COMMENTS ON PROPOSED OL REGULATORY LANGUAGE

1. Section 170 - Corrective Action Plan

Section H language has been added and we object to establishing an unachievable standard, which is inconsistent with proposed language of Section C. 

The proposed language in Section H introduces an unachievable measure; while it is reasonable for a provider to develop and implement risk mitigation efforts in an effort to “correct any systemic deficiencies” to eliminate risk by following the language proposed in Section C, it is totally unreasonable to “prevent the recurrence of a regulatory violation”. We also object to the stated requirement to repeatedly continue implementation of corrective action plans-full prevention is unreasonable regardless of the number of attempts.

We recommend eliminating 170 Section H completely

H. The provider shall monitor implementation and effectiveness of approved corrective actions as part of its quality improvement program required by 12VAC35-105-620. If the provider determines that an approved corrective action was fully implemented, but did not prevent the recurrence of a regulatory violation or correct any systemic deficiencies, the provider shall:

Continue implementing the corrective action plan and put into place additional measures to prevent the recurrence of the cited violation and address identified systemic deficiencies; or submit a revised corrective action plan to the department for approval. 

2. Section 520 - Risk management

We have concerns about the qualifying statement requiring “department approved training”. 

We suggest that DBHDS both provide the curriculum AND provide the training since this is the most effective way to ensure consistency.

3. Section 660 - Individualized Services Plan (ISP)

We are requesting clarity in the language of section 2

Section 2 states that:

4. 1. If no alternative services are available to the individual, it shall be clearly documented within the ISP, or within documentation attached to the ISP, that alternative services were not available as well as any steps taken to identify if alternative services were available       

We suggest clarity as to whether this is a responsibility of the Support Coordinator, and if it belongs in Parts 1 through 4 (which is reasonable) rather than expecting each provider to document in each Part 5.

Similarly, Section 3 b and c states that:

5. 2. The proposed and alternative services and their respective risks and benefits were explained to the individual or the individual's authorized representative, and;
   3. The reasons the individual or the individual's authorized representative chose the option included in the ISP.

We suggest clarity as to whether this is a responsibility of the Support Coordinator, and if it belongs in Parts 1 through 4 (which is reasonable) rather than expecting each provider to document in each Part 5 for each service.

We recommend changing the term “authorized representative” to “substitute decision maker” in both of these sections

4. Section 665 - ISP requirements

We object to the requirement proposed in section D.  While we agree that it is appropriate for DSPs to demonstrate a working knowledge of each individual’s detailed health and safety protocol, it is not reasonable to impose that requirement on our contractors who consult about services for a group of individuals.  It is also unreasonable for a staff whose role is supervisory to have this requirement for a large number of individuals, just because they may have an assigned role in ISP implementation.

D. Employees or contractors who are responsible for implementing the ISP shall demonstrate a working knowledge of the objectives and strategies contained in the individual's current ISP [, including an individual's detailed health and safety protocols].