Monday Musings

December 21, 2020

A couple of things for thought this morning:

  • The most recent DOJ Independent Reviewer’s Report to the Court was released late last week, and the Executive Summary is attached here.  There are a couple of significant points made by Mr. Fletcher, and a a significant one we think he missed:
    • He was complimentary of the efforts made by providers to not only protect their individuals from the pandemic, but to provide supports needed even if not being paid!
    • He concludes that Virginia must provide the resources needed to help to recruit and retain  staff.
    • He traces an interesting history of the efforts to create and implement a Quality and Risk Management System in the Commonwealth, noting delays caused by the inadequacy of the original QSR contractor and the length of time required to develop and implement the regulations for Licensing (finally approved in August 2020) and those for the DD Waivers (not yet final).
    • He concludes with the observation that at the point Licensing could have implemented their “assessments of adequacy,” and that the Case Management oversight (RAT, On-site Reviews, etc)  and the new QSR contract were finally ready for implementation, we found ourselves in the midst of COVID.  While he acknowledges that virtual activities were taking place, as face-to-face and on-site reviews were not possible the efforts could not be sufficient to meet the requirements of the Settlement Agreement.
    • He reminds the Court that he said in December 2019 that the Department did not have time (1.e., minimum of two years) to demonstrate that the QSR process could achieve it’s desired outcomes.   He commends the Department for their efforts during this very challenging year, sadly he fails to acknowledge that the Department’s push to exit this coming summer (which was, apparently, not going to happen) placed providers in an untenable position!
  • DBHDS announced this morning that the accreditation status for CCCA (as a behavioral health facility) which they have used since 1990, is not the appropriate status for the billing they have been doing for Medicaid & Medicare.  Somehow, during the workgroup formed in the last Session to look alternatives, the error was discovered. 
    • CMS has now been informed, billing has stopped and the Commonwealth is waiting to learn how much of the $11M + dollars they will need to repey for the Federal share.  Meanwhile, there are many things, including structural changes, that need to be done to allow for re-accreditation!