TITLE 9. ENVIRONMENT

STATE AIR POLLUTION CONTROL BOARD

Final Regulation

Title of Regulation: 9VAC5-40. Existing Stationary Sources (amending 9VAC5-40-7400, 9VAC5-40-7420).

Statutory Authority: § 10.1-1308 of the Code of Virginia; §§ 110, 111, 123, 129, 171, 172 and 182 of the Clean Air Act; 40 CFR Parts 51 and 60.

Effective Date: November 19, 2026.

Agency Contact: Julia Wack, Regulatory Analyst, Department of Environmental Quality, 1111 East Main Street, Suite 1400, Richmond, VA 23219, telephone (804) 432-3581, or email julia.n.wack@deq.virginia.gov.

Background: On October 26, 2015 (80 FR 65292), the U.S. Environmental Protection Agency (EPA) strengthened the primary and secondary O₃ new ozone national ambient air quality standards (NAAQS) to 0.070 ppm by adding 50.19 and Appendix U to 40 CFR Part 50. The Northern Virginia Ozone Moderate Nonattainment Area and Stafford County, which correspond to the Northern Virginia volatile organic compound (VOC) and nitrogen oxides (NOX) emissions control areas, and which are part of the Ozone Transport Region (OTR), must meet the reasonably available control technology (RACT) requirements of 40 CFR 51.1316 established by EPA on December 6, 2018 (83 FR 62998). The state regulations must be consistent with the federal regulations in order for the state to implement RACT.

Summary:

The amendments codify requirements for RACT determinations mandated by the Clean Air Act in the OTR when NAAQS are promulgated.

9VAC5-40-7400. Standard for volatile organic compounds (eight-hour ozone standard).

A. No owner or other person shall cause or permit to be discharged from any affected facility any volatile organic compounds (VOCs) emissions in excess of that resultant from using RACT.

B. The provisions of this section apply to all facilities that (i) are within a stationary source in the emissions control areas specified in Table 4-51B and (ii) are within a stationary source that has a theoretical potential to emit at the applicable source thresholds specified Table 4-51B.

C. For facilities subject to the provisions of this section, the owners shall, by the notification dates specified in Table 4-51B, (i) notify the board of their applicability status, (ii) commit to making a determination as to what constitutes RACT for the facilities, and (iii) provide a schedule acceptable to the board for making this determination and for achieving compliance with the emission standard as expeditiously as possible but no later than the compliance dates specified in Table 4-51B.

D. Nothing in this article shall exempt any facility subject to the provisions of 9VAC5-40-7390 from being subject to the provisions of this section. The board may reevaluate any RACT determination made under 9VAC5-40-7390 and require compliance with a new RACT determination as necessary to implement this section.

E. Upon the request of the board, the owner of a facility subject to or exempt from the provisions of 9VAC5-40-7390 shall provide such information as the board deems necessary to determine if the facility is subject to this section.

9VAC5-40-7420. Standard for nitrogen oxides (eight-hour ozone standard).

A. No owner or other person shall cause or permit to be discharged from any affected facility any nitrogen oxides (NO_X) emissions in excess of that resultant from using RACT.

B. Unless the owner demonstrates otherwise to the satisfaction of the board, facilities to which the presumptive RACT provisions of 9VAC5-40-7430 are applicable shall comply with the provisions of subsection A of this section by the use of presumptive RACT.

C. The provisions of this section apply to all facilities that (i) are within a stationary source in the emissions control areas specified in Table 4-51E and (ii) are within a stationary source that has a theoretical potential to emit at the applicable source thresholds specified in Table 4-51E.

D. For facilities subject to the provisions of this section and for which there is no presumptive RACT definition, the owners shall, by the notification dates specified in Table 4-51E, (i) notify the board of their applicability status, (ii) commit to making a determination as to what constitutes RACT for the facilities, and (iii) provide a schedule acceptable to the board for making this determination and for achieving compliance with the emission standard as expeditiously as possible but no later than the compliance dates specified in Table 4-51E.

E. For facilities subject to the provisions of this section and for which there is a presumptive RACT definition, the owners shall, by the notification dates specified in Table 4-51F, (i) notify the board of their applicability status, (ii) commit to accepting the presumptive RACT emission limits as RACT for the applicable facilities or to submitting a demonstration as provided in subsection B of this section, and (iii) provide a schedule acceptable to the board for submitting the demonstration no later than the demonstration dates specified in Table 4-51F and for achieving compliance with the emission standard as expeditiously as possible but no later than the compliance dates specified in Table 4-51F.

F. Nothing in this article shall exempt any facility subject to the provisions of 9VAC5-40-7410 from being subject to the provisions of this section. The board may reevaluate any RACT determination made under 9VAC5-40-7410 and require compliance with a new RACT determination as necessary to implement this section.

G. Upon the request of the board, the owner of a facility subject to or exempt from the provisions of 9VAC5-40-7410 shall provide such information as the board deems necessary to determine if the facility is subject to this section.

TITLE 9. ENVIRONMENT

VIRGINIA WASTE MANAGEMENT BOARD

Forms

Title of Regulation: 9VAC20-90. Solid Waste Management Permit Action Fees and Annual Fees.

Agency Contact: Sanjay Thirunagari, Programs Manager, Department of Environmental Quality, 1111 East Main Street, Suite 1400, Richmond, VA 23219, telephone (804) 659-1532, or email sanjay.thirunagari@deq.virginia.gov.

FORMS (9VAC20-90)

Solid Waste Information and Assessment Program Reporting Table, Form DEQ 50-25 with Statement of Economic Benefits Form and Instructions (rev. 12/2018)

Solid Waste Annual Permit Quarter Payment Form PF001 (rev. 6/2024)

Solid Waste Annual Fee Quarter Payment Form PF001 (rev. 8/2026)

TITLE 12. HEALTH

STATE BOARD OF HEALTH

Fast-Track Regulation

Title of Regulation: 12VAC5-67. Advance Health Care Directive Registry (amending 12VAC5-67-10, 12VAC5-67-20, 12VAC5-67-30; adding 12VAC5-67-5).

Statutory Authority: §§ 32.1-12, 54.1-2994, and 54.1-2995 of the Code of Virginia,

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: November 18, 2026.

Effective Date: December 3, 2026.

Agency Contact: Rilee Bennett, Senior Policy Analyst, Virginia Department of Health, 2001 Maywill Street, Suite 101, Richmond, VA 23230, telephone (804) 662-6258, or email rilee.bennett@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 and other laws of the Commonwealth administered by the board, the State Health Commissioner, or the Department of Health. Section 54.1-2994 of the Code of Virginia directs the Virginia Department of Health to make available a secure online central registry for advance health care planning. Section 54.1-2995 of the Code of Virginia requires the board to promulgate regulations related to the Advance Health Care Planning Registry.

Purpose: This action critical for safeguarding the health, safety, and welfare of Virginia residents because the changes establish a framework for timely access to a patients' critical health care planning information stored in the Advance Health Care Planning Registry, better clarify the types of advance health care planning documentation that may be stored in the registry, and specify who may access the documentation stored in the registry. Establishing clear criteria for document submission and access ensures that important health planning documents are easily and securely stored. This is particularly important in emergency situations where a patient may be unable to communicate preferences and health care providers need immediate access to these documents to make informed decisions about the patient's medical treatment.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking action because the changes conform the regulation to current law and practice. The agency does not anticipate any reduction in the services provided that are associated with the regulatory changes.

Substance: The amendments (i) define terms; (ii) permit the submission of other documents supporting advance health care planning into the Advance Health Care Planning Registry, including Durable Do Not Resuscitate Orders and portable medical order forms; (iii) remove a restriction placed on licensed health care providers by permitting them to access and query the registry for a patient's advance directive information even if the patient is comatose, incapacitated, or incapable of communication; and (iv) make technical changes.

Issues: The primary advantages to the public, the Commonwealth, and regulated and business entities include (i) clarification of the processes and requirements related to the filing, storage, and accessibility of health care planning documentation in Virginia's Advance Health Care Planning Registry and (ii) expansion of health care provider access to the documentation stored in the registry, which will provide medical professionals with the critical information needed to make timely and accurate medical decisions on behalf of patients. There are no known disadvantages to the public, regulated entities, or business entities as a result of the regulatory changes. The primary disadvantage to the agency and the Commonwealth is the increased cost charged to the agency to enhance and administer a registry that can be queried by health care providers.

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) seeks to update the regulation governing the Advance Health Care Directive Registry to implement changes based on a 2022 period review and 2024 legislation.² The proposed changes would (i) expand the types of documents that may be filed in the registry, (ii) expand the situations in which licensed health care providers may access the registry and who can obtain access, and (iii) align the regulation to current practice.

Background. The Advance Health Care Directive Registry was first established by Chapter 696 of the 2008 Acts of Assembly, which directed the Virginia Department of Health (VDH) to, "make available a secure only central registry for advance health care directives" and to promulgate regulations to implement certain provisions; accordingly, this regulation (12VAC5-67) became effective in 2011. The registry is maintained by Virginia Health Information (VHI).³ Chapters 231 and 274 of the 2024 Acts of Assembly renamed the registry to the Advance Health Care Planning Registry and added "any other document that supports advance health care planning, including Durable Do Not Resuscitate Order or portable medical order forms" to the list of documents that could be filed in the registry. Thus, the board seeks to amend the title of the regulation by replacing "directive" with "planning" and to conform the regulation to statute by adding the new documents specified in the legislation to the list in section 20 (Criteria for submission of an advanced directive to the Advance Health Care Planning Registry). Section 30 (Access to the Advance Health Care Planning Registry) currently states that "Licensed health care providers shall have access to the registry for the purpose of a query for advance directive information on patients who are comatose, incapacitated, or otherwise mentally or physically incapable of communication." The board seeks to replace this sentence to allow a licensed health care provider to access the registry, "when conducting a query for advance health care planning information on a patient with whom the [provider] has a treatment relationship." This change would provide greater flexibility for patients and providers. Specifically, in practice, providers would have broader access to the registry regardless of the patient's condition even if "they have not been previously informed of an advance directive or planning document by the patient." Lastly, the board seeks to (i) add definitions, (ii) clarify that the registry is available to the public, and (iii) specify that only the individual who executed the document, or their legal representative or designee, can file the document in the registry.

Estimated Benefits and Costs. The proposed amendments would benefit readers of the regulation by ensuring that the regulation is clear and conforms to statute. Licensed health care providers who use the registry would benefit by having access to the information they need in a timely manner so that they may honor their patients' advance directives. Individuals who choose to use the registry would benefit to the extent that their providers are able to access and follow the advance planning documents that they have filed. Although § 54.1-2995 of the Code of Virginia allows the board to charge individuals a fee for filing documents in the registry, the regulation does not currently contain any fees and VDH has confirmed that VHI does not charge individuals any fees to create an online account or file documents (collectively, these constitute "registration"). VDH reports that VHI incurs a cost of $4.95 per individual for registration, which is billed to and reimbursed by VDH. VDH also reports that VHI enrolls 25 new providers per year and is in the process of gradually increasing the enrollment of licensed health care providers, which resulted from legislative changes that expanded providers' ability to access the registry. VDH reports that VHI pays annual fees of $1800 per new provider (which reflects additional onboarding costs) and $1200 per existing provider. These costs are also billed to and reimbursed by VDH. Providers are not charged any fees to access documents filed by their patients.

Businesses and Other Entities Affected. The proposed amendments would benefit individuals who choose to use the registry as well as their healthcare providers by clarifying the documents that may be filed and ensuring that the regulation conforms to statute. As mentioned above, VDH incurs the cost of maintaining the registry and reimburses VHI for registration fees for individuals and enrollment fees for providers. However, these costs derive from statute and would not be newly created by the proposed amendments to the regulation. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁴ 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.⁵ As noted above, the proposed amendments conform the regulation to statute and do not create new costs or reduce net benefits. Thus, an adverse impact is not indicated.

Small Businesses⁶ Affected.⁷ The proposed amendments would not adversely affect small businesses.

Localities⁸ Affected.⁹ The proposed amendments would neither affect any locality in particular, nor introduce costs for local governments.

Projected Impact on Employment. The proposed amendments would not affect total employment.

Effects on the Use and Value of Private Property. The proposed amendments would not affect the use and value of private property. The proposed amendments do not affect 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/ViewPReview.cfm?PRid=2225 and https://legacylis.virginia.gov/cgibin/legp604.exe?241+sum+HB188, respectively.
³ See https://www.vhi.org/hie/advance-care-planning-registry/.

⁴ 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.

⁵ 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.

⁶ 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."

⁷ 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.

⁸ "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.

⁹ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

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

Summary:

The amendments conform the regulation to statute by (i) clarifying the types of advance care planning documentation that may be stored in the Advance Health Care Planning Registry and (ii) specifying who is permitted to access the documentation stored within the registry. Technical changes are also included.

Chapter 67

Advance Health Care Directive Planning Registry

12VAC5-67-5. Definitions.

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

"Advance directive" has the same meaning as defined in § 54.1-2982 of the Code of Virginia.

"Department" means the Virginia Department of Health.

"Registry" means the Advance Health Care Planning Registry.

12VAC5-67-10. General provisions.

A. In accordance with Article 9 (§ 54.1-2994 et seq.) of Chapter 29 of Title 54.1 of the Code of Virginia and this chapter, the Department of Health department shall make available to the public an Advance Health Care Directive Planning Registry available to the public by (i) contracting with a vendor, (ii) publicizing the availability of an existing registry maintained by another entity, or (iii) entering into a public-private partnership.

B. The department shall ensure that the contracted vendor, public-private partnership, or any other entity through which the department has made the registry available to citizens of the Commonwealth annually contacts persons who have registered documents to remind them of which documents they have registered.

12VAC5-67-20. Criteria for submission of an advance directive to the registry Advance Health Care Planning Registry.

A. Documents that may be submitted to the registry include:

1. A health care power of attorney.

2. An advance directive created pursuant to Article 8 (§ 54.1-2981 et seq.) of Chapter 29 of Title 54.1 of the Code of Virginia or a subsequent act of the General Assembly.

3. A declaration of an anatomical gift made pursuant to the Revised Uniform Anatomical Gift Act (§ 32.1-291.1 et seq. of the Code of Virginia).

4. Any other document that supports advance health care planning, including Durable Do Not Resuscitate Orders or portable medical order forms.

B. The document shall be submitted for filing by Only the person who executed the document or his the person's legal representative or designee may submit a document for filing in the registry.

C. The person submitting documents to the registry shall be responsible for payment of any fee required by the contracted vendor, public-private partnership, or any other entity through which the department has made the registry available to citizens of the Commonwealth. Fees associated with the registry shall not exceed the direct costs associated with the development and maintenance of the registry, and with the education of the public about the availability of the registry.

12VAC5-67-30. Access to the registry Advance Health Care Planning Registry.

A. The person registering documents in the registry may specify a legal representative or other persons to have access to such registered documents. It shall be the responsibility of the The person registering to the documents shall provide such persons the individuals with the information necessary to access the registry.

Licensed B. A licensed health care providers shall provider may have access to the registry for the purpose of when conducting a query for advance directive health care planning information on patients who are comatose, incapacitated, or otherwise mentally or physically incapable of communication a patient with whom the licensed health care provider has a treatment relationship.

TITLE 12. HEALTH

STATE BOARD OF HEALTH

Fast-Track Regulation

Title of Regulation: 12VAC5-67. Advance Health Care Directive Registry (amending 12VAC5-67-10, 12VAC5-67-20, 12VAC5-67-30; adding 12VAC5-67-5).

Statutory Authority: §§ 32.1-12, 54.1-2994, and 54.1-2995 of the Code of Virginia,

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: November 18, 2026.

Effective Date: December 3, 2026.

Agency Contact: Rilee Bennett, Senior Policy Analyst, Virginia Department of Health, 2001 Maywill Street, Suite 101, Richmond, VA 23230, telephone (804) 662-6258, or email rilee.bennett@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 and other laws of the Commonwealth administered by the board, the State Health Commissioner, or the Department of Health. Section 54.1-2994 of the Code of Virginia directs the Virginia Department of Health to make available a secure online central registry for advance health care planning. Section 54.1-2995 of the Code of Virginia requires the board to promulgate regulations related to the Advance Health Care Planning Registry.

Purpose: This action critical for safeguarding the health, safety, and welfare of Virginia residents because the changes establish a framework for timely access to a patients' critical health care planning information stored in the Advance Health Care Planning Registry, better clarify the types of advance health care planning documentation that may be stored in the registry, and specify who may access the documentation stored in the registry. Establishing clear criteria for document submission and access ensures that important health planning documents are easily and securely stored. This is particularly important in emergency situations where a patient may be unable to communicate preferences and health care providers need immediate access to these documents to make informed decisions about the patient's medical treatment.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking action because the changes conform the regulation to current law and practice. The agency does not anticipate any reduction in the services provided that are associated with the regulatory changes.

Substance: The amendments (i) define terms; (ii) permit the submission of other documents supporting advance health care planning into the Advance Health Care Planning Registry, including Durable Do Not Resuscitate Orders and portable medical order forms; (iii) remove a restriction placed on licensed health care providers by permitting them to access and query the registry for a patient's advance directive information even if the patient is comatose, incapacitated, or incapable of communication; and (iv) make technical changes.

Issues: The primary advantages to the public, the Commonwealth, and regulated and business entities include (i) clarification of the processes and requirements related to the filing, storage, and accessibility of health care planning documentation in Virginia's Advance Health Care Planning Registry and (ii) expansion of health care provider access to the documentation stored in the registry, which will provide medical professionals with the critical information needed to make timely and accurate medical decisions on behalf of patients. There are no known disadvantages to the public, regulated entities, or business entities as a result of the regulatory changes. The primary disadvantage to the agency and the Commonwealth is the increased cost charged to the agency to enhance and administer a registry that can be queried by health care providers.

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) seeks to update the regulation governing the Advance Health Care Directive Registry to implement changes based on a 2022 period review and 2024 legislation.² The proposed changes would (i) expand the types of documents that may be filed in the registry, (ii) expand the situations in which licensed health care providers may access the registry and who can obtain access, and (iii) align the regulation to current practice.

Background. The Advance Health Care Directive Registry was first established by Chapter 696 of the 2008 Acts of Assembly, which directed the Virginia Department of Health (VDH) to, "make available a secure only central registry for advance health care directives" and to promulgate regulations to implement certain provisions; accordingly, this regulation (12VAC5-67) became effective in 2011. The registry is maintained by Virginia Health Information (VHI).³ Chapters 231 and 274 of the 2024 Acts of Assembly renamed the registry to the Advance Health Care Planning Registry and added "any other document that supports advance health care planning, including Durable Do Not Resuscitate Order or portable medical order forms" to the list of documents that could be filed in the registry. Thus, the board seeks to amend the title of the regulation by replacing "directive" with "planning" and to conform the regulation to statute by adding the new documents specified in the legislation to the list in section 20 (Criteria for submission of an advanced directive to the Advance Health Care Planning Registry). Section 30 (Access to the Advance Health Care Planning Registry) currently states that "Licensed health care providers shall have access to the registry for the purpose of a query for advance directive information on patients who are comatose, incapacitated, or otherwise mentally or physically incapable of communication." The board seeks to replace this sentence to allow a licensed health care provider to access the registry, "when conducting a query for advance health care planning information on a patient with whom the [provider] has a treatment relationship." This change would provide greater flexibility for patients and providers. Specifically, in practice, providers would have broader access to the registry regardless of the patient's condition even if "they have not been previously informed of an advance directive or planning document by the patient." Lastly, the board seeks to (i) add definitions, (ii) clarify that the registry is available to the public, and (iii) specify that only the individual who executed the document, or their legal representative or designee, can file the document in the registry.

Estimated Benefits and Costs. The proposed amendments would benefit readers of the regulation by ensuring that the regulation is clear and conforms to statute. Licensed health care providers who use the registry would benefit by having access to the information they need in a timely manner so that they may honor their patients' advance directives. Individuals who choose to use the registry would benefit to the extent that their providers are able to access and follow the advance planning documents that they have filed. Although § 54.1-2995 of the Code of Virginia allows the board to charge individuals a fee for filing documents in the registry, the regulation does not currently contain any fees and VDH has confirmed that VHI does not charge individuals any fees to create an online account or file documents (collectively, these constitute "registration"). VDH reports that VHI incurs a cost of $4.95 per individual for registration, which is billed to and reimbursed by VDH. VDH also reports that VHI enrolls 25 new providers per year and is in the process of gradually increasing the enrollment of licensed health care providers, which resulted from legislative changes that expanded providers' ability to access the registry. VDH reports that VHI pays annual fees of $1800 per new provider (which reflects additional onboarding costs) and $1200 per existing provider. These costs are also billed to and reimbursed by VDH. Providers are not charged any fees to access documents filed by their patients.

Businesses and Other Entities Affected. The proposed amendments would benefit individuals who choose to use the registry as well as their healthcare providers by clarifying the documents that may be filed and ensuring that the regulation conforms to statute. As mentioned above, VDH incurs the cost of maintaining the registry and reimburses VHI for registration fees for individuals and enrollment fees for providers. However, these costs derive from statute and would not be newly created by the proposed amendments to the regulation. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁴ 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.⁵ As noted above, the proposed amendments conform the regulation to statute and do not create new costs or reduce net benefits. Thus, an adverse impact is not indicated.

Small Businesses⁶ Affected.⁷ The proposed amendments would not adversely affect small businesses.

Localities⁸ Affected.⁹ The proposed amendments would neither affect any locality in particular, nor introduce costs for local governments.

Projected Impact on Employment. The proposed amendments would not affect total employment.

Effects on the Use and Value of Private Property. The proposed amendments would not affect the use and value of private property. The proposed amendments do not affect 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/ViewPReview.cfm?PRid=2225 and https://legacylis.virginia.gov/cgibin/legp604.exe?241+sum+HB188, respectively.
³ See https://www.vhi.org/hie/advance-care-planning-registry/.

⁴ 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.

⁵ 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.

⁶ 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."

⁷ 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.

⁸ "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.

⁹ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

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

Summary:

The amendments conform the regulation to statute by (i) clarifying the types of advance care planning documentation that may be stored in the Advance Health Care Planning Registry and (ii) specifying who is permitted to access the documentation stored within the registry. Technical changes are also included.

Chapter 67

Advance Health Care Directive Planning Registry

12VAC5-67-5. Definitions.

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

"Advance directive" has the same meaning as defined in § 54.1-2982 of the Code of Virginia.

"Department" means the Virginia Department of Health.

"Registry" means the Advance Health Care Planning Registry.

12VAC5-67-10. General provisions.

A. In accordance with Article 9 (§ 54.1-2994 et seq.) of Chapter 29 of Title 54.1 of the Code of Virginia and this chapter, the Department of Health department shall make available to the public an Advance Health Care Directive Planning Registry available to the public by (i) contracting with a vendor, (ii) publicizing the availability of an existing registry maintained by another entity, or (iii) entering into a public-private partnership.

B. The department shall ensure that the contracted vendor, public-private partnership, or any other entity through which the department has made the registry available to citizens of the Commonwealth annually contacts persons who have registered documents to remind them of which documents they have registered.

12VAC5-67-20. Criteria for submission of an advance directive to the registry Advance Health Care Planning Registry.

A. Documents that may be submitted to the registry include:

1. A health care power of attorney.

2. An advance directive created pursuant to Article 8 (§ 54.1-2981 et seq.) of Chapter 29 of Title 54.1 of the Code of Virginia or a subsequent act of the General Assembly.

3. A declaration of an anatomical gift made pursuant to the Revised Uniform Anatomical Gift Act (§ 32.1-291.1 et seq. of the Code of Virginia).

4. Any other document that supports advance health care planning, including Durable Do Not Resuscitate Orders or portable medical order forms.

B. The document shall be submitted for filing by Only the person who executed the document or his the person's legal representative or designee may submit a document for filing in the registry.

C. The person submitting documents to the registry shall be responsible for payment of any fee required by the contracted vendor, public-private partnership, or any other entity through which the department has made the registry available to citizens of the Commonwealth. Fees associated with the registry shall not exceed the direct costs associated with the development and maintenance of the registry, and with the education of the public about the availability of the registry.

12VAC5-67-30. Access to the registry Advance Health Care Planning Registry.

A. The person registering documents in the registry may specify a legal representative or other persons to have access to such registered documents. It shall be the responsibility of the The person registering to the documents shall provide such persons the individuals with the information necessary to access the registry.

Licensed B. A licensed health care providers shall provider may have access to the registry for the purpose of when conducting a query for advance directive health care planning information on patients who are comatose, incapacitated, or otherwise mentally or physically incapable of communication a patient with whom the licensed health care provider has a treatment relationship.

TITLE 12. HEALTH

STATE BOARD OF HEALTH

Final Regulation

Title of Regulation: 12VAC5-610. Sewage Handling and Disposal Regulations (amending 12VAC5-610-599).

Statutory Authority: §§ 32.1-12 and 32.1-164 of the Code of Virginia.

Effective Date: November 18, 2026.

Agency Contact: Lance Gregory, Director, Onsite Sewage and Water 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.

Summary:

Pursuant to Chapter 212 of the 2026 Acts of the Assembly, the amendments exempt certain agritourism activities located in Planning District 23 from the prohibition on pumping and hauling sewage on a permanent basis unless done under the auspices and supervision of a government entity.

12VAC5-610-599. Permanent pumping and hauling.

A. Pumping and hauling on a permanent basis is prohibited unless done under the auspices and supervision of a government entity as provided for in 12VAC5-610-599.3 (see subdivision 2 of 12VAC5-610-410 for exception). Pumping and hauling for over one year shall be considered as a permanent pumping and hauling operation.

B. In Planning District 23, when an agritourism activity, as that term is defined in § 3.2-6400 of the Code of Virginia, is unable to establish and maintain a connection to an existing sewer or onsite sewage system, it shall be exempt from the prohibition on pumping and hauling sewage on a permanent basis unless done under the auspices and supervision of a government entity. Any pumping and hauling exempted pursuant to this subsection shall require storage facilities and vehicle specifications to conform to Article 7 (12VAC5-610-990 et seq.) and Article 8 (12VAC5-610-1020 et seq.) of Part V of this Chapter.

TITLE 12. HEALTH

DEPARTMENT OF MEDICAL ASSISTANCE SERVICES

Fast-Track Regulation

Title of Regulation: 12VAC30-141. Family Access to Medical Insurance Security Plan (amending 12VAC30-141-10, 12VAC30-141-40, 12VAC30-141-150, 12VAC30-141-175, 12VAC30-141-180, 12VAC30-141-500, 12VAC30-141-700, 12VAC30-141-810, 12VAC30-141-830; repealing 12VAC30-141-50, 12VAC30-141-60, 12VAC30-141-70, 12VAC30-141-670, 12VAC30-141-710, 12VAC30-141-720, 12VAC30-141-730).

Statutory Authority: §§ 32.1-324 and 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: November 18, 2026.

Effective Date: December 3, 2026.

Agency Contact: Emily McClellan, Regulatory Supervisor, Policy Division, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-4300, fax (804) 786-1680, or email emily.mcclellan@dmas.virginia.gov.

Basis: Section 32.1-325 of the Code of Virginia authorizes the Board of Medical Assistance Services to administer and amend the State Plan for Medical Assistance and to promulgate regulations. Section 32.1-324 of the Code of Virginia grants the Director of the Department of Medical Assistance Services (DMAS) the authority of the board when it is not in session.

Purpose: This action is necessary for the protection of public health, safety, and welfare of Medicaid and FAMIS members because it makes technical program updates and changes and repeals obsolete, out-of-date, and unnecessary provisions.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking process because it conforms the regulation to current practice and removes outdated language.

Substance: The amendments (i) clarify that appeals of adverse benefit determinations by a Managed Care Organization (MCO) may be made in accordance with 12VAC30-120-420 and that appeals of adverse actions or an MCO's internal appeal decision of an adverse benefit determination may be made in accordance with 12VAC30-110-10 through 12VAC30-110-370; (ii) clarify and remove obsolete and outdated language referencing payments and copayments; (iii) remove outdated prior authorization information; and (iv) repeal 12VAC30-141-670, Definitions, and merge chapter definitions into a single section at 12VAC30-141-10.

Issues: The primary advantage to the public and the Commonwealth is that the action aligns the regulation with current practices and removes outdated and unnecessary language. There are no disadvantages to the public, the agency, the Commonwealth, or the regulated community.

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. In accordance with Executive Order 19 (2022) (EO 19),² the director of Department Medical Assistance Services (DMAS) proposes to make clarifications and remove language that DMAS has determined is redundant, duplicative, obsolete, or outdated . These changes involve appeals, payments and copayments, and prior authorizations. Accordingly, DMAS would remove redundant language in six sections that is addressed in two other DMAS regulations and would update and remove duplicative language in nine sections. Obsolete and outdated language would also be removed in seven sections.

Background. This regulation sets out rules for the Family Access to Medical Insurance Security Plan (FAMIS). According to DMAS, the proposed changes are editorial in nature and would not affect any of the current practices.

Estimated Benefits and Costs. Because the proposed amendments do not change any of the existing rules in practice, no significant economic effect is expected other than updating the regulatory language to align with current practices and removing outdated and unnecessary language from the Virginia Administrative Code.

Businesses and Other Entities Affected. This regulation primarily applies to FAMIS providers and recipients. According to DMAS, there are 92,977 children and 5,008 pregnant/postpartum women enrolled in FAMIS as of February 1, 2026. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.³ 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.⁴ As no proposed amendment increases costs or reduces net revenue for any entity, no adverse impact is indicated.

Small Businesses⁵ Affected.⁶ The proposed amendments do not adversely affect small businesses.

Localities⁷ Affected.⁸ The proposed amendments do not introduce costs for localities, nor do they disproportionately affect any locality.

Projected Impact on Employment. The proposed amendments do affect total employment.

Effects on the Use and Value of Private Property. No impact on the use and value of private property nor on real estate development costs is expected.

_____________________________

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 https://townhall.virginia.gov/EO-19-Development-and-Review-of-State-Agency-Regulations.pdf.

³ 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.

⁴ 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.

⁵ 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."

⁶ 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.

⁷ "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.

⁸ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Department of Medical Assistance Services has reviewed the economic impact analysis prepared by the Department of Planning and Budget and raises no issues with this analysis.

Summary:

The action makes technical changes to conform the regulation to current practice. Specifically, the amendments (i) update or repeal appeals-related requirements in several sections, (ii) clarify and remove obsolete and outdated language referencing payments and copayment, (iii) remove outdated prior authorization language, and (iv) merge chapter definitions into a single section.

12VAC30-141-10. Definitions.

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

"Adverse action," consistent with 42 CFR 457.1130, means the denial of eligibility; failure to make a timely determination of eligibility; suspension or termination of enrollment, including disenrollment for failure to pay cost sharing; or delay, denial, reduction, suspension, or termination of health services, in whole or in part, including a determination about the type or level of services; and failure to approve, furnish, or provide payment for health services in a timely manner; provided, however, that determination of eligibility to participate in and termination of participation in the FAMIS Select program shall not constitute an adverse action.

"Adverse benefit determination," consistent with 42 CFR 438.400, means the denial or limited authorization of a requested service; the failure to take action or timely take action on a request for service; the reduction, suspension, or termination of a previously authorized service; denial in whole or in part of a payment for a service; failure to provide services within the timeframes required by the state; for a resident of a rural exception area with only one MCO, the denial of a enrollee's request to exercise the enrollee's right under 42 CFR 438.52(b)(2)(ii) to obtain services outside of the network; the denial of a an enrollee's request to dispute a financial liability as provided in 42 CFR 438.400(b)(7); or the failure of an MCO to act within the timeframes provided in 42 CFR 438.408(b).

"Agency" means a local department of social services, the central processing unit, or other entity designated by DMAS to make eligibility determinations for FAMIS and FAMIS MOMS.

"Agent" means an individual designated in writing to act on behalf of a FAMIS Plan or FAMIS MOMS applicant or enrollee during the administrative review process.

"Appeal" means an enrollee's request for review of an adverse benefit determination by an MCO or an adverse action by the LDSS, CPU, or DMAS.

"Applicant" means a child or pregnant person who has filed an application (or who has an application filed on his the individual's behalf) for child health insurance and is awaiting a determination of eligibility. A child The individual is an applicant until his the individual's eligibility has been determined.

"Application for health insurance" means the. single streamlined application for determining eligibility in public health insurance programs operated by the Commonwealth.

"Authorized representative" means a person, 18 years of age or older, who is authorized to conduct the personal or financial affairs for an individual.

"Central processing unit" or "CPU" means Cover Virginia, which is the centralized entity supported by DMAS to accept and act on applications for health insurance.

"Child" means an individual younger than 19 years of age.

"Conservator" means a person appointed by a court of competent jurisdiction to manage the estate and financial affairs of an incapacitated individual.

"Continuation of coverage" means ensuring an enrollee's benefits are continued until completion of the review process, with the condition that should the enrollee not prevail in the review process, the enrollee shall be liable for the repayment of all benefits received during the review process.

"Director" means the individual, or his the individual's designee, specified in § 32.1-324 of the Code of Virginia with all of the attendant duties and responsibilities to administer the State Plan for Medical Assistance and the State Plan for FAMIS Title XXI.

"DMAS" or "department" means the Department of Medical Assistance Services.

"Enrollee" means an applicant who has been determined eligible to participate in FAMIS or FAMIS MOMS and is enrolled in FAMIS or FAMIS MOMS.

"Ex parte review" means the review of administratively available information pertinent to the application or renewal process, conducted by eligibility staff, in order to expediently process the applicant's renewal without seeking that information from the applicant.

"Family," when used in the context of the FAMIS Select component, means a unit or group that has access to a private or employer's group health plan. Thus, it includes the policyholder or employee and any dependents who can be covered under the plan.

"FAMIS" means the Family Access to Medical Insurance Security Plan.

"FAMIS MOMS" means the Title XXI program available to eligible pregnant persons.

"FAMIS Select" means an optional program available to children determined eligible for FAMIS, whereby DMAS provides premium assistance to the family to cover the child through a private or employer-sponsored health plan instead of directly through the FAMIS program.

"Federal poverty level" or "FPL" means that income standard as published annually by the U.S. Department of Health and Human Services in the Federal Register.

"Fee-for-service" means the traditional Medicaid health care delivery and payment system in which physicians and other providers receive a payment for each unit of service they provide.

"Fixed premium assistance amount" means a predetermined amount of premium assistance that DMAS will pay per child to a family who chooses to enroll its FAMIS eligible child in a private or employer-sponsored health plan. The fixed premium assistance amount will be determined annually by DMAS to ensure that the FAMIS Select program is cost-effective as compared to the cost of covering a child directly through the FAMIS program.

"Guardian" means a person appointed by a court of competent jurisdiction to be responsible for the affairs of an incapacitated individual, including responsibility for making decisions regarding the person's support, care, health, safety, habilitation, education, and therapeutic treatment, and if not inconsistent with an order of commitment, residence.

"Household" means the household composition and follows the federal tax rules through the use of modified adjusted gross income (MAGI) methodology. An individual's household is based upon the tax filing relationships of applicant, persons living with the individual, and those claimed as dependents and as outlined in 42 USC § 435.603(3)(f)(1) through (f)(4).

"Household income" means the sum of MAGI-based income as outlined in 42 USC § 435.603(3)(d) through (3)(e) to include every individual in the household.

"Incapacitated" means a person who, pursuant to an order of a court of competent jurisdiction, has been found to be incapable of receiving and evaluating information effectively or responding to people, events, or environments to such an extent that the individual lacks the capacity to (i) meet the essential requirements of the individual's health, care, safety, or therapeutic needs without the assistance or protection of a guardian or (ii) manage property or financial affairs or provide for the individual's support or for the support of the individual's legal dependents without the assistance or protection of a conservator.

"Internal appeal" means a request to the MCO by an enrollee, an enrollee's authorized representative, or a provider, acting on behalf of the enrollee and with the enrollee's written consent, for review of an MCO's adverse benefit determination. The internal appeal is the only level of appeal with the MCO and must be exhausted by an enrollee or deemed exhausted according to 42 CFR 438.408(c)(3) before the enrollee may initiate a state fair hearing.

"Lawfully residing" means the individual is lawfully present in the United States.

"LDSS" or "local department" means the local department of social services.

"Managed care organization" or "MCO" means an organization that offers managed care health insurance plans (MCHIPs) as "MCHIP" is defined in § 32.1-137.1 of the Code of Virginia.

"Pregnant person" means a person of any age who is medically determined to be pregnant. The pregnant person definition is met from the first day of the earliest month that the medical practitioner certifies as being a month in which the person was pregnant, and continues for the duration of the 12-month period beginning the date of the end of the pregnancy, including any remaining days of the calendar month in which the 12-month period ends, regardless of the reason the pregnancy ended.

"Premium assistance" means the portion of the family's cost of participating in a private or employer's health plan that DMAS will pay to cover the FAMIS-eligible children under the private or employer-sponsored plan if DMAS determines it is cost effective to do so.

"Private or employer-sponsored health plan" means a health insurance policy that is either purchased by an individual directly or through an employer. This component of FAMIS refers to the ability of DMAS to provide coverage to FAMIS-eligible children by providing premium assistance to families who enroll the FAMIS-eligible children in a private or employer-sponsored health plan.

"Provider" means the individual, facility or other entity registered, licensed, or certified, as appropriate, and enrolled by an MCHIP or in fee-for-service to render services to FAMIS or FAMIS MOMS enrollees eligible for services.

"Reasonable opportunity period" means a 90-calendar-day period given to applicants to supply verification of citizenship and identity.

"State fair hearing" means, consistent with 42 CFR 438.400, the process set forth in 42 CFR 431 Subpart E.

"Targeted low-income child" means an uninsured child younger than age 19 years of age whose household income is within the FAMIS eligibility standards established by the Commonwealth.

"Title XXI" means the federal State Children's Health Insurance Program as established by Subtitle J of the Balanced Budget Act of 1997.

12VAC30-141-40. Appeal of adverse actions or adverse benefit determinations.

A. Upon written request, all FAMIS applicants and enrollees shall have the right to a state fair hearing of an adverse action made by the local department of social services, CPU, or DMAS and to an internal appeal Appeals of an adverse benefit determination made determinations by an MCO may be made in accordance with 12VAC30-120-420.

B. During the appeal Appeals of a suspension or termination of enrollment or a reduction, suspension, or termination of services, the enrollee shall have the right to continuation of coverage if the enrollee requests an adverse actions or an MCO's internal appeal with the MCO or an appeal to DMAS prior to the effective date of the suspension or termination of enrollment or suspension, reduction, or termination of services decision of an adverse benefit determination may be made in accordance with 12VAC30-110-10 through 12VAC30-110-370.

C. An appeal of an adverse action made by the local department of social services, CPU, or DMAS shall be heard and decided by an agent of DMAS who has not been directly involved in the adverse action under appeal.

D. An internal appeal of an adverse benefit determination made by the MCO must be conducted by a person or agent of the MCO who has not been directly involved in the adverse benefit determination under appeal.

E. C. Pursuant to 42 CFR 438.402(c)(1)(B), after exhausting the MCO's internal appeals process, there shall be opportunity for the enrollee to request an external medical review by an independent external quality medical review organization. "External quality medical review organization" means the independent contractor assigned by DMAS to handle quality medical reviews and to conduct final review of MCHIP adverse actions for FAMIS. The review is optional and shall not be required before proceeding to a state fair hearing. The review shall not extend any of the timeframes for issuing a decision and shall not disrupt any continuation of coverage granted to the enrollee.

F. There will be no opportunity for appeal of an adverse action to the extent that such adverse action is based on a determination by the director that funding for FAMIS has been terminated or exhausted. There will be no opportunity for appeal if the sole basis for the decision is a provision in the State Plan or in a state or federal law requiring an automatic change in eligibility or enrollment or is a change in coverage under the health benefits package that affects all applicants or enrollees or a group of applicants or enrollees without regard to their individual circumstances.

G. The burden of proof shall be assigned to the party who is attempting to make a change per 12VAC30-110-220 C.

H. At no time shall the failure of the local department of social services, MCO, CPU, or DMAS to meet the timeframes set in this chapter or set in the MCO or DMAS written appeal procedures constitute a basis for granting the applicant or enrollee the relief sought.

I. D. Adverse actions related to health benefits covered through the FAMIS Select program shall be resolved between the insurance company or employer's plan and the FAMIS Select enrollee and are not subject to further appeal by DMAS or its contractors.

12VAC30-141-50. Notice of adverse action or adverse benefit determination. (Repealed.)

A. The local department of social services, CPU, or DMAS shall send written notification to enrollees at least 10 calendar days prior to suspension or termination of enrollment.

B. DMAS or the MCO shall send written notification to enrollees at least 10 calendar days prior to reduction, suspension, or termination of a previously authorized health service.

C. The local department of social services, CPU, DMAS, or the MCO shall send written notification to applicants and enrollees of all other adverse actions within 10 calendar days of the adverse action.

D. Notice shall include:

1. The determination the LDSS, CPU, DMAS, or MCO has made or intends to make;

2. The reasons for the determination, including the right of the enrollee to be provided, upon request and free of charge, reasonable access to and copies of all documents, records, and other information relevant to the determination;

3. An explanation of applicable rights to request an appeal of that determination. For adverse benefit determinations by an MCO, this shall include information on the MCO's internal appeal process and, after the internal appeal process is exhausted, a state fair hearing pursuant to 42 CFR 402(b) and 42 CFR 402(c);

4. The procedure for exercising these appeal rights;

5. The circumstances under which an appeal process can be expedited and how to request it; and

6. The circumstances under which enrollment or services may continue pending appeal, how to request benefits be continued, and the circumstances, consistent with state policy, under which the enrollee may be required to pay the costs of these services.

12VAC30-141-60. Request for appeal. (Repealed.)

A. Requests for internal appeal of MCO adverse benefit determinations shall be submitted orally or in writing to the MCO. Unless the enrollee requests an expedited appeal, an oral appeal request must be followed by a written appeal request. The enrollee must exhaust the MCO's internal appeals process before appealing to DMAS.

B. If the MCO fails to adhere to the notice or timing requirements set forth in this part, the enrollee is deemed to have exhausted the MCO's internal appeals process and may initiate a state fair hearing.

C. Requests for appeal of adverse actions made by the local department of social services, CPU, or DMAS or of internal appeal decisions by the MCO shall be submitted to DMAS.

D. Any communication expressing a desire to have an adverse benefit determination by an MCO reviewed shall be treated as a request for an internal appeal. Any communication expressing a desire to have an adverse action by the LDSS, CPU, or DMAS reviewed shall be treated as a request for a state fair hearing. Any communication expressing a desire to have an MCO's internal appeal decision reviewed shall be treated as a request for a state fair hearing.

E. To be timely, requests for internal appeal of an MCO's adverse benefit determination shall be received by the MCO no later than 60 calendar days from the date of the MCO's notice of adverse benefit determination.

F. To be timely, a request for an appeal of an adverse benefit determination upheld in whole or in part by the MCO's internal appeal decision shall be received by DMAS within 120 calendar days from the date of the internal appeal decision.

G. To be timely, requests for appeal of a local department of social services, DMAS, or CPU adverse action shall be filed with DMAS no later than 30 calendar days from the date of the notice of adverse action. Requests for appeal of an agency determination shall be considered filed with DMAS on the date the request is postmarked if mailed, or on the date the request is received if delivered other than by mail, by DMAS.

12VAC30-141-70. Appeal procedures. (Repealed.)

A. At a minimum, the MCO internal appeal shall be conducted pursuant to written procedures as defined in § 32.1-137.6 of the Code of Virginia and 42 CFR 438.400 et seq. Such procedures shall be subject to review and approval by DMAS.

B. Any adverse benefit determination upheld in whole or in part by the internal appeal decision issued by the MCO may be appealed by the enrollee to DMAS in accordance with the DMAS client appeals regulations at 12VAC30-110-10 through 12VAC30-110-370. DMAS shall conduct an evidentiary hearing in accordance with the 12VAC30-110-10 through 12VAC30-110-370 and shall not base any appealed decision on the record established by any internal appeal decision of the MCO. The MCO shall comply with the DMAS appeal decision. The DMAS decision in these matters shall be final and shall not be subject to appeal by the MCO.

C. Appeals of adverse actions by the LDSS, CPU, or DMAS shall be conducted pursuant to 12VAC30-110.

D. Copies of the procedures shall be promptly provided by the MCO or DMAS to applicants and enrollees upon receipt of timely requests for internal appeals or state fair hearings. Such written procedures shall include the following:

1. The right to representation by an attorney or other agent of the applicant's or enrollee's choice, but at no time shall the MCO, local department of social services, DSS, or DMAS be required to obtain or compensate attorneys or other agents acting on behalf of applicants or enrollees;

2. The right to timely review of files and other applicable information relevant to the internal appeal or state fair hearing decision;

3. The right to fully participate in the internal appeal or state fair hearing process, whether the internal appeal or state fair hearing is conducted in person or in writing, including the presentation of supplemental information during the internal appeal or state fair hearing process;

4. The right to have personal and medical information and records maintained as confidential;

5. The right to a written final decision:

a. For internal appeals to the MCO, within 30 calendar days of receipt of the request for an internal appeal; or

b. For state fair hearings, within the time limitations for appeals imposed by federal regulations and as permitted in 12VAC30-110-30;

6. For eligibility and enrollment matters, if the applicant's or enrollee's physician or health plan determines that the 90-calendar-day timeframe could seriously jeopardize the applicant's or enrollee's life or health or ability to attain, maintain, or regain maximum function, an applicant or enrollee will have the opportunity to request an expedited appeal. Under these conditions, a request for an expedited appeal shall result in a written final decision within 72 hours after DMAS receives the expedited appeal request from the physician or health plan with the case record and information indicating that taking the time for a standard resolution of the appeal request could seriously jeopardize the applicant's or enrollee's life or health or ability to attain, maintain, or regain maximum function, unless the applicant or enrollee requests an extension;

7. For health services matters for FAMIS enrollees receiving services through an MCO:

a. If the enrollee's physician or health plan determines that the 30-calendar-day timeframe for a standard internal appeal could seriously jeopardize the enrollee's life or health or ability to attain, maintain, or regain maximum function, an enrollee will have the opportunity to request an expedited internal appeal. Under these conditions, a request for an internal appeal shall result in a written decision by the MCO within 72 hours from the time the expedited internal appeal is requested, unless the applicant, enrollee, or authorized representative requests a delay. If a delay is requested by the applicant, enrollee, or authorized representative, then the expedited internal appeal may be extended up to 14 calendar days.

b. If the adverse benefit determination is upheld in whole or in part by the expedited internal appeal decision issued by the MCO, and if the enrollee's physician or health plan determines that the timeframe for a standard appeal to DMAS could seriously jeopardize the enrollee's life or health or ability to attain, maintain, or regain maximum function, and enrollee will have the opportunity to request an expedited appeal to DMAS. Under these conditions, a request for a state fair hearing shall result in a written decision within 72 hours from the time an enrollee requests the expedited appeal, unless the applicant, enrollee, or authorized representative requests a delay. If a delay is requested by the applicant, enrollee, or authorized representative, then the expedited appeal may be extended up to 14 calendar days; and

8. For health services matters for FAMIS enrollees receiving services through fee-for-service, if the enrollee's physician or health plan determines that the 90-calendar-day timeframe for a standard appeal could seriously jeopardize the enrollee's life, health, or ability to attain, maintain, or regain maximum function, an enrollee will have the opportunity to request an expedited review. Under these conditions, a request for an expedited appeal shall result in a written decision within 72 hours from the time the expedited appeal is requested, unless the applicant, enrollee, or authorized representative requests a delay. If a delay is requested by the applicant, enrollee, or authorized representative, then expedited appeal may be extended up to 14 calendar days.

12VAC30-141-150. Application requirements.

A. Availability of program information. DMAS or its designee shall furnish the following information in written form and orally as appropriate to all applicants and to other individuals who request it:

1. The eligibility requirements;

2. Summary of covered benefits; 3. Copayment amounts required; and

4. 3. The rights and responsibilities of applicants and enrollees.

B. Opportunity to apply. DMAS or its designee must afford an individual, wishing to do so, the opportunity to apply. Applicants may file an application by mail, by fax, by phone, via the internet Internet, or in person at local departments of social services. Face-to-face interviews for the program are not required. Eligibility determinations for FAMIS shall occur at either local departments of social services, DMAS, or the CPU.

C. Application. DMAS or its designee shall require an application from the applicant if the applicant is at least 18 years of age or older, or from a parent, adult relative caretaker, guardian, legal custodian, or authorized representative if the applicant is younger than 18 years of age or the applicant is incapacitated. "Incapacitated" means a person who, pursuant to an order of a court of competent jurisdiction, has been found to be incapable of receiving and evaluating information effectively or responding to people, events, or environments to such an extent that the individual lacks the capacity to (i) meet the essential requirements of his the individual's health, care, safety, or therapeutic needs without the assistance or protection of a guardian, or (ii) manage property or financial affairs or provide for his the individual's support or for the support of his the individual's legal dependents without the assistance or protection of a conservator.

1. DMAS employs a single, streamlined application developed by the state and approved by the Secretary of the Department of Health and Human Services in accordance with § 1413(b)(I)(B) of the Affordable Care Act.

2. DMAS may employ an alternative application used to apply for multiple human service programs approved by the Secretary of the Department of Health and Human Services, provided that the agency makes readily available the single or alternative application used only for insurance affordability programs to individuals seeking assistance only through such programs.

D. Right to apply. An individual who is 18 years of age shall not be refused the right to complete an application for himself and shall not be discouraged from asking for assistance for himself under any circumstances.

E. Applicant's signature. The applicant must sign state-approved application forms submitted, even if another person fills out the form, unless the application is filed and signed by the applicant's parent, adult relative caretaker, legal guardian or conservator, attorney-in-fact, or authorized representative.

F. The authorized representative for an individual 18 years of age or older shall be those individuals as set forth in 12VAC30-110-1380.

G. The authorized representative for children younger than 18 years of age shall be those individuals as set forth in 12VAC30-110-1390.

H. Persons prohibited from signing an application. An employee of, or an entity hired by, a medical service provider who stands to obtain FAMIS payments shall not sign an application for health insurance on behalf of an individual who cannot designate an authorized representative.

I. Assistance with application. DMAS or its designee shall allow an individual of the applicant's choice to assist and represent the applicant in the application process, a renewal process, or both.

J. Timely determination of eligibility. The time processing standards for determining eligibility begin with the date an application is submitted online, by telephone, by fax, or received in hard copy either at a an LDSS or the CPU. An application for health insurance shall have an eligibility determination performed within the established federal case processing time standards.

K. Notice of the decision concerning eligibility. The determining agency shall send each applicant a written notice of the agency's or designee's decision on the applicant's application, and if approved, the applicant's obligations under the program. If eligibility for both FAMIS and Medicaid is denied, notice must be given concerning the reasons for the action and an explanation of the applicant's right to request a review of the adverse actions, as described in 12VAC30-141-50.

L. Case documentation. The determining agency shall include in each applicant's record all necessary facts to support the decision on the applicant's application and must dispose of each application by a finding of eligibility or ineligibility, unless (i) there is an entry in the case record that the applicant voluntarily withdrew the application and that the agency or its designee sent a notice confirming the applicant's decision; or (ii) there is a supporting entry in the case record that the applicant cannot be located.

M. Case maintenance. All cases approved for FAMIS shall be maintained at local departments of social services or another entity designated by DMAS. The determining agency will be responsible for providing newly enrolled recipients with program information, benefits available, how to secure services under the program, a FAMIS handbook, and for processing changes in eligibility and annual renewals within established timeframes. DMAS outreach resources may also provide information or assistance to the enrollee.

N. Renewal of eligibility. DMAS, LDSS, or the CPU shall redetermine the eligibility of enrollees with respect to circumstances that may change at least every 12 months. During the 12-month period of coverage, enrollees must make timely and accurate reports if an enrollee no longer resides in the Commonwealth of Virginia or when changes in income exceed 200% of the federal poverty level plus a 5.0% income disregard. The agency responsible for managing the case shall promptly redetermine eligibility when it receives information about changes in a FAMIS enrollee's circumstances that may affect eligibility. DMAS or its designee may assist with documenting changes reported by the enrollee.

O. Notice of decision concerning eligibility. The agency responsible for managing the case shall give enrollees timely notice of proposed action to terminate their eligibility under FAMIS. The notice must meet the requirements of 42 CFR 457.1180.

12VAC30-141-175. FAMIS Select.

A. Enrollees in FAMIS may, but shall not be required to, enroll in a private or employer-sponsored health plan if DMAS or its designee determines that such enrollment is cost effective cost-effective, as defined in this section.

B. Eligibility determination. FAMIS children may elect to receive coverage under a health plan purchased privately or through an employer and DMAS may elect to provide coverage by paying all or a portion of the premium if all of the following conditions are met:

1. The children are determined to be eligible for FAMIS;

2. The cost of coverage for the child under FAMIS Select is equal to or less than the Commonwealth's cost of obtaining coverage under FAMIS only for the eligible targeted low-income children involved. The cost-effectiveness determination methodology is described in subsection E of this section;

3. The policyholder agrees to assign rights to benefits under the private or employer-sponsored health plan to DMAS to assist the Commonwealth in pursuing these third-party payments for childhood immunizations. When a child is provided coverage under a private or employer-sponsored health plan, that plan becomes the payer for all other services covered under that plan; and

4. The policyholder is not under a court order to provide medical support for the applicant child.

C. DMAS will continually verify the child's or coverage under the private or employer-sponsored health plan and will redetermine the eligibility of the child for the FAMIS Select component when it receives information concerning an applicant's or enrollee's circumstances that may affect eligibility.

D. Application requirements.

1. DMAS shall furnish the following information in written form and orally, as appropriate, to the families of FAMIS children who have indicated an interest in FAMIS Select:

a. The eligibility requirements for FAMIS Select;

b. A description of how the program operates, the amount of premium assistance available, and how children can move from FAMIS Select into FAMIS if requested;

c. A summary of the covered benefits and cost-sharing requirements available through FAMIS;

d. A guide to help families make an informed choice by comparing the FAMIS plan to their private or employer-sponsored health plan. Such guide shall include a notice to the effect that children covered by FAMIS Select will not receive FAMIS-covered services, but only those health services covered by their private or employer-sponsored health plan, and that the FAMIS Select enrollee shall be responsible for any and all costs associated with their chosen health plan;

e. Information on coverage for childhood immunizations through FAMIS; and

f. The rights and responsibilities of applicants and enrollees.

2. DMAS will provide interested families with applications for FAMIS Select.

3. An electronic or written application for the FAMIS Select component shall be required from interested families.

4. DMAS shall determine eligibility for the FAMIS Select component promptly, within 45 calendar days from the date of receiving an application that contains all information and verifications necessary to determine eligibility, except in unusual circumstances beyond the agency's control. Actual enrollment into the FAMIS Select component may not occur for extended periods of time, depending on the ability of the family to enroll in the employer's plan.

5. Incomplete FAMIS Select applications shall be held for a period of 30 calendar days to enable applicants to provide outstanding information needed for a FAMIS Select eligibility determination. Any applicant who, within 30 calendar days of the receipt of the initial application, fails to provide information or verifications necessary to determine FAMIS Select eligibility shall have his application denied.

6. DMAS must send each applicant a written notice of the agency's decision on his application for FAMIS Select and, if approved, his obligations under the program. If eligibility is denied, notice will be given concerning the reasons for the denial.

E. Cost effectiveness Cost-effectiveness. DMAS may elect to provide coverage to FAMIS children by paying all or a portion of the family's private or employer-sponsored health insurance premium if the cost of such premium assistance under FAMIS Select is equal to or less than the Commonwealth's cost of obtaining coverage under FAMIS only for the eligible, targeted, low-income child involved. Providing premium assistance for the FAMIS-eligible children may result in the coverage of an adult or other relative or dependent; however, this coverage shall be solely incidental to covering the FAMIS child.

1. To ensure that the FAMIS Select program remains cost effective cost-effective, DMAS will establish a fixed premium assistance amount per child that will be paid to a family choosing to enroll their its FAMIS-eligible child in FAMIS Select. The fixed premium assistance amount will be determined annually by:

a. Determining the cost of covering a child under FAMIS. The cost will be determined by using the capitated payment rate paid to MCHIPs, or an average cost amount developed by DMAS;

b. Determining the administrative costs associated with the FAMIS Select program; and

c. Establishing a fixed premium assistance amount that includes administrative costs and is less than or equal to the cost of covering the FAMIS child under FAMIS.

DMAS will ensure that the total of the fixed premium assistance amounts for all the FAMIS-eligible children per family do not exceed the total cost of the family's health insurance premium payment for the private or employer-sponsored health plan. If the total fixed premium assistance amounts do exceed the family's premium payment, then the family premium assistance will be reduced by an amount necessary to ensure the premium assistance payment is less than or equal to the family's premium payment.

F. Enrollment and disenrollment.

1. FAMIS children applying for FAMIS Select will receive coverage under FAMIS until their eligibility for coverage under the FAMIS Select component is established and until they are able to enroll in the private or employer-sponsored health plan.

2. The timing and procedures employed to transfer FAMIS children's coverage to the FAMIS Select component will be coordinated between DMAS and the agency managing the case to ensure continuation of coverage.

3. Participation by families in the FAMIS Select component shall be voluntary. Families may disenroll their child from the FAMIS Select component as long as the proper timing and procedures established by DMAS are followed to ensure continued health coverage.

G. Premium assistance. When a child is determined eligible for coverage under the FAMIS Select component, premium assistance payments shall become effective the month in which the FAMIS child is enrolled in the employer's plan. Payment of premium assistance shall end:

1. On the last day of the month in which FAMIS eligibility ends;

2. The On the last day of the month in which the child loses eligibility for coverage under the private or employer-sponsored health plan;

3. The On the last day of the month in which the family notifies DMAS that it wishes to disenroll its child from the FAMIS Select component; or

4. On the next business day following a request by the family to immediately transfer the child from FAMIS Select into the FAMIS program. The request must include notification that the child's private or employer-sponsored health plan has been terminated as of the date of transfer and an agreement by the family to return to DMAS the premium assistance payment prorated for that portion of the month in which the child was not enrolled in the private or employer-sponsored health plan.

H. Supplemental health benefits coverage will be provided to ensure that FAMIS children enrolled in the FAMIS Select component receive all childhood immunizations available under the FAMIS benefits. FAMIS children can obtain these supplemental benefits through Medicaid providers.

I. Cost sharing. FAMIS Select families will be responsible for all copayments, deductibles, coinsurance, fees, or other cost-sharing requirements of the private or employer-sponsored health plan in which they enroll their children. There is no Title XXI family cost-sharing cap applied to families with children enrolled in FAMIS Select.

There is no copayment required for the supplemental immunization benefits provided through FAMIS.

12VAC30-141-180. Liability for excess benefits; liability for excess benefits or payments obtained without intent; recovery of FAMIS payments.

A. Any person who, without the intent to violate this section, obtains benefits or payments under FAMIS to which he the person is not entitled shall be liable for any excess benefits or payments received. If the enrollee knew or reasonably should have known that he was not entitled to the excess benefits, he the enrollee may also be liable for interest on the amount of the excess benefits or payments at the judgment rate as defined in § 6.1-330.54 of the Code of Virginia from the date upon which excess benefits or payments were made to the date on which repayment is made to the Commonwealth. No person shall be liable for payment of interest, however, when excess benefits or payments were obtained as a result of errors made solely by DMAS or its designee.

B. Any payment erroneously made on behalf of a FAMIS enrollee or former enrollee may be recovered by DMAS from the enrollee or the enrollee's income, assets, or estate unless state or federal law or regulation otherwise exempts such property.

12VAC30-141-500. Benefits reimbursement.

A. Reimbursement for the services covered under FAMIS fee-for-service and MCHIPs shall be as specified in this section.

B. Reimbursement for physician services, surgical services, clinic services, prescription drugs, laboratory and radiological services, outpatient mental health services, early intervention services, emergency services, home health services, immunizations, mammograms, medical transportation, organ transplants, skilled nursing services, well baby and well child care, vision services, durable medical equipment, disposable medical supplies, dental services, case management services, physical therapy, occupational therapy, or speech-language therapy services, hospice services, school-based health services, behavioral therapy services, including applied behavior analysis, and certain community-based mental health services shall be based on the Title XIX rates.

C. Reimbursement to MCHIPs shall be determined on the basis of the estimated cost of providing the MCHIP benefit package and services to an actuarially equivalent population. MCHIP rates will be determined annually and published 30 days prior to the effective date.

D. Exceptions.

1. Prior authorization is required after five visits in a fiscal year for physical therapy, occupational therapy, and speech-language therapy provided by home health providers and outpatient rehabilitation facilities and for home health skilled nursing visits. Prior authorization is required for the following nonemergency outpatient procedures: Magnetic Resonance Imaging, including Magnetic Resonance Angiography (MRA), Computerized Axial Tomography (CAT) scans, including Computed Tomography Angiography (CTA), or Positron Emission Tomography (PET) scans performed for the purpose of diagnosing a disease process or physical injury. Prior authorization for dental services will be based on the Title XIX prior authorization requirements for dental services.

2. 1. Reimbursement for inpatient hospital services will be based on the Title XIX rates in effect for each hospital. Reimbursement shall not include payments for disproportionate share or graduate medical education payments made to hospitals. Payments made shall be final and there shall be no retrospective cost settlements.

3. 2. Reimbursement for outpatient hospital services shall be based on the Title XIX rates in effect for each hospital. Payments made will be final and there will be no retrospective cost settlements.

4. 3. Reimbursement for inpatient mental health services other than by free standing psychiatric hospitals will be based on the Title XIX rates in effect for each hospital. Reimbursement will not include payments for disproportionate share or graduate medical education payments made to hospitals. Payments made will be final and there will be no retrospective cost settlements.

5. 4. Reimbursement for outpatient rehabilitation services will be based on the Title XIX rates in effect for each rehabilitation agency. Payments made will be final and there will be no retrospective cost settlements.

6. 5. Reimbursement for outpatient substance abuse treatment services will be based on rates determined by DMAS for children ages six through 18 years of age. Payments made will be final and there will be no retrospective cost settlements.

7. 6. Reimbursement for prescription drugs will be based on the Title XIX rates in effect. Reimbursements for Title XXI do not receive drug rebates as under Title XIX.

8. 7. Reimbursement for covered prescription drugs for noninstitutionalized FAMIS recipients receiving the fee-for-service benefits will be subject to review and prior authorization when their current number of prescriptions exceeds nine unique prescriptions within 180 calendar days, and as may be further defined by the agency's guidance documents for pharmacy utilization review and the prior authorization program. The prior authorization process shall be applied consistent with the process set forth in 12VAC30-50-210 A 7.

12VAC30-141-670. Definitions. (Repealed.)

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

"Adverse action," consistent with 42 CFR 457.1130, means the denial of eligibility; failure to make a timely determination of eligibility; suspension or termination of enrollment, including disenrollment for failure to pay cost sharing; or delay, denial, reduction, suspension, or termination of health services, in whole or in part, including a determination about the type or level of services; and failure to approve, furnish, or provide payment for health services in a timely manner; provided, however, that determination of eligibility to participate in and termination of participation in the FAMIS Select program shall not constitute an adverse action.

"Adverse benefit determination," consistent with 42 CFR 438.400, means the denial or limited authorization of a requested service; the failure to take action or timely take action on a request for service; the reduction, suspension, or termination of a previously authorized service; denial in whole or in part of a payment for a service; failure to provide services within the timeframes required by the state; for a resident of a rural exception area with only one MCO, the denial of a enrollee's request to exercise the enrollee's right under 42 CFR 438.52(b)(2)(ii) to obtain services outside of the network; the denial of a enrollee's request to dispute a financial liability as provided in 42 CFR 438.400(b)(7); or the failure of an MCO to act within the timeframes provided in 42 CFR 438.408(b).

"Agency" means the same as defined in 12VAC30-141-10.

"Agent" means an individual designated in writing to act on behalf of a FAMIS MOMS Plan applicant or enrollee during the administrative review process.

"Appeal" means an enrollee's request for review of an adverse benefit determination by an MCO or an adverse action by the LDSS, CPU, or DMAS.

"Applicant" means a pregnant woman who has filed an application (or who has an application filed on her behalf) for health insurance and is awaiting a determination of eligibility. A pregnant woman is an applicant until her eligibility has been determined.

"Application for health insurance" means the single streamlined application for determining eligibility in public health insurance programs operated by the Commonwealth.

"Authorized representative" means a person who is authorized to conduct the personal or financial affairs for an individual who is 18 years of age or older.

"Central processing unit" or "CPU" means Cover Virginia, which is the same as defined in 12VAC30-141-10.

"Child" means an individual younger than 19 years of age.

"Conservator" means a person appointed by a court of competent jurisdiction to manage the estate and financial affairs of an incapacitated individual.

"Continuation of coverage" means ensuring an enrollee's benefits are continued until completion of the review process, with the condition that should the enrollee not prevail in the review process, the enrollee shall be liable for the repayment of all benefits received during the review process.

"Director" means the individual, or his designee, specified in § 32.1-324 of the Code of Virginia with all of the attendant duties and responsibilities to administer the State Plan for Medical Assistance and the State Plan for Title XXI.

"DMAS" or "department" means the Department of Medical Assistance Services.

"Enrollee" means a pregnant woman who has been determined eligible to participate in FAMIS MOMS and is enrolled in the FAMIS MOMS program.

"FAMIS" means the Family Access to Medical Insurance Security Plan.

"FAMIS MOMS" means the Title XXI program available to eligible pregnant women.

"Federal poverty level" or "FPL" means that income standard as published annually by the U.S. Department of Health and Human Services in the Federal Register.

"Fee-for-service" means the traditional Medicaid health care delivery and payment system in which physicians and other providers receive a payment for each unit of service they provide.

"Guardian" means a person appointed by a court of competent jurisdiction to be responsible for the affairs of an incapacitated individual, including responsibility for making decisions regarding the person's support, care, health, safety, habilitation, education, and therapeutic treatment, and, if not inconsistent with an order of commitment, residence.

"Incapacitated " means a person who, pursuant to an order of a court of competent jurisdiction, has been found to be incapable of receiving and evaluating information effectively or responding to people, events, or environments to such an extent that the individual lacks the capacity to (i) meet the essential requirements of her health, care, safety, or therapeutic needs without the assistance or protection of a guardian, or (ii) manage property or financial affairs or provide for her support or for the support of her legal dependents without the assistance or protection of a conservator.

"LDSS" or "local department" means the local department of social services.

"Managed care organization" or "MCO" means an organization that offers managed care health insurance plans (MCHIPs) as defined in § 32.1-137.1 of the Code of Virginia.

"Pregnant woman" means a woman of any age who is medically determined to be pregnant. The pregnant woman definition is met from the first day of the earliest month that the medical practitioner certifies as being a month in which the woman was pregnant, through the last day of the month in which the 60th day occurs, following the last day of the month in which her pregnancy ended, regardless of the reason the pregnancy ended.

"Provider" means the individual, facility, or other entity registered, licensed, or certified, as appropriate, and enrolled by an MCHIP or in fee-for-service to render services to FAMIS MOMS enrollees eligible for services.

"State fair hearing" means, consistent with 42 CFR 438.400, the process set forth in 42 CFR 431 Subpart E.

"Title XXI" means the federal State Children's Health Insurance Program as established by Subtitle J of the Balanced Budget Act of 1997.

12VAC30-141-700. Appeal of adverse actions or adverse benefit determinations.

A. Upon request, all FAMIS MOMS program applicants and enrollees shall have the right to a state fair hearing of an adverse action made by the local department of social services, CPU, or DMAS, or an internal appeal Appeals of an adverse benefit determination made determinations by the an MCO may be made in accordance with 12VAC30-120-420.

B. During the appeal Appeals of a suspension or termination of enrollment or a reduction, suspension, or termination of services, the enrollee shall have the right to continuation of coverage if the enrollee requests adverse actions or an MCO's internal appeal with the MCO or an appeal to DMAS prior to the effective date of the suspension or termination of enrollment or suspension, reduction, or termination of services decision of an adverse benefit determination may be made in accordance with 12VAC30-110-10 through 12VAC30-110-370.

C. An appeal of an adverse action made by the local department of social services, CPU, or DMAS shall be heard and decided by an agent of DMAS who has not been directly involved in the adverse action under appeal.

D. An internal appeal of an adverse benefit determination made by the MCO must be conducted by a person or agent of the MCO who has not been directly involved in the adverse benefit determination under appeal.

E. Pursuant to 42 CFR 438.402(c)(1)(B), after exhausting the MCO's internal appeals process, there shall be opportunity for the enrollee to request an external medical review by an independent external quality review organization. "External quality review organization" means the independent contractor assigned by DMAS to handle quality reviews and to conduct final review of MCHIP adverse actions for FAMIS MOMS. The review is optional and shall not be required before proceeding to a state fair hearing. The review shall not extend any of the timeframes for issuing a decision and shall not disrupt any continuation of coverage granted to the enrollee.

F. There will be no opportunity for appeal of an adverse action to the extent that such adverse action is based on a determination by the director that funding for FAMIS MOMS has been terminated or exhausted. There will be no opportunity for appeal if the sole basis for the decision is a provision in the State Plan or in a state or federal law requiring an automatic change in eligibility or enrollment or a change in coverage under the health benefits package that affects all applicants or enrollees or a group of applicants or enrollees without regard to their individual circumstances.

G. The burden of proof shall be assigned to the party who is attempting to make a change per 12VAC30-110-220 C.

H. At no time shall the failure of MCO, LDSS, CPU, or DMAS to meet the timeframes set in this chapter or set in the MCO or DMAS written appeal procedure constitute a basis for granting the applicant or enrollee the relief sought.

12VAC30-141-710. Notice of adverse action or adverse benefit determination. (Repealed.)

A. The LDSS, CPU, DMAS, or DMAS contractor shall send written notification to enrollees at least 10 calendar days prior to suspension or termination of enrollment.

B. DMAS or the MCO shall send written notification to enrollees at least 10 calendar days prior to reduction, suspension, or termination of a previously authorized health service.

C. The local department of social services, CPU, DMAS, or MCO shall send written notification to applicants and enrollees of all other adverse actions within 10 calendar days of the adverse action.

D. Notice shall include:

1. The determination the LDSS, CPU, DMAS, or MCO has made or intends to make;

2. The reasons for the determination, including the right of the enrollee to be provided upon request and free of charge reasonable access to and copies of all documents, records, and other information relevant to the determination;

3. An explanation of applicable rights to request an appeal of that determination. For adverse benefit determinations by an MCO, this shall include information on the MCO's internal appeals process and, after the internal appeals process is exhausted, a state fair hearing pursuant to 42 CFR 402(b) and 42 CFR 402(c);

4. The procedures for exercising these appeal rights;

5. The circumstances under which an appeal process can be expedited and how to request it; and

6. The circumstances under which enrollment or services may continue pending appeal, how to request benefits be continued, and the circumstances, consistent with state policy, under which the enrollee may be required to pay the costs of these services.

12VAC30-141-720. Request for appeal. (Repealed.)

A. Requests for internal appeal of MCO adverse benefit determinations shall be submitted orally or in writing to the MCO. Unless the enrollee requests an expedited appeal, an oral appeal request must be followed by a written appeal request. The enrollee must exhaust the MCO's internal appeals process before appealing to DMAS.

B. If the MCO fails to adhere to the notice or timing requirements set forth in this part, the enrollee is deemed to have exhausted the MCO's internal appeals process and may initiate a state fair hearing.

C. Requests for appeal of adverse actions made by the LDSS, CPU, or DMAS, or of internal appeal decisions by the MCO shall be submitted to DMAS.

D. Any communication expressing a desire to have an adverse benefit determination by an MCO reviewed shall be treated as a request for an internal appeal. Any communication expressing a desire to have an adverse action by the LDSS, CPU, or DMAS reviewed shall be treated as a request for a state fair hearing. Any communication expressing a desire to have an MCO internal appeal decision reviewed shall be treated as a request for a state fair hearing.

E. To be timely, requests for an internal appeal of an MCO's adverse benefit determination shall be received by the MCO no later than 60 calendar days from the date of the MCO's notice of adverse benefit determination.

F. To be timely, requests for an appeal of an adverse benefit determination upheld in whole or in part by the MCO's internal appeal decision shall be received by DMAS within 120 calendar days from the date of the internal appeal decision.

G. To be timely, requests for appeal of a local department of social services, DMAS, or CPU adverse action shall be filed with DMAS no later than 30 calendar days from the date of the notice of adverse action. Requests for appeal of an agency determination shall be considered filed with DMAS on the date the request is postmarked if mailed, or on the date the request is received if delivered other than by mail, by DMAS.

12VAC30-141-730. Appeal procedures. (Repealed.)

A. At a minimum, the MCO internal appeal shall be conducted pursuant to written procedures as defined in § 32.1-137.6 of the Code of Virginia and 42 CFR 438.400 et seq. Such procedures shall be subject to review and approval by DMAS.

B. Any adverse benefit determination upheld in whole or in part by the internal appeal decision issued by the MCO may be appealed by the enrollee to DMAS in accordance with the DMAS client appeals regulations at 12VAC30-110-10 through 12VAC30-110-370. DMAS shall conduct an evidentiary hearing in accordance with 12VAC30-110-10 through 12VAC30-110-370 and shall not base any appealed decision on the record established by any internal appeal decision of the MCO. The MCO shall comply with the DMAS appeal decision. The DMAS decision in these matters shall be final and shall not be subject to appeal by the MCO.

C. Appeals of adverse actions by the LDSS, CPU, or DMAS shall be conducted pursuant to 12VAC30-110.

D. Copies of the procedures shall be promptly provided by the MCO or DMAS to applicants and enrollees upon receipt of timely requests for internal appeals or state fair hearings. Such written procedures shall include the following:

1. The right to representation by an attorney or other agent of the applicant's or enrollee's choice, but at no time shall the MCO, LDSS, DSS, or DMAS be required to obtain or compensate attorneys or other agents acting on behalf of applicants or enrollees;

2. The right to timely review of files and other applicable information relevant to the internal appeal or state fair hearing of the decision;

3. The right to fully participate in the internal appeal or state fair hearing process, whether the internal appeal or state fair hearing is conducted in person or in writing, including the presentation of supplemental information during the internal appeal or state fair hearing process;

4. The right to have personal and medical information and records maintained as confidential;

5. The right to a written final decision:

a. For internal appeals to the MCO, within 30 calendar days of receipt of the request for an internal appeal; or

b. For state fair hearings, within the time limitations for appeals imposed by federal regulations and as permitted in 12VAC30-110-30;

6. For eligibility and enrollment matters, if the applicant's or enrollee's physician or health plan determines that the 90-calendar-day timeframe could seriously jeopardize the applicant's or enrollee's life or health or ability to attain, maintain, or regain maximum function, an applicant or enrollee will have the opportunity to request an expedited appeal. Under these conditions, a request for an expedited appeal shall result in a written final decision within 72 hours after DMAS receives the expedited appeal request from the physician or health plan with the case record and information indicating that taking the time for a standard resolution of the appeal request could seriously jeopardize the applicant's or enrollee's life or health or ability to attain, maintain, or regain maximum function, unless the applicant or enrollee requests an extension;

7. For health services matters for FAMIS MOMS enrollees receiving services through an MCO:

a. If the enrollee's physician or health plan determines that the 30-calendar-day timeframe for a standard internal appeal could seriously jeopardize the enrollee's life, health, or ability to attain, maintain, or regain maximum function, an enrollee will have the opportunity to request an expedited internal appeal. Under these conditions, a request for an internal appeal shall result in a written decision by the MCO within 72 hours from the time the expedited internal appeal is requested, unless the applicant, enrollee, or authorized representative requests a delay. If a delay is requested by the applicant, enrollee, or authorized representative, then expedited internal appeal may be extended up to 14 calendar days.

b. If the adverse benefit determination is upheld in whole or in part by the expedited internal appeal decision issued by the MCO, and if the enrollee's physician or health plan determines that the timeframe for a standard appeal to DMAS could seriously jeopardize the enrollee's life or health or ability to attain, maintain, or regain maximum function, an enrollee will have the opportunity to request an expedited appeal to DMAS. Under these conditions, a request for a state fair hearing shall result in a written decision within 72 hours from the time an enrollee requests the expedited appeal, unless the applicant, enrollee, or authorized representative requests or causes a delay. If a delay is requested by the applicant, enrollee, or authorized representative, then the expedited appeal may be extended up to 14 calendar days; and

8. For health services matters for FAMIS MOMS enrollees receiving services through fee-for-service, if the enrollee's physician or health plan determines that the 90-calendar-day timeframe for a standard appeal could seriously jeopardize the enrollee's life, health, or ability to attain, maintain, or regain maximum function, an enrollee will have the opportunity to request an expedited review. Under these conditions, a request for an expedited appeal shall result in a written decision within 72 hours from the time the expedited appeal is requested, unless the applicant, enrollee, or authorized representative requests or causes a delay. If a delay is requested or caused by the applicant, enrollee, or authorized representative, then expedited appeal may be extended up to 14 calendar days.

12VAC30-141-810. Liability for excess benefits.

A. Any person who, without the intent to violate this section, obtains benefits or payments under FAMIS MOMS to which she the person is not entitled shall be liable for any excess benefits or payments received. If the enrollee knew or reasonably should have known that she the enrollee was not entitled to the excess benefits, she the enrollee may also be liable for interest on the amount of the excess benefits or payments at the judgment rate as defined in § 6.1-330.54 of the Code of Virginia from the date upon which excess benefits or payments were made to the date on which repayment is made to the Commonwealth. No person shall be liable for payment of interest, however, when excess benefits or payments were obtained as a result of errors made solely by DMAS or its designee.

B. Any payment erroneously made on behalf of a FAMIS MOMS enrollee or former enrollee may be recovered by DMAS from the enrollee or the enrollee's income, assets, or estate unless state or federal law or regulation otherwise exempts such property.

12VAC30-141-830. Benefits reimbursement.

A. Reimbursement for the services covered under FAMIS MOMS fee-for-service and MCHIPs shall be as specified in this section.

B. Reimbursement for physician services, surgical services, clinic services, prescription drugs, laboratory and radiological services, outpatient mental health services, early intervention services, emergency services, home health services, immunizations, mammograms, medical transportation, organ transplants, skilled nursing services, well baby and well child care, vision services, durable medical equipment, disposable medical supplies, dental services, case management services, physical therapy/occupational therapy/speech-language therapy services, hospice services, school-based health services, and certain community-based mental health services shall be based on the Title XIX rates.

C. Reimbursement to MCHIPs shall be determined on the basis of the estimated cost of providing the MCHIP benefit package and services to an actuarially equivalent population. MCHIP rates will be determined annually and published 30 days prior to the effective date.

D. Exceptions.

1. Prior authorization is required after five visits in a fiscal year for physical therapy, occupational therapy and speech therapy provided by home health providers and outpatient rehabilitation facilities and for home health skilled nursing visits. Prior authorization is required after five visits for outpatient mental health visits in the first year of service and prior authorization is required for the following nonemergency outpatient procedures: Magnetic Resonance Imaging, Computer Axial Tomography scans, or Positron Emission Tomography scans.

2. 1. Reimbursement for inpatient hospital services will be based on the Title XIX rates in effect for each hospital. Reimbursement shall not include payments for disproportionate share or graduate medical education payments made to hospitals. Payments made shall be final and there shall be no retrospective cost settlements.

3. 2. Reimbursement for outpatient hospital services shall be based on the Title XIX rates in effect for each hospital. Payments made will be final and there will be no retrospective cost settlements.

4. 3. Reimbursement for inpatient mental health services other than by free standing psychiatric hospitals will be based on the Title XIX rates in effect for each hospital. Reimbursement will not include payments for disproportionate share or graduate medical education payments made to hospitals. Payments made will be final and there will be no retrospective cost settlements.

5. 4. Reimbursement for outpatient rehabilitation services will be based on the Title XIX rates in effect for each rehabilitation agency. Payments made will be final and there will be no retrospective cost settlements.

6. 5. Reimbursement for outpatient substance abuse treatment services will be based on rates determined by DMAS for children ages six through 18 years of age. Payments made will be final and there will be no retrospective cost settlements.

7. 6. Reimbursement for prescription drugs will be based on the Title XIX rates in effect. Reimbursements for Title XXI do not receive drug rebates as under Title XIX.

8. 7. Reimbursement for covered prescription drugs for non-institutionalized FAMIS MOMS individuals receiving the fee-for-service benefits will be subject to review and prior authorization when their current number of prescriptions exceeds nine unique prescriptions within 180 days, and as may be further defined by the agency's guidance documents for pharmacy utilization review and the prior authorization program. The prior authorization process shall be applied consistent with the process set forth in 12VAC30-50-210 A 7.

TITLE 12. HEALTH

STATE BOARD OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

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 Behavioral Health and Developmental Services intends to consider amending 12VAC35-105, Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services. The purpose of the proposed action is to add Article 8 (12VAC35-105-1412 through 12VAC35-105-1419), Recovery and Empowerment Center, containing new sections establishing Mental Health Clubhouse Services in Virginia, including (i) definitions necessary for the integration of recovery and empowerment centers (REC) into the licensing regulations; (ii) REC admission criteria; (iii) REC discharge criteria; (iv) minimum service delivery requirements for REC; (v) minimum requirements for REC staffing; and (vi) standards for REC physical environment. The amendments are mandated by Item 297 of Chapter 1 of the 2026 Acts of Assembly, Special Session I.

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

Statutory Authority: §§ 37.2-203 and 37.2-400 of the Code of Virginia.

Public Comment Deadline: November 18, 2026.

Agency Contact: Susan Puglisi, Regulatory Research Specialist, Department of Behavioral Health and Developmental Services, Jefferson Building, 1220 Bank Street, Fourth Floor, Richmond, VA 23219, telephone (804) 975-0538, fax (804) 371-6638, TDD (804) 371-8977, or email susan.puglisi@dbhds.virginia.gov.

TITLE 12. HEALTH

STATE BOARD OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

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 Behavioral Health and Developmental Services intends to consider amending 12VAC35-105, Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services. The purpose of the proposed action is to add Article 9 (12VAC35-105-1420 through 12VAC35-105-1425), Community Psychiatric Support and Treatment (CPST), containing new sections establishing CPST services in Virginia, including (i) definitions necessary for the integration of CPST services into the licensing regulations; (ii) CPST admission criteria; (iii) CPST discharge criteria; (iv) minimum service delivery and location requirements for CPST; and (v) minimum requirements for treatment teams and staffing for CPST. The amendments are mandated by Item 297 of Chapter 1 of the 2026 Acts of Assembly, Special Session I.

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

Statutory Authority: §§ 37.2-203 and 37.2-400 of the Code of Virginia.

Public Comment Deadline: November 18, 2026.

Agency Contact: Susan Puglisi, Regulatory Research Specialist, Department of Behavioral Health and Developmental Services, Jefferson Building, 1220 Bank Street, Fourth Floor, Richmond, VA 23219, telephone (804) 975-0538, fax (804) 371-6638, TDD (804) 371-8977, or email susan.puglisi@dbhds.virginia.gov.

TITLE 12. HEALTH

STATE BOARD OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

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 Behavioral Health and Developmental Services intends to consider amending 12VAC35-105, Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services. The purpose of the proposed action is to add Article 10 (12VAC35-105-1426 through 12VAC35-105-1429), Coordinated Specialty Care, containing new sections establishing Coordinated Specialty Care (CSC) services in Virginia, including (i) definitions necessary for the integration of CSC into the licensing regulations; (ii) CSC admission criteria; (iii) CSC discharge criteria; (iv) minimum service delivery requirements for CSC; and (v) minimum requirements for treatment teams and staffing for CSC. The amendments are mandated by Item 297 of Chapter 1 of the 2026 Acts of Assembly, Special Session I.

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

Statutory Authority: §§ 37.2-203 and 37.2-400 of the Code of Virginia.

Public Comment Deadline: November 18, 2026.

Agency Contact: Susan Puglisi, Regulatory Research Specialist, Department of Behavioral Health and Developmental Services, Jefferson Building, 1220 Bank Street, Fourth Floor, Richmond, VA 23219, telephone (804) 975-0538, fax (804) 371-6638, TDD (804) 371-8977, or email susan.puglisi@dbhds.virginia.gov.

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY

Fast-Track Regulation

Title of Regulation: 18VAC30-21. Regulations Governing Audiology and Speech-Language Pathology (amending 18VAC30-21-60).

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

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: November 18, 2026.

Effective Date: December 3, 2026.

Agency Contact: Kelli Moss, Executive Director, Board of Audiology and Speech-Language Pathology, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 597-4132, fax (804) 939-5238, or email kelli.moss@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia authorizes the Board of Audiology and Speech-Language Pathology to promulgate regulations that are reasonable and necessary to effectively administer the regulatory system.

Purpose: This action is essential to protect the health, safety, and welfare of citizens because the General Assembly has directed the board to regulate the profession. This change is in the best interest of the profession and increases the available number of audiologists in Virginia.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking process because the proposed change is a reinsertion of language that was previously in regulation and was mistakenly removed by a previous regulatory action.

Substance: The amendment permits an applicant who holds a current and unrestricted certification issued by the ABA to obtain a license. This exact language was removed previously.

Issues: The primary advantage to the public is an increase in pathways for individuals who want to obtain a license as an audiologist, possibly increasing the number of audiologists in Virginia. There are no disadvantages to the public. There are no advantages or disadvantages to the agency 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 Board of Audiology and Speech-Language Pathology (board) seeks to amend the qualifications for initial licensure to re-insert language that had been erroneously removed in a previous action.

Background. The qualifications for initial licensure (18VAC30-21-60) previously stated that the board may grant an initial license to an applicant who holds a current and unrestricted certification issued by the American Board of Audiology (ABA). This language was unintentionally struck in an action that became effective in February 2025.² The American Academy of Audiology filed a petition for rulemaking in December 2025 to include the ABA certification as a pathway to licensure.³ The board seeks to insert language that would once again include the ABA certification as an acceptable qualification for licensure.

Estimated Benefits and Costs. The proposed amendment would correct the regulatory text and resolve any confusion regarding eligibility for licensure as an audiologist or speech-language pathologist. The Department of Health Professions (DHP) reports that applicants with ABA certification comprise a small minority of license applicants and that the board did not see a drop in license applications due to the 2025 regulatory action. Thus, DHP does not expect the proposed change to lead to a significant increase in the number of applicants. To the extent that any new candidates for licensure holding an ABA certification have refrained from applying since February 2025, the proposed change would benefit those candidates by clearly establishing their eligibility in the regulation.

Businesses and Other Entities Affected. The proposed amendment would benefit individuals with an ABA certification by (once again) including it in the acceptable qualifications for licensure. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁴ 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.⁵ As noted above, since the proposed amendment is intended to correct an error and not establish a brand new pathway to licensure, it would not increase net costs or reduce net benefits. Thus, an adverse impact is not indicated.

Small Businesses⁶ Affected.⁷ The proposed amendments would not adversely affect small businesses.

Localities⁸ Affected.⁹ The proposed amendments would not disproportionately affect any locality in particular. The proposed amendments do not introduce costs for local governments.

Projected Impact on Employment. The proposed amendments would not affect total employment.

Effects on the Use and Value of Private Property. The proposed amendments would not affect the use and value of private property. The proposed amendments do not affect 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/ViewStage.cfm?stageid=9924.

³ See https://townhall.virginia.gov/L/viewpetition.cfm?petitionid=447.

⁴ 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.

⁵ 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.

⁶ 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."

⁷ 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.

⁸ "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.

⁹ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Board of Audiology and Speech-Language Pathology concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

In response to a petition for rulemaking, the amendments permit an applicant who holds a current and unrestricted certification issued by the American Board of Audiology to obtain a license.

18VAC30-21-60. Qualifications for initial licensure.

A. The board may grant an initial license to an applicant for licensure in audiology or speech-language pathology who:

1. Holds a current and unrestricted Certificate of Clinical Competence issued by ASHA; or

2. Holds a current and unrestricted certification issued by the ABA; or

3. Submits evidence of the following:

a. Documentation of graduation from a program accredited by the Council on Academic Accreditation of ASHA or an equivalent accrediting body recognized by the board;

b. Passage of the qualifying examination from an accrediting body recognized by the board; and

c. Evidence of six months of practice pursuant to a provisional license as described in 18VAC30-21-70 and submission of recommendation for licensure from the applicant's supervisor during practice as a provisional licensee.

B. The board may grant a license to an applicant as a school speech-language pathologist who holds a master's degree in speech-language-pathology.

C. The board may refuse to issue a license to any applicant who has been determined to have committed an act in violation of 18VAC30-21-160.

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD FOR BARBERS AND COSMETOLOGY

Notice of Extension of Emergency Regulation

Title of Regulation: 18VAC41-20. Barbering and Cosmetology Regulations (amending 18VAC41-20-10, 18VAC41-20-100, 18VAC41-20-140, 18VAC41-20-160, 18VAC41-20-170, 18VAC41-20-180, 18VAC41-20-260, 18VAC41-20-270, 18VAC41-20-280; adding 18VAC41-20-35).

Statutory Authority: §§ 54.1-201 and 54.1-700.1 of the Code of Virginia.

The Governor has approved the request of the Board for Barbers and Cosmetology to extend the expiration date of the emergency regulation for 18VAC41-20 for six months as provided for in § 2.2-4011 D of the Code of Virginia. Therefore, the emergency regulation is continued in effect through April 28, 2027. This extension is required to avoid a negative impact on cosmetologists practicing pursuant the Cosmetology Compact. The board is currently waiting for the completion of Executive Branch review of the final regulation. The emergency regulation was published in 41:17 VA.R. 1817-1825 April 7, 2025.

Effective Date Extended Through: April 28, 2027.

Agency Contact: Ashley Reed, Executive Director, Board for Barbers and Cosmetology, 9960 Mayland Drive, Suite 400, Richmond, VA 23233, telephone (804) 367-8590, fax (866) 245-9693, or email barbercosmo@dpor.virginia.gov.

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

CEMETERY BOARD

Final Regulation

Title of Regulation: 18VAC47-20. Cemetery Board Rules and Regulations (amending 18VAC47-20-150).

Statutory Authority: § 54.1-2313 of the Code of Virginia.

Effective Date: December 1, 2026.

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

Summary:

Pursuant to Chapter 772 of the 2026 Acts of Assembly, the amendments (i) provide that the Cemetery Board may take disciplinary cases under advisement in lieu of other disciplinary sanctions as provided for in § 54.1-201 A 7 of the Code of Virginia and (ii) clarify the actions the board may take against a credential held by a regulant.

18VAC47-20-150. Grounds for disciplinary action.

The In accordance with § 54.1-2314 of the Code of Virginia, the board may suspend a license or registration for a stated period or indefinitely, revoke any license or registration, censure or reprimand or impose a monetary penalty against any person licensed or registered by the board or (i) suspend, (ii) place such person on probation for such time as it may designate, (iii) fail to renew, or (iv) revoke any license or registration when any licensee or registrant has been found to have violated or cooperated with others in violating any provision of Chapter 23.1 (§ 54.1-2310 et seq.) of Title 54.1 of the Code of Virginia or any regulation of the board. The board may also take a case against a licensee or registrant under advisement as provided for in § 54.1-201 A 7 of the Code of Virginia.

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF COUNSELING

Fast-Track Regulation

Title of Regulation: 18VAC115-80. Regulations Governing the Registration of Qualified Mental Health Professionals (amending 18VAC115-80-110).

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

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: November 18, 2026.

Effective Date: December 3, 2026.

Agency Contact: Maria S. Stransky, Executive Director, Board of Counseling, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4610, or email maria.stransky@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia authorizes the Board of Counseling to promulgate regulations that are reasonable and necessary to effectively administer the regulatory system.

Purpose: This action is essential to protect the health, safety, and welfare of citizens because the General Assembly has determined that the board should regulate qualified mental health professionals (QMHPs) and ensure quality of care.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and is therefore appropriate for the fast-track rulemaking process because it creates a new pathway to regain a registration as a QMHP-trainee, which could be considered a reduction in burden.

Substance: The amendments (i) add a renewal pathway for a QMHP-trainee whose registration has expired within one year and (ii) outline requirements for reinstatement for QMHP-trainees.

Issues: The primary advantages to the public are more QMHP-trainees in the workforce. There are no disadvantages to the public. There are no advantages or disadvantages to the agency 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 Board of Counseling (board) proposes to enable qualified mental health professional² (QMHP)-trainees whose registration has expired to: (i) renew their registration if it has been expired for one year or less, and (ii) reinstate their registration if it has been expired for more than a year.

Background. Prior to an exempt action (Action 6549)³ that became effective May 7, 2025, registration as a QMHP-trainee expired five years from the date of issuance and could not be renewed. Action 6549 amended the regulatory text to have QMHP-trainee registration last one year but be renewable. However, action 6549 did not address late renewal or reinstatement for QMHP-trainee registration. According to the Department of Health Professions (DHP), former QMHP-trainees have contacted the board to ask about returning to become a QMHP-trainee, prompting recognition that the regulation did not provide a pathway for reinstatement. Consequently, the board proposes to establish that a person whose registration as a QMHP-trainee has been expired for more than a year can reinstate it by (i) paying the $75 reinstatement fee and (ii) submitting evidence of enrollment in or completion of a bachelor's degree program from an institution of higher education listed as accredited on the U.S. Department of Education College Accreditation database found on the U.S. Department of Education website or accredited by another accrediting agency recognized by the Board. The education requirement is consistent with the requirement to gain initial QMHP-trainee registration. Additionally, the proposed regulation states that "A person whose registration as a QMHP-trainee has expired may renew it within one year by paying the late renewal fee [$20] and renewal fee [$10]."

Estimated Benefits and Costs. There is a relative shortage of QMHPs available to serve the public. The DHP Healthcare Workforce Data Center's publication Virginia's Qualified Mental Health Professional Workforce: 2025⁴ reports that less than one percent of QMHPs are involuntary unemployed. The U.S. Bureau of Labor Statistics also projects strong growth in the demand for mental health-related occupations.⁵ Enabling QMHP-trainees who are up to one year late in paying their registration renewal to renew by just paying a late fee (in addition to the registration fee) is beneficial for the trainee and employers of trainees. Similarly, allowing former QMHP-trainees to reinstate their registration by paying the $75 reinstatement fee and showing evidence that the education requirement is satisfied would benefit individuals who wish to return to working toward being a QMHP and those who wish to employ them. Moreover, the proposed introduction of late renewal and reinstatement of QMHP-trainee registration may moderately increase the future supply of QMHPs and help alleviate the shortage noted above.

Businesses and Other Entities Affected. § 54.1-3500 of the Code of Virginia states in part that a QMHP-trainee "shall provide such services as an employee or independent contractor of the Department of Behavioral Health and Developmental Services, the Department of Corrections, or the Department of Education or a provider licensed by the Department of Behavioral Health and Developmental Services." Thus, these state agencies would be potentially affected by the proposed amendments. As of December 31, 2025, there were 8,288 QMHP-trainees.⁶ The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁷ 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.⁸ The proposed amendments neither increase net cost nor reduce net benefit for any entity. Thus, no adverse impact is indicated.

Small Businesses⁹ Affected.¹⁰ The proposed amendments do not adversely affect small businesses.

Localities¹¹ Affected.¹² The proposed amendments neither disproportionately affect particular localities nor introduce costs for local governments.

Projected Impact on Employment. The proposed amendments may enable employers of QMHPs to fill some currently unfilled QMHP positions. Otherwise, the proposal is unlikely to substantively affect employment.

Effects on the Use and Value of Private Property. The proposed amendments may help enable some individuals to become employed as QMHP-trainees and eventually QMHPs, which could increase their net worth. The proposed amendments do not affect 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 Section 54.1-3500 of the Code of Virginia defines "qualified mental health professional" as "a person who has (i) completed, at a minimum, a bachelor's degree; (ii) registered with the Board to practice in accordance with the provisions of § 54.1-3520 and the regulations of the Board; and (iii) a combination of work, training, or experience in providing collaborative behavioral health services for youth or adults. A "qualified mental health professional" shall provide such services as an employee or independent contractor of the Department of Behavioral Health and Developmental Services, the Department of Corrections, or the Department of Education or a provider licensed by the Department of Behavioral Health and Developmental Services."

³ See https://www.townhall.virginia.gov/L/ViewAction.cfm?actionid=6549.

⁴ See page 10: https://www.dhp.virginia.gov/media/dhpweb/docs/hwdc/behsci/0732QMHP2025.pdf.

⁵ See https://www.bls.gov/opub/ted/2024/strong-growth-projected-in-mental-health-related-employment.htm.

⁶ See https://www.dhp.virginia.gov/about/stats/2026Q2/04CurrentLicenseCountQ2FY2026.pdf.

⁷ 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.

⁸ 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.

⁹ 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."

¹⁰ 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.

¹¹ "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.

¹² Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

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

Summary:

The amendments introduce a reinstatement pathway for qualified mental health professional-trainees.

18VAC115-80-110. Late renewal and reinstatement.

A. A person whose registration as a QMHP has expired may renew it within one year after its expiration date by paying the late renewal fee and the registration renewal fee as prescribed in 18VAC115-80-20 for the year in which the registration was not renewed and by providing documentation of completion of continuing education as prescribed in 18VAC115-80-80.

B. A person whose registration as a QMHP-trainee has expired may renew the registration within one year by paying the late renewal fee and renewal fee as prescribed by 18VAC115-80-20.

C. A person who fails to renew a registration as a QMHP after one year or more shall:

1. Apply for reinstatement;

2. Pay the reinstatement fee for a lapsed registration;

3. Provide a current report from the NPDB, if applicable; and

4. Submit evidence of completion of eight hours of continuing education for each year in which the license has been inactive or lapsed, not to exceed 32 hours.

C. D. A person who fails to renew a registration as a QMHP-trainee after one year or more shall:

1. Apply for reinstatement;

2. Pay the reinstatement fee for a lapsed registration; and

3. Submit evidence of enrollment in or completion of a bachelor's degree program as required in 18VAC115-80-65.

E. A person whose registration has been suspended or who has been denied reinstatement by board order, having met the terms of the order, may submit a new application and fee for reinstatement of registration as prescribed in 18VAC115-80-20. Any person whose registration has been revoked by the board may, three years subsequent to such board action, submit a new application and fee for reinstatement of registration as prescribed in 18VAC115-80-20. The board in its discretion may, after an administrative proceeding, grant the reinstatement sought in this subsection.

TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

REAL ESTATE APPRAISER BOARD

Final Regulation

Title of Regulation: 18VAC130-20. Real Estate Appraiser Board Rules and Regulations (amending 18VAC130-20-30, 18VAC130-20-60, 18VAC130-20-210, 18VAC130-20-250).

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

Effective Date: December 1, 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.

Summary:

Pursuant to Chapter 81 of the 2026 Acts of Assembly, the amendments (i) require applicants for licensure by the Real Estate Appraiser Board to complete a minimum two-hour course on fair housing and appraisal bias, (ii) specify required fair housing and appraisal bias course content, and (iii) require annual review of qualifying courses by the Fair Housing Board.

18VAC130-20-30. General qualifications for licensure.

Every applicant to the board for a certified general, certified residential, or licensed residential real estate appraiser license must meet the following qualifications:

1. The applicant must meet the current educational and experience requirements and submit a license application to the department or its agent prior to the time the applicant is approved to take the licensing examination.

2. The applicant must sign, as part of the application, a statement verifying that the applicant has read and understands the Virginia real estate appraiser license law and the regulations of the board.

3. The applicant must report any action taken by any board or administrative body in any jurisdiction against a professional or occupational license, certification, or registration issued to the applicant, to include any suspension, revocation, or surrender of a license, certification, or registration, imposition of a monetary penalty, or requirement to take remedial education or other corrective action. The board, in its discretion, may deny licensure to any applicant for any prior action taken by any board or administrative body in any jurisdiction. The applicant has the right to request further review of any such action by the board under the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia).

4. In accordance with § 54.1-204 of the Code of Virginia, each applicant must disclose the following information:

a. All misdemeanor convictions involving fraudulent or dishonest acts, sexual offense, non-marijuana drug distribution, or physical injury within five years of the date of the application; and

b. All felony convictions.

The board, in its discretion, may deny licensure to any applicant in accordance with § 54.1-204 of the Code of Virginia.

5. The applicant must be at least 18 years of age.

6. The applicant must have successfully completed minimum education standards established by the Appraiser Qualifications Board in its January 2022 Real Property Appraiser Qualification Criteria. The Real Property Appraiser Qualification Criteria and Interpretations of the Criteria, effective January 1, 2022, are incorporated by reference. For applications received on or after January 1, 2026, the applicant must have successfully completed the minimum education standards established by the Appraiser Qualifications Board in its January 2026 Real Property Appraiser Qualification Criteria. The Real Property Appraiser Qualification Criteria, effective January 1, 2026, are incorporated by reference.

7. The applicant must successfully complete a minimum of two hours of education on fair housing and appraisal bias administered by the board or approved by the board.

8. The applicant must, as part of the application for licensure, verify the applicant's experience in the field of real estate appraisal.

a. All applicants must submit, upon application, sample appraisal reports as specified by the board.

(1) All experience must be acquired within the five-year period immediately preceding the date application is made and be supported by adequate written reports or file memoranda, which must be made available to the board upon request.

(2) The board, at its discretion, may extend the five-year period for applicants who have suffered serious personal illness or injury, death in the immediate family, obligation of military service or service in the Peace Corps, or for other good cause of similar magnitude approved by the board. Documentation of these circumstances must be provided to the board.

b. Experience requirements.

(1) Fee and staff appraisals. To qualify for fee and staff appraiser experience, an individual must have prepared written appraisal reports that comply with the Uniform Standards of Professional Appraisal Practice and demonstrate competence in the act or process of valuation of real property or preparing an appraisal report.

(2) Ad valorem experience. Ad valorem tax appraisal experience may be obtained either through individual property appraisals or through mass appraisals as long as applicants under this category of experience can demonstrate the use of techniques to value real property similar to those being used by fee and staff appraisers and the effective utilization of the appraisal process.

(a) To qualify for ad valorem tax appraisal experience for individual property appraisals, an individual must have prepared written appraisal reports that comply with the Uniform Standards of Professional Appraisal Practice. An applicant claiming only ad valorem tax appraisal experience must also include a fee and staff appraiser assignment as part of the application.

(b) To qualify for ad valorem tax appraisal experience for mass appraisals, an individual must have prepared mass appraisals or have documented mass appraisal reports that comply with the Uniform Standards of Professional Appraisal Practice, including Standard 6.

(c) To qualify for ad valorem tax appraisal experience, the applicant's experience log must be attested to by the applicant's supervisor.

(3) Reviewer experience. Reviewer experience must not constitute more than 1,000 hours of total experience claimed, and at least 50% of the review experience claimed must be in field review wherein the individual has personally inspected the real property that is the subject of the review.

(a) To qualify for reviewer experience, an individual must have prepared written reports after January 30, 1989, recommending the acceptance, revision, or rejection of the fee and staff appraiser's opinions that comply with the Uniform Standards of Professional Appraisal Practice, including Standard 3.

(b) Signing as "Review Appraiser" on an appraisal report prepared by another will not qualify an individual for experience in the reviewer category. Experience gained in this capacity will be considered under the cosigner subcategory of fee and staff appraiser experience.

(4) Real estate consulting experience. To qualify for real estate consulting experience, an individual must have prepared written reports that comply with the Uniform Standards of Professional Appraisal Practice. Real estate consulting must not constitute more than 500 hours of experience for any type of appraisal license.

c. Experience hours.

(1) The applicant for a licensed residential real estate appraiser license must have a minimum of 1,000 hours of appraisal experience obtained in no fewer than six months. Hours may be treated as cumulative in order to achieve the necessary 1,000 hours of appraisal experience.

(2) The applicant for a certified residential real estate appraiser license must have a minimum of 1,500 hours of appraisal experience obtained in no fewer than 12 months. Hours may be treated as cumulative in order to achieve the necessary 1,500 hours of appraisal experience.

(3) The applicant for a certified general real estate appraiser license must have a minimum of 3,000 hours of appraisal experience obtained in no fewer than 18 months. Hours may be treated as cumulative in order to achieve the necessary 3,000 hours of appraisal experience. At least 50% of the appraisal experience required (1,500 hours) must be in nonresidential appraisal assignments and include assignments that demonstrate the use and understanding of the income approach. An applicant whose nonresidential appraisal experience is predominately in such properties that do not require the use of the income approach may satisfy this requirement by performing two or more appraisals on properties in association with a certified general appraiser that include the use of the income approach. The applicant must provide evidence that the applicant has substantially contributed to the development of the income approach in such reports.

(4) Applicants completing a Licensed Residential Practical Applications of Real Estate Appraisal (PAREA) Program will receive credit for:

(a) 100% of the experience required by board regulations as a condition of licensure as a licensed residential real estate appraiser;

(b) 67% of the experience required by board regulations as a condition of licensure as a certified residential real estate appraiser; or

(c) 33% of the experience required by board regulations as a condition of licensure as a certified general real estate appraiser.

(5) Applicants completing a Certified Residential PAREA Program will receive credit for:

(a) 100% of the experience required by board regulations as a condition of licensure as a licensed residential real estate appraiser or certified residential real estate appraiser; or

(b) 50% of the experience required by board regulations as a condition of licensure as a certified general real estate appraiser.

8. 9. Applicants must pass the board-approved examination within 24 months of being approved to take the examination.

9. 10. Applicants for licensure who do not meet the requirements set forth in subdivisions 3 and 4 of this section may be approved for licensure following consideration of their application by the board.

18VAC130-20-60. Qualifications for licensure as an appraiser trainee.

An applicant for licensure as an appraiser trainee must meet the following educational requirements in addition to those set forth in subdivisions 1 through 5 and 9 10 of 18VAC130-20-30.

1. Within the five-year period immediately preceding application for licensure, the applicant must have successfully completed 75 hours of approved real estate appraisal courses from accredited colleges, universities, or junior and community colleges; adult distributive or marketing education programs; local, state, or federal government agencies, boards, or commissions; proprietary schools; or real estate appraisal or real estate related organizations. The classroom hours must include the 15-Hour National Uniform Standards of Professional Appraisal Practice course.

2. Complete an Appraiser Qualifications Board approved course specifically oriented to the requirements and responsibilities of supervising appraisers and appraiser trainees.

3. There is no experience requirement for the appraiser trainee classification.

4. Responsibilities of supervising appraisers.

a. The appraiser trainee must be subject to direct supervision by a supervising appraiser who completed an Appraiser Qualifications Board approved course specifically oriented to the requirements and responsibilities of supervising appraisers and appraiser trainees, has been state certified for at least three years, is in good standing, and has not been subject to any disciplinary action within the last three years that affects the supervising appraiser's legal eligibility to engage in appraisal practice.

b. The supervising appraiser must be responsible for the training and direct supervision of the appraiser trainee by:

(1) Accepting responsibility for the appraisal report by signing and certifying the report is in compliance with the Uniform Standards of Professional Appraisal Practice;

(2) Reviewing the appraiser trainee appraisal reports; and

(3) Personally inspecting each appraised property with the appraiser trainee until the supervising appraiser determines the appraiser trainee is competent in accordance with the Competency Provision of the Uniform Standards of Professional Appraisal Practice for the property type.

c. The appraiser trainee is permitted to have more than one supervising appraiser, but a supervising appraiser may not supervise more than three trainees at one time, unless a state program in the licensing jurisdiction provides for progress monitoring, supervising certified appraiser qualifications, and supervision and oversight requirements for supervising appraisers.

d. An appraisal experience log must be maintained jointly by the supervising appraiser and the appraiser trainee. It is the responsibility of both the supervising appraiser and the appraiser trainee to ensure the appraisal experience log is accurate, current, and complies with the board's requirements. At a minimum, the appraisal log requirements are (i) type of property, (ii) date of report, (iii) address of appraised property, (iv) description of work performed by the appraiser trainee and scope of the review and supervision of the supervising appraiser, (v) number of actual work hours by the appraiser trainee on the assignment, and (vi) the signature and state certification number of the supervising appraiser. Separate appraisal logs must be maintained for each supervising appraiser, if applicable.

18VAC130-20-210. Standards for the approval of appraisal educational offerings for prelicensure credit.

A. Content.

1. Prior to licensure, applicants must have successfully completed (i) the 15-hour National Uniform Standards of Professional Appraisal Practice course and, (ii) an eight-hour valuation bias and fair housing laws and regulations course as described in the January 2026 Real Property Appraiser Qualification Criteria, and (iii) a minimum two-hour course on fair housing and appraisal bias as described in § 54.1-2013 B of the Code of Virginia.

2. While various appraisal courses may be credited toward the classroom requirement specified for each classification of licensure, all applicants for licensure as an appraiser trainee or a licensed residential, certified residential, or certified general real estate appraiser must demonstrate that course work included coverage of the required topics listed in this subdivision.

3. Any course related to fair housing and appraisal bias designed to meet the requirements of subdivision 7 of 18VAC130-20-30 must include instruction on (i) the legacy of segregation, unequal treatment, and the historic lack of access to opportunities in housing; (ii) unequal access to amenities and resources on the basis of race, disability, and other protected classes; (iii) federal, state, and local fair housing laws; and (iv) anti-bias practices.

4. All appraisal and appraisal-related offerings presented for prelicense credit must have a final, written examination. The examination may not be an open book examination.

4. 5. Credit toward the classroom hour requirement to satisfy the educational requirement prior to licensure will be granted only where the length of the educational offering is at least 15 classroom hours, except for the eight-hour course on valuation bias and fair housing laws and regulations.

B. Instruction. With the exception of courses taught at accredited colleges, universities, junior and community colleges, or adult distributive or marketing education programs, all other prelicense educational offerings given after January 1, 1993, must be taught by instructors certified by the board. All courses in the Uniform Standards of Professional Appraisal Practice must be instructed by an Appraisal Qualifications Board certified instructor.

18VAC130-20-250. Reapproval of courses required.

A. Approval letters issued under this chapter for educational offerings will expire two years from the last day of the month in which they were issued, as indicated in the approval letter. The reapproval fee will be equivalent to the original approval fee specified in 18VAC130-20-240.

B. Any course related to fair housing and appraisal bias designed to meet the requirements of subdivision 7 of 18VAC130-20-30 must be reviewed annually by the Fair Housing Board.

TITLE 20. PUBLIC UTILITIES AND TELECOMMUNICATIONS

STATE CORPORATION COMMISSION

Extend Public Comment Period

Title of Regulation: 20VAC5-340. Rules Governing Shared Solar Program (amending 20VAC5-340-10, 20VAC5-340-40, 20VAC5-340-60, 20VAC5-340-65).

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

AT RICHMOND, SEPTEMBER 14, 2026

COMMONWEALTH OF VIRGINIA, ex rel.

STATE CORPORATION COMMISSION

CASE NO. PUR-2026-00127

Ex Parte: In the matter of amending regulations

governing shared solar programs

ORDER AMENDING PROCEDURAL SCHEDULE

The Rules Governing Shared Solar Program, 20VAC5-340-10 et seq., adopted by the State Corporation Commission (Commission) pursuant to Virginia Code (Code) §§ 56-594.3 and 56-594.4, establish the requirements for customers of Virginia Electric and Power Company d/b/a Dominion Energy Virginia (Dominion) and Appalachian Power Company (APCo) to participate in shared solar projects.¹ Chapters 670, 671, 673, and 674 of the 2026 Virginia Acts of Assembly (collectively, 2026 Shared Solar Legislation) amended Code §§ 56-594.3 and 56-594.4, effective July 1, 2026. The 2026 Shared Solar Legislation modified certain statutory provisions applicable to Dominion's and APCo's shared solar programs.

On August 25, 2026, the Commission entered an Order Establishing Proceeding² that, among other things, required Dominion and APCo to serve a copy of the Order Establishing Proceeding upon each of their existing shared solar customers and each of their registered subscriber organizations no later than September 11, 2026, and to file with the Clerk of the Commission a certificate of service no later than September 25, 2026. Commission Staff has, however, advised the Commission that Dominion and APCo had not been included in this docket's service list and consequently did not receive service of the Commission's Order Establishing Proceeding concurrent with its entry on August 25, 2026.³

NOW THE COMMISSION, upon consideration of the matter, is of the opinion and finds that the procedural schedule in this case should be extended.

Accordingly, IT IS ORDERED THAT:

(1) On or before September 21, 2026, Dominion and APCo shall serve a copy of the Order Establishing Proceeding and this Order Amending Procedural Schedule upon each of their existing shared solar customers and each of their registered subscriber organizations and shall file with the Clerk of the Commission a certificate of service no later than October 5, 2026.

(2) On or before October 16, 2026, any interested person may comment on, propose modifications or supplements to, or request a hearing on the Proposed Amendments following the instructions on the Commission's website: scc.virginia.gov/case-information/submit-public-comments. Those unable, as a practical matter, to submit comments 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 such documents shall refer to Case No. PUR-2026-00127. Individuals should be specific in their comments, proposals, or supplements to the Proposed Amendments and should address only those issues pertaining to the 2026 Shared Solar Legislation. Issues outside the scope of addressing these amendments will not be open for consideration. Any request for hearing shall state with specificity why the issues raised in the request for hearing cannot be adequately addressed in written comments. 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.

(3) On or before November 6, 2026, the Staff shall file with the Clerk of the Commission a report on or a response to any comments, proposals, or requests for hearing submitted to the Commission on the Proposed Amendments.

(4) All other provisions of the Order Establishing Proceeding shall remain in full force and effect.

(5) This matter is continued.

A COPY hereof shall be sent electronically by the Clerk of the Commission to all persons on the official Service List in this matter. The Service List is available from the Clerk of the Commission.

_____________________________

¹ Commonwealth of Virginia, ex rel. State Corporation Commission, Ex Parte: In the matter of establishing regulations for a shared solar program pursuant to § 56-594.3 of the Code of Virginia, Case No. PUR-2020-00125, 2020 S.C.C. Ann. Rept. 574, Order Adopting Rules (Dec. 23, 2020); Commonwealth of Virginia, ex rel. State Corporation Commission, Ex Parte: In the matter of amending regulations governing shared solar programs, Case No. PUR-2024-00122, 2024 S.C.C. Ann. Rept. 574, Order Adopting Regulations (Nov. 25, 2024).

² The Commission's Order Establishing Proceeding included an attachment containing Commission Staff's proposed amendments (Proposed Amendments) to the Shared Solar Rules.

³ On September 10, 2026, Staff counsel determined that such service had not been made and concurrently provided information to APCo and Dominion representatives concerning this rulemaking docket and the Commission's August 25, 2026 Order Establishing Proceeding.

The State Corporation Commission noticed a public comment period on amendments to the Rules Governing Shared Solar Program (20VAC5-340) in the September 21, 2026, issue of the Virginia Register of Regulations (43:3 V.A.R. 216-222 September 21, 2026).

The public comment period has been extended through November 16, 2026

Agency Contact: Matthew Unger, Principal Analyst, Public Utility Regulation Division, State Corporation Commission, P.O. Box 1197, Richmond, VA 23218, telephone (804) 371-9849, or email matthew.unger@scc.virginia.gov.