TITLE 12. HEALTH

STATE BOARD OF HEALTH

Fast-Track Regulation

Title of Regulation: 12VAC5-217. Regulations of the Patient Level Data System (amending 12VAC5-217-20).

Statutory Authority: §§ 32.1-12 and 32.1-276.6 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: March 25, 2026.

Effective Date: April 9, 2026.

Agency Contact: Kindall Bundy, Policy Analyst, Virginia Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 986-5270, or email kindall.bundy@vdh.virginia.gov.

Basis: Section 32.1-12 of the Code of Virginia authorizes the State Board of Health to make, adopt, promulgate, and enforce regulations. Section 32.1-276.6 of the Code of Virginia requires the board to establish and administer an integrated system for collection and analysis of data used by consumers, employers, providers, purchasers of health care, and state government and requires each inpatient hospital to submit patient-level data to the board.

Purpose: This action is essential to protect the health, safety, and welfare of citizens because the regulation does not reflect current data elements submitted by inpatient hospitals or statutory mandates, therefore burdening the regulated community. Amending the regulation to include statutory mandates, updated data elements, and technical changes for form and style will ensure that the language from the emergency regulation is permanently adopted, that data elements reflect current industry practices, and that the regulation is clear and uniform.

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 conforms the regulation to statutory mandates and the existing data elements currently submitted by the inpatient hospitals in Virginia. Regulated entities are already submitting the data elements being added to the regulatory text because they are required by federal rules or because the data elements are part of the Uniform Billing Form, which is the standard claim form that hospitals use for all data related to hospital admissions and would be collected even if the board did not require reporting of the data elements to Virginia Health Information (VHI).

Substance: The amendments (i) add codes for the legal status of voluntary or involuntary psychiatric admissions to the data required to be reported to the board; (ii) replace the data element table with a new table consisting of all data elements currently submitted by inpatient hospitals to VHI; and (iii) remove nonregulatory references to the Uniform Billing Form and Manual.

Issues: The primary advantages to the public are the removal of nonregulatory language, the addition of legislative mandates that were not previously incorporated into the regulation, and the addition of data elements currently submitted by inpatient hospitals. The primary advantages to the agency and the Commonwealth are increased clarity of the reporting requirements for inpatient hospitals of patient-level data elements, which may reduce staff time spent reviewing incorrect or incomplete submissions and avoid data resubmissions. There are no disadvantages to the public or the Commonwealth.

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. As the result of a 2020 budget mandate, the State Board of Health (board) is proposing to make permanent an emergency regulation that requires inpatient hospitals to report the admission source (legal status) for any individuals meeting the criteria for voluntary or involuntary psychiatric commitment.² The board also now proposes to amend the regulation to reflect the data reporting elements currently submitted by inpatient hospitals to Virginia Health Information (VHI).

Background. Item 307 D.1 of the 2020 Appropriation Act states that:³ Inpatient hospitals shall report the admission source of any individuals meeting the criteria for voluntary or involuntary psychiatric commitment as outlined in § 16.1-338, 16.1-339, 16.1-340.1, 16.1-345, 37.2-805, 37.2-809, or 37.2-904 of the Code of Virginia, to the State Board of Health. The board shall collect and share any and all data regarding the admission source of individuals admitted to inpatient hospitals as a psychiatric patient, pursuant to § 32.1-276.6, Code of Virginia, with the Department of Behavioral Health and Developmental Services. Further, the Act instructed the Virginia Department of Health (VDH) to promulgate an emergency regulation for this purpose.

In response, in an emergency regulation⁴ that became effective on January 17, 2022, the board added an additional category (legal status) to the list of patient level data elements that inpatient hospitals must submit. This category is comprised of seven different possible admission sources, as follows:

1= § 16.1-338 Parental admission of minors < 14 and nonobjecting minors 14 years of age or older

2=§ 16.1-339 Parental admission of objecting minor 14 years of age or older

3=§ 16.1-340.1 Involuntary TDO⁵ (minor)

4=§ 16.1-345 Involuntary commitment (minor)

5=§ 37.2-805 Voluntary admission (adult)

6=§ 37.2-809 Involuntary TDO (adult)

7=§ 37.2-904 Sexually violent predators (prisoners or defendants)

The board is proposing to amend the regulation to make the reporting of legal status permanent. The board also proposes to amend the regulation to reflect the data reporting elements currently submitted by inpatient hospitals to VHI, which would change the numbering and order of the data elements being reported. Section 32.1-276.4 of the Code of Virginia requires that the VDH commissioner negotiate and enter into contracts or agreements with a nonprofit organization for the compilation, storage, analysis, and evaluation of data submitted by health care providers.⁶ In practice, VHI is that nonprofit organization.

Estimated Benefits and Costs. Collecting admission source data for individuals meeting the criteria for psychiatric commitment is beneficial in that it can be used to help produce better-informed public policy. The proposed required reporting does entail some additional staff time for inpatient hospitals. In any case, the requirement is a legislative mandate and is not discretionary for the board. Amending the regulation to reflect the data reporting elements that are submitted by inpatient hospitals to VHI is beneficial in that it improves clarity by reflecting the existing reporting practices. Accordingly, no additional costs are expected.

Businesses and Other Entities Affected. The 102 hospitals that submit patient level data are affected.⁷ The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁸ 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.⁹ No proposed discretionary change increases net cost or reduces net benefit for any entity. Thus, an adverse impact is not indicated.

Small Businesses¹⁰ Affected.¹¹ VDH reports that none of the hospitals qualify as small businesses.

Localities¹² Affected.¹³ The proposed amendments neither disproportionally affect any particular localities, nor affect costs for local governments.

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

Effects on the Use and Value of Private Property. The proposed amendments do not substantively affect the use and value of private property. The proposed amendments do not affect 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 See https://townhall.virginia.gov/L/viewmandate.cfm?mandateid=1107.

³ See https://budget.lis.virginia.gov/item/2020/1/HB30/Chapter/1/307/.

⁴ See https://townhall.virginia.gov/L/ViewStage.cfm?stageid=9398.

⁵ TDO stands for temporary detention order.

⁶ See https://law.lis.virginia.gov/vacode/title32.1/chapter7.2/section32.1-276.4/.

⁷ Data source.

⁸ 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.

⁹ 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.

¹⁰ 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."

¹¹ 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.

¹² "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.

¹³ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Virginia Department of Health concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

Item 307 D 1 of Chapter 552 of the 2021 Acts of Assembly, Special Session I, requires inpatient hospitals to report the admission source of any individuals meeting the criteria for voluntary or involuntary psychiatric commitment as outlined in § 16.1-338, 16.1-339, 16.1-340.1, 16.1-345, 37.2-805, 37.2-809, or 37.2-904 of the Code of Virginia to the State Board of Health. The board is required to collect and share such data regarding the admission source of individuals admitted to inpatient hospitals as a psychiatric patient with the Department of Behavioral Health and Developmental Services (DBHDS). The amendments (i) conform the provisions in the regulation to reflect the data reporting elements currently submitted by inpatient hospitals to Virginia Health Information (VHI) and (ii) remove nonregulatory language to conform to 1VAC7-10-40.

12VAC5-217-20. Reporting requirements for patient level data elements.

Every Each inpatient hospital shall submit, in an electronic data format, a complete filing of each patient level data element listed in the table in this section for each hospital inpatient, including a separate record for each infant, if applicable. Most of these data elements are currently collected from a Uniform Billing Form located in the latest publication of the Uniform Billing Manual prepared by the National Uniform Billing Committee. The Uniform Billing Form and the Uniform Billing Manual are located on the National Uniform Billing Committee's website at www.nubc.org. The Uniform Billing Manual provides a detailed field description and any special instruction pertaining to that element. An asterisk (*) indicates when the required data element is either not on the billing form or in the Uniform Billing Manual. The instructions provided under that particular data element should then be followed. Inpatient hospitals that submit patient level data directly to the board or the nonprofit organization shall submit it in an electronic data format.