number of employees are onboarding concurrently.  If not able to move to within 30 days, recommend making this consistent with 14 business days.


All new employees, contractors, volunteers and students shall complete all orientation and training required under 12VAC35-106-300 (B)(1)-(3) and demonstrate competency through testing prior to carrying out job responsibilities without supervision. Documentation of competency testing shall be kept in the employee or contractor’s personnel file.


-Competency Testing is mentioned several times. This is not relevant to many jobs and there are no standard “tests” for competencies. Recommend deleting throughout.


Page 37

The provider shall notify the department of any changes to policies required by this regulatory chapter prior to implementation of the change. B. The provider shall notify the department of any changes to policies required by this regulatory chapter prior to implementation of the change.

-Need clarification as to process.  Also, based on basic information provided, this seems onerous and significantly slows down the process of implementing policy changes. Policy changes also require going through individual boards. Appears outside of scope for licensing.


TB assessment

-Specify if assessment for TB is sufficient.  In recent years, there has been a shortage of serum needed to do TB testing, affecting ability to have all certified as TB free; rather assess and determine if warrant actual TB test. 


Page 39

 The provider shall publish, post, and make available its mission statement to individuals receiving services and, if applicable, their authorized representatives. The provider shall submit the mission statement to the department:

-Does not seem reasonable or within the bounds of licensing for entities to submit a Mission Statement to the Department. Also suggest replacing “shall” to “upon request.” Clients are given an enormous amount of information at admission and this would likely get lost a month other important material.


Page 40

Formerly stated we must provide a written schedule of rates and charges upon request, has been changed to upon admission

  • Does not seem reasonable to provide this to everyone when they have not requested it.  Recommend keeping language as is.
  • Also states we must publish and post the fee schedule: because what we charge, and what is paid by different insurance companies does not always match, this would add more confusion for clients.


Page 41

 New requirement to implement a written policy that defines the process for transitioning an individual between services operated by the same provider (internal transfers). 

-Formerly required to be a procedure, recommend keeping it a procedure as process often change. Changing policies at CSBs require board approval and this can slow down the ability to make necessary changes quickly.


New requirement to implement a written policy that defines the process for transitioning or discharging an individual who experiences an emergency or crisis that the provider is not equipped to serve. 

  • This does not seem to be in the realm of policies, recommend making this a procedure.


Page 43

New requirement to implement a written policy to address the day-to-day handling of facility funds to include handling of deposits and petty cash and writing checks. 

  • Formerly required to have “written internal controls” – recommend keeping that language.


Page 44

New requirement for emergency medical information

– if pregnant must include expected date of delivery and name of hospital to provide delivery services. Recommend removing as this does not seem to fall under “emergency” medical needs and not all have a hospital identified, particularly if early in the pregnancy.

CommentID: 76793