March 27, 2018
A review of the more than 225 responses/comments on the proposed DBHDS Licensing Regulations was revealing; the major themes and areas of concern are:
- The definition of select “serious incidents” and the resultant requirement that they be reported in the CHRIS system.
- Primary among these are the definition of “missing” as being too broad and, in fact, potential restrictive of the freedoms inherent in both our regulatory requirements and in our philosophical approach to providing person centered supports.
- Also noted as problematic is the requirement to report all rather than “unplanned” hospitalizations as “incidents;” besides the obvious contradiction, this exceeds the recently published recommendation of the HHS-OIG.
- Others mentioned were “allegations of exploitation or theft” and “disaster, fire emergency,” etc both of which, while important, are reported via other requirements; their inclusion on this list is duplicative.
- The applicability and implementation of the requirement for completing a “root cause analysis” for all Tier 2 and 3 incidents within 30 days; it is likely that this will force providers to minimize the importance and value by making this a “fill-in-the-blank” kind of exercise
- The significant impact that requiring the review of background check (Criminal History and CPS) prior to hiring will have on the possibility of filling positions in an already extraordinarily stressed workforce market. In addition, it also appears to conflict with §19.2-389 A 29 of the Code of Virginia!
- The process for developing and review of the ISP also prompted a number of comments as it appears to not be “in sync” with the Person-centered Planning process already in place
- Also of grave concern was the impact that these changes would have on providers of services other than DD Services – as was rightly pointed out, these regulations affect a wide range of services and providers and changes to comply with DOJ requirements are not necessarily applicable
The greatest number of comments were received about removal of the option for “live-in” staff in a licensed group home; we pointed out that a policy decision of this magnitude should perhaps not be made in Emergency Regulations where it could not be carefully vetted. Not only would this change cause a significant disruption to the service system, but if the reported logic for making the change is true, it is in direct conflict with the HCBS Community Rule which we are trying to implement now in Virginia.
As one additional note – while it is not the main focus of this initiative, this draft probably should have reflected the recent changes made in the “Q” definitions!