Proposed regulation for Mental Health Skill-Building ISP development: (Pg 19 I #3): the "LMHP, LMHP- supervisee, or LMHP- resident shall complete, sign and date an ISP within 30 days of the admission to this service"

• Concerns:
  • MHSS regulations now allows for QMHPPs to provide the direct service. The rationale for this change has been because MHSS is considered less intensive than other community based services such as IIH, Crisis Stabilization, and ICT. Presently, IIH, Crisis Stabilization, and ICT do NOT require an LMHP or LMHP-eligible to complete the initial or following ISPs nor do similar level-of-care services such as Psychosocial rehabilitation or TDT.
  • Throughout most of Virginia, there is a significant shortage of licensed or licensed eligible individuals that providers can find to hire to fill the various roles/duties the regulations already require of these individuals. This proposed regulation only contributes to the already existing workforce issues involving LMHP and LMHP-eligible employees.
  • These individuals require higher salaries than the individuals who currently complete this level of paperwork which will cause a financial hardship on businesses providing MHSS.
  • This level of paperwork does not clinically require a LMHP/LMHP-eligible person to complete and many LMHP's are not going to assume positions/roles in which writing ISPs is part of the job description.
  • This regulation is not clinically sound as the ISPs would be written by staff who have very little contact with the client therefore causing the ISPs to actually be less individualized.

Proposed Regulation for Mental Health Skill-Building proposed ISP hours per week (pg 19 I #3): "The ISP shall include documentation of how many days per week and how many hours per week are required to carry out the goals in the ISP. The total time billed for the week shall not exceed the frequency established in the individual's ISP."

• Due to the clinical needs of the individuals involved with this service, the frequency of services in a given week varies depending on the client's mental health state. Based on a recovery model, clients involved in MHSS have serious mental illnesses which inherently have a pattern of recovery fluctuation. There are unit limits that are already imposed which providers work within the scope of. However, by limiting the amount of services on a weekly basis, this does not meet the client's needs in a person-centered manner. Will providers be paid if they provide services outside of these prescribed levels set forth in the ISP if there is justification of need clearly documented in the client's chart/session note?

Proposed regulation for Crisis Stabilization (pg 17 H #1): "This service shall be authorized following a face-to-face service-specific provider intake by either an LMHP, LMHP-S, LMHP-R, LMHP-RP or a certified prescreener"

• Due to the current 2 - 5 day time frame to receive authorization approval for service, if the intention is for providers to begin services immediately due to the individual being in crisis, waiting for approval is not clinically in the best interest of the client who during that approval wait time could cause harm to self or others and/or end up in a higher level of care that is more restrictive and more expensive.
• If providers do begin services without the approval due to the individual's immediate need, are providers going to be able to bill for services rendered without approval if the authorization ends up being denied?