The Eastern Shore Community Services Board (ESCSB) does not support the VACSB's position on this issue. DMAS should not pay for TDOs for patients who are NOT receiving acute inpatient level of care that a TDO indicate is warranted.  The ESCSB's understanding of this proposal is that TDO Patients are being "placed" in a 23-hour Crisis Recovery Center (CRC)recliner, instead of being placed in an actual inpatient TDO bed. A 23-hour CRC facility is by definition a voluntary facility. CRC patients have the capacity to volunteer and have been assessed to be at a sub-acute level of care, otherwise they would have been assessed to meet the regulatory criteria for acute in-patient care wither voluntary or under a TDO. At the very minimum a TDO patient is placed against their will either by refusing or by lacking the capacity to make an informed decision. Thus, requiring in-patient psychiatric care. 

Submitted by John Konkel, LPC Emergency Services and CIT Coordinator, ESCSB