We would like to express our concern regarding this portion of the proposed regulation for multiple reasons:

• Providers are required to develop and maintain a Quality Improvement Program.  The core concept of quality improvement is that organizations utilize a systematic approach to identify deficiencies and implement plans addressed towards continuous improvement in reducing/eliminating the deficiency.  Even the best Quality Improvement Program cannot guarantee that a deficiency will never occur again.
• A recurrence of a deficiency versus a systemic issue within a program are two different issues and should not be treated the same.  A single recurrence of a deficiency does not represent the program as a whole. 
• As licensed DBHDS providers, we serve individuals with unique and often challenging needs.  Most providers and their staff genuinely perform this work because they care and are often doing so with limited resources due to reimbursement rates and their ability to attract and retain quality staff.  Maintaining a positive and collaborative relationship between the provider and licensing specialist is in the best interest of those we serve.  We are concerned, based on the language in the proposed regulation, that this process could be perceived as adversarial and punitive and result in unnecessary adverse consequences for the provider.