New laws passed during the 2020 General Assembly session take effect July 1. Numerous measures like the bills related to the Long Term Services and Supports (LTSS) screening process, individual service plans, audio visual recording of assisted living residents, direct agencies like DMAS or DSS to make regulatory changes. In addition, facilities should evaluate the impact of a law regarding guardianship proceedings.  

Guardianship Bill

SB 1072 addresses guardianship issues raised in a series in the Richmond Times Dispatch. As part of the legislation, courts may, for good cause shown, order that the reasonable costs for a guardian or conservator be paid by the petitioner during the time the respondent is under the care of the medical care facility. 

Read this article by Ronald Ray with Forrester & Ray outlining the changes and considerations to be weighed: Nursing Facilities May Now Be Ordered to Pay the Ongoing Fees Of A Court-Appointed Guardian Or Conservator

Please note this article is informational only and is not intended to be legal advice for any specific factual scenario. Please contact your own attorney with specific legal questions.

Nursing Facility Bills 

LTSS Screening –HB 902/SB 902 will improve the LTSS Screening process for patients receiving nursing facility care. It provides an efficient and responsible approach to screening patients who have been discharged from the hospital to receive short-stay skilled rehabilitation in a nursing facility should they subsequently need access to Medicaid long term services and supports. VHCA-VCAL worked closely with DMAS and a broad stakeholder group on this legislation.

This legislation removes the requirement for the hospital screening teams to do a Medicaid assessment for individuals discharging from the hospital to a nursing facility for a non-Medicaid, short-stay rehabilitation admission. Under the bills, a patient would instead only be screened to determine if he or she needs Medicaid coverage of long term services and supports at a later point if his or her condition has changed and may warrant such services. This change will make the screening process more efficient and effective for this specific circumstance. The legislation does not affect the need for hospital screening when the patient is discharging directly to Medicaid long term care services, nor does it affect community screenings at all.

DMAS is in the process of developing regulations and amend the State Plan with CMS to effectuate this change; the actual effective date of the change is not yet certain due to this process. 

Staffing Ratios – SB 397, which as introduced included language about staffing ratios, training, and background checks, was rewritten directing the VDH to establish a work group that includes VHCA-VCAL and other stakeholders to look at increasing nursing facility workforce availability. VDH is in the process of establishing the work group. 

Possession of cannabidiol or THC-A in nursing homes or assisted living facilities – SB 185 clarifies the role nursing facility and assisted living facility staff can play in administering CBD or THC-A to residents or patients who have a valid, written certification for these medications.  

Assisted Living Bills 

VHCA-VCAL will be monitoring the activities of the Virginia Board of Social Services as it has been directed to act on the following items: 

Assisted Living Individualized Service Plans (ISPs) – SB 686 requires Board of Social Services to amend its regulations to require only documentation in individual service plans (ISPs) of “significant change” of condition, not any change. Under current regulations, if any aspect of the resident’s condition changes, the resident or his/her responsible party and facility staff need to sign to affirm those changes to the ISP. VHCA-VCAL and other assisted living stakeholders supported the bill. 

Regulations to allow audio-visual recording of ALF residents – SB 355 directs the Board of Social Services to promulgate regulations by July 1, 2021, governing audio-visual recording of residents in ALFs, and requires DSS to convene a workgroup of stakeholders to make recommendations on such regulations by December 1, 2020. 

Employment Bills 

Minimum Wage – The General Assembly passed a minimum wage increase (HB 395 and SB 7). The compromise legislation will increase the hourly wage as follows:

• • May 1, 2021 (previously January 1), 2021: $9.50 / hour
  • January 1, 2022: $11.00 / hour
  • January 1, 2023: $12.00 / hour

The bill also includes language directing the Virginia’s Department of Housing and Community Development, Economic Development Partnership Authority and Employment Commission to conduct a study in 2022 about the effects of the minimum wage and also consider whether a regional approach would be useful and how it would be done.

If wages are to rise further, legislators would have to pass a measure to reenact the legislation for increases to $13.50 in 2024 and $15.00 in 2025. If the General Assembly opts to keep the minimum wage at $12.00 per hour, it would be linked to the CPI-U for 2024 forward. If wages are increased to $15.00, the indexing will begin after 2025.

As we have stated previously, VHCA-VCAL will be discussing with DMAS how the added wage costs will be captured in the rate setting process; the fiscal year 2021 rates have not been adjusted for the six months of the increased wage at $9.50 per hour. 

Workers’ compensation for repetitive motion injuries – VHCA-VCAL opposed HB 617, which would have added repetitive motion injuries to the list of compensable injuries covered by workers’ compensation. The bill has been rewritten as a Section 1 bill directing the Workers’ Compensation Commission to engage a national research firm to examine the implications of covering repetitive motion injuries.