106-20 Definition of Emergency Services (Crisis Intervention) – please make sure that the definition of ES is consistent with the forthcoming Project Bravo plans for Crisis Intervention Services. If there will be different expectations between DMAS and DBDHS’ definitions of what constitutes CI services please clarify the distinct different between ES and CI now.
106-20 Definition of OP services – the definition includes the term hourly which could be taken to mean that any time frame less than 60 minutes is not meeting the definition of services despite DMAS’ approval to bill in smaller increments (15 min blocks).
106-20 Definition of Serious Incident – in addition to using the term WRAP in item 4 of a level two incident please consider including different types of advance planning to include Psychiatric Advance Directives, etc. It is important to acknowledge that voluntary admissions are planned admissions and not indicative of an emergency and therefore should not be CHRIS reportable.
106-20 Definition of Serious Incident – Level III number 3. Please remove to bring definition into alignment with changes made in 2020. Level II number 2 please clarify that if a competent adult does not a sexual assault reported to CHRIS that organizations are not required to report.
106-20 – Definition of Succession plan. Please consider including an exemption for CSB as there is no specific “license holder” at a CSB.
106-20 – Consider adding a definition of a service animal to be alignment with ADA definition of a service animal
106-20 – SAIOP and SAOP definitions -- Please add ASAM levels to definitions to any services that have specific ASAM level requirements
106-20 – definition of systemic deficiency – do you mean to use the word defects or is this supposed to be deficiencies? Please be more specific as to what “multiple” means in context of the size and scope of an organization?
106-30 – Please add licenses for Small, Medium and Large ACT teams such as SAIOP and SAOP.
106-40 D.2 – please make both timelines 60 calendars days so they are consistent. Please add timelines for DBHDS to respond to initial applications and other follow up requests.
106-50.2.f /50-3.e – The commissioner may lower a license at any time? This seems rather capricious. Shouldn’t this only be as a last resort after certain conditions are met such as repeated failures to fix a problem? The way this reads a provider could receive 1 CAP and end up with a reduced license. The conditions under which this punishment could happen and the due process afforded a provider need to be spelled out.
106-60 – expecting every record needed within 2 hours of request might be an untenable requirement due to things such as travel distances for some CSBs as well as having to potentially access paper records located in storage. Please modify this to state that access to the EHR within 2 hours and any paper, scanned, or County documents/records within 1 business day.
106-80 A – please specify the time frame that DBHDS has to respond to any service modification requests and make sure they are in alignment. Currently the guidance is that DBHDS has 60 days to process so that actually means that a provider has to submit 60 days ahead of time in order to give DBHDS their allotted 60 days prior to implementing the change.
106-80 A.4 and E.5 – does this mean that every time a CSB updates a service description they have to send to DBHDS with a service modification form for review and approval?
106-80.E.8 – is this inability to service a specific individual or is this intended to address at a service level?
106-80. A and 80.E – several of these items overlap including geographic location/office locations and service descriptions.
106.90 – please include timeframes in which DBDHS is required to respond in writing recommend within 30 calendar days.
106-110 B.5 –Please be more specific as to what “multiple” means in context of the size and scope of an organization? Do you mean to use the word defects or deficiencies?
106-120 – Please clarify that not all errors resulting in a CAP are indicative of a “systemic deficiency” even if there are several of the same errors and therefore systemic issues do not need to be documented to with each CAP. In organizations as large as CSBs, serving thousands of clients and with hundreds of employees, there can be instances of just human error despite the robustness of systems put in place to meet all reporting regulations.
106-20-- Current guidance from the department has been that CAPs are to be completed within 60 days. This is often not enough time to complete items (such as implementing a training for several hundred staff) and goes against the idea that some deficiencies are “systemic” and therefore require a systemic response (changing policies, developing SOPs, modifying/developing forms). Please consider spelling out expectations about timelines for implementation and completion of CAPs.
106-20.E – please include a timeframe indicating the timeframe in which DBHDS is required to respond (accept/reject) a CAP. Please include a timeframe indicating how far after a deficiency DBHDS is allowed to issue a CAP (for example for an error noted by DBHDS on January 1 can they still issue a CAP on July 1). These timelines regarding CAPs need to be consistent across all departments and units charged with issuing CAPs to organizations so that there is consistency and organizations don’t inadvertently miss a timeline due to confusion as to which department/unit issued the CAP.
406-120 E. 1 and 2 – Please modify this to include a collaborative process in developing an acceptable CAP prior to just dictating a plan that may or may not be able to be implemented by the organization? So, for E.2 the department’s next step is go straight to punishing an organization? This regulation reads as if organizations that fail to get a CAP “right” within two tries is intentionally trying to get away with something as opposed to genuine misunderstanding. Building in more collaborative language will help facilitate better working relationships between DBHDS and organizations.
106-120. F – Appealing to the licensing supervisor’s supervisor in “collaboration” with a director – does this mean the director is there and available for the organization to speak to or is everything run through the specialist and they got to collaborate and relay information back? Is there a way to appeal to “the” director of licensing or can they delegate to others? If so, are organizations also allowed to have their directors delegate any appeals to “a” director for their choosing?
106-180 – please include language that CSBs are exempted from this requirement as they do not operate in this manner
106-190 – the executive director shall be on the premises during regular business hours? CSB’s often have regular business hours that cover more than 12 hours each day. Does this mean that if an ED is off site for a couple of hours for a meeting or even out of town for a conference but available by phone/email that there has to be someone officially appointed in their place? Please clarify what “ensuring” each site has an “appropriately” appointed designee would look like/require. How does telework impact this requirement? If and ED is working from home for the day but responsive to requests does this equal being on the premises?
106-200 – DBHDS should review all regulations to ensure compliance with gender neutral language. Is the intent of this requirement that each executive director has a personnel file on file with the organization or does this mean that the ED needs to submit their education and prior experience verification to DBHDS?
106-240 A.1. – please add clarification regarding exceptions for peers. Specifically which timeframes that will allow certain barrier crimes are waived.
106-240 D.1 – re: an “annual” disclosure from an “applicant.” Should “annual” be removed if this is regarding job applicants? Is this a way for organizations to get around the “ban the box” initiatives throughout the state? Is this only for barrier crimes or is this for any crime and or pending charges? Or is this statement intended to say from employee? If so, this is yet another unfunded mandate from the department that will take up significant resources and time (particularly for organizations that have hundreds of employees) when most employees will not have anything to discover.
106-250-2 – How should organizations verify high school educations? Also, what happens when transcripts are being held hostage by institutions due to an applicant owing the institution money?
106-250 – Are organizations able to accept driver’s license issued by a different state? What if the applicant is moving from another state and therefore there is no driving record in the state of Virginia? Wording makes it seem as if only Virginia documents will be accepted.
106-250.D – does this also apply to individuals hired through temp agencies?
106-280.D – How does an organization address this for positions that do not serve a specific population and are more a generalist? Also, what about job descriptions that are generalized across various positions in various programs such as a “therapist II” position that resides in all the licensed programs throughout the agency?
106-290 B.1. Is 14 business days a typo? Please modify to 15 business days for a full three weeks. For 290.B.1.A does this also include the actual training in the behavior management intervention? If so please increase the time to 60 business days for that specific part to allow for time to access quarterly trainings.
106-290.2.A/B Please increase the time frame in which to get this completed to 60 business days to allow for sufficient time to access training opportunities. Please also clarify that if a new employee comes in with valid CPR/FA, behavior intervention training, and/or Medication administration training from a different employer that is accepted to meet these criteria. Please also clarify if this is required for medical staff (doctors, nurses, PAs, etc.) or is it accepted that their formal education was sufficient training?
106-290.C – Please reconsider the wording on this. Not all items listed in 290.B.1 and 2 are required or necessary annually specifically, things such as the objectives and philosophy of the provider, personnel policies/grievance procedures, etc. The ever increasing training requirements from both DBHDS, DMAS and the MCOs are putting significant stress on the system, are unfunded mandates, and end up taking away considerable time from providing client services.
106-300.B. – please provide clarification as to what substantive changes means? Organizations are constantly reviewing and revising policies. Does DBHDS want organization to send them a copy each time there is a modification? Does this mean that DBHDS has to approve the changes or just that they are informed? Also please clarify who we would be sending them to?
106-310. Thank you for removing the annual recertification for co-occurring OP/Residential program.
106-320.A – please clarify if a contractor includes staff hired through a temporary agency. For contract employees is a review of the contract annually sufficient for a performance review?
106-370.C – Can this please be modified to provide information regarding business hours to DBHDS upon request? If not, who are we sending this information to and how often?
106-460-B – isn’t this a duplication of 106-590 F? Also does this match information in the Human Rights regulations in 115-175?
106-470.1 – Again, succession planning does not pertain to government entities. Please clarify.
106-480 – In an electronic health record all this information is readily accessible and not necessary to be placed on a “face sheet”. Face sheet terminology is a holdover from the time of paper charts. Requiring all this information to be located on the initial screen of a client record will make it unwieldy and duplicative as information regarding medical interventions and medications, diagnoses, etc are located in other places.
106-480.9 – is this excessive amount of information related to pregnancy necessary for all programs? This is excessive and really only needed for residential programs.
106-490.B. – please further define emergency and crisis. Also please increase the time from one business day as this is restrictive depending on the extent of the emergency/crisis.
106-500 – please further define post. Does this mean putting up on the walls of the building or is making available via internet acceptable?
106-560 – Would the organization be required to check all employee’s and contractors driving records even if they do not provide transportation to clients? If not, please clarify.
106-570. B. -- Please increase in the time frame of reporting to CHRIS from 24 hours to the next business day. There is no one at the department to review the reports over the weekend so making organization report them is burdensome. Thiis requirement results in another unfunded mandate by the DBHDS for organization as they have to pay staff overtime (or hire extra) staff to cover reporting on the weekends instead of waiting until the next business day.
106-570.C – please consider increasing to 30 business days
106-570.C.2.9(d) – please clarify that this is only if the death is reportable as a Level III incident to the department. Please consider increasing the time for the RCA in these types of events because if someone dies of an unknown reason it often takes a significant about of time to an autopsy report back in order to accurately complete a RCA -- suggest 30 days from receipt of an autopsy report (if one is to be completed).
106-580.C.3 – staff competency in what? Please clarify.
106-580.F – please define serious injury.
106-590.G – This has the potential for another significant increase in administrative tasks for the organization and yet another unfunded mandate by the state. It will be confusing for individuals as to which compliant/investigation process is available to them. Also please clarify if this requirement and the regular complaint process for HR is for individuals who are receiving services within a licensed service only or if it is for any client involved in any service provided by a provider that holds any license (which is what we have been informed by the disability law center is the case).
105-600.A.4. – please add language that “reasonable security measures” are expected. In emergencies it is not always possible to plan for and or avoid all issues.
105-620 A. – please clarify if this is required as part of the onboarding of an individual to each service (such as both OP and PSR services) or as part of the individual’s onboarding to the organization as a whole. Please provide more time for this as providing it all on the first day an individual is not always possible based on client need. Consider language such as within 3 service visits.
106-680 and 106-690 – is specific to certain services. Should be moved to those chapters.
106-700 – define that service animals must be maintained but that other animals are not required to be allowed on the premises in keeping with 700.D. please define service animals and suggest using definition per the ADA.
106-720 B – recommend moving this to the residential services chapter as this is not possible nor appropriate at many center-based services to provide persons served with access to a internet and a computer upon demand.
