Service Area Strategic Plan
4/24/2014   9:13 pm
Department of Behavioral Health and Developmental Services (720)
Biennium:
Service Area 1 of 1
Regulation of Health Care Service Providers (720 561 03)
Description

Regulation of Health Care Service Providers involves licensing of mental health, intellectual disability, and substance abuse services; developmental disability waiver services; and residential brain injury services. The Department licenses all behavioral health (mental health and substance abuse), developmental (intellectual disability), developmental disability waiver, and residential brain injury services. It ensures that providers meet and adhere to regulatory standards of health, safety, service provision, and individual rights; conducts annual unannounced inspections, investigates complaints and reports of serious injuries and deaths in licensed services; and initiates actions such as sanctions and revocations, where necessary.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    Regulation of Public Facilities and Services supports the Department's mission of promoting quality services that are safe and healthy, respect human rights, and conducive to providing treatment to individuals that promote consumer self determination, empowerment, recovery, resilience, inclusion, and participation.
  • Describe the Statutory Authority of this Service
    Chapter 2 of Title 37.2 of the Code of Virginia establishes the State Behavioral Health and Developmental Services Board.
    • § 37.2-202 outlines the powers and duties of the Board, which include establishing programmatic and fiscal policies governing the operations of state facilities and community services boards (CSBs) and adopting regulations, for example, licensing regulations.

    Chapter 4 of Title 37.2 of the Code of Virginia describes the protections available to consumers of mental health, mental retardation, and substance abuse services, including the Department’s licensing of providers.
    • §§ 37.2-404 through 37.2-422 give the Commissioner authority to grant licenses and define regulatory responsibilities of the Department to implement this responsibility.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Providers licensed by the Department (including CSBs and other public and private providers) Providers licensed by the Department (including CSBs, other public, and private providers) 612 750

Anticipated Changes To Agency Customer Base
The Department experienced a 92 percent increase in the number of licensed providers and a 70 percent increase in the number of licensed services between FY 2002 and FY 2009. The ratio of licensing staff to services licensed has gone from 1:73 in FY 2002 to 1:99 in FY 2009. From FY 2005 to FY 2008 the number of licensed children’s residential services increased 41 percent, intensive in-home by 57 percent, and supportive in-home by 44 percent.
Partners
Partner Description
Community services boards and behavioral health authority (CSBs): The Department’s licensing function regulates CSBs and works with CSBs to revise and streamline licensing processes.
Individuals receiving services, family members, and advocacy organizations: The Department’s licensing function shares and receives information with and from individuals receiving services and their families and advocacy organizations regarding issues of mutual concern.
Local governments: The Department’s licensing function works with local zoning, fire, health, taxation, social services, and Comprehensive Services Act officials to implement regulations and share information.
Private providers (for profit and non-profit organizations): The Department’s licensing function works with private providers to ensure that they meet licensing and human rights requirements. Private providers participate in the licensing function's efforts to implement the Department's mission and vision and have a voice in policy, planning, and regulatory development for the services system.
Provider associations: The Department’s licensing function works with provider associations to address issues of mutual concern. Provider associations have a voice in policy, planning, and regulatory development for the services system.
State and local agencies: The Department’s licensing function collaborates closely with state and local agencies that provide, fund, or regulate a range of services and supports, including health care, education, vocational training, social services, and housing assistance, that respond to individuals with behavioral health and developmental services needs. Representatives of these agencies participate in the licensing function's efforts to implement the Department's mission and vision and have a voice in policy, planning, and regulatory development for the services system.
Products and Services
  • Factors Impacting the Products and/or Services:
    o Several major factors affect Regulation of Public Facilities and Services products and services:
    • New or revised federal and state statutes and regulatory or funding requirements;
    • Development and funding of new services throughout the state with significant increases in applicants due to children's transformation initiative;
    • Significant modifications to existing licenses due to the economy;
    • Reduction in the number of licensing positions by five during FY 2009;
    • Consumers and advocacy group issues; and
    • Media or community attention to licensed services as a result of serious incidents or community concerns.
  • Anticipated Changes to the Products and/or Services
    o Continued growth of community based services due to reductions in beds at state facilities and children's transformation initiative will affect the Department's licensing activities. The central office will issue more licenses and will conduct more licensing and human rights related investigations.

    o Increased focus on community services may increase likelihood of investigations by VOPA or the media, which affects and generally increase licensing monitoring activities.
  • Listing of Products and/or Services
    • Issue new licenses and renew licenses for mental health, mental retardation, and substance abuse services and, developmental disability and waiver services providers
    • Conduct unannounced monitoring of licensed services
    • Perform complaint investigations of licensed services
    • Maintain data on serious injuries and deaths in services
    • Perform revocation and sanction actions against licensed services
    • Provide information to the public about licensed providers or revocation and sanction actions against licensed services
    • Verify to payment sources (Department of Medical Assistance Services, insurance payers, Department of Social Services) that a provider is licensed
    • Train applicants to become licensed
    • Compile reports on licensed programs
Finance
  • Financial Overview
    This service area is funded with 98 percent general funds and 2 percent non-general funds. Non-general funds are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and Federal entitlement programs related to indirect services costs of patient care.
  • Financial Breakdown
    FY 2011    FY 2012
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $1,566,227 $34,224    $1,566,227 $34,224
    Change To Base $0 $0    $0 $0
               
    Service Area Total   $1,566,227  $34,224     $1,566,227  $34,224 
Service Area Objectives
 
  • Issue and renew licenses and perform monitoring and oversight necessary to assure that licensed programs meet and maintain established standards of care.
    Objective Description
    The extent to which the Department is able to perform its licensing function in an efficient and effective manner, the closer Virginia will become to fully realizing desired standards of care. Recognizing significant growth in the numbers and types of community providers and the increasing complexity of populations served in state facilities and community settings, coupled with current budget realities that constrain staff resources, the Department is examining how it performs these oversight activities. For the licensing program specifically, the Department is seeking opportunities to improve the ability of the program to perform its mandated responsibilities within existing resources and in a manner that promotes the vision of recovery, self-determination, empowerment, and community integration for individuals receiving services.
    Alignment to Agency Goals
    • Agency Goal: Align administrative and funding incentives and organizational processes to support and sustain quality individually-focused care, promote innovation, and assure efficiency and cost-effectiveness.
    Objective Strategies
    • Identify program efficiencies that would increase time that staff would have available to perform core licensing responsibilities.
    • Identify work assignment strategies to ensure inspections are made, complaints are investigated, and licenses are issued within reasonable timeframes.
    • Focus staff energy on service areas with the highest risk or in most need of development.
    • Review all licenses within six months of expiration.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Ratio of licensed services per licensing specialist
      Measure Class:
      Other
      Measure Type:
      Output
      Measure Frequency:
      Annual
      Preferred Trend:
      Maintain
      Measure Baseline Value:
      75.5
      Date:
      6/30/2005

      Measure Baseline Description: Ratio of licensed services per licensing specialist

      Measure Target Value:
      100
      Date:
      6/30/2012

      Measure Target Description: Ratio of licensed services per licensing specialist

      Data Source and Calculation: Source: Office of Licensing Information System (OLIS) Calculation: Number of licensed services divided by total number of filled specialist positions on June 30


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