Comments - General Chapter 12VAC35-108
12VAC35-108-10. Definitions.
12VAC35-108-50.A Secondary screening.
Please define waitlist. Also, given the variable nature of the work and programming offered by providers, the census of waitlists should be set by Providers.
12VAC35-108-60.F.2.d Assessment.
Please reconsider the appropriateness as these are non-center based services. Revise to note provider shall attempt to obtain BAC or administer a breathalyzer, to reflect that individuals have the right of refusal.
12VAC35-108-70 Individualized services plan (ISP)/Individualized support plan/Services planning.
Include language so the ISP section is consistent with Assessment section in that if the initial ISP is comprehensive that there is no need for 2 separate plans – an initial and a comprehensive (if an initial ISP is comprehensive, this should be accepted as sufficient).
12VAC35-108-80.B.1 ISP requirements.
Add language that reflects that each need may not be addressed, but rather those the consumer wants to address are. Such as each need “per the consumer’s choice which are” documented within the individual’s assessment.
12VAC35-108-80.C ISP requirements.
Revise language so that the copy of the ISP is offered, but the consumer could decline, rather than the plan be “given.” Experience is that some do not want or decline/refuse a copy.
12VAC35-108-80-E ISP requirements.
While staff members should be knowledgeable about the contents of the ISPs for individuals served, establishing an expectation to train and test all staff members involved with service delivery is an unrealistic expectation that will significantly detract from service delivery. Observations of competency in and knowledge about providing services is part of the supervisory and evaluation process. For example, staff of a Large ACT team may serve up to 120 individuals at a time and all staff members may be providing services to these individuals. It is not feasible for all members of the team to be tested on 120 ISPs, each time a plan is revised (with concurrent expectations to increase the frequency of updating ISPs). This will significantly detract from time available to provide services. Promoting this is likely to result in providers making fewer updates to ISPs to avoid retraining and testing staff. It will also promote the development and use of plans that are less individualized.
There is no realistic way to document this knowledge and competency without documentation of confidential information about individuals served, which should not be part of a Personnel File. This also places an undue burden on Human Resources staff members who maintain personnel files. File sizes would become unmanageable.
Job descriptions already include the minimum requirements and KSAs. Staff are required to be oriented to their position and supervision is to be documented. Documentation of this would be available to auditors if there was a question of competency. Perhaps a compromise would be a staff attestation upon the staff signing the Treatment Plan, indicating they have a working knowledge of the plan including health and safety protocols. If the issue is with specific competencies that DBHDS has concerns about, perhaps those could be enumerated and only those require further education and training. As written, it is too vague to be accomplished.
12VAC35-108-90.C Reassessments and ISP reviews.
Remove, as this is not applicable for home/non-center based services, which are inherently not medication-only in nature.
12VAC35-108-90.F.3. Reassessments and ISP reviews.
A 15-day grace period conflicts with some DMAS regulations. Perhaps a grace period should not be referenced in the Licensing regulations, but note the DMAS timelines for that service. This would eliminate the conflicting information.
12VAC35-108-100.A Progress notes or Other Documentation
Certainly, the format of progress notes across all locations of one service is desirable. However, the format of notes across the various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources. Revise this section to reflect that the format of progress notes is to be consistent across all locations of the same service type. Updating the language to better clarify what is meant by “format” would be more beneficial.
12VAC35-108-110.A.5 Health care policy.
Specify that this pertains only to tests, treatments, and examinations provided by or prescribed by the provider. Assuming this responsibility for other services and types of providers will result in staff members engaging in practices that are beyond their scope.