No comment forum defined for this notice.

The purpose of this notice is to request comments from interested stakeholders on an initial draft of revisions to 12VAC35-210, following a periodic review.

Comments may be submitted to Name: Ruth Anne Walker, Title: Regulatory Coordinator, Address: PO Box 1797, City: Richmond, State: Virginia, Zip: 23218-1797, Telephone: (804) 225-2252, FAX: (804) 786-8623, email address: ruthanne.walker@dbhds.virginia.gov.

Comments must include the commenter's name and address (physical or email) information in order to receive a response to the comment from the agency. Following the close of the comment period, a report the comments received will be posted on the Town Hall.

DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

DRAFT as Result of Periodic Review

CHAPTER 210
REGULATIONS TO GOVERN TEMPORARY LEAVE FROM STATE MENTAL HEALTH AND STATE MENTAL RETARDATION FACILITIES

12VAC35-210-10. Authority and applicability.

This regulation is adopted pursuant to § 37.2-837 B of the Code of Virginia to establish a process to facilitate community integration and the conditions for granting a trial or home visit to individuals admitted to state hospitals or training centers operated by the Department of Mental Behavioral Health, Mental Retardation and Substance Abuse Developmental Services.

This regulation shall not apply to individuals receiving services in a facility who are committed pursuant to Chapter 9 (§ 37.2-900 et seq.) of Title 37.2, Title 19.2 or Title 53.1 of the Code of Virginia.

12VAC35-210-20. Definitions.

The following words or terms when used in this regulation shall have the following meanings unless the context clearly indicates otherwise:

"Authorized representative" or "AR" means a person permitted by law or the State Mental Health, Mental Retardation, and Substance Abuse Services Board's regulations this chapter to authorize the disclosure of information; to or consent to treatment and services, or participation in human research; and to authorize the disclosure of information on behalf of an individual who lacks the mental capacity to make these decisions. The decision-making authority of an authorized representative recognized or designated under this chapter is limited to decisions pertaining to the designating provider. Legal guardians, attorneys-in-fact, or health care agents appointed pursuant to § 54.1-2983 of the Code of Virginia may have decision-making authority beyond such provider.

"Community services board" or “CSB” means the public body established pursuant to § 37.2-501 of the Code of Virginia that provides mental health, mental retardation developmental, and substance abuse services to individuals within each city or county that established it; the term “community services board” shall include administrative policy community services boards, operating community service boards, and local government departments with policy-advisory community services boards. For the purpose of these regulations, community services board also includes a behavioral health authority established pursuant to § 37.2-602 of the Code of Virginia.

"Day pass" means authorized leave from the a state facility without a staff escort generally occurring during the day and not extending overnight.

"Department" means the Department of Mental Behavioral Health, Mental Retardation and Substance Abuse Developmental Services.

"Family visit" means an authorized overnight absence from a state hospital or training center that allows an individual to spend time with family members, an authorized representative, or other responsible person or persons.

"Individual" means a person who is receiving services in a state hospital or training center. This term includes the terms "consumer," "patient," "resident," and "client."

"Individualized services plan" or "ISP" means a comprehensive and regularly updated written plan that includes but is not limited to an describes the individual's needs, the measurable goals and objectives to address those needs, and strategies to reach the individual’s goals.  An ISP is person-centered, empowers the individual, and is designed to meet the needs and preferences of the individual. The ISP is developed through a partnership between the individual and the provider and includes an individual's treatment plan, functional plan, habilitation plan, person-centered plan, or plan of care that meets the needs and preferences of an individual and describes the measurable goals, objectives, and expected outcomes. 

"Missing person" means an individual who is not physically present when and where he should be and his absence cannot be accounted for or explained.

"Responsible person" means an individual's parent, legal guardian, relative, friend, or other person whom the facility director determines is capable of providing the individual with the needed care and supervision, and if the individual has an AR for whom the AR has given written consent to supervise the individual during temporary leave from the state facility. The responsible person has responsibility for the care, custody or control of an incapacitated person by operation of law or has assumed such responsibility voluntarily, by contract, or in fact.

"State facility" or "facility" means a hospital or training center operated by the department for the care and treatment of individuals with mental illness or mental retardation intellectual disability.

"Trial visit" means an authorized overnight absence from a state facility without a staff escort for the purpose of assessing an individual's readiness for discharge. Trial visits do not include special hospitalizations, facility-sponsored summer camps, or other facility-sponsored activities that involve staff supervision.

12VAC35-210-30. General requirements for temporary leave.

A. Directors of state facilities shall develop written operating policies and procedures for authorizing and implementing the following types of temporary leave from the facility:

1. Day passes for periods that do not extend overnight;

2. Family visits and trial visits for a maximum of 28 consecutive days per episode for individuals in training centers; and

3. Family visits and trial visits for a maximum of 14 consecutive days per episode for individuals in state hospitals.

B. The justification for all temporary leave shall be documented in the ISP. This documentation shall include:

1. The reason for granting the specific type of leave;

2. The benefit to the individual;

3. How the individual participated in the decision-making related to temporary leave; and

4. How the leave addresses a specific objective or objectives outcome or outcomes in the individual's ISP; and

5. The signature of the facility director or designee authorizing the temporary leave.

C. Responsible persons during leave.

1. Adults and emancipated minors receiving services in state hospitals who are granted a day pass, family visit, or trial visit may be:

a. Placed in the care of a parent, spouse, relative, legal guardian, friend, or other person determined capable by facility director, or AR, a facility licensed by the department or other responsible person or persons; or

b. Authorized to leave the facility on his own recognizance, when, in the judgment of the individual and the facility director, this leave is appropriate.

2. Individuals in training centers and minors receiving services in any state hospital, who are granted a day pass, family visit, or trial visit shall be placed in the care of:

a. The parent, legal guardian, or LAR AR; or

b. Another relative, friend, or other responsible person or persons, or a facility licensed by the department with the prior written consent of the AR.

D. The state facility granting a trial or family visit to an individual shall not be liable for his expenses during the period of that visit. Expenses incurred by an individual during a trial visit or family visit shall be the responsibility of the person into whose care the individual is entrusted or the appropriate local department of social services of the county or city of which the individual at the time of his admission to the facility, as appropriate, pursuant to § 37.2-837 B of the Code of Virginia.

12VAC35-210-40. Day passes.

Each facility shall have specific policies for day passes that include:

1. Criteria for granting day passes;

2. Designation of staff members who are authorized to issue day passes; and

3. Any forms to be used by the facility regarding the issuance of day passes.

12VAC35-210-50. Trial visits.

A. The facility and the CSB may arrange trial visits for the purpose of assessing an individual's readiness for discharge from the facility. These trial visits shall be planned during the regularly scheduled review of the ISP or at other times in collaboration with (i) the individual, (ii) the individual's family or AR or (iii) any other person or persons requested by the individual. When trial visits are used in conjunction with discharge planning, the state facility treatment team shall meet with the individual to discuss his preferences for residential settings and give due consideration to his expressed preferences. If the treatment team cannot reasonably accommodate the individual's preferences, a member of the treatment team shall meet with the individual to discuss the reasons for this determination and the options that are available to him. The treatment team shall document in the individual's record that it has met with the individual to consider his preferences and review the available options. All plans for trial visits shall be documented in the ISP and include consideration of the following:

1. The individual's preferences for residential setting; and

2. The individual's essential support needs for support and supervision requirements.

B. In advance of the trial visit, the facility shall work with the individual, CSB, and responsible persons, as appropriate, to develop an emergency contingency plan to ensure appropriate and timely crisis response.

12VAC35-210-60. Family visits.

A. Family visits may include visits with the individual's immediate or extended family, AR, friends, or other persons arranged by the family or AR.

1. Training centers shall plan family visits in collaboration with the individual, his family or AR, and when appropriate, the CSB;

2. State hospitals shall plan family visits in collaboration with the individual and his family or AR, and when appropriate, the CSB.

B. When planning family visits facilities shall:

1. Ensure all identified essential support needs are reviewed with the responsible person or persons;

2. Develop plans to address potential emergencies or unexpected events;

2.3. Consider whether the visit has an impact on the treatment or training schedule for the individual and make appropriate accommodations; and

3.4. Give consideration to the individual's medical, behavioral, and psychiatric status.

12VAC35-210-70. Required authorizations and documentation.

The facility shall not release individuals for day passes, trial visits, or family visits unless the required authorizations have been obtained and documentation is included in the individual's record.

12VAC35-210-80. Illness or injury occurring during a family or trial visit.

A. When a facility is notified that an individual is injured or ill and requires medical attention while on a day pass, trial, or family visit, the facility director or designee shall notify the (i) facility medical director, (ii) treatment team leader, (iii) risk manager, (iv) facility human rights advocate, and (iv) (v) the CSB. The facility director shall also ensure that all events are reported in accordance with department and facility policy and protocol for risk management.

B. The facility director or designee may assist the CSB or the responsible person to identify an appropriate setting for the evaluation and treatment of the individual. The facility medical director may also consult with the physician and any other medical personnel who are evaluating or treating the individual. However, the individual shall not return to the facility until he is medically stabilized.

C. Individuals who have been admitted to a state hospital on a voluntary basis and require acute hospital admission for illness or injury while on temporary leave from the state hospital may voluntarily return to the state hospital following discharge from an acute care hospital if they continue to meet the admission criteria.

D. If an individual has been legally committed to a state facility hospital and his length of stay in an acute care hospital exceeds the period of commitment to the state facility hospital, the facility hospital shall:

1. Discharge the individual in collaboration with the CSB; and

2. Notify the individual or his AR in writing of the discharge.

E. If the facility is notified that an individual has died while on temporary leave, the facility director or designee shall:

1. Notify the appropriate facility and other department staff, including, the medical director, risk manager, treatment team leader, and human rights advocate;

2. Notify the appropriate CSB and AR;

3. File the appropriate documentation of the death in accordance with department policies and procedures; and

4. Notify the state medical examiner in writing of the death.

12VAC35-210-90. Failure to return to training centers.

A. When an individual fails to return to a training center from any authorized day pass, family visit, or trial visit within two hours of the scheduled deadline, the facility director or designee shall contact the responsible person into whose care the individual was placed to determine the cause of the delay.

B. Upon the request of the responsible person, the facility director may extend the period of a family or trial visit for up to 72 hours beyond the time the individual was scheduled to return when:

1. An emergency or unforeseen circumstances delay the individual's return to the training center; and

2. The individual's AR agrees to the extension.

Extensions for emergency or unforeseen circumstances shall not be granted in advance of the family visit or trial visit.

C. If an individual does not return to the training center from a day pass, trial visit, or family visit within two hours of the established deadline for his return and the training center is unable to contact the responsible person into whose care the individual was placed, the facility director or designee may extend the period of the visit for up to 24 hours if, in his judgment, the extension is justified. During this period the facility shall continue efforts to contact the responsible person.

D. If an individual does not return to the training center and his absence cannot be accounted for or reasonably explained by the responsible person or a family member, he shall be classified as a missing person, and the facility shall follow the department's policies and procedures for management of individuals who are missing.

E. If no emergency or unforeseen circumstances exist that may prevent the individual's return to the facility, and the responsible person does not agree to the return of the individual to the training center as scheduled, the facility director shall contact the CSB and discharge the individual. Written notification of discharge shall be sent to the individual's AR.

12VAC35-210-100. Failure to return to hospitals.

A. When an individual fails to return to a state hospital from any authorized day pass, family visit, or trial visit within two hours of the scheduled deadline, the facility director or designee shall contact the responsible person into whose care the individual was placed to determine the cause of the delay.

B. Upon the request of the responsible person, the facility director may extend the period of the visit for up to 72 hours beyond the time the individual was scheduled to return when:

1. An emergency or unforeseen circumstances delay the individual's return to the hospital; and

2. The individual or his AR agree to the extension.

Extensions for emergency or unforeseen circumstances shall not be granted in advance of the family visit or trial visit.

C. If an individual agrees to return to the facility, the facility director or designee may assist the individual to make arrangements for his return in collaboration with the CSB and the responsible person, when necessary.

D. If an individual is unwilling to return to the facility, the facility director or his designee shall contact the responsible person to determine whether continued hospitalization is appropriate or the individual should be discharged.

1. If there is no evidence that the individual meets the criteria for hospitalization then the facility shall discharge the individual in collaboration with the CSB.

2. If the individual has been legally committed to the hospital and the facility director determines that the individual may require further hospitalization and he currently meets commitment criteria, or that the individual cannot be located, the facility director shall:

a. Ensure that the commitment order is valid;

b. Classify the individual as a missing person;

c. Alert the CSB pursuant to the department's policies and procedures for managing of individuals who are missing from state facilities;

d. Issue a warrant for the individual's return under § 37.2-834 of the Code of Virginia; and

e. Arrange for a physical examination at the time of the individual's return to the facility.

3. If the individual is on voluntary status or the commitment order is no longer valid the facility director, after consulting with the appropriate clinical staff, shall:

a. Discharge the individual; and

b. Alert the CSB of the individual's status.

F. When it is determined that an individual who has been legally committed to the facility must be returned to the facility and the individual refuses to return on his own accord, the facility director or his designee shall:

1. Issue a warrant for the individual's return under § 37.2-834 of the Code of Virginia to the hospital; and

2. Contact the CSB upon revocation of the trial visit.