Comment on Proposed Licensing Regs 12VAC35-105

Many of our concerns identified in the implementation of the Emergency Regulations have been addressed.  However, we continue to have the following concerns.   

General
Unfunded mandates
The requirement of Risk management, quality improvement and serious incident reporting requirements proposed and included in the proposed recommendations are not included in the DD rate methodology and subsequent rates developed by Burns & Associates.

Crosswalk among Licensure, Human Rights, Medicaid Waiver and HCBS to provide consistency.
We have continued to recommend the development of a crosswalk among Licensure, Human Rights, Medicaid Waiver and the HCBS site requirements/transition plan during various work groups.  It was also a recommendation of the DBHDS Provider Issues Resolution Workgroup (PIRW) of which we are an active member.  

Deemed Status for CARF Accreditation
We have consistently recommended that providers who receive a full 3-year CARF accreditation be granted “deemed status” by the DBHDS and be exempt from licensing regulatory requirements.  This would allow the DBHDS to focus its limited licensing resources on new providers or troublesome providers. This would provide a significant benefit in terms of reducing onerous and redundant procedure development and implementation by providers.

105-160.D.2
The requirement is for providers to report “the consequences or risk of harm” for Level 11 and Level 111.  Requiring providers to meet the “risk of harm” is putting a unique burden upon them to speculate on what could have been occurred or may have occurred.  

105-170.E – Corrective Action Plans –
There is no deadline for the DBHDS response and no requirement for the response to be in writing.  Deadline = number of business days?  A stated deadline is necessary so that providers are not held in limbo – especially when there is a licensing personnel change or an evolving standard. Also provides written documentation that providers need to prepare for any appeals process.

105-140 – Orientation
Is the specific 15 days to complete orientation necessary?  Recommend deletion of specific reference to 15 days.  Is it “work days” or “calendar days” – a difference of whether 2 or 3 weeks.  Recommend language that specifies that providers can not bill for services until orientation has been completed and documented, etc. This is the goal of the requirement.  15 days is burdensome.  If requirement is kept to specifying number of days – please change to 30 “work days”. 

400.C
The statement should read “C. The provider shall submit all information required by the department to comply with the Code of Virginia to complete…….”

400
Add “D.2……”memoranda from the department transmitting the results to the provider, if applicable, ……

105-520
The language requires that the provider “incorporate uniform risk triggers and thresholds as defined by the department”.  Have these been published?

105-520.A Qualifications for Risk Manager
Has the term “expertise” in the phrase “training and expertise in conducting investigations, root cause analysis and data analysis” been defined?  The term is vague and subjective.  Also, burdensome in that it implies that someone has received specific training to acquire this expertise.  Experience supporting expertise should be considered for an individual to satisfy requirements.