Members of the VACSB MH/SUD Council had much feedback on these proposed regulations. Overall the comments shared indicate that the new regulations added unnecessary administrative and financial burdens. The question is “What is the value added to the client?” Additionally, the regulations do not move in the direction of cohesion among different state agencies as directed by Secretary Carey. Some of the content is contrary to STEP VA and DMAS. Additionally, DBHDS hired Scott Lloyd with MTM Services to assist the state with implementing Same Day Access, the DLA 20 and other initiatives. This organization instructed providers to utilize a comprehensive needs assessment at SDA and to look at consolidating the paperwork at admission. These regulations contradict this directive. Moreover, he shared that the paperwork requirements were as burdensome as any he had seen in the country. The increased oversight and regulation adds even more pressure to an already stressed system. In the future, it may be helpful to include providers and clients on work groups that review and develop regulations.
Thank you for the opportunity to provide feedback.
Leslie Stephen, LCSW MH Council Chair for VACSB
12VAC35-106-20 Definitions
Comprehensive Needs assessment:
The definition in the new draft directly and significantly impacts Same Day Access. During the implementation of SDA throughout the CSB system, the consultant that the hired (MTM) for this process informed the system that the comprehensive needs assessment was to be conducted at SDA. Many CSB’s ensured that licensed professionals are available to provide these comprehensive needs assessments when the person initially requests services. Changing this process would cause an undue burden on the system and is not how the state’s own consultants trained the CSB system. Suggest that the words “that updates and finalizes the initial assessment” be deleted.
Initial assessment:
CSBs were informed during the development of SDA, the initial assessment and the comprehensive needs assessment could be one in the same. This definition undoes that understanding between DBHDS and the CSBs. An assessment is a service and is reimbursable by Medicaid and private insurance alike. It was suggested that this definition be completely removed as the initial assessment is the comprehensive needs assessment as recommended by the state consultants and implemented by the CSBs.
Inpatient psychiatric service:
Consider aligning the definition with DMAS when possible.
Intensive Outpatient Services:
Recommend aligning this definition with that of DMAS and ASAM criteria so there is consistency as encouraged by Secretary Carey.
Medication Assisted treatment:
Medication assisted treatment is utilized for more than opiate use disorder. Alcohol use disorder also has very effective medications that are utilized. This should not include just the medications that treatment OUD.
Outpatient Services:
Could this definition please match the definition utilized in Step VA? It would help to have consistency within DBHDS and also with DMAS. Secretary Carey has publicly encouraged DMAS and DBHDS to work together to streamline processes. Having the same definitions seems appropriate.
PACT definitions:
Recommend not stating “10 full time staff are needed.” Rather, consider using ratios such as 1:10 staff to clients.
Recovery:
Suggest using the SAMHSA definition for Mental Health and Substance Use Disorder recovery. “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
12VAC35-106-60 Inspection Requirements
It is the hope that those organizations /services that are accredited by CARF be exempt from annual reviews and move to a triennial review.
Additionally the 1 hour time frame to produce a record places an undue burden on the agency. Many agencies have sites that are up to an hour or more away. This could negatively impact the everyday functions of the provider and negatively impact the clients. We request that this be removed until all parts of the client record is electronic at all providers.
12VAC35-106-70 Renewals
In the past there has been a grace period for those organizations that may miss the deadline to submit a completed renewal application so as to prevent a disruption of services to those served by that agency. Respectfully request that a grace period be added to this regulation.
12VAC35-106-110 Compliance
“All applicable federal, state, or local laws and regulations and all applicable department guidance….” This is a massive change. This seems to indicate that department guidance has the same level of importance as regulations and laws. While regulations allow for public comment and feedback, there is no such provision for guidance documents. Please remove “applicable department guidance” from this regulation.
12VAC35-106-180 Governance
These regulations appear overly prescriptive and do not take into consideration the requirements of the localities, the differences in the communities, and the different CSB/BHA structures. These regulations do not allow for the flexibility needed for the vastly different communities that the CSB system serves. Not all providers have a governing body. Suggest removing this language. Recommend a complete rewrite or full elimination of this regulation.
12VAC35-106-200 Executive director or administrator
What is the purpose of the minimum education requirement and the short list of degrees accepted? Suggest eliminating this.
12VAC35-106-240 Criminal background and registry searches
A. Placing the information in the employee’s record within 3 days does not give time for appeal of accuracy. The employee has a right to see and potentially challenge the accuracy of the findings per Virginia Code, however, this can’t be accomplished within 3 days.
B.3. – “…background checks on a minimum of 20% of all existing employees annually.” This creates both an administrative and financial burden. Suggest, that each CSB has a policy about the frequency and they follow that policy. Does this include administrative staff or direct service staff only?
12VAC35-106-250 Full-time and part-time employee
Hiring of staff and the onboarding process is very long and arduous. Vacancies/workforce shortages are negatively impacting clients. Regulating additional requirements adds an excessive burden. Most direct service positions require outside licensing and certifications. (OMHP, Peers, LCSW, LPC, etc).
Recommend allowing use of a 3rd party vendor for primary source verification of educational history.
TB testing – Recommend specifying “assessment” for TB. At times there are shortages of the serum needed to perform TB testing.
Driver’s license – Staff may work in VA but live in another state such as North Carolina, Tennessee, West Virginia, Maryland, etc. Recommend removing the requirement for a VA license. This is a barrier to employment. Each provider should have the freedom to work with their Risk Management Department to identify an appropriate policy for that provider.
A.5. –“Three job –related references…” This will eliminate many of those new to the field. Suggest that this be changed to 2 job related references.
12VAC35-106-260 Contracted Employees
A.5. – “Three job related references…” Again, this seems excessive. See above.
Driver’s license – Staff may work in VA but live in another state such as North Carolina, Tennessee, West Virginia, Maryland, etc. Recommend removing the requirement for a VA license. This is a barrier to employment. Each provider should have the freedom to work with their Risk Management Department to identify an appropriate policy for that provider.
12VAC135-106-300 Employee training
B.1 – 7 day training requirement is not feasible. This is overly prescriptive and adds a huge financial burden to the provider. Most providers are unable to accommodate this. Availability of trainings such as CPR/First Aid/Medication Assistance are not always available same week. It is reasonable to provide basic orientation as to job duties and agency policy and procedures within the first 7 days, but to require all of the training to happen in that amount of time appears unmanageable. One suggestion is that staff does not work alone without completing necessary training.
C. – It appears that the requirement for at least one employee on duty at each location to have a current CPR and First Aid certification is being removed, what is the new requirement? Is the expectation that everyone must be trained? If so, this is a huge expense and an unwarranted burden on the provider.
12VAC35-106-310 Notification of policy changes
B. Notification “prior to implementation” prohibits organizations from quickly implementing changes and responding to concerns. At times, providers find that they need to quickly implement a change for the health and safety of clients, this will not allow providers to be nimble and responsive to the needs of their clients/communities. Policy changes are often required to be approved through individual boards/localities.