CAMDIAN is an innovative, reliable, and respected Software in the market!

It is a Software created from a Provider's perspective that also addresses and assists with compliance of Virginia's Rules and Regulations.

I was extremely impressed with the attention to detail shown throughout the entire System and the built-in Compliance Protocols that will assist Providers with obtaining and maintaining more systemic Compliance within their Programs.

CAMDIAN is very user-friendly and appears to be the best of all worlds for: Providers, Regulatory Agencies, Managed Care Organizations, Members, their Support Systems and all other Partnering Service Providers involved in collaborated Service Delivery.

I strongly recommend the use of CAMDIAN by Providers and look forward to its growth as a Software Company!

Dr. Cleopatra Booker, Psy.D., Licensed Clinical Psychologist (Former Director of the Office of Licensing - DBHDS)

PAPER CHARTS

I have had the opportunity of using three methods of writing and submitting progress notes and reports during my time working as a QMHP. The first method was in the form of a word template. This method was the most basic method that I’ve used and it did not provide me with the ability to specify goals or objectives addressed during the session and it was very limited on the amount of information (detail) that could be added to the template. I have also used word templates to write quarterly reports and this method also proved limited in the amount of information that could be added as well. Another daunting task associated with the word documents, is that I had to purposefully go into the office on a weekly basis in order to sign each progress note that was submitted through email. Another con with this method was that I had to also separately email a time sheet, which on occasions caused billing issues.


ANOTHER SOFTWARE SYSTEM

The second method used was Lauris online. This method proved to be a little better than writing in word documents, however there are still some cons associated with it as well. Lauris does not allow the time sheet to automatically calculate, so emailing a time sheet is still necessary, sometimes causing billing issues once again. Lauris does however allow the objectives and goals to be added to each session submitted and it has an electronic signature feature that keeps me from having to manually write my name on each submitted progress note and/or report. Lauris does not however allow the Consumer to sign any of their documentation and progress notes as well as reports submitted in Lauris still have to be printed and added to a Consumer chart housed within the office.


CAMDIAN

Last but not least there is CAMDIAN. With CAMDIAN, my experience has been nothing short of amazing. This may sound cliche’, but it is the truth. Everything that needs to be documented with each and every Consumer, from reports (quarterlies, monthly reports, etc), assessment information, ISP’s, release of information, personal forms for each Consumer such as fall risk plans, safety plans, just to name a few, is all there at the click of a button separated into individual Consumer charts electronically. Everything that would ever need to be documented for a Consumer is located within CAMDIAN. CAMDIAN also holds me accountable and compliant with my reports as well as my own personnel chart documentation. I never have to guess when a report is due, for example, because it is all there located in the “Dashboard”. With CAMDIAN there is no need to submit a separate time sheet, because it is automatically calculated based on the dates and times that notes are submitted and is located in the timesheet tab in CAMDIAN. CAMDIAN provides a tab for Resources (such as Treatment Planners) and a place to review Supervision Notes (which comes in handy in order to provide each Consumer the best services possible based on the recommendations suggested by my Clinical Supervisor). CAMDIAN also has an Electronic Signature feature for the QMHP that is accessible at the end of each progress note and/or report. Each Consumer can also review and sign documents that requires a signature from a phone or a tablet and it is instantly stored automatically within CAMDIAN in the individual Consumer charts. I could go on and on about the great features that CAMDIAN has to offer. It offers the best technology that I have used to date, and it really needs to be the universal innovative software designed to transition providers away from paper based and mediocre filing systems.


Jamica Allen, QMHP-A & QMHP-C

PRO: (CAMDIAN)
Dashboard feature that indicates all my Personnel Chart information, due dates, and required documents in order to maintain my documents and stay in compliance.
CON: (Paper Process)
The need to go into the office to view and review Personnel Charts, misplaced documents, and learning multiple filing systems.

PRO: (CAMDIAN)
Dashboard feature has alerts that will remind months and days in advance of when each document is due for update. Dashboard feature that indicates all the Client Chart information including 1st, 2nd, 3rd, and 4th Quarterly Review, for instance, making the process seamless in knowing when documents and reports are required to remain in compliance. Also has a reminder/alert feature.
CON: (Paper Process)
Email reminders that often times get overlooked due to an influx of emails or confusion about dates and time.

PRO: (CAMDIAN)
Everything is one login away to access all pertinent documentation for Clients and QMHPs. Ability to use search features to quickly locate what you are looking for. User-Friendly and efficient. All Client Chart information is accessible and separated by Active vs. Discharged Clients.
CON: (Paper Process)
It was cumbersome to deal with large file folders with all the client's information and often times things were misplaced and difficult to locate due to it not being refiled in the appropriate place (multiple filing systems).

PRO: (CAMDIAN)
Supervision information located on the website for ease of access and the ability to revisit the supervision discussions.
CON: (Paper Process)
I was not able to view or review past supervision discussions for recommendations etc.

PRO: (CAMDIAN)
Counselor Timesheet that tracks Progress Notes & Contact Logs Timesheets. Timesheets are simple to deal with and it auto-populates the times when you upload the Progress Notes. Administration Timesheet that covers vital interactions between myself and the company such as New Hire Training & Orientation. One Reviewer for all my Progress Notes & Contact Logs/ Client Reports Timesheet with easy to see comments on individual PNs should there need to make revisions.
CON: (Paper Process)
Had to print of timesheet or go to the office to get timesheet then upload or go back to the office to return it. Often several Reviewers with differing ways to write PNs leading to inefficient Notes.

PRO: (CAMDIAN)
The regulations and requirements that need to be specified in each PN are easy to document by clicking and easy to add narrative if needed. Eliminating the human error of forgetting to add this or that. Such as Suicide/Risk Assessment which also keeps a daily reminder that these are important criteria to document well.
CON: (Paper Process)
Multiple new Word Documents to create and keep track of for each Client. Using up space/megabytes on my computer.

PRO: (CAMDIAN)
Electronic signature with ease of adding to documents. Clients and their Family/Legal Guardian can remotely review and sign documents that require their signature from their own device without having to come into the office or should there be scheduling conflicts. This decreases difficulties with obtaining signature and aids in remaining in compliance. Ability to print/download/email all Reports if necessary without the need to go to the office.
CON: (Paper Process)
Always needed to go to the office to sign all PNs and Reports after the Review process. Needing to make copies of already printed documents which often time the integrity of the document becomes compromised over time (dull, hardly able to see words etc).

PRO: (CAMDIAN)
Want to go on CAMDIAN to check on progress and ensure I am in compliance, this can be done at any time, 24/7. The autonomy to work round the clock or at your convenience.
CON: (Paper Process)
Reliance on other’s time and availability to manage your own Clientele Charts or Personnel Charts. Abide by office hours.

Some of my Favorite CAMDIAN Features:
•Resources tab located in CAMDIAN that enable me to utilize company approved resources such as Treatment Planners, etc.
•Pay Cycles & Pay Dates are transparent, easily see and calculate what you have done and check against pay for appropriate compensation.
•Added features such as personal To-Do Lists with alerts set to a specific date/time or Daily, Weekly Monthly, etc.
•Calendar features for Company and Clinical Supervisor for ease of syncing dates/times and reminders.

Danneca Mundle, QMHP-A & QMHP-C

Not only has using CAMDIAN been instrumental in allowing me to review all items in my Clients’ Charts, inclusive of Assessments, Intake Forms, Releases Of Information Forms, Progress Notes, etc., it keeps me informed of upcoming due dates for Reports, Requests for Personnel Chart Items, and so much more. I also have the privilege of keeping track of Pay Cycles and my projected income based on Progress Notes/Units submitted. CAMDIAN is user-friendly and increases Chart Compliance.

I would recommend CAMDIAN for any QMHP whose busy schedule could use some assistance increasing quality in service delivery.

Trebor Abner, QMHP-A & QMHP-Trainee

CAMDIAN is a dynamic tool used to make counseling documentation easy and handy. This tool assists in providing immediate access to counseling charts, creating needed documents within the counseling field, providing training tools at your fingertips and providing an awesome human resource approach.

When completing Assessments and Progress Notes, CAMDIAN allows one to work anywhere with ease. Everything that you possibly need is available in a Client’s Chart, and communication/information is updated daily. I would definitely encourage any Mental Health Agency to obtain CAMDIAN as opposed to the old “pen and paper” method. Other programs are out there, but I have not seen one that is as unique and all-inclusive as CAMDIAN.

Sasha Davenport, LPC-Resident

Finally a software exists SPECIFIC TO THE SERVICES & POPULATION WE SERVE!

CAMDIAN is the only software that comes prepackaged to align and be in compliance with the Rules & Regulations for IIH, MHSS & TDT; unlike some of the other software I have used, specifically Lauris & Sharenote.

As an Assessor and Clinical Supervisor, CAMDIAN has a number of great features that provide Leaders in the Mental Health Field with confidence, security, and support to carry out our Positional Duties to the fullest extent.

CAMDIAN has allowed me to:

1. Provide Remote Supervisions at least 1x a week, no matter where I am located (which has assisted my company with adherence to mandated Clinical Supervision for QMHPs).

2. Maintain Compliance with the creation and updating of mandated Client Reports, requiring all Service-Specific Client Reports are completed and approved by me as a Clinical Supervisor first before Progress Notes can be submitted; which increases accountability and compliance at all times.

I also love running COMPLIANCE REPORTS within CAMDIAN for my Team, whenever and wherever I am (via any and all Devices: Phone, Tablet and/or Computer). I no longer have to be in the office pulling Paper Charts to check for Client Reports, Progress Notes or Assessments and other Documentation. Thank You CAMDIAN!!!

Janiya Johnson, LPC & RPT

We at James Bentley Treatment Program (JBTP) selected CAMDIAN as our Electronic Health Record (EHR) system because it was a web-based program that was intuitive to the end user and tailored to our business as an Intensive In-Home and Mental Health Skill-Building Services provider.

The EHR system's architecture has built-in features unique to our licensed services within the mental health field that allows JBTP to leverage the EHR system to ensure companywide safety, compliance, and sustainability.

We have been using CAMDIAN since September of 2017 and our perception on the software was validated by our most recent License Inspection by DBHDS.

Theodore J. Pinnock, Program Director/Owner of James Bentley Treatment Program (JBTP)

For Medicaid individuals who are enrolled in the Commonwealth Coordinated Care Plus (CCC Plus) Program, DMAS is preparing to transition the Community Mental Health Rehabilitation Services (CMHRS) into the CCC Plus managed care organization (MCO) contract. A separate transition is planned for individuals who are enrolled in the Medallion 3.0 and FAMIS programs.

The CCC Plus program began its regional roll out on August 1, 2017. This regional roll out will continue until December 1, 2017. Additionally, all current CCC (dual demonstration) members and all Aged, Blind and Disabled individuals currently in the Medallion 3.0 program will move to CCC Plus on January 1, 2018. For more details about the CCC Plus Program, please visit the DMAS website at:

•http://www.dmas.virginia.gov/Content_pgs/mltss-home.aspx.

The CMHRS transition to CCC Plus will occur January 1, 2018. On this date, Magellan of Virginia, DMAS’s Behavioral Health Services Administrator (BHSA), will no longer administer CMHRS for CCC Plus-enrolled members. Instead, CMHRS will transition into the CCC Plus MCO contract, utilizing DMAS’ current CMHRS coverage criteria and program requirements. CMHRS coverage for Medallion 3.0 members will continue to be administered through Magellan of Virginia until the implementation of Medallion 4.0 at the end of 2018. Magellan of Virginia will continue to manage the CMHRS services for individuals who are enrolled in the DMAS fee-for-service program (including, but not limited to, the Governor’s Access Plan, individuals who are excluded from managed care, and individuals who are awaiting managed care enrollment).

Why are QMHPs required to register with the Board of Counseling?

During the 2017 General Assembly House Bill 2095 was introduced and passed authorizing the Board of Counseling to register QMHPs and Peer Recovery Specialists. The registration of QMHPs and Peer Recovery Specialists through the Board of Counseling provides accountability and transparency.

Please see the following link for Frequently Asked Questions for Applicants:

•https://www.dhp.virginia.gov/counseling/QHMPapplicants.htm

Background

Since the Settlement Agreement between the Commonwealth and the United States Department of Justice (DOJ) was signed, a number of significant changes in the system have occurred. Most recently, in 2017 the definition of the term “developmental disability” was expanded to include "intellectual disability" in the Code of Virginia. In 2016, the Medicaid Waivers underwent needed changes. Also since the Settlement Agreement was signed, DOJ and the court’s appointed Settlement Agreement Independent Reviewer have commented on the need for changes to the Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services (“Licensing Regulations”) in order to comply with the Settlement Agreement.

During the most recent open status hearing regarding implementation of the Settlement Agreement in the United States District Court for the Eastern District of Virginia on December 19, 2017, the Court specifically asked about the status of changes to the Licensing Regulations.

This followed the Settlement Agreement Independent Reviewer’s 11th Report to the Court, dated December 13, 2017, which stated the following regarding the Licensing Regulations:

The DBHDS Licensing Regulations have long been, and continue to be, an obstacle to substantial progress toward compliance with many provisions of the Settlement Agreement... Its licensing regulations continue, however, to restrict the Commonwealth from requiring submission of information or attendance at trainings related to developing the required quality and risk management processes. Its most recent draft revisions to the Licensing Regulations, dated July 17, 2017, [correction: dated July 7, 2017] show an improved alignment with some provisions of the Agreement, including a clarification of expectations around root cause analysis, risk triggers and thresholds, risk management programs and quality improvement programs. It is the Independent Reviewer’s considered opinion that, without revisions to its Licensing Rules and Regulations, the Commonwealth will continue to be unable to make substantial progress toward implementing the required quality and risk management system…

Therefore, notice is hereby given of the following draft amendments to an existing regulation relating to licensed providers. [Note: Amendments in current regulatory actions (ex. QMHP's) are not reflected here; only current language is used.]

The draft amendments are posted on the DBHDS website for public comment through March 16, 2018.

Virginia Medicaid has successfully transitioned Community Mental Health Rehabilitation Services (CMHRS) and Behavioral Therapy into the CCC Plus managed care organizations (MCOs). The Medallion 4.0 Program will begin regional rollouts of CMHRS on August 1, 2018, through December 1, 2018. Using the Integrated Care Model, this benefit will impact over 750,000 Medicaid members including children enrolled in Medallion 4.0 and Family Access to Medical Insurance Security (FAMIS) Plan.

The purpose of this memo is to provide information about this transition and other updates associated with mental health services as they relate to Medallion 4.0. For more details about the Medallion 4.0 Program, please visit the DMAS website at:

•http://www.dmas.virginia.gov/Content_pgs/medallion_4-home.aspx.

Questions regarding Medallion 4.0 can be e-mailed to M4.0Inquiry@dmas.virginia.gov. Questions regarding the CMHRS transition into Medallion 4.0 can be e-mailed to M4.0 CMHRS@dmas.virginia.gov.

The CMHRS and Behavioral Therapy transition to Medallion 4.0 will occur in accordance with the regional implementation of the program, beginning August 1, 2018. On each effective date, Magellan of Virginia, DMAS’s Behavioral Health Services Administrator (BHSA) will no longer administer CMHRS and Behavioral Therapy for Medallion 4.0 enrolled members. Instead, CMHRS and Behavioral Therapy will transition into the Medallion 4.0 MCO contract, utilizing DMAS’ current CMHRS coverage criteria and program requirements. Once CMHRS goes live in a region, providers should be billing the correct managed care plan for services. Magellan of Virginia will continue to manage the CMHRS and Behavioral Therapy services for individuals who are enrolled in the DMAS fee-for-service program (including, but not limited to, the Governor’s Access Plan, individuals who are excluded from managed care, and individuals who are awaiting managed care enrollment).

•Aetna Better Health of Virginia
•Anthem HealthKeepers Plus
•Magellan Complete Care of Virginia
•Optima Health Plan
•UnitedHealthcare
•Virginia Premier Health Plan

The Common Core Formulary includes all the “preferred” drugs on DMAS’ Preferred Drug List (PDL). The DMAS PDL currently includes 90 drug classes; therefore, the health plans’ formularies will be more extensive. Medallion 4.0 health plans are required at a minimum to cover all “preferred” drugs on Virginia Medicaid’s PDL. The health plans can add drugs to the Common Core Formulary but cannot remove drugs or place additional restrictions (such as prior authorizations, step therapies, and quantity limits) for drugs included on the Common Core Formulary. For drugs not included on the DMAS PDL (e.g., oral oncology drugs, HIV drugs, etc.), each health plan will publish a formulary with the plan’s covered drugs.

Providers can access the DMAS PDL at https://www.virginiamedicaidpharmacyservices.com. Please note that the Common Core Formulary does not apply to Medicaid members that receive Medicare benefits and full Medicaid benefits (dual eligible). Drug benefits for dual eligible members are defined by the member’s Medicare Part D plan and not DMAS.

DMAS has established a mailbox for providers to send their questions regarding Common Core Formulary drug coverage issues for members enrolled in Medallion 4.0 and CCC Plus. Issues related to drug denials for preferred drugs on the DMAS PDL should be sent to CommonCoreFormulary@dmas.virginia.gov.

The 2018 Appropriations Act, Item 303(V)(2), states that DMAS and the appealing provider “may jointly agree to stay the deadline for the informal appeal decision or for the formal appeal recommended decision of the Hearing Officer for a period of up to sixty (60) days to facilitate settlement discussions. If the parties reach a resolution as reflected by a written settlement agreement within the sixty-day period, then the stay shall be extended for such additional time as may be necessary for review and approval of the settlement agreement in accordance with § 2.2-514 of the Code of Virginia.”

As authorized by the General Assembly, DMAS will amend the regulations governing the provider appeal process to: reflect that settlement proposals may be tendered during the appeal process; describe the framework for submission of the settlement proposal; explain that the stay only affects the informal appeal decision deadline or the deadline for the recommended decision of the Hearing Officer in a formal appeal (depending on the appeal stage); and state that approval of the settlement is subject to the review of the Office of the Attorney General (and Governor, if applicable).

Pending amendment of the appeal regulations, the Department will use the following general process for the receipt of settlement proposals during the appeals process. Settlement proposals are to be submitted to the Director of the DMAS Appeals Division, who will then refer the proposal to one of the DMAS Appeal Representatives authorized by the Office of the Attorney General (“OAG”) to represent DMAS in administrative proceedings. A settlement proposal should be submitted as soon as possible after the appeal has been filed. Once the proposal is received, the Appeal Representative will contact the provider to discuss the terms of the proposed settlement. If both parties jointly agree to the stay pending negotiations, the deadline for the informal appeal decision or the formal appeal Hearing Officer’s recommended decision will be stayed for up to 60 days to facilitate settlement discussions, with the 60-day period commencing on the date that both parties agree to the stay. The Appeal Representative will notify the Appeals Division Director that a stay has been initiated and when the stay concludes.

The Appeal Representative will communicate the terms of the proposed settlement to the DMAS Director, who will make a determination whether to reject the offer, propose a counteroffer, or request approval of the settlement (as proposed or as modified during the negotiations) from the OAG (and Governor, if applicable). If the Director of DMAS authorizes a settlement proposal to be forwarded to the OAG (and Governor, if applicable) for approval, then the stay will continue beyond the 60-day limit and until that review process is completed.

A stay might conclude for reasons including, but not limited to:

(i) the parties are unable to reach an agreement on proposed settlement terms during the 60-day stay;

(ii) a party no longer agrees to the 60-day stay and terminates settlement discussions; or

(iii) the settlement agreement is not approved.

If the stay concludes, then the time period to issue the informal appeal decision or recommended decision resumes on the day the stay is removed (e.g. if a stay is jointly agreed to on the 10th day during an informal appeal, but the settlement agreement is not approved, then the informal appeals agent will have 170 days from the date that the stay is removed to issue the decision).

The purpose of this memorandum is to detail changes related to Community Mental Health Rehabilitative Services (CMHRS). The Department of Medical Assistance Services (DMAS) will be updating the CMHRS provider manual with the following changes: 1) Implementing the Comprehensive Needs Assessment (effective January 1, 2019); 2) Clarifying the recommendation for a psychiatric evaluation in Crisis Stabilization services; and 3) Removing the At Risk of Physical Injury form (P502) requirement in Therapeutic Day Treatment (TDT) and Intensive In- Home (IIH) Services.

Comprehensive Needs Assessment

Effective January 1, 2019, DMAS is implementing the Comprehensive Needs Assessment in CMHRS to allow for a single assessment to be used when recommending one or more CMHRS services provided by the same Department of Behavioral Health and Developmental Services (DBHDS) licensed agency. Allowing one Comprehensive Needs Assessment in place of multiple Service-Specific Provider Intakes (SSPIs) is intended to support member access to care and efficiency by reducing the time and administrative burden on providers and members they serve. Licensed agencies include providers with a specific DBHDS license to provide one or more of the following services: IIH, psychosocial rehabilitation (PSR), TDT, day treatment/partial hospitalization, mental health skill building (MHSS), intensive community treatment (ICT), crisis stabilization, crisis intervention and mental health case management. SSPIs and Psychiatric Diagnostic Interviews completed prior to January 1, 2019 will not apply to the Comprehensive Needs Assessment criteria. Effective January 1, 2019, a Comprehensive Needs Assessment that follows the guidelines in this memorandum is required for new requests for CMHRS services and CMHRS services previously recommended by a SSPI that is outdated (greater than 12 months old).

The Comprehensive Needs Assessment must document the medical necessity for each recommended CMHRS service including mental health case management. The Comprehensive Needs Assessment for CMHRS shall be conducted by a Licensed Mental Health Professional (LMHP), LMHP-Resident (LMHP-R), LMHP-Supervisee (LMHP-S) or LMHP Resident in Psychology (LMHP-RP). The Comprehensive Needs Assessment requires a face-to-face assessment by a LMHP, LMHP-R, LMHP-S or LMHP-RP to gather information about the individual’s mental health status and symptoms from the individual and parent, guardian or other family members as appropriate. The Comprehensive Needs Assessment must include the same 15 elements previously required by the SSPI and as described in Chapter 4 of the CMHRS provider manual. The Comprehensive Needs Assessment is required prior to the development of the Individual Service Plan (ISP) for each service and is used as the basis for the ISP for the entire duration of services.

A DBHDS licensed agency can use a Psychiatric Diagnostic Interview (90791, 90792) completed by a LMHP, LMHP-R, LMHP-RP or LMHP-S employed or contracted by the agency as the Comprehensive Needs Assessment as long as all 15 required elements for the Comprehensive Needs Assessment are included. If not all 15 required elements are included in the Psychiatric Diagnostic Interview, a LMHP, LMHP-R, LMHP-RP or LMHP-S may create an addendum to address any of the missing elements required for a Comprehensive Needs Assessment to recommend CMHRS services. Providers shall not bill for this addendum to the Psychiatric Diagnostic Interview. All providers shall ensure they meet the DMAS requirements as well as the DBHDS licensing requirements for completion of assessments.

To read more of this Medicaid Memo, please visit:
https://www.ecm.virginiamedicaid.dmas.virginia.gov/WorkplaceXT/getContent?impersonate=true&id={8A1ED0ED-281A-461E-A414-C389E2CE050F}&vsId={A0833267-0000-C811-87E5-70706AE3D3E7}&objectType=document&objectStoreName=VAPRODOS1

12VAC35-105-620. Monitoring and evaluating service quality.

The provider shall develop and implement a quality improvement program sufficient to identify, monitor, and evaluate clinical and service quality and effectiveness on a systematic and ongoing basis. The program shall: (i) include a quality improvement plan that is reviewed and updated at least annually; (ii) establish measurable goals and objectives; (iii) include and report on statewide performance measures, if applicable, as required by DBHDS; (iv) utilize standard quality improvement tools, including root cause analysis; (v) implement a process to regularly evaluate progress toward meeting established goals and objectives; and (vi) incorporate any corrective action plans pursuant to 12VAC35-105-170. Input from individuals receiving services and their authorized representatives, if applicable, about services used and satisfaction level of participation in the direction of service planning shall be part of the provider's quality improvement plan. The provider shall implement improvements, when indicated.

To read more of this Guidance Document, please visit:
http://townhall.virginia.gov/L/GetFile.cfm?File=GuidanceDocs%5C720%5CGDoc_DBHDS_6414_v1.pdf

12VAC35-105-20. Definitions.

“Serious incident" means any event or circumstance that causes or could cause harm to the health, safety, or well-being of an individual. The term serious incident includes death and serious injury. "Level I serious incident" means a serious incident that occurs or originates during the provision of a service or on the premises of the provider and does not meet the definition of a Level II or Level III serious incident. "Level I serious incidents" do not result in significant harm to individuals, but may include events that result in minor injuries that do not require medical attention, or events that have the potential to cause serious injury, even when no injury occurs.

"Level II serious incident" means a serious incident that occurs or originates during the provision of a service or on the premises of the provider that results in a significant harm or threat to the health and safety of an individual that does not meet the definition of a Level III serious incident. "Level II serious incident" also includes a significant harm or threat to the health or safety of others caused by an individual.

To read more of this Guidance Document, please visit:
http://townhall.virginia.gov/L/GetFile.cfm?File=GuidanceDocs%5C720%5CGDoc_DBHDS_6415_v1.pdf