12VAC35-105-520 A and C 2:

Is it the expectation of DBHDS that the person designated as risk manager completes clinical assessments and/or reassessments?  

12VAC35-105-520 C:

I think it’s important to highlight the irony of this guidance document including “business risks,” and “workforce risks” as “other risks that providers should consider.”   

The financial toll on providers, resulting from this overly complex and unfunded risk management requirement is directly related to the diminished ability to provide living wages for qualified direct support professionals. 

Also, the guidance language does not offer any examples of “high risk procedures” outside of seclusion and restraint.  If the department is only concerned with these then remove "high risk procedures" all together.  And while this guidance was developed solely in response to the Settlement Agreement, it will ultimately apply to all populations supported by providers licensed by DBHDS, not just Virginians living with developmental disabilities.  Therefore should the department be concerned with more than seclusion and restraint, further examples in this guidance should be inclusive of all populations supported by DBHDS-licensed providers. 

12VAC35-105-520 D:

“DBHDS will disseminate information about uniform risk triggers and thresholds in separate guidance when they are developed.”

The terms “risk triggers” and “thresholds” have been used in various DBHDS communications for a number of years (including a recent inclusion in the Risk Awareness Tool training) yet now that they are seemingly a requirement; there is still no guidance as to what DBHDS means by them or what additional unfunded mandates they will imply.   It is concerning that providers will be held to a standard that has not been defined simply to impress upon the Department of Justice that DBHDS is serious about risk management. 

As a result, the only comment that can be made regarding these terms is that they should not be in guidance or regulation until the department makes it a priority to define them and train providers in their utilization.  Whenever that happens, it would be helpful if the guidance was not limited to their application in the support of people living with developmental disabilities, but other populations as well.  There are many other people (and providers supporting them) to whom those terms should have meaning.