REGISTER INFORMATION PAGE
Vol. 42 Iss. 23 - June 29, 2026

THE VIRGINIA REGISTER OF REGULATIONS is an official state publication issued every other week throughout the year. Indexes are published quarterly, and are cumulative for the year. The Virginia Register has several functions. The new and amended sections of regulations, both as proposed and as finally adopted, are required by law to be published in the Virginia Register. In addition, the Virginia Register is a source of other information about state government, including petitions for rulemaking, emergency regulations, executive orders issued by the Governor, and notices of public hearings on regulations.

ADOPTION, AMENDMENT, AND REPEAL OF REGULATIONS

Unless exempted by law, an agency wishing to adopt, amend, or repeal regulations must follow the procedures in the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia). Typically, this includes first publishing in the Virginia Register a notice of intended regulatory action; a basis, purpose, substance and issues statement; an economic impact analysis prepared by the Department of Planning and Budget; the agency’s response to the economic impact analysis; a summary; a notice giving the public an opportunity to comment on the proposal; and the text of the proposed regulation.

Following publication of the proposed regulation in the Virginia Register, the promulgating agency receives public comments for a minimum of 60 days. The Governor reviews the proposed regulation to determine if it is necessary to protect the public health, safety, and welfare, and if it is clearly written and easily understandable. If the Governor chooses to comment on the proposed regulation, his comments must be transmitted to the agency and the Registrar of Regulations no later than 15 days following the completion of the 60-day public comment period. The Governor’s comments, if any, will be published in the Virginia Register. Not less than 15 days following the completion of the 60-day public comment period, the agency may adopt the proposed regulation.

The Joint Commission on Administrative Rules or the appropriate standing committee of each house of the General Assembly may meet during the promulgation or final adoption process and file an objection with the Registrar and the promulgating agency. The objection will be published in the Virginia Register. Within 21 days after receipt by the agency of a legislative objection, the agency shall file a response with the Registrar, the objecting legislative body, and the Governor.

When final action is taken, the agency again publishes the text of the regulation as adopted, highlighting all changes made to the proposed regulation and explaining any substantial changes made since publication of the proposal. A 30-day final adoption period begins upon final publication in the Virginia Register.

The Governor may review the final regulation during this time and, if he objects, forward his objection to the Registrar and the agency. In addition to or in lieu of filing a formal objection, the Governor may suspend the effective date of a portion or all of a regulation until the end of the next regular General Assembly session by issuing a directive signed by a majority of the members of the appropriate legislative body and the Governor. The Governor’s objection or suspension of the regulation, or both, will be published in the Virginia Register.

If the Governor finds that the final regulation contains changes made after publication of the proposed regulation that have substantial impact, he may require the agency to provide an additional 30-day public comment period on the changes. Notice of the additional public comment period required by the Governor will be published in the Virginia Register. Pursuant to § 2.2-4007.06 of the Code of Virginia, any person may request that the agency solicit additional public comment on certain changes made after publication of the proposed regulation. The agency shall suspend the regulatory process for 30 days upon such request from 25 or more individuals, unless the agency determines that the changes have minor or inconsequential impact.

A regulation becomes effective at the conclusion of the 30-day final adoption period, or at any other later date specified by the promulgating agency, unless (i) a legislative objection has been filed, in which event the regulation, unless withdrawn, becomes effective on the date specified, which shall be after the expiration of the 21-day objection period; (ii) the Governor exercises his authority to require the agency to provide for additional public comment, in which event the regulation, unless withdrawn, becomes effective on the date specified, which shall be after the expiration of the period for which the Governor has provided for additional public comment; (iii) the Governor and the General Assembly exercise their authority to suspend the effective date of a regulation until the end of the next regular legislative session; or (iv) the agency suspends the regulatory process, in which event the regulation, unless withdrawn, becomes effective on the date specified, which shall be after the expiration of the 30-day public comment period and no earlier than 15 days from publication of the readopted action.

A regulatory action may be withdrawn by the promulgating agency at any time before the regulation becomes final.

FAST-TRACK RULEMAKING PROCESS

Section 2.2-4012.1 of the Code of Virginia provides an alternative to the standard process set forth in the Administrative Process Act for regulations deemed by the Governor to be noncontroversial. To use this process, the Governor's concurrence is required and advance notice must be provided to certain legislative committees. Fast-track regulations become effective on the date noted in the regulatory action if fewer than 10 persons object to using the process in accordance with § 2.2-4012.1.

EMERGENCY REGULATIONS

Pursuant to § 2.2-4011 of the Code of Virginia, an agency may adopt emergency regulations if necessitated by an emergency situation or when Virginia statutory law or the appropriation act or federal law or federal regulation requires that a regulation be effective in 280 days or fewer from its enactment. In either situation, approval of the Governor is required. The emergency regulation is effective upon its filing with the Registrar of Regulations, unless a later date is specified per § 2.2-4012 of the Code of Virginia. Emergency regulations are limited to no more than 18 months in duration; however, may be extended for six months under the circumstances noted in § 2.2-4011 D. Emergency regulations are published as soon as possible in the Virginia Register and are on the Register of Regulations website at register.dls.virginia.gov.

During the time the emergency regulation is in effect, the agency may proceed with the adoption of permanent regulations in accordance with the Administrative Process Act. If the agency chooses not to adopt the regulations, the emergency status ends when the prescribed time limit expires.

STATEMENT

The foregoing constitutes a generalized statement of the procedures to be followed. For specific statutory language, it is suggested that Article 2 (§ 2.2-4006 et seq.) of Chapter 40 of Title 2.2 of the Code of Virginia be examined carefully.

CITATION TO THE VIRGINIA REGISTER

The Virginia Register is cited by volume, issue, page number, and date. 34:8 VA.R. 763-832 December 11, 2017, refers to Volume 34, Issue 8, pages 763 through 832 of the Virginia Register issued on December 11, 2017.

The Virginia Register of Regulations is published pursuant to Article 6 (§ 2.2-4031 et seq.) of Chapter 40 of Title 2.2 of the Code of Virginia.

Members of the Virginia Code Commission: Marcus B. Simon, Chair; Russet W. Perry, Vice Chair; Katrina E. Callsen; Nicole Cheuk; Richard E. Gardiner; Travis Hill; Ryan T. McDougle; Michael Mullin; Christopher R. Nolen; Charles S. Sharp; Malfourd W. Trumbo; Amigo R. Wade.

Staff of the Virginia Register: Holly Trice, Registrar of Regulations; Anne Bloomsburg, Assistant Registrar; Nikki Clemons, Managing Editor; Erin Comerford, Regulations Analyst.

PUBLICATION SCHEDULE AND DEADLINES
Vol. 42 Iss. 23 - June 29, 2026

July 2026 through July 2027

Volume: Issue

Material Submitted By Noon*

Will Be Published On

42:24

June 24, 2026

July 13, 2026

42:25

July 8, 2026

July 27, 2026

42:26

July 22, 2026

August 10, 2026

43:1

August 5, 2026

August 24, 2026

43:2

August 19, 2026

September 7, 2026

43:3

September 2, 2026

September 21, 2026

43:4

September 16, 2026

October 5, 2026

43:5

September 30, 2026

October 19, 2026

43:6

October 14, 2026

November 2, 2026

43:7

October 28, 2026

November 16, 2026

43:8

November 10, 2026 (Tuesday)

November 30, 2026

43:9

November 23, 2026 (Monday)

December 14, 2026

43:10

December 9, 2026

December 28, 2026

43:11

December 21, 2026 (Monday)

January 11, 2027

43:12

January 5, 2027 (Tuesday)

January 25, 2027

43:13

January 20, 2027

February 8, 2027

43:14

February 3, 2027

February 22, 2027

43:15

February 17, 2027

March 8, 2027

43:16

March 3, 2027

March 22, 2027

43:17

March 17, 2027

April 5, 2027

43:18

March 31, 2027

April 19, 2027

43:19

April 14, 2027

May 3, 2027

43:20

April 28, 2027

May 17, 2027

43:21

May 12, 2027

May 31, 2027

43:22

May 26, 2027

June 14, 2027

43:23

June 9, 2027

June 28, 2027

43:24

June 23, 2027

July 12, 2027

43:25

July 7, 2027

July 26, 2027

*Filing deadlines are Wednesdays unless otherwise specified.

PETITIONS FOR RULEMAKING
Vol. 42 Iss. 23 - June 29, 2026

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF MEDICINE

Agency Decision

Title of Regulation: 18VAC85-20. Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic.

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

Name of Petitioner: Bernadette Lozano.

Nature of Petitioner's Request: The petitioner requests that the board amend 18VAC85-20 to insert a requirement that a practitioner must disclose the serial number, manufactured date, and expiration date information of a medical implant device upon discharge from a hospital or surgery center when one has been inserted.

Agency Decision: Request denied.

Statement of Reason for Decision: At the Board of Medicine meeting on June 4, 2026, the board voted to deny the petition because the information requested to be recorded by the treating practitioner is available from entities (hospitals and ambulatory surgery centers) that are not under the jurisdiction of the board and any request for change should be directed to the agency that does oversee those entities, which is the Virginia Department of Health.

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, or email erin.barrett@dhp.virginia.gov.

VA.R. Doc. No. PFR26-21; Filed February 2, 2026, 8:46 a.m.

Agency Decision

Title of Regulation: 18VAC85-20. Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic.

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

Name of Petitioner: Dr. Timothy Mountcastle.

Nature of Petitioner's Request: The petitioner requests that the Board of Medicine promulgate regulations that (i) state that cosmetic injections constitute the practice of medicine; (ii) establish documentation standards for cosmetic injection consultations and procedures; (iii) define supervision requirements, including emergency protocols; and (iv) evaluate supervision standards for cosmetic injection services, including off-site supervision and on-site supervision.

Agency Decision: Request denied.

Statement of Reason for Decision: At the Board of Medicine meeting on June 4, 2026, the board voted to deny the petition. Current statutory law and regulation cover the specific practice actions mentioned by the petitioner. Development of an agency-wide guidance document regarding medical spas and IV clinics to address the issues listed is ongoing.

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, or email erin.barrett@dhp.virginia.gov.

VA.R. Doc. No. PFR26-23; Filed March 2, 2026, 2:53 p.m.

PERIODIC REVIEWS AND SMALL BUSINESS IMPACT REVIEWS
Vol. 42 Iss. 23 - June 29, 2026

TITLE 1. ADMINISTRATION

DEPARTMENT OF GENERAL SERVICES

Report of Findings

Pursuant to §§ 2.2-4007.1 and 2.2-4017 of the Code of Virginia, the Department of General Services (DGS) conducted a periodic review and a small business impact review of 1VAC30-45, Certification for Noncommercial Environmental Laboratories, and determined that this regulation should be retained as is. The department is publishing its report of findings dated June 1, 2026, to support this decision.

The regulation is necessary pursuant to § 2.2-1105 of the Code of Virginia, which directs the Division of Consolidated Laboratory Services to establish a program to certify environmental laboratories that perform tests, analyses, measurements, or monitoring required pursuant to the Commonwealth's air, waste, and water laws and regulations. The regulation is written clearly and is easily understandable, and outlines the required standards and the process by which owners of noncommercial environmental laboratories may obtain certification for their laboratories. After receiving no comments during the public comment period, DGS is retaining this regulation as is. Since there are no changes to the regulation, DGS has determined that there is no economic impact of small businesses that has not previously been documented.

Contact Information: Kimberly Freiberger, Policy Planning Specialist III, Department of General Services, 1100 Bank Street, Suite 420, Richmond, VA 23219, telephone (804) 205-3861, or email kimberly.freiberger@dgs.virginia.gov.

Report of Findings

Pursuant to §§ 2.2-4007.1 and 2.2-4017 of the Code of Virginia, the Department of General Services (DGS) conducted a periodic review and a small business impact review of 1VAC30-46, Accreditation for Commercial Environmental Laboratories, and determined that this regulation should be retained as is. The department is publishing its report of findings dated June 1, 2026, to support this decision.

The regulation is necessary pursuant to § 2.2-1105 of the Code of Virginia, which directs the Division of Consolidated Laboratory Services to establish a program to certify environmental laboratories that perform tests, analyses, measurements, or monitoring required pursuant to the Commonwealth's air, waste, and water laws and regulations. The regulation is written clearly and is easily understandable, and outlines the required standards and the process by which owners of commercial environmental laboratories may obtain certification for their laboratories. After receiving no comments during the public comment period, DGS is retaining the regulation as is. Since there are no changes to the current regulation, DGS has determined that there is no economic impact of small businesses that has not previously been documented.

Contact Information: Kimberly Freiberger, Policy Planning Specialist III, Department of General Services, 1100 Bank Street, Suite 420, Richmond, VA 23219, telephone (804) 205-3861, or email kimberly.freiberger@dgs.virginia.gov.

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TITLE 22. SOCIAL SERVICES

STATE BOARD OF SOCIAL SERVICES

Report of Findings

Pursuant to §§ 2.2-4007.1 and 2.2-4017 of the Code of Virginia, the State Board of Social Services conducted a periodic review and a small business impact review of 22VAC40-160, Fee Requirements for Processing Applications, and determined that this regulation should be amended. The department is publishing its report of findings dated April 6, 2026, to support this decision.

The regulation is necessary for the protection of the health, safety, and welfare of the children and adults served by assisted living facilities, adult day centers, and child welfare agencies. It provides information on the fees and method of payment options available to licensed Department of Social Services programs to submit payments for licensure fees. The regulation is clearly written and easily understandable. The agency recommends amending the regulation to increase the fees for licenses as the annual fees have remained unchanged since 1991.

This regulation is necessary to provide information regarding licensure fees. No comments were received regarding the regulation. The regulation is concise and understandable. The regulation does not overlap or duplicate any other federal or state law or regulation. Past regulatory actions were completed in 2017 to make technical changes, in 2021 to remove child day programs that transferred to the State Board of Education, and in 2022 to update the licensing fee payment options to include an online payment system. The regulation now needs to be amended to increase the fees assessed to licensed programs. The amendments may have a minimal economic impact on small businesses that operate licensed programs.

Contact Information: Samantha Fogt, Licensing Consultant, Department of Social Services, 5600 Cox Road, Glen Allen, VA 23060, telephone (804) 845-0308, fax (804) 726-7132, or email samantha.fogt@dss.virginia.gov.

NOTICES OF INTENDED REGULATORY ACTION
Vol. 42 Iss. 23 - June 29, 2026

TITLE 12. HEALTH
Food Regulations
Notice of Intended Regulatory Action

TITLE 12. HEALTH

STATE BOARD OF HEALTH

Notice of Intended Regulatory Action

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the State Board of Health intends to consider amending 12VAC5-421, Food Regulations. The Food Regulations (12VAC5-421) establish minimum sanitary standards for the operation of food establishments, which include traditional restaurants, mobile food units, temporary food establishments, hospitals, nursing facility food service, and school food service. The State Board of Health adopts the most recent version of the U.S. Food and Drug Administration (FDA) Food Code into 12VAC5-421 through an exempt action that does not require extensive stakeholder involvement. In contrast, this intended regulatory action addresses updates outside of the FDA Food Code and will follow the full regulatory process that includes input from stakeholders and industry representatives, aiming to address emerging and evolving business models in the retail food industry, such as mobile food units (MFUs) and temporary food establishments (TFEs). Amendments may also provide other necessary clarifications to the regulation.

Unlike traditional food establishments that operate from fixed locations with established infrastructure, MFUs and TFEs are inherently mobile and temporary, often operating in diverse environments with varying access to necessary resources. MFUs typically function year-round, requiring consistent infrastructure and equipment, while TFEs operate for no more than 14 consecutive days during specific events, such as festivals or fairs. These operational differences necessitate tailored regulations to address unique challenges. By revising the regulations to separately define and govern MFUs and TFEs, Virginia can ensure more effective oversight, reduce public health risks, and provide clearer guidance to operators, ultimately fostering a safer and more efficient food service environment.

The agency intends to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: §§ 35.1-11 and 35.1-14 of the Code of Virginia.

Public Comment Deadline: July 29, 2026.

Agency Contact: Lance Gregory, Director, Office of Environmental Health Services, Virginia Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-7491, fax (804) 864-7475, or email lance.gregory@vdh.virginia.gov.

VA.R. Doc. No. R26-8555; Filed June 01, 2026
TITLE 16. LABOR AND EMPLOYMENT
Prevailing Wage Regulations for Public Works Contracts
Notice of Intended Regulatory Action

TITLE 16. LABOR AND EMPLOYMENT

DEPARTMENT OF LABOR AND INDUSTRY

Notice of Intended Regulatory Action

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the Department of Labor and Industry intends to consider promulgating 16VAC15-80, Prevailing Wage Regulations for Public Works Contracts. The purpose of the proposed action is to fulfill the directive of Chapters 1014 and 1060 of the 2026 Acts of Assembly and establish a statewide framework for determining and administering prevailing wage requirements applicable to public works contracts in Virginia, which may include establishing methodologies for conducting surveys of construction wages in order to determine prevailing wages in accordance with statute.

The agency does not intend to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: §§ 40.1-2.1 and 40.1-6 of the Code of Virginia.

Public Comment Deadline: July 29, 2026.

Agency Contact: Cristin Bernhardt, Regulatory Coordinator, Department of Labor and Industry, 6606 West Broad Street, Suite 500, Richmond, VA 23230, telephone (804) 786-2392, fax (804) 786-8418, or email cristin.bernhardt@doli.virginia.gov.

VA.R. Doc. No. R26-8691; Filed June 01, 2026
TITLE 16. LABOR AND EMPLOYMENT
Paid Sick Leave Regulation
Notice of Intended Regulatory Action

TITLE 16. LABOR AND EMPLOYMENT

DEPARTMENT OF LABOR AND INDUSTRY

Notice of Intended Regulatory Action

Notice is hereby given in accordance with § 2.2-4007.01 of the Code of Virginia that the Department of Labor and Industry intends to consider promulgating 16VAC15-90, Paid Sick Leave Regulation. The purpose of the proposed action is to establish a statewide framework to implement and enforce paid sick leave rights for Virginia employees. When established, the regulation will provide qualifying employees with the right to accrue and use paid sick leave for: (i) the employee's mental or physical illness, injury, or health condition, including the medical diagnosis, care, or treatment of a mental or physical illness, injury, or health condition, or for preventive medical care; (ii) care of a family member who has a mental or physical illness, injury, or health condition, including the medical diagnosis, care, or treatment of a mental or physical illness, injury, or health condition, or who needs preventive medical care; or (iii) absence due to domestic violence, sexual assault, or stalking, provided that the leave is to allow the employee to seek or obtain medical care, mental health care, counseling, legal services, relocation, securing of an existing home, or other victim services for the employee or the employee's family member. Chapters 1128 and 1129 of the 2026 Acts of Assembly direct the Commissioner of Labor and Industry to promulgate regulations for the implementation and enforcement of paid sick leave rights for Virginia workers pursuant to § 40.1-33.6:7 of the Code of Virginia.

The agency does not intend to hold a public hearing on the proposed action after publication in the Virginia Register.

Statutory Authority: § 40.1-33.6:7 of the Code of Virginia.

Public Comment Deadline: July 29, 2026.

Agency Contact: Cristin Bernhardt, Regulatory Coordinator, Department of Labor and Industry, 6606 West Broad Street, Suite 500, Richmond, VA 23230, telephone (804) 786-2392, fax (804) 786-8418, or email cristin.bernhardt@doli.virginia.gov.

VA.R. Doc. No. R26-8724; Filed June 09, 2026

REGULATIONS
Vol. 42 Iss. 23 - June 29, 2026

TITLE 12. HEALTH
DEPARTMENT OF HEALTH
Fast-Track

TITLE 12. HEALTH

STATE BOARD OF HEALTH

Fast-Track Regulation

Title of Regulation: 12VAC5-371. Regulations for the Licensure of Nursing Facilities (amending 12VAC5-371-10, 12VAC5-371-30, 12VAC5-371-60, 12VAC5-371-70, 12VAC5-371-90, 12VAC5-371-100, 12VAC5-371-110, 12VAC5-371-150, 12VAC5-371-180, 12VAC5-371-300, 12VAC5-371-410; adding 12VAC5-371-55).

Statutory Authority: §§ 32.1-12 and 32.1-127 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: July 29, 2026.

Effective Date: August 13, 2026.

Agency Contact: Geoff Garner, Senior Policy Analyst, Virginia Department of Health, 9960 Mayland Drive, Suite 401, Richmond, VA 23233, telephone (804) 367-2157, fax (804) 527-4502, or email regulatorycomment@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 necessary to carry out the provisions of Title 32.1 of the Code of Virginia. Section 32.1-127 of the Code of Virginia requires the board to adopt regulations that include minimum standards for (i) the construction and maintenance of nursing facilities to ensure the environmental protection and the life safety of residents, employees, and the public and (ii) the vaccination of residents, unless medically contraindicated or declined by the resident.

Purpose: This action is essential to protecting the health, safety, and welfare of citizens because unclear requirements may hamper a licensee's ability to comply with the regulation, and out-of-date regulations may reference standards and practices that are not consistent with current clinical practices. The goals of this action are to improve consistency across the regulation, bring the regulatory text into alignment with the statutes, and update references to current clinical guidelines.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial because it conforms the regulation to statute and details longstanding licensing procedures. No new requirements are being developed. Additionally, the agency's subject matter experts believe that changes do not jeopardize the protection of public health, safety, and welfare. The action does not alter the intent of the regulation or the requirements placed on nursing facilities.

Substance: The amendments (i) establish that nursing facility licenses may not be transferred or assigned; (ii) consolidate and clarify plan of correction provisions, including adding minimum elements and a timeline for submission and completion; (iii) clarify frequency of inspection and set out the process by which the Office of Licensure and Certification will evaluate the need for an on-site complaint inspection; (iv) conform prohibited acts and disciplinary options to statute; (v) more clearly define a mid-term license change and the process to obtain a changed license; (vi) add provisions regarding visitation during public health emergencies related to COVID-19; (vii) update language regarding individuals required to register with the Sex Offender and Crimes Against Minors Registry to match statute; (viii) replace references to THC-A oil and cannabidiol oil with cannabis oil; (ix) make technical changes; and (x) update documents incorporated by reference.

Issues: The primary advantages to the public are (i) removal of language or requirements that are unclear, inconsistent, or outdated and (ii) addition of legislative mandates that were not yet incorporated into the regulation. The primary advantage to the agency and the Commonwealth is clarity regarding the minimum requirements for nursing facilities and the Virginia Department of Health in the administration of the nursing facility licensing program. 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. The State Board of Health (board) proposes to amend the regulation for the licensure of nursing facilities to conform to the Code of Virginia and implement multiple recent legislative mandates. The proposed changes would also group related requirements, remove outdated language, make certain terminology more consistent throughout the regulation, and update the text to reflect current practice.

Background. The proposed changes are primarily intended to implement the following legislative mandates, which the Virginia Department of Health (VDH) reports have largely been previously implemented in practice because statutory requirements apply even if a regulation has not yet been updated to reflect a particular mandate: Chapter 72 of the 2021 Acts of Assembly, Special Session I, which prohibits discriminating against health insurance enrollees on the basis of the enrollee being a litigant or potential litigant due to a motor vehicle accident.2 This mandate is already in effect. Chapters 10 and 11 of the 2020 Acts of Assembly, Special Session I, which require the board to amend regulations governing nursing homes, certified nursing facilities, and hospices to require that, during a public health emergency related to COVID-19, each entity establish a protocol to allow each patient to receive visits, consistent with guidance from the Centers for Disease Control and Prevention (CDC) and as directed by the Centers for Medicare and Medicaid Services (CMS) and the board.3 This action would newly require nursing facilities to establish such a protocol. However, facilities that are certified by CMS have likely already done this since it was a federal requirement prior to the enactment of the 2020 legislation. Chapter 829 of the 2020 Acts of Assembly, which updated the language in existing requirements for nursing homes and certified nursing facilities to register with the State Police to receive notice that person living in the same zip code are on the Sex Offenders and Crimes Against Minors (SOCAM) Registry and to verify whether a potential patient is required to register with the SOCAM Registry.4 Although this mandate is already in effect, this action would require nursing facilities to update their written policy on this subject. Chapters 1080 and 1081 of the 2020 Acts of Assembly, which prohibited balance billing by out-of-network providers.5 This mandate is already in effect. Chapter 1278 of the 2020 Acts of Assembly, which redefined and replaced occurrences of THC-A oil and cannabidiol oil with cannabis oil.6 This action would update the regulatory language to conform to statute. Chapters 177 and 222 of the 2005 Acts of Assembly, which directed the board to add minimum design and construction guidelines for hospitals and nursing facilities in the regulations for licensure.7 The proposed changes in this action would replace references to the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities with the 2022 edition and update the documents incorporated by reference. This change will only be binding for new license applications whose facility plans are dated after this regulatory action is effective. Chapter 762 of the 2004 Acts of Assembly, which requires certified nursing facilities and nursing homes to provide or arrange for the optional administration of annual influenza vaccines and the pneumococcal vaccination, in accordance with CDC most recent recommendations.8 This mandate is already in effect. The proposed changes in this action would update the language of the regulation to match current terminology (pneumonia to pneumococcal) and update the documents incorporated by reference with the most recent CDC guidelines. Accordingly, the board proposes to make a number of changes to the regulation. The most substantive changes are summarized below. The six sections indicated with an asterisk include changes that would implement a legislative mandate.

12VAC5-371-55 is a new section, which consolidates requirements currently found in other sections of the regulation, mainly 12VAC5-371-60 and 12VAC5-371-70. The proposed changes clearly specify the minimum elements of a plan of correction and add a 45-day timeline for submission and completion of a plan of correction. Board intent is to standardize the plan of correction process and make it more similar to the federal plan of correction process, so that the same requirements are applied across all facilities.9

12VAC5-371-60 is renamed, and the proposed changes include adding language about frequency of inspections, which matches the current practice followed by VDH, Office of Licensure and Certification (OLC). The board also proposes to add more details regarding the inspection process so that facilities know what to expect during an inspection.10

12VAC5-371-70 is amended to include the factors taken into consideration by OLC in determining whether a complaint should be investigated. The proposed changes would give VDH flexibility in determining whether a complaint warrants an on-site inspection and allow them to make more effective use of agency resources.11

12VAC5-371-90 is renamed and incorporates statutory provisions about prohibited acts and disciplinary options available. Specifically, the proposed changes would implement the legislative mandates relating to prohibitions on balance billing and discriminating against health insurance enrollees on the basis of the enrollee being a litigant or potential litigant due to a motor vehicle accident.

12VAC5-371-100 is renamed and specifies that a nursing facility must notify the OLC in writing 30 days in advance of implementing any change in the location, ownership, operator, or name of the nursing facility; change in the management contract or lease agreement to operate the nursing facility; change of services being provided, regardless of whether licensure is required for that service; and closure of the nursing facility. The current requirement only applies to a change in ownership and facility closure. The proposed changes would add that OLC shall determine if any of these changes affect the terms of the license or the continuing eligibility for a license, and that an inspector may inspect the facility during the process of evaluating a proposed change. The proposed changes would also add stipulations that licenses cannot be transferred or assigned and that a change in the operator of the facility requires that a new license be issued. Further, if the nursing facility is closing, it shall notify resident, legal representatives, and the OLC at least seven days prior to closing where all clinical records are to be located following closure or cessation of operations.

12VAC5-371-110 is updated so that references to the documents incorporated by reference to the most recent recommendations of the CDC Advisory Committee on Immunization Practices. These changes would continue to implement the 2004 legislative mandate mentioned previously.

12VAC5-371-150 is updated to match statutory language about registration, reregistration, and verification with the SOCAM Registry, pursuant to Chapter 829 of the 2020 Acts of Assembly.

12VAC5-371-180 implements Chapters 10 and 11 of the 2020 Acts of Assembly, Special Session I, by adding provisions about visitation during public health emergencies related to COVID-19. VDH reports that 282 of the 289 licensed nursing facilities are also certified by CMS and have therefore already been subject to these requirements.

12VAC5-371-300 replaces THC-A oil and cannabidiol oil with cannabis oil, implementing Chapter 1278 of the 2020 Acts of Assembly.

12VAC5-371-410 updates the documents incorporated by reference to the most recent (2022) Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, adding the Errata document issued separately, complying with a 2005 legislative mandate.

Estimated Benefits and Costs. The primary benefit of the proposed changes would be to improve clarity for nursing facilities surrounding the requirements to maintain their license, what to expect in an inspection, how to submit and undertake a plan of correction (if necessary), and current requirements and CDC guidelines. Entities wishing to build new facilities would know to use the updated 2022 Guidelines for construction plans. To the extent that these changes improve the quality of service, transparency of facility policies, and patient outcomes, both patients and their families would also benefit from the proposed changes. The proposed changes would require nursing facilities to update their policies with respect to visitation during public health emergencies and with respect to verification of potential patients with the SOCAM Registry. Other new costs may arise if a facility meets one of the newly added criteria for reporting a mid-term change of license, or if the facility is closing and must comply with new requirements with respect to informing patients and legal representatives about where medical records will be located and surrendering its license. VDH also reports that as a result of the mandate to comply with the 2022 edition of the applicable design and construction guidelines, there may be a quantifiable indirect cost equal to 0.2% increase in construction costs for a 180-bed nursing facility that has more than one story of non-combustible construction, and a 0.4% increase in construction costs for a 180-bed nursing facility that has a single story of combustible construction.12 VDH reports that economic impact for most proposed changes have already been incurred either as a result of the legislative mandates and changes to statutory requirements, or as a result of changes to federal CMS guidelines. This includes the one-time cost to update policies and procedures regarding visitation during public health emergencies for 282 of the 289 licensed facilities that are also federally certified by CMS. However, although VDH reports that agency policy regarding visitation has been consistent with the 2020 legislative mandate, the seven licensed facilities that are not federally certified by CMS may have to update their visitation policies to reflect the new regulatory requirements if they have not already done so. In addition, VDH reports that for some nursing homes (if they were unaware of the statutory amendments), the one-time cost to update policies and procedures regarding the SOCAM Registry may not have yet been incurred. VDH estimates that each nursing facility is likely to spend about $1,250 in staff time to update each of these policies.13

Businesses and Other Entities Affected. VDH reports that there are 289 licensed nursing facilities, and all of them will be required to comply with the regulatory changes. Many of these facilities have already complied with the new requirements since most of the changes result from legislative mandates, which often reflect federal guidelines and requirements. Two of these licensed nursing facilities are operated by the Virginia Department of Veterans Services and one is operated by the County of Bedford. The remaining facilities are privately owned and operated. VDH could not ascertain how many entities own and operate multiple facilities but reported that a majority of facilities are owned by companies with a portfolio of nursing facilities.14 The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.15 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. The proposed changes would create new costs for licensed nursing facilities, even if some of those changes are required by federal and state law and have already been borne by nursing facilities. Thus, an adverse impact is indicated.

Small Businesses16 Affected.17 VDH reports that they do not have sufficient information to determine which nursing facilities have fewer than 500 full-time employees.18 In addition, as mentioned previously, even if some small independent nursing homes meet the criteria for a small business, a majority of them are owned by larger business entities.

Localities19 Affected.20 The proposed amendments do not introduce costs for local governments. The County of Bedford owns and operates a licensed nursing facility and is the only locality to do so. Consequently, an adverse economic impact is indicated for Bedford.21

Projected Impact on Employment. The proposed amendments are unlikely to impact the number of nursing facilities that obtain and remain licensed and the staffing in those facilities. Thus, the proposed amendments are not projected to significantly impact employment.

Effects on the Use and Value of Private Property. The proposed amendments raise costs for nursing facilities, which would reduce their value. The proposed amendments do not affect real estate development costs in general but would result in a small increase in construction costs for new nursing facilities based on changes contained in the updated 2022 Guidelines.

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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=1341.

3 See https://lis.virginia.gov/cgi-bin/legp604.exe?ses=202&typ=bil&val=ch10.

4 See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1343.

5 See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1349.

6 See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1350.

7 See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1359. This mandate was first implemented in 2005 (https://register.dls.virginia.gov/vol22/iss07/v22i07.pdf) to add the 2006 Guidelines for Design and Construction of Hospital and Health Care Facilities issued by the American Institute of Architects as minimum design standards. These standards are updated every four years and the regulation has been updated accordingly via exempt actions.

8 See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1351. This mandate was first implemented in 2004 (https://register.dls.virginia.gov/vol20/iss26/v20i26.pdf) and incorporated CDC guidelines for these vaccines that were current at that time.

9 Agency Background Document (ABD), page 13. See https://townhall.virginia.gov/l/GetFile.cfm?File=58\6170\9898\AgencyStatement_VDH_9898_v3.pdf.

10 ABD, p. 15.

11 ABD, pp. 16-17. VDH reports that while the COVID-19 pandemic significantly altered the pattern of complaints for this facility type, they typically receive weekly complaints, some of which originate from the facilities themselves when they file self-report incidents. They also report that the timeline for resolving a complaint depends on how a complaint is triaged; it can be an immediate jeopardy complaint, a 10-day complaint, or a 180-day complaint.

12 See ORM Economic Review Form, page 3: https://townhall.virginia.gov/l/ GetFile.cfm?File=58\6170\9898\ORM_EconomicImpact_VDH_9898_v2.pdf.

13 ABD, p. 8.

14 VDH shared that the ownership and corporate structure of nursing facilities has become a significant policy issue and has started to draw the attention of the federal government. See for example: https://www.gao.gov/products/gao-23-104813, https://www.cms.gov/newsroom/fact-sheets/disclosures-ownership-and-additional-disclosable-parties-information-skilled-nursing-facilities-and, and https://www.cms.gov/newsroom/press-releases/biden-harris-administration-makes-more-medicare-nursing-home-ownership-data-publicly-available.

15 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.

16 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."

17 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.

19 "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.

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

21 Adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined.

Agency Response to Economic Impact Analysis: The State Board of Health has reviewed the economic impact analysis (EIA) prepared by the Department of Planning and Budget. The board believes the contents of the EIA to have been substantively complete and accurate as of the date of the EIA, and no modification of the EIA is warranted.

Summary:

The amendments conform Regulations for the Licensure of Nursing Facilities (12VAC5-371) to multiple legislative mandates by (i) providing for visitation during public health emergencies related to COVID-19; (ii) clarifying obligations of nursing facilities regarding the Sex Offenders and Crimes Against Minors Registry; (iii) replacing references to THC-A oil and cannabidiol oil with cannabis oil; and (iv) updating documents incorporated by reference. Additional amendments update terminology, consolidate and clarify language to match current clinical and industry practices, and make technical changes.

12VAC5-371-10. Definitions.

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

"Abuse" means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, or deprivation by an individual, including caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This includes verbal, sexual, physical, or mental abuse.

"ACIP" means the Advisory Committee on Immunization Practices of the CDC.

"Administrator" means the individual licensed by the Board of Long-Term Care Administrators and who has the necessary authority and responsibility for management of the nursing facility.

"Admission" means the process of acceptance into a nursing facility, including orientation, rules and requirements, and assignment to appropriate staff. Admission does not include readmission to the facility after a temporary absence.

"Advance directive" means (i) a witnessed written document, voluntarily executed by the declarant in accordance with the requirements of § 54.1-2983 of the Code of Virginia, or (ii) a witnessed oral statement, made by the declarant subsequent to the time the declarant is diagnosed as suffering from a terminal condition and in accordance with the provision of § 54.1-2983 of the Code of Virginia.

"Assessment" means the process of evaluating a resident for the purpose of developing a profile on which to base services. Assessment includes information gathering, both initially and on an ongoing basis, designed to assist the multi-disciplinary staff in determining the resident's need for care, and the collection and review of resident-specific data.

"Attending physician" means a physician currently licensed by the Board of Medicine and identified by the resident, or legal representative, as having the primary responsibility in determining the delivery of the resident's medical care.

"Barrier crime" means any offense set forth in clause (i) of the definition of barrier crime in § 19.2-392.02 of the Code of Virginia.

"Board" means the State Board of Health.

"Business day" means any day that is not a Saturday, Sunday, legal holiday, or day on which the OLC is closed. For the purposes of this chapter, any day on which the Governor authorizes the closing of the state government shall be considered a legal holiday.

"Cannabidiol Cannabis oil" means the same as the term is defined in § 54.1-3408.3 A of the Code of Virginia.

"CDC" means the Centers for Disease Control and Prevention.

"Certified nurse aide" means the title that can only be used by individuals who have met the requirements to be certified, as defined by the Board of Nursing, and who are listed in the nurse aide registry.

"Chemical restraint" means a psychopharmacologic drug (a drug prescribed to control mood, mental status, or behavior) that is used for discipline or convenience and not required to treat medical symptoms or symptoms from mental illness or mental retardation intellectual disability that prohibit an individual from reaching his highest level of functioning.

"Clinical record" means the documentation of health care services, whether physical or mental, rendered by direct or indirect resident-provider interactions. An account compiled by physicians and other health care professionals of a variety of resident health information, such as assessments and care details, including testing results, medicines, and progress notes.

"CMS" means the Centers for Medicare and Medicaid Services.

"Commissioner" means the State Health Commissioner.

"Complaint" means any allegation received by the Virginia Department of Health other than an incident reported by the facility staff. Such allegations include abuse, neglect, exploitation, or violation of state or federal laws or regulations.

"Comprehensive plan of care" means a written action plan, based on assessment data, that identifies a resident's clinical and psychosocial needs, the interventions to meet those needs, and treatment goals that are measurable and that documents the resident's progress toward meeting the stated goals.

"Construction" means the building of a new nursing facility or the expansion, remodeling, or alteration of an existing nursing facility and includes the initial and subsequent equipping of the facility.

"Criminal record report" means either the criminal record clearance with respect to convictions for barrier crimes or the criminal history record from the Central Criminal Records Exchange of the Virginia Department of State Police.

"Department" means the Virginia Department of Health.

"Dignity" means staff, in their interactions with residents, carry out activities that assist a resident in maintaining and enhancing the resident's self-esteem and self-worth.

"Discharge" means the process by which the resident's services, delivered by the nursing facility, are terminated.

"Discharge summary" means the final written summary of the services delivered, goals achieved, and post-discharge plan or final disposition at the time of discharge from the nursing facility. The discharge summary becomes a part of the clinical record.

"Drug" means (i) articles or substances recognized in the official United States "Drug" Pharmacopoeia National Formulary or official Homeopathic Pharmacopoeia of the United States, or any supplement to any of them; (ii) articles or substances intended for the use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animal; (iii) articles or substances, other than food, intended to affect the structure or any function of the body of man or other animal; and (iv) articles or substances intended for use as a component of any article specified in clause (i), (ii), or (iii). This does not include devices or their components, parts, or accessories.

"Electronic monitoring" means the use of a surveillance device with a fixed position video camera or recording device, or a combination thereof, that is installed in a resident's room and broadcasts or records activities or sounds occurring within the confines of the room. Electronic monitoring does not include use of a device that enables audio communication into the resident's room from another source.

"Emergency preparedness plan" means a component of a nursing facility's safety management program designed to manage the consequences of natural disasters or other emergencies that disrupt the nursing facility's ability to provide care.

"Employee" means a person who performs a specific job function for financial remuneration on a full-time or part-time basis.

"Facility-managed" means an electronic monitoring system that is installed, controlled, and maintained by the nursing facility with the knowledge of the resident or legal representative in accordance with the facility's policies.

"Family member" means the resident's spouse, parent, stepparent, child, stepchild, brother, sister, half-brother, half-sister, grandparent, or grandchild.

"Full-time" means a minimum of 35 hours or more worked per week in the nursing facility.

"Inspector" means an individual employed by or contracted by the department and designated by the commissioner to conduct inspections, investigations, or evaluations.

"Intelligent personal assistant" means a combination of an electronic device and a specialized software application designed to assist users with basic tasks using a combination of natural language processing and artificial intelligence, including such combinations known as digital assistants or virtual assistants.

"Legal representative" means a person legally responsible for representing or standing in the place of the resident for the conduct of the resident's affairs. This may include a guardian, conservator, attorney-in-fact under durable power of attorney, trustee, or other person expressly named by a court of competent jurisdiction or the resident as the resident's agency in a legal document that specifies the scope of the representative's authority to act. A legal representative may only represent or stand in the place of a resident for the function for which the representative has legal authority to act.

"Licensee" means a person that has received and maintains an active license under the provisions of Article 1 (§ 32.1-123 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia and this chapter.

"Medication" means any substance, whether prescription or over-the-counter drug, that is taken orally or injected, inserted, topically applied, or otherwise administered.

"Neglect" means a failure to provide timely and consistent services, treatment, or care to a resident necessary to obtain or maintain the resident's health, safety, or comfort or a failure to provide timely and consistent goods and services necessary to avoid physical harm, mental anguish, or mental illness.

"Nursing facility" means any nursing home as defined in § 32.1-123 of the Code of Virginia.

"OLC" means the Office of Licensure and Certification of the Virginia Department of Health.

"Person" means any individual, corporation, partnership, association, trust, or other legal entity, whether governmental or private, owning, managing, or operating a nursing facility.

"Physical restraint" means any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily which that restricts freedom of movement or normal access to one's own body.

"Policy" means a written statement that describes the principles and guides and governs the activities, procedures, and operations of the nursing facility.

"Procedures" means a series of activities designed to implement program goals or policy, which may or may not be written, depending upon the specific requirements within this chapter. For inspection purposes, there must be evidence that procedures are actually implemented.

"Progress note" means a written statement, signed and dated by the person delivering the care, consisting of a pertinent, chronological report of the resident's care. A progress note is a component of the clinical record.

"Qualified" means meeting current legal requirements of licensure, registration, or certification in Virginia; having appropriate training and experience commensurate with assigned responsibilities; or, if referring to a professional, possessing an appropriate degree or having documented equivalent education, training, or experience.

"Quality assurance" means systematic activities performed to determine the extent to which clinical practice meets specified standards and values with regard to such things as appropriateness of service assignment and duration, appropriateness of facilities and resources utilized, adequacy, and clinical soundness of care given. Such activities should also ensure changes in practice that do not meet accepted standards. Examples of quality assurance activities include the establishment of facility-wide goals for resident care, the assessment of the procedures used to achieve the goals, and the proposal of solutions to problems in attaining those goals.

"Readmission" means a planned return to the nursing facility following a temporary absence for hospitalization, off-site visit or therapeutic leave, or a return stay or confinement following a formal discharge terminating a previous admission.

"Resident" means the primary service recipient, admitted to the nursing facility, whether that person is referred to as a client, consumer, patient, or other term.

"Resident-managed" means an electronic monitoring system that is installed, controlled, and maintained by the resident with the knowledge of the nursing facility.

"Supervision" means the ongoing process of monitoring the skills, competencies, and performance of the individual supervised and providing regular, face-to-face guidance and instruction.

"Sworn disclosure" means a written statement or affirmation disclosing any criminal convictions or any pending criminal charges, whether within or outside the Commonwealth, by an applicant for compensated employment with a nursing facility.

"THC-A oil" means the same as the term is defined in § 54.1-3408.3 A of the Code of Virginia.

"Volunteer" means a person who, without financial remuneration, provides services to the nursing facility.

12VAC5-371-30. License.

A. This chapter is not applicable to:

1. Those entities listed in § 32.1-124 of the Code of Virginia; and or

2. Facilities established or operated for the practice of religious tenets pursuant to § 32.1-128 of the Code of Virginia, except that such facilities shall comply with the statutes and regulations on environmental protection and life safety.

B. A license to operate a nursing facility is shall be issued to a person or organization. An organization may be a partnership, association, corporation, or public entity.

C. Each license and renewal thereof shall be issued for one expire at midnight December 31 of the year issued. A nursing facility shall operate within the terms of its license, which include the:

1. Name of the nursing facility;

2. Name of the operator;

3. Physical location of the nursing facility;

4. Maximum number of beds allowed, except as provided in 12VAC5-371-40 G; and

5. Date the license expires.

D. A separate license shall be required for nursing facilities maintained on separate premises, even though they if the facilities are owned or are operated under the same management.

E. Every nursing facility shall be designated by a permanent and unique name.

F. The number of resident beds allowed in a nursing facility shall be determined by the department commissioner. Requests to increase beds must be made in writing and must include an approved Certificate of Public Need, except as provided in 12VAC5-371-40 G.

G. Nursing facility Long-term care nursing units located in and operated by hospitals shall be licensed under Regulations for the Licensure of Hospitals in Virginia (12VAC5-410). Approval for such units shall be included on the annual license issued to each hospital.

H. Any person establishing, conducting, maintaining, or operating a nursing facility without a license shall be guilty of a Class 6 felony.

I. The licensee shall at all times:

1. Maintain an active and accurate license; and

2. Post its current license in a place readily visible and accessible to the public at the nursing facility.

12VAC5-371-55. Plan of correction.

A. Upon receipt of a written inspection report, the administrator or the administrator's designee shall prepare a written plan of correction addressing each licensing violation cited at the time of inspection.

B. The administrator or the administrator's designee shall submit to the OLC a written plan of correction no more than 15 business days after receipt of the inspection report. The plan of correction shall contain, for each licensing violation cited:

1. A description of the corrective action to be taken and the position title of the employees to implement the corrective action. If employees share the same position title, the administrator or the administrator's designee shall assign the employees a unique identifier to distinguish them;

2. The expected correction date, not to exceed 45 business days from the exit date of the inspection; and

3. A description of the measures implemented to prevent a recurrence of each licensing violation.

C. The administrator or the administrator's designee shall ensure that the person responsible for the validity of the plan of correction signs, dates, and indicates the person's title on the plan of correction.

D. The OLC shall notify the administrator or the administrator's designee if the OLC determines any item in the plan of correction is unacceptable.

E. The OLC may conduct an inspection to verify any portion of a plan of correction has been implemented.

F. The administrator or the administrator's designee shall ensure the plan of correction is implemented and monitored so that compliance is maintained.

G. The commissioner may deny licensure or renewal of licensure or revoke licensure if the administrator or the administrator's designee fails to submit an acceptable plan of correction or fails to implement an acceptable plan of correction.

H. The OLC shall consider the submission date of a plan of correction to be the date the plan of correction is postmarked or the date it is received, whichever is earlier.

12VAC5-371-60. On-site inspections Inspection procedure.

A. The licensing representative OLC shall make periodic unannounced on-site inspections of the nursing facility as necessary but not less often than biennially. The licensee shall be responsible for correcting any deficiencies found during any OLC may make on-site inspection inspections of applicants for licensure. Compliance with all standards will shall be determined by the OLC.

B. The licensee or applicant shall make:

1. Make available to the licensing representative inspector any necessary requested records;

2. Permit an inspector to enter upon and into the licensee's or applicant's property to inspect or investigate, as the inspector reasonably deems necessary, in order to determine the state of compliance with the provisions of this chapter and all laws administered by the board; and

3. Allow the inspector access to interview the agents, employees, independent contractors, residents, legal representatives, resident's family members, and any person under the licensee's or applicant's control, direction, or supervision.

C. The licensee shall also allow the licensing representative to interview the agents, employees, residents, family members, and any person under its custody, control, direction or supervision.

D. C. After the on-site inspection, the licensing representative inspector shall discuss the findings of the inspection with the administrator or designee:

1. Discuss the findings of the inspection with the administrator or the administrator's designee; and

2. Provide a written inspection report to the administrator or the administrator's designee.

E. As applicable, the administrator D. If the OLC cites one or more licensing violations in the written inspection report, the administrator or the administrator's designee shall submit an acceptable a plan for correcting any deficiencies found during an on-site inspection of correction in accordance with 12VAC5-371-55.

F. The administrator will be notified whenever any item in the plan of correction is determined to be unacceptable.

G. The administrator shall be responsible for assuring the plan of correction is implemented and monitored so that compliance is maintained.

12VAC5-371-70. Complaint investigation.

A. The OLC has the responsibility to shall investigate any complaints regarding alleged violations of the standards or statutes and complaints of the abuse or neglect of persons in care. The Department of Social Services and the State Ombudsman are notified of complaints received and determine if an investigation requires an on-site inspection. In making this determination, the OLC shall consider several factors, to include:

1. Whether the complainant has first-hand knowledge of the alleged incident;

2. The nursing facility's regulatory history, including the number and severity of substantiated prior complaints;

3. Whether the OLC has recently inspected the nursing facility and whether the alleged incident would have been reviewed during the prior inspection;

4. The nature of the complaint, including degree of potential serious harm to residents; and

5. Whether the complaint may be investigated pursuant to Title XVIII or Title XIX of the Social Security Act (42 USC § 301 et seq.).

B. Complaints The OLC may request records from the licensee to assist in making a determination pursuant to subsection A of this section. The licensee shall provide the requested records no more than seven calendar days after OLC makes a request pursuant to this subsection.

C. The OLC may be received receive complaints in written or oral form and may be receive anonymous complaints.

C. D. When the investigation is complete, the OLC shall notify the licensee and the complainant, if known, will be notified in writing of the findings of the investigation.

D. As applicable E. For any licensing violation cited during a complaint investigation, the administrator or the administrator's designee shall submit an acceptable a plan for correcting any deficiencies found during a complaint investigation of correction in accordance with 12VAC5-371-55.

E. The administrator will be notified whenever any item in the plan of correction is determined to be unacceptable.

F. The administrator shall be responsible for assuring the plan of correction is implemented and monitored so that compliance is maintained.

12VAC5-371-90. Administrative sanctions Disciplinary action.

A. Nothing in this part shall prohibit the department from exercising its responsibility and authority to enforce the regulation, including proceeding directly to imposition of administrative sanctions, when the quality of care or the quality of life has been severely compromised.

A. The licensee may not:

1. Violate the provisions of this chapter or Article 1 (§ 32.1-123 et seq.) or 2 (§ 32.1-138 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia;

2. Permit, aid, or abet the commission of any illegal act in the nursing facility; or

3. Engage in a pattern of violations of § 38.2-3445.01 of the Code of Virginia.

B. The commissioner may impose such administrative sanctions or take such actions as are appropriate for violation of any of the standards or statutes or for abuse or neglect of persons in care. Such sanctions include:

1. Restricting or prohibiting For each violation of subsection A of this section:

a. Deny, revoke, or suspend the license to operate the nursing facility;

b. Restrict or prohibit new admissions to any nursing facility in accordance with the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia);

2. Petitioning the court to impose c. Refer the licensee for criminal prosecution pursuant to § 32.1-27 A of the Code of Virginia;

d. Petition an appropriate court for an injunction, mandamus, or other appropriate remedy against the licensee pursuant to § 32.1-27 B of the Code of Virginia;

e. Petition an appropriate court for imposition of a civil monetary penalty or to appoint a receiver, or both; or 3. Revoking or suspending the license of a nursing facility against the licensee pursuant to § 32.1-27 C or 32.1-27.1 A of the Code of Virginia; or

f. Petition an appropriate court for appointment of a receiver pursuant to § 32.1-27.1 B of the Code of Virginia; and

2. For each violation of subdivision A 3 of this section, levy a fine upon the licensee in an amount not to exceed $1,000 per violation, in accordance with the Administrative Process Act.

C. The following reasons may be considered by the department for the imposition of administrative sanctions or the imposition of civil penalties: 1. Failure to demonstrate or maintain compliance with applicable standards or for violations of the provisions Suspension of a license shall in all cases be for an indefinite time.

D. For each violation of subsection A of this section and with the consent of the person who has violated subsection A of this section, the board may provide, in an order issued by the board, for the payment of civil charges for past violations in specific sums, which may not exceed the limits specified in § 32.1-27 or 32.1-27.1 of the Code of Virginia; 2. Permitting, aiding, or abetting the commission of any illegal act in the nursing facility; or 3. Deviating significantly from the program or services for which a license was issued without obtaining prior written approval from the OLC, or failure to correct such deviations within a specified time.

D. Violations which in the judgment of the OLC jeopardize the health and safety of residents shall be sufficient cause for immediate imposition of this section.

E. The licensee will receive a notice of the department's intent to impose sanctions. The notice shall describe the reasons for imposing the sanction Upon receipt of a completed application and a nonrefundable service charge, the commissioner may issue a new license to the licensee that has had its license revoked if the commissioner determines that:

1. The conditions upon which revocation was based have been corrected; and

2. The applicant is in compliance with this chapter, Articles 1 (§ 32.1-123 et seq.) and 2 (§ 32.1-138 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia, and all other applicable state and federal law and regulations.

F. Upon receipt of the notice to impose a sanction, the licensee has the right and the opportunity to appeal according to the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia). The procedures for filing an appeal shall be outlined in the notice a completed application, the commissioner may partially or completely restore a suspended license to the licensee if the commissioner determines that:

1. The conditions upon which suspension was based have been completely or partially corrected; and

2. The interests of the public will not be jeopardized by resumption of operation.

G. The commissioner may not require an additional fee for restoring a license pursuant to subsection F of this section.

H. The licensee shall submit evidence relevant to subdivisions E 1, E 2, F 1, and F 2 of this section that is satisfactory to the commissioner or the commissioner's designee. The commissioner or the commissioner's designee may conduct an inspection prior to making a determination.

12VAC5-371-100. Surrender of a license; mid-term change of license.

A. Upon revocation or suspension of a license, the licensee must shall surrender its license to a representative of the OLC.

B. If a license is revoked, a new license may be issued by the commissioner after satisfactory evidence is submitted that the conditions upon which revocation was based have been corrected and after proper inspection has been made and compliance with this chapter and applicable state and federal law has been obtained.

C. Suspension of a license shall in all cases be for an indefinite time. The commissioner may completely or partially restore a suspended license when he determines that the conditions upon which suspension was based have been completely or partially corrected and that the interests of the public will not be jeopardized by resumption of operation.

D. Other circumstances under which a license must be surrendered include transfer of ownership and discontinuation of services. The licensee must notify the OLC, in writing, 30 days before discontinuing services.

B. A licensee shall notify the director of the OLC in writing by submitting a mid-term change application no fewer than 30 calendar days in advance of implementing any:

1. Change of location of the nursing facility;

2. Change of ownership of the nursing facility;

3. Change of operator of the nursing facility;

4. Change of name of the nursing facility;

5. Change of bed capacity, except as provided in 12VAC5-371-40 G, which shall be accompanied by an approved Certificate of Public Need if the requested change is for an increase in bed capacity;

6. Change in management contract or lease agreement to operate the nursing facility;

7. Change of services being provided, including any proposed addition or discontinuation, regardless of whether licensure is required for the service; or

8. Closure of the nursing facility.

C. The OLC shall:

1. Consider the submission date of a mid-term change application to be the date the application is postmarked or the date it is received, whichever is earlier; and

2. Notify the licensee in writing if the commissioner will issue a changed license.

D. The commissioner's issuance of changed license to the licensee shall satisfy the requirements of subdivision C 2 of this section.

E. Upon receipt of the changed license, the licensee shall surrender its prior license issued by the commissioner to the OLC and destroy any copies of the prior license.

F. A license may not be transferred or assigned. The commissioner may not issue a changed license in response to a change of operator of the nursing facility, but shall instead require the nursing facility to obtain a new license. If the nursing facility intends to implement a change of operator, it shall:

1. File for a new license, in accordance with 12VAC5-371-40, no fewer than 30 calendar days in advance of any operator change; and

2. Upon receipt of the new license, surrender its prior license issued by the commissioner to the OLC and destroy any copies of the prior license.

G. If the nursing facility is closing or will otherwise no longer be operational, it shall:

1. Notify residents, legal representatives, and the OLC, no fewer than seven calendar days prior to closing or ceasing operations, where all clinical records are to be located following closure or cessation of operations; and

2. Surrender its license to the OLC and destroy all copies of its license no more than five calendar days after the nursing facility closes or ceases operations.

H. The OLC shall determine if any changes listed in subsection B of this section affect the terms of the license or the continuing eligibility for a license. An inspector may inspect the nursing facility during the process of evaluating a proposed change.

12VAC5-371-110. Management and administration.

A. No person shall own, establish, conduct, maintain, manage, or operate any nursing facility, as defined in § 32.1-123 of the Code of Virginia, without having obtained a license.

B. The nursing facility must comply with:

1. These regulations (12VAC5-371) This chapter;

2. Other applicable federal, state, or local laws and regulations; and

3. Its The nursing facility's own policies and procedures.

C. The nursing facility shall submit, or make available, reports and information necessary to establish compliance with these regulations this chapter and applicable statutes.

D. The nursing facility shall submit, in a timely manner as determined by the OLC, and implement a written plan of action to correct any noncompliance with these regulations identified during an inspection. The plan shall include:

1. Description of the corrective action or actions to be taken;

2. Date of completion for each action; and

3. Signature of the person responsible for the operation.

E. D. The nursing facility shall permit representatives from the OLC to conduct inspections to:

1. Verify application information;

2. Determine compliance with this chapter;

3. Review necessary records; and

4. Investigate complaints.

F. A nursing facility shall give written notification 30 calendar days in advance of implementation of changes affecting the accuracy of the license. Changes affecting the accuracy of the license are:

1. Address;

2. Operator;

3. Name of the nursing facility;

4. Any proposed change in management contract or lease agreement to operate the nursing facility;

5. Implementing any proposed addition, deletion, or change in nursing facility services whether or not licensure is required;

6. A change in ownership; or

7. Bed capacity.

Notices shall be sent to the attention of the director of the OLC.

G. The current license from the commissioner shall be posted in a place clearly visible to the general public.

H. E. The nursing facility shall fully disclose its admission policies, including any preferences given, to applicants for admission.

I. F. The nursing facility shall identify its operating elements and programs, the internal relationship among these elements and programs, and the management or leadership structure.

J. The G. Unless the vaccination is medically contraindicated or the resident declines the offer of vaccination, the nursing facility shall provide, or arrange for, the administration to its residents of an annual influenza vaccination and a pneumonia pneumococcal vaccination according to the "Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season" and "Guidelines for Preventing Health-Care-Associated Pneumonia" from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, unless the vaccination is medically contraindicated or the resident declines the vaccination offer in accordance with the following recommendations of ACIP:

1. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022–23 Influenza Season, MMWR 71 (1), 2022, CDC;

2. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of ACIP - United States, MMWR 71 (4), 2022, CDC;

3. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged > 65 Years: Updated Recommendations of ACIP, MMWR 68 (46), 2019, CDC;

4. Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of ACIP, MMWR 64 (34), 2015, CDC;

5. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged > 65 Years: Recommendations of ACIP, MMWR 63 (37), 2014, CDC;

6. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children Aged 6 - 18 Years with Immunocompromising Conditions: Recommendations of ACIP, MMWR 62 (25), 2013, CDC;

7. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of ACIP, MMWR 61 (40), 2012, CDC;

8. Prevention of Pneumococcal Disease Among Infants and Children - Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine: Recommendations of ACIP, MMWR 59 (RR-11), 2010, CDC; and

9. Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23), MMWR 59 (34), 2010, CDC.

K. H. Upon request of the nursing facility's family council, the nursing facility shall send notices and information about the family council mutually developed by the family council and the administration of the nursing facility, and provided to the nursing facility for such purpose, to the legal representative or a contact person of the resident's choice up to six times a year. Such notices may be included together with a monthly billing statement or other regular communication. Notices and information shall also be posted in a designated location within the nursing facility.

12VAC5-371-150. Resident rights.

A. The nursing facility shall develop and implement policies and procedures that ensure a resident's rights as defined in §§ 32.1-138 and 32.1-138.1 of the Code of Virginia.

B. The procedures shall:

1. Not restrict any right a resident has under law;

2. Provide staff training to implement resident's resident rights; and

3. Include grievance procedures.

C. The name and telephone number of the complaint coordinator of the OLC, the Adult Protective Services toll-free telephone number, and the toll-free telephone number for the State Ombudsman shall be conspicuously posted in a public place.

D. Copies of resident rights shall be given to residents upon admittance to the nursing facility and made available to residents currently in residence, to legal representatives, next of kin, or sponsoring agency or agencies, and to the public.

E. The nursing facility shall have a plan to review resident rights with each resident annually, or with the legal representative at least annually, and have a plan to advise each staff member at least annually.

F. The nursing facility shall certify, in writing, that it is in compliance with the provisions of §§ 32.1-138 and 32.1-138.1 of the Code of Virginia, relative to resident rights, as a condition of license issuance or renewal.

G. The nursing facility shall register with the Department of State Police to receive notice of the registration or, reregistration, or verification of any sex offender person required to register with the Sex Offender and Crimes Against Minors Registry pursuant to Chapter 9 (§ 9.1-900 et seq.) of Title 9.1 of the Code of Virginia within the same or a contiguous zip code area in which the nursing facility is located pursuant to § 9.1-914 of the Code of Virginia.

H. Prior to admission, each nursing facility shall determine ascertain if a potential resident is a registered sex offender when required to register with the Sex Offender and Crimes Against Minors Registry pursuant to Chapter 9 of Title 9.1 of the Code of Virginia if the potential resident is anticipated to have a length of stay:

1. Greater Is anticipated by the nursing facility to have a length of stay greater than three days; or

2. In fact stays longer than three days.

I. The nursing facility shall not restrict the rights of a resident's family and legal representative to meet in the nursing facility with the families and legal representatives of other residents.

12VAC5-371-180. Infection control.

A. The nursing facility shall establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to prevent the development and transmission of disease and infection.

B. The infection control program shall encompass the entire physical plant and all services.

C. The infection control program addressing the surveillance, prevention, and control of infections in the nursing facility shall include:

1. Procedures to isolate the infecting organism;

2. Access to handwashing equipment for staff;

3. Training of staff in proper handwashing techniques, according to accepted professional standards, to prevent cross contamination cross-contamination;

4. Implementation of universal precautions by direct resident care staff;

5. Prohibiting employees with communicable diseases or infections from direct contact with residents or their resident food, if direct contact will transmit disease;

6. Monitoring staff performance of infection control practices;

7. Handling, storing, processing, and transporting linens, supplies, and equipment in a manner that prevents the spread of infection;

8. Handling, storing, processing, and transporting regulated medical waste in accordance with applicable regulations;

9. Maintaining an effective pest control program; and

10. Staff education regarding infection risk-reduction behavior.

D. The nursing facility shall report promptly to its local health department diseases designated as "reportable" according to 12VAC5-90-80 when such cases are admitted to or are diagnosed in the nursing facility and shall report any outbreak of infectious disease as required by 12VAC5-90. An outbreak is defined as an increase in incidence of any infectious disease above the usual incidence at the nursing facility.

E. During a declared public health emergency related to a communicable disease of public health threat, the nursing facility shall establish a protocol to allow residents to receive visits from a rabbi, priest, minister, or clergy member of any religious denomination or sect consistent with guidance from the Centers for Disease Control and Prevention CDC and the Centers for Medicare and Medicaid Services CMS and subject to compliance with any executive order, order of public health, department guidance, or any other applicable federal or state guidance having the effect of limiting visitation.

1. Such protocol may restrict the frequency and duration of visits and may require visits to be conducted virtually using interactive audio or video technology.

2. Any such protocol may require the person visiting a resident pursuant to this subsection to comply with all reasonable requirements of the nursing facility adopted to protect the health and safety of the person, residents, and staff of the nursing facility.

F. During a public health emergency related to COVID-19, a nursing facility shall establish a protocol to allow each resident to receive visits, consistent with guidance from the CDC and as directed by CMS and the board, which shall include:

1. Provisions describing:

a. The conditions, including conditions related to the presence of COVID-19 in the nursing facility and community, under which in-person visits will be allowed and under which in-person visits will not be allowed and visits will be required to be virtual;

b. The requirements with which in-person visitors will be required to comply to protect the health and safety of the residents and staff of the nursing facility;

c. The types of technology, including interactive audio or video technology, and the staff support necessary to ensure visits are provided as required by this subsection; and

d. The steps the nursing facility will take in the event of a technology failure, service interruption, or documented emergency that prevents visits from occurring as required by this subsection;

2. A statement of the frequency with which visits, including virtual and in-person, where appropriate, will be allowed, which shall be at least once every 10 calendar days for each resident;

3. A provision authorizing a resident or the resident's personal representative to waive or limit visitation, provided that such waiver or limitation is included in the resident's health record; and

4. A requirement that the nursing facility publish on its website or communicate to each resident or the resident's authorized representative, in writing or via electronic means, the nursing facility's plan for providing visits to residents as required by this subsection.

12VAC5-371-300. Pharmaceutical services.

A. Provision shall be made for the procurement, storage, dispensing, and accounting of drugs and other pharmacy products in compliance with 18VAC110-20. This may be by arrangement with an off-site pharmacy, but must include provisions for 24-hour emergency service.

B. Each nursing facility shall develop and implement policies and procedures for the handling of drugs and biologicals, including procurement, storage, administration, self-administration, and disposal of drugs.

C. Each nursing facility shall have a written agreement with a qualified pharmacist to provide consultation on all aspects of the provision of pharmacy services in the nursing facility.

D. The consultant pharmacist shall make regularly scheduled visits, at least monthly, to the nursing facility for a sufficient number of hours to carry out the function of the agreement.

E. Excluding cannabidiol oil and THC-A cannabis oil, no drug or medication shall be administered to any resident without a valid verbal order or a written, dated, and signed order from a physician, dentist, podiatrist, nurse practitioner, or physician assistant, licensed in Virginia.

F. Nursing facility employees who are authorized to possess, distribute, or administer medications to residents may store, dispense, or administer cannabidiol oil or THC-A cannabis oil to a resident who has:

1. Been Has been issued a valid written certification for the use of cannabidiol oil or THC-A cannabis oil in accordance with § 54.1-3408.3 B of the Code of Virginia; and

2. Registered Is registered with the Board of Pharmacy.

G. Advanced medication aides registered by the Board of Nursing pursuant to Article 7 (§ 54.1-3041 et seq.) of Chapter 30 of Title 54.1 of the Code of Virginia may administer drugs that would be administered by a registered medication aide pursuant to § 54.1-3408 M of the Code of Virginia in an assisted living facility licensed by the Department of Social Services, in addition to drugs determined permissible by the Board of Nursing, in a nursing home licensed by the Virginia Department of Health. Advanced medication aides shall administer drugs pursuant to this section:

1. In accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration;

2. In accordance with regulations promulgated by the Board of Pharmacy relating to security and recordkeeping;

3. In accordance with the licensed nursing home's policies and procedures; and

4. In accordance with such any other regulations promulgated by the Board of Nursing governing the practice of medication aides.

H. Verbal orders for drugs or medications shall only be given to a licensed nurse, pharmacist, or physician.

I. Drugs and medications not limited as to time or number of doses when ordered shall be automatically stopped, according to the written policies of the nursing facility, and the attending physician shall be notified.

J. Each resident's medication regimen shall be reviewed by a pharmacist licensed by the Board of Pharmacy. Any irregularities identified by the pharmacist shall be reported to the physician and the director of nursing, and their response documented.

K. Medication orders shall be reviewed at least every 60 days by the attending physician, nurse practitioner, or physician's assistant.

L. Prescription and nonprescription drugs and medications may be brought into the nursing facility by a resident's family, friend, or other person, provided:

1. The individual delivering the drugs and medications ensures timely delivery, in accordance with the nursing facility's written policies, so that the resident's prescribed treatment plan is not disrupted;

2. Each drug or medication is in an individual container; and

3. Delivery is not allowed directly to an individual resident.

In addition, prescription medications shall be obtained and labeled as required by law.

12VAC5-371-410. Architectural drawings and specifications.

A. All construction of new buildings and all additions, renovations, or alterations, or repairs of existing buildings for occupancy as a nursing facility shall conform to state and local codes, zoning ordinances, and the Virginia Uniform Statewide Building Code (13VAC5-63).

In addition, nursing facilities shall be designed and constructed consistent with Parts 1 and 2 and section Chapter 3.1 of Part 3 of the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities of the, 2022 Edition (The Facility Guidelines Institute pursuant to § 32.1-127.001 of the Code of Virginia), as amended by the August 2022 Errata for Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, 2022 Edition (The Facilities Guidelines Institute).

B. Architectural drawings and specifications for all new construction or for additions, alterations, or renovations to any existing building, shall be dated, stamped with professional seal, and signed by the architect. The architect shall certify that the drawings and specifications were prepared to conform to the Virginia Uniform Statewide Building Code and to be consistent with Parts 1 and 2 and section Chapter 3.1 of Part 3 of the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities of the, 2022 edition (The Facility Guidelines Institute), as amended by the August 2022 Errata for Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, 2022 Edition (The Facilities Guidelines Institute).

C. Additional approval may include a Certificate of Public Need.

D. Upon completion of the construction, the nursing facility shall maintain a complete set of legible "as built as-built" drawings showing all construction, fixed equipment, and mechanical and electrical systems, as installed or built.

DOCUMENTS INCORPORATED BY REFERENCE (12VAC5-371)

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, 2018 The Facilities Guidelines Institute, 2022 Edition, Facility Guidelines Institute http://www.fgiguidelines.org

Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, MMWR 53 (RR-3), Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season, 2020, MMWR 69 (RR-8), Centers for Disease Control and Prevention.

Errata for Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, The Facilities Guidelines Institute, 2022 Edition, https://fgiguidelines.org/guidelines/errata-addenda/ (eff. 8/2022)

Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of ACIP, MMWR 64 (34), 2015, CDC

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022–23 Influenza Season, MMWR 71 (1), 2022, CDC

Prevention of Pneumococcal Disease Among Infants and Children - Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine: Recommendations of ACIP, MMWR 59 (RR-11), 2010, CDC

Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23), MMWR 59 (34), 2010, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged > 65 Years: Recommendations of ACIP, MMWR 63 (37), 2014, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >65 Years: Updated Recommendations of ACIP, MMWR 68 (46), 2019, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of ACIP, MMWR 61 (40), 2012, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children Aged 6 -18 Years with Immunocompromising Conditions: Recommendations of ACIP, MMWR 62 (25), 2013, CDC

Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of ACIP - United States, MMWR 71 (4), 2022, CDC

VA.R. Doc. No. R26-6021; Filed June 08, 2026
TITLE 14. INSURANCE
STATE CORPORATION COMMISSION, BUREAU OF INSURANCE
Proposed

TITLE 14. INSURANCE

STATE CORPORATION COMMISSION

Proposed Regulation

REGISTRAR'S NOTICE: The State Corporation Commission is claiming an exemption from the Administrative Process Act in accordance with § 2.2-4002 A 2 of the Code of Virginia, which exempts courts, any agency of the Supreme Court, and any agency that by the Constitution is expressly granted any of the powers of a court of record.

Title of Regulation: 14VAC5-310. Rules Governing Actuarial Opinions and Memoranda (repealing 14VAC5-310-10 through 14VAC5-310-120).

Statutory Authority: §§ 12.1-13 and 38.2-223 of the Code of Virginia.

Public Hearing Information: A public hearing will be held upon request.

Public Comment Deadline: August 12, 2026.

Agency Contact: Greg Chew, Chief Insurance Financial Analyst, Bureau of Insurance, State Corporation Commission, P.O. Box 1157, Richmond, VA 23218, telephone (804) 371-9689, or email greg.chew@scc.virginia.gov.

Summary:

The proposed amendments repeal Rules Governing Actuarial Opinions and Memoranda (14VAC5-310). The regulation has been replaced by the National Association of Insurance Commissioners' Valuation Manual, effective January 1, 2017, rendering 14VAC5-310 obsolete.

AT RICHMOND, JUNE 1, 2026

COMMONWEALTH OF VIRGINIA, ex rel.

STATE CORPORATION COMMISSION

CASE NO. INS-2026-00045

Ex Parte: In the matter of Repealing the Rules

Governing Actuarial Opinions and Memoranda

ORDER ESTABLISHING PROCEEDING

Section 12.1-13 of the Code of Virginia (Code) provides, in relevant part, that "[i]n the administration and enforcement of all laws within its jurisdiction, the [State Corporation Commission (Commission)] shall have the power to promulgate rules and regulations[.]" Section 38.2-223 of the Code provides that the Commission may issue any rules and regulations necessary or appropriate for the administration and enforcement of Title 38.2 of the Code. Section 38.2-1367 of the Code provides the requirements for actuarial opinions of reserves. The regulations issued by the Commission pursuant to §§ 38.2-223 and 38.2-1367 of the Code are set forth in Chapter 310 of Title 14 of the Virginia Administrative Code (Chapter 310).1

The Bureau of Insurance (Bureau) has submitted to the Commission a proposal to repeal Chapter 310. The Bureau proposes repealing Chapter 310 because the regulations have effectively been replaced by the National Association of Insurance Commissioners (NAIC) Valuation Manual (Valuation Manual).2 Section 38.2-1367 A of the Code provides the requirements for actuarial opinions "prior to the operative date of the valuation manual [,]" and the regulations for that section are found in Chapter 310. Section 38.2-1367 B of the Code provides the requirements for actuarial opinions "after the operative date of the valuation manual [,]" and provides that "[t]he valuation manual will prescribe the specifics of th[ese] opinion[s], including any items deemed to be necessary to [their] scope." The operative date for the Valuation Manual was January 1, 2017.3 The Bureau therefore proposes repealing Chapter 310 because it has been rendered obsolete.

NOW THE COMMISSION, upon consideration of this matter, is of the opinion and finds that a proceeding should be established to consider repealing Chapter 310. To initiate this proceeding, the Bureau has prepared the proposal that Chapter 310 be repealed which is appended to this Order Establishing Proceeding (Order). The Commission finds that notice of the proposal to repeal Chapter 310 should be given to the public, and that interested persons should be provided an opportunity to file written comments on or request a hearing on the proposal.

Accordingly, IT IS ORDERED THAT:

(1) This case is docketed and assigned Case No. INS-2026-00045.

(2) All comments and other documents and pleadings filed in this matter shall be submitted electronically to the extent authorized by 5VAC5-20-150, Copies and format, of the Commission's Rules of Practice and Procedure (Rules of Practice).4 Confidential and Extraordinarily Sensitive Information shall not be submitted electronically and shall comply with 5VAC5-20-170, Confidential information, of the Rules of Practice. Any person seeking to hand deliver and physically file or submit any pleading or other document shall contact the Clerk’s Office Document Control Center at (804) 371-9838 to arrange the delivery.

(3) On or before August 12, 2026, any interested person may comment on, or request a hearing on, the proposal to repeal Chapter 310 by following the instructions on the Commission’s website: scc.virginia.gov/case-information/submit-public-comments. Those unable, as a practical matter, to submit such documents electronically may file such comments by U.S. mail to the Clerk of the State Corporation Commission, c/o Document Control Center, P.O. Box 2118, Richmond, Virginia 23218-2118. All documents shall refer to Case No.

INS-2026-00045. Any request for hearing shall state why a hearing is necessary and why the issues raised in the request for hearing cannot be addressed adequately in written comments.

(4) The Bureau shall file its response to any comments or requests for hearing filed pursuant to Ordering Paragraph (3) on or before September 11, 2026.

(5) If a sufficient request for hearing is not received, the Commission may consider the matter and enter an order based upon the comments, documents or other pleadings filed in this proceeding.

(6) The Bureau shall provide notice of this Order to any interested persons as the Bureau may designate.

(7) The Commission's Office of General Counsel shall provide a copy of this Order, together with the proposal to repeal Chapter 310, to the Virginia Registrar of Regulations for publication in the Virginia Register of Regulations.

(8) Interested persons may download unofficial copies of the Order and the proposal to repeal Chapter 310 from the Commission's website: scc.virginia.gov/case-information/.

(9) This matter is continued.

A COPY hereof shall be sent by the Clerk of the Commission to: John E. Farmer, Jr., Senior Assistant Attorney General, jfarmer@oag.state.va.us, Office of the Attorney General, Division of Consumer Counsel, 202 North 9th Street, 8th Floor, Richmond, Virginia 23219-3424; and the Commission's Office of General Counsel and the Bureau of Insurance in care of Deputy Commissioner Doug Stolte.

_____________________________

2 See also § 38.2-1365 of the Code ("Valuation manual" means the manual of valuation instructions adopted by the NAIC as specified in this article or as subsequently amended.")

3 Valuation Manual, page 1, available at https://content.naic.org/sites/default/files/pbr_data_valuation_manual_current_edition.pdf (noting the "operative date of Jan. 1, 2017" for the Valuation Manual).

4 5VAC5-20-10 et seq.

VA.R. Doc. No. R26-8686; Filed June 02, 2026
TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD FOR ARCHITECTS, PROFESSIONAL ENGINEERS, LAND SURVEYORS, CERTIFIED INTERIOR DESIGNERS AND LANDSCAPE ARCHITECTS
Fast-Track

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD FOR ARCHITECTS, PROFESSIONAL ENGINEERS, LAND SURVEYORS, CERTIFIED INTERIOR DESIGNERS AND LANDSCAPE ARCHITECTS

Fast-Track Regulation

Title of Regulation: 18VAC10-20. Board for Architects, Professional Engineers, Land Surveyors, Certified Interior Designers and Landscape Architects Regulations (amending 18VAC10-20-105).

Statutory Authority: § 54.1-201 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: July 29, 2026.

Effective Date: September 1, 2026.

Agency Contact: Kathleen R. Nosbisch, Executive Director, Board for Architects, Professional Engineers, Land Surveyors, Certified Interior Designers, and Landscape Architects, 9960 Mayland Drive, Suite 400, Richmond, VA 23233, telephone (804) 367-8514, fax (866) 465-6206, or email apelscidla@dpor.virginia.gov.

Basis: Section 54.1-201 of the Code of Virginia requires the Board for Architects, Professional Engineers, Certified Interior Designers, and Landscape Architects to establish the qualifications of applicants for certification or licensure and to promulgate regulations necessary to ensure continued competency, prevent deceptive or misleading practices by practitioners, and effectively administer the regulatory system. Section 54.1-404 of the Code of Virginia requires the board to promulgate regulations governing the board's organization, the professional qualifications of applicants, the requirements necessary for passing examinations, the proper conduct of examinations, the implementation of exemptions from license requirements, and the proper discharge of the board's duties. Section 54.1-404.2 of the Code of Virginia requires the board to promulgate regulations governing continuing education requirements for architects, professional engineers, land surveyors, and landscape architects licensed by the board. Section 54.1-406.1 of the Code of Virginia requires the board to adopt regulations establishing (i) work and education experience equivalencies that provide an alternative to the requirement of a professional degree in architecture from a program accredited by the National Architectural Accrediting Board (NAAB) pursuant to 18VAC10-20-110; (ii) a credit system to account for varying degrees of work and education experience based on the applicability of work or education experience to the practice of architecture; and (iii) requirements for applicants seeking licensure to certify work and education experience on an annual basis.

Purpose: The performance of professional work by those who lack sufficient expertise poses a risk to the public health, safety, and welfare, including the potential for damage to property, personal injury, and death. In addition, the improper performance of professional work can pose a substantial risk of financial harm to property owners and the public, including costs to remediate defective work. The amendments ensure that qualified individuals with significant education and work experience can become licensed through an alternative pathway while protecting public welfare by requiring substantial verified experience.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and appropriate for the fast-track rulemaking process because the American Institute of Architects (AIA) Virginia, a professional society representing architects, was the principal proponent of the legislation mandating the amendments and participated in the development of the regulation. The action is also expected to be supported by the regulant population.

Substance: The amendments (i) add an alternative education qualification for individuals to qualify based on at least 10 years of education and work experience in lieu of a degree from an NAAB-accredited architectural training program and (ii) establish a credit system to account for varying degrees of work and education experience.

Issues: The primary advantage of this action for the public is expanded access to licensure through a new alternative pathway for individuals who do not hold an NAAB-accredited degree. There are no disadvantages to the public as the regulation continues to require documented education, verified supervised experience, and passage of the National Council of Architectural Registration Boards licensing examination to ensure competence. The primary benefit to the agency and the Commonwealth is the potential positive economic impact resulting from the introduction of a new pathway to licensure. There are no disadvantages to the Commonwealth or the agency.

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 a 2025 legislative mandate,2 the Board for Architects, Professional Engineers, Land Surveyors, Certified Interior Designers, and Landscape Architects (board) seeks to establish an alternative pathway to licensure for architects who do not hold a professional degree from a program accredited by the National Architecture Accrediting Board (NAAB). The law directs the board to adopt regulations creating work and education experience equivalencies as an alternative to the NAAB degree requirement.

Background. The current regulation requires applicants to either (i) hold a professional degree in architecture from an NAAB-accredited program, or (ii) have a non-accredited degree (or coursework) evaluated for NAAB equivalency by the National Council of Architectural Registration Board (NCARB) at the applicant's expense. The current regulation states that the board reserves the right to reject any evaluation submitted. In addition to the education requirements, the current regulation also has a work experience requirement and an examination requirement, which are required by the NCARB. These work experience requirement and examination requirements were not addressed by the 2025 legislation, nor would they be amended by this regulatory action.3 There are currently only three educational institutions in Virginia that offer NAAB-accredited professional programs in architecture: Virginia Tech offers a five-year bachelor's program as well as a master's program, Hampton University offers a five-year master's program (for undergraduate enrollment), and the University of Virginia offers a three-year master's program (for graduate enrollment).4 However, the University of Virginia and Norfolk State university offer non-accredited bachelor's degrees in architecture, and at least six community colleges offer associate's degrees in architecture or related fields.5 The Department of Professional and Occupational Regulation (DPOR) reports that the NAAB-accreditation process is rigorous and costly to schools, which in turn restricts the opportunities available to individuals who want to become licensed architects.

Chapters 534 and 541 of the 2025 Acts of Assembly added § 54.1-406.1 to the Code of Virginia, directing the board to establish an alternative to the current education requirement for the licensure of architects. The legislation specifically directs the board to (i) require a minimum of 10 years of qualifying work experience, education experience, or combination of work and education experience; (ii) establish a credit system to account for varying degrees of work and education experience based on the applicability of such experience to the practice of architecture; (iii) develop requirements for applicants seeking licensure to certify work and education on an annual basis. Further, the legislation requires the board to review applicants' past work and education experience in addition to the annual reporting until July 1, 2028. DPOR reports that American Institute of Architects (AIA) Virginia, a professional society representing architects, was the principal proponent of the legislation mandating this regulatory change and participated in the development of the regulation. Information shared with the board by AIA VA indicates that the legislation was motivated by a desire to increase and diversify the workforce and number of architects in Virginia, while continuing to protect the health, safety, and welfare of the public. The alternative pathway is intended to support individuals who cannot afford the expenses or debt of higher education and individuals who acquire knowledge differently. The 2025 legislation and proposed regulation would align Virginia with 17 other states that allow an alternative path.6

Pursuant to the legislative mandate, the board seeks to establish an alternative education pathway by creating the following credit system: A baccalaureate degree in architecture or architectural design provides four years of credit, requiring six years of supplemental work or education experience; A baccalaureate degree in a related discipline provides three years of credit, requiring seven years of supplemental work or education experience (related disciplines include engineering, interior design, landscape architecture, and building construction); a non-related baccalaureate degree provides two years of credit, requiring eight years of supplemental work or education experience; an associate's degree in the field of architecture provides one year of credit, requiring nine years of supplemental work or education experience. The proposed language would prohibit double counting of education experience in the alternative pathway when an applicant has more than one degree by not allowing lower degrees, such as an associate degree, to be counted separately if credits from that degree were applied toward a higher degree, such as a baccalaureate degree. In that case, only the baccalaureate degree would be counted. However, credits for two non-overlapping baccalaureate degrees, or for a baccalaureate degree in a related or non-related discipline and an associate's degree in architecture could be combined. In addition, applicants may be awarded one year of education experience for each completed full-time equivalent academic year for a graduate degree in the field of architecture or six months of education experience for each completed full-time equivalent academic year for a graduate degree in a related discipline, defined above. Applicants may also be awarded one year of education experience for each successfully completed full-time equivalent academic year for NAAB accredited coursework. The proposed language would also (i) specify that all work experience must have been gained under the supervision of a licensed architect and (ii) provide a list of activities or areas for the work experience to meet the statutory requirement of being applicable to the practice of architecture.

To meet the annual certification requirement in statute, the proposed language would require education and work experience to be reported on a board-approved form by January 31 for the preceding year. The Department of Professional and Occupational Regulation (DPOR) reports that the board has an Architect Experience Verification Form and an Architect Degree Verification Form, both of which may be submitted annually with no fee. Procedurally, DPOR reports that board staff will send letters at the beginning of December each year to remind applicants who have applied through this new pathway to resubmit their experience and degree verification forms, and that candidates will be asked to submit a transcript to verify the completion of a degree.

Estimated Benefits and Costs. A "license wage premium" for a professional license refers to the additional wages earned by a license-holder relative to individuals in the same field with the similar educational backgrounds, skills, and experience who do not possess a license. Thus, the benefits and costs of the alternative pathway include its impact on the magnitude and distribution of the license wage premium. Individuals who seek an architect license but cannot qualify for it under the current pathways would now have the option to utilize the alternative pathway. These individuals would benefit from the alternative pathway as long as the expected license wage premium accrued over the remainder of their careers is greater than any upfront costs resulting from the required education and the efforts to find appropriate work experience. Thus, the alternative pathway offers the greatest benefit to future high school graduates who would be able to refer to the proposed credit system and accordingly decide exactly what combination of education and work experience would be most appropriate, accessible, and affordable. For example, if high school graduates using the alternative pathway are able to become licensed roughly 15 years after graduating high school (10 years for the alternative pathway plus five years for the NCARB's experience and examination requirements), they would be expected to accrue the license wage premium over the longest time horizon. In contrast individuals who use the alternative pathway to make a mid-career transition would have less time to accrue the license wage premium. However, individuals who already meet some or all of the requirements of the alternative pathway could apply for licensure with the board at any point (once the regulation becomes effective) as long as they are able to provide transcripts and verify that their work experience was obtained under a supervision of a licensed architect and included the areas described in the regulation. Early-career or mid-career applicants may require additional years of work experience credit; they would benefit from the alternative pathway provided that the expected license wage premium accrued over the remainder of their careers is greater than any upfront costs associated with finding or switching jobs to obtain the appropriate work experience. On the other hand, graduates of NAAB-accredited professional programs (NAAB graduates) would face increased competition, both pre-licensure when seeking employment to meet the NCARB work experience requirement and subsequently when seeking employment as licensed architects. NAAB graduates seeking licensure must currently complete 3,740 hours of work experience, as required by the NCARB and the current regulation, of which a minimum of 1,860 hours must be work performed for an architecture firm under the direct supervision of an architect licensed in a U.S. or Canadian jurisdiction. As mentioned previously, this experience requirement would also apply to individuals seeking licensure under the alternative pathway after they have acquired 10 years worth of credit. In the short run, unless there was some growth in the employment opportunities for candidates specifically seeking work experience under a licensed architect, the competition for such jobs would intensify and wages for unlicensed workers in these positions would be expected to fall. While this would benefit licensed architects (or firms) by expanding their hiring pool and suppressing the wages they could offer, there may be a glut of candidates to sort through and the quality of candidates from the new alternative pathway may be unpredictable. As a result, in the medium run, it may take longer for candidates to meet the experience requirements (and then pass the exam) which could suppress the growth of applications for initial licensure.7 In the long run, as the alternative pathway gradually increases the overall supply of licensed architects in the market, the resulting increase in competition will cause the license wage premium to shrink unless (i) the demand for licensed architects increases or (ii) the supply of licensed architects is simultaneously decreased by attrition or retirement by current license-holders. Thus, although the legislation and proposed regulation could benefit a number of individuals who would not otherwise have had a pathway to licensure, the long-term effects would make the profession more competitive and could suppress wage growth for both licensed architects as well as candidates for licensure seeking work experience. At the same time, colleges offering non-NAAB accredited degrees, including community colleges offering associates degrees, in architecture or related fields, may benefit from higher enrollment in those programs, whereas NAAB-accredited programs may see a decrease in applicants.

Businesses and Other Entities Affected. As described above, the proposed amendments would directly affect applicants seeking initial licensure as an architect under the alternative pathway, architects or firms that would employ candidates seeking work experience under the alternative pathway, and non-NAAB accredited programs that offer bachelor's or associate's degrees in architecture or related fields. NAAB-accredited programs and their graduates would be indirectly affected as described above. The number of individuals who may seek licensure under the alternative pathway is currently unknown. However, the board received an average of 144 applicants by exam per year between 2023 and 2025. AIAVA reported to the board that roughly 2.0% of initial applicants in Virginia do not hold an NAAB degree and that this number is roughly twenty to thirty percent in states that already allow alternative pathways to licensure; this would imply an additional 25 to 40 new applicants per year. DPOR reports that as of January 1, 2026, approximately 7,858 architects are licensed by the board; however, the number of licensed architects who are able to employ others and supervise their work may be significantly smaller. Employers would benefit from an increase in the number of candidates seeking work experience. Lastly, the following schools, which offer non-NAAB accredited programs may benefit from a growth in applicants and enrollment: The University of Virginia, Norfolk State University, Richard Bland College, Northern Virginia Community College, Brightpoint Community College, J Sargeant Reynolds Community College, Central Virginia Community College, and Tidewater Community College.

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 As described above, NAAB graduates seeking employment to meet the work experience requirements for licensure would face greater competition and lower wages; in the long run, the license wage premium for architects could shrink. However, since these reductions in benefits result from the 2025 legislative mandate, an adverse impact from this regulatory change is not indicated.

Small Businesses10 Affected.11 DPOR reports that there are 5,307 APELSCIDLA businesses across all regulated professions, all of which likely fall within the meaning of "small business" as defined in § 2.2-4007.1 of the Code of Virginia. However, as mentioned previously, the proposed amendments would benefit small businesses by increasing their hiring pool.

Localities12 Affected.13 The proposed amendments do not disproportionately affect particular localities or directly affect costs for local governments.

Projected Impact on Employment. The proposed amendments would likely increase the number of candidates seeking employment under a licensed architect, as well as eventually increasing the number of licensed architects seeking employment.

Effects on the Use and Value of Private Property. The proposed amendments could marginally increase the value of firms that would employ candidates seeking employment under a licensed architect or firms that employ licensed architects by reducing their hiring costs. However, the value of these firms may decrease if they eventually face greater competition for the same clients or projects. If wages for licensed architects eventually decrease, or architect wage growth is suppressed, as a result of an increase in the supply of architects, this may marginally reduce real estate development costs.

_____________________________

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/ViewAction.cfm?actionid=6967.

3 The experience and examination components are required by the NCARB; more details can be found at https://www.ncarb.org/sites/default/files/AXP-Guidelines.pdf; this hyperlink is included in the regulation.

4 See https://naab-dir.weaveaccreditation.com/.

5 Richard Bland College (Architecture and Related Services), Northern Virginia Community College (Architecture Technology), Brightpoint Community College (Architectural Engineering Technology), J Sargeant Reynolds Community College (Architectural and Engineering Technology Building Construction Management Specialization), Central Virginia Community College (Engineering and Architectural/Civil), and Tidewater Community College (Architectural Drafting and Design Technology). These were found on the State Council for Higher Education's Education Wizard.

6 See https://www.ncarb.org/earn-a-degree/study-architecture/accredited-programs/education-alternatives.

7 It should be noted that most license applicants in Virginia apply through comity (soon to be considered "endorsement"). DPOR reports that over a three-year period, beginning January 1, 2023, and ending December 31, 2025, the board received an average of 144 applicants by exam per year, and an average of 354 applicants by comity per year.

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 Board for Architects, Professional Engineers, Land Surveyors, Certified Interior Designers, and Landscape Artists makes the following clarification regarding statements in the economic impact analysis pertaining to the submission of transcripts by applicants for licensure: Applicants applying through the proposed new architect education alternative will need to provide the board with transcripts if such applicants only have a high school diploma or equivalent. Applicants who have a post-secondary degree or completed post-secondary coursework will be required to submit a degree verification form to the board.

Summary:

Pursuant to Chapters 534 and 541 of the 2025 Acts of Assembly, the amendments establish an alternative pathway to licensure for architects with at least 10 years of qualifying education and work experience who do not hold a professional degree from a National Architecture Accrediting Board (NAAB)-accredited program.

18VAC10-20-105. Qualifications for licensure as an architect.

A. Upon completing the requirements of this section, applicants may apply for licensure with the board.

B. Education. Applicants must hold a high school diploma or equivalent and submit documentation acceptable to the board verifying that one of the following educational qualifications has been met:

1. Applicants for original licensure must hold The applicant holds a professional degree in architecture from a program accredited by NAAB. The degree program must have been accredited by NAAB no later than two years after the date of the applicant's graduation from the program.

2. Applicants seeking The applicant has received credit for a degree or coursework that is not NAAB-accredited, whether foreign or domestic, that is not NAAB-accredited. Such applicant must establish an NCARB record and must have that degree or coursework evaluated for equivalency to a an NAAB-accredited professional degree in architecture through NAAB's evaluation service. The board reserves the right to reject any evaluation submitted. Any costs attributable to evaluation will be borne by the applicant.

3. The applicant has a minimum of 10 years of qualifying work experience, education experience, or a combination of work and education experience as provided for in Table 1 of this subdivision. For the purposes of this subdivision B 3, (i) "education experience" means credit awarded toward the alternative educational requirement provided for in this subdivision based on completed education; and (ii) "work experience" means credit awarded toward the alternative to educational requirement provided for in this subdivision based on completed work under the direct supervision a licensed architect.

a. Applicants may combine work experience and education experience in the following methods.

Table 1

Education

Education Experience Credited

Supplemental Work or Additional Education Experience Required

Architecture baccalaureate degree, to include architectural design

Four years

Six years

Baccalaureate degree in a related discipline, to include engineering, interior design, landscape architecture, and building construction

Three years

Seven years

Nonrelated baccalaureate degree

Two years

Eight years

Associate degree in the field of architecture

One year

Nine years

b. The methods in Table 1 may not be combined if the lower-level degree was used as academic credit toward the higher-level degree.

c. Applicants may be awarded one year of education experience for each successfully completed full-time equivalent academic year for a graduate degree in the field of architecture.

d. Applicants may be awarded six months of education experience for each successfully completed full-time equivalent academic year for a graduate degree in a related discipline, to include engineering, interior design, landscape architecture, or building construction.

e. Applicants may be awarded one year of education experience for each successfully completed full-time equivalent academic year for completed NAAB accredited coursework.

f. Applicants must provide a transcript from the institution awarding a degree or granting coursework credit. The board may make further inquiries into an applicant's program to assess whether a degree is in a related discipline.

g. Education experience used to qualify under this subdivision B 3 may not be combined with experience used to meet experience qualifications under subsection C of this section.

h. All work experience must have been gained under the direct supervision of a licensed architect. Work experience will be evaluated in accordance with 18VAC10-20-35. Work experience gained must include all of the following areas:

(1) Architectural programming.

(2) Site and environmental analysis.

(3) Schematic design.

(4) Construction cost analysis.

(5) Code research.

(6) Design development.

(7) Construction documents.

(8) Specifications and materials research.

(9) Document checking and coordination.

(10) Bidding procedures.

(11) Construction phase – office.

(12) Construction phase – observation.

(13) Project management.

(14) Office management.

i. Applicants qualifying under this subdivision B 3 must certify work and education experience annually. Any experience gained under the alternative education requirement must be reported to the board on the board-designated form no later than January 31 for the preceding year's experience. Nothing in this provision prohibits the board from awarding education experience earned prior to an individual becoming an applicant, including out-of-state experience.

C. Experience.

1. Applicants for original licensure must successfully complete the NCARB-administered Architectural Experience Program (https://www.ncarb.org/sites/default/files/AXP-Guidelines.pdf), which satisfies the experience requirement outlined in 18VAC10-20-35.

2. Applicants with a NAAB-accredited degree or who are actively participating in or who have completed the NCARB-accepted integrated path to architectural licensure option are required to document experience or training in architecture before licensure.

D. Examination. The board is a member board of NCARB and applicants for original licensure are required to pass the NCARB-prepared exam.

NOTICE: The following forms used in administering the regulation have been filed by the agency. Amended or added forms are reflected in the listing and are published following the listing. Online users of this issue of the Virginia Register of Regulations may also click on the name to access a form. The forms are also available from the agency contact or may be viewed at the Office of Registrar of Regulations, General Assembly Building, 201 North Ninth Street, Fourth Floor, Richmond, Virginia 23219.

FORMS (18VAC10-20)

Architect License Application, A416-0401LIC-v4 (rev. 5/2026)

Architect License Application, A416-0401LIC-v5 (rev. 9/2026)

Architect - Verification of Examination and Licensure Form, A416-0401ELV-v3 (rev. 5/2026)

Architect Experience Verification Form, 0401LIC_2018 (rev. 7/2018)

Architect Client Experience Verification Form, 0401CEXP-v2 (rev. 5/2026)

Architect Degree Verification Form, 0401DEG (rev. 4/2012)

Architect License Reinstatement Application, A416-0401REI-v2 (rev. 8/2025)

Professional Engineer License Application, A416-0402LIC-v8 (rev. 5/2026)

Professional Engineer License Reinstatement Application, A416-0402REI-v4 (rev. 8/2025)

Professional Engineer and Engineer-in-Training Degree Verification Form, 0402_20DEG (rev. 4/2012)

Engineer Experience Verification Form, A416-0402EXP-v2 (rev. 5/2026)

Engineer Verification of Examination and Licensure Form, A416-0402_20ELV-v3 (rev. 5/2026)

Engineer-in-Training Designation Application, A416-0420DES-v8 (rev. 5/2026)

Course Requirements for Engineering Technology Program, 0402CREQ (rev. 4/2012)

Land Surveyor License Application, A416-0403LIC-v4 (rev. 5/2026)

Land Surveyor License Reinstatement Application, A416-0403REI-v2 (rev. 8/2025)

Land Surveyor B - License Application, A416-0404LIC-v3 (rev. 5/2026)

Land Surveyor B License Reinstatement Application, A416-0404REI-v2 (rev. 8/2025)

Land Surveyor and Surveyor-in-Training Degree Verification Form, 0403_30DEG (rev. 4/2012)

Land Surveyor - Verification of Examination and Licensure Form, A416-0403_30ELV-v3 (rev. 5/2026)

Land Surveyor and Surveyor-in-Training Experience Verification Form, 0403_30EXP_2018 (rev. 7/2018)

Surveyor Photogrammetrist License Application, A416-0408LIC-v4 (rev. 5/2026)

Surveyor Photogrammetrist Experience Verification Form, 0408EXP_2018 (rev. 7/2018)

Surveyor Photogrammetrist License Reinstatement Application, A416-0408REI-v3 (rev. 8/2025)

Surveyor Photogrammetrist Degree Verification Form, 0408DEG (rev. 4/2012)

Surveyor Photogrammetrist Verification of Examination and Licensure Form, 0408elvf (eff. 4/2012)

Surveyor-in-Training Designation Application, A416-0430DES-v5 (rev. 5/2026)

Landscape Architect License Application, A416-0406LIC-v3 (rev. 5/2026)

Landscape Architect - Verification of Examination and Licensure Form, A416-0406ELV-v2 (rev. 5/2026)

Landscape Architect Experience Verification Form for Examination and Comity Applicants, 0406EXP (rev. 4/2012)

Landscape Architect Degree Verification Form, 0406DEG (rev. 4/2012)

Landscape Architect License Reinstatement Application, A416-0406REI-v2 (rev. 8/2025)

Interior Designer Certificate Application, A416-0412CERT-v4 (rev. 5/2026)

Interior Designer Certificate - Universal License Recognition (ULR) Application, A416-0412UNIV-v3 (8/2025)

Interior Designer - Verification of Examination and Certification Form, A416-0412ELV-v3 (rev. 5/2026)

Interior Designer Degree Verification Form, 0412DEG (rev. 4/2012)

Interior Designer Experience Verification Form, 0412EXP_2018 (rev. 7/2018)

Interior Designer Certificate Reinstatement Application, A416-0412REI-v2 (rev. 8/2025)

Business Entity Registration or Reinstatement Application, A416-04BUSREG-v8 (rev. 5/2026)

Business Entity - Place of Business Form, A416-0411BPOB-v1 (eff. 5/2026)

Criminal Conviction Reporting Form, A406-01CCR-v1 (eff. 5/2015)

Disciplinary Action Reporting Form, A406-01DAR-v1 (eff. 5/2015)

Criminal Conviction - Supplemental Form, Requesting an Informal Fact Finding (IFF) Conference, A713-01IFF-v1 (eff. 1/2016)

VA.R. Doc. No. R26-8419; Filed June 03, 2026
TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
BOARD OF PHARMACY
Final

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF PHARMACY

Final Regulation

REGISTRAR'S NOTICE: The Board of Pharmacy is claiming an exemption from Article 2 of the Administrative Process Act in accordance with § 2.2-4006 A 13 of the Code of Virginia, which exempts amendments to regulations of the board to schedule a substance in Schedule I or II pursuant to subsection D of § 54.1-3443 of the Code of Virginia. The board will receive, consider, and respond to petitions by any interested person at any time with respect to reconsideration or revision.

Title of Regulation: 18VAC110-20. Regulations Governing the Practice of Pharmacy (amending 18VAC110-20-322).

Statutory Authority: §§ 54.1-2400 and 54.1-3443 of the Code of Virginia.

Effective Date: July 29, 2026.

Agency Contact: Caroline Juran, RPh, Executive Director, Board of Pharmacy, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4456, fax (804) 527-4472, or email caroline.juran@dhp.virginia.gov.

Summary:

The amendments add two compounds into Schedule I of the Drug Control Act as recommended by the Virginia Department of Forensic Science pursuant to § 54.1-3443 of the Code of Virginia. The compounds added by this regulatory action will remain in effect for 18 months or until the compounds are placed in Schedule I by legislative action of the General Assembly.

18VAC110-20-322. Placement of chemicals in Schedule I.

A. Pursuant to subsection D of § 54.1-3443 of the Code of Virginia, the Board of Pharmacy places the following in Schedule I of the Drug Control Act:

1. Compound expected to have depressant properties. 7-Bromo-5-(2-chlorophenyl)-1,3-dihydro-2H-1,4-benzodiazepin-2-one (other name: phenazepam), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

2. Cannabimimetic agent. Methyl N-[(5-methyl-1H-indazol-3-yl)carbonyl]-3-methyl-valinate (other name: MDMB-5Me-INACA), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

The placement of drugs listed in this subsection shall remain in effect until November 21, 2026, unless enacted into law in the Drug Control Act.

B. Pursuant to subsection D of § 54.1-3443 of the Code of Virginia, the Board of Pharmacy places the following in Schedule I of the Drug Control Act:

1. The following compounds classified as synthetic opioids:

a. 2-[(4-methoxyphenyl)methyl]-5-nitro-1-(2-pyrrolidin-1-ylethyl)benzimidazole (other names: metonitazepyne, N-pyrrolidino metonitazene), its isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, unless specifically excepted, whenever the existence of these isomers, esters, ethers, and salts is possible within the specific chemical designation.

b. 2-[2-[(4-ethoxyphenyl)methyl]-5-nitrobenzimidazol-1-yl]-N-ethylethanamine (other name: N-desethyl etonitazene), its isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, unless specifically excepted, whenever the existence of these isomers, esters, ethers, and salts is possible within the specific chemical designation.

c. N-(2-methylphenyl)-N-[1-(2-phenethyl)piperidin-4-yl]propanamide (other name: ortho-methylfentanyl), its isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, unless specifically excepted, whenever the existence of these isomers, esters, ethers, and salts is possible within the specific chemical designation.

2. The following compounds expected to have hallucinogenic properties:

a. [3-[2-(diethylamino)ethyl]-1H-indol-4-yl] acetate (other names: 4-acetoxy-N,N-diethyltryptamine; 4-acetoxy DET; 4-AcO-DET; ethacetin), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

b. 3-[2-(diethylamino)ethyl]-1H-indol-4-ol (other names: 4-hydroxy-N,N-diethyltryptamine; 4-hydroxy DET; ethocin), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

c. 3-methylmethcathinone (other names: 3-MMC; metaphedrone; 2-(methylamino)-1-(3-methylphenyl)propan-1-one), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

3. The following compounds classified as cannabimimetic agents:

a. N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1H-indazole-3-carboxamide (other name: ADB-INACA), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

b. N-cyclohexyl-2-(1-pentylindol-3-yl)acetamide (other names: cyclohexyl-PIATA, CH-PIACA, CH-PIATA), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

The placement of drugs listed in this subsection shall remain in effect until November 21, 2026, unless enacted into law in the Drug Control Act.

C. Pursuant to subsection E of § 54.1-3443 of the Code of Virginia, the Board of Pharmacy places the following compounds into Schedule I of the Drug Control Act to conform to federal scheduling changes:

1. Meta-fluorofentanyl (other name: N-(3-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)propionamide);

2. Meta-fluoroisobutyryl fentanyl (other name: N-(3-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide);

3. Para-methoxyfuranyl fentanyl (other name: N-(4-methoxyphenyl)-N-(1-phenethylpiperidin-4-yl)furan-2-carboxamide);

4. 3-furanyl fentanyl (other name: N-(1-phenethylpiperidin-4-yl)-N-phenylfuran-3-carboxamide);

5. 2′,5′-dimethoxyfentanyl (other name: N-(1-(2,5-dimethoxyphenethyl)piperidin-4-yl)-N-phenylpropionamide);

6. Isovaleryl fentanyl (other name: 3-methyl-N-(1-phenethylpiperidin-4-yl)-N-phenylbutanamide);

7. Ortho-fluorofuranyl fentanyl (other name: N-(2-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)furan-2-carboxamide);

8. Para-methylcyclopropyl fentanyl (other name: N-(4-methylphenyl)-N-(1-phenethylpiperidin-4-yl)cyclopropanecarboxamide);

9. Methyl 2-[[1-(4-fluorobutyl)indole-3-carbonyl]amino]-3,3-dimethyl-butanoate (other names: 4F-MDMB-BUTICA; 4F-MDMB-BICA);

10. 5-Pentyl-2-(2-phenylpropan-2-yl)pyrido[4,3-b]indol-1-one (other names: CUMYL-PEGACLONE; SGT-151);

11. Ethyl 2-[[1-(5-fluoropentyl)indole-3-carbonyl]amino]-3,3-dimethyl-butanoate (other names: 5F-EDMB-PICA; 5F-EDMB-2201); and

12. 2-(4-ethoxybenzyl)-5-nitro-1-(2-(piperidin-1-yl)ethyl)-1H-benzimidazole (other names: N-piperidinyl etonitazene; etonitazepipne).

D. Pursuant to subsection D of § 54.1-3443 of the Code of Virginia, the Board of Pharmacy places the following in Schedule I of the Drug Control Act:

1. The following compound expected to have hallucinogenic properties: N,N-dipropyl-1H-indole-3-ethanamine (other names: Dipropyltryptamine; N,N-DPT), its salts, isomers (optical, position, and geometric), and salts of isomers, whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation; and

2. The following cannabimimetic agent: N-(1-amino-3-methyl-1-oxobutan-2-yl)-3-(dimethylsulfamoyl)-4-methylbenzamide (other name: AB-MDMSBA), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

The placement of drugs listed in this subsection shall remain in effect until April 8, 2027, unless enacted into law in the Drug Control Act.

E. Pursuant to subsection D of § 54.1-3443 of the Code of Virginia, the Board of Pharmacy places the following in Schedule I of the Drug Control Act:

1. The following compound classified as a synthetic opioid: N-(2-methylphenyl)-1-(2-phenylethyl)piperidin-4-amine (other name: Despropionyl o-methylfentanyl), its isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, unless specifically excepted, whenever the existence of these isomers, esters, ethers, and salts is possible within the specific chemical designation.

2. The following compounds expected to have hallucinogenic properties:

a. [3-[2-(dimethylamino)ethyl]-1H-indol-4-yl] propanoate (other names: 4-propionoyloxy-N,N-dimethyltryptamine, 4-propanoyloxy DMT, 4-ProO DMT), its salts, isomers (optical, position, and geometric), and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

b. 1-(1,3-benzodioxol-5-yl)-2-(2-methylpropylamino)propan-1-one (other names: 3,4-methylenedioxy-N-isobutylcathinone; N-isobutyl methylone; 3,4-methylenedioxy-α-isobutylaminopropiophenone), its salts, isomers (optical, position, and geometric), and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

c. 2-bromo-Deschloroketamine (other name: 2-(2-bromophenyl)-2-(methylamino)-cyclohexanone), its salts, isomers (optical, position, and geometric), and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

3. The following compound expected to have depressant properties: 1-methyl-8-nitro-6-phenyl-4H-[1,2,4]triazolo[4,3-a][1,4]benzodiazepine (other name: Nitrazolam), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

4. The following compounds classified as cannabimimetic agents:

a. Naphthalen-1-yl 3-(dimethylsulfamoyl)-4-methylbenzoate (other names: NMDMSB; 1-naphthyl 3-(dimethylsulfamoyl)-4-methylbenzoate), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

b. N-[1-(5-fluoropentyl)-2-hydroxyindol-3-yl]iminobenzamide (other names: 5-fluoro BZO-POXIZID, 5-fluoropentyl MDA 19), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

The placement of drugs listed in this subsection shall remain in effect until September 11, 2027, unless enacted into law in the Drug Control Act.

F. Pursuant to subsection D of § 54.1-3443 of the Code of Virginia, the Board of Pharmacy places the following compounds expected to have depressant properties in Schedule I of the Drug Control Act:

1. 5-(2-chlorophenyl)-1,3-dihydro-1-methyl-7-nitro-2H-1,4-benzodiazepin-2-one (other name: Methylclonazepam), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation; and

2. 8-bromo-1-ethyl-6-phenyl-4H-[1,2,4]triazolo[4,3-a][1,4]benzodiazepine (other name: Ethylbromazolam), its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation.

The placement of drugs listed in this subsection shall remain in effect until January 29, 2028, unless enacted into law in the Drug Control Act.

VA.R. Doc. No. R26-8500; Filed June 08, 2026
TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING
REAL ESTATE APPRAISER BOARD
Final

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

REAL ESTATE APPRAISER BOARD

Final Regulation

REGISTRAR'S NOTICE: The following regulatory action is exempt from Article 2 of the Administrative Process Act in accordance with § 2.2-4006 A 4 c of the Code of Virginia, which excludes regulations that are necessary to meet the requirements of federal law or regulations, provided such regulations do not differ materially from those required by federal law or regulation. The Real Estate Appraiser Board will receive, consider, and respond to petitions by any interested person at any time with respect to reconsideration or revision.

Title of Regulation: 18VAC130-20. Real Estate Appraiser Board Rules and Regulations (amending 18VAC130-20-180).

Statutory Authority: §§ 54.1-201 and 54.1-2013 of the Code of Virginia.

Effective Date: July 29, 2026.

Agency Contact: Anika Coleman, Executive Director, Real Estate Appraiser Board, 9960 Mayland Drive, Suite 400, Richmond, VA 23233, telephone (804) 367-8552, fax (866) 826-8863, or email reappraisers@dpor.virginia.gov.

Background: 12 USC § 3339 requires that real estate appraisals be performed in accordance with, and reviewed for compliance with, generally accepted standards as evidenced by the appraisal standards promulgated by the Appraisal Standards Board of the Appraisal Foundation, known as the Uniform Standards of Professional Appraisal Practice (USPAP). Pursuant to § 54.1-2013 of the Code of Virginia, the Real Estate Appraiser Board "may do ... all things required or expected of a state appraiser certifying and licensing agency under Title 11 of the Financial Institutions Reform, Recovery and Enforcement Act of 1989 (12 USC § 3331 et seq.)." The board must require adherence to the USPAP in regulation.

Summary:

The amendment restores a provision requiring licensees of the board to comply with USPAP standards when developing a real property appraisal, which conforms the regulation to the federal standards.

18VAC130-20-180. Standards of professional practice.

A. The provisions of subsections C through L of this section will not apply to local, state, and federal employees performing in their official capacity.

B. Maintenance of licenses. The board is not responsible for the failure of a licensee, registrant, or certificate holder to receive notices, communications, and correspondence.

1. Change of address. All licensed real estate appraisers, appraiser trainees, and certified instructors must at all times keep the board informed in writing of their current home address.

Registered real estate appraisal business entities must at all times keep the board informed in writing of their current business address. Licensees, registrants, and certificate holders must report any change of address to the board within 30 days of such change.

2. Change of name or business entity.

a. All real estate appraisers, appraiser trainees, and certified instructors must notify the board in writing within 30 days and provide appropriate written legal verification of any change of name.

b. Registered real estate appraisal business entities must notify the board of any change of name within 30 days.

c. Whenever the legal business entity holding the registration is dissolved or altered to form a new business entity, the original registration becomes void and must be returned to the board within 30 days of the change. Additionally, the firm must apply for a new registration within 30 days of the change in the business entity. Such changes include:

(1) Death of a sole proprietor;

(2) Death or withdrawal of a general partner in a general partnership or the managing partner in a limited partnership; and

(3) Conversion, formation, or dissolution of a corporation, a limited liability company, an association, or any other business entity recognized under the laws of the Commonwealth of Virginia.

3. No license, certification, or registration issued by the board will be assigned or otherwise transferred.

4. All licensees, certificate holders, and registrants must operate under the name in which the license or registration is issued.

C. Use of signature and transmission of report.

1. The signing or transmission of an appraisal report indicates that the licensee has exercised complete direction and control over the appraisal.

2. All original appraisal reports must be signed by the licensed appraiser and contain the license number of the appraiser. For form appraisals, the signature must appear on the page designated for the appraiser's signature and final estimate of value. All temporary licensed real estate appraisers must sign and affix the temporary license to the appraisal report or letter for which the appraiser obtained the license to authenticate such report or letter. An appraiser may provide market analysis studies or consulting reports, which do not constitute appraisals of market value, provided such reports, studies, or evaluations must contain a conspicuous statement that such reports, studies, or evaluations are not an appraisal as defined in § 54.1-2009 of the Code of Virginia.

D. Report definitions. A report must state the type of value, provide the definition, and cite the source for the definition Development of appraisal. In developing a real property appraisal, all licensees must comply with the provisions of the Uniform Standards of Professional Appraisal Practice.

E. Appraisal report requirements. In reporting a real property appraisal, a licensee must meet the requirements of the Uniform Standards of Professional Appraisal Practice.

F. Reviewing an appraisal. In performing a review appraisal, a licensee must comply with the requirements of the Uniform Standards of Professional Appraisal Practice. The reviewer's signature and license number must appear on the certification page of the report.

G. Mass appraisals. In developing and reporting a mass appraisal for ad valorem tax purposes, a licensee must comply with the requirements of the Uniform Standards of Professional Appraisal Practice.

H. Recordkeeping requirements.

1. A licensee must abide by the Record Keeping Rule as stated in the Uniform Standards of Professional Appraisal Practice.

2. A licensee or registrant of the board must, upon request or demand, promptly produce to the board or any of its agents within 10 days of the request, any document, book, record, work file, or electronic record in a licensee's possession concerning any appraisal that the licensee performed, or for which the licensee is required to maintain records for inspection by the board or its agents. The board or any of its agents may extend such timeframe upon a showing of extenuating circumstances prohibiting delivery within such 10-day period.

3. The appraiser trainee is entitled to obtain copies of appraisal reports and work files prepared by the appraiser trainee. The supervising appraiser must keep copies of appraisal reports for a period of at least five years or at least two years after final disposition of any judicial proceedings in which testimony was given, whichever period expires last.

I. Disclosure requirements. A licensee appraising property in which the licensee, any member of the licensee's family, the licensee's firm, any member of the licensee's firm, or any entity in which the licensee has an ownership interest has any interest must disclose, in writing, to any client such interest in the property and the licensee's status as a real estate appraiser licensed in the Commonwealth of Virginia. As used in the context of this chapter, "any interest" includes an ownership interest in the property to be appraised or in an adjacent property or involvement in the transaction, such as deciding whether to extend credit to be secured by such property.

J. Competency. A licensee must abide by the Competency Rule as stated in the Uniform Standards of Professional Appraisal Practice.

K. Scope of work. A licensee must abide by the Scope of Work Rule as stated in the Uniform Standards of Professional Appraisal Practice.

L. Jurisdictional exception. A licensee must abide by the Jurisdictional Exception Rule as stated in the Uniform Standards of Professional Appraisal Practice.

M. Prohibited acts.

1. A licensee must act as a certified general real estate appraiser, certified residential real estate appraiser, or licensed residential real estate appraiser in such a manner as to safeguard the interests of the public and must not engage in improper, fraudulent, or dishonest conduct.

2. A licensee may not have been convicted, found guilty, or pled guilty, regardless of adjudication, in any jurisdiction of the United States of a misdemeanor involving fraudulent or dishonest acts or of any felony there being no appeal pending therefrom or the time for appeal having elapsed.

3. A licensee must inform the board in writing within 30 days of being convicted, regardless of adjudication, of any felony or of a misdemeanor involving fraudulent or dishonest acts in any jurisdiction.

4. A licensee may not have had a license or certification as a real estate appraiser that was suspended, revoked, or surrendered in connection with a disciplinary action or that has been the subject of discipline in any jurisdiction.

5. A licensee must inform the board in writing within 30 days of any disciplinary action taken in any jurisdiction against any appraiser license or certification to include the suspension, revocation, or surrender of an appraiser license or certification.

6. A licensee must perform all appraisals in accordance with Virginia Fair Housing Law (§ 36-96.1 et seq. of the Code of Virginia).

7. A licensee must respond to an inquiry by the board or its agents, other than requested under subdivision H 2 of this section, within 21 days.

8. A licensee must not provide false, misleading, or incomplete information in the investigation of a complaint filed with the board.

VA.R. Doc. No. R26-8601; Filed June 05, 2026

ERRATA
Vol. 42 Iss. 23 - June 29, 2026

BOARD FOR ARCHITECTS, PROFESSIONAL ENGINEERS, LAND SURVEYORS, CERTIFIED INTERIOR DESIGNERS AND LANDSCAPE ARCHITECTS

Title of Regulation: 18VAC10-20. Board for Architects, Professional Engineers, Land Surveyors, Certified Interior Designers and Landscape Architects Regulations.

Publication: 42:13 VA.R 1578-1607; February 9, 2026.

Correction to Final Regulation:

Page 1605, 18VAC10-20-790, subdivision 8, beginning of line 4, after "9" change "8" to "7"

VA.R. Doc. No. R24-7640; Filed June 5, 2026, 2:42 p.m.