The requirement to report level II and III serious incidents and human rights in CHRIS on weekends and holidays is unnecessary and an unfunded burden.  DBHDS does not review incidents on Saturdays, Sundays, or holidays, and therefore doesn’t have the same expectations on themselves nor the same budgetary burdens to pay staff on weekends, holidays, and/or overtime. If it truly is urgent and produces results, DBHDS should be reviewing on weekends and holidays as we are required to enter reports on weekends and holidays. We recommend the requirement to enter such reports be changed from within 24 hours to “within 24 hours or as soon as possible the next business day.”

Definitions: “Level II serious incidents include… “an emergency room visit”:  this is too broad and will result in hundreds of unnecessary reporting, which increases unfunded staff time and unfunded administrative burdens not already included in provider’s budgets.  Also, the definition of “unplanned psychiatric hospitalization” should be expanded to allow for instances in which an individual has utilized community-based interventions, including crisis management services, but continues to be in crisis and requests to hospitalized as a Planned hospitalization.

12VAC35-105-520. Risk management—Part A, related to experience/training of the Risk Manager—this should be broadened to accept relevant experience and not require DBHDS training.  If this requirement stands, please allow a grace period to come into compliance without ramifications. 

12VAC35-105-530. Emergency preparedness and response plan, A. 9, “Fire and evacuation drills shall be conducted at least monthly”—this is a reasonable expectation for any residential service, but an overwhelming expectation for facilities like outpatient clinics.  This will disrupt services significantly every month and represents another unfunded burden to providers.  Facility supervisors will have to manage these drills, while they should be supervising service provision, and these disruptions will also result in reduction of services rendered and have an impact on budgets. The previous requirement was annually and we are curious as to why the significant change without any discussion with providers.

All of these items are examples of unfunded mandates, that require additional administrative positions and ever-increasing nonbillable activities, not already included in providers’ budgets.