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DBHDS regulations:

Section 12VAC30-122-120 Provider Requirements:

                4. Accept referrals for services only when staff is available to initiate services within 30 calendar days of the referral and perform such services on an ongoing basis.

RESPONSE/ CONCERNS: What happens/ how does the provider document that the services cannot be started within the 30 calendar days? It is possible a staff person unexpectedly resigns and the individual or their family wants to wait for the provider to get a staff person and NOT to start the process with another provider.  How can this be properly documented it’s the individual’s preference to wait?

                9.d Providers shall prepare and maintain unique person-centered progress notes…. Such documentation shall be written on the date of service delivery, in instances when the individual does not communicate through words the provider shall note his observations about the individual’s condition and observable responses, if any, at the time of the service delivery.

RESPONSE/ CONCERNS:

There are occurrences whereby staff do not have access to computers/ tablets to write daily notes ‘that day’ depending on the service and where they are providing the service.  Internet / computers can break down.  Emergencies can arise whereby staff would have to write the note within a few days.

12VAC30-122-320 Community Engagement (the proposed regs below are for all services)

                E Service documentation and requirements:

                1 c. Documentation confirming the individual’s attendance and the amount of the individual’s time in the service and providing specific information regarding the individual’s response to various settings and supports. Observations of the individual’s responses to the service shall be available in at least a daily note.  Data shall be collected as described in the ISP, analyzed to determine if the strategies are effective, summarized and then clearly documented in the progress notes or support checklist.

RESPONSE/ CONCERNS:  It is expected that DSP is analyzing the strategies to determine if they are effective?  This seems unclear and places a great deal of expectations on the DSP if that is the expectation.

                1.d Documentation to support units or service delivered, and the documentation shall correspond with billing.  Providers shall maintain separate documentation for each type of service rendered for an individual.

RESPONSE/ CONCERNS:  There has been discussion that some of this was being alleviated. the notes for each service or quarterly for each service?   This statement about documentation refers again to separate notes/ separate quarterlies. 

2:  sections about supervision of staff documented bi annually (this is throughout the document for all services)

                2e semiannual documentation by the supervisor concerning the individual’s satisfaction with service provision.

RESPONSE/ CONCERNS: Staff’s caseloads can change during any given time.  Is this individual satisfaction with service provision to be tied back to the staff supervision? It is confusing as written.  A neutral party such as Support Coordinator can better obtain unbiased information from an individual as to the person’s level of satisfaction.

12VAC30-122-400 Group and individual supported employment

A1. Group and individual supported employment service shall be provided in work settings where persons without disabilities are employed.

RESPONSE/ CONCERNS:  Is the intent of this statement that individuals are in integrated employment settings with non-disabled peers?  It is possible other persons with disabilities can be employed at the same place (think large manufacturing plant/ hotel setting) ….  The statement as written can be interpreted as NO OTHER persons with disabilities would be employed at that work setting.  

12VAC30-122-200. Supports Intensity Scale® requirements; Virginia Supplemental Questions; levels of support; supports packages.

A.1- Delete “to 72” and add “or older” after “years of age.”  If the SIS is only validated to age 72 then language should be added to automatically assign all individuals age 72 or older to Level 5, Tier 4. Level 5 is the highest level denoting significant need in general but not specifying it to medical or behavioral.  Tier 4 is mid-range denoting significant need, which is appropriate for an aging population.  However, there should be a statement that these individuals shall not be excluded from consideration of an individualize rate because of medical or behavioral needs

12VAC30-122-380 - Group Day Service.

• B.1. Support the addition of the following that are included in the new CL waiver renewal application but are not currently included in the proposed final regulations:
  • Participation in community volunteer opportunities or education programs;
  • Staff coverage for transportation of the individual between service activity sites. Transportation is included as part of the service.  The provider may be reimbursed for the time spent transporting the individual to community locations as part of the waiver billing
  • Personal types of activities (i.e. assistance with ADLs). These allowable activities are critical for individuals that need them but are not necessarily “skill building”.
• C. Add 6.  Recommend annual allocation for Group Day and Community Engagement hours to allow increased flexibility.  Currently, Group Day hours and Community Engagement hours are authorized on a monthly basis with additional estimated “flex hours”.  We recommend that there period of authorization be lengthened to allow more flexibility and consumer choice.  For example, individuals choose whether they want to go out in the community or stay in a center on any given day.  Because of weather or other personal circumstances of the individual, the individual may want to stay in the center more often in the winter and in the community more often in the Spring/Summer/Fall.  Hours could then be drawn from a quarterly, semi-annual or annual “pool” of hours based on their person-centered plan.