SB 130 — Public health emergency; hospital or nursing home, addition of beds.

RECONVENED SESSION REENROLLED VIRGINIA ACTS OF ASSEMBLY --–– 2022 RECONVENED SESSION CHAPTER 712R An Act to amend and reenact §§ 32.1-102.2 and 32.1-127 of the Code of Virginia, relating to public health emergency;

E N [S 130] Approved AprilR 27,O 20221. Be it enacted by the General Assembly of Virginia:

1.

L A.

L 1.

Shall establish concise procedures for the prompt review of applications for certificatescertificatesEconsistent consistent with the provisions of this article which may include a structured batching process which incorporates, but is not limited to, authorization for the Commissioner to request proposals for certain projects.projDcts.

In any tomographicstructured (CT)batching scanning,process magneticestablished resonanceby imagingthe (MRI),Board, positronapplications, emissioncombined tomographicor (PET)mputedseparate, for computed scanning, radiation therapy, stereotactic radiotherapy other than radiotherapy performed using a linear accelerator or other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy, and proton beam therapy shall be considered in the radiation therapy batch.

A single application may be filed for a combination of (i) radiation therapy, stereotactic radiotherapy other than radiotherapy performed using a linear accelerator or other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy, andSnd proton beam therapy and (ii) any or all of the computed tomographic (CT) scanning, magnetic resonanceres1nance imagingima2. (MRI), and positron emission tomographic (PET) scanning;

2.

R 3.

5.reviewable pursuant to subdivision B 8 of § 32.1-102.1:3.

ShallRegulations establishestablishing anthe expeditedexpeditedts application and review processprocedure shall include provisions for anynotice certificateand opportunity for projectspublic reviewablecomment on the application for a certificate, and criteria pursuant to subdivisionwhich Ban 8application that would normally undergo the review process would instead undergo the full certificate of public need review process set forth in § 32.1-102.1:3.32.1-102.6;

Regulations establishing the expedited application and review procedure shall include provisions for notice and opportunity for public comment on the application for a certificate, and criteria pursuant to which an application that would normally undergo the review process would instead undergo the full certificate of public need review process set forth in § 32.1-102.6;

Shall establish an exemption from the requirement for a certificate for a project involving a temporary increase in the total number of beds in an existing hospital or nursing home, including a temporary increase in the total number of beds resulting from the addition of beds at a temporary structure or satellite location operated by the hospital or nursing home, provided that the ability remains to safely staff services across the existing hospital or nursing home, (i) for a period of no more than the duration of the Commissioner's determination plus 30 days, for projects involving a temporary increase in the total number of beds in an existing hospital or nursing home when the Commissioner has determined that a natural or man-made disaster has caused the evacuation of a hospital or nursing home and that a public health emergency exists due to a shortage of hospital or nursing home beds or (ii) for a period of no more than the duration of the emergency order entered pursuant to § 32.1-13 or 32.1-20 plus 30 days when the Board, pursuant to § 32.1-13, or the Commissioner, pursuant to § 32.1-20, has entered an emergency order for the purpose of suppressing a nuisance dangerous to public health or a communicable, contagious, or infectious disease or other danger to the public life and health;

The Board shall promulgate regulations providing for time limitations for schedules for completion and limitations on the exceeding of the maximum capital expenditure amount for all reviewable projects.

However, the Commissioner may approve a significant change in of 6 cost for an approved project that exceeds the authorized capital expenditure by more than 20 percent, provided the applicant has demonstrated that the cost increases are reasonable and necessary under all of 6 the circumstances and do not result from any material expansion of the project as approved.

Shall also require that each hospital establish a protocol for organ donation, in compliance with federal law and the regulations of the Centers for Medicare and Medicaid Services (CMS), particularly 42 C.F.R.

Each hospital shall have an agreement with an organ procurement organization designated in CMS regulations for routine contact, whereby the provider's designated organ procurement organization certified by CMS (i) is notified in a timely manner of all deaths or imminent deaths of patients in the hospital and (ii) is authorized to determine the suitability of the decedent or patient for organ donation and, in the absence of a similar arrangement with any eye bank or tissue bank in of 6 Virginia certified by the Eye Bank Association of America or the American Association of Tissue Banks, the suitability for tissue and eye donation.

The hospital shall also have an agreement withwRth at least one tissue bank and at least one eye bank to cooperate in the retrieval, processing, preservation,preservatiEn, storage, and distribution of tissues and eyes to ensure that all usable tissues and eyes are obtained from potential donors and to avoid interference with organ procurement.

The protocol shall ensure that the hospitalhospitaltential of 6 collaborates with the designated organ procurement organization to inform the family of each potential donor of the option to donate organs, tissues, or eyes or to decline to donate.

The individual makingNaking contact with the family shall have completed a course in the methodology for approaching potential donor families and requesting organ or tissue donation that (a) is offered or approved by the organ procurement organization and designed in conjunction with the tissue and eye bank community andandO(b) (b) encourages discretion and sensitivity according to the specific circumstances, views, and beliefs of the relevantorganization family.in educating the staff responsible for contacting the organ procurement organization'srement personnel on donation issues, the proper review of death records to improve identification of potential donors, and the proper procedures for maintaining potential donors while necessary testing and E placement of potential donated organs, tissues, and eyes takes place.

In addition, the hospital shall work cooperatively with the designated organ procurement organization in educating the staff responsible for contacting the organ procurement organization's personnel on donation issues, the proper review of death records to improve identification of potential donors, and the proper procedures for maintaining potential donors while necessary testing and placement of potential donated organs, tissues, and eyes takes place.

5.or transfer of any pregnant woman who presents herself while in labor;ces establish a protocol for admission 6.

Shall require that each hospital that provides obstetrical services establish a protocol for admission or transfer of any pregnant woman who presents herself while in labor;

6.

Appropriate referrals may include, but need not be limitedlimitSd to, treatment services, comprehensive early intervention services for infants and toddlers with disabilitiesdis1bilities and their families pursuant to Part H of the Individuals with Disabilities Education Act, 20 U.S.C.U.0.C.

§the 1471extent etpossible, seq.,the other parent of the infant and family-orientedany preventionmembers services.of the patient's extended family whoo may participate in the follow-up care for the mother and the infant.

The discharge planning process shall involve, to the extent possible, the other parent of the infant and any members of the patient's extended family who may participate in the follow-up care for the mother and the infant.

Shall require that each nursing home and certified nursing facility fully disclose to the applicant forfor8. admission the home's or facility's admissions policies, including any preferences given;

8.

Such standards may be differentiated for various levels or categories of care and may include, but need not be limited to, requirements for staffing credentials, staff/patient ratios, equipment, and medical protocols;

Shall permit hospital personnel, as designated in medical staff bylaws, rules and regulations, or hospital policies and procedures, to accept emergency telephone and other verbal orders for medication or treatment for hospital patients from physicians, and other persons lawfully authorized by state statute to give patient orders, subject to a requirement that such verbal order be signed, within a reasonable period of time not to exceed 72 hours as specified in the hospital's medical staff bylaws, rules andandle regulations or hospital policies and procedures, by the person giving the order, or, when such person is not available within the period of time specified, co-signed by another physician or other person authorized to give the order;

Shall require, unless the vaccination is medically contraindicated or the resident declines the offer of the vaccination, that each certified nursing facility and nursing home provide or arrange for the administration to its residents of (i) an annual vaccination against influenza and (ii) a pneumococcal vaccination, in accordance with the most recent recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;Prevention;visory Committee on of 6 13.

13.

Shall require that each nursing home and certified nursing facility ascertain, prior to admission, whether a potential patient is required to register with the Sex Offender and Crimes Against Minors Registry pursuant to Chapter 9 (§ 9.1-900 et seq.) of Title 9.1, if the home or facility anticipates the of 6 potential patient will have a length of stay greater than three days or in fact stays longer than three days;

Such policy shall ensure that the patient, his agent, or the person authorized to of 6 make medical decisions pursuant to § 54.1-2986 (a) are informed of the patient's right to obtain his medical record and to obtain an independent medical opinion and (b) afforded reasonable opportunityopportuRity to participate in the medical review committee meeting.

Nothing in such policy shall prevent the patient,pEtient, his agent, or the person authorized to make medical decisions pursuant to § 54.1-2986 from obtaining legal counsel to represent the patient or from seeking other remedies available at law, including seeking court review, provided that the patient, his agent, or the person authorized to make medical decisions pursuant to § 54.1-2986, or legal counsel provides written notice to the chief executive officerofficeN of the hospital within 14 days of the date on which the physician's determination that proposed medical treatment is medically or ethically inappropriate is documented in the patient's medical record;

Shall require every hospital with an emergency department to establish protocols to ensureensuOe that security personnel of the emergency department, if any, receive training appropriate to the populations of 6 served by the emergency department, which may include training based on a trauma-informed approach in identifying and safely addressing situations involving patients or other persons who pose a risk of harm to themselves or others due to mental illness or substance abuse or who are experiencing a mental health crisis;

E 23.

§ 1395dd(e)(1), the hospital shall provide the patient or his authorized representative with written or electronic notice that the patient (i) may have a choice of transportation by an air medical transportation provider or medically appropriate ground transportation by an emergency medical services provider and (ii) will be responsible for charges incurred for such transportation in the event that the provider is not a contracted network provider of the patient's health insurance carrier or such charges are not otherwise covered in full or in part by the patient's health insurance plan;