New laws related to eligibility for employment in nursing centers or assisted living facilities, vaccine administration, TB testing, family councils, employment in assisted living, penalties for inspection issues, adult exploitation, and other issues affecting long term care providers take effect on July 1.  With the start of the Commonwealth’s new fiscal year (FY) on July 1, new Medicaid reimbursement rates for dates of service on or after July 1 will begin.

Take a look at the key changes in state statutes affecting post-acute and long term care providers as passed by the General Assembly earlier this year.

Medicaid Rates

To access the updated Medicaid rates, visit the Nursing Facilities webpage of the DMAS website and scroll to the section on SFY 2018 Price-Based Rates.

Bills VHCA-VCAL supported

Adult Vaccine and PPD Testing Administration by LPNs – HB 2301 will allow licensed practical nurses (LPNs) to administer vaccines to adults and conduct tuberculosis (PPD) testing without the immediate and direct supervision of a registered nurse. At the request of multiple nursing center and assisted living community members, VHCA-VCAL partnered with other provider organizations to pursue a legislative fix to address the requirement that an RN be immediately physically present when an LPN administers a vaccine or performs PPD testing.  VHCA-VCAL worked with affected stakeholder groups to secure their support for this change.  It will streamline how nursing centers and assisted living facilities provide care while maintaining safeguards for residents.  

Advance Medical Directives – HB 1747 and SB 1242 broaden who can assist individuals with completing advance medical directives.

Durable Do Not Resuscitate Orders – HB 2153 establishes reciprocity for Durable Do Not Resuscitate (DDNR) orders or other orders regarding life-sustaining treatment executed in accordance with the laws of another state.

Medicaid Long Term Care Reforms – HB 2304 included a series of reforms to the Medicaid program.  Among them are provisions to improve the reliability of Medicaid screening using the Uniform Assessment Instrument (UAI) for LTSS and language directing DMAS to work with stakeholders to assess whether hospital screening teams are making appropriate recommendations regarding placement in institutional care or home and community-based care.  The budget included funding for these initiatives as well.

Other bills

Frequency of Department of Health Inspections – HB 2300 would prohibit the Department of Health from inspecting a licensee (i.e., nursing centers, restaurants, campgrounds, etc), before every other licensee in that category have also been inspected.  Language was added to the bill at VHCA-VCAL’s recommendation to allow for exceptions when required by CMS, including special focus surveys.  The Department of Health, given their staffing level and geographic locations, have interpreted the legislation as potentially de-coupling the annual CMS certification survey from the state licensure survey, which must occur every other year.  VHCA-VCAL will monitor the situation and potentially pursue a legislative tweak should this law result in member inconvenience.

Nursing Facility Family Councils – HB 2072 was amended to include language specifying that “No family member of a resident or other resident representative shall be restricted from participating in meetings in the facility with the families or resident representatives of other residents in the facility.”  This amendment conforms the bill to existing federal regulations governing family councils.  VHCA-VCAL appreciates that Del. Vivian Watts (D-Annandale), the bill patron, was willing to amend her bill to conform it to the Requirements of Participation regulations.

Criminal History Record Checks – Barrier Crimes – SB 1008 clarifies the individual crimes that constitute a barrier for individuals seeking employment at nursing facilities, assisted living facilities and other providers; and applicants for licensure, registration, or approval as assisted living facilities. The bill would also add certain offenses to the list of barrier crimes.  View the list here.

Eligibility for Employment in Assisted Living – SB 1434 clarifies that individuals who were convicted of non-abuse misdemeanors would be eligible to work in assisted living facilities (ALF) if five years have elapsed following the conviction.

Increase in the Cap on Civil Penalties for ALFs – HB 1919 and SB 1191 would increase the aggregate amount of civil penalties that the Commissioner of the Department of Social Services may assess against an ALF for noncompliance with the terms of its license from $10,000 per 24-month period to $10,000 per 12-month period. 

Study of Assisted Living Staffing – A resolution, SJ 266, calling for a report of staffing ratio requirements in assisted living communities and special care units was referred to the Joint Commission on Health Care to study the issue. 

Statistical Reporting of Alleged Incidences of Adult Abuse – HB 2061 would have required DSS to keep records and report on cases of alleged suspected adult abuse, neglect, or exploitation and the disposition of such reports.  The bill was tabled in committee.  

Suspected Financial Exploitation – HB 1922 and SB 1462 clarify that all cases involving suspected financial exploitation of an adult be immediately referred by Adult Protective Services (APS) to a local law enforcement agency for investigation.  Previously the value had to be over $50,000 for the mandated referral, but there will now be no minimum financial requirement.  The bill also requires that local law enforcement agencies provide a preferred point of contact for those referrals.

Updated Definition of “Adult Exploitation” – HB 1945 updates the definition of “adult exploitation” for the purposes of social services law to include “the unauthorized, improper, or fraudulent use of an adult,” which applies to anyone over 60 and anyone from 18 to 59 years of age if incapacitated.  It also addresses various forms of financial exploitation and further clarifies what is considered undue influence and coercion.