DEPARTMENT OF ENVIRONMENTAL QUALITY
Proposed Consent Order for Craft Machine Works Inc.
An enforcement action has been proposed for Craft Machine Works Inc. for the Craft Facility in Hampton, Virginia. Department of Environmental Quality (DEQ) proposes to issue a consent order to Craft Machine Works Inc. to address noncompliance with State Water Control Law. A description of the proposed action is available at the DEQ office listed or online at www.deq.virginia.gov from April 10, 2023, to May 10, 2023.
Contact Information: Thomas Jackson, Enforcement Specialist, Department of Environmental Quality, 5636 Southern Boulevard, Virginia Beach, VA 23462, FAX (804) 698-4178, or email thomas.jackson@deq.virginia.gov.
Proposed Consent Order for Holding Tree Ventures II LLC
An enforcement action has been proposed for Holding Tree Ventures II LLC for alleged violations in Fluvanna County, Virginia. Department of Environmental Quality (DEQ) proposes to issue a consent order with penalty to Holding Tree Ventures II LLC to address noncompliance with State Water Control Law. A description of the proposed action is available at the DEQ office listed or online at www.deq.virginia.gov. Francesca Wright will accept comments from April 10, 2023, through May 9, 2023.
Contact Information: Francesca Wright, Enforcement Specialist, Department of Environmental Quality, 4411 Early Road, Harrisonburg, VA 22801, FAX (804) 698-4178, or email francesca.wright@deq.virginia.gov.
Proposed Consent Special Order for Morgan Lumber Company Inc.
An enforcement action has been proposed for Morgan Lumber Company Inc. for violations in Red Oak, Virginia. The Department of Environmental Quality (DEQ) proposes to issue a special order by consent to Morgan Lumber Company Inc. to address noncompliance with the State Water Control Law and regulations. A description of the proposed action is available at the DEQ office listed or online at www.deq.virginia.gov. The staff contact person will accept comments by email or postal mail from April 10, 2023, through May 9, 2023.
Contact Information: Tim Fletcher, Department of Environmental Quality, 901 Russell Drive, Salem, VA 24153, or email timothy.fletcher@deq.virginia.gov.
Proposed Consent Special Order for Radford Army Ammunition Plant
An enforcement action has been proposed for the Radford Army Ammunition Plant for violations in Radford, Virginia. The Department of Environmental Quality (DEQ) proposes to issue a special order by consent to the United States Army (owner) and BAE Systems Ordinance Systems Inc. (operator) to address noncompliance with the State Water Control Law and regulations. A description of the proposed action is available at the DEQ office listed or online at www.deq.virginia.gov. The staff contact will accept comments by email or postal mail from April 10, 2023, through May 9, 2023.
Contact Information: Tim Fletcher, Department of Environmental Quality, 901 Russell Drive, Salem, VA 24153, or email timothy.fletcher@deq.virginia.gov.
STATE BOARD OF HEALTH
Public Comment Opportunity for New Scoring Sheet for the Drinking Water State Revolving Fund
The Virginia Department of Health (VDH) Office of Drinking Water (ODW) is pleased to accept comments on the new application scorecards for both traditional construction applications and the Lead Elimination Assistance Program (LEAP) applications.
With the passage of the Bipartisan Infrastructure Law (BIL) and the renewed emphasis on infrastructure at drinking water systems, new score sheets are necessary. The Financial Construction Assistance Program (FCAP) last revised scoresheets in April 2019. The 2019 construction scoresheet did not address many of the infrastructure issues that BIL implements. The revised project scoresheet includes additional points for the replacement of lead jointed cast iron pipe, the replacement of asbestos cement pipe, and the installation of emergency electric power generators, among other changes.
The LEAP scorecard was updated to expand eligibility criteria for vulnerable populations by adding the poverty indicator and pre-K enrollment indicator from the VDH Youth Well-Being Index. The LEAP scorecard expands eligibility criteria for young children who are most vulnerable to exposure from lead in drinking water; adding a "Readiness to Proceed" section to prioritize projects that are ready to move forward now; and adding bonus points for lead service line (LSL) replacement projects to separate them from the LSL inventory projects. Removal of LSLs reduces risks to public health.
Both the construction and LEAP scorecards are available at https://www.vdh.virginia.gov/drinking-water/fcap/drinking-water-funding-program/ or by contacting the agency contact, Kelly Ward. Comments on the scorecards are due by April 17, 2023. All comments submitted should include the name, address, and telephone number of the person providing the comments.
Contact Information: Kelly Ward, Financial Construction Assistance Program Director, Office of Drinking Water, Virginia Department of Health, 109 Governor Street, 6th Floor, Richmond, VA 23219, telephone (804) 864-7500, or email kelly.ward@vdh.virginia.gov.
Public Comment Opportunity – Draft Amendments for Hospital Emergency Departments (12VAC5-410) pursuant to Chapter 417 of the 2023 Acts of Assembly
Introduction: The first enactment clause of Chapter 417 of 2023 Acts of Assembly requires the State Board of Health to amend its hospital regulations to require hospitals with emergency departments "to establish a security plan…using standards established by the International Association for Healthcare Security and Safety or other industry standard" that is "based on the results of a security risk assessment of each emergency department location of the hospital." This security plan must "include the presence of at least one off-duty law-enforcement officer or trained security personnel who is present in the emergency department at all times as indicated to be necessary and appropriate by the security risk assessment." Chapter 417 further enumerates what identified risks hospitals must consider when developing security plans and training requirements for security personnel and authorizes the State Health Commissioner to "provide a waiver from the requirement that at least one off-duty law-enforcement officer or trained security personnel be present at all times in the emergency department if the hospital demonstrates that a different level of security is necessary and appropriate for any of its emergency departments based upon findings in the security risk assessment."
The second enactment clause of Chapter 417 exempts the regulatory action from the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia), provided that the State Board of Health gives an opportunity for public comment prior to adoption. This notice serves as public comment opportunity.
In drafting the proposed regulatory text, the Virginia Department of Health (VDH) sought to address (i) development of security plans using standards other than those established by the International Association for Healthcare Security and Safety; (ii) the minimum information needed to evaluate requests for waivers of the requirement of "one off-duty law-enforcement officer or trained security personnel who is present in the emergency department at all times"; (iii) updates to security plans and duration of waivers; and (iv) protection of sensitive security and operational information about hospitals that VDH has in its possession as part of the waiver process.
VDH also took into consideration that currently all general hospitals in Virginia are certified by the Centers of Medicare and Medicaid Services (CMS) as hospitals or critical access hospitals and that some may seek CMS certification as rural emergency hospitals. CMS requires all of these providers to develop and maintain emergency preparedness plans that include facility-based and community-based risk assessments, which are required to be updated at least every two years (42 CFR §§ 482.15(a), 485.542(a), and 485.625(a)). To reduce the administrative burden on hospitals while ensuring that security plans required by Chapter 417 are kept current, VDH proposes to have security plans be updated at the same interval as the emergency preparedness since both plans have similar components.
Public comment period: April 10, 2023, to May 10, 2023.
How to comment: Submit comments through the Public Comment Forum feature of the Virginia Regulatory Town Hall website at https://townhall.virginia.gov. Members of the public may also submit comments by mail, email, or fax to Rebekah E. Allen, Senior Policy Analyst, 9960 Mayland Drive, Suite 401, Henrico, Virginia 23233, telephone (804) 367-2102, FAX (804) 527-4502, or email regulatorycomment@vdh.virginia.gov.
All comments must be received during the comment period. Commenters are strongly encouraged to provide name, organization represented (if any), mailing address or email address, and telephone number.
Draft regulatory text: The draft exempt regulation is available for review as follows. Stricken text indicates existing text that is proposed to be repealed. Underlined text indicates new text that is proposed to be promulgated.
12VAC5-410-280. Emergency service.
A. Hospitals with an emergency department/service shall have 24-hour staff coverage and shall have at least one physician on call at all times. Hospitals without emergency service shall have written policies governing the handling of emergencies.
B. No less than one registered nurse shall be assigned to the emergency service on each shift. Such assignment need not be exclusive of other duties, but must have priority over all other assignments.
C. Those hospitals that provide ambulance services shall comply with Article 2.1 (§ 32.1-111.1 et seq.) of Chapter 4 of Title 32.1 of the Code of Virginia and 12VAC5-31.
D. The hospital shall provide equipment, drugs, supplies, and ancillary services commensurate with the scope of anticipated needs, including radiology and laboratory services and facilities for handling and administering of blood and blood products. Emergency drugs and equipment shall remain accessible in the emergency department at all times.
E. Current roster of medical staff members on emergency call, including alternates and medical specialists or consultants shall be posted in the emergency department.
F. Hospitals shall make special training available, as required, for emergency department personnel.
G. Toxicology reference material and poison antidote information shall be available along with telephone numbers of the nearest poison control centers.
H. Each emergency department shall post notice of the existence of a human trafficking hotline to alert possible witnesses or victims of human trafficking to the availability of a means to gain assistance or report crimes. This notice shall be in a place readily visible and accessible to the public, such as the patient admitting area or public or patient restrooms. The notice shall meet the requirements of § 40.1-11.3 C of the Code of Virginia.
I. Every hospital with an emergency department shall establish protocols to ensure that security personnel of the emergency department receive training appropriate to the populations served by the emergency department. This training may include training based on a trauma-informed approach in identifying and safely addressing situations involving patients or other persons who pose a risk of harm to themselves or others due to mental illness or substance abuse or who are experiencing a mental health crisis. a security plan for each emergency department that:
1. Is developed using standards established in the Healthcare Security Industry Guidelines, 13th Edition (International Association for Healthcare Security and Safety), except as provided in subdivision J 2 of this section;
2. Is based on:
a. The results of a security risk assessment of each emergency department location of the hospital; and
b. Risks for the emergency department identified in consultation with the emergency department medical director and nurse director, including:
(1) Trauma level designation;
(2) Overall patient volume;
(3) Volume of psychiatric and forensic patients;
(4) Incidents of violence against staff;
(5) Level of injuries sustained from such violence; and
(6) Prevalence of crime in the community;
3. Includes the presence of at least one off-duty law-enforcement officer or trained security personnel who is present in the emergency department at all times as indicated to be necessary and appropriate by the security risk assessment, except as provided in subsection K of this section; and
4. Outlines training requirements for security personnel in:
a. The potential use of and response to weapons;
b. Defensive tactics;
c. De-escalation techniques;
d. Appropriate physical restraint and seclusion techniques;
e. Crisis intervention;
f. Trauma-informed approaches; and
g. Safely addressing situations involving patients, family members, or other persons who pose a risk of harm to themselves or others due to mental illness or substance abuse or who are experiencing a mental health crisis.
J. The hospital may:
1. Accept from its security personnel the satisfactory completion of the Department of Criminal Justice Services minimum training standards for auxiliary police officers as required by § 15.2-1731 of the Code of Virginia in lieu of the training prescribed by subdivision I 4 of this section; and
2. Request to use industry standards other than those specified in subdivision I 1 of this section by submitting a written request for alternative industry standards to the OLC that:
a. Specifies the title, edition, and author of the alternative industry standards; and
b. Provides an explanation of how the alternative industry standards are substantially similar to those specified in subdivision I 1 of this section.
K. Every hospital with an emergency department shall update its security plan, including its security risk assessment, for each emergency department location of the hospital as often as necessary but not to exceed 2 years.
L. The commissioner shall provide a waiver from the requirement that at least one off-duty law-enforcement officer or trained security personnel be present at all times in the emergency department if the hospital demonstrates that a different level of security is necessary and appropriate for any of its emergency departments based upon findings in the security risk assessment.
1. A hospital shall submit a written request for a waiver pursuant to this subsection and shall:
a. Specify the location of the emergency department for which the waiver is requested;
b. Provide a dated copy of the security risk assessment performed for the specified emergency department that has been reviewed and approved by the governing body or its designee; and
c. Indicate the requested duration of the waiver.
2. If the commissioner grants a waiver pursuant to this subsection, he shall specify:
a. The location of the emergency department for which the waiver is granted;
b. The level of security to be provided at the specified emergency department location;
c. The effective date of the waiver; and
d. The duration of the waiver, which may not exceed two years from the date of issuance.
3. A hospital granted a waiver pursuant to this subsection shall:
a. Notify the commissioner in writing no less than 30 calendar days after its security risk assessment changes and if such change impacts when and how many off-duty law-enforcement officers or trained security personnel should be present at the emergency department for which a waiver was granted;
b. Provide a dated copy of the changed security risk assessment performed for the specified emergency department that has been reviewed and approved by the governing body or its designee; and
c. Indicate whether the hospital is:
(1) Requesting a modification to its existing waiver; or
(2) Surrendering its existing waiver.
4. The commissioner may request additional information from the hospital in evaluating the requested waiver.
5. The commissioner may modify or rescind a waiver granted pursuant to this subsection if:
a. The security risk assessment changes;
b. Additional information becomes known which alters the basis for the original decision; or
c. Results of the waiver jeopardize the health or safety of patients, employees, contractors, or the public.
6. Pursuant to the Virginia Freedom of Information Act (§ 2.2-3700 et seq. of the Code of Virginia), the Department of Health:
a. May not release to the public information that a hospital discloses pursuant to this subsection, the waiver request, and the response to the waiver to the extent those records are exempt from disclosure; and
b. Shall notify the Secretary of Public Safety and Homeland Security of any request for records specified in subdivision L 6 a of this section, the person making such request, and the Department of Health’s response to the request.
J. M. Each hospital with an emergency department shall establish a protocol for treatment of individuals experiencing a substance use-related emergency to include the completion of appropriate assessments or screenings to identify medical interventions necessary for the treatment of the individual in the emergency department. The protocol may also include a process for patients who are discharged directly from the emergency department for the recommendation of follow-up care following discharge for any identified substance use disorder, depression, or mental health disorder, as appropriate, that may include:
1. Instructions for distribution of naloxone;
2. Referrals to peer recovery specialists and community-based providers of behavioral health services; or
3. Referrals for pharmacotherapy for treatment of drug or alcohol dependence or mental health diagnoses.
Documents Incorporated by Reference (12VAC5-410)
Guidelines for Design and Construction of Hospitals, 2018 Edition, Facility Guidelines Institute, Washington D.C., http://www.fgiguidelines.org
Guidelines for Design and Construction of Outpatient Facilities, 2018 Edition, Facility Guidelines Institute, Washington, D.C., https://fgiguidelines.org
Healthcare Security Industry Guidelines, International Association for Healthcare Security and Safety, 13th Edition, https://www.iahss.org/
Contact Information: Michael Capps, Senior Policy Analyst, Virginia Department of Health, James Madison Building, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-7190, FAX (804) 864-7022.
DEPARTMENT OF MEDICAL ASSISTANCE SERVICES
Intent to Amend the Virginia State Plan for Medical Assistance Pursuant to § 1902(a)(13) of the Social Security Act (USC § 1396a(a)(13)) - Update Average Commercial Rate Calculation of Supplemental Payments for Physicians Affiliated with Type One Hospitals
The Virginia Department of Medical Assistance Services (DMAS) hereby affords the public notice of its intention to amend the Virginia State Plan for Medical Assistance to provide for changes to the Methods and Standards for Establishing Payment Rates; Other Types of Care (12VAC30-80).
This notice is intended to satisfy the requirements of 42 CFR 447.205 and § 1902(a)(13) of the Social Security Act, 42 USC § 1396a(a)(13). A copy of this notice is available for public review from the contact listed at the end of this notice.
DMAS is specifically soliciting input from stakeholders, providers, and beneficiaries on the potential impact of the proposed changes discussed in this notice. Comments or inquiries may be submitted in writing within 30 days of this notice publication to Meredith Lee and such comments are available for review at the same address. Comments may also be submitted, in writing, on the Virginia Regulatory Town Hall public comment at https://townhall.virginia.gov/L/generalnotice.cfm.
Methods and Standards for Establishing Payment Rates-Other Types of Care (12VAC30-80).
In accordance with the 2022 Appropriations Act, Item 304 B(4), the state plan is being amended to update the average commercial rate calculation of supplemental payments for physicians affiliated with Type One Hospitals in Virginia effective April 1, 2023. The updated average commercial rate percentage of Medicare will be 238% (combined).
The anticipated expenditures are $2,953,150 in state general funds and $3,523,056 in federal funds in federal fiscal year 2023.
Contact Information: Meredith Lee, Policy, Regulations, and Manuals Supervisory, Policy, Regulation, and Member Engagement Division, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, 23219, telephone (804) 371-0552, FAX (804) 786-1680, TDD (800) 343-0634, or email meredith.lee@dmas.virginia.gov.
VIRGINIA CODE COMMISSION
Notice to State Agencies
Contact Information: Mailing Address: Virginia Code Commission, Pocahontas Building, 900 East Main Street, 8th Floor, Richmond, VA 23219; Telephone: (804) 698-1810; Email: varegs@dls.virginia.gov.
Meeting Notices: Section 2.2-3707 C of the Code of Virginia requires state agencies to post meeting notices on their websites and on the Commonwealth Calendar at https://commonwealthcalendar.virginia.gov.
Cumulative Table of Virginia Administrative Code Sections Adopted, Amended, or Repealed: A table listing regulation sections that have been amended, added, or repealed in the Virginia Register of Regulations since the regulations were originally published or last supplemented in the print version of the Virginia Administrative Code is available at http://register.dls.virginia.gov/documents/cumultab.pdf.
Filing Material for Publication in the Virginia Register of Regulations: Agencies use the Regulation Information System (RIS) to file regulations and related items for publication in the Virginia Register of Regulations. The Registrar's office works closely with the Department of Planning and Budget (DPB) to coordinate the system with the Virginia Regulatory Town Hall. RIS and Town Hall complement and enhance one another by sharing pertinent regulatory information.