What’s happening: Virginia has implemented a new Advanced Registered Medication Aide (ARMA) role to expand medication administration capacity in long-term care settings within nursing homes licensed by VDH. The regulatory framework and practice guidelines for ARMAs are established by the Virginia Board of Nursing (BON) and VDH.

How it happened:

• ARMA credential created:
  • Issued by the VBON
  • Effective March 11, 2026
  • Establishes ARMA registration, training requirements, scope of practice, and disciplinary authority

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• Use of ARMAs in nursing homes authorized:
  • Issued by the VDH
  • Effective November 19, 2025
  • Allows ARMAs to administer medications only in licensed nursing homes
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State Code and Regulation Specifics

Board of Nursing ARMA Credential Requirements | 18VAC90-60-130 and 18VAC90-60-140

To become an ARMA in Virginia, individuals must:

• • Hold current Virginia certification as both a Certified Nurse Aide (CNA) and a Registered Medication Aide (RMA).
  • Complete at least 60 hours of advanced training in a nursing facility that includes population and medication specific training.
    • VHCA-VCAL asked the BON for guidance or specifications regarding these hours, here was the response we received:

“This educational component is not regulated by the Board. The facility must provide the documentation that the ARMA completed training provided by the facility that included both population specific and medication specific training. The method and content of that training is up to the facility.”

• • Submit an application and pay the required fee.

Annual renewal requirements:

• • Maintaining CNA certification.
  • Completing continuing education, including 4 hours of nursing-facility-specific training.

*Failure to renew results in automatic lapse of registration. Practicing with a lapsed registration is considered unlicensed activity and may lead to prosecution.

Standards of Practice for ARMA in Licensed Nursing Homes | 18VAC90-60-150

ARMAs are authorized to:

• • Administer medications as prescribed, including oral, topical, and certain subcutaneous injections (e.g., insulin, glucagon, GLP-1, Vitamin B12, anticoagulants).
  • Document and report medication administration, errors, and adverse reactions.
  • Report suspected abuse, neglect, or exploitation.

ARMAs are not permitted to:

• • Take or transmit verbal medication orders.
  • Assess patients or alter medication regimens.
  • Administer IV medications or medications via NG/PEG tubes.
  • Mix or reconstitute multiple drug products (except insulin/glucagon).

Disciplinary Provisions for ARMA | 18VAC90-60-160

ARMAs are held accountable for ethical practice, competence, accurate documentation, client safety, and compliance with all applicable laws and regulations.

The BON may deny, suspend, revoke, or otherwise discipline an ARMA for violations of Virginia law. Disciplinary action may occur for:

• • Fraud or deceit in obtaining or maintaining registration, including submitting false information, misrepresenting facts on applications, or improperly assisting with competency evaluations.
  • Unprofessional conduct, such as:
    • practicing beyond the authorized scope or without adequate training or maintained competency;
    • misusing medications, supplies, or equipment;
    • falsifying client, medication, or employer records;
    • abuse, neglect, or abandonment of clients;
    • boundary violations, including exploitation or sexual misconduct;
    • violations of client privacy laws;
    • failure to follow facility medication management policies; or
    • violations of ARMA standards of practice or other regulatory requirements.
  • A pattern of medication errors that poses a risk to client or public health may also be grounds for discipline.

VDH Office of Licensure and Certification Licensure Regulations | 12VAC5-371-300(G)

Nursing homes licensed by VDH may employ ARMAs to administer medications to long-term care residents who do not have a clinical condition that requires evaluation by a registered nurse or licensed practical nurse for the administration of medications.

ARMAs must follow:

• • prescriber instructions;
  • Board of Pharmacy regulations on security and recordkeeping;
  • facility policies and procedures; and
  • BON regulations for medication aides.

ARMAs are not authorized to practice in hospitals or other non-nursing home settings.

Additional information specific to assisted living facilities (ALFs): DSS issued this March 4 memo to clarify the scope of practice for Advanced Registered Medication Aides (ARMAs) in ALFs.

• The intent of the memo is to reinforce that the expanded ARMA scope does not apply in assisted living settings and that existing RMA limitations remain in place for VDSS‑licensed ALFs.

Key context: We wanted to flag this memo for members’ awareness and note a wording nuance that may be helpful context for some providers.

• Nursing homes are often referred to broadly as skilled nursing facilities (SNFs); however, ARMA scope of practice was intentionally limited to long‑term care, specifically nursing homes licensed by VDH by legislation backed by VHCA-VCAL and passed during the 2025 General Assemlby session.

We appreciate DSS and the Department of Health Professions’ continued collaboration and efforts to support provider understanding as these changes are implemented.

• Please contact April Payne if you have any questions.