Source: http://register.dls.virginia.gov/details.aspx?id=7084
Timestamp: 2019-01-20 13:10:01
Document Index: 430301940

Matched Legal Cases: ['§ 2', '§ 54', '§ 37', '§ 37', '§ 37', '§ 37']

Vol. 35 Iss. 2 (Fast-Track Regulation) 12VAC35-115, Regulations To Assure The Rights Of Individuals Receiving Services From Providers Licensed, Funded, Or Operated By The Department Of Behavioral Health And Developmental Services September 17, 2018
Title of Regulation: 12VAC35-115. Regulations to Assure the Rights of Individuals Receiving Services from Providers Licensed, Funded, or Operated by the Department of Behavioral Health and Developmental Services (amending 12VAC35-115-30, 12VAC35-115-105).
Agency Contact: Deb Lochart, Director, Office of Human Rights, Department of Behavioral Health and Developmental Services, Jefferson Building, 1220 Bank Street, 13th Floor, Richmond, VA 23219, telephone (804) 786-0032, FAX (804) 371-2308, TTY (804) 371-8977, or email deb.lochart@dbhds.virginia.gov.
Basis: Sections 37.2-203 and 37.2-304 of the Code of Virginia authorize the State Board of Behavioral Health and Developmental Services to adopt regulations that may be necessary to carry out the provisions of Title 37.2 of the Code of Virginia and other laws of the Commonwealth administered by the commissioner and the department.
Purpose: Licensed behavior analysts (LBAs) are one of the main professions providing behavioral services in Virginia. Currently, there is a six-month waiting list for behavioral plan development. The amendment to the language makes it easier for individuals to have access to behavioral health services, protecting public health.
Rationale for Using Fast-Track Rulemaking Process: The amendments are noncontroversial. LBAs have been a licensed profession in Virginia since the 2012 Session of the General Assembly established the profession (Chapter 3 of the 2012 Acts of Assembly) and since then, LBAs have been active in the behavioral health and developmental services system.
Substance: The amendments will increase the number of those professionals available to develop the plans by adding language allowing licensed behavior analysts to make assessments on the use of restraints or time outs.
Issues: The primary advantage of the amendments to the public and to the agency is the enhancement of the protection of rights for individuals in the system by allowing the most appropriately trained professionals (subject matter experts) to develop and implement behavioral treatment plans. There is no identified disadvantage to the public or the Commonwealth in making this change.
Summary of the Proposed Amendments to Regulation. The State Board of Behavioral Health and Developmental Services (Board) proposes 1) to allow licensed behavior analysts to make assessments on the use of individualized restrictions such as restraints or time outs in a behavioral treatment plan and 2) to limit behavioral treatment plans requiring review by an independent committee to those involving the use of restraints or time outs.
Estimated Economic Impact. Effective February 9, 2017 these regulations were extensively revised. During the rollout of the changes, an inadvertent error was discovered involving the assessment of individualized restrictions and the review of plans involving such restrictions.
The current language specifically allows a "licensed professional" to assess the use of restraints or time outs, but the definition of "licensed professional" does not include licensed behavior analysts who are qualified to make such assessments. The Board proposes to add language allowing licensed behavior analysts to make such assessments. Currently, there are 893 licensed behavior analysts in Virginia.1 Allowing licensed behavior analysts to make those assessments will broaden the pool of professionals who can make such assessments. A larger number of authorized professionals will likely be beneficial by speeding up the assessment process. According to the Department of Behavioral Health and Developmental Services (DBHDS), there is currently a six-month waiting list for behavioral plan development, and individuals consistently report that this is a service that they have difficulty in accessing due to the limited number of appropriate licensed professionals.
Also, the language in the previous revisions of the regulation requires that all behavioral treatments plans are to be reviewed prior to their implementation by an independent review committee established by the provider. The intent of that revision was not to require review of all plans but rather only those involving the use of individualized restrictions. Thus, the Board proposes to amend the current language to limit the committee review of plans to those involving such restrictions. This proposed change will reduce the number of reviews by the independent review committees and will likely result in some staff time savings to the providers. According to DBHDS, it would take about 30 minutes to conduct a review of a behavioral treatment plan. DBHDS estimates that there are approximately 502 providers utilizing over 800 plans statewide. Of the 800 plans, the number of plans involving restrictions is not known.
Businesses and Entities Affected. This regulation applies to 502 providers. Currently, there are 893 licensed behavior analysts in Virginia.
Projected Impact on Employment. The proposed regulation will reduce the demand for labor by reducing the number of plans requiring committee review, but no significant impact on employment is expected.
Businesses. The proposed amendments do not have an adverse impact on businesses.
The amendments (i) adjust the definition of "independent review committee," (ii) add licensed behavior analysts as licensed professionals who may conduct the required detailed and systematic assessment of behavioral treatment plans that include individualized restrictions such as restraint or timeout before a provider is allowed to employ such a plan, and (iii) clarify that behavioral treatment plans involving the use of restraint or timeout must be submitted to an independent review committee prior to implementation.
"Abuse" means any act or failure to act by an employee or other person responsible for the care of an individual in a facility or program operated, licensed, or funded by the department, excluding those operated by the Department of Corrections, that was performed or was failed to be performed knowingly, recklessly, or intentionally, and that caused or might have caused physical or psychological harm, injury, or death to a person receiving care or treatment for mental illness, intellectual disability, or substance abuse. Examples of abuse include acts such as:
6. Use of physical or mechanical restraints on a person that is not in compliance with federal and state laws, regulations, and policies; professionally accepted standards of practice; or the person's individualized services plan; and
"Administrative hearing" means an administrative proceeding held pursuant to Chapter 40 (§ 2.2-4000 et seq.) of Title 2.2 of the Code of Virginia.
"Authorization" means a document signed by the individual receiving services or that individual's authorized representative that authorizes the provider to disclose identifying information about the individual. An authorization shall be voluntary. To be voluntary, the authorization shall be given by the individual receiving services or his authorized representative freely and without undue inducement; any element of force, fraud, deceit, or duress; or any form of constraint or coercion.
"Authorized representative" means a person permitted by law or this chapter to authorize the disclosure of information or to consent to treatment and services or participation in human research. The decision-making authority of an authorized representative recognized or designated under this chapter is limited to decisions pertaining to the designating provider. Legal guardians, attorneys-in-fact, or health care agents appointed pursuant to § 54.1-2983 of the Code of Virginia may have decision-making authority beyond such provider.
"Community services board" or "CSB" means the public body established pursuant to § 37.2-501 of the Code of Virginia that provides mental health, developmental, and substance abuse services to individuals within each city and county that established it. For the purpose of these regulations, "community services board" also includes a behavioral health authority established pursuant to § 37.2-602 of the Code of Virginia.
"Complaint" means an allegation of a violation of this chapter or a provider's policies and procedures related to this chapter.
"Consent" means the voluntary agreement of an individual or that individual's authorized representative to specific services. Consent shall be given freely and without undue inducement; any element of force, fraud, deceit, or duress; or any form of constraint or coercion. Consent may be expressed through any means appropriate for the individual, including verbally, through physical gestures or behaviors, in Braille or American Sign Language, in writing, or through other methods.
"Director" means the chief executive officer of any provider delivering services. In organizations that also include services not covered by this chapter, the director is the chief executive officer of the services or services licensed, funded, or operated by the department.
"Exploitation" means the misuse or misappropriation of the individual's assets, goods, or property. Exploitation is a type of abuse. (See § 37.2-100 of the Code of Virginia.) Exploitation also includes the use of a position of authority to extract personal gain from an individual. Exploitation includes violations of 12VAC35-115-120 and 12VAC35-115-130. Exploitation does not include the billing of an individual's third party payer for services. Exploitation also does not include instances of use or appropriation of an individual's assets, goods, or property when permission is given by the individual or his authorized representative:
"Governing body of the provider" means the person or group of persons with final authority to establish policy.
2. Reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, and training, licensing, or credentialing activities;
4. Other activities contained within the definition of health care operations in 45 CFR 164.501.
"Health plan" means an individual or group plan that provides or pays the cost of medical care, including any entity that meets the definition of "health plan" in 45 CFR 160.103.
"Historical research" means the review of information that identifies individuals receiving services for the purpose of evaluating or otherwise collecting data of general historical significance.
"Human rights advocate" means a person employed by the commissioner upon recommendation of the State Human Rights Director to help individuals receiving services exercise their rights under this chapter. See 12VAC35-115-260 C.
"Independent review committee" means a committee appointed or accessed by a provider to review and approve the clinical efficacy of the provider's behavioral treatment plans and associated data collection procedures. An independent review committee shall be composed of professionals with training and experience in applied behavioral behavior analysis and interventions who are not involved in the development of the plan or directly providing services to the individual.
"Licensed professional" means a licensed physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed or certified substance abuse treatment practitioner, or licensed psychiatric nurse practitioner.
"Local human rights committee" or "LHRC" means a group of at least five people appointed by the State Human Rights Committee. See 12VAC35-115-270 A for membership and duties.
"Neglect" means failure by a person, program, or facility operated, licensed, or funded by the department, excluding those operated by the Department of Corrections, responsible for providing services to do so, including nourishment, treatment, care, goods, or services necessary to the health, safety, or welfare of an individual receiving care or treatment for mental illness, intellectual disability, or substance abuse. See § 37.2-100 of the Code of Virginia.
"Next friend" means a person designated in accordance with 12VAC35-115-146 B to serve as the authorized representative of an individual who has been determined to lack capacity to consent or authorize the disclosure of identifying information, when required under this chapter.
"Protection and advocacy agency" means the state agency designated under the federal Protection and Advocacy for Individuals with Mental Illness Act (PAIMI) and the Developmental Disabilities Assistance and Bill of Rights Act (DD). The protection and advocacy agency is the disAbility Law Center of Virginia (dLCV).
"SCC" means a specially constituted committee serving an intermediate care facility for individuals with intellectual disabilities as described in the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (42 CFR 483.440(f)(3)).
"State Human Rights Committee" or "SHRC" means a committee of nine members appointed by the board that is accountable for the duties prescribed in 12VAC35-115-270 C.
"State human rights director" means the person employed by and reporting to the commissioner who is responsible for carrying out the functions prescribed for the position in 12VAC35-115-260 D.
"Treatment" means the individually planned, sound, and therapeutic interventions that are intended to improve or maintain functioning of an individual receiving services delivered by providers licensed, funded, or operated by the department. In order to be considered sound and therapeutic, the treatment shall conform to current acceptable professional practice.
B. Providers may use individualized restrictions such as restraint or time out in a behavioral treatment plan to address challenging behaviors that present an immediate danger to the individual or others, but only after a licensed professional or licensed behavior analyst has conducted a detailed and systematic assessment of the behavior and the situations in which the behavior occurs. Providers shall document in the individual's services record that the lack of success or probable success of less restrictive procedures attempted or considered, and the risks associated with not treating the behavior, are greater than any risks associated with the use of the proposed restrictions.
VA.R. Doc. No. R19-5182; Filed August 23, 2018, 10:24 a.m.