What’s happening: VDH is accepting comments on the proposed Nursing Home Administrative Sanctions Guidance Document through September 9. The guidance explains how the Office of Licensure and Certification (OLC) and the State Health Commissioner may evaluate and consider administrative sanctions under existing authority.

• Of note, the guidance document is not a regulation and does not create new regulatory requirements or enforcement authorities.

VHCA-VCAL is reviewing the proposed guidance and preparing comments.

• Members are encouraged to review the document and share questions or suggested revisions with April Payne for consideration in our collective response during the public comment period.

What is the purpose of the guidance? According to VDH, the guidance is designed to provide greater transparency regarding how administrative sanctions may be evaluated and applied under existing authority in 12VAC5-371-90 and related provisions of the Code of Virginia.

The document states that it:

• does not create new requirements.
• does not establish mandatory enforcement levels.
• does not limit the authority of VDH or the commissioner.
• is intended to support more consistent internal review of potential sanctions.

The guidance also clarifies that plans of correction are not administrative sanctions and that facilities remain responsible for preparing and implementing plans of correction when deficiencies are cited.

Which sanctions are addressed? The document outlines the currently authorized sanctions into three levels:

Level 1 – Restriction of New Admissions

• • The commissioner may place limitations or conditions on new admissions.

Level 2 – Prohibition of New Admissions

• • The commissioner may prohibit all new admissions to the facility.

Level 3 – Licensure Action

• • The commissioner may suspend or revoke a facility license.
  • In certain situations, the commissioner may petition a court to impose a civil penalty, appoint a receiver, or both.

The guidance emphasizes that these levels are intended to support consistent review and are not required sequential steps. VDH states that sanctions decisions will remain fact-specific and based on the circumstances of each case.

What could trigger a sanctions review? The proposed guidance identifies several circumstances that may trigger OLC review of whether sanctions should be considered, including:

• repeated citations of the same requirement;
• three or more citations of the same requirement within an 18-month period;
• multiple citations in the same regulatory area during a survey cycle;
• failure to correct deficiencies by revisit;
• repeated failed revisits;
• increasing severity or resident impact of deficiencies;
• abuse or neglect of persons in care;
• illegal acts occurring within the facility;
• serious threats to resident health or safety;
• severe compromise of resident quality of care or quality of life; or
• systemic or persistent failure to maintain compliance

The guidance states that citation counts are review triggers only and do not automatically result in sanctions. Administrative sanctions may also be considered when serious resident safety or quality concerns exist, even if a citation threshold has not been met.

Why it matters: The guidance provides a framework for how OLC could review compliance histories and consider administrative sanctions. Provider feedback can help ensure that the proposed review triggers, sanction considerations, and implementation language are clear, consistent, and predictable for nursing facilities.

• We will keep members informed as the guidance process moves forward and additional information becomes available.