The General Assembly marked crossover this week. Crossover is the deadline by which the House and Senate must act on legislation that originated in their respective chambers.

• The House and Senate are also considering their respective budget amendments announced on Sunday, February 2. VHCA-VCAL is seeking clarification from budget committee staff on the intent of a $21.65 million appropriation for Medicaid nursing home rates. The House budget includes $2 million in funding for pilot programs that support individuals with dementia or geriatric individuals who may otherwise be admitted to a state facility.

Highlights of bills tracked by VHCA-VCAL.

Nursing Facility Legislation

Advanced medication aides: HB 2468, which passed the House unanimously, has been assigned to the Senate Education and Health Committee’s health professions subcommittee for a hearing.

• The bill 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.

Electronic monitoring in resident rooms: SB 821, which passed the Senate unanimously, has been assigned to the health subcommittee of the House Committee on Health and Human Services for consideration.

• As approved by the Senate, the bill text reflects VHCA-VCAL amendments to the original language providing more specificity on conditions required for the use of electronic monitoring devices in private rooms.
• Before the electronic monitoring requirements take effect, VDH would have to promulgate regulations to implement the changes. Development of the regulations could take 18-24 months after the bill takes effect.

Nursing home sanctions/civil penalties: The House and Senate passed their respective versions of the bills to establish additional state sanctions against nursing homes, HB 2253 and SB 1383.

• 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  and SB 1484 were both passed unanimously and have been referred to the respective health committees in the opposite chamber for consideration. Due to a procedural issue, the bills are not in identical format regarding the establishment of the fund to hold the fees. However, it is expected that the Senate version will be conformed to adopt the language in the House bill.

• Last week 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.

Professional liability insurance requirements for nursing homes and certified nursing facilities: SB 1152 passed the Senate.

• In its current form, the legislation includes 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.

Critical access hospital (CAHs) swing beds: HB 1552  passed the House unanimously an and has been favorably reported by the Senate Education and Health Committee. SB 1177 passed the Senate and has been referred to the House HHS Committee.

• 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.

Certificate of public need expedited review: HB 2119 and SB 1203 as introduced would have established an expedited application and review process for COPN projects that will serve a medical desert. They were amended to direct the State Health Commissioner to have the State Health Services Plan Task Force develop recommendations on establishing an expedited COPN review process for projects in medical deserts.

• The bill passed their originating chambers and have been referred to the opposite chamber’s health committees for hearings.

Assisted Living Legislation

Provisional licenses for ALFs: HB 2597 and SB 937, which specify 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, have passed their originating chambers.

• The House bill will be heard by the Senate Committee on Rehabilitation and Social Services; the Senate bill is awaiting committee referral.

Appointment of receiver: SB 1153, which would specify the circumstances under which the DSS Commissioner may petition the court for a receiver for an assisted living facility, has passed the Senate.