Thank you for giving me the information to participate in this forum.
I suggest the following changes,
"Program rules" means the operational rules and expectations that providers establish to promote the general safety and well-being of all individuals in the program and to set standards for how individuals will interact with one another in the program. Program rules include any expectation that produces a consequence for the individual within the program. Program rules may be included in a handbook or policies and shall be available to the individual.
My suggestion: Program rules may be included in a handbook or policies and shall be available to the individual (-add- or his AR and a document should be signed stating that the policy handbook was received. This would protect both parties).
D. The provider's duties
3. Providers shall assure the following relative to abuse, neglect, and exploitation:
b. The director shall immediately take necessary steps to protect the individual until an investigation is complete. This may include the following actions:
My suggestion: (5) Immediately notify guardian or authorized representative of the occurance and the steps taken to protect the individual until an investigation is complete.
Consent or not consent to receive or participate in services.
a. The ISP and discharge plan shall incorporate the individual's My suggestion: or authorized representative's as appropriate preferences consistent with his condition and need for service and the provider's ability to address them;
b. The individual's services record shall include evidence of the individual's My suggestion: or authorized representative's as appropriate participation in the development of his ISP and discharge plan, in changes to these plans, and in all other significant aspects of his treatment and services, including significant changes in any service setting ; and
B. The provider's duties.
1. Providers shall respect, protect, and help develop each individual's My suggestion: or his authorized representative's ability to participate meaningfully in decisions regarding all aspects of services affecting him. This shall be done by involving the individual, to the extent permitted by his capacity, in decision making decision-making regarding all aspects of services.
2. Providers shall ask the individual My suggestion: or his authorized representative to express his preferences about decisions regarding all aspects of services that affect him and shall honor these preferences to the extent possible.
3. Providers shall give each individual My suggestion: or his authorized representative the opportunity and any help he needs to participate meaningfully in the preparation of his services plan, discharge plan, and changes to these plans, and all other aspects of services he receives. Providers shall document these opportunities in the individual's services record.
5. Providers may initiate, administer, or undertake a proposed treatment without the consent of the individual or the individual's authorized representative in an emergency My suggestion: if court ordered.
c. Providers shall notify the human rights advocate My suggestion: immediately, if an order is issued by the court to administer treatment without consent.
* DBHDS must know that NO provider has the right to initiate, administer, or undertake a proposed treatment without the consent of the individual or the consent of the authorized representative. At minimum, follow the law and get a court order if you are going to give providers permission to make decisions for their clients. This verbiage gives the "provider" carte blanche to order treatment under the pretense of an "emergency". This rule goes against the individual's human and civil rights to make a personal decision or to allow a chosen decision maker to make the decision. No one has the right to take control of another human being without permission.
Important: The provider must go through the court system to get emergency treatment if the individual or his representative does not approve the treatment, just like they would have to do if the individual is not disabled. This policy is discriminatory and I object!
d. My suggestion: Upon entry into the program, providers shall develop and integrate treatment strategies into the ISP to address My suggestion: emergencies to the extent of getting a durable power of attorney that appoints more than one person that the individual gives permission to make medical decisions on his or her behalf.
My suggestion: Remove this provision because providers do not have a right to authorize treatment - emergency or not. 6. Providers shall obtain and document in the individual's services record the consent of the individual or his authorized representative to continue any treatment initiated in an emergency that lasts longer than 24 hours after the emergency began.
My suggestion: This is the one that should be kept. 7. Providers may provide treatment in accordance with a court order or in accordance with other provisions of law that authorize such treatment or services including § 54.1-2970 of the Code of Virginia and the Health Care Decisions Act (§ 54.1-2981 et seq. of the Code of Virginia). The provisions of these regulations are not intended to be exclusive of other provisions of law but are cumulative.
My suggestion: This is the one that should be kept.
8. Providers shall respond to an individual's request for discharge set forth in statute and shall make sure that the individual is not subject to punishment, reprisal, or reduction in services because he makes a request. However, if an individual leaves a service against medical advice, any subsequent billing of the individual by his private third party payer shall not constitute punishment or reprisal on the part of the provider.
g. Preadmission screening, services, and discharge planning: My suggestion: With permission from the individual or his authorized representative, providers may disclose to the department, the CSB, or to other providers information necessary to screen individuals for admission or to prepare and carry out a comprehensive individualized services or discharge plan (see § 37.2-505 of the Code of Virginia).
m. Psychotherapy notes: Providers shall obtain an individual's authorization for any disclosure of psychotherapy notes, except when disclosure is made:
My suggestion: Take this out, this goes against the individual's human/civil rights and it is discrimatory because provider's of individuals who are not disabled do not have the right to disclose their clients' personal information for the provider's own training programs. (1) For the provider's own training programs in which students, trainees, or practitioners in mental health are being taught under supervision to practice or improve their skills in group, joint, family or individual counseling;
My suggestion: Take this out, this goes against the individual's human/civil rights and it is discrimatory because provider's of individuals who are not disabled do not have the right to disclose their clients' personal information for the provider's own defense. Provider's must get a subpoena to acquire and release information. (2) To defend the provider or its employees or staff against any accusation or wrongful conduct;
9. Upon request, the provider shall tell the individual or his authorized representative the sources of information contained in his services records and provide a written listing of disclosures of information made without authorization.
My suggestion: Take all of this section out - except for disclosures: a. To employees of the department, CSB, the provider, or other providers; Chapter 115, Periodic Review Response DRAFT 2024.09.19 Page 22 of 56 b. To carry out treatment, payment, or health care operations; c. That are incidental or unintentional disclosures that occur as a by-product of engaging in health care communications and practices that are already permitted or required; d. To an individual or his authorized representative; e. Pursuant to an authorization; f. For national security or intelligence purposes; g. To correctional institutions or law-enforcement officials; or h. That were made more than six years prior to the request.
12VAC35-115-90. Access to and amendment of services records.
A. With respect to his own services record, each individual and his authorized representative has the right to:
1. See, read, and get a copy of his own services record, except information that is privileged pursuant to § 8.01-581.17 of the Code of Virginia. My suggestion: Take all of the remaining section out and information compiled by the provider in reasonable anticipation of or for use in a civil, criminal, or administrative action or proceeding;
This makes no sense. Why would anyone be able to amend an individual's record without their permission? My suggestion: #4 needs to be rewritten or taken out. 4. Let anyone who sees his record, regardless of whether amendments to the record have been made, know that the individual has tried to amend the record or explain his position and what happened as a result.
If an attorney-in-fact, health care agent or legal guardian is not available, the director My suggestion: (specify - Director of what?) shall designate a substitute decision maker as authorized representative in the following order of priority:
My suggestion: All of "B" should remain in the document. B. The individual shall: 1. Be contacted by the director or the director's designee regarding the complaint within 24 hours; 2. Have access to a human rights advocate for assistance with the complaint; 3. Be protected from retaliation and harm; 4. Have the complaint reviewed, investigated, and resolved as soon as possible; 5. Receive a report with the director's decision and action plan within 10 working days; and 6. Be notified in writing of his right to and the process for appealing the director's decision and action plan to the LHRC.
