The progressive actions for citations in violation of 12VAC35-105-160D.2 are too punitive and do not leave room for human error.

Enforcing a consequence for not complying with standards is reasonable however threatening to end an essential service to the community because a report was late 4 times in 2 years is unreasonable.  It is prioritizing an arbitrary time-sensitive reporting requirement over the quality service provision.  As other commenters have stated, DBHDS does not have personnel reviewing reports on weekends and holidays; why is the report required in a 24-hr time frame?  A report submitted to CHRIS during those times would be subject to missing information from medical personnel or missing test results.  The report would possibly be submitted prior to an internal investigation which may resolve the initial concern.  It would more reasonable and efficient for providers have 2 business days to submit accurate information and/or perform an investigation.

How is it justifiable to give a small provider the same number of "strikes" as a larger provider?  How is it fair that both have the same number of strikes when one of them has a much higher risk of incident simply because they support more people?

If enforced as written, this guidance could have a negative effect on provider availability for individuals with disabilities.  It is already very difficult to recruit and train quality staff as a provider in a field that is already unable to pay the work force at a competitive rate.   Add to this strain a flurry of rather seemingly insignificant corrective actions for example, actions for “late reporting” which, if more than four errors in the course of two years the provider’s license is threatened for suspension. It is prioritizing an arbitrary time-sensitive reporting requirement over the quality service provision.

The department should position itself to support (literally prop up and sustain) providers to provide care to individuals with disabilities.  The department should be a resource by looking for ways to improve the quality of care we provide.  How do we increase the workforce in this field?  We have all but closed the institutions but made unachievable goals for the providers now caring for this population.  How are more punitive, corrective actions for late reporting to an agency which is closed after 5:00pm, on weekends, and on holidays going to improve the quality of care? 

And, what of the concern that late reporting could result in corrective action and thereby result in not reporting?  Failing to report an incident is far different and far more concerning than late-reporting.  The first indicates either a deliberate attempt to hide an incident or (much more likely) a general and possibly systemic misunderstanding of what constitutes an incident. The second indicates that the reporting was unintentionally overlooked, but something was in place to make sure it got reported anyway, regardless of consequences from the department for being late.   According to this guidance document it's a guaranteed threat to their license if reported late.

Please reconsider this guidance document in its entirety.  It's hard enough to find, hire and train qualified professionals willing to perform all the different services necessary to support our communities living with mental health disorders, substance use disorders and developmental disabilities. 

It's going to be even harder when they have to do that work under the constant threat of license revocation for having the audacity to support a person through an incident but forgetting to tell the department in time.