Comments RE: Amendments DBHDS Licensing Regulations 12VAC35-105

§20 Definitions

Definition of “Group Home”
Addition of the line “that provides 24-hour supervision by persons in direct care positions who do not live in the home” is seriously problematic.  It is a significant policy change and deserves careful consideration and full public discussion and contemplation with various stakeholders.  Including it in emergency regulations is not the appropriate vehicle to be used to implement such a policy change.  It should be deleted.

Definition of Risk management – change “prevention’ to “mitigation”

Definition of “serious incident”:  With respect to the criteria defining “serious incident”, please provide additional clarification regarding:

• Item 3 – an individual who is missing for “any period of time”.  It suggests that a report would be filed in any circumstance.
• Item 4 -  "Hospital Admission" Because hospital admission can take place as part of a routine or planned medical service, please qualify this provision as "Unplanned Hospital Admission".
• The tiered system is a bit confusing. Tier 1 has no definition, so it is not clear what types of incidents would fall under that category. The tiers are not all-inclusive which makes it open to interpretation and open to corrective action if done improperly
• Do not include allegations of exploitation or theft as a “serious incident” to be reported to the Office of Licensing as it would be duplicative of the report required under 12VAC35-115 to the Office of Human Rights as an allegation of abuse. This item should be removed from the Serious Incident list.

Definition of QDDP – The definition listed is inconsistent with the definition published in the January 8, 2018 Virginia register Issue 10 volume 34 action ID #4928.  Which definition will be used going forward?

Definition of QMHPs - The proposed regulations still have the old definition of a QMHP which requires 1 year of experience.  This needs to be changed to correspond with DHP that requires 1500 hours experience not 1 year (2080 hours).  The CHMRS Manual, DHP and Licensure need to match.

§160 C - Add language as follows: “ . . . shall collect, maintain and review, at least quarterly, reports, and related documentation of all Level I serious incidents . . .”

§160 D 2 - Add language as follows “ .  and by phone or other agreed upon means to anyone . . . such notice, and to the individual’s authorized representative, and to the individual’s Case Manager, as appropriate..”

§160 E - Completion of the specified “root cause analysis” within 30 days and then re-reviewing Level I incidents quarterly seems redundant; Level I review (as described in 160 C) is both sufficient and more comprehensive for this type of incident.  Exempt Level I incidents from this section.

Insert “level 2 or level 3” before the phrase “serious incident” to clarify that a root cause analysis is not necessary for level 1 critical incidents

§320 - Agree with the following language proposed by the VACSB - “The provider shall ensure adequate staff to safely evacuate all individuals during an emergency.”

§400 B - The form required by DSS contains information which is not relevant to a hiring decision and may be considered inappropriate to be asked prior to employment.

§400 E -  This section implies that the criminal history background check and the CPS registry report will be available “prior to hiring the applicant” – the Code of Virginia §19.2-389 A 29 specifies that a criminal background check may be completed for “applicant who accepts employment in any direct care position” – it is clear that to process a criminal background check the offer of employment must have been made and accepted.

It is already extremely difficult to hire qualified applicants.  The proposed requirement of a review of the background check and registry prior to hiring will further delay and create a bottleneck in an already long hiring process and add additional administrative burden. Although a new on-line process is expected at DBHDS, the private sector must still wait for a letter to be prepared and mailed by DBHDS.  The process will not be complete for review “prior to hiring.”  In addition, the CPS registry check takes four to six weeks from submission.  Applicants will not wait lengthy periods of time to be officially hired.  

Current code §19.2-389 designates the acceptance of employment as the driver for determining if the applicant has been convicted of a barrier crime.

§520 C -  What are the risk triggers and thresholds?  Definition is needed. The “uniform risk triggers and thresholds as defined by the department” should be included as part of these regulations if they are to be expected. Providers will be subject to multiple interpretations, revisions of lists without notice, and will be unable to develop policy or consistent practice. 

§660 C - This new language does not “fit” within the person-centered process used by DD providers – the documentation from the team meeting (some of which is contained in those sections of the plan prepared by the Case Manager) should be sufficient to explain the individual’s choices.  What does “full participation” mean?  Needs to be defined.

§675 – 3 – Define “team members”.  Applying to all services is extraordinary.  What would be the time frame of when team meeting would occur?