While we appreciate the recognition that there may be unusual circumstances preventing a provider, on rare occasions, from being able to enter a report into the CHRIS system, offering only an email alternative fails to take into account the fact that a network outage may impact a provider’s ability to utilize email.  We request the establishment of a mechanism that providers may use to report an inability to access both CHRIS and email in the event of an outage.

The required timeframe to submit updates to Serious Incident Reports in CHRIS should be two business, days.  A 48-hour period does not account for the fact that many services do not operate on a seven day/week basis.  Thus, a provider may not receive an update within 48 hours.  This change would have  no negative impact on individuals receiving services and there is no gain to individuals by updating the IMU on weekends and holidays.  There is, however, a negative impact for providers, who must continue to divert funds from service delivery or other activities to pay staff members to report during the weekends and holidays.  From a more general perspective, regardless of weekends/holidays, information may not be available to providers within 48 hours and we recommend that the timeline be reconsidered.  The memo does not specify how IMU will contact providers – please share this information and ensure IMU staff are attentive to out of office messages when calling or emailing provider staff.

We appreciate efforts to standardize and publicize expectations regarding the content of CAPs and recommend revising the CAP form to promote successful fulfillment of the expectations, which benefits both the Office of Licensing and providers.  While we understand the importance of including systemic corrections, the expectations allow no latitude for the reality that some events are idiosyncratic and do not require a systemic level correction.   Please specify the timeframe allotted to Licensing Specialists to send a CAP to a provider and to review and follow up with providers after a CAP is submitted.

While we understand the need for progressive actions for repeated citations in a single area, we are highly concerned by the approach that has been implemented as it fails to use available data or to account for base rates, which vary by both size and type of provider.  The stated approach is biased against larger providers.  We highly recommend using existing CHRIS data to establish base rates for numbers of CHRS-reportable incidents by a provider’s license(s) and connecting the progressive citation to a percent of reports that are late, vs. a flat number.  A provider with late reporting for two of ten reports (20%) is quite different than a provider reporting two of fifty reports in an untimely manner (4%). 

In addition, while it is understood that multiple sites are licensed under the same type of license, this approach does not take into consideration that a provider might reasonably have sites offering the same service that fall under a different chain of command.  To conclude that if a single incident is late from each of two widely separate (either geographically or organizationally) locations there is an underlying systemic problem presumes a root cause without performing any analysis of the system or consideration of the context.   

What is the current percent of timely or untimely reporting?  What analysis has DBHDS undertaken to determine if patterns of late reports relate to specific providers or types of providers?  How was the data used to formulate an action plan?  The current approach establishes negative consequences for those who are honest in reporting/honest in late reporting and does little to monitor providers who don’t report or under report.  This elevates concerns that some providers may opt not to report at all if the report will be late.  The chances of getting “caught” doing so and the consequence are less significant than the consequences of submitting a second report a few hours late.

Please clarify and confirm that for providers with multiple licenses, the escalation of citations & consequences is by individual license, not the overarching license.  Please clarify how the two-year clock is being measured – calendar year, rolling basis, date of the provider’s license?

Referring to this as a “proposed memo” and issuance of an effective date that precedes the opening of the public comment period is highly disappointing and subverts the intent and spirit of the Town Hall process.  While we respect the importance of ensuing compliance with the terms of the DOJ Settlement agreement, we are also concerned that the manner of implementation detracts from the desired collaborative partnership with DBHDS.

Finally, we continue to have concerns regarding the economic impact of the increasing administrative burden placed on providers.  We support accountability and recognize the need to meet the terms of the DOJ Settlement agreement.  However, over the course of the past five – six years, increasing requirements on both administrative and service delivery staff have not been recognized via commensurate increases in reimbursement.  Although payment rates are not under DBHDS’s purview, from a more global perspective increased costs without increased funding result in the loss of good quality providers and services.  Staff members cannot be compensated adequately.  Funds that would be able to improve services for individuals are diverted to non-revenue generating resources, ultimately having a negative impact on individuals in need of services.  Previously issued statements that providers already have staff in place to absorb the additional duties does not accurately reflect our experience, or that of our colleagues at other agencies.