Comments - General Chapter 12VAC35-106

12VAC35-106-20. Definitions

• ACT – definitions must be consistent and clear across chapters. Be sure small and large teams’ language corresponds. The number of definitions are different across chapters.
• Case management services – providers are responsive to needs, yes, but the term desires seems expansive. Consider updating to the term “preferences” instead.
• Corrective Action Plan – (This insertion is more appropriately seated in the Human Rights regulations). Embed language to note that system issued will be addressed “where indicated” and will take into account instances of human error, acts of God, accidents and isolated instances attributed to one employee or factors outside of the provider’s control. 
• Crisis Stabilization - Revise definition to align with DMAS terminology, which does not specify that Crisis Stabilization services be available 24-hours per day or differentiate between community based and residential crisis stabilization, where the latter inherently provides services 24-hours per day. Consistency with Project BRAVO language and parameters is key.
• Serious Incident, Level III, item 3.  Remove to reflect change made in 2020.
• Please add Service animals – no definition, consider adding definition and/or refer to ADA regulations

12VAC35-106-40.D.2 Applications

Recommend making both dates 60 calendar days, to increase consistency and clarity. 40b also references succession plan.  Perhaps a broader scope would be helpful, such as submitting an organization chart to fulfill requirement. Add a timeframes for when providers can expect things back from DBHDS i.e., applications, CAP responses.

12VAC35-106-40.D.2 License types

A1f.  One conditional license at a time??  Might be a typo that providers may NOT have more than one service on a conditional license. 

A2f and 3Ae.  Commissioner may lower a full license to a conditional license at any time??  Doesn’t allow for due process or explain what process will be used.

12VAC35-110.D Compliance

How will this be determined?  Will context of numbers of individuals served and numbers of locations be taken into consideration?  While looking at systemic issues within one licensed service type is understandable, this potentially broadens the idea across services for a provider with multiple license types.  Distinct services under one organizational license should not be included.  Rather, each service type should be looked at distinctly.  It would, however, be understandable for a Licensing Specialist who identifies Systemic Noncompliance in one service type to ensure other service types within the organization are maintaining compliance.

B5 uses the language “defects”; perhaps it’s deficiencies.

12VAC35-160-120.E Corrective action plan.

Specify the timeframe the Department has to review plans and determine if they are approved.

E1.  Request timeframes for how far after a deficiency is noted that a CAP can be issued and also the timeframe for response back from DBHDS.  With these thresholds, timeliness is very important, so you’re not committing the same error before you’re even issued the CAP or its long since been resolved by the time you get the CAP.  And that timeframes to be consistent across all Offices and Departments at DBHDS.

12VAC35-160-240A.1 Criminal background and registry searches.

Providers shall not employ persons that have been convicted of any of the barrier crimes listed in §19.2-392.02 of the Code of Virginia, except as otherwise provided by the Code of Virginia.  How does this impact employability of peers for instance?  Exceptions in the Code of Virginia aren’t listed.  (Joe Hudson bill – Senate Bill 555 in 2018 removing burglary as a barrier crime.)

12VAC35-106-290 Employee training

Increase from 14 to 15 business days after start date (typo). Is this meant to include training in behavior interventions, too (e.g., CPI, TO, Mandt, etc.)?  If so, increase this to 30 business days, or denote that behavior intervention policies are to be reviewed within 15 business days while allowing 30 business days to provide training for in any approved hands-on emergency interventions.

Please reflect that a currently valid certification from a previous source prior to employment is acceptable.  Recommend changing timeframe to 90 calendar days for First Aid/CPR, behavior intervention and MAR training.  This requirement puts an undue burden on providers – the cost of training more of your staff as trainers or contracting with a trainer or travel expenses to get the soonest class regardless of distance.

12VAC35-106-580.C.3 Risk management

What DBHDS is looking for to test staff competence?

12VAC35-106-590.G Monitoring and evaluating service quality

If this will remain a part of the regulations, additional information is needed. Specifically, how does this intersect when an individual complains about an issue covered under the Human Rights complaint process, which most complaints are. This presents the possibility of a significant increase in administrative burden on the provider for a task that has heretofore been the responsibility of the Licensing Specialists. Having an OHR process and a licensing process will be confusing to individuals.

12VAC35-106-720.B Computers and Internet Access

It is recommended to relocate this verbiage to the residential services chapter, as this has limited applicability to other services, or, work with OHR to have this including in Chapter 115 instead, under Freedoms of Everyday Living.  In the residential chapter, consider overt allowance for limiting access during early phases of SUD/Detox types of programs or specifying this as a requirement for long-term residential services, not short-term.  Including this for non-residential services is not applicable.  In many cases, the expectation is for individuals to be participating in the services/programming outlined in the Service Description, which would not include having people engaging in “at request” (i.e. on demand) use of computer and internet – they are at the location to receive a specific service and there are reasonable, understood, expectations for participation in services during those hours.  For those services where use of computers may be beneficial for service delivery, providers would be expected to provide the necessary resources for staff members to provide services appropriately. This is unclear and can be easily misinterpreted by the client. A client asking for an accommodation is one thing however a client asking for a computer and internet access during an intensive outpatient stay is another. Are we to put computers in our lobbies?