We disagree with the assertion that the emergency regulatory changes have had little impact on providers as “there is already staff in place to support this work”.  Specifically, many providers have needed to increase staff doing work related to Serious Incident reporting and follow up.  This work has not been absorbed without additional cost.  With the past few years, our agency has more than doubled the number of staff members completing work related to changes enacted due to the DOJ Settlement and have had to make difficult decisions when there is a need decrease our efforts in other areas.  From the broader perspective of an agency, this detracts from our ability to hire more staff for direct service provision.  In addition, program supervisors and staff have been tasked with spending time providing more information about incidents and participating in the root cause analysis process.  While more recent guidance and some listed herein have, indeed, allowed for more targeted reporting, gathering the additional information and conducting a greater degree of follow up is accounts for much of the theoretically “freed up” time.  The financial cost for ensuring appropriate training occurs is not small and we encourage the Office of Licensing to support the provision of regular, high-quality training across the Commonwealth on topics such as root cause analysis, risk management, data analysis, and investigation skills.

In addition, there has been an impact on staffing within our Developmental Services division, particularly the Case Management unit.  Increased responsibilities for Developmental Services Case Managers/Support Coordinators is straining the system as the additional work justifies smaller caseloads, while positions remain difficult to fill and as there are increasing difficulties in retaining staff members. 

We request confirmation that unplanned psychiatric hospitalization is synonymous with psychiatric hospitalization under a Temporary Detention Order and that voluntary hospitalization is exempt from the Level III reporting requirements.

We request inclusion of timeframe allotted to Licensing Specialists to provide feedback about whether proposed corrective action plans are or are not acceptable.  When there is a lack of feedback providers will, either begin to implement changes in good faith or will delay implementation of systemic changes unduly, while awaiting confirmation that the action steps are acceptable.  Similarly, when providers do not receive approval of corrective action plans, it is difficult to feel confident in adding this information to a quality improvement plan, as required in 105-620.

There are several changes for which we are appreciative.  Specifically, thank you for the removal of the concept of a Level III serious incident involving the possibility of permanent impairment. Incidents of these types that occur during service provision or on provider property will be captured under Level II reporting and review requirements.  Similarly, thank you for shifting the focus of RCAs for Level III events to those that occur during service provision or on provider property.  It has, indeed, been difficult to complete a meaningful RCA for events occurring outside of these times.  In addition, we appreciate efforts to ensure alignment of Licensing and Human Rights definitions, such as “Informed consent” and for including exemptions of reporting information about individuals who receive no services from a provider other than Emergency Services.