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.

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. 

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.