On behalf of the Virginia Association of Community-Based Providers (VACBP), thank you for the opportunity to comment on the latest proposed changes to Mental Health Skill-building Services, Crisis Stabilization Services and Crisis Intervention Services.

VACBP Comments on Proposed Regulations:

Regarding the proposed regulation which states that LMHP, LMHP- Supervisee, or LMHP- resident shall complete, sign and date an ISP:

In order for providers to have an LMHP/LMHP-like staff member to complete ISP’s, additional staff will need to be hired.

• In many parts of the state, there is a severe shortage of licensed or licensed eligible individuals to fill these positions.  If this change is approved, MHSS providers will likely not be able to fill the needed number of positions, resulting in a reduction or elimination of the service. 

• It is our experience as private providers that those licensed or licensed eligible staff who are available are not apt to take jobs such as these because they are paperwork intensive and their training causes a desire to work with people, not just fill out papers.  In addition, the work that would be required of these positions does not meet the requirement for hours toward licensure and as such does not make these jobs attractive to licensed eligible individuals, making it even more difficult to find staff to fill these roles.

• If this change is adopted for this service, it may be the only service that does not permit QMHP-A or QMHP-E credentialed professionals to complete an ISP.

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 and LMHP to write the ISP. 

• To the extent these ISP’s could be written, they would be written by staff who have very little contact with the client.

• Approving this change will reduce access to services that are needed by Virginians who suffer from serious mental illness.

Regarding the proposed regulation requiring an authorization for Crisis Intervention and Crisis Stabilization:

• Currently, registration is required and can be done expeditiously.The timeframe for receiving an authorization for other services is anywhere from 2-5 days.  Considering that a client is in a crisis situation when they come into this service, it does not seem feasible to wait for an authorization to be approved to begin services.  An authorization requires a large amount of paperwork and this would further delay the beginning of actual services during a critical time.

• If the intention is for providers to begin services without an authorization, are providers guaranteed payment if the authorization is eventually denied?

• Delays in the beginning of the provision of these services could lead to clients seeking more expensive and intrusive higher levels of care.

Regarding the proposed regulation that Service Specific Provider Intakes (SSPI’s) shall be “repeated” for all individuals who have received at least six months of MHSS to determine the continued need for the service:

• Does this mean that the SSPI must be re-done after six months?If so, this would be an unnecessary burden and distraction from delivering care for providers and consumers.We support appropriate review of the original SSPI.

Regarding the proposed regulation on the number of days per week and hours per week required to carry out the goals in the ISP:

• Will providers be reimbursed 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 issues that arise may require additional hours/days of services.  Will these either be denied or reclaimed in an audit? 

• Approving this proposed change diminishes a person-centered approach and the ability to meet a client’s specific needs as they arise.

Regarding the deletion of the change in the billing unit structure that was formerly mentioned in the proposed regulations:

• This change would have resulted in a reduction in the quality and access to services and we wholeheartedly support the wise decision not to pursue it.

• While the Department of Planning and Budget’s (DBP’s) Economic Impact Analysis states that the proposed changes to the billing unit and rate structure may be budget neutral, providers estimate a reimbursement reduction of 10-25% if this change were approved.  This would seriously impact the 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.

Regarding the proposed 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.

Thank you for considering our comments and concerns.

Michael Carlin

Executive Director

Virginia Association of Community-Based Providers