106-20, Page 5-6. “Emergency services (crisis intervention)” means unscheduled and sometimes scheduled crisis intervention, stabilization, and referral assistance provided over the telephone or face-to-face, if indicated, available 24 hours a day and seven days per week. Emergency services shall provide immediate mental health care in the home or community to assist individuals who are experiencing acute psychiatric dysfunction requiring immediate clinical attention. Emergency services shall include assessment, short-term counseling designed to stabilize the individual and care coordination. Emergency services also may include walk-ins, home visits, office visits, jail interventions, and preadmission screening activities associated with the judicial process or telephone contact. – The proposed revision appears to be aligned with DBHDS/DMAS’s preliminary recommendations regards to Behavioral Health Redesign and the future Crisis Services. However, the Crisis Workgroup to date only met a handful of times in August and did not include any formal discussion on the role of Emergency Services. Language referenced in the proposed definition appears consistent with DBHDS’s proposal for future Mobile Crisis, which is separate from the statutory role of Emergency Services and proposed to be regionally managed. This should be separated. Emergency’s Services’ clinicians need to have discretion to determine the most appropriate location based on information provided with each distinct call. That certainly includes a variety of locations but these recommendations also institute proposed changes without associated funding. Instead, we respectfully recommend the following language:
“Emergency services means unscheduled and sometimes scheduled crisis intervention, and referral assistance provided over the telephone or face-to-face, if indicated, available 24 hours a day and seven days per week. Emergency services shall provide immediate mental health care in the most appropriate and least restrictive environment available to include the home and community settings to assist individuals who are experiencing acute psychiatric dysfunction requiring immediate clinical attention. Emergency services shall include assessment, short-term counseling designed to stabilize the individual and care coordination. Emergency services also may include walk-ins, home visits, office visits, jail interventions, and preadmission screening activities associated with the judicial process or telephone contact.”
106-50, Page 20 2f. The commissioner may lower a full license to a provisional license at any time a provider shows an inability to comply with licensing regulations. – This statement is vague and needs clarification as to what is meant by “a provider shows an inability to comply with licensing regulations.” This section would need to offer the standard of measure to which providers would be held if enforced.
106-50, Page 20 – 3. A full license shall be issued after a provider or service demonstrates substantial compliance with all the applicable regulations. The phrase “substantial compliance” is vague and requires clarification as to what is meant in order for providers to understand the standard of measure to which they would be held if enforced.
106-50, Page 21 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. Setting the stringent parameter of “within one hour” to provide documentation during an (often unannounced) onsite review would present a number of challenges for your average provider. Despite the use of electronic health records and other supportive technologies, requests for multiple records and documents, the manpower to access them, and technological challenges frequently impact the pace at which this task is completed. The application of a “one hour” deadline is not considerate of circumstances that can occur outside of the providers control and could be, unintentionally, punitive. In order to promote a more successful review process, the following edit to the abovementioned statement it recommended: “Any records or information requested by department staff in order to conduct the onsite review shall be made available to department staff, on demand, at the request for such information.”
106-70, Page 22 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. Complete closure of a license following a failure to submit a renewal application in a timely manner is not the best way to respond to the needs of the individuals being served. It is recommended the provider be placed on a temporary suspension in order to complete the steps necessary to reinstate the license, especially if the service provided is one that fills a significant service gap for the community. The needs of the individuals being served may go unaddressed for a significant period of time during the waiting period for an initial application for licensure to be processed.
106-240, Page 33. B.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. This change would require an approximate $7000 increase annually.
106-240, Page 33, 6. Employee or contractor personnel records. Results of reasonable efforts to secure job-related references. What qualifies as reasonable efforts? Employers are refusing to provide reference information and many have outsourced this function to third party vendors requiring, at times, up to $40 per employee reference without an annual subscription. This requirement requires Human Resources staff spending countless hours trying to complete the required, three work related and personal references per employee.
106-300, Page 36 B. 1. Required initial training: Within 7 business days following an employee or contractor’s start date... The proposed window of seven (7) days for providers to offer required initial training to new employees or contractors is not feasible. This would require a significant increase in the number of training staff personnel.
106-320, Page 37. Tuberculosis Screening. Changing from the current requirement of within 30 days to prior to initial contact with individuals would mean screening would have to be done with pre-employment.
106-340, Page 38, B. Grievances. The provider shall hold grievance information within an employee’s or contractor’s personnel record in a confidential manner to ensure the information shall only be disseminated to authorized individuals. Grievance information is a separate matter and should not be included in the personnel file. This should be handled in a similar manner to how criminal records are maintained.
106-710, Page 56. Traffic Pattern. Language should be included to update this proposed regulatory statement to recognize that all properties of service provision are not within the ownership of the provider and thus, traffic pattern establishment and governance may not be within the control of the provider. Language that states the provider “shall make every effort to” develop or enforce a traffic pattern, if able or applicable, is more aligned with the nuances that may be experienced by some providers.
106-740, Page 57. Personal Necessities. The whole section uses language that lacks person-centeredness. Words such as “toileting” and “diapering” are no longer utilized in the field and are contrary to the language currently being taught in Person-Centered Thinking classes. It is important that the entirety of the regulations mirror in spirit and actuality the paradigm of person-centeredness.