TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

DEPARTMENT OF HEALTH PROFESSIONS

Final Regulation

Titles of Regulations: 18VAC76-50. Regulations Governing Practitioner Self-Referral (adding 18VAC76-50-10 through 18VAC76-50-80).

18VAC76-60. Regulations Governing the Criteria for Certification of Dialysis Technicians (adding 18VAC76-60-10, 18VAC76-60-20, 18VAC76-60-30).

Statutory Authority: §§ 54.1-2410 and 54.1-2505 of the Code of Virginia.

Effective Date: November 19, 2025.

Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, fax (804) 915-0382, or email erin.barrett@dhp.virginia.gov.

Summary:

Pursuant to Chapter 341 of the 2025 Acts of Assembly, which eliminates the Board of Health Professions and transfers certain powers and duties from the board to the Department of Health Professions, the department is moving Regulations Governing Practitioner Self-Referral and Regulations Governing the Criteria for Certification of Dialysis Technicians into the department's regulatory catalog without substantive changes to ensure statutory duties once performed by the board will continue to be performed by other boards within the department.

Chapter 50

Regulations Governing Practitioner Self-Referral

Part I

General Provisions

18VAC76-50-10. Definitions.

Statutory definitions of words and terms related to the Practitioner Self-Referral Act are established in § 54.1-2410 of the Code of Virginia.

The following additional words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise:

"Act" means the Practitioner Self-Referral Act, Chapter 24.1 (§ 54.1-2410 et seq.) of Title 54.1 of the Code of Virginia.

"Applicant" means a practitioner or entity who has applied to the board for an advisory opinion on the applicability of the Act, or for an exception to the prohibitions of the Act.

"Appropriate regulatory board" means the regulatory board within the Department of Health Professions that licenses or certifies the practitioner.

"Committee" means an informal conference committee of a regulatory board.

"Department" means the Department of Health Professions.

"Director" means the Director of the Department of Health Professions.

Part II

Advisory Opinions and Exceptions

18VAC76-50-20. Application for advisory opinions.

A. Any practitioner or entity may request an advisory opinion on the applicability of the Act upon completion of an application and payment of a fee.

B. Requests shall be made on an application form prescribed by the department. The request shall contain the following information:

1. The name of the practitioner or entity;

2. Identification of the practitioner or entity and description of the health care services being provided or proposed;

3. The type and amount of existing or proposed investment interest in the entity;

4. A description of the nature of the investment interest and copies of any existing or proposed documents between the practitioner and the entity, including leases, contracts, and organizational documents; and

5. Certification and notarized signature of the practitioner or principal of the entity requesting the advisory opinion that the information and supporting documentation contained within it is true and correct.

C. The application shall be reviewed for completeness, and the department may request such other additional information or documentation the department deems necessary from the practitioner or entity.

D. Upon a determination that a request for an advisory opinion is complete and that it has sufficient information, the department shall notify the practitioner or entity that the department will consider the practitioner or entity's request.

E. At the conclusion of an informal conference, the department shall issue an advisory opinion to the practitioner or entity.

18VAC76-50-30. Application for exception.

A. A practitioner or entity may request an exception to the prohibitions of the Act upon completion of an application and payment of a fee.

B. Requests shall be made on an application form prescribed by the department. The application shall contain the following information:

1. The name and identifying information of the practitioner or entity;

2. The information and documentation regarding community need and alternative financing as required by § 54.1-2411 B of the Code of Virginia; and

3. Certification and notarized signature of the practitioner or principal of the entity requesting the exception that the information contained in the application and supporting documentation is true and correct.

C. The application shall be reviewed for completeness, and the department may request additional information and documentation from the applicant.

D. Upon a determination that an application is complete and that it has sufficient information, the department shall notify the applicant that the department will consider the request.

E. At the conclusion of an informal conference, the department shall issue a decision regarding the request for an exception to the applicant.

F. Exceptions to the Act shall be valid for a period of no more than five years.

G. An exception shall be renewed upon payment of a renewal fee and the receipt of certification from the practitioner or entity that the conditions under which the original exception was granted continue to warrant the exception.

18VAC76-50-40. Fees.

A. An application fee for an opinion on applicability of the Act shall be $500.

B. An application fee for an exception to the Act shall be $1,000.

C. The renewal fee for board approval of exceptions to the Act shall be $250.

Part III

Discipline

18VAC76-50-50. Disciplinary action against entities.

The department shall determine violations of prohibitions of the Act on the part of an entity other than a practitioner as defined in § 54.1-2410 of the Code of Virginia in accordance with the provisions of the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia).

18VAC76-50-60. Disciplinary action against practitioners.

A. Upon receipt of an investigative report of an alleged violation of the Act by a practitioner as defined in § 54.1-2410 of the Code of Virginia, the director shall provide a copy of the report to the appropriate regulatory board.

B. Violations of the Act by a practitioner shall be determined by the appropriate regulatory board within the department and shall be subject to disciplinary action by that regulatory board in accordance with § 54.1-2412 D of the Code of Virginia.

C. Upon closure of a case involving an alleged violation of the Act by a practitioner, the appropriate regulatory board shall provide a copy of the final order or of the letter of dismissal of the case to the director.

D. The director shall review periodically the disposition of cases involving allegations of violation of the Act by practitioners to ensure the protection of the public and the fair and equitable treatment of health professionals.

18VAC76-50-70. Decision to delegate.

The director may delegate an informal conference to an agency subordinate to consider an application for an advisory opinion or an exception to the provisions of the Act.

18VAC76-50-80. Criteria for an agency subordinate.

An agency subordinate authorized by the director to conduct an informal conference may include current or past members of regulatory boards and professional staff or other persons deemed knowledgeable by virtue of their training and experience in the organizational structure of entities providing the health care services identified in the application.

FORMS (18VAC76-50)

Application for an Exception to the Prohibitions of the Virginia Practitioner Self-Referral Act (rev. 9/2025)

Application for an Advisory Opinion - Virginia Self-Referral Act (rev. 9/2025)

Chapter 60

Regulations Governing the Criteria for Certification of Dialysis Technicians

18VAC76-60-10. Definitions.

The following terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Dialysis patient care technician" or "dialysis care technician" means a person who has obtained certification from an organization approved by the director to provide, under the supervision of a licensed practitioner of medicine or a registered nurse, direct care to patients undergoing renal dialysis treatments in a Medicare-certified renal dialysis facility. Such direct care may include the administration of heparin, topical needle site anesthetics, dialysis solutions, sterile normal saline solution, and blood volumizers in accordance with the order of a licensed physician, nurse practitioner, or physician assistant.

"Director" means the Director of the Department of Health Professions.

18VAC76-60-20. General provisions; scope of practice.

A. In accordance with Chapter 27.01 (§ 54.1-2729.1 et seq.) of Title 54.1 of the Code of Virginia and this chapter, only those persons who hold certification from an entity approved by the director as prescribed in 18VAC76-60-30 shall:

1. Provide direct patient care in a Medicare-certified renal dialysis facility.

2. Administer medications in accordance with § 54.1-3408 T of the Code of Virginia.

B. Dialysis patient care technicians or dialysis care technicians shall practice only under the supervision of a licensed practitioner of medicine or a registered nurse.

C. Dialysis patient care technicians or dialysis care technicians shall administer medications only under the orders of a licensed physician, nurse practitioner, or physician assistant and under the direct and immediate supervision of a registered nurse.

D. Persons who do not hold such certification shall not hold the restricted titles or use any other title or term that implies a minimum level of education, training, and competence. Unregulated persons shall only perform services relating to the technical elements of dialysis, such as equipment maintenance and preparation of dialyzers for reuse by the same patient.

18VAC76-60-30. Criteria for use of the titles of dialysis patient care technician or dialysis care technician.

In order to use the titles of dialysis patient care technician or dialysis care technician or administer medications in a Medicare-certified renal dialysis facility, a person shall hold one of the certifications approved by the director.