With respect to:

12VAC35-105-20 Definitions, Missing Person.  It is not clear how this broad definition might apply to any number of environments, including Day Support, Community Engagement, Residential, etc.  It is arguable that "missing" is quite different from an individual being "at any time not physically present when and where he is expected or is supposed to be."  By this definition, "missing" could refer to a person being in the restroom when expected in the kitchen.  Clarification needed.

Definitions, Serious incident.  The proposed system of 3 levels implies a three-tiered system of citations, although this is not expressed.  Examples of Level I incidents should be provided, although none are.  Level II incidents include the afore-mentioned "Missing" category, which requires definition.  Level III incidents are, by definition given, incidents which may have occurred outside of service hours and off provider premises: guidance is needed as to which entity bears the burden of recording such an incident.  Additionally, will these proposed levels be in addition to data already entered into the CHRIS system?

12VAC35-105-160.E, Root Cause Analysis.  This proposed regulation is burdensome and apparently duplicative of the data currently entered into CHRIS.  Additionally, Section 160.C requires the provider to "collect, maintain, and review at least quarterly all Level I serious incidents" without apparent regard to successful corrective action.  Under Section 160.D.2 instructions for Level II and III incidents include listing "the consequences or risk of harm that resulted..."  Risk of harm would be speculative and could be physical or emotional; additionally, Level III incidents are those incidents which may have occurred outside of the provider's service, making such speculation potentially harmful or libelous. Guidance needed.