12VAC35-105-520. Risk Management A:

Loudoun County MHSADS is seeking clarity in the wording of section A in three areas:

1. While the regulation indicates “a person responsible for risk management function” should be delegated and meet training requirements, the guidance indicates that training is required for the person with “risk management responsibilities.” Our understanding is that the regulation calls for an individual to have managing/monitoring role over the functioning of risk management and that individual should have training in relevant areas.  By changing the language from risk management ‘functions’ to ‘responsibilities’ is it the intent of DBHDS to require each individual with involvement or responsibilities that encompass risk management activities to be trained in all aspects of risk management or that one individual be responsible for all risk management activities?  The idea that organizations can have one individual complete all responsibilities associated with risk management (especially large organizations with many programs and staff) is not practical.  We ask that DBHDS clarify the distinction being made between risk management ‘functions’ in the regulations and ‘responsibilities’ in the guidance. 
2. We are seeking clarity as to the meaning of "individual risk screenings.”  The guidance appears to indicate the risk manager will have a clinical responsibility.  While a risk manager would be looking for issues, they would not necessarily have the clinical expertise needed to conduct individual risk screenings.
3. We have concerns regarding the requirement to complete DBHDS provided risk management training.  Individuals have training within the organization and the addition of the DBHDS provided training would be redundant.  We would like information within the guidance regarding the timeline expectations.  Would training need to be completed within so many days of hire, prior to hire, will this be an orientation requirement?  We further ask that DBHDS provide at least a 30 day window for any staff in a risk management position to complete training when guidance goes into effect and clarify what the effective date is for this guidance. 

12VAC35-105-520. Risk Management C:

Regarding Section C(1): Environment of Care, we ask that the guidance is tailored to the type of service being provided and reflect that the provider is only responsible for the environment of care for which they have control.  For example, as a provider, we do not have the ability to manipulate the environment in an individual’s home or require refrigerator temperature checks in the community.

Regarding Section C(2): Clinical Assessment or Reassessment, the review of individual health risks should be conducted by the treatment team rather than a risk manager.  While the risk manager should look to see if assessments are completed and plans changed, they would not be reviewing individual health risks.  Please clarify the responsibilities of the risk manager when it comes to the review of the individual’s health risks.

Regarding Section C(4): Use of High Risk Procedures, we are seeking clarity as to what besides seclusion and restraint is perceived as a high risk procedure.  We ask that DBHDS provide in the guidance some examples of the ‘other high risk procedures’ they would consider applicable to this section.

Regarding Section C(6): Uniform Risks and Triggers, we are seeing more information.  We are unable to comment about whether this is an appropriate task to be completed and included for the overall risk manager unless DBHDS identifies what is considered uniform risk triggers and thresholds and what the expectations will be regarding these.