Title of Regulation: 18VAC95-30. Regulations Governing the Practice of Assisted Living Facility Administrators (amending 18VAC95-30-130, 18VAC95-30-150, 18VAC95-30-180, 18VAC95-30-190; adding 18VAC95-30-201; repealing 18VAC95-30-95).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

July 11, 2013 - 9 am - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, 2nd Floor, Suite 201, Board Room 1, Henrico, VA

Public Comment Deadline: August 30, 2013.

Agency Contact: Lisa Russell Hahn, Executive Director, Board of Long-Term Care Administrators, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4595, FAX (804) 527-4413, or email ltc@dhp.virginia.gov.

Basis: Section 54.1-2400 provides the board the authority to promulgate regulations that are reasonable and necessary to administer effectively the regulatory system. In addition, the second enactment clause of Chapter 609 of the 2011 Acts of Assembly, which amended §§ 54.1-3103.1 and 63.2-1803 of the Code of Virginia, mandated that the board promulgate regulations for the oversight of acting administrators of assisted living facilities who have sought licensure but who are not yet licensed as long-term care administrators by a preceptor registered or recognized by the board.

Purpose: The purpose of the regulatory action is to comply with the second enactment of Chapter 609 of the 2011 Acts of the Assembly. To implement the provisions of Chapter 609, the board will amend certain regulations for an administrator-in-training to ensure adequate oversight by the preceptor who is supervising the training of a person serving as the acting administrator for an assisted living facility to protect its residents, who are generally a very vulnerable population.

Since the revised law will allow an acting administrator (unlicensed person) to remain in charge of an assisted living facility for up to 180 days (rather than the current 90 days), it is essential for the health, welfare, and safety of residents in that facility to ensure appropriate oversight by the person who is supervising and training the acting administrator and to identify the status of the acting administrator to the public.

Substance: Regulations will require identification to the public that the acting administrator of an assisted living facility is an administrator-in-training, that the preceptor is responsible for appropriate oversight by being present in the facility for training on a regular basis (at least two hours per week), and that survey visit reports for the facility become part of the administrator-in-training reports. The time frame for completion of an assisted living facility administrator-in-training program is set at 150 days since the law provides that in no case shall an assisted living facility be operated with an acting administrator for more than 180 days from the last date of employment of a licensed administrator.

Issues: The primary advantage of the amendments is increased oversight of an unlicensed person who is serving as an acting administrator. If the acting administrator has applied for licensure and is in an administrator-in-training program, he may serve for 150 days with a possible 30-day extension if the acting administrator is awaiting the results of the licensure examination. During that six-month period, the facility is being run by an unlicensed person who has not yet demonstrated minimal competency. Oversight by a preceptor and appropriate identification of the acting administrator provides a measure of assurance that the residents are adequately protected. There are no disadvantages to the public. There are no advantages or disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to Chapter 609 of the 2011 Acts of the Assembly, the Board of Long-Term Care Administrators (Board) proposes to amend its requirements for the training of acting administrators of assisted living facilities who intend to become licensed administrators.

Result of Analysis. Benefits likely outweigh costs for all proposed changes.

Estimated Economic Impact. Prior to 2011, the State Board of Social Services, as the entity that licenses long term care facilities, had the authority to decide how long acting administrators could replace licensed Long Term Care Administrators. Board of Social Services regulations allowed long term care facilities 90 days after a licensed administrator left employment to hire a new licensed administrator and allowed an acting administrator to run the facility in the interim. In 2011, the General Assembly passed a bill that allows an acting administrator to do the job of a licensed administrator for 90 days while a long term care facility finds a new licensed administrator except when the acting administrator has applied to be an administrator-in-training; in that case the acting administrator can fulfill the duties of a licensed administrator for 150 days and can apply for a 30 day extension to that 150 days if the acting administrator has completed all training and testing and is just awaiting their results on the national examination.

In response to this change to the Code of Virginia, the Board of Long-Term Care Administrators proposes to change its regulations to reflect that acting administrators have 150 days to finish their administrator-in-training program and to require that preceptors for acting administrators have at least two hours of face to face contact per week with their trainees.

The change in preceptor rules is proposed because most administrators-in-training (AIT) work in a facility where the current administrator is their preceptor and, so, AITs have many hours of face to face contact. This is not the case when the acting administrator is also an AIT being trained by an outside preceptor. The Board believes that requiring a minimal amount of weekly face to face training between preceptors and acting administrators who are also AITs will result in more consistent training. Preceptors may incur some additional travel costs on account of this proposed change but these costs are likely outweighed by the benefits for the acting administrator AITs, who may get more valuable individual direction from their preceptors, and for the public served by long term care facilities.

Both the change to the Code of Virginia and the change to these regulations that give acting administrators 150 days to become licensed represent a loosening of requirements. Because this is the case, no affected entity is likely to incur any additional costs.

Businesses and Entities Affected. The Department of Health Professions (DHP) reports that the Board currently licenses approximately 600 long term care administrators. DHP further reports that fewer than 12 facilities a year have acting administrators at some time during the year. All of these entities will likely be affected by these proposed regulations.

Localities Particularly Affected. No locality will be particularly affected by this proposed regulatory action.

Projected Impact on Employment. These proposed regulations will likely have no effect on employment in the Commonwealth.

Effects on the Use and Value of Private Property. These proposed regulations will likely have no effect on the use and value of private property in the Commonwealth.

Small Businesses: Costs and Other Effects. DHP reports that most licensees are employed by small private businesses or non-profit ventures. None of these entities are, however, likely to incur any additional costs.

Small Businesses: Alternative Method that Minimizes Adverse Impact. No affected small businesses are likely to incur any additional costs on account of these proposed regulations.

Real Estate Development Costs. This regulatory action will likely have no effect on real estate development costs in the Commonwealth.

Legal Mandate. 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 Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Board of Long-Term Care Administrators concurs with the analysis of the Department of Planning and Budget for the proposed regulation, 18VAC95-30, Regulations Governing the Practice of Assisted Living Administrators.

Summary:

The proposed amendments require (i) identification to the public that the acting administrator of an assisted living facility is an administrator-in-training, (ii) that the preceptor responsible for appropriate oversight of the acting administrator be present in the facility for training on a regular basis (at least two hours per week), and (iii) that survey visit reports for the facility become part of the administrator-in-training reports.

Part III
Requirements for Licensure

18VAC95-30-95. Licensure of current administrators. (Repealed.)

A. Until January 2, 2009, any person who has served in one of the following positions for the period of one of the four years immediately preceding application for licensure may be licensed by the board:

1. A full-time administrator of record in accordance with requirements of 22VAC40-72-200, or an assistant administrator in an assisted living facility, as documented on an application for licensure; or

2. A full-time regional administrator with onsite supervisory responsibilities for one or more assisted living facilities with at least two years of previous experience as the administrator of an assisted living facility as documented on an application for licensure.

B. Persons who are applying for licensure based on experience as an administrator as specified in subsection A of this section shall document a passing grade on the national credentialing examination for administrators of assisted living facilities approved by the board.

18VAC95-30-130. Application package.

A. An application for licensure shall be submitted after the applicant completes the qualifications for licensure.

B. An individual seeking licensure as an assisted living facility administrator or registration as a preceptor shall submit:

1. A completed application as provided by the board;

2. Additional documentation as may be required by the board to determine eligibility of the applicant, to include the most recent survey report if the applicant has been serving as an acting administrator of a facility;

3. The applicable fee; and

4. An attestation that he has read and understands and will remain current with the applicable Virginia laws and the regulations relating to assisted living facilities.

C. With the exception of school transcripts, examination scores, and verifications from other state boards, all parts of the application package shall be submitted at the same time. An incomplete package shall be retained by the board for one year, after which time the application shall be destroyed and a new application and fee shall be required.

18VAC95-30-150. Required hours of training.

A. The ALF AIT program shall consist of hours of continuous training as specified in 18VAC95-30-100 A 1 in a facility as prescribed in 18VAC95-30-170 to be completed within 24 months, except a person in an ALF AIT program who has been approved by the board and is serving as an acting administrator shall complete the program within 150 days. An extension may be granted by the board on an individual case basis. The board may reduce the required hours for applicants with certain qualifications as prescribed in subsection B of this section.

B. An ALF AIT applicant with prior health care work experience may request approval to receive hours of credit toward the total hours as follows:

1. An applicant who has been employed full time for one of the past four years immediately prior to application as an assistant administrator in a licensed assisted living facility or nursing home or as a hospital administrator shall complete 320 hours in an ALF AIT;

2. An applicant who holds a license or a multistate licensure privilege as a registered nurse and who has held an administrative level supervisory position in nursing for at least one of the past four consecutive years in a licensed assisted living facility or nursing home shall complete 320 hours in an ALF AIT; or

3. An applicant who holds a license or a multistate licensure privilege as a licensed practical nurse and who has held an administrative level supervisory position in nursing for at least one of the past four consecutive years in a licensed assisted living facility or nursing home shall complete 480 hours in an ALF AIT.

18VAC95-30-180. Preceptors.

A. Training in an ALF AIT program shall be under the supervision of a preceptor who is registered or recognized by a licensing board.

B. To be registered by the board as a preceptor, a person shall:

1. Hold a current, unrestricted Virginia assisted living facility administrator or nursing home administrator license;

2. Be employed full-time as an administrator in a training facility or facilities for a minimum of one of the past four years immediately prior to registration or be a regional administrator with on-site supervisory responsibilities for a training facility or facilities; and

3. Submit an application and fee as prescribed in 18VAC95-30-40. The board may waive such application and fee for a person who is already approved as a preceptor for nursing home licensure.

C. A preceptor shall:

1. Provide direct instruction, planning and evaluation;

2. Be routinely present with the trainee in the training facility; and

3. Continually evaluate the development and experience of the trainee to determine specific areas needed for concentration.

D. A preceptor may supervise no more than two trainees at any one time.

E. A preceptor for a person who is serving as an acting administrator while in an ALF AIT program shall be present in the training facility for face-to-face instruction and review of the trainee's performance for a minimum of two hours per week.

18VAC95-30-190. Reporting requirements.

A. The preceptor shall maintain progress reports on forms prescribed by the board for each month of training. For a person who is serving as an acting administrator while in an ALF AIT program, the preceptor shall include in the progress report evidence of face-to-face instruction and review for a minimum of two hours per week.

B. The trainee's certificate of completion plus the accumulated original monthly reports shall be submitted by the preceptor to the board within 30 days following the completion of the program.

18VAC95-30-201. Administrator-in-training program for acting administrators.

A. A person who is in an ALF AIT program while serving as an acting administrator pursuant to § 54.1-3103.1 of the Code of Virginia shall be identified on his nametag as an acting administrator-in-training.

B. The facility shall post the certificate issued by the board for the acting administrator and a copy of the license of the preceptor in a place conspicuous to the public.