As you read through the comments from my colleagues, a common theme emerges that has been plaguing Virginia’s human services for years.  As DBHDS and DMAS leadership hastily attempt to strive for compliance with the DOJ settlement and the feedback from the Independent Reviewer, they seem to think that increasing regulations, documentation, tracking and administrative responsibility will solve the problem.  Meanwhile, what most providers agree on is that “quality” occurs during the interaction between the Direct Support Professional and the individual receiving services.  By increasing the administrative burden on providers, DBHDS and DMAS are literally forcing DSPs to pay for these mandates because they get what is left of the provider rates after all these mandated back-office activities are completed.  Providers are having to increase their “white collar” administrative supports which are typically higher paid, higher educated and more experienced workers.  Meanwhile, Direct Support Professionals who are doing the actual work with the customer, are left with an extremely low wage putting them near or under the poverty level.  These low DSP wages are significantly limiting the provider's ability to attract and retain quality staff.  HR departments are having to lower their standards and accept workers who are not ideal for the position and may not be a good match for the customer's needs.  No amount of back-office administrative efforts will improve quality until we get the DSP compensation competitive to other jobs that have a similar level of complexity and responsibility. DSPs are Essential Workers and it is time that DBHDS and DMAS leadership acknowledge this by redirecting their efforts away from unnecessary/ ineffective back office activities and onto DSP wages, benefits, training, turnover and overall job satisfaction.  This is the only way to improve the lives of persons with disabilities in Virginia!  Members of the General Assembly and the Governor (via his administration) are the only entities that can hold DBHDS and DMAS leadership accountable for these outcomes. 

My provider colleagues brought up some concerns that I completely support but said it much better than I ever could. Please acknowledge my full support of the following.

#83912 by Ken Crum.

#83850 by Jennifer Fidura.

#84017 by Karen Tefelski.

#83909 by Kris Walsh.

I also agree with the following comment about the unintended consequences of these standards related to the Correction Action Process.  “The standard that implementing a CAP should prevent any repeat recurrences of level II or III incidents is an unrealistic standard.  Any punitive actions associated with failing to meet these standards, including simply added administrative burdens, will only further discourage (reasonably so) providers from taking clients with higher medical or behavioral needs.”

I agree that DBHDS needs to produce their “approved risk management training” (12VAC35-105-520) before there is a requirement for taking the training in the regulations.  If DBHDS is going to produce this training, it should only be done in conjunction with a representative group of providers who understand are capable of predicting how the new standards will be implemented in day to day operations.  I also agree that providers should be able to obtain their risk management training from anywhere on the open market. There is no reason for DBHDS to micromanage providers to this level. Providers should weigh their own risks based on their individual circumstances, geographic location, customer base and leadership team.

“12VAC35-105-520.F The provider shall document serious injuries to employees, contractors, students, volunteers, and visitors that occur during the provision of a service “or on the provider's property”. Documentation shall be kept on file for three years. The provider shall evaluate serious injuries at least annually.”

I agree with others that 12VAC35-105-520.F is out of the scope/jurisdiction of DBHDS and should be stricken from the code.

Guidance on Corrective Action Plans ( CAP) 12VAC35-105-170 12VAC35-105-20 -definitions

I am concerned with the language in this section.  Historically, individual licensing specialists are commonly known to be inconsistent in their guidance.  For providers who work with multiple specialists in different geographical areas, attempting to remain in compliance can be both frustrating and time-consuming.  Licensing specialists should be mandated to limit the items in their Corrective Action Plans to exactly what is in the regulation.  Although the opinion/preference of the OL specialist can be helpful at times, they must refrain from including as part of the corrective action plan acceptance process. Furthermore, I agree with the solution included in comment 83955 from Vickie Williams.  “If the licensing specialist refuses to honor the CAP developed by the provider and their team an appeal process needs to be included. The case should be reviewed by a neutral party ( arbitrator, mediator, hearing officer) providers should be permitted to request a formal change to an official decision as appeals function both as a process for error correction as well as a process of clarifying and interpreting the law.”