TITLE 8. EDUCATION

STATE BOARD OF EDUCATION

Fast-Track Regulation

Title of Regulation: 8VAC20-800. Standards for Licensed Family Day Homes (amending 8VAC20-800-70, 8VAC20-800-220).

Statutory Authority: §§ 22.1-16 and 22.1-289.046 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: December 17, 2025.

Effective Date: January 1, 2026.

Agency Contact: Alyson Williams, Legislative Consultant, Department of Education, Office of Child Care Health and Safety, 101 North 14th Street, 14th Floor, Richmond, VA 23219, telephone (804) 774-6273, or email alyson.williams@doe.virginia.gov.

Basis: Section 22.1-16 of the Code of Virginia authorizes the State Board of Education to promulgate regulations necessary to carry out its powers and duties and the provisions of Title 22.1 of the Code of Virginia. Section 22.1-289.046 of the Code of Virginia requires the board to adopt regulations for the activities, services, and facilities to be employed by persons and agencies required to be licensed under Chapter 14.1 (§ 22.1-289.02 et seq.) of Title 22.1 of the Code of Virginia, which shall be designed to ensure that such activities, services, and facilities are conducive to the welfare of the children under the control of such persons or agencies.

Purpose: The action is essential to enhancing the health, safety, and welfare of children in care because it protects children with undiagnosed allergies in cases when exposure to the allergen may result in anaphylaxis that could be deadly. The action is required to comply with the provisions of Chapters 122 and 123 of the 2023 Acts of Assembly.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking process because it is required by Chapters 122 and 123 of the 2023 Acts of Assembly.

Substance: The amendments require (i) each family day home provider or at least one other caregiver employed by such provider to be trained in epinephrine administration and (ii) each family day home provider to notify the parents of each child who receives care in such family day home whether the provider stores an appropriate weight-based dosage of epinephrine in the residence or home in which the family day home operates. The amendments include technical edits.

Issues: The advantage of this action is that the requirement that each family day home provider or at least one other caregiver employed by such provider to be trained in epinephrine administration increases protections for children by ensuring that caregivers are trained to respond to anaphylaxis and could potentially save the life of a child who experiences anaphylactic shock as a result of an allergic reaction. The requirement that family day homes notify the parents of each child who receives care in such family day home whether the provider stores an appropriate weight-based dosage of epinephrine supports parental choice by allowing parents to make informed decisions related to child care placement based on the availability of undesignated epinephrine in a family day home. There are no disadvantages to this regulatory action.

Department of Planning and Budget Economic Impact Analysis:

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 Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. Pursuant to Chapter 122 and Chapter 123 of the 2023 Acts of Assembly (mandate), which amended § 22.1-289.059 of the Code of Virginia, the Board of Education (board) proposes amendments to the regulation concerning the possession and administration of epinephrine at family day homes licensed by the Virginia Department of Education.

Background. Consistent with § 22.1-289.02 of the Code of Virginia, the regulation defines family day home as a child day program offered in the residence of the provider or the home of any of the children in care for one through 12 children less than 13 years of age, exclusive of the provider's own children and any children who reside in the home, when at least one child receives care for compensation. The mandate, as codified in § 22.1-289.059 of the Code of Virginia, states that the board shall amend its regulations to require each family day home provider or at least one other caregiver employed by such provider in the family day home to be trained in the administration of epinephrine and to notify the parents of each child who receives care in such family day home whether the provider stores an appropriate weight-based dosage of epinephrine in the residence or home in which the family day home operates. The Board proposes to amend the regulation in this manner. Possession of epinephrine would be optional for family day homes. The family day homes would be required to notify parents in writing whether it stores an appropriate weight-based dosage of undesignated or stock epinephrine in the residence or home in which the family day home operates. The proposed text specifies that the provider or at least one other caregiver shall receive training in the administration of epinephrine, and: The administration of undesignated or stock epinephrine shall be performed by the provider or a caregiver who (i) [has satisfactorily completed a training program for this purpose developed or approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist], (ii) has satisfactorily completed a training course developed or approved by the Department of Education in consultation with the Department of Health, or (iii) completed a course taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist that includes the following: 1. Recognizing signs and symptoms of anaphylaxis; 2. Emergency procedures for responding to anaphylaxis; and 3. Instructions and procedures for administering epinephrine. This requirement applies to all family day homes, even those that decide not to possess epinephrine.

Estimated Benefits and Costs. Anaphylaxis is a severe, life-threatening allergic reaction. It can happen seconds or minutes after a person has been exposed to an allergen.² Immediate use of an epinephrine autoinjector can keep anaphylaxis from worsening and can be lifesaving.³ Thus, if family day homes choose to store undesignated or stock epinephrine, requiring that at least one person is qualified to administer epinephrine has the potential to save the lives of children with undiagnosed allergies in cases when exposure to the allergen may result in anaphylaxis. An EpiPen package comes with two auto-injectors of 0.3 mg and is approved for adults and children who weigh 66 lbs or more. The EpiPen JR package comes with two auto-injectors of 0.15 mg and is approved for children who weigh 33 lbs to 66 lbs.⁴ There are now also Food and Drug Administration (FDA) approved epinephrine auto-injectors of 0.1 mg for infants and toddlers.⁵ Retail prices for a package of two brand name epinephrine auto-injectors range from $650 to $750 without insurance.⁶ FDA-authorized generic epinephrine is available from CVS at $109.99 per two-pack.⁷ Epinephrine autoinjectors have a shelf life of 12 to 18 months from the date of manufacture.⁸ For a child day center with children that fall into all three weight groups, and uses the FDA-authorized generic epinephrine from CVS, it would cost approximately $330 annually to maintain non-expired epinephrine on hand.⁹ DOE reports that it is already under contract with an outside entity that provides training in medication administration, including epinephrine administration. DOE is proposing a training program for staff at family day homes on the administration of epinephrine by this entity. If the training proposal is approved by VDH, the undesignated or stock epinephrine training would be developed. DOE's plan is for the training to be offered at no cost to the family day homes.

Businesses and Other Entities Affected. The proposed amendments would affect the 1,338 licensed family day homes. DOE believes that all would qualify as small businesses. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.¹⁰ An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.¹¹ As acquiring and storing epinephrine would be optional, and since it appears that the training may be offered for free to the family day homes, no adverse impact is indicated.

Small Businesses¹² Affected.¹³ As noted above, all family day homes appear to be small businesses. The proposed regulation does not appear to introduce costs beyond those already required by the legislation.

Localities¹⁴ Affected.¹⁵ The proposed amendments neither appear to disproportionally affect particular localities nor affect costs for local governments.

Projected Impact on Employment. The proposed amendments do not appear to substantively affect total employment.

Effects on the Use and Value of Private Property. The proposed amendments do not substantively affect the use and use value of private property or real estate development costs.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² Source: Mayo Clinic https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468.

³ Source: Mayo Clinic https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474.

⁴ See https://www.goodrx.com/epinephrine-epipen/how-to-save-cost.

⁵ See https://www.fda.gov/media/127806/download.

⁶ Supra, note 4.

⁷ See https://www.cvs.com/content/epipen-alternative.

⁸ See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720482/.

⁹ Average of $110 per epinephrine auto-injector package, and three separate packages for the three different weight groups.

¹⁰ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

¹¹ Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.

¹² Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

¹³ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

¹⁴ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

¹⁵ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to the Economic Impact Analysis: The State Board of Education thanks the Department of Planning and Budget for its thorough economic impact analysis.

Summary:

Pursuant to Chapters 122 and 123 of the 2023 Acts of Assembly, the amendments require (i) each family day home provider or at least one other caregiver employed by such provider to be trained in epinephrine administration and (ii) each family day home provider to notify the parents of each child who receives care in such family day home whether the provider stores an appropriate weight-based dosage of epinephrine in the residence or home in which the family day home operates.

8VAC20-800-70. Written information for parents.

A. Before the child's first day of attendance, parents shall be provided, in writing, the following information:

1. Operating information, including the hours and days of operation, holidays, or other times closed, and the telephone number where a message can be left for a caregiver;

2. Schedule of fees and payment plans;

3. Check in Check-in and check out check-out procedures;

4. Policies for the administration of medications;

5. Whether or not there is liability insurance of at least $100,000 per occurrence and $300,000 aggregate in force on the family day home operation as required by § 22.1-289.050 of the Code of Virginia;

6. Requirement for the family day home to notify the parent when the child becomes ill and for the parent to arrange to have the child picked up as soon as possible if so requested by the home;

7. Requirement for the parent to inform the family day home within 24 hours or the next business day after his the child or any member of the immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life-threatening diseases, which must be reported immediately;

8. Requirement for the child to be adequately immunized as required by 8VAC20-800-90;

9. Requirement for paid caregivers to report suspected child abuse or neglect according to § 63.2-1509 of the Code of Virginia;

10. Custodial parent's right to be admitted to the family day home any time the child is in care as required by § 22.1-289.054 of the Code of Virginia;

11. General daily schedule that is appropriate for the age of the enrolling child;

12. Policies for the provision of food;

13. Presence of a pet or animal in the home;

14. Discipline policies, including acceptable and unacceptable discipline measures;

15. Amount of time per week that an adult assistant or substitute provider instead of the provider is scheduled to care for the child and the name of the adult assistant or substitute provider;

16. Provisions of the family day home's emergency preparedness and response plan;

17. Parental notifications required in 8VAC20-800-650;

18. Policies for termination of care; and

19. Whether the provider stores an appropriate weight-based dosage of undesignated or stock epinephrine in the residence or home in which the family day home operates as required by § 22.1-289.059 of the Code of Virginia; and

20. Address of the website of the department, with a note that a copy of this chapter and additional information about the family day home may be obtained from the website, including compliance history that includes information after July 1, 2003.

B. The provider shall obtain the parent's written acknowledgement of the receipt of the information in this section.

8VAC20-800-220. Medication administration training.

A. To safely perform medication administration practices listed in 8VAC20-800-710 and 8VAC20-800-720 whenever the family day home has agreed to administer prescription medications or nonprescription medications, the administration shall be performed by a caregiver who:

1. Has satisfactorily completed a training program for this purpose developed or approved by the Board of Nursing and taught by a registered nurse, licensed practical nurse, doctor of medicine or osteopathic medicine, or pharmacist; or

2. Is licensed by the Commonwealth of Virginia to administer medications.

B. Caregivers The administration of undesignated or stock epinephrine shall be performed by the provider or a caregiver who:

1. Meets the requirements of subsection A of this section;

2. Has satisfactorily completed a training course developed or approved by the Department of Education in consultation with the Virginia Department of Health; or

3. Completed a course taught by a registered nurse, licensed practical nurse, nurse practitioner, physician assistant, doctor of medicine or osteopathic medicine, or pharmacist that includes the following:

a. Recognizing signs and symptoms of anaphylaxis;

b. Emergency procedures for responding to anaphylaxis; and

c. Instructions and procedures for administering epinephrine.

C. The provider and caregivers required to have the training in subdivision A 1 and subsection B of this section shall be retrained at three-year intervals.

D. The provider or at least one other caregiver shall receive training in the administration of epinephrine pursuant to subsections B and C of this section.