115-50.D.5, 115-230.B.3
While the intent of these provisions is to remind providers of their mandated reporter responsibilities, there is a lack of clarity regarding expectations. This is particularly evident given the differing thresholds for classifying events as potential abuse, neglect, or exploitation across the Office of Human Rights (OHR), Adult Protective Services (APS), and Child Protective Services (CPS). OHR classifies a broader range of incidents as potential maltreatment requiring investigation than APS and CPS.

If the intent is to require providers to contact APS or CPS whenever an allegation is made under these Human Rights regulations, it may result in an excessive number of unnecessary reports to social services. However, if the expectation is that providers should only report founded allegations to social services, this would cause compliance issues with mandated reporter requirements by delaying reporting until after an internal investigation. To enhance clarity and streamline the process, OHR should collaborate with APS and CPS to better align notification expectations and thresholds for determining potential abuse, neglect, or exploitation.

115-90
Thank you for using this opportunity to better align access to records with similar regulatory frameworks.

115-145
The proposed changes increase the complexity of an already challenging requirement and reduce clarity. The specification in 145.B that an “attending physician” must both conduct a capacity evaluation (i, ii, iii) and obtain written certification from a capacity reviewer (iv) is confusing and suggests the following implications:

1. A new requirement for two separate evaluations to determine incapacity, which is an increased burden not present in the current regulations.

2. An assumption that a provider has an attending physician on staff or that an individual’s primary care physician (PCP) (if a physician and not a physician extender) will conduct the evaluation and provide certification. However, B.2 states that the evaluator cannot be currently involved in the individual's treatment, making it unclear who is permitted to perform this function.

3. Many DBHDS-licensed providers do not have a physician on staff, and requiring access to both an attending physician and a capacity reviewer places an unrealistic burden on providers.

Further concerns include:

• B.2 conflicts with APS expectations since APS prefers capacity evaluations to be conducted by professionals already familiar with the individual.

• The regulation does not clarify who is responsible for paying for capacity evaluations when the provider does not have an in-house evaluator, and health insurance may not cover such assessments.

• H. outlines necessary elements of capacity evaluations, but providers typically have no control over how external evaluators structure their reports. Creating provider-specific forms does not streamline the process, as evaluators are not required to use them and may charge additional fees for administrative requests.

• The restriction on Co-Authorized Representatives (Co-ARs) provides a mechanism for resolving conflicts but fails to acknowledge situations where both parents of an adult service recipient previously had equal decision-making authority.

115-175

• C.8 and E.6.d: While the formal investigation timeline is unchanged, the requirement to provide the final decision and action plan in writing within ten business days shortens the time available for the investigation itself. Post-investigation activities, including distribution of outcome information, require additional time.

• F.3: While resolving complaints quickly is ideal, requiring investigations for all complaints—regardless of whether they rise to the level of abuse, neglect, or exploitation—creates unnecessary delays and administrative burdens.

115-260

• A.7: This additional requirement lacks clarity and does not appear to simplify or streamline compliance requirements.

• A.9: The proposed requirement does not simplify or streamline processes but rather increases the burden on both providers and DBHDS. Since DBHDS’ training is the only accepted option, it is the Department’s responsibility to ensure it meets competency-based standards. OHR’s training may need to be offered more than four times per year to meet demand. Expecting providers to develop their own training is impractical, as many only have one or two trained investigators, who would also be responsible for creating competency-based training. A more effective approach could be integrating competency evaluation into OHR’s Look-Behind process, with technical assistance or remedial training provided as needed. Request: A more robust training program for investigators from DBHDS.

• A.12: Specify that this notification should be completed by updating contact information in the current web-based application (CHRIS or CONNECT) and ensure that these systems support this function.

• B.1: Requiring all staff members to read this entire chapter is an unrealistic administrative burden. The regulations include complex details, such as variance and appeals processes, that are not relevant to most staff members. The existing requirement for competency-based training is more effective. Instead, DBHDS should consider developing a standardized training module for general staff to ensure consistent and accessible training across all levels of a provider’s organization.

Summary of Key Recommendations:

1. Clarify mandated reporting expectations and align OHR, APS, and CPS thresholds to avoid unnecessary reports or delayed reporting.

2. Simplify and clarify 115-145 to ensure realistic implementation, considering that many providers do not have physicians on staff.

3. Adjust the investigation timeline in 115-175 to allow sufficient time for thorough investigations before requiring written reports.

4. Enhance DBHDS training availability for investigators rather than requiring providers to develop their own competency-based training.

5. Revise the 115-260.B.1 requirement to focus on competency-based training rather than requiring all staff to read the full regulations.

Thank you for the opportunity to provide feedback on these important regulatory changes. We appreciate the effort to improve the clarity and effectiveness of these regulations and look forward to further collaboration to ensure practical implementation.