Titles of Regulations: 18VAC90-20. Regulations Governing the Practice of Nursing (amending 18VAC90-20-30, 18VAC90-20-40, 18VAC90-20-60, 18VAC90-20-151, 18VAC90-20-160).

18VAC90-25. Regulations Governing Certified Nurse Aides (amending 18VAC90-25-80).

18VAC90-30. Regulations Governing the Licensure of Nurse Practitioners (amending 18VAC90-30-50).

18VAC90-40. Regulations for Prescriptive Authority for Nurse Practitioners (amending 18VAC90-40-70).

18VAC90-50. Regulations Governing the Certification of Massage Therapists (amending 18VAC90-50-30).

18VAC90-60. Regulations Governing the Registration of Medication Aides (amending 18VAC90-60-30).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

September 14, 2010 - 11 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Avenue, Suite 201, Richmond, VA

Public Comment Deadline: November 12, 2010.

Agency Contact: Jay P. Douglas, R.N., Executive Director, Board of Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4515, FAX (804) 527-4455, or email jay.douglas@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia provides the board the authority to promulgate regulations to administer the regulatory system and to levy fees. The specific regulatory mandate for an increase in fees is found in § 54.1-113 of the Code of Virginia.

Purpose: The issue to be addressed is the need of the Board of Nursing to increase its fees to cover expenses for essential functions of licensure, investigation of complaints, and adjudication of disciplinary cases to ensure minimal competency for persons licensed, certified, or registered by the board. The board also reviewed and considered expenditures relating to initial or continued approval of nursing education programs.

The scope of the board's regulatory responsibility includes the following 12 occupations or entities with approximately 182,000 licensees, certificate holders, and registrants:

Registered nurses

Licensed practical nurses

Licensed nurse practitioners

Authorization to prescribe

Clinical nurse specialists

Certified nurse aides

Advanced nurse aides

Medication aides

Certified massage therapists

Virginia professional schools of nursing

Virginia practical schools of nursing

Volunteer registration

Section 54.1-113 of the Code of Virginia requires that at the end of each biennium, an analysis of revenues and expenditures of each regulatory board shall be performed. It is necessary that each board have sufficient revenue to cover its expenditures. By the close of FY10, it is projected that the Board of Nursing (in the combined budgets of Nursing and Certified Nurse Aides) will have $10,879,889 in expenses and only $8,359,143 in revenue. With a modest surplus carried forward from previous years, the board is expected to end the fiscal year with a deficit of $687,532 by June 30, 2010, and will continue to build increasing deficits through the fiscal years going forward. Since the fees from regulants will no longer generate sufficient funds to pay operating expenses for the board, promulgation of regulations for a fee increase is essential. To begin to reduce the deficits and have sufficient funding for the operation of the board by calendar year 2011, amendments to regulations must be adopted at the earliest possible date.

Fee increases for licensees regulated by the Board of Nursing are necessary in order for the board and the Department of Health Professions to continue performing essential functions of licensing, certifying, or registering new practitioners, and protecting the public from continued practice by incompetent or unethical practitioners. Since the Board of Nursing is the only health regulatory board with a statutory responsibility for approval of education programs, it must also have additional revenue to support functions related to assuring that new and existing nursing education programs meet minimal standards.

Substance: The Board of Nursing is proposing amendments to increase fees charged to regulants and applicants and to establish new fees to cover the cost of continued approval of nursing education programs. Biennial renewal fees would be increased as follows: (i) registered nurses, $45; (ii) licensed practical nurses, $25; (iii) licensed nurse practitioners, $30; (iv) certified massage therapists, $25; and (v) clinical nurse specialists, $20.

For initial approval of a nursing education program, there is an increase of $450 in the application fee. Fees for survey visits to nursing education programs ($2,200) and site visits for failure to achieve 80% NCLEX passage rates ($1,500) would be added in amounts sufficient to offset the board's expenses for such visits.

For certified nurse aides, the board proposes to change the renewal cycle from biennial (current fee of $50) to annual (proposed fee of $30). The annual fee for medication aides would also be raised by $5.00 for an annual fee of $30. Other fees, including application, inactive licensure, and late fees for all professions, are increased proportionally.

Issues: The primary advantage to the public would be that increased fees will produce adequate revenue to fund the licensing and disciplinary activities of the board. With the shortfall at $687,532 at the end of FY10 and projected to increase to almost $13.5 million in FY14, there could be significant delays in (i) licensing new nurses, CNA's, medication aides, and nurse practitioners, and (ii) the investigation and adjudication of complaints against licensees. There are no disadvantages; increases in biennial renewal fees ranging from $25 to $45 for nurses and in annual renewal fees for CNA's and medication aides should not significantly impact the cost of nursing care for Virginians.

There are no disadvantages to the agency; the advantage would be that fees would be sufficient to cover expenditures, which is a requirement of the Code of Virginia.

The Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Nursing (Board) proposes to increase most fees paid by licensees, registrants, and certificate holders that are subject to the Board's authority and to establish new fees to cover the cost of continued approval of nursing education programs.

Result of Analysis. There is insufficient information to accurately gauge whether benefits are likely to outweigh costs for these proposed changes.

Estimated Economic Impact. Under current regulations, registered nurses (RNs) and licensed practical nurses (LPN) pay the same licensure fees. Currently, schools that are planning on starting a nursing education program, and are applying for Board approval, must currently submit, at least 12 months in advance of the expected opening, a statement of intent and $1,200 application fee.

With these proposed regulations, the Board intends to separate most licensure fees paid by RNs from those paid by LPNs (all fees except the fee for reinstatement of a suspended or revoked license), raise the application fee for approval of nursing programs and establish new fees for survey visits for nursing program that are being newly approved and site visits for nursing programs whose NCLEX (National Council Licensure Examination) passage rates fall below 80%. Board staff reports that these new fees are needed to cover the costs associated with required staff on-site visits. The Board also proposes to raise all fees set in chapter 18 VAC 90-20 except the fee on returned checks. Below is a comparison table for current and proposed fees:

FEE TYPE	CURRENT FEE	PROPOSED FEE	% INCREASE
Application for Licensure by Examination RN	$130	$190	46.15%
Application for Licensure by Endorsement RN	$130	$190	46.15%
Application for Licensure by Examination LPN	$130	$170	30.77%
Application for Licensure by Endorsement LPN	$130	$170	30.77%
Reapplication for Licensure by Examination	$25	$50	100%
Biennial License Renewal RN	$95	$140	47.36%
Biennial Inactive License Renewal RN	$50	$70	40%
Biennial License Renewal LPN	$95	$120	26.32%
Biennial Inactive License Renewal LPN	$50	$60	20%
Late Renewal RN	$35	$50	42.86%
Late Renewal LPN	$35	$40	14.29%
Reinstatement of Lapsed License RN	$145	$225	55.17%
Reinstatement of Lapsed License LPN	$145	$200	37.93%
Reinstatement of a Suspended or Revoked License	$185	$300	62.16%
Duplicate License	$5	$15	200%
Replacement Wall Certificate	$15	$25	66.67%
Verification of License	$25	$35	40%
Transcript of All or Part of Applicant/ Licensee Records	$25	$35	40%
Returned Check Charge	$35	$35	unchanged
Application of Clinical Nurse Specialist (CNS) Registration	$95	$130	36.84%
Biennial Renewal of CNS Registration	$60	$80	33.33%
Reinstatement of Lapsed CNS Registration	$105	$125	19.05%
Verification of CNS Registration to Another Jurisdiction	$25	$35	40%
Late Renewal of CNS Registration	$20	$35	75%
Application for Approval of a Nursing Education Program	$1,200	$1,650	37.5%
Survey Visit For Nursing Education Program	N/A	$2,200	New Fee
Site Visit for NCLEX Passage Rate for Nursing Education Program	N/A	$1,500	New Fee

The Board also proposes to require certified nurse aides to renew their certification annually, rather than biennially, and proposes to change the renewal fee from $50 every two years to $30 every year. This change will affectively raise the cost of renewal by $10 (20%) every two years. Additionally, the Board proposes to raise fees in 18 VAC 90-30 (covering nurse practitioners), 18 VAC 90-40 (covering prescriptive authority for nurse practitioners), 18 VAC 90-50 (covering certified massage therapists) and 18 VAC 90-60 (medication aides).

Below is a comparison table of current and proposed fees for nurse practitioners:

FEE TYPE		CURRENT FEE	PROPOSED FEE	% INCREASE
Application for Licensure	$85		$125	47.06%
Biennial Licensure Renewal	$50		$80	60%
Late Renewal	$20		$25	30.77%
Reinstatement of Licensure	$85		$150	76.47%
Reinstatement of Suspended or Revoked License	$85		$200	135%
Verification of Licensure to Another Jurisdiction	$25		$35	40%
Duplicate License	$5		$15	200%
Duplicate Wall Certificate	$15		$25	66.67%
Returned Check Charge	$35		$35	unchanged

A comparison table of current and proposed fees for prescriptive authority:

FEE TYPE	CURRENT FEE	PROPOSED FEE	% INCREASE
Initial Issuance of Prescriptive Authority	$50	$75	50%
Biennial Renewal	$25	$35	40%
Late Renewal	$25	$30	20%
Reinstatement of Lapsed Authorization	$60	$90	50%
Reinstatement of Revoked or Suspended Authorization	$85	$85	unchanged
Duplicate of Authorization	$5	$15	200%
Returned Check Charge	$35	$35	unchanged

And a comparison table of current and proposed fees for massage therapists:

FEE TYPE	CURRENT FEE	PROPOSED FEE	% INCREASE
Application and Initial Certification	$105	$140	33.33%
Biennial Renewal	$70	$95	35.71%
Late Renewal	$25	$30	20%
Reinstatement of Certification	$120	$150	25%
Reinstatement after Revocation or Suspension	$150	$200	33.33%
Duplicate Certificate	$5	$15	200%
Replacement Wall Certificate	$15	$25	66.67%
Verification of Certification	$25	$35	40%
Transcript of All or Part of Applicant/ Certificate Holder Records	$25	$35	40%
Returned Check Charge	$35	$35	unchanged

The Board proposes to increase the annual renewal fee (from $25 to $30) and the duplicate registration fee (from $5 to $15) for medication aides.

Board staff reports that the Board expects to run a deficit of $687,532 for FY2010 and that, absent approval of these fee increases, there will be deficit spending through the fiscal years going forward. Board staff further reports that these fee increases are needed to cover 1) the costs associated with the increased number of disciplinary actions, particularly involving certified nurse aides, 2) the costs associated with on-site inspections of nursing education programs for which the Board is currently not reimbursed and 3) increasing costs for information technology (IT) services.

Board staff reports that investigation of voluminous complaints against certified nurse aides has increased the Boards disciplinary costs. The Board feels, however that trying to only adjust certified nurse aide fees to pay for these increased costs would have a significant and chilling effect on individuals decisions to work in this field. The Board, instead, proposes to increase all nursing fees incrementally to cover these costs. As an alternative to the portion of fee increases that will be used to cover increased disciplinary costs, the Board may wish to consider measures that have costs falling to certified nurse aides or their employers. The Board might, for instance, look in to requiring employers of certified nurse aides to carry surety bonds that would make them responsible for poor behavior on the part of their employees. Such an action would likely require the cooperation of other regulatory bodies in the Commonwealth that set requirements for facilities that hire certified nurse aides.

The Department of Health Professions (DHP) reports that a portion of the expected expenditure increases over their forecast horizon are needed to cover increased costs for services from the Virginia Information Technologies Agency (VITA). DHP reports that its VITA services costs have almost doubled over the last two years, and are expected to increase approximately $500,000 this year. For comparison, DHPs VITA expenditures for FY 2005 were, in total, $476,600. For FY 2010, the agency has budgeted $1,587,788 for VITA costs.. A large portion of the increase in costs, at least for FY 2010 and FY 2011, can be attributed to the planned move of DHPs licensing servers from DHP to Northrop Grumman. DHP anticipates that this will increase the costs for maintaining these servers by approximately $80,000 per month ($960,000 per year). The Board is and will be responsible for a proportional share of these costs. Although it is likely beyond the capacity of DHP to control the very rapid growth of these costs, licensees of this Board (and all other DHP boards) would benefit from increased scrutiny of services provided to DHP through VITA.

The Board does not believe that these fee increases are large enough to affect either regulated entities choice to be employed in their current fields or the cost of nursing care in Virginia. One would expect to see, however, some marginal decrease in the number of individuals choosing to be licensed, certified or registered as the cost of licensure, certification and registration increases even if those increases are moderate. Particularly, individuals who are making little to no extra money at the tasks licensed, certified, and registered by the Board, when compared to their next best option for employment, will likely choose their next best option if their costs for doing their current jobs increase. To the (likely minimal) extent that individuals who are currently licensed or registered find that these proposed fee increases cause them to leave their current professions, total employment for this group in these professions may decrease by some small amount.

Businesses and Entities Affected. DHP reports that the Board currently regulates 91,316 registered nurses, 29,828 licensed practical nurses, 5,887 licensed nurse practitioners (3,456 of whom are authorized to prescribe medication), 5,335 certified massage therapists, 436 clinical nurse specialists, 3,577 medication aides, 46,281 certified nurse aides, 99 advanced certified nurse aides, 68 professional schools of nursing and 80 practical schools of nursing. All of these entities, as well as any individuals or entities who may wish to become licensed, certified or registered in the future, will be affected by these proposed regulations.

Localities Particularly Affected. No locality will be particularly affected by this proposed regulatory action.

Projected Impact on Employment. This regulatory action may decrease the number of individuals who choose to work in professional fields that are regulated by the Board.

Effects on the Use and Value of Private Property. To the extent that the proposed fee increases for nursing schools increase costs for affected proprietary nursing schools, profits will likely decrease. If this happens, the value of these businesses will marginally decrease. Proposed fee increases that would affect only new nursing schools may slightly decrease the chance of new programs starting in the future.

Small Businesses: Costs and Other Effects. DHP reports that there are 13 proprietary RN programs and 23 proprietary LPN programs in the Commonwealth; all of these are likely small businesses. Existing nursing program small businesses in the Commonwealth will incur costs for increased fees only if the NCLEX passage rates of their graduates fall below 80%.

Small Businesses: Alternative Method that Minimizes Adverse Impact. There are several actions that the Board could take that might mitigate the necessity of raising fees overall (including fees that fall on proprietary nursing schools). The Board could slightly lengthen the time that it takes to process both license applications and complaints so that staff costs could be cut. This option would benefit current licensees but would slightly delay licensure, and the ability to legally work, for new applicants. Affected small businesses would also likely benefit from increased scrutiny of the IT costs that are driving increases in both agency and Board expenditures.

Real Estate Development Costs. This regulatory action will likely have no effect on real estate development costs in the Commonwealth.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 36 (06). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPBs best estimate of these economic impacts.

Agency's Response to the Department of Planning and Budget's Economic Impact Analysis:

The Board of Nursing does not concur with the analysis of the Department of Planning and Budget for the proposed amendments to Regulations of the Board of Nursing, to increase fees for the following reasons:

1) The Board does not agree that sharply higher fees for certified nurse aides might have an ameliorative effect on the poor behavior of this group.

• There is absolutely no historic evidence for any health regulatory board to support the assertion that a sharp increase in fees would cause the professionals to police themselves and the behavior of their cohorts. On July 14, 2004, there was a 36% increase in the renewal fees for registered nurses. For the fiscal year ending June 30, 2005, number of complaints per 1,000 licensees for registered nurses was 5.21; for the fiscal year ending June 30, 2006, the number per 1,000 was 5.64.

• While there are a large number of complaints filed and disciplinary proceedings held for certified nurse aides, the rate of complaints is far less than many other professions. During the 2007-08 fiscal year, the complaint rate for certified nurse aides was 9.95 per 1,000; for licensed practical nurses, the rate was 13.15 and for nurse practitioners, the rate was 13.25. There are a large number of cases because there are a large number of certified nurse aides (typically 42,000 to 43,000).

• The problem is that the Board of Nursing is not permitted by federal law to charge a fee to place a person on the Nurse Aide Registry (charge an application fee), and the profession is not highly compensated so its renewal fees alone cannot support the disciplinary and administrative costs of operation. Other similar professions, such as pharmacy technicians, do not support the activities associated with investigating and disciplining the profession with their renewal fees alone.

2) The Board has no authority to consider measures that would pass on the costs for the nurse aide registry to the employers, as is suggested in the EIA. Further, the purchase of a surety bond, as recommended in the EIA, could not accrue to the budget of the Board. A surety bond protects against financial losses to the facility or institution making such a purchase; it would not make them responsible for poor behavior on the part of their employees.

3) In order to make fees for certified nurse aides sufficient to cover expenditures related to that portion of the budget, the current fee of $50 per biennium would need to be increased to approximately $170, just to offset the accumulated shortfall. That action would likely deplete the workforce that primarily provides care in all long-term care facilities and many other patient settings.

4) The EIA notes that one would expect to see some marginal decrease in the number of individuals choosing to be licensed, certified or registered affecting total employment in these professions. In 2003 and 2004, there was a substantial increase in fees for nurses; yet the number of licensed nurses increased from 122,653 in FY03 to 126,454 in FY04 and 127,858 in FY05. Clearly, there are factors other than a biennial renewal fee that determine licensure and employment in a health care profession such as nursing.

Summary:

The proposed amendments would increase fees charged to regulants and applicants and establish new fees to cover the cost of continued approval of nursing education programs. Biennial renewal fees for registered nurses would be increased by $45 and for licensed practical nurses by $25. For initial approval of a nursing education program, there would be an increase in the application fee of $450. Fees for survey visits and site visits to nursing education programs would be added in amounts sufficient to offset the board's expenses for such visits.

Similar increases are proposed for clinical nurse specialists, licensed nurse practitioners, and certified massage therapists. For certified nurse aides, the board proposes to change the renewal cycle from a biennial cycle (current fee of $50) to an annual cycle (proposed fee of $30). The annual fee for medication aides would also be raised by $5.00 for an annual fee of $30. Other fees, including application, inactive licensure, and late fees for all professions would be increased proportionally.

18VAC90-20-30. Fees.

Fees required by the board are:

1. Application for licensure by examination - RN	$130 $190
2. Application for licensure by endorsement - RN	$130 $190
3. Application for licensure by examination - LPN	$170
4. Application for licensure by endorsement - LPN	$170
3. 5. Reapplication for licensure by examination	$25 $50
4. 6. Biennial licensure renewal - RN	$95 $140
7. Biennial inactive licensure renewal - RN	$70
8. Biennial licensure renewal - LPN	$120
9. Biennial inactive licensure renewal - LPN	$60
5. 10. Late renewal - RN	$35 $50
11. Late renewal - LPN	$40
6. 12. Reinstatement of lapsed license - RN	$145 $225
13. Reinstatement of lapsed license - LPN	$200
7. 14. Reinstatement of suspended or revoked license	$185 $300
8. 15. Duplicate license	$5 $15
9. 16. Replacement wall certificate	$15 $25
10. 17. Verification of license	$25 $35
11. 18. Transcript of all or part of applicant/licensee records	$25 $35
12. 19. Returned check charge	$35
13. 20. Application for CNS registration	$95 $130
14. 21. Biennial renewal of CNS registration	$60 $80
15. 22. Reinstatement of lapsed CNS registration	$105 $125
16. 23. Verification of CNS registration to another jurisdiction	$25 $35
17. 24. Late renewal of CNS registration	$20 $35
18. Inactive licensure renewal	$50
19. Late renewal of an inactive license	$15
25. Application for approval of a nursing education program	$1,650
26. Survey visit for nursing education program	$2,200
27. Site visit for NCLEX passage rate for nursing education program	$1,500

Part II
Nursing Education Programs

Article 1
Establishing a Nursing Education Program

18VAC90-20-40. Application.

A. An institution wishing to establish a nursing education program shall:

1. Submit to the board, at least 12 months in advance of expected opening date, a statement of intent to establish a nursing education program along with an application fee of $1,200 as prescribed in 18VAC90-20-30.

2. Submit to the board evidence documenting adequate resources for the projected number of students and the ability to provide a program that can meet the requirements of Article 2 (18VAC90-20-70 et seq.) of this part to include the following information:

a. Organizational structure of the institution and relationship of nursing program therein;

b. Purpose and type of program;

c. Availability of qualified faculty sufficient to provide classroom instruction and clinical supervision for the number of students specified by the program;

d. Budgeted faculty positions sufficient in number to provide classroom instruction and clinical supervision;

e. Availability of clinical training facilities for the program as evidenced by copies of contracts or letters of agreement specifying the responsibilities of the respective parties and indicating sufficient availability of clinical experiences for the number of students in the program;

f. Availability of academic facilities for the program, including classrooms, laboratory, and library;

g. Evidence of financial resources for the planning, implementation and continuation of the program with budget projections for three years;

h. Tentative time schedule for planning and initiating the program; and

i. An enrollment plan specifying the beginning dates and number of students for each class for a two-year period from the date of initial approval.

3. Respond to the board's request for additional information.

B. A site visit may be conducted by a representative of the board.

C. The Education Special Conference Committee (the "committee"), composed of not less than two members of the board, shall, in accordance with § 2.2-4019 of the Code of Virginia, receive and review applications and the report of the site visit and shall make recommendations to the board regarding the granting or denial of approval of the program application.

1. If the board accepts the recommendation to approve the program application, the institution may apply for provisional approval of the nursing education program as set forth in this chapter.

2. If the committee recommendation is to deny approval of the program application, no further action will be required of the board unless the program requests a hearing before the board or a panel thereof in accordance with § 2.2-4020 and subdivision 9 of § 54.1-2400 of the Code of Virginia.

18VAC90-20-60. Program approval.

A. The application for approval shall be complete when:

1. A self-evaluation report of compliance with Article 2 (18VAC90-20-70 et seq.) of this part has been submitted along with the fee for a survey visit as required by 18VAC90-20-30;

2. The first graduating class has taken the licensure examination, and the cumulative passing rate for the program's first-time test takers taking the NCLEX over the first four quarters following graduation of the first class is not less than 80%; and

3. A satisfactory survey visit and report has been made by a representative of the board verifying that the program is in compliance with all requirements for program approval.

B. The committee shall, in accordance with § 2.2-4019 of the Code of Virginia, receive and review the self-evaluation, the NCLEX results and survey reports and shall make a recommendation to the board for the granting or denial of approval or for continuance of provisional approval.

C. If the committee's recommendation is to deny approval, no further action will be required of the board unless the program requests a hearing before the board or a panel thereof in accordance with § 2.2-4020 of the Code of Virginia.

18VAC90-20-151. Passage rate on national examination.

A. For the purpose of continued approval by the board, a nursing education program shall maintain a passage rate for first-time test takers on the NCLEX that is not less than 80%, calculated on the cumulative results of the past four quarters in each year.

B. If a program falls below 80% for two consecutive years, the board shall conduct a site visit and place the program on conditional approval. Prior to the conduct of such a visit, the program shall submit the fee for a site visit pursuant to the NCLEX passage rate as required by 18VAC90-20-30. If a program falls below 80% for three consecutive years, the board may withdraw program approval.

C. For the purpose of program evaluation, the board may provide to the program the examination results of its graduates. However, further release of such information by the program shall not be authorized without written authorization from the candidate.

Article 3
Maintaining or Closing an Approved Nursing Education Program

18VAC90-20-160. Maintaining an approved nursing education program.

A. The program director of each nursing education program shall submit an annual report to the board.

B. Each nursing education program shall be reevaluated as follows:

1. A program that has not achieved accreditation as defined in 18VAC90-20-10 shall be reevaluated at least every eight years for a practical nursing program and every six years for a registered nursing program by submission of a comprehensive self-evaluation report based on Article 2 (18VAC90-20-70 et seq.) of this part, and a survey visit by a representative(s) of the board on dates mutually acceptable to the institution and the board.

2. A program that has maintained accreditation as defined in 18VAC90-20-10 shall be reevaluated at least every 10 years by submission of a comprehensive self-evaluation report as provided by the board. As evidence of compliance with specific requirements of this chapter, the board may accept the most recent study report, site visit report and final decision letter from the accrediting body. The board may require additional information or a site visit to ensure compliance with requirements of this chapter. If accreditation has been withdrawn or a program has been placed on probation, the board shall conduct an on-site survey visit within one year of such action. If a program fails to submit the documentation required in this subdivision, the requirements of subdivision 1 of this subsection shall apply.

C. The Education Special Conference Committee (the "committee"), composed of not less than two members of the board, shall, in accordance with § 2.2-4019 of the Code of Virginia, receive and review the self-evaluation and survey reports and shall make a recommendation to the board to grant continued approval, place the program on conditional approval or withdraw approval.

1. A nursing education program shall continue to be approved provided the requirements set forth in Article 2 of this part are attained and maintained.

2. If the committee determines that a nursing education program is not maintaining the requirements of Article 2 of this part, the committee shall recommend to the board that the program be placed on conditional approval and the governing institution shall be given a reasonable period of time to correct the identified deficiencies.

a. The committee shall receive and review reports of progress toward correcting identified deficiencies and, when a final report is received at the end of the specified time showing correction of deficiencies, make a recommendation to the board to grant continued approval, continue the program on conditional approval or withdraw approval.

b. If the nursing education program fails to correct the identified deficiencies within the time specified by an order of the board, the board may withdraw the approval following a formal hearing.

c. The governing institution may request a formal hearing before the board or a panel thereof pursuant to § 2.2-4020 and subdivision 9 of § 54.1-2400 of the Code of Virginia if it objects to any action of the board relating to conditional approval.

D. Interim visits shall be made to the institution by board representatives at any time within the approval period either by request or as deemed necessary by the board. Prior to the conduct of such a visit, the program shall submit the fee for a survey visit as required by 18VAC90-20-30.

E. Failure to submit the required fee for a survey or site visit may subject an education program to board action or withdrawal of board approval.

18VAC90-25-80. Renewal or reinstatement of certification.

A. Renewal of certification.

1. No less than 30 days prior to the expiration date of the current certification, a notice for renewal shall be mailed by the board to the last known address of record of each currently registered certified nurse aide.

2. The certified nurse aide shall annually submit a completed renewal application with the required fee of $50 $30 and verification of performance of nursing-related activities for compensation within the two years immediately preceding the expiration date.

3. Failure to receive the application for renewal shall not relieve the certificate holder of the responsibility for renewing the certification by the expiration date.

4. A certified nurse aide who has not performed nursing-related activities for compensation during the two years preceding the expiration date of the certification shall repeat and pass the nurse aide competency evaluation prior to applying for recertification.

5. The board shall also charge a fee of $35 for a returned check.

B. Reinstatement of certification.

1. An individual whose certification has lapsed for more than 90 days shall submit the required application and renewal fee and provide:

a. Verification of performance of nursing-related activities for compensation in the two years prior to the expiration date of the certificate and within the preceding two years; or

b. Evidence of having repeated and passed the nurse aide competency evaluation.

2. An individual who has previously had a finding of abuse, neglect or misappropriation of property is not eligible for reinstatement of his certification, except as provided in 18VAC90-25-81.

18VAC90-30-50. Fees.

Fees required in connection with the licensure of nurse practitioners are:

1. Application	$85 $125
2. Biennial licensure renewal	$50 $80
3. Late renewal	$20 $25
4. Reinstatement of licensure	$85 $150
5. Verification of licensure to another jurisdiction	$25 $35
6. Duplicate license	$5 $15
7. Duplicate wall certificate	$15 $25
8. Return check charge	$35
9. Reinstatement of suspended or revoked license	$200

18VAC90-40-70. Fees for prescriptive authority.

The following fees have been established by the boards:

1. Initial issuance of prescriptive authority	$50 $75
2. Biennial renewal	$25 $35
3. Late renewal	$10 $15
4. Reinstatement of lapsed authorization	$60 $90
5. Reinstatement of suspended or revoked authorization	$85
6. Duplicate of authorization	$5 $15
7. Return check charge	$35

18VAC90-50-30. Fees.

A. Fees listed in this section shall be payable to the Treasurer of Virginia and shall not be refunded unless otherwise provided.

B. Fees required by the board are:

1. Application and initial certification	$105 $140
2. Biennial renewal	$70 $95
3. Late renewal	$25 $30
4. Reinstatement of certification	$120 $150
5. Reinstatement after suspension or revocation	$150 $200
6. Duplicate certificate	$5 $15
7. Replacement wall certificate	$15 $25
8. Verification of certification	$25 $35
9. Transcript of all or part of applicant/certificate holder records	$25 $35
10. Returned check charge	$35

18VAC90-60-30. Fees.

A. The following fees shall apply:

1. Application for program approval	$500
2. Application for registration as a medication aide	$50
3. Annual renewal for medication aide	$25 $30
4. Late renewal	$15
5. Reinstatement of registration	$90
6. Returned check	$35
7. Duplicate registration	$5 $15
8. Reinstatement following suspension, mandatory suspension or revocation	$120

B. Fees shall not be refunded once submitted.

C. The fee for the competency evaluation shall be paid directly to the examination service contracted by the board for its administration.