Minimum staffing legislation for nursing facilities has been introduced by Chairman of the Health, Welfare and Institutions Committee Bobby Orrock (R-Caroline).

• The legislation, HB 1446, is aligned with and builds on the Medicaid Value-Based Purchasing (VPB) Program implemented earlier this year.
• VHCA-VCAL supports the goals set out in the VBP Program for staffing and other clinical measures.

VHCA-VCAL has long advocated for measures that would allow nursing facilities to hire additional staff.

• This bill, along with the VBP Program and increased Medicaid payments will work to achieve this goal as it couples a staffing requirement with increased and on-going funding.

What the legislation would do: The legislation will require each certified nursing facility to provide at least 3.08 hours of case mix-adjusted total nurse staffing hours per resident per day on average as determined annually by DMAS for use in the Virginia Medicaid Nursing Facility VBP Program.

• Any facility that attains under the VBP Program at any level is compliant with the staffing standard.
• Enforcement of the new standard would be tied to the VPB measurement period, reviewed annually, and does not require additional data reporting.
• Facilities achieving “Improvement” under VBP parameters avoid any sanction beyond an annual corrective action plan.
• Monetary sanctions are only imposed after repeated noncompliance and non-improvement under corrective action plans (three consecutive years).
• Licensure-related sanctions are only imposed after repeated noncompliance and non-improvement under corrective action plans (four consecutive years).
• Implementation and enforcement are predicated on funding of these costs
• • Reflected in the base Medicaid rates and
  • Fully funded (including full annual inflation) and
  • The VBP program (indexed for inflation beginning with SFY 2025) is at least maintained
• If a federal staffing ratio is established, this staffing standard is revoked
• The legislation includes a delayed enactment to July 1, 2025, the start of the 2026 state fiscal year.

What’s next: The General Assembly session begins January 11, 2023.

• VHCA-VCAL will be meeting with legislators to ask for their support of the legislation as introduced.
• Look for opportunities to get engaged in our grassroots work to support the legislation.