Comments on DBHDS Initial Draft NEW Center-Based Services Chapter dtd 7.12.22
12VAC35-109-10 Definitions. “Substance abuse intensive outpatient service” definition needs to include that services delivered to children/adolescents require a minimum of 2 hours of service per day to align with DMAS regulation 12VAC30-130-5090.
12VAC35-109-10 Definition. The definition of “Initial assessment” includes “An assessment is not a service.” Recommend that OL expand on this statement and provide more clarity on what OL is intending to convey as it relates to these regulations.
12VAC35-109-40 Screening. All these “required elements” do not seem necessary for all levels or types of service to screen individuals for assessment for admission, or referral to more appropriate services or providers. Current OL regulations at 12VAC35-105-645 are sufficient and recommend leave as written. These proposed regulations seem to be confusing an initial contact/screening with an initial assessment to determine eligibility for admission. Additionally,
Gender Identity should not be a required element for screening for services, only optional. Should not have to collect this for every individual at screening; more appropriate for the intake/initial assessment.
Recommend changing “medical symptoms” to “current symptoms” to not exclude behavioral, emotional symptoms.
Current medications and these specific details are not necessary for an initial screening for all types of services or providers.
12VAC35-109-50 Secondary Screening. All of the information required to be updated/collected in the Secondary Screening would be updated/collected at the initial intake/assessment prior to or at admission, so why would a Secondary Screening be necessary? Just seems to be a redundant process. A Secondary Screening only makes sense when an individual is on a wait list for an extended period of time without being assessed for admission. Perhaps it should just be a “follow-up screening”, completed at defined timeframes while the individual remains on the waitlist to collect new/updated information and changes in symptoms and treatment needs that may move them to a priority list or immediate referral to another level of care.
Should define a timeframe in which a “secondary screening” (or follow-up) is needed. On waitlist longer than 30 days, 45 days, 60 days?
In A.2 – Providers should not be required to collect Emergency contact information at the initial screening; this is typically collected at the time of admission/intake to service (see current regulation 12VAC35-105-890, Individual Service Record for admitted individuals and -750 Emergency Medical Information). Was also not a required element to be collected in the initial Screening in proposed section -40 above, so nothing to update.
12VAC35-109-60.F(1)(g) Assessments. Remove “continue”. Individuals have not started treatment at this phase of the admission process/initial assessment.
12VAC35-109-70.D ISP. Need to clarify what this added language about case managers is attempting to convey and require.
12VAC35-109-80 ISP Requirements. The requirements written here for an Initial ISP are almost identical to the Comprehensive ISP. The Initial ISP is based on the Initial Assessment and generally will not cover all assessed needs, only the initial service plan to address immediate health, safety, and treatment needs at the start of services. The requirements listed here are much more comprehensive and require further assessment and planning than what can be defined and implemented with 24 hours from the initial assessment. These elements of an ISP generally follow the completion of the comprehensive Assessment.
12VAC35-109-80.E.2 ISP Requirements. The requirement to test a provider’s competency on each individual’s ISP AND to document the test within their personnel records is excessive and a huge documentation and labor burden on providers. The general competency assessment requirement to determine and document a provider’s abilities and knowledge should just remain part of the General Chapter, Article 4 – Personnel.
12VAC35-109-90.F Reassessments and ISP Reviews. Recommend changing “to determine if the individual is satisfied with the services provided” to ”to determine if the individual’s treatment needs and preferences are being met” in keeping with the language used in the definition of an ISP in 109-10. “Satisfaction” has quality improvement implications, whereas the review of the ISP should remain clinically-focused.
12VAC35-109-100.A Progress Notes or other documentation. Does the OL mean here that progress notes should be consistent across provider service “locations”? To maintain a consistent format across different types of services can be challenging since different types of information are captured and documented depending on the service type and/or level of care the individual is receiving.
12VAC35-109-100.B.6 Progress Notes or other documentation. Progress Notes should be signed and dated by the clinical staff who provided/rendered the service in keeping with DMAS and most payer requirements, not who entered the note, which may not necessarily be the same staff.
12VAC35-109-200 through -350 only apply to OTPs. Unlike the other service-specific sections at -360 through -500, the service name is not included in the section titles making it difficult to determine that these requirements are specific to MAT/OTP. Recommended adding the service name to these section titles.
12VAC35-190-400.1 Substance abuse intensive outpatient program criteria. The number of service hours per day should align with the DMAS regulations for this service. See 12VAC30-130-5090. Services for children/adolescents only require a minimum of 2 service hours per day.