Section 20  & 30 Definitions – Every effort must be made to bring the definitions in line with those used by Medicaid and or the Department of Health Professions.  Contradictions and lack of consistency impose a hardship of the providers

Section 60  Modification – In order to accommodate a rapidly changing environment, the process for modification of an existing license needs a complete overhaul to include a streamlined process for adding sites to a current service and for changing the capacity within a specific licensed location.  The current process is burdensome for both the provider and for the Office of Licensing, can limit flexibility needed to provide access to services, and causes financial hardship on the provider.

Section 150  Compliance with applicable laws, regulations and policies – This section is the one that would be the most logical to “interpret” with a guidance document.  As the various relevant federal and state laws and rules are subject to change, apply differently (if at all) to different types of providers, and are monitored by the entity responsible, it would be most appropriate for DBHDS/OL to provide guidance which outlines which aspects of a particular rule the Licensing Specialist may review.  For example, the HCBS “Settings” Rule relevant to locks on bedroom doors in a group home is one easily observed and verified by someone doing an onsite inspection.

Section 210  Fiscal accountability – The requirement for 90 days of operating funds was appropriate when the majority of the services were funded privately or through local contracts.  As the vast majority of the services are now funded through Medicaid and prompt payment rules apply, the 90 reserve is irrelevant for any agency in operation for more than a year.  In recessionary or uncertain times obtaining and/or maintaining a credit line for several million dollars is expensive!

Section 260  Building inspection and classification – Consider combining Sections concerning physical plant

Section 330  Beds – Create a provision that allows the “certification” of a location based on the requirements of size specified in Section 340; this would allow a provider to be more flexible in expanding or reducing licensed capacity without a site inspection.

Section 400  Criminal registry checks – needs to be rewritten to comply with recent additions to the Code of Virginia as others than employees are now subject to background checks

Section 520  Risk management – This section could be strengthened to include some requirements for the provider conducting a root cause analysis of significant incidents, maintaining data of critical events and producing clear written analysis and recommendations to lead to a more robust QI process

Section 540  Access to telephone in emergencies; emergency telephone numbers – This section may need to be brought up to the 21st Century!

Section 645  Initial contacts, screening, admission, assessment, service planning, orientation and discharge – The OL regulations need to be better aligned with the concept of prior authorization for service/payment; in cases where the service must be authorized the admission occurs when that is complete, and prior work is considered a screening.

Section 650  Assessment policy – DBHDS should allow the assessment authorized by the funding source as sufficient.

Section 1180  Sponsor qualification and approval process – The role of the Sponsored Residential Provider needs to be clarified; the current practice does not coincide with these regulations and has become a barrier to placement.  Sections 280, 300, 340, 350, 360 & 380 invest in the provider the authority and responsibility for approving the physical plant, etc.