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Virginia Regulatory Town Hall
Agency
Department of Behavioral Health and Developmental Services
Guidance Document Change: This is a new guidance document regarding the current requirement for 90 days of operating expenses per the Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services (12VAC35-105).
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9/4/19  10:25 pm
Commenter: Kwaku Agyeman, St. John’s Community Services – Virginia (SJCS-VA)

Comments Regarding Proposed 90-day Reserve Requirement
 

St. John’s Community Services – Virginia (SJCS-VA) has been providing services in Virginia since 1991 and provides employment, community based day, and residential services.  SJCS-VA is a subsidiary corporation of St. John's Community Services.

Since 1868, St. John’s Community Services’ role as a nonprofit, human service agency has been to develop creative ways to support people with disabilities as well as the communities in which they live. SJCS embodies a continuing search for the most effective ways to include people with disabilities into the living fabric of our community. We advance our mission through practices that offer innovative models for other agencies through advocacy, education, and collaboration with the government at every level as part of the policy creation process.

To advance an individual's quality of life, St. John's promotes community support of the individual while at the same time creating opportunities to heighten community awareness of diversity. We work with individuals to enhance their skills, while educating the community about the gifts and contributions of this unique population we serve.

We agree with the vaACCSES and the VNPP comments that the proposed guidance document contradicts the language in the current regulation for which the guidance seeks to interpret.

Current regulation 12VAC35-105-210 states “The provider shall document financial arrangements or a line of credit that are adequate to ensure maintenance of ongoing operations for at least 90 days on an ongoing basis. This amount needed shall be based on a working budget showing projected revenue and expenses.

The proposed DBHDS guidance Office of Licensing stated below exceeds the intent and spirit of the current regulation and creates a new onerous regulatory requirement.

“Therefore, both applicants for licensure and licensed providers must be able to provide proof, at any time when requested by a representative from the department, that they have sufficient funds for 90 days of operating expenses, whether in cash or a line of credit.”

This proposed regulatory requirement is a substantive policy change and therefore requires the proposed guidance interpretation go through the traditional regulatory process.

We understand and support the importance of all licensed providers to maintain their legal and financial obligations. However, applying an overly strict interpretation of the current regulation will impose an unfunded mandate and will create an undue hardship on both large and small providers.

We oppose the proposed guidance document language for the following reasons:

  • The term “projected revenue” is missing from the new language. This is a significant omission and must be included as a key factor when considering 90 days of operating budget. The exclusion of this option is also a substantive policy change. Any substantive policy change requires that it proceed through the traditional regulatory process and not through an interpretive guidance document.
  • The requirement of maintaining 90 days of sequestered cash is onerous and unreasonable. The proposed interpretation: 
  • Removes millions of dollars statewide from the DD service system by requiring licensed providers to place a significant amount of resources in an untouchable “escrow” account.
  • Prevents providers from using essential amounts of money needed to maintain operational capacity (i.e. recruit and retain staff and expand program services) in a fiscal climate already negatively impacted by years of low Medicaid reimbursement rates. 
  • Increases fiscal hardships such that some providers may have no option but to cease operations entirely.

We propose the following recommendations:

·       “Projected revenue” must continue to be included as an option for providers to meet their financial obligations for a 90-day operating budget. An organization’s financial obligations are usually based on a combination of cash on hand, including lines of credit, accounts receivable on hand, and future revenues generated in conjunction with the delivery of future services. Ignoring both future revenues and an organization’s accounts receivable imposes an unnecessary and unwarranted burden on providers.

· Licensing staff do not have the necessary expertise in interpreting financial documents nor should we expect them to have this expertise. There are reliable alternatives to ensuring and determining an organization’s fiscal stability other than the sequestration of 90 days of operating expenses in cash or a line of credit equivalent.

  • Require a financial review or audit by an external certified accounting firm and/or an accompanying auditor’s letter stating that the auditor found the organization’s accounting standards to be compliant with U.S. generally acceptable accounting practices with no significant audit findings, that the organization has positive cash flow to sustain ongoing operations, and that the financial viability of the organization is supported with reliable and sound fiscal management.
  • Waive the requirement of a 90-day operating budget if an organization is CARF accredited or a United Way member. CARF accreditation requires strict fiscal policy and operation standards. United Way members already complete an annual audit review that includes submission of annual audits and 990’s that are reviewed by United Way for administrative costs and expense-to-income standards.
  • For not-for-profits, DBHDS can also use GuideStar to assess and research the annual audits and/or 990’s of licensed not-for-profits. GuideStar gathers, organizes and distributes information about U.S. not-for-profits in their data base.
CommentID: 76017