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Virginia Regulatory Town Hall
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Department of Behavioral Health and Developmental Services
 
Board
State Board of Behavioral Health and Developmental Services
 
chapter
Rules and Regulations For Licensing Providers by the Department of Behavioral Health and Developmental Services [12 VAC 35 ‑ 105]
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11/26/21  11:58 am
Commenter: john humphreys

Staffing Concerns
 

12 VAC 35 – 105 – 440 requires that all DSPs receive a full regimen of orientation trainings within 15 days of hire and the proposed 12 VAC 35 – 106 – 290 – B1 – further restricts the training period to only 14 days. While this is often more than sufficient time for individuals who accept a full-time position and have no other job, this provision occasionally creates barriers to hiring part-time individuals and to starting the training for full-time hires while they work out their notice at their previous job. For example, we have had to decline part-time hires (who would have been very good at the job) because their existing full-time position, family and other responsibilities only made them available for training on the weekends or for a reduced number of hours on a reduced number of days during the week, that would not have permitted them to complete the initial training within the 2 week timeframe required by the regulations; the same factors prevent a jumpstart on training efforts for individuals while they work out their notice at the job they're leaving, creating unnecessary delays in their availability once their notice at their old job is complete. Hiring is extremely difficult and the available pool of applicants are very weak, artificial provisions that serve no realistic function, provide no additional benefit to individual protections/services and deter the hiring of individuals because they have other things going on in her life need to be corrected to address this growing concern. RECOMMENDATIONS: 1) remove the strict time requirement and replace it with a provision that does not permit new hires from being a part of the staffing plan, having independent contact with individuals served and/or providing any supports until they have completed the full introductory training regimen; 2) exempt small businesses and/or part-time/working out notice hires from the provision.

12 VAC 35 – 107 – 80 – E2 and 12 VAC 35 – 108 – 80 – E – both contain provisions that would require a written competency test for each annual ISP/part 5 plan and additionally for each addendum to that plan throughout the year based on emerging circumstances, reassessment and/or quarterly review. These provisions fail several of the review criteria, as they are completely unnecessary, excessively burdensome and failed to minimize the impact on small businesses. 1st – these provisions are completely unnecessary to protect the health, safety or welfare of the individual served, as a written test provides no additional evidence of a competent understanding of the material beyond that which could be established by verbal interaction and verbal verification of a competent understanding (what we do now); the test alone would be insufficient to verify competency (as the actual implementation of the elements is where competency verification can be done most effectively) and ongoing supervision of individual DSP efforts to implement the plan, maintain DBHDS competencies and meet the needs of the individual provide superior evidence of competency for implementation that render a written test superfluous. 2nd – a written test requirement creates another unnecessary, significant and unfunded mandate not considered in the current Burns rebase analysis; not only is there the additional administrative time in creating, printing, proctoring and grading the test, there is also the fact that because of personnel limits most training for full-time individuals has to be done on overtime hours which greatly increases the cost of any additions to the training time and these problems are magnified considerably when the proposed regulation requires written test not only annually for each individual, but multiple times throughout the year whenever reassessment, tweaks and/or minor addendum's to the plan are made to keep them up-to-date; resulting in a very real time and money resource drain for no net benefit; 3rd – this requirement would be particularly onerous for small businesses that have very limited administrative staff/time/resources, very few part-time employees and frequent/close staff supervision. In fact, the provision could have a negative impact on staff training for new plans/elements, if the provider created a very simple/obvious answer test and administered it in lieu of training to document the competency. If the provider is more diligent/dedicated than this to begin with then they would already be doing the training, verbal verification of competency and follow-on supervisory observation that makes the written test meaningless. This provision does nothing for the services of the individuals, it just provides another mechanism for bureaucrats to set at their desk in Richmond, conduct remote reviews and check all the boxes regardless of what the provider is actually doing. RECOMMENDATIONS: 1) delete the written test provision and require training with verbal verification of competency; 2) provide an option for verbal verification of competency if it is documented by the supervisor post training; 3) exempt small businesses from the onerous burden of the requirement.

12 VAC 35 – 106 – 240 –D1- requiring annual disclosure statements on convictions across all employees –The annual disclosure statement documentation requirement in D1 of this regulation is rendered unnecessary by B2, fails to efficiently reduce risk to individuals due to delayed reporting, creates another additional drain on resources not included in the Burns analysis and fails to minimize the impact on small businesses. The regulatory requirement in B2 creates an affirmative burden for each employee to report any conviction of a barrier crime and/or found registry complaint for abuse or neglect; which would accomplish the objective of an annual disclosure statement with more immediacy than waiting till their one-year date arrives and requesting information then. If an individual decides to omit this information from their reporting when it becomes relevant, then that same individual would appear to have no qualms whatsoever about lying on the annual disclosure statement as well – rendering the annual disclosure statement useless when it's actually needed. The regulation creates an additional time delay in reporting, as it is dependent upon "convictions" and "founded", which would delay any reporting until after the investigation and in the case of convictions possibly for several years as the case worked its way through the courts. We require immediate reporting of any arrest for a barrier crime and/or the initiation of any DSS/CPS/APS investigation, while we may not take immediate action and wait for the case to be resolved, this early reporting requirement permits increased observation/supervision, internal investigation and a timely opportunity to protect individuals if the specific circumstances appear to warrant action. Again, this approach renders the regulatory requirement for an annual disclosure statement useless for the protection of individuals, it just provides another mechanism for bureaucrats to set at their desk in Richmond, conduct remote reviews and check all the boxes regardless of what the provider is actually doing. As a result, this provision merely represents another incremental increase in resource cost for both administrative time and money that is not included in the Burns analysis won't be reimbursed and becomes another straw that may be the one that breaks the camel’s back. Of course, once again no effort is made to apply the applicable law and minimize the impact on small businesses where both the administrative time and cost will have the maximum impact and any additional benefit is much more unlikely as the small provider in a small community is much more likely to be able to monitor these concerns through the local media and internal grapevine given the gravity of the offenses and their particular circumstance. RECOMMENDATIONS: 1) delete the annual disclosure statement; 2) Strengthen the B2 requirement to include arrest and/or the initiation of an investigation; 3) exempt small businesses from the onerous burden of the requirement.

12 VAC 35 – 106 – 250 – A2- verified education history for all hires – While this may make some sense for college degrees, advanced certifications and other supervisory/professional staff education claimed on their resume, it is an unnecessary, problematic and resource draining inclusion for basic DSP hires where only elementary/high school education is indicated in their application. 1st – given the dramatic decline in elementary/high school education to achieve even basic progress standards, grade inflation and the focus on social indoctrination over actual academic skills in elementary/high school education even if verified this is no longer an indication of relevant skills and direct provider verification of the basic skills necessary for the DSP position during the DSPs early probationary period is the only way to adequately verify that they have sufficient academic background to meet the job requirements – making these verifications useless. 2nd – while transcripts, certificates, continuing education credits etc. are verifiable with some effort, verifying someone's elementary/high school attendance and graduation is extremely more difficult and given the increased focus on privacy may not be possible to accomplish – how does the state suggest we verify education at these levels. 3rd – this represent yet another additional unfunded mandate not considered in the Burns analysis that will be costly in terms of both time and other resources and this impact will fall disproportionately on small providers who have more limited resources, given that no effort is made in the regulatory inclusion to minimize the impact on small businesses. RECOMMENDATIONS: 1) Delete A2; 2) exclude elementary and high school education verifications from the requirement; 3) Provide a good faith exception if the provider documents that they attempted to verify elementary/high school but were unable to do so; 4) provide an exemption for small businesses to reduce the disproportionate burden on them from this requirement.

 

12 VAC 35 106 – 560 – B - Driving records – this section includes several unnecessary elements that in no way contribute to the health, safety or welfare of individuals served, the requirement in B 2 makes the random sample annually in B1 unnecessary, creates an additional administrative time and resource drain, creates a disincentive to accept an offer of hire and again contains no elements to minimize the impact on small businesses who would be disproportionately affected by the administrative time/cost. 1st – the B1 requirement that the provider obtain driving records from all employees and contractors at the time of employment is unnecessarily broad; if the employee/contractor will never be used to transport individuals served and it is not a part of their job description then there is no reason whatsoever to have a copy of their driving record to accomplish the intent of the proposed regulatory inclusion. 2nd – the affirmative duty for all employees to immediately report any conviction of driving or operating a vehicle under the influence or reckless driving in B2 is sufficient to accomplish the intent of the regulation without the random sample annual checks included in B1, making the required annual checks duplicative and unnecessary. 3rd – the annual random sample of driving record checks is also rendered unnecessary by the existence of liability/vehicle insurance which includes a driver's list, as when anyone on the company driver's list is convicted of these offenses, the insurance company (that regularly monitors for changes in individuals on the driving list) will notify you immediately and change your insurance rate; a process that would accomplish the intent of the proposed regulation much more efficiently and timely than the inclusion of an annual driving record check. 4th – a reliance on convictions and the annual requirement create the same time delay flaws as the annual requirement for a background check disclosure statement and they should cross apply here. 5th – obtaining a driving record creates an additional drain on administrative time and has an associated cost, the increased administrative burden is unavoidable if the regulation remains and the cost of the driving record would either have to be paid by the provider or the individual employee (who would also have the time/inconvenience burden of going to the DMV to obtain the record) further dis-incentivizing accepting/maintaining employment in our field. RECOMMENDATIONS: 1) Change the requirement for an initial driving record check in B1 to only apply to those individuals whose job description includes transporting individuals served; 2) Delete the requirement to obtain a random cross-section of driving records annually; 3) Provide an exception if the provider documents that they have all employees/contractors who will transport individuals served on a drivers list filed with an Insurance company; 4) provide an exemption for small businesses to reduce the disproportionate burden on them from this requirement.

 

12 VAC 35 – 106 – 290 – C – annual repetitions all employee training, represents an unnecessary expansion of employee training requirements, that significantly increases the resource drain on providers and has a disproportionate impact on small businesses that is not addressed in the regulation. 1st – the increased requirement for annual repetition of all initial employee trainings is unnecessary and provides no benefit to the health, safety or welfare of individuals served for a variety of reasons: ongoing supervision and the continuous observation/lapses documentation of the required competencies, renders these retrainings superfluous as any lapse in the employees/contractors knowledge (which the retraining's are designed to prevent) would be detected in real time rather than waiting to the end of a full year. Additionally, the requirement in C2 would require retraining of the offending individual and all other staff in the event that a knowledge, service or other lapse was detected/observed in the actual provision of services, which again makes the annual retraining not only unnecessary but also duplicative when actual concerns exist. This approach is actually more beneficial as it avoids the time delay of waiting until the annual date to address knowledge lapses, making this a much better way to address the concern that the regulation tends to address. These inclusions only serve to punish diligent/dedicated providers, who use ongoing supervision to instill a corporate culture which adequately addresses all of the elements which would be included in the retraining’s and provide real-time training whenever knowledge lapses appear, while having no impact whatsoever on less diligent providers who will simply pencil whip through the training requirement providing no real value in addressing the intended concerns – so it's unnecessary in most cases and useless in those cases where it would be beneficial. Finally, even if they wanted to keep the existing annual requirements there is no demonstrated necessity to increase these into new areas as done in the proposed regulation. 2nd –The annual training requirements represent a significant increase in cost of administrative time and other resources. In order to be comprehensive each of these trainings would require significant amount of time both administratively to develop, type, print, administer and grade the training effort and a significant increase in employee cost as they expect to be paid for the time spent in training. It is important to note that just like the previous Burns analysis, none of these expanded requirements will be included in the current Burns analysis for the rate rebase and again all of these cost become another unfunded mandate adding to the already excessive burden on provider resources. 3rd – the impact of this substantially increased resource burden would fall disproportionately on small businesses, as they have much more limited administrative staff to eat the increased time requirement and they are reliant on mostly full-time employees with very few part-timers which assures that most of these additional trainings are typically provided to employees/contractors at the overtime rate significantly increasing the cost from both concerns to small business providers; which is not addressed in the regulations. RECOMMENDATIONS: 1) Delete the blanket approach to annual retraining's and replace the requirement with a stronger C2 requirement to provide retraining across staff to address specific incidents where knowledge, service or other lapses have been demonstrated; 2) reduce the number of areas where annual retraining's are required to reduce the cost; 3) provide an exemption for small businesses to most of the annual requirements to accommodate the disproportionate impact that these regulations would have on their resources

 

12 VAC 35 – 106 – 310 – B – annual tuberculosis training is yet another unnecessary, costly/burdensome requirement that disproportionately impacts on small businesses. 1st – the annual requirement serves no function as the necessary information is limited, does not change over time and is unlikely to impact on the basic knowledge base of anyone more than the initial training. This requirement is also rendered unnecessary if the provider includes a provision in their policies and procedures which requires immediate reporting, as a condition of employment, of either contact with a known case of active TB or the development of TB symptoms lasting 3 weeks. Active supervision/observation of staff also makes the annual training requirement unnecessary – if any employee reported to work demonstrating the symptomologies listed a diligent provider would develop a concern in the 1st few days much less 3 weeks that would require them to directly address the concerns with the individual and create an opportunity to provide symptoms retraining in real time that would be far superior to waiting for the annual training date to arrive; making the annual training duplicative, superfluous and unnecessary. 2nd – the annual requirement represents yet another increased drain on resources both in terms of administrative time and payroll cost that is not included in the Burns analysis and just becomes another additional unfunded mandate added to the already excessive onerous burden. 3rd – the resource drain in terms of administrative time and cost would fall disproportionately on small businesses due to the factors indicated above and no provision to alleviate this increase burden for small businesses has been included. RECOMMENDATIONS: 1) Delete the annual retraining for TB; 2) replace the annual training requirement with a requirement for all employees/contractors to immediately report any of the events included in C; 3) provide an exemption for small businesses to the annual requirement to accommodate the disproportionate impact that these regulations would have on their resources

 

 

CommentID: 116742