108-10

Comprehensive Assessment.  Thank you for recognizing that there are situations where the initial assessment meets the requirements of a comprehensive assessment and that an update is not required.  This increases alignment with DMAS expectations for many services.

108-60.F.2.d

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 to refuse and still receive services.

108-70

Include language so the ISP section is consistent with the 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, that should be accepted as such).

108-80.B.1

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 is” documented within the individual’s assessment.

108-80.C

Revise language so that the copy is offered, but the consumer could decline, rather than the plan be “given.”  Experience is that some do not want a copy.

108-80.E

While we agree that 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 are 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 the 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 use of less individualized plans. 

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 minimum requirements and KSAs. Staff are required to be oriented to their position.  Supervision is to be documented.  Documentation of this would be available to auditors if there was a question about competency.  Perhaps a compromise would be a staff attestation upon the staff signing the Tx Plan that 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.

108-90.C.

Remove, as this is not applicable for home/non-center based services, which are inherently not medication-only in nature.

108-90.F.3

A 15 day grace period conflicts with some DMAS regs.  Perhaps specific grace periods shouldn’t be referenced in Licensing, but reference the DMAS timelines for that service.  If not, then the regs would conflict.

108-100.A

The intent of this is unclear so it is difficult to make a substantive comment.  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 to reflect the unique nature of each service and affiliated requirements from pay sources.  Revise to reflect that the format of progress notes is to be consistent across all locations of the same service type.

Is the concern that some providers may be a mix of EHR and paper?  If so, revise language to clarify that this is what is meant by “format”.

108-100.C

Revise to read that the provider shall document when the individual…

108-100.D

Can this be more specific by type of service, rather than each time the individual receives services?  Is the intent for immediate/concurrent documentation or more consistency with DMAS that it be at the time of service, no later than 24 hours or 1 business day? 

Clarify if the intent is about timeliness or the frequency of documentation.

108-110.A.5

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.

108-120.C.5

Remove “outpatient” and “inpatient” as these are not home or non-center-based services.

108-120-C.6

Remove “psychosocial rehabilitation” as this is not a home or non-center-based service.

108-120.D

Remove – applicable for Chapter 107, Residential services

108-130

Could DBHDS provide more guidance as to what input they are looking for in this section?  Suggestion - to be consistent with the staff qualifications that DMAS requires.

108-130-A

Reference ACT in Section 210 rather than in more than 1 section.

108-160.A

What is involved in having a crisis and emergency policies be “approved by the department”?  Does this mean to be approved by OHR or by OL in addition to OHR?  Is this for providers who are initiating services for the first time or is this an ongoing review process for all providers before implementation?  And what is the response timeline from DBHDS to return their review to providers?

108-200

The general recommendation that all things about ACT be a separate Article 2, similar to the structure of Chapter 107 where each type of Residential service has was a separate Article for specifics if needed.

108-220

How does this align with DMAS allowances for the use of telehealth with this service, beyond the end of the current (2020/2021) state of emergency?