106-20

Case management while it is important to be responsive to need, the word “desires” seems expansive.  Can this be replaced with “preferences”?

106-20

Crisis Stabilization.  Revise definition aligns with DMAS terminology, which does not specify that Crisis Stabilization services are available 24 hours per day or differentiate between community-based and residential crisis stabilization, where the latter inherently provides services 24 hours per day.

106-20

Comprehensive Assessment.  Thank you for recognizing that there are situations where the initial assessment meets the requirements of a comprehensive assessment and that an update is not required.  This increases alignment with DMAS expectations for many services.

106-20

Suggest a need for a comprehensive ISP definition that includes a statement that a comprehensive ISP may be completed at the time of the initial ISP if all elements of a comprehensive ISP are included.

106-20

Corrective Action Plan Address systemic change adding “where indicated.” While this is important, this definition/expectation gives no latitude for human error, accidents, and other isolated incidents not indicative of a systemic issue. 

Similarly, revised to address systemic changes, if applicable… and include a definition of systemic or concepts about an acceptable rate of human error.

https://blog.gembaacademy.com/2020/06/08/lean-thinking-for-solving-systemic-problems/

106-20

Crisis Stabilization.  Please ensure definitions are consistent with forthcoming changes related to Project Bravo.

106-20

Emergency Services (crisis intervention).  If the Crisis Intervention license will be separated from Emergency Services, as anticipated under Project Bravo, ensure definitions are clear and distinct.

106-20

Licensing Report - Can there be a licensing report of no violations? This seems to say that all visits will result in a citation. This does not seem appropriate.

106-20

Mental Health Outpatient – treatment to individuals on an “hourly schedule” seems prescriptive.

106-20

The definition of PHI could be difficult for those to understand who have not gone through extensive HIPAA Privacy Regulation training.

106-20

Serious Incident, Level II, item 4.  Thank you for the inclusion of WRAP.  This is important, but limiting addition; there are other applicable, relevant concepts, such as Psychiatric Advance Directives.  Also, clearly stating that voluntary psychiatric hospitalizations are planned hospitalizations will decrease confusion and demonstrate a recognition that, unlike surgical procedures, psychiatric inpatient care is not scheduled days or weeks in advance.

106-20

Serious Incident Level III, item 2. 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.

106-20

Serious Incident, Level III, item 3.  Remove to reflect a change made in 2020.

106-20

Service animals – considering adding the ADA definition or specification-refer only to ADA accepted service animals.

106-20

Succession Plan.  Request an exception be specified for Community Services Boards, as this concept does not apply if you work for those that belong to the County.

Also, be aware that this term is defined differently in CARF.

106 – 20

Supervised Living. Making a blanket requirement of daily monitoring does not promote independence and is not person-centered. Staff are available on a 24-hours basis and provide services based on the assessment and ISP. We need this option to help to foster independence with individuals and provide the least restrictive service.

106-30

There are 3 licenses for ACT (small, medium, and large), but there is no mention here.  A recommendation that all licenses and ASAM levels be listed.

106-30

Defining on the license addendum the maximum capacity of enrolled individuals the provider may service at a given time is impossible to define. Defining appropriate staff to individual ratio is important. However, the capacity can fluctuate with available staff and the needs of those served. Given the response time for licensing to make changes and the need to provide services, this is a barrier to services. Provider shall be responsible for stating staff to individual ratio and ensuring that services are delivered within that model at all times. This is very problematic.

106-40.B

Perhaps a broader scope would be helpful, such as submitting an organization chart to fulfill requirements, instead of a succession plan.

7. is problematic. The exact documentation the department requests should be written out here. Providers should know exactly what they need to submit for a license application.

106-40.D

Recommend making both dates 60 calendar days, to increase consistency and clarity. Recommend changing “business” to “calendar” throughout regulations. Calendar days will cause confusion and late reporting.

There are no specified timeframes for when providers can expect a response from DBHDS.

106-50

A1f.  Is it a typo that should read that providers may NOT have more than one service on a conditional license at a time? 

A2f and 3Ae.  Stating that the Commissioner may lower a full license to a conditional license “at any time” does not allow for due process or explain what process will be used.

106-60

An overall comment that does not pertain only to this section is that there are specific and often There are specific and sometimes unreasonable timelines for providers to submit information and respond to information; however, there is nothing including the department’s responsibility to respond within appropriate and reasonable timelines. This has caused many issues. If timelines are set for the providers, there must be timelines for when the department will respond.

106-60

F. This is unreasonable. Depending on the number of records requested, location, if needed electronically or in person, this is not appropriate. The provider shall make all reasonable efforts to make records available within an appropriate time period consistent with the type of records being requested, the volume of records requested, format requested, and staff available to gather outside of impacting service delivery and appropriate staffing ratios.

106-80.A

Recommendation to change to 45 calendar days, which is more realistic for many providers.

We recommend emergency options. Such as right now, given the hospital crisis, if able to expand requiring 45 days would be inappropriate.

106-80.A.4

By modification to service descriptions, is this meant to imply that any revisions to a written program description need to be submitted with a Service Modification form? 

106-80 D.

There are times a provider may not be able to provide 90 business days’ notice to change ownership (e.g., death).

106-80.E

There is overlapping content with 106-80.A.  For example, Service Description is mentioned in both; there is not a clear distinction between geographic location (E.4) and locations where services are provided (A.6); the name of the provider is in both.  Recommend removing Service Description changes from 80.A and removing geographic location from 80.E  E.3 – business hours is encompassed by the Service Description.

106-80.E.8  This seems unrealistic. The individual is in the hospital or recovering from something and a notification has to be sent in. Define a significant period of time? What does notification mean?

106-90

Please specify the timeframes in which DBHDS will respond.

106-110.B.5

How will this be determined?  Will the context of numbers of individuals served and numbers of locations be taken into consideration?  While looking at systemic issues within one licensed service type is understandable, this potentially broadens the idea across services for a provider with multiple license types.  Distinct services under one organizational license should not be included.  Rather, each service type should be looked at distinctly.  It would, however, be understandable for a Licensing Specialist who identifies Systemic Noncompliance in one service type to ensure other service types within the organization are maintaining compliance.

B.5.  Should “defects” read “deficiencies”?

106-120

We request timeframes the department has to issue licensing reports with requests for corrective action plans. From experience, it can take six months or longer to get a CAP issued from inspections. 

106-120.C.1

The idea of addressing systemic deficiencies is important.  However, there is a need to recognize that not all instances of non-compliance involve an underlying systemic problem.  While the language “correct any systemic deficiencies” provides latitude and understanding that there may not be systemic deficiencies, related guidance (guidance document or standard text when citations are issues) should be updated to also reflect the possibility that not all violations involve systemic problems.  

106-120.C.2

Concerns are not related to this language, but rather to current practices when certain citations are issued.  In some instances, providers are directed to identify corrective actions that can be completed within 60 days.  This is not reflected in the regulations and true systemic corrections are often more complex and may not be readily implemented in this narrow timeframe.  It is important to ensure that guidance and expectations allow providers the time to make actual systemic changes when indicated.

106-120.E

Specify the timeframe the Department has to review plans and determine if they are approved.

E1.  Request timeframes for how far after a deficiency is noted that a CAP can be issued and the timeframe for the response back from DBHDS with information about whether the CAP is or is not accepted.  Timeliness helps providers avoid committing the same error before being issued a CAP or finding that a citation is received well after the matter has been resolved.  Such timeframes should be consistent across all Offices and Divisions of DBHDS.

106-120.E.1 and .2

106-120.F

As phrased, this allows a limited opportunity for collaborative problem solving and dialogue between a provider and the Department.  E and F are not fully consistent.  If there is disagreement about whether a revised corrective action plan is acceptable, is there the opportunity for discussion, or does the Department automatically issue a plan for the provider, or pursue an adverse action?  The language of E.1 and .2 presumes that the provider is intentionally avoiding the submission of an acceptable action plan. 

Does “A” Director mean an Assistant Director of the Office of Licensing may determine a CAP, and if so, is there an appeal to THE Director?

106-120.H.1

This presumes that additional measures are needed, without considering the possibility that the original action plans are working, but may take time to fully take hold.

106-180.B

Include an exception for CSBs, which do not operate in this manner.

106-190.B

We are a large agency with multiple offices and clinic locations. It is overreaching to have the executive director at their designated office location full-time M-F. It is not always feasible to have a designee on site.

Onsite Director for the full 40 hours per week?  This doesn’t allow for off-site meetings or increases the notification burden of an acting director when the Director is otherwise available by phone or could respond onsite in a reasonable amount of time.

What adjustments will be made to this stipulation considering recent events and increasing shifts to telework?

106-200 B.

The way this is written the ED must have a narrow scope of Master’s degrees. What about medical professions? JDs? experience in place of higher education. The executive director shall have a degree and experience providing the types of services he/she will be overseeing. However, an executive director may not have experience working with all disability populations served. In large organizations, this is not possible. This is completely out of line.

106-240.A

Providers shall not employ persons that have been convicted of any of the barrier crimes listed in §19.2-392.02 of the Code of Virginia, except as otherwise provided by the Code of Virginia. 

How does this impact employability of peers for instance?  Exceptions in the Code of Virginia aren’t listed.  (Joe Hudson bill – Senate Bill 555 in 2018 removing burglary as a barrier crime.)

Barrier crimes link:  https://law.lis.virginia.gov/vacode/19.2-392.02/

Appreciative of changes in 2 and 3 to get people started working.

106-240.D

The provider shall maintain the following documentation:
1. The annual disclosure statement from the applicant stating whether he has ever been
convicted of or is the subject of pending charges for any offense;

Is it appropriate to require an annual disclosure from the employee stating that they haven’t committed a crime? If language is retained, should “applicant” read “employee”?  Or should annual be removed b/c this only applies to an applicant?  There are concerns that this is a way around ban the box, where it’s not asked on the application, but it’s still asked of the applicant.  Should people be attesting to pending charges, because they haven’t been convicted yet?  Is this for all crimes or should this just apply to barrier crimes?