Q & A

Q: What is the Virginia Department of Behavioral Health and Developmental Services (DBHDS)?

A: DBHDS oversees the delivery of mental health, developmental, and substance use disorder services across Virginia, ensuring quality care and support for individuals in need​.

Q: What are Home and Community-Based Services (HCBS)?

A: HCBS are Medicaid-funded services that allow individuals with disabilities to receive care in their homes or communities, promoting independence and integration rather than institutionalization​.

Q: What is the Waiver Management System (WaMS)?

A: WaMS is an online system used to manage the application, approval, and tracking of Medicaid waiver services for individuals with disabilities in Virginia. The Program Director oversees the use of WaMS and is responsible for submitting and tracking waiver service requests and authorizations​.

Q: What is the Medicaid Enterprise System (MES)?

A: MES is an integrated system supporting the administration of Medicaid programs, including eligibility, enrollment, claims processing, and provider management​.

Program Management at Sunny Haven

Q: What are the responsibilities of the Program Director at Sunny Haven?

A: The Program Director is responsible for:

• Supervising Program Managers and Providers/House Managers across all services.

• Overseeing all operations of all services provided by Sunny Haven.

• Ensuring compliance with DBHDS, Medicaid, and other regulatory requirements.

• Overseeing the use of WaMS for Sunny Haven.

• Submitting and tracking waiver service requests and authorizations.

• Ensuring accurate and timely documentation of services provided.

• Monitoring the status of waiver applications and service approvals.

• Serving as the point of contact for all questions related to services​.

Q: What are the responsibilities of the Program Manager (PM) at Sunny Haven?

A: The Program Manager at Sunny Haven is responsible for:

• Conducting visits to homes per state requirements.

• Completing monthly inspections of each home.

• Completing monthly medication error reviews.

• Completing quarterly medication error reviews.

• Ensuring all homes complete a monthly fire drill.

• Ensuring all MARs, medication disposal forms, and controlled medication count sheets are uploaded to Lauris monthly.

• Ensuring yearly forms and documentation are updated in Lauris by providers.

• Completing all intake forms for new services for individuals.

• Attending annual ISP meetings for individuals supported by Sunny Haven​.

Training and Staff Requirements

Q: I'm PRN staff (as needed/seasonal). Why do I keep getting training emails?

A: ALL PRN staff must maintain the same standards and training compliance as full-time and part-time staff.
DBHDS and other regulatory entities do not differentiate between "PRN staff" and other active staff members. If you are considered active staff, regardless of PRN status, you are required to complete:

• Renewals

• Reauthorizations

• All required training and paperwork
  This ensures compliance with state regulations and licensing standards​.

Service Delivery and Documentation

Q: What documentation is required to maintain compliance with DBHDS and HCBS regulations?

A: Required documentation includes:

• Individual Service Plans (ISPs) and person-centered plans.

• Progress notes and service delivery records.

• Incident reports and safety assessments.

• Training records for staff.

• Monthly MARs, medication disposal forms, and controlled medication count sheets (ensured by the PM at Sunny Haven).

• Yearly PRN/OTC Forms, Annual Physical Examination forms, and Dental Appointment forms (when applicable) (updated by providers).

Q: When do I need to upload documents (paper forms - logs, MAR, medication disposal forms, printouts from medical appointments, etc.) to Lauris?

A: You must upload all required documents within the first week of the following month​.

Q: How often should managers approve notes submitted by staff?

A: Notes should be approved daily to ensure documentation accuracy, compliance, and timely corrections​.

Point of Contact for Service-Related Questions

Q: Who should I contact with questions related to services at Sunny Haven?

A: The Program Director is the primary point of contact for all service-related questions. They oversee all services and ensure compliance with regulations, making them the best resource for addressing concerns or clarifications​.

Speech-to-Text Implementation in Lauris

Q: Is there any type of talk-to-text application we could implement in Lauris?

A: Currently, Lauris does not offer built-in speech-to-text functionality. However, staff can use an external speech-to-text service separately and then copy and paste the transcribed text into Lauris.

Using a Speech-to-Text Service with Lauris:

1. Choose a Speech-to-Text Tool

   • Google Docs Voice Typing (Chrome browser required)

   • Otter.ai (Free and paid plans available)

   • Microsoft Word Dictation (Included with Office 365)

   • Apple Dictation (Built into iPhones, iPads, and MacBooks)

   • Android Speech-to-Text (Built into Google Keyboard)

2. Open the Speech-to-Text Tool and Speak Clearly

3. Copy the Transcribed Text

4. Paste the Text into Lauris

5. Review and Submit the Entry

Benefits of Using an External Speech-to-Text Tool

✅ Saves time compared to manual typing.
✅ Reduces documentation errors.
✅ Allows staff to focus on providing care rather than extensive note-taking​

Q: Is it okay to change my email address for work correspondence?

A: Yes, you can change your email address for work correspondence, but you should:

1. Notify HR and the Program Manager as soon as possible so they can update your contact information in all relevant systems​.

Q: What happens if an auditor finds the MAR is missing initials and documentation?

A: If an auditor finds that the Medication Administration Record (MAR) is missing initials and documentation, several consequences could arise:

1. Non-Compliance Citation: The facility may be cited for non-compliance with DBHDS and healthcare regulations.

2. Corrective Action Plan: The facility may be required to submit a corrective action plan to address the issue.

3. Increased Scrutiny: More frequent audits may occur until compliance is consistently demonstrated.

4. Potential Fines: Financial penalties may be imposed depending on the severity of the issue.

5. Risk to Licensing: Repeated violations could jeopardize the facility’s DBHDS licensing​.

Q: How do providers find out about referrals?

A: Providers receive referrals through the Program Director. The Program Director receives referrals from various sources, including support coordinators​.

Q: Where do I find out how much an individual receives for SSI each month?

A: You can determine an individual's Supplemental Security Income (SSI) by:

1. Reviewing award letters from the Social Security Administration (SSA).

2. Checking the individual’s My Social Security online account.

3. Calling SSA at 1-800-772-1213 (Ensure you have the necessary permissions to access this information)​.

4. Speak with the individual's Legal Guardian or Authorized Representative or Representative Payee

Q: How long does an individual have to find placement before they lose their waiver?

A: There is no universal time limit for securing placement once a waiver is approved. However:

• Individuals should work actively with their support coordinator to secure services as soon as possible.

• Failure to obtain services within a reasonable time may jeopardize waiver eligibility.

• If delays occur, the support coordinator can assist in exploring alternative solutions​.

Q: Who is responsible for filling out the tardy/call-out form in Lauris?

A: Managers are responsible for completing the tardy/call-out form in Lauris. This ensures accurate documentation and compliance with company policies​.

Q: Are PRN medications included on the Emergency Medical Form?

A: Yes, PRN (as needed) medications must be listed on the Emergency Medical Form. This ensures that all necessary medications are documented for emergency situations​.

Q: Do fire drills need to be done by a certain date each month?

A: No, but fire drills must be completed once per month to ensure staff and individuals are familiar with emergency procedures​.

Q: Do OTC medications require a doctor’s order in sponsored residential and group homes?

A: Yes, a doctor’s order is required for all over-the-counter (OTC) medications in sponsored residential homes and group homes under Virginia regulations (12VAC35-105-780)​.

Q: What should I do if an individual is not at the residential home (e.g., with family or at camp)?

A: You should:

1. Document a note in Lauris stating the individual is away and specify the location.

2. Notify Human Resources of the individual's departure and expected return date.

3. Understand that provider payments are affected—providers are paid based on billed days, so missing billing days impacts their payments​.

Q: Who is responsible for an individual's Medicaid renewal?

A: The Support Coordinator is responsible for ensuring an individual's Medicaid renewal is completed on time.

• Providers are not responsible for submitting Medicaid renewal paperwork.

• However, providers must inform the Support Coordinator if they receive any notices indicating Medicaid is due for renewal.

• If Medicaid lapses, services cannot be billed until the renewal is processed and approved.

• Individuals and their guardians (if applicable) should also stay informed and cooperate with the renewal process to prevent any disruptions in services.

Q: Can licensure show up unannounced?

A: Yes, DBHDS can conduct unannounced audits to verify compliance. Providers should always maintain updated documentation and ensure their facility remains in compliance​.

Q: How should family-administered medications be documented on the MAR?

A: When a family member administers medications, providers should:

1. Note on the MAR that the medication was given by a family member.

2. Include specific details (e.g., family member's name, any observations).

3. Use a Medication Transfer Sheet to verify administration.

4. Follow DBHDS documentation policies​.

Q: What if a family member does not administer medication while an individual is away?

A: If a family member fails to administer medications, the provider must document the missed doses and report it to ensure proper follow-up and medical oversight​.

Q: What do I do if an individual will not self-report bowel movements?

A: If an individual will not self-report bowel movements, document that observations were not possible and monitor their health closely​.

Q: Which individuals need a bowel log?

A: Individuals with a bowel obstruction protocol require documentation in a bowel log to monitor their health and prevent complications​.

Q: What happens if my home has strong odors (urine, waste, pets)?

A: Strong odors from human waste, urine, or pets can result in:

1. Health hazards (bacteria, ammonia exposure).

2. Inspection issues (DBHDS citations or fines).

3. Negative impact on residents (discomfort, stress).

4. Damage to reputation (complaints from families and clients).

5. Property damage (embedded odors in floors, furniture).

6. Contract cancellation (if the issue isn't corrected immediately, and continues to be an ongoing observation)

Actions to Take:

1. Thoroughly clean and sanitize affected areas.

2. Improve ventilation (use air purifiers).

3. Consider professional cleaning services if odors persist.

4. Ensure proper incontinence and hygiene management​

Q: What is illegal for staff to do in relation to the Medication Administration Record (MAR)?

A: The following actions are illegal and strictly prohibited when handling the Medication Administration Record (MAR):

1. Falsifying Documentation – It is illegal to sign off on medication administration that was not actually given or to alter MAR records in any way that misrepresents the truth.

2. Pre-charting – Staff cannot document that a medication was given before it has actually been administered.

3. Administering Medications Without Proper Certification – Only med-certified staff may administer and document medications. It is illegal for non-certified staff to handle medications.

4. Tampering with Medications – Staff must not alter, withhold, or dispose of medications without documenting the reason and following proper procedures.

5. Sharing Medications – It is illegal to give one individual’s prescribed medication to another person, even if the medications appear to be the same.

6. Altering Physician Orders – Staff cannot change a dosage, frequency, or discontinue a medication without a doctor’s written order.

7. Failing to Document Errors – If a medication error occurs, it must be reported and documented immediately. Failure to do so is a legal violation.

8. Destroying Records – MARs are legal medical records and must not be destroyed, altered, or removed without following official record retention policies.

9. Covering Up Errors – If a mistake is made, it must be properly reported and documented. Attempting to cover up errors is illegal and a violation of DBHDS regulations.

10. Administering Expired or Discontinued Medications – Staff must not give expired or discontinued medications. These must be disposed of properly following DBHDS and pharmacy guidelines.

Violations of these regulations may result in:

• Legal consequences, including criminal charges.

• Loss of med certification and termination of employment.

• Licensing violations for the facility.

Q: Where do staff document when they get new controlled medications until it’s time to start them? (For example, receiving a new shipment 4 days before the current supply is finished.)

A: If the new controlled medications are not yet being administered, they should not be added to the MAR until it is time to begin using them.

• The medication will be added to the MAR once administration begins.

• It will also be added to the Emergency Medical Form at that time.

• Until use begins, controlled medications must be double locked to comply with DBHDS regulations and medication security protocols.

Q: Can the Program Director make changes to an individual’s outcomes or key steps in the ISP?

A: No, the Program Director cannot make changes to an individual’s outcomes or key steps in the Individual Service Plan (ISP).

• Any modifications to an ISP’s outcomes or key steps must be requested through the individual’s Support Coordinator.

• Changes require team discussion and approval, ensuring that the individual’s goals remain person-centered and aligned with their needs.

• The Program Director can provide input and ensure that services are delivered in accordance with the current ISP, but they do not have the authority to modify the plan directly in WaMS or any other system.

For any necessary changes, the Support Coordinator must be contacted, and an ISP review meeting may be required.

Q: What’s involved in asking for an emergency SIS meeting?

A: An emergency Supports Intensity Scale (SIS) meeting may be requested when there is a significant change in an individual's support needs that impacts their current level of care or services.

To request an emergency SIS meeting:

1. Identify the Need for a Reassessment:

   • A major change in the individual's health, behavior, living situation, or support needs has occurred.

   • The individual requires additional services or a change in their current service authorization.

   • There has been a decline in functional abilities or new risk factors that were not previously considered.

2. Contact the Support Coordinator:

   • The Support Coordinator is responsible for initiating the SIS reassessment process.

   • Explain the reason for the emergency request, providing specific examples of changes in the individual’s condition or needs.

3. Provide Supporting Documentation:

   • Medical reports, behavioral data, incident reports, and staff documentation should be submitted to justify the need for an emergency reassessment.

   • Any recent evaluations or professional recommendations should also be included.

4. Await DBHDS Review and Approval:

   • DBHDS and the SIS assessment team will review the request to determine if an emergency reassessment is warranted.

   • If approved, an emergency SIS meeting will be scheduled to reassess the individual’s support needs.

5. Participate in the Emergency SIS Meeting:

   • The meeting will include the individual, their guardian (if applicable), support coordinator, residential/day provider representatives, and SIS assessor.

   • The team will re-evaluate the individual's support needs and determine if a new level of support is required.

6. Implement Any Approved Changes:

   • If the reassessment leads to new service authorizations or changes in support levels, those adjustments will be reflected in the updated ISP and WaMS.

   • Providers must ensure that any new supports or staffing requirements are implemented accordingly.

Q: Are the note clock-in and clock-out functions for Lauris only available with the scheduling module?

A: Yes, the clock-in and clock-out functions in Lauris are only available when using the scheduling module.

• Sunny Haven does not have the scheduling module, so staff must manually enter shift times when documenting notes.

• The scheduling module automates time tracking, ensuring accurate timestamps for service delivery, but this feature is not available at Sunny Haven.

• Since Sunny Haven does not use this module, staff must ensure accurate documentation of their shift times manually.

• You may, however, document two shifts per note :)