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Settlement Agreement Provision

The Commonwealth shall have a statewide core competency-based training curriculum for all staff who provide services under this Agreement. The training shall include person-centered practices, community integration and self-determination awareness, and required elements of service training.

Quality Review Team (QRT) Reports

Provider Data Summary Reports

Compliance Indicators

Compliance Indicators V.H.1

1. DBHDS makes available an Orientation Training and Competencies Protocol that communicates DD Waiver requirements for competency training, testing, and observation of Direct Support Professionals (DSPs) and DSP supervisors.

2. The Commonwealth requires DSPs and DSP Supervisors, including contracted staff, providing direct services to meet the training and core competency requirements contained in DMAS regulation 12VAC30-122-180, including demonstration of competencies specific to health and safety within 180 days of hire. The core competencies include:

a. the characteristics of developmental disabilities and Virginia’s DD Waivers;

b. person-centeredness (and related practices such as dignity of risk and self-determination in alignment with CMS definitions);

c. positive behavioral supports;

d. effective communication;

e. at a minimum, the following identified potential health risks of individuals with developmental disabilities and appropriate interventions: choking, skin care (pressure sores, skin breakdown), aspiration pneumonia, falls, urinary tract infections, dehydration, constipation and bowel obstruction, change of mental status, sepsis, seizures, and early warning signs of such risks, and how to avoid such risks;

f. community integration and social inclusion (e.g., community integration, building and maintaining positive relationships, being active and productive in society, empowerment, advocacy, rights and choice, safety in the home and community); and

g. DSP Supervisor-specific competencies that relate to the supervisor’s role in modeling and coaching DSPs in providing person-centered supports, ensuring health and wellness, accurate documentation, respectful communication, and identifying and responding to changes in an individual’s status.

3. DSPs and DSP Supervisors who have not yet completed training and competency requirements per DMAS regulation 12VAC30-122-180, including passing a knowledge-based test with at least 80% success, are accompanied and overseen by other qualified staff who have passed the core competency requirements for the provision of any direct services. Any health-and-safety related direct support skills will only be performed under direct supervision, including observation and guidance, of qualified staff until competence is observed and documented.

4. At least 95% of DSPs and their supervisors receive training and competency testing per DMAS regulation 12VAC30-122-180.

5. DBHDS makes available for nurses and behavioral interventionists training, online resources, educational newsletters, electronic updates, regional meetings, and technical support that increases their understanding of best practices for people with developmental disabilities, common DD-specific health and behavioral issues and methods to adapt support to address those issues, and the requirements of developmental disability services in Virginia, including development and implementation of individualized service plans.

6. Employers and contractors responsible for providing transportation will meet the training requirements established in the DMAS transportation fee for service and managed care contracts. Failure to provide transportation in accordance with the contracts may result in liquidated damages, corrective action plans, or termination of the vendor contracts.

7. The DBHDS Office of Integrated Health provides consultation and education specific to serving the DD population to community nurses, including resources for ongoing learning and development opportunities.

8. Per DBHDS Licensing Regulations, DBHDS licensed providers, their new employees, contractors, volunteers, and students shall be oriented commensurate with their function or job-specific responsibilities within 15 business days. The provider shall document that the orientation covers each of the following policies, procedures, and practices:

a. Objectives and philosophy of the provider;

b. Practices of confidentiality including access, duplication, and dissemination of any portion of an individual’s record;

c. Practices that assure an individual’s rights including orientation to human rights regulations;

d. Applicable personnel policies;

e. Emergency preparedness procedures;

f. Person-centeredness;

g. Infection control practices and measures;

h. Other policies and procedures that apply to specific positions and specific duties and responsibilities; and

i. Serious incident reporting, including when, how, and under what circumstances a serious incident report must be submitted and the consequences of failing to report a serious incident to the department in accordance with the Licensing Regulations.

9. The Commonwealth requires through the DBHDS Licensing Regulations specific to DBHDS-licensed providers that all employees or contractors who are responsible for implementing an individual’s ISP demonstrate a working knowledge of the objectives and strategies contained in each individual’s current ISP, including an individual’s detailed health and safety protocols.

10. The Commonwealth requires all employees or contractors without clinical licenses who will be responsible for medication administration to demonstrate competency of this set of skills under direct observation prior to performing this task without direct supervision.

11. The Commonwealth requires all employees or contractors of DBHDS licensed providers who will be responsible for performing de-escalation and/or behavioral interventions to demonstrate competency of this set of skills under direct observation prior to performing these tasks with any individual service recipient.

12. At least 86% of DBHDS licensed providers receiving an annual inspection have a training policy meeting established DBHDS requirements for staff training, including development opportunities for employees to enable them to support the individuals receiving services and to carry out their job responsibilities. These required training policies will address the frequency of retraining on serious incident reporting, medication administration, behavior intervention, emergency preparedness, and infection control, to include flu epidemics. Employee participation in training and development opportunities shall be documented and accessible to the department. DBHDS will take appropriate in action in accordance with Licensing Regulations if providers fail to comply with training requirements required by regulation.

13. Consistent with CMS assurances, DBHDS, in conjunction with DMAS QMR staff, reviews citations (including those related to staff qualifications and competencies) and makes results available to providers through quarterly provider roundtables.

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