Please consider consolidating regulatory actions on Licensing regulations.  DBHDS is trying to separate regulations into a general chapter and service specific chapters which no longer all align with other efforts to end certain services and establish others as part of Behavioral Health Redesign with DMAS.  This is inefficient and confusing.  We should be moving forward with one process that can both overhaul regulations while speaking to the services of Behavioral Health Redesign.

I appreciate the opportunity to provide feedback on the proposal to repeal 12VAC35-46 and 12VAC35-105 and restructure the Department of Behavioral Health and Developmental Services licensing regulations into a general chapter with multiple service-specific chapters.

Concerns:

1. Fragmentation of Regulations
   Splitting licensing rules into six separate chapters may create unnecessary confusion for providers and staff. Many providers operate across multiple service types (residential, crisis, case management, etc.), which will force them to cross-reference several chapters rather than using one integrated framework. This increases the risk of misinterpretation, inconsistency, and regulatory burden without clear benefit.

2. Timing with DMAS Behavioral Health Redesign
   The Department of Medical Assistance Services (DMAS) is still in the process of redesigning behavioral health services. The DBHDS licensing overhaul appears disconnected from this redesign effort. If the two processes move forward on separate timelines, providers will face overlapping but unaligned changes to regulations and service definitions. This timing could cause duplication, inefficiency, and added compliance costs during an already unstable transition period.

3. Regulatory Overload for Providers
   The system has seen a wave of new initiatives: Marcus Alert, crisis service transformation, new performance contract requirements, DBHDS risk management memos, and pending updates on case management. Adding a full licensing restructure at the same time may overwhelm providers and divert resources away from quality improvement and direct care.

4. No Planned Public Hearing
   Given the scale of this change, not holding a public hearing reduces transparency and limits meaningful input from those most impacted. Providers, families, and advocates deserve the opportunity for live discussion and feedback before a decision is made.

Recommendations:

• Consolidate the Process: Align the DBHDS licensing overhaul with DMAS Behavioral Health Redesign so that regulations and services are integrated into a single, coordinated framework.

• Phase Changes Gradually: Consider targeted updates to address urgent gaps (e.g., new service types) but delay full restructuring until DMAS redesign details are finalized.

• Maintain a Central Framework: If DBHDS proceeds with service-specific chapters, ensure there is one consolidated reference guide or integrated portal that shows how requirements interact across service types.

• Add a Public Hearing: Provide stakeholders the opportunity to discuss these changes openly before they move forward.

• Conduct Impact Analysis: Before adoption, DBHDS should assess the administrative and financial impact on providers, particularly smaller CSBs and community agencies already under resource strain.

Conclusion:
While the goal of clarity and service-specific detail is understood, moving forward now with this broad regulatory overhaul risks creating confusion, duplication, and instability across the system. A more coordinated, phased approach that aligns with DMAS redesign would better serve providers, individuals, and the Commonwealth.

The DBHDS plan to separate the Licensing Regulations into a general chapter and separate service-specific chapters does not align with the DMAS Behavioral Health Redesign efforts.  PWC CSB supports moving forward with one process that can both overhaul regulations while speaking to the services of Behavioral Health Redesign.

In response to the Notice of Intended Regulatory Action (NOIRA) for the Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services, 12 VAC 35- 105-10, et seq, please reconsider the proposed action of separating regulations into a general chapter and service specific chapters.  With pending regulation and service changes related to the Behavioral Health Redesign, the proposed action action would not be in alignment with the ending of certain services and establishing of other services in the Redesign model. We should be moving forward with one process that can both overhaul regulations while speaking to the services of Behavioral Health Redesign. 

Thank you for the opportunity to provide feedback on the restructuring of the DBHDS licensing regulations into a general chapter with multiple service-specific chapters. I would like to submit the following concerns:

Fragmentation: splitting licensing rules into six categories may create confusion for providers operating across multiple service types. Staff will need to cross-reference multiple sources, increasing the risk of inconsistency and compliance errors.

Regulatory Overload: CSBs are already implementing major initiatives, including Marcus Alert, crisis service transformation, new performance contract requirements, and overwhelming providers and diverting resources away from care.

Transparency: The absence of a public hearing limits meaningful stakeholder engagement on changes of this scale.

Recommendations

Phase-In Changes: address urgent gaps first, delaying full restructuring until the system stabilizes.

Provide a Central Reference: if separate chapters are adopted, create a consolidated tool to show how requirements interact.

Hold a Public Hearing: allow providers, families, and advocates to give direct input.

Impact Analysis: Assess the administrative and financial burdens on CSBs and other community providers

While clarity is important, moving forward now with a broad restructuring risks duplications and instability, particularly with the massive DMAS changes and the need for those changes to properly align with DBHDS regulations, as they often do not. A phased, coordinated approach would better serve providers, individuals, and the Commonwealth. 

In the definitions section of the Center Based updated regulations in the Provider definition the term mental retardation is used - followed by intellectual disability in parenthesis.  I understand that it is reflecting the Code of Virginia definition  - but can we please advocate to have the Code of Virginia definition updated??

12VAC35-109-60 references standardized state assessment tools.  Where can we access these?

12VAC35-109=70 The section discussion alternate services seems like excessive documentation when working with and individual seeking center based day support.  Is this intended for all center based services?

12VAC35-109-B.14  Doesn't seem pertinent to most Center Based Day Support plans.

12VAC35-109-80.E 1 & 2  Training and review of individual service plans is very important and something we do at regular team meetings.  But if I am reading paragraph 2 correctly - we are expected to develop tests specific to each individual training plan and maintain copies of these tests?  Everytime we admit a new individual?  For every staff member that will work with them or be in rotation for coverage?  This really sounds excessive.  Over managing an already administratively burdened group of people.

12VAC35-109-90F.4.b&c  Center based day support initial planning isn't typically focused on discharge planning.  Center based day support is generally long term, with discharge planning discussed when appropriate by the team.  Why add this measure before it is appropriate for the individual?

I value the work done to separate the the regulations into chapter that are more organized and meaningful - but it seems like Group Day Support is so different from other Center Based providers, that maybe a little more division would help.  Great job over all - with updates that were needed.