Prince William CS

Comments regarding draft guidance document related to 12VAC35-105

July 22, 2020

1A. Prince William CS appreciates the efforts to clarify the CAP process and agrees that providers should be in compliance with regulations and failure to meet a regulation requires that the agency determine why they were not in compliance and what can be done to remain in the compliance for the future.  However, since regulations cover everything from lighting to paperwork to behavioral restrictions, for an agency our size (serving 8000+ people per year, 400+ staff, 50+ new staff each year, 10+ locations throughout the County) it is to be expected that there will be occasional individualized missteps that don’t always require a “systemic” plan of action. The regulations do not currently indicate individualized responses such as additional supervision/training for a single staff person is acceptable. 

1C.  How are providers to submit documentation for each part of the CAP to DBHDS? This is not clarified in the current policy and how often would that documentation need to be submitted (using your example of weekly chart reviews how long would the licensing specialist require to receive the reviews?)

Re: 2VAC35-105-170 C: “If a CAP is returned to the provider a third time for failure to meet all requirements within 12VAC35-105-170, the CAP will be returned with an additional citation for violating regulation 12VAC35-105-170.C and the CAP dispute process will be initiated automatically as outlined in 12VAC35-105-170.F”

This seems excessively punitive for a situation that is most likely a miscommunication or lack of clarity regarding what is needed/expected.  This threat of an additional citation seems almost as if the department is trying to force providers to just accept what they are told and eliminates the collaborative process between the providers and the department.  Additionally, there is no clarification if the additional citation would be removed if the dispute process ends in the favor of the provider. If it ends  

D.  Please clarify the guidance regarding requests for extensions, is it 10 days from the original due date or 10 days from the date of request for extension?  A 10-day extension that is granted from the date of request instead of 10 days from the original due date penalizes organization for being proactive about requesting an extension.

E.  Please specify the time frame in which the licensing specialist is required to respond to the submitted CAP.

F. Please provide time frames regarding the various stages of the CAP dispute resolution process.  Please include that the DOL will provide a written response regarding the final resolution of the dispute process.

General Comments:

1. Prince William County CS continues to comply with all DBHDS regulatory requirements.  However, as DBHDS has consistently added expectations, measures, and requirements meeting these obligations have become significantly more challenging at our current staffing levels. Prince William CS encourages DBHDS to consider funding for additional administrative, IT and QA staff for CSB in order to meet current and future regulations.  The ever-expanding regulations have a significant economic impact on providers that is certainly not being recouped in our current funding. 
2. In the future please consider including community providers in the drafting of guidance documents prior to their release in order to determine impacts and unintended consequences that may make implementation problematic.
3. Since multiple departments now issue CAPS it is imperative that DBHDS develop a centralized system for providers to submit responses like the CHRIS system but one that allows electronic signatures from all parties.  The reality is that depending on which licensing specialist/IMU/investigators issues the CAP there is a different way they want to receive it, how it is to be signed, etc. Some require printing, then hard signing, scanning into a PDF and returning.  Some want it signed ahead and then submitted, some require that it not be signed and prior to the licensing specialist signing it, some don’t require signatures other than a typed name, etc.  The variety of ways to return the CAP and the idiosyncrasies of the specialist on how to receive it leave providers open to failing to not meeting the return deadline by inadvertently sending it to the wrong specialist in the wrong format and then receiving yet another CAP.