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.

Effective Date: July 6, 2011.

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.

Summary:

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

Similar increases are adopted for clinical nurse specialists, licensed nurse practitioners, and certified massage therapists. For certified nurse aides, the board changed the renewal cycle from a biennial cycle to an annual cycle with a fee of $30. The annual fee for medication aides is 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.

Summary of Public Comments and Agency's Response: A summary of comments made by the public and the agency's response may be obtained from the promulgating agency or viewed at the office of the Registrar of Regulations.

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.