The Virginia Association of Community-Based Providers (VACBP) represents private-sector providers of behavioral health, substance use disorder and ABA services throughout the Commonwealth of Virginia, and submits these comments on behalf of our members.

Page 27, 3.b.i, Medical Necessity Criteria for Community Stabilization

Proposed language:

The individual needs community stabilization as a transition due to either i. or ii. below and also meets iii. below:

(i) A LMHP, LMHP-R, LMHP-RP or LMHP-S at a Community Services Board (CSB) same day access intake, a Managed Care Organization, or Fee-For-Service contractor determines Community Stabilization is needed to support a transition in care and link an individual to appropriate services; or

(ii) The individual is being discharged from one of the below services: (a) 23-Hour Crisis Stabilization (b) Acute Psychiatric Inpatient Services (c) ASAM levels 3.1 – 4.0 (d) Hospital Emergency Department (e) Short-term detention or incarceration (f) Mobile Crisis Response (g) Partial Hospitalization Program (Mental Health or ARTS) (h) Psychiatric Residential Treatment Facility (i) Residential Crisis Stabilization Unit (j) Therapeutic Group Home

Concern: The proposed changes to the admission criteria exclude individuals who recently experienced a behavioral health crisis (within the past 24-72 hours) and who meet all of the medical necessity criteria except for discharging from a higher level of care.

While the proposed language allows, “a LMHP, LMHP-R, LMHP-RP or LMHP-S at a Community Services Board (CSB) same day access intake,” to “determine Community Stabilization is needed to support a transition in care and link an individual to appropriate services,” there is no comparable mechanism that enables a private provider to make such a determination.

Requiring a private provider to refer an individual in crisis to the CSB to receive “same-day access” to enable them to be deemed eligible to receive Community Stabilization will cause delayed treatment, increased inefficiency, stresses to an already overloaded system, and increased costs. This also conflicts with the “no wrong door” approach to ensuring those in crisis can receive services as efficiently, effectively and as quickly as possible.

Recommendations:

• Allow a licensed person at a private provider agency to determine that Community Stabilization is needed in a comparable way to how a licensed person at a CSB can via same day access intake, as proposed.
• Add the following to the admission criteria: “Individuals who recently experienced a behavioral health crisis.” Recently may be defined as within the past 24-72 hours.