We support this opportunity to improve clarity within the DBHDS Human Rights regulations and to decrease administrative burden, while maintaining the core function of supporting and protecting the rights of individuals. Alignment with other regulations and requirements to the greatest extent possible can facilitate this; areas to consider include Medicaid (particularly Home and Community Based Services requirements), HIPAA, 42 CFR - Part 2, Adult Protective Services and Child Protective Services expectations, and standards regarding the investigation of medication errors, as well as the Health Care Decisions Act. Greater alignment would support consistent interpretation, reduce duplicative or conflicting processes, and allow providers and oversight bodies to focus more effectively on meaningful rights protection.

Analysis of citations issued to providers for human rights matters other than those due to founded complaints and allegations may provide an opportunity for revisions to help address the root causes of these citations. When regulations are unclear, there is greater opportunity for misinterpretation and inconsistency.

Authorized Representative regulations are difficult to operationalize. Often, providers do not have employees qualified to perform these evaluations, have limited ability to help individuals obtain these evaluations from outside professionals, and may experience the requirement to obtain capacity evaluations as an unfunded mandate. Providers have no authority to direct an outside party on how to document capacity evaluations. Providers should be expected to share results of capacity evaluations they conducted if proper authorizations are in place. Directing providers to ask a court to appoint a guardian or to ask a court to authorize treatment does not consider the affiliated costs and does not provide an interim solution when another substitute is not available.

Restrictions, behavioral supports, and restraints are another area where providers need clearer thresholds, timelines, and decision-making pathways. Providers can be placed between the obligation to follow medical orders and requirements to present information to an LHRC for approval, creating risk of service disruption or delayed implementation of clinically indicated supports. Timelines, LHRC volunteer availability, independent review committee members availability, and the understandable desire of individuals and their families for people to avoid service interruptions make it difficult for providers to know how to proceed. Neither providers nor LHRC members have authority to override a medical order and failure to implement a medical order may create health, safety, or maltreatment concerns. Requirements may be difficult for individuals and families to understand. In addition, while misuse of restrictions/restraints has been real, neither providers nor LHRC members have the authority to override a medical order.

The current restriction process might benefit from a tiered framework that distinguishes between low-risk, non-invasive safety supports and high-impact rights restrictions. Requiring LHRC review for straightforward, clinically justified measures may create unnecessary delays and reduce focus on more significant rights concerns. Establishing clear thresholds for LHRC involvement could improve both efficiency and protection of individual rights.

We encourage the Department to use this regulatory review to clarify expectations, reduce inconsistent interpretation, and provide practical pathways for providers to protect individual rights while also meeting clinical, safety, and service-continuity obligations. Clearer language, realistic timelines, and alignment with related state and federal requirements would benefit individuals receiving services, families, providers, and oversight bodies.