Fidelity standards and Licensure regulations

• Some requirements seem better suited for fidelity measures versus the regulation. Aligning regulations to the base level of compliance with TMACT standards may help smaller CSBs, or those in the highest workforce shortage areas, to still operate ACT to the best of their ability.
• The proposed changes to the Code that exceed fidelity requirements handicaps programs that can provide based on TMACT standards, but for myriad reasons, cannot attain the additional DBHDS licensure requirements.
• Confusion about the difference between base TMACT fidelity, Licensing regulations, and medical necessity criteria could result in MCOs denying payment to teams providing services based on TMACT fidelity.

Staffing

• The requirement to hire additional personnel to be compliant with new ACT requirements penalizes boards that have been providing services that meet TMACT fidelity standards but lack resources to fund additional positions. A team in compliance with the current ICT licensing guidelines will have to reduce its census, resulting in a loss of revenue that is essential to operate the program.
• Licensed practitioners - LMHP-Es are essential to our workforce. As a smaller locality, we have difficulty recruiting LMHPs (salary competitiveness and many licensed staff exiting the CSB system).
• ICT Peer specialist- recommend removing the requirement to be a QMHP. Requiring that the ICT Peer specialist earn the CPRS credential is more in line with the expectations and the professional path DBHDS has established for Peers.
• Nursing staff - Do not regulate 2 FTE nursing positions (1 RN and 1 LPN) for a medium-sized ACT team. Let the nursing FTE ratio be measured in fidelity reviews rather than mandated by regulations. Hiring additional nursing staff may not be fiscally feasible for smaller boards.