We strongly oppose the change as written.  DBHDS indicates the proposed changes are to align the ISP Quarterly Review Dates with DMAS regulations.  While the attempt to align requirements is appreciated, this proposed change is not in line with the established processes and DMAS requirements for Developmental Support Coordination (Case Management) and Mental Health Case Management.  The current requirement for completing the Case Management/Support Coordination Quarterly is 30 days from the date the Quarterly Review Period ended.  This timing in critical for Support Coordinators/Case Managers to complete the requirements of their job and ensure ability to review services provided to individuals.  Further, this is critically important for Support Coordinators to meet the expectations for oversight of services as indicated in the DOJ settlement agreement.  Other providers must submit their quarterlies to the Support Coordinator so the Support Coordinator can review how all services are going for the individual.  Further, the Support Coordination/Case management review of providers’ Quarterly ISP reviews helps to identify risks so they can be addressed. 

It is suggested the regulation be changed to be effective for all services except Case Management Services.  Then adding the following requirement for Case Management:  Case Management services must complete the Review documentation and add to the individual’s record no later than 30 calendar days from the date the review period ended. 

We are concerned that "the 15 calendar day from the date the review is due" does not align with current DMAS regs which allows a 10 day grace period for providers and a 30 day grace period for Case Managers.  The preference is for the Office of Licensing to align with the DMAS regulation to honor the above grace periods for the Case Management Review to be completed.  This will allow sufficient time to recieve provider documentation, assess the information received in order to complete a quality CM review. Furthermore, if the expectation becomes that the provider and CM reviews are due on the same day (15 calendar days from the date review is due), it is likely that provider reviews will not be received until the 15th day which would not allow the CM the opportunity to review the documentation in a timely manner in order to complete their review thoroughly and remain in compliance.  

I wanted offer comment to the proposed regulation indicating that the quarterly reviews need to be in the individual’s record no later than 15 calendar days from the date the review was due to be completed.  This is a concern for Case Managers/Support Coordinators as they need to receive and review the providers quarterly reviews  incorporating  the information in their review.

There are occasions in which the provider is late or does not provide quarterly documentation at all, even with numerous follow up by the CM/SC.  This regulation will prevent the CM/SC an opportunity to review the provider quarterlies and synthesize the information as needed.  It would also create a potential citation for not meeting a regulation when it is not within their control.

 Can the regulation be edited to offer a period of time for the CM/SC to review provider quarterlies and then complete the Case Management quarterly?

 Thanks so much for reviewing the information and working to resolve.

 If you have any questions or follow up please do not hesitate to contact me directly.

There is some confusion as to whether support coordinators are included in the defintion of "provider" noted here. If they are, this would institue an unwelcome change which reduces the amount of time support coordinators have to complete and document a quarterly review.  If support coordinators are not intended to be included in the definition of "provider" in this instance, this should be clarified.

There is concern about the change in due dates for reviews.  Currently direct service providers are required to send their quarterly report to the Case Manager within a 10 day grace period and the Case Manager then has 30 days from the end of the quarter to review the services provided.  There are several providers who do not send their quarterly reports within the 10 days and some that do not send the report by the Case Manager’s 30 day grace period.   For example, in the month of December 2018, Hanover County DD Services had a total of 57 quarterlies to complete by December 31, 2018;  21 were not received within the 10 day grace period. The Hanover County Case Manager’s standard response is  to follow up with the provider with at least two phone calls  and  then a standard letter is sent to the provider which is copied to the DBHDS Community Resource Consultant.  By December 31, 2018, 15 quarterlies were not received by the case manager’s 30 day grace period. In January, 45 quarterlies were due, 18 were not received by the 10 day grace period and 7 were not received by the end of the month after the Case Manager’s attempts to receive the review.    

If the Case Manager is going to be required to complete a quarterly review by the 15th day of the month, then provider information will likely not be included.  To meet the expectations of the DOJ Settlement, Case Managers must have the time to review the provider information.   We would like to suggest that the providers of direct services be allowed a 15 day grace period to complete their quarterly and that Case Management services be required to complete the quarterly review no later than 30 calendar days from the date of the end of the review period.  We would also like to see language added to describe how providers are to be held responsible by Licensure if a quarterly is not received within the grace period, as well as a description of expectations of the Case Manager in obtaining the quarterly.  Language should also be added to reflect the responsibility of DBHDS staff in providing oversight to those providers who consistently miss sending requested quarterly information. 

Thank you for your consideration of these comments.  If you need any further information, please feel free to contact me. 

The proposed licensing change does not align with the regulations set by DMAS regarding ID/DD case management documentation. Per DMAS guidelines, the Support Coordinator (SC) is permitted a 30-day grace period to complete the person-centered review (quarterly). In addition, providers are allowed a 10-day window (within the 30 day period) to complete and submit their provider QRs to the SC. The SC is responsible for obtaining, reviewing and incorporating all provider quarterlies into the person-centered review. The proposed licensing regulation would not allow the SC time to obtain the needed documentation from external providers and complete the person-centered review within the required timeframe. The recommendation would be for the licensing regulation to align with the DMAS regulations to allow a 30-day window to complete the person-centered review.  

We sincerely appreciate the efforts of the Office of Licensing to improve coordination with the requirements of the Department of Medical Assistance Services on the topic of quarterly progress reviews.  As stated, the proposed change is unclear regarding whether or not the progress review itself may be completed within 15 days of the end of the quarter, or only the documentation of said review.  We request language clarification such that the actual review may be completed within a specified window after the end of the quarter.  This is a more natural process, as the documentation of such a review is typically completed concurrent with the actual review of affiliated information (e.g. progress notes, summaries provided by other providers).  In addition, we request an alteration of the approach, using previously articulated DMAS requirements for providers of intellectual disability services, wherein a reasonable grace period (e.g. 15 days) is allotted to providers of services other than case management, while a more extended grace period is allotted to case managers (e.g. 30 days). This will allow case managers the opportunity to review and synthesize information from other providers into their review and their updates to the ISP, a key requirement of this service and an expectation for support coordinators assisting individuals with developmental disabilities.

The  proposed requirement of having the quarterly reviews in the individual ‘s record no later than 15 calendar days from the day the review was due to be completed  is very alarming when it comes to the IDD Case Management /Support Coordination. This will create an issue for the   IDD Case Managers /Support Coordinators require to incorporate into the review information from provider(s) who are not always provide the documentation in timely manner.  In order to remain with Licensure compliance and DOJ settlement agreement, the staff must provider summary of the individual progress, lack of progress assessment of the person’s identified and unidentified risk.

We strongly advocate for that the regulation to exclude the IDD Case Management /Support Coordination from the requirement of having Quarterly Review documentation in record no later than 15 days from the date the review period ended. IDD Case Management ought to complete the the Review documentation and add to the individual’s record no later than 30 calendar days from the date the review period ended.

The proposed changes to the DBHDS regulation are welcomed, given the Department’s attempt to align the requirements put forth by DMAS and DBHDS governing licensed behavioral healthcare Providers. However, the proposed changes should ensure its additions will not contradict the current operations of Case Management/Support Coordination in the completion of related tasks. More specifically, this updated section of regulation [12VAC35-105-675], similar to the original, does not identify whether CM/SC staff is included in the definition of Provider. Clarification of this might require extension of the proposed quarterly submission and filing timelines to accommodate CM/SC responsibilities of acquiring collateral documents from other providers, appraisal and incorporating into quarterly review documentation. A blanket 15-days for completion and submission into the medical record for all Providers is not sufficient in this respect.