Thank you for giving me the opportunity to comment on the Draft Case Management Chapter Regulations for DBHDS. Below you will find my comments and recommendations.

12VAC35-110-10

Thank you for defining legal guardian and comprehensive assessment. We recommend adding a definition for enhanced case management.

12VAC35-110-30

Recommend a wording change in the first sentence. We would prefer the sentence to say “Case management services are designed as applicable to assist” rather than “Case management services shall be designed”. I also recommend that ID/DD and MH/SUD Case Management be separated as they each provide unique services to their client. 

12VAC35-110-40

Recommend removal of the word “knowing” from number 11 as the Case Manager may not always know medical information as it may not be shared or disclosed by the individual.

12VAC35-110-50

Recommend changing letter g Medical Symptoms to Medical Conditions. 

12VAC35-110-70

This section specifically states that the provider shall be actively involved through face-to-face contact. Could part of these contact be made through telehealth?

12VAC35-110-80

Section C(2) states that the provider shall distribute the ISP to the individual and others authorized to receive it prior to the implementation of the ISP. The ISP meeting may be out in the community which would make it difficult for the case manager to distribute. Recommend removing the statement “prior to the implementation of the ISP” to give case managers time to distribute the ISP instead it could state a timeframe or by the next scheduled service.

Section F states that when a case management agency provides more than one service to an individual the agency may maintain a single document however sections A and B states that a case manager shall complete a distinct, separate, initial case management ISP. Please clarify the requirements as these sections contradict each other. 

Section I is confusing as it does not define what readily accessible means. Please define readily accessible. If the case manager must bring a printed copy of the ISP we have concerns with protecting that information during transport as it is not HIPAA compliant to take paper copies out in the community. Also, it is not environmentally conscious to print ISPs that take up multiple pieces of paper. If the case manager could have electronic access that may be safer and more HIPAA compliant however there would be a cost to the CSB in purchasing the needed equipment to ensure the information is accessible.

12VAC35-110-90

Section G is confusing as it does not define what readily accessible means. Please define readily accessible. If the case manager must bring a printed copy of the ISP we have concerns with protecting that information during transport as it is not HIPAA compliant to take paper copies out in the community. Also, it is not environmentally conscious to print ISPs that take up multiple pieces of paper. If the case manager could have electronic access that may be safer and more HIPAA compliant however there would be a cost to the CSB in purchasing the needed equipment to ensure the information is accessible.

12VAC35-110-110

If this section pertains to ID/DD services only this need to be stated. Please clarify.

12VAC35-110-120

For sections A.1, 5, 6, 7, 8 please replace ensure with facilitate or coordinate. Section A is not person-centered as it is not giving the individual a choice in their health care. Recommend adding a statement on client choice.

12VAC35-110-130

Please provide guidance on how to demonstrate and capture the listed competencies. I feel that maintaining this documentation in our personnel records would cause an additional administrative burden on our administrative departments.