Regulation

Comment

106-20

The definitions for the Initial Assessment and Comprehensive Assessment imply that these are two separate documents. This implies there will be two documents.  This needs to be removed as the information in the comprehensive assessment is needed at the initial assessment to meet DMAS requirements for many services. Requiring two separate documents is not person centered or appropriate.

We recommend language such as “the comprehensive assessment may be completed at the time of initial assessment if it includes all elements of the comprehensive assessment.”

106-20

Emergency Services - This indicates that emergency services will be in the home and community.  This sounds like mobile crisis; there must be a way to distinguish between emergency services and mobile crisis.

106-20

Licensing Report - A report should be sent to a provider following a visit to indicate no issues identified, not just when asking for a corrective action plan.

106-20

Mental Health Skill Building - The idea of restore to baseline functioning is problematic. This seems to imply a person would have had to know how to complete a task or skill, lose the ability and then be “restored”.  This would eliminate being able to work with someone on developing new skills and abilities for more independence.  This definition also is not person-centered.

106-20

Partial Hospitalization Program - This definition seems to eliminate individuals with co-occurring Developmental disorders. Those with a DD who have a serious mental illness might benefit from partial hospitalization and should be clinical screened to determine appropriateness.  Is the intent to exclude those with DD dual diagnosis, even when clinical determined they would benefit from the service?

106-20

What does health status mean in the definition of quality improvement plan?  The “health status” of a diagnosis might not improve; however, the individual could make progress in independence, ability to recognize symptoms and take actions for assistance. Improvement in health status may not be possible.

106-20

Risk Management - Concern with “ensure the safety”; this is not risk management, nor is it person-centered and honoring of dignity of risk.  “Risk management” mean an integrated system-wide program to identify, mitigate (as appropriate) and evaluate risks to individuals, employees.  Risk management includes education and ensuring informed choice for individuals receiving services.  Risk management is not intended to prevent individuals from making informed choices nor for restricting an individual’s rights without following the process identified in the Human Rights regulations.

106-20

Who determines what is adequate information and knowledge as referenced in the informed choice definition?

106-20

Screening needs further definition as the components of the regulations in this chapter do not speak to its application.

106-20

Serious incident:

Disagree that a sexual assault should be categorized as a level III. During the provision of outpatient services, this information may be disclosed. Adults with capacity may not wish to follow-up with that information. Additionally, reporting such incidents may negatively affect the therapeutic relationship the individual establishes with a provider.  This would be outside the scope of disclosing information as the individual should be able to determine who receives the information.  The provider’s role is to assist the individual with ensuring personal safety and reporting to appropriate authorities.  The appropriate calls would be to APS/CPS and police.  Additionally, an individual may disclose a past sexual assault to a provider to work on the trauma.  Reporting this incident to DBHDS is not appropriate and takes DBHDS beyond the scope of responsibility.

Suicide Attempt - Again concern with scope of reporting.  A person may reveal in an assessment or service of past attempts; reporting these incidents would serve no purpose if historical in nature.  Additionally, who makes the determination of “intent to die” if it was in the past?  This too seems to ask for information outside of what is helpful for quality assurance and DBHDS responsibility.

106-20

Structural Modification - What is fundamental change to the structure of a building?  If change is happening in a non-service area of a building why would DBHDS need to know? This is goes beyond licensing’s role.

106-20

Supervised Living - To be person-centered and allow for appropriate independence, this definition must be changed from requiring daily monitoring to monitoring up to daily.  It could be that a person would need support five days a week, but not seven.  What is meant by daily monitoring? For a continuum of care and to be person-centered, suggest looking to have definition to be less restrictive than requiring daily monitoring.

106-40

The department should be required to provide providers specific information about the budget requirements; there needs to be a review process.  How is this going to be consistently applied?  What is the bases of “appropriateness”?

106-40

Clarification requested on “maximum capacity of individuals served at a given time.” For example; many individuals attending day support programs do not attend five week days, but rather anywhere from one to five days. A day support program may have a maximum number it can support per day which is very different from the maximum number of individuals it can have enrolled. As the current definition is not specific, there is concern that providers may not be able to support individuals due to this requirement of defining the maximum individuals to serve. This has the potential for individual to lose vital services. Seems setting staffing ratios is a better method than putting on the license and needing to make modifications.  What is the purpose for this information?  How is it going to be used?