106-30 C. 1 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. C. 3. Clarification requested on “maximum capacity of individuals served at a given time.” For example; many individuals attending day support programs do not attend five weekdays, but rather anywhere from one to five days. A day support program may have a maximum number it can support per day which is very different from the maximum number of individuals it can have enrolled. As the current definition is not specific, there is concern that providers may not be able to support individuals due to this requirement of defining the maximum individuals to serve. This has the potential for individual to lose vital services. B 5 Strike requirement to provide maximum number of individuals to be served at any given time at a non-residential facility. 106-40 Applications A.1. Appropriateness of the budget shall be at the discretion of the department- Strike language about the appropriateness of the budget being at the discretion of the department. This language will be problematic with CSB’s who get a large amount of their funding from local govern. It will be very difficult for CSB’s that are largely funded by local government. These entities will not allow DBHDS to dictate how local dollars are budgeted for services. A2. providers have mentioned several times the difficulty of having available funds for 90 days of operating expenses. This could mean over 4 months of operating expenses for programs operating 5 days per week, depending on the interpretation. 90 calendar days or 90 business days? In particular the feeling is this could be a challenge for small providers whose cash flow and reserves may be more constrained than larger providers. 106-50 License Types A 1. D- This language limits the ability for a new organization to come in and open multiple licensed services. Some organization’s that operate in other states have strong infrastructures and could do so successfully. I recommend changing the language to allow for greater flexibility. 106-60 Inspection Requirements F. Requiring records within a time frame does not seem to be something you put in regulations. This may not always be possible in rural sites where the agency is partly electronic and paper. It depends on what site the licensure specialist arrives and where the paper chart is located. Transporting a document could take more than one hour if the full record set is to be provided. This requirement will cause issues in large county government CSB’s. To retrieve necessary information, it takes staff dropping all client services to include potential emergency issues to respond. Consider adding, “one hour or a reasonable timeframe” or other way to ensure continuity of client services. 106-70 Renewals F: Can there be a warning for a provider before the closure of the license? Having a step in between seems to be a more efficient process. This requirement will cause issues in large county government CSB’s. 106-80Changes to licenses and notifications to the department A. 4) Modification to service descriptions; #7 The provider’s normal business hours”- Requiring a licensed program to submit a service modification when modifying its service descriptions and hours is burdensome for services provider, removes the flexibility to respond to needs in a timely basis. Requesting this is removed. E. 6. Any changes that cause a provider to be unable to provide services to any individual for a significant period of time- define “significant period of time” 106-90 Variances B 2. The increase in regulatory requirements does come with a cost to organizations. It is requested that the department study the financial impacts on organizations as regulations increase to provide financial assistance to providers to meet the increase in administrative and quality assurance requirements. 106-110 Compliance A. 3. Department guidance documents are not regulations and should not be added to the regulatory requirements. This was a discussion when the RCA guidance came out and this question was asked. There is not an opportunity to give feedback on guidance documents as in draft regulation. They may be best practices, but providers may not have the ability to implement the guidance documents as written. An example is the guidance document on how to complete a root cause analysis. A4. What is the formula for determining the provisional license for a provider for violations of human rights and/or multiple violations-the size of the organization should be in the formula-and if multiple individuals are involved, multiple HR violations are put in which skews the data and may look like large numbers of violations. 106-120 Corrective Action Plan Regulation does not specify timeframe for Licensing Specialist to return the approved CAP or notify if not approved. Recommend adding this information. 106-170 Informal Hearings 1. Requesting 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. Time frames should be added to each step so the provider knows the time commitment to an appeal process and knows what to expect. Each provider should experience the informal hearings the same way such as in the Human Rights hearing processes. Timeframes should occur in both departments not just Human Rights. 106-180 Governance Under the terms of the Core Services Taxonomy with DHBDS, CSBs have four options for how to be structured. Does this definition contradict and limit choice of how a Board would function/it’s role within the organization? If so, rephrase to ensure in alignment for CSBs. Submission of personal, home addresses of Board members who are not employees? A. How does this effect boards that are part of a government agency in which the County provides this level of oversight and more? CSB board members are volunteers, they are not paid positions that you can find someone with the proposed distinct expertise. This is not realistic. #9. Requiring a specific standing committee is prescriptive and may not be effective if the board does not have this level of expertise in their volunteers. This section needs revisiting. Section B regarding, “The duties and responsibilities of the governing body shall include: (5.) Oversight of programs is listed as a duty. What about “Operating Boards” that fall under a County or City? Typically, oversight is provided through the municipalities chain of command. (10.) provider’s audit – what audit? 106-200 Executive director or Administrator Executive Director or Administrator B educational requirements: With the expansion of Medicaid and programs now living in the managed care world, it is necessary for organizations to operate more like a business. The proposed definition limits the ability for an organization to have an executive director with this as their primary area of expertise. An organization can have someone with a business background be the executive director and have someone else be the clinical director for services. 106-210 Finances B.The language about separation of provider’s accounts from other records is not clear. F: The language should be changed to reflect if there is significant change to DBHDS funding. If local government chooses to move its funding DBHDS should not need to be notified. 106-220 Liabilities and insurance B. Remove reference to department guidance. 106-230 Confidentiality of Records D: This language causes conflict with the requirements to supply information within 60 minutes of request by a licensing specialist. Large local governments may/will have a separate personnel office than the CSB. The background checks may be housed there to comply with the law, and the licensing specialist may have to visit that separate location.