Page 10

 "Outpatient service" means treatment provided to individuals on an hourly schedule, on an individual, group, or family basis, and usually in a clinic or similar facility or in another location.

                -suggest removing “hourly” schedule and many services are provided in units less than an hour.

Outpatient services shall not include practitioners who hold a license issued by a health regulatory board of the Department of Health Professions or who are exempt from licensing pursuant to §§ 54.1-2901, 54.1-3001, 54.1-3501, 54.1-3601 and 54.1-3701 of the Code of Virginia.

-Unsure what this statement in trying to convey.

"Partial hospitalization service" definition…         

-Highly recommend removing the “medically-directed” language so as not confuse ASAM language that often notes medically monitored or medically managed. This ASAM 2.5 equivalent does require psychiatric or other medical consultation to be available. Medical services that may be needed can be made available by referral.  

PACT definitions

-Recommend not specifying that 10 full time staff are needed. Program size should be tailored to the community and need. Rural vs. Urban may require different staffing levels. Recommend removing specific number of staff listed. Typically PACT team sizes are determined by client ratios, example 1:10 staff to clients.

Page 13

 Residential Treatment Services…Clinically based

-Suggest aligning with ASAM language to be Clinically Managed which encompasses 3.5, 3.3, and 3.1. Even with that, 3.7 facilities are licensed as “residential” as well and “medically monitored.” May be best to deleted the addition all together. 

Page 14

 "Service" or "services" as defined by § 37.2-403 of the Code of Virginia means (i) planned individualized interventions intended to reduce or ameliorate mental illness, developmental disabilities…

-Suggest removing the word “planned” as crisis intervention and assessment are services, and may not be planned.

Page 17

 Services:

 -change emergency crisis intervention to simply “Crisis Intervention”

-change to simply Withdrawal Management Services. That would cover levels 3.3-4.0 Medical Detox, to most, is referring to 4.0 would need to be done in a hospital specifically.

Page 18

 Applications, Finances  

1.A working budget showing projected revenue and expenses for the first year of operation, including a revenue plan. Appropriateness of the budget shall be at the discretion of the department.

• Licensing should not take on budget approval duties and determining appropriateness, especially in light of no specifics definitions, and as board of directors at CSBs approve budgets.

   

  B. Providers shall submit an application listing each service to be provided and. Providers submitting an initial application shall only be licensed for one service. Providers shall submit the following items for each service:

  -Some of these may be duplications, particularly in terms of policies, that would require unneeded paper, and result in redundancy. Recommend keeping original language if applying for multiple services.

Page 21

Any records or information requested by department staff in order to conduct the onsite review shall be available to department staff within one hour of the request for such information.

-This would have a significantly negative impact on provision of staff information. With the c                combination of both electronic and physical records.  We hire over 100 staff per year and as such, records may not be in such order as to achieve a 1 hour turnaround.

Page 22

 Service Modifications –A. A provider shall submit a written service modification application and all attachments required by this chapter at least 45 business days in advance

D. describe the services licensed, the disabilities of individuals who may be served, the age range of individuals who may be served, the specific locations where services are to be provided or administered, the provider’s office locations and normal business hours,

-Suggest the removal of the “normal business hours” as hours may change and would then require a service modification to change the hours on the license. This reduces the flexibility of services provider to change hours when accommodations may be needed quickly to meet needs.

Page 23

E.The provider shall notify the department in writing prior to implementing changes that affect: 6. Any changes that cause a provider to be unable to provide services to any individual for a significant period of time.

-This is very broad, and gets into potentially into day to day business practices that may be outside the providers control, such as a temporary vacancy/work force issue. Does not seem that this should be required, particularly as “significant” is not defined.

Page 24

3. All applicable federal, state, or local laws, and regulations and all applicable department guidance including:  

-Department guidance documents are not regulations and should not be added to the regulatory requirements. 

Page 25

 Corrective Action Plan: Regulation does not specify timeframe for Licensing Specialist to return the approved CAP or notify if not approved.  Recommend adding a timeline which would allow for consistency across licensing specialist.  Would suggest 15 business days for the licensing specialist.  This is the timeframe that providers have to submit the corrective action plan to the licensing specialist.    

Page 28

 Informal Hearings B. 1. “Reasonable” notice of the informal hearing, which shall include contact information consisting of the name, telephone number and government email address of the person designated by the department to answer questions or otherwise assist a named party;

-Request that time frames are placed in the informal hearings such as within 15 days of receipt. Regulations should have clear time frames for providers and for the Office of Licensure. 

Page 29

Governance: General comments

-Governing Body requirements are excessive and do not ensure quality of services.  These requirements will only add to bureaucracy that is not directly correlated with service quality or provider fiscal sustainability.

-Many of these seem to specify required business practices that seem out of the ordinary for a licensing manual and do not allow for flexibility that may be needed based on entity size, purpose, and resources.

-Under the terms of the Core Services Taxonomy with DHBDS, CSBs have four options for how to be structured.  Do these contradict and limit choice of how a Board would function?