Virginia Regulatory Town Hall
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Department of Medical Assistance Services
 
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Board of Medical Assistance Services
 
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11/14/25  3:23 pm
Commenter: Arlington County DHS

Caseload Size/Contact Requirements
 

Limiting a caseload size to 30 individuals will be challenging for many of the existing CSC teams in the state.  We are one of the smallest teams and are caseload size is already above 30.  This also does not allow the flexibility to serve individuals with varying levels of acuity.  For example, caseloads can be higher if there are clients who are further along in their treatment with less clinical need.  The same goes for monthly the contact requirements.  In my 11 years of working on an FEP team I have seen that it is crucial to slowly transition our clients to less and less monthly contact as they get closer to discharge because that level of care more closely aligns with the care they will receive after an FEP program.  Clients who go from numerous contacts a month to more traditional programs often decompensate without a transition period.  To try to better prepare our clients for this transition when clinically appropriate we may only see them once or twice a month for the last 4-6 months of their treatment.  I've also found that if we force FEP clients to meet with us too often they will often choose to discharge prematurely.  Engagement is very delicate balance with this population and, therefore, more flexibility in the contact requirements and caseload sizes will lead to better outcomes and the ability to serve more of those in need. 

CommentID: 237627