This week at the General Assembly session, legislators acted on key bills VHCA-VCAL is intensely involved in, including legislation to increase VDH’s authority to sanction nursing homes, increase nursing home licensure fees, and specify the requirements for electronic monitoring in resident rooms.

• Bills must be acted on in their originating chamber by next week, so committee votes were needed to determine if bills would advance to the full House or Senate for consideration.

Highlights of bills tracked by VHCA-VCAL.

Nursing Facility Legislation

Advanced medication aides: HB 2468 was reported with a unanimous vote by the House Health and Human Resources Committee and is headed to a floor vote.

• The bill, which will make technical updates to the legislation VHCA-VCAL supported in 2024 to establish a regulatory pathway to allow advanced medication aides to administer drugs to long term care residents in nursing facilities licensed by VDH, has been favorably reported by the health professions subcommittee.

Minimum staffing standards: HB 1753 was laid on the table by a 5-3 subcommittee vote this week, effectively killing the bill for the year.

• The bill would have directed 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. VHCA-VCAL opposed the bill.

Electronic monitoring in resident rooms: SB 821 passed the Senate this week on a unanimous vote of 39-0.

• As approved by the Senate, the bill text reflects VHCA-VCAL amendments to the original language providing more specificity on conditions required for use of electronic monitoring devices in private rooms.

Nursing home sanctions/civil penalties: The bills to establish additional state sanctions against nursing homes, HB 2253 and SB 1383, were approved by the respective House and Senate health committees in identical form. The house bill was then rereferred to the Appropriations Committee because of its fiscal impact.

• In their current form, the legislation will allow VDH to levy sanctions on nursing homes as part of their state licensure inspections when those inspections are conducted timely. The new sanctions would include licensure probation and civil monetary penalties not to exceed $500 per day, capped at $10,000 for a series of related incidents of non-compliance.
• The bills include language specifying VDH’s authority to impose sanctions as it relates to their CMS certification survey findings by limiting the VDH sanctions to Level 1 or 2 under CMS definitions.
• The bills direct VDH to begin developing regulation to implement the provisions of the bill on July 1, 2025 and states that the health commissioner shall not impose any of the new sanctions until the regulations are promulgated by the Board of Health.
• Although VHCA-VCAL does not support the bills, the revisions are an improvement over prior versions of the bills.

Nursing home licensure fee increase: HB 2255 was reported by the HHS Committee and referred to the Appropriations Committee. SB 1484 was reported by the Education and Health Committee and is headed for a floor vote.

• VHCA-VCAL worked with the bill patrons and VDH on language that is acceptable to all parties to give VDH 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. Licensure fees have not been updated since 1979.
• The bills include language specifying that the fees shall change no more frequently than annually and that fee changes shall only be initiated if the expenses allocated to the Hospital and Nursing Home Licensure and Inspection Program Fund plus any state or other funding sources appropriated for the hospital and nursing home licensure and inspection program, are shown to be more than 10 percent greater or less than the annual costs of operating the hospital and nursing home licensure and inspection program in a manner that ensures timely completion of inspections. This analysis shall be conducted separately for hospital fees and nursing home fees, and resulting fee changes shall be established such that fees are sufficient to cover unfunded expenses but not excessive.

Critical access hospital (CAHs) swing beds: HB 1552 and SB 1177 have passed their respective originating chambers on unanimous votes. The bills will modify how the CAHs would calculate the 10-swing-bed per day limit as well as direct VDH to collect data on how the swing beds are used and make that data publicly available. The bill has an expiration date of July 1, 2028.

Medical malpractice cap: VHCA-VCAL and other healthcare provider groups oppose SB 904 which would repeal the medical malpractice cap in actions that occur after July 1, 2025 against a patient age 10 or younger.

• The Senate Finance and Appropriations Committee, to which the bill was referred after being heard by the Courts of Justice Committee, was ultimately defeated on motion to “pass by indefinitely” on a 9-6 vote.

Professional liability insurance requirements for nursing homes and certified nursing facilities: SB 1152 was reported from the Education and Health Committee in an amended form with language that addresses some, but not all of VHCA-VCAL’s concerns with the bill. The association will continue to work with the bill patron, Sen. Mark Obenshain (R-Harrisonburg) to get the bill in a more favorable posture as it continues through the legislative process.

Certificate of public need: HB 2119 and SB 1203 would establish an expedited application and review process for COPN projects that will serve a medical desert.

• VHCA-VCAL opposes these bills, which have not yet been heard in subcommittee.

Assisted Living Legislation

Licensure of assisted living administrators: The House Rules committee tabled HB 1978, the bill that would have directed the Joint Commission on Health Care (JCHC) to conduct a study on licensure of assisted living facility (ALF) administrators and any barriers to licensure. The committee will send a letter to the JCHC requesting the study be completed. 

Provisional licenses for ALFs: HB 2597, which specifies that the denial of the issuance of a provisional license for an ALF, adult day center, or child welfare agency is not subject to appeal under the provisions allowing appeal for issuance or refusal of a license, the provisions allowing appeal of a notice of intent, or the Administrative Process Act was reported by the HHS Committee and is headed for a floor vote..

Appointment of receiver: SB 1153 would specify the circumstances under which the DSS Commissioner may petition the court for a receiver for an assisted living facility. The bill has been referred to the Rehabilitation and Social Services Committee.