Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]
Action Mental Health Skill-building Services
Stage Proposed
Comment Period Ended on 10/23/2015
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10/23/15  5:47 pm
Commenter: Krista C. Mobley, Mainstream Mental Health Services, Inc.

Regarding Proposed Changes to Regulations Governing Mental Health Skill-Building Services

A recent review of proposed regulations and professional conversation with members of the VACBP as well as other private providers has raised some significant concerns for our agency. Concerning the proposed regulations which states that LMHP, LMHP- Supervisee, or LMHP- resident may complete, sign and date an ISP:

  • In order for providers to have an LMHP/LMHP-like staff member to complete ISP’s, they need to hire staff.
    • In many parts of the state, there is a severe shortage of licensed or licensed eligible individuals to fill these positions which will mean that MHSS providers will not be able to fill the positions or stay in business.  Those licensed or licensed eligible who are available are not apt to take jobs such as these because they are paperwork intensive and they want to work with people, not just fill out papers.
    • These individuals are in high demand and will require higher salaries than the individuals who currently complete this level of paperwork which will be a financial hardship on businesses providing MHSS.
    • The work that would be required of these positions does not meet the requirement for hours toward licensure and as such do not make these jobs attractive to licensed eligible individuals, making it even more difficult to find staff to fill these roles.
  • This approach to writing the ISP’s seems contrary to current trends.
    • The definition, scope of service and intent of MHSS has been modified to the point that regulatory bodies state that a QMHPP can provide the service, implying that the service is less intensive than others, yet it now requires an LMHP to write the ISP. 
    • These ISP’s will be written by staff who have very little contact with the client and who have minimal opportunity to develop a plan that is based on person-centered practices or that promotes the individual's active participation in their services and planning.
  • Concerning the proposed regulation regarding the established number of days per week and hours per week that are required to carry out the goals and objectives in the ISP:

    Will providers be paid if they provide services outside of these prescribed levels set forth in the ISP?  Client’s needs fluctuate greatly over the course of time and have issues that arise that may require additional hours/days of services.  Will these either be denied or reclaimed on audit?  This does not seem that it lends itself to meeting the client’s needs or a person-centered approach.

  • Concerning the deletion of the change in the unit structure that was formerly mentioned in the proposed regulations:

    While the language in the Economic Impact Statement states that the proposed changes to rate structure were budget neutral, provider’s estimate a loss of 10-25% of revenue would be lost due to the change.  This would seriously impact providers ability to continue to provide services as well as have the quality assurance and supervisory measures in place to make sure the services that are provided are of high quality. Any decisions made to reduce reimbursement rates or restructure reimbursement rates for MHSS, based on cost savings alone, should be postponed until a comprehensive review of the impact of regulation changes which became effective in 2013 are studied and determined, with specific attention given to reduction in cost as a result of changes in the criteria for eligibility.

    We wholeheartedly support the deletion of the language that may have led to these reductions.

  • Concerning the regulation change in which Non-Residential Crisis Stabilization may be used as a higher level of care in the consideration of MHSS eligibility criteria:

    We support the addition of this service as a higher level of care, as the services provided in non-residential are the same as in residential CSS, they are just provided in a different setting. In addition, I would challenge the validity of the history of hospitalization, PACT, ICT, ECO, etc. as an effective indicator of need for services, as a person's history of treatments accessed can be dependent on so many factors in addition to the severity of the illness, including financial and other personal resources, level of education, support network, cultural beliefs, personal experience, etc. 

Thank you for your attention to and consideration of our concerns. Together we can accomplish great things!

CommentID: 42333