12VAC35-109-10. Definitions

Wondering why “Center Based Respite Care services” is included here rather than in chapter regarding residential services?

Developmental Disability Professional

 “Interesting aspect to add this information- Does this line up with DMAS definition?”

Qualified Mental Health Professional Eligible

“Board of Counseling utilizes language of Qualified Mental Health Progression Trainee or QMHP-T. Please change to match Board of Counseling in definitions and throughout regulations.”

12VAC35-109-20. Services

12VAC35-109-30. Service descriptions

“Having definitions here could be problematic as will they align with DMAS regulations?  If one changes the other might not; there needs to be a way for them to reference to the same place---otherwise we are going to be in an ongoing struggle to figure out what to do when one or the other changes.  This adds administrative burden to providers.”

Section A

“Appreciate this language as often services are talked about to "cure" 

Section K

“Continue to find it interesting this is included here rather than in a residential section

12VAC35-109-40. Screening.

 “Is this new? I cannot find 109-40. This seems to be more requirements than current practice for screening”

A.2.e.  Current Diagnoses:  Diagnostic is part of the intake process and not screening. Request to amend this to state current diagnoses from medical providers as appropriate.

12VAC35-109-50. Secondary Screening

- “This section should indicate a time frame for when this is needed----and can this be part of the assessment rather than a separate screening?  

Additionally, admission is defined in the definition section as ""Admission" means the process of acceptance into a service as defined by the provider's policies. 

Thus, admission is a process so figuring out when a secondary screening is required could prove challenging.”

“Can this also be at the time of admission? Someone's placement on a waitlist might be a very short period of time (ie 48 hours).”

Waitlist needs to be defined.

12VAC35-109-60. Assessment.

 Section C:  Please define “medical screenings.”

 Section F.1.g

 “This seems a bit like a catch all that might be overused.  I would like something more specific that indicates what should be addressed otherwise, we are on a slippery slope of not being able to meet this expectation”

Section F.2

“Concern about what is meant for high risk for medical complications---If we mean concerns of complications because of detox, that is one thing and can see this as appropriate; however, if this is general medical complications what is expected, we are not physical doctors. I think this statement about pose a danger to self or others for substance abuse places into stereotypes”

“What is the definition of high-risk here?”

Please specify medical complications due to substance use.

Section G.6

“Understand this is an important aspect around case management; What is the expectation of other center-based services to address?  If it is in the assessment, it means it has to be in the provider's ISP.  So, what is this expectation.”

Section G.10

I think using “competency,” which is a legal term, in a sentence about AR and rep payee is conflating the use of “competency” and “compacity.”

12VAC35-109-70. Individualized services plan (ISP); Individualized supports plan; Service planning

 Section A.1

“This is problematic.  For most DD services, authorization is required prior to beginning services.  To get the authorization, plans must be updated.  Thus, this may be done before admission.”

“Completed within 60 days of what?  See previous comments about concern of using "admission".”

Section B

“Is A 1 and A 2 supposed to take the place of this information?   Otherwise, this seems repetitive.”

Section C

This section seems to repeat what is in A.2”

Section D

“Why is this statement put here and not in the case management section?  Not sure why this needs to be state here--- Also, even if the person has a case manager, the ISP needs to be developed including the information below.  I'm confused on what is being state here.”

Section D.1.C

“This one has always been a concern as it is not well defined.  What is there are alternatives to the service or alternatives to the service provider?  Is this the benefits of receiving the service with the specific provider or of the service in general?  There is no way to name all the accompanying risks---what are they wanting here.”

12VAC35-109-80. ISP requirements.

 Section A

“What about the individual’s preference? There are times the individual declines to have elements in their ISP that are health and safety and immediate needs”

Section A.1

“The word each is problematic. There may be needs identified that are outside scope of the service to address and individuals can choose not to address (dignity of risk); need to include documentation if person does not want to include”

Section A.2

“Frequency to accomplish may be beyond the scope of what can be authorized or what the person wants---Is this the ideal or the frequency of supports that the service will be provided and the person agrees too?”

Section A.4

“While possible to identify the service or agency for other aspects, it is unreasonable to be expect that employees of other agencies are identified in a services ISP.”

Section B.7

“Not all center-based services have to do a fall risk plan, yet this is written as though it is required.”

Section B.13

“Isn't the individuals self-directing all services in a person-centered service?  What is meant by elects to self-direct?”

Section C.1

“This becomes another transactional task to be tracked."

Section E.2

“Training on the ISP and the importance of the ISP is valuable, but this whole section is an overreach and unrealistic to implement.”

“This is a documentation nightmare for "test." Competency is a word that is thrown around in this sentence and has lots of baggage--- Additionally, they should be responsible for knowledge of the aspects they are implementing, not each part of a person's full ISP.”

“Over-regulating and paternalistic. We are to test the providers' knowledge and/or competency on every objective and strategy contained within all ISP's and document in their personnel files? If taken literally, this would be so cumbersome to implement as to disrupt services.”

Section E.3

“‘Be made aware’ is an overreach, employees are responsible for reviewing the ISP to know of any changes.”

12VAC35-109-90. Reassessments and ISP reviews.

 Section D

“Are all other requirements n/a for meds only?”

12VAC35-109-100.Progress notes or other documentation

 Section B.1

What does this mean?  The information included in progress notes for different services may look different based goals and objectives of the service. 

Section B.6

“What is meant by clinical staff?  Clinical is a word that causes confusion on what is meant.  Suggest:  Be signed and dated by staff or contractor qualified to provide the service.”

12VAC35-109-110. Staffing

 Section A

“For this section, with respect to defining who can supervise different services, the issues are the same as noted when providing service definitions. Does this line up with DMAS?  What happens when they do not align?

Section I

“Can the information state the staff must be the credentials of 12VAC35-109-210E?  This would ensure that they line up if changed in other section of Virginia code.”

Section M.3

“This is new. Seems to state that access to medication is required to provide therapy. Recommend deleting this sentence”

12VAC35-109-120. Health care policy.

 Section A.5

“Ethical consideration in having the results provided by a provider who cannot answer questions about the results. Omit this statement.”

12VAC35-109-130. Emergency preparedness and response plan

 “Appreciate wanting providers to be prepared.  This is very complex and challenging. The scope of this needs to be based on the service provided.  Additionally, there is no way all of this can be done for each type of emergency.  “

12VAC35-109-140. Building inspection and classification.

12VAC35-109-150. Physical environment.

Section E

“Find it interesting there is no upper limit to temperatures.  There should be something about not having individuals in rooms higher than 85 or something around there.”

12VAC35-109-160. Building and grounds.

12VAC35-109-170. Floor plan and building modifications.

Section A

“There needs to be an emergency clause so that updates can be submitted less than 45 days when needed.  This timeline prevents providers from being able to adapt to needs of individuals.”

Section B

“Renovations is a broadly used term and creates administrative burden.  Does this mean when floors are replaced an application must be submitted?  Suggest indicating statement of renovations which will change the size or dimensions of service areas.”

12VAC35-109-180. Lighting.

Section D

“Each staff member has his/her own flashlight? Or enough available that clusters of staff can use the light from one shared flashlight?”

12VAC35-109-190. Sewer and water inspections.

12VAC35-109-200. Standards for the evaluation of new licenses for providers of services to individuals with opioid addiction

Section E.6

“Unrealistic staffing credentials especially in today's workforce shortage”

Section E.7

“Recommend deleting”

Section E.9

“Access to emergency care vs. Access to higher levels of care are not the same. Access to an ED is one thing. Access to IOP, PHP, CSU, or inpatient is unrealistic”

12VAC35-109-230. Criteria for involuntary termination from treatment.

" Though implied, this code does not explicitly state that it is for MAT programming only and is general enough to be misconstrued as being broader than MAT”

12VAC35-109-260. Initial and periodic assessment services.

Sections E

This seems like too much for a provider to access especially if no payment”

12VAC35-109-270. Special services for pregnant individuals.

Section A

“How is this feasible for self-pay individuals”

12VAC35-109-280. Counseling sessions.

“What is this? Counseling for what? What is counseling vs. Therapy? If in therapy, do we need to do counseling too?”

“Though implied, this code does not explicitly state that it is for MAT programming only and is general enough to be misconstrued as being broader than MAT”

12VAC35-109-450. Substance abuse outpatient services admission criteria.

“Concern of matching information and requirements in the DMAS ARTS manual.  Not having them match creates many challenges for providers.  Similar concern as mentioned regarding service definitions and staffing.”

12VAC35-109-480. Mental health partial hospitalization program criteria.

“Concern of matching information and requirements in the DMAS manual.  Not having them match creates many challenges for providers.  Similar concern as mentioned regarding service definitions and staffing.”