Provider feedback for CMHRS Draft Regulations

As a provider of community mental health services and the Treasurer of Virginia Association for Preservation Services (VAFP), I have concerns about proposed regulation changes pertaining to Intensive In-Home Services. Below I have referenced the specific Draft Regulations and my comments and recommendations.

12VAC30-50-130 (Draft Regulations)

Re: the addition of language "Care coordination" and elimination of “case management activities”

Comments/Recommendations:  The change in this language restricts the range of therapeutic activities allowed by the QMHP.  The new language only allows coordination of care with other health care providers and prevents coordination with schools, courts, social service agencies, childcare providers and probation officers.  This will significantly limit the role of the QMHP and result in a fragmented treatment model.  It undermines the intention of IIH services which is to stabilize an individual in their community setting.  I recommend that the definition of “Care coordination” include collaboration with all professional services to include but not limited to schools, courts, social service agencies, childcare providers and probation officers. 

12VAC30-50-226 (Draft Regulations)

Re: addition of language “The documentation shall describe how the alternative community service location supports the identified clinical needs of the individual and describe how it facilitates the implementation of the ISP” and removal of the language “In some circumstances, such as lack of privacy or unsafe conditions, services may be provided in the community instead of the home”.

Comments/Recommendations:

The new language creates an unnecessary and subjective burden by requiring documentation of a correlation that may not exist.  Conducting a session in “an alternative community service location” is not always done to support the “identified clinical needs” of the client.  In fact, going outside the home is usually done for logistical purposes such as establishing privacy.  A QMHP will frequently relocate a session to the community (i.e. counselor’s vehicle, near-by park, school, restaurant, church or public space) because the home is crowded, unsafe, lacks seating, or has no privacy.  By requiring the burden of additional documentation to describe “how the alternative community service location supports the identified clinical needs of the individual and facilitates the implementation of the ISP” suggests that each specific location outside the home needs to be correlated to a treatment objective in the ISP.  It is the clinical intervention that correlates to the treatment objectives not the location of the session.      

12VAC30-60-61 (Draft Regulations)

Re: addition of the language “documented” in the follow policy:

b. Exhibit such inappropriate behavior that documented, repeated interventions by the mental health, social services or judicial system are or have been necessary.

Comments/Recommendations:

The addition of this language will create an unnecessary barrier to services.  Currently, the “treatment history” of the individual is obtained during the clinical interview (only reimbursed as a one hour session). During the interview the QMPH will collect the history of previous interventions by the mental health, social services, and judicial system by having the client and legal guardian give an oral account of the client’s treatment history.  The proposed language adds an additional burden of obtaining proof that the prior treatment was “documented”.  This requirement is not necessary to assess the risk level of an individual.  However it could significantly delay or prevent an individual to qualify for the service.