12VAC35-105-20. Definitions.
“Missing” – This definition is concerning as providers would be required to report in CHRIS any time an individual is not physically present when and where he is expected or supposed to be. Under this definition; an individual could go to the restroom for 5 minutes and be considered “missing.” Individuals often do not show for therapy, would they then be considered “missing” if the clinician is unable to contact them to find their whereabouts because they are not answering their phone? This is not person-centered and does allow for a person’s right to be where he or she chooses to be.
“Neglect” – failure by a person… funded by the department. We operate programs that are “funded” from DBHDS (Prevention/Intervention), but individuals utilizing these services are not admitted and there is no way to report this into CHRIS, as CHRIS is built around licensed services.
“Serious Incident” –
12VAC35-105-160. Reviews by the department; requests for information; required reporting.
C. How would this quarterly review of Level I serious incident be reported to DBHDS? What is the expectation? Why a quarterly review of only Level I incidents? How does this correspond with the root cause analysis as described below? There are expectations for providers to have corrective actions for every incident; however, not every incident warrants corrective actions. For example, air-borne illnesses are not something that a provider did incorrectly that needs to be corrected. Would like to see this defined further in the regulations.
D. 2. Reporting Level II and III serious incidents by phone to anyone designated by the individual to receive such notice and to the individual’s AR. There could be unintended 42 C.F.R. Part 2 and HIPAA consequences with this requirement. Providers will need to ensure that they have the required authorization to disclose this information.
E. A root cause analysis of each serious incident seems excessive. Many level I serious incidents include illnesses that an individual contracts just from being around other people (colds, flu, gastrointestinal viruses) and when solutions to mitigate its reoccurrence is unreasonable (we can’t keep individuals from going out in public all winter) or it will be the same for all similar incidents (proper hand washing; flu shots).
This will also increase administrative costs and time associated with completing a root cause analysis for every serious incident. What is the expectation for reporting these to DBHDS? What will be the expectation if we are already conducting a human rights investigation?
12VAC35-105-400. Criminal background checks and registry searches.
B. Concerns that providers must obtain written consent and personal information to search the registry prior to hiring. This would entail obtaining consent at the interview process. Providers would, therefore, have to obtain this information for applicants who providers end up not hiring. Interviewees may have concerns with providing this information prior to hiring an applicant, especially to an employer they may not end up working for.
E. Reviewing the criminal history background check and registry search results prior to hiring is of a concern for similar reasons as noted above. This will delay the hiring process; thus resulting in longer vacancy periods to fill valuable direct care positions. These background checks can take weeks or months to have back for review. Providers will be unable to provide valuable services and individuals will ultimately go without services.
There are also financial concerns; this will increase costs as more background checks will be completed on applicants, many of whom will not be hired on.
It is difficult to find qualified people who are willing to work in health and human services. This provision will make the hiring process even more cumbersome. This will deter people from considering employment with us and many applicants will find other employment while waiting for their background check to return. This has the potential to greatly affect services; programs will have to place a hold on new admissions, thus waitlists will increase and individuals will go without services.
12VAC35-105-520. Risk management.
C. What are the risk triggers and thresholds? It would be beneficial to have those defined within the regulations.
12VAC35-105-660. Individualized services plan (ISP).
C. What does “full participation” mean? Many individuals and their families (especially those in crisis and those who are very familiar with services) will not want to sit through and discuss all that is entailed in this section to document informed choice. Will there be a consideration if this is attempted, but the individual/AR does not want this information?
12VAC35-105-675. Reassessments and ISP reviews.
D. 3. This will require additional meetings and increased meeting frequency with the team and individual. Individual circumstances may make this difficult to accomplish.
12VAC35-105-691. Transition of individuals among service.
B. 2. What is the expectation of how informed choice will be documented? Will there be a required form?
12VAC35-105-1245. Case management direct assessments.
Specifically what risks are required to be assessed by the case managers? The previous sections of these regulations speak to having the individual provide informed choice and preferences; this section does not explicitly suggest that individuals are providing their feedback on how their services and supports are being implemented.