As you read through the comments from my colleagues, a common theme emerges that has been plaguing Virginia’s human services for years. As DBHDS and DMAS leadership hastily attempt to strive for compliance with the DOJ settlement and the feedback from the Independent Reviewer, they seem to think that increasing regulations, documentation, tracking and administrative responsibility will solve the problem. Meanwhile, what most providers agree on is that “quality” occurs during the interaction between the Direct Support Professional and the individual receiving services. By increasing the administrative burden on providers, DBHDS and DMAS are literally forcing DSPs to pay for these mandates because they get what is left of the provider rates after all these mandated back-office activities are completed. Providers are having to increase their “white collar” administrative supports which are typically higher paid, higher educated and more experienced workers. Meanwhile, Direct Support Professionals who are doing the actual work with the customer, are left with an extremely low wage putting them near or under the poverty level. These low DSP wages are significantly limiting the provider's ability to attract and retain quality staff. HR departments are having to lower their standards and accept workers who are not ideal for the position and may not be a good match for the customer's needs. No amount of back-office administrative efforts will improve quality until we get the DSP compensation competitive to other jobs that have a similar level of complexity and responsibility. DSPs are Essential Workers and it is time that DBHDS and DMAS leadership acknowledge this by redirecting their efforts away from unnecessary/ ineffective back office activities and onto DSP wages, benefits, training, turnover and overall job satisfaction. This is the only way to improve the lives of persons with disabilities in Virginia! Members of the General Assembly and the Governor (via his administration) are the only entities that can hold DBHDS and DMAS leadership accountable for these outcomes.
Unfunded Mandates and Unreasonable Timelines
We object that this guidance document should not be in effect as of June 15th, since the review of public comments is not yet complete (July 22nd Public Comment Deadline). The short period between issuance and effectiveness is unreasonable and insufficient to prepare providers for such a significant system’s change. We consider private providers to be a partner of DBHDS, yet this directive was issued unilaterally and contains punitive language, ignoring the fact that in Virginia, we have a history of working as a partnership of public and private providers.
Two-Year Time Frame - We object to the reference of a 2-year time frame to track citations since there is no definition in this document of the 2-year period. We are unclear if it is based on a calendar, a fiscal period or based on an arbitrary date for each provider.
There seems to be a “punitive intent” to add citations to providers rather than addressing the serious issue of care provision based on inadequate reimbursement and onerous reporting requirements. We object that this memorandum is focused on effective reporting rather than improving the system of care to individuals our members support.
24-hour and 48-hour Deadlines - We object to the requirements of 24-hour and 48-hour deadlines which create a significant unfunded administrative burden for providers. The administrative burden to collect, verify, and submit report updates is often limited by delayed access to necessary information, which is essential to produce accurate reports based on a system of root cause analysis.
Recommendation: Rather than a 24-hour reporting requirement in CHRIS, we propose allowing 2 business days for reporting so that providers have adequate time to collect and analyze data in a responsible and complete manner.
We object to the 48-hour time frame to update CHRIS with medical reports or other records. This health information comes from external sources, and providers often have no control over the time frames of external medical entities who are not governed by DBHDS reporting requirements.
Recommendation: Rather than a 48-hour follow up in CHRIS, we propose allowing an additional 2 business days for adding additional information. This is especially critical when providers are awaiting medical information from external sources. We note that, for example, waiting on results of a COVID test often takes more than 48 hours, and as a provider, this time frame is beyond our control.
We object to the arbitrary threshold of four late reports. Our provider members are committed to a robust approach to risk management and quality improvement - and, this seems punitive in nature. Has the Department considered a threshold that incorporates proportionality such that the number of citations would be measured in proportion to the number of service recipients enrolled with the provider?
This is a significant unfunded mandate for a provider system already stretched to the limits. There needs to be adequate accommodation within the rate setting formula to compensate providers for these administrative and managerial requirements which are beyond the DSP and first level supervision. It is also well beyond the limited administrative overhead allowance in the current DD Waiver rate methodology