What’s happening: January 8, marked the opening day of the 2025 Virginia General Assembly Session. However, the General Assembly met only briefly to pass procedural measures and then recessed with plans to reconvene on Monday, January 13, due to the water issues in Richmond. 

We are expecting to play defense on a number of issues this session. Additionally, we will be asking key legislators to champion budget amendments to make continued investments in the Medicaid program.

Here’s a brief rundown of major issues that we will be tackling this session. We are working diligently to meet with legislators, draft amendments, and develop our positions on these and other bills. Legislators have until January 13 to introduce legislation, so additional bills of interest to long term care may still be introduced. 

• Electronic monitoring in nursing facility resident rooms: Sen. Christie Craig (R-Chesapeake) has reintroduced legislation, SB 821, to change the regulations for electronic monitoring in nursing homes. Presently, regulations give nursing homes discretion to specify whether monitoring is allowed or not, and if allowed, outlines requirements that must be met.
  • Under the proposed bill, residents would be given the right to place electronic monitoring devices in their rooms under specific conditions, including being in a room with no roommate. We are working closely with Sen. Craig to explain members’ concerns with how these requirements would be operationalized by facilities. If you have specific comments on this legislation, please let us know immediately.

• Nursing home licensure fee increase: VDH is seeking authority to increase the licensure fees paid by nursing homes to cover the cost of operating the licensure and inspection program to ensure timely completion of inspections as required in the Code of Virginia. The bill, HB 2255 has been introduced by Del. Otto Wachsmann (R-Sussex)
  • The agency proposed increasing the licensure fee in 2019. VHCA-VCAL supported the increase, but legislation was not passed. While we are waiting for details of the fee schedule from VDH, we support the fee increase in concept and efforts to improve staffing levels at the Office of Licensure and Certification.

• Nursing home sanctions: VDH is also seeking to increase its authority to impose sanctions/civil monetary penalties (CMPs) against nursing homes in certain situations where CMPs are not imposed by CMS. At present HB 2253 has been filed to this effect, and we anticipate a version of the bill will also be filed in the Senate.
  • VHCA-VCAL strongly opposes this unnecessary legislation since VDH already evaluates nursing homes using a robust system of citations and federal CMPs under the Requirements of Participation.

• Minimum staffing standards: Del. Vivian Watts (D-Fairfax), a longtime advocate for nursing home staffing standards, introduced HB 1753 directing VDH to develop regulations to implement the CMS final rule for minimum staffing standards for nursing facilities and repeal the Virginia staffing standard passed in 2023, which is slated to take effect on July 1, 2025.
  • VHCA-VCAL opposes this bill.

• Medical malpractice cap: Sen. Bill Stanley reintroduced his legislation, SB 904, to repeal the medical malpractice cap in actions that occur after July 1, 2025 against a patient age 10 or younger.
  • VHCA-VCAL, along with the Medical Society of Virginia and the Virginia Hospital and Healthcare Association, engaged Milliman to analyze the impact of repealing the cap and will be part of a coalition of providers opposing this legislation.
  • We anticipate that other legislation related to malpractice and professional liability insurance requirements will also be introduced.

• Advanced registered medication aides: This legislation, HB 2468, makes technical updates to the legislation we supported in 2024 to establish a regulatory pathway to allow medication aides to administer drugs to long term care residents in nursing facilities licensed by VDH.
  • Passage of this bill is a legislative priority for VHCA-VCAL to expand the clinical workforce.

Medicaid and budget amendments: VHCA-VCAL is also pursuing four budget amendments with the support of the leaders of the respective Health and Human Resources subcommittees of the budget committees, Del. Mark Sickles and Sen. Creig Deeds.

• Staffing mandate funding: This amendment, offered in both the House and Senate, will address the requirement that the Medicaid base rates reflect the cost of increased staffing in order for the Virginia mandate to be enforced. The amendment is intended to provide better cost coverage for more facilities.

• VBP Prospective Payment: These House and Senate budget amendments are intended to modify the Medicaid Value-Based Payment program to move the payment from an annual retrospective lump sum payment arrangement to an annual prospective rate add-on arrangement to eliminate the current 7-10 month lag facilities experience before receiving their VBP payments.

• Add Guardrail to PDPM Conversion to NF Methodology: These House and Senate amendments are meant to limit potential provider-specific rate reductions as Virginia transitions from its RUGs-based payment method to a Patient Drive Payment Model (PDPM) methodology.
  

• Behavioral Health Pilot Sites: This House amendment would provide funding for the establishment of additional pilot sites for alternative placements in nursing facilities for Medicaid-eligible individuals who would otherwise need services in state hospitals. The proposed language calls for a Medicaid rate add-on for patients served under the pilot program and infrastructure startup funding for the pilot sites. Del. Sickels requested that the association explore ways to support geriatric patients with behavioral health needs.

We will provide an update on the legislation and session activities during the Legislative Conference on January 29-30 at the Omni Richmond.