TITLE 32.1. HEALTH.

§ 32.1-14. See § 2.2-608; SB 6.

§ 32.1-19.1 repealed.
Reporting of telemedicine initiatives. Repeals the statute that requires the Commissioner of Health to annually report by October 1 to the Governor and the General Assembly on the status of telemedicine initiatives by agencies of the Commonwealth. SB 278; CH. 683.

§ 32.1-23.1 amended.
Promotion of pharmaceutical assistance programs and pharmaceutical discount purchasing cards. Requires the Commissioner of Health and the Commissioner of the Department for the Aging to develop a strategy, in coordination with the Virginia Area Agencies on Aging and other private and nonprofit organizations, for disseminating information to the public concerning the availability of pharmaceutical assistance programs and for training senior citizen volunteers to assist in completing applications for such programs and discount purchasing cards. The bill also requires the Commissioners to disseminate, with such funds as may be made available, information to the public relating to recent congressional actions concerning pharmaceutical benefits to be provided under the Medicare program and how such benefits may help senior citizens with the costs of pharmaceutical benefits. In addition, the two Commissioners will encourage pharmaceutical manufacturers to include application forms for pharmaceutical discount purchasing card programs on their respective websites in a format capable of being downloaded and printed by consumers. The Department for the Aging will include direct links to the forms on its website, when practicable. The bill also requires the Commissioners to report to the Governor and the General Assembly on the feasibility of developing a single application form for Virginians to use to seek eligibility for the nearly 50 pharmaceutical assistance programs and pharmaceutical discount purchasing cards. The bill also requires the Commissioners to disseminate, with such funds as may be made available, information to the public relating to recent congressional actions concerning pharmaceutical benefits to be provided under the Medicare program and how such benefits may help senior citizens with the costs of pharmaceutical benefits. In determining the feasibility, the Commissioners must obtain copies of the application forms used by such pharmaceutical assistance programs and pharmaceutical discount purchasing cards in Virginia, compile a list of the various information required to complete such application forms, identify common elements, and analyze the forms for readability and simplicity. In order to perform the duties provided in the new subsection, the Commissioners may appoint an advisory task force of stakeholders to assist them. HB 1202; CH. 318.

§ 32.1-23.1 amended.
Dissemination of Medicare pharmaceutical benefits information; certain training of senior citizen volunteers. Requires the Commissioners of Health and the Department for the Aging to disseminate, with such funds as may be made available, information to the public relating to recent congressional actions relating to pharmaceutical benefits to be provided under the Medicare program and how such benefits may help senior citizens with the costs of pharmaceutical benefits. This bill also requires the Commissioner of Health and the Commissioner of the Department for the Aging to develop a strategy, in coordination with the Virginia Area Agencies on Aging, for disseminating information to the public concerning the availability of pharmaceutical assistance programs and for training senior citizen volunteers to assist in completing applications for pharmaceutical assistance programs and pharmaceutical discount purchasing cards. SB 158; CH. 73.

§§ 2.2-3705, 17.1-503, 32.1-42, 32.1-43, 32.1-44, 32.1-45, 32.1-48, 32.1-48.01 through 32.1-48.04, 32.1-116.3, 32.1-127.1:03, 44-146.16, and 44-146.17 amended; §§ 32.1-48.05 through 32.1-48.17 added.
Communicable diseases of public health threat; quarantine and isolation. Sets out a procedure for the State Health Commissioner to issue orders of quarantine when a person or persons or an affected area in Virginia have been known to be exposed to or infected with or may reasonably be suspected to be exposed to or infected with a communicable disease of public health threat. The bill also sets out a procedure for the State Health Commissioner to prepare orders of isolation when he determines that a person or persons or an affected area have been infected or reasonably may be suspected to be infected with a communicable disease of public health threat and that exceptional circumstances exist rendering the isolation procedures that apply to communicable diseases of public health significance insufficient control measures to contain the communicable disease of public health threat. Amendments are provided to exempt the State Health Commissioner's records of findings for an order of quarantine or order of isolation from the Freedom of Information Act, to authorize disclosure of patient's health records to the State Health Commissioner or his designee, to coordinate any quarantine or isolation of an affected area with a declaration of a state of emergency by the Governor and to make certain cross-related sections consistent. The Board of Health is required to promulgate emergency regulations to implement this provision. An enactment clause states there is an emergency, thus rendering the bill effective upon passing. Technical amendments to list definitions in alphabetical order and correct archaic syntax are also included. HB 1483; CH.773/SB 685; CH. 1021.

§§ 2.2-2818, 32.1-46, 32.1-50, 32.1-60, 32.1-64.1, 32.1-138, 32.1-325, 32.1-331.15, 45.1-161.35, 45.1-161.70, 45.1-161.292:43, 46.2-208, 46.2-322, 53.1-22, 54.1-3812, 59.1-297, 59.1-298, 59.1-310.4, and 63.2-1808 amended; § 54.1-2957.02 added.
Licensed nurse practitioners; forms and certificates. Provides that licensed nurse practitioners may sign various forms and certificates, and provide medical information or treatment in certain situations, including situations involving the immunization of children, examination of persons suspected of having tuberculosis, prenatal tests, nursing homes, release of certain privileged medical information, competency for driver licenses, release of certain veterinary records, and assisted living facilities. The bill also provides that whenever any law or regulation requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, it will be deemed to include a signature, certification, stamp, verification, affidavit or endorsement by a nurse practitioner. Three enactment clauses provide that: (i) these provisions will take effect 60 days after the effective date of the regulations of the Boards of Medicine and Nursing; (ii) the Boards of Medicine and Nursing must promulgate emergency regulations, i.e., within 280 days of enactment, with the amendments requiring the nurse practitioners' authority for signatures, certifications, stamps, verifications, affidavits and endorsements to be included in the written protocol between the supervising physician and the nurse practitioner; and (iii) that the tanning facility signs will be updated in compliance with the new law when posted or replaced after the effective day of the act. HB 855; CH. 855 (effective - see bill).

§ 32.1-65 amended.
Screening tests for infants. Directs that the physician or certified nurse midwife charged with an infant's care after delivery perform the screening test for inborn errors of metabolism rather than the physician, nurse or midwife in charge of the delivery of the baby. HB 1133; CH. 760.

§ 32.1-102.1 amended.
Certificate of public need for medical care facilities; intermediate care facilities for the mentally retarded. Removes the requirement to obtain a certificate of public need (COPN) for intermediate care facilities for the mentally retarded that will have no more than 12 beds and are in an area identified as in need of residential services for people with mental retardation in any plan of the Department of Mental Health, Mental Retardation and Substance Abuse Services. Other intermediate care facilities will continue to be covered by COPN. SB 197; CH. 75.

§§ 32.1-102.3 and 32.1-102.6 amended.
Certificate of public need for medical care facilities; criteria for determining need. Modifies the criteria relating to the extent to which the project will be accessible to all residents of the area proposed to be served by a medical care facility to require the Commissioner of Health to consider the effects on accessibility of any proposed relocation of an existing service or facility. The bill also requires the appropriate health planning agency to notify the local governing bodies in the planning district where the project is proposed to be located. Finally, the bill requires the health planning agency to consider comments from the relevant local governing bodies and all other public comments in making its decision, and stipulates that such comments must be part of the record provided to the Department of Health. HB 391; CH. 95/ SB 86; CH. 71.

§§ 32.1-125.01 and 32.1-127.1:03. See § 54.1-2400; HB 577.

§§ 32.1-126 and 63.2-1800 amended.
Location of licensed nursing homes and assisted living facilities; notification to electric utilities. Requires the State Health Commissioner to notify electric utilities in Virginia on a quarterly basis as to the location of all licensed nursing homes in the State, and requires the Commissioner of the Department of Social Services to do the same for assisted living facilities. The purpose of the bill is to facilitate the restoration of electrical service and prioritization of customers during widespread power outages. The requirement of a quarterly notification can also be met by the maintenance of an accessible electronic database. HB 891; CH. 304.

§ 32.1-127 amended.
Vaccines in certified nursing facilities and nursing homes. Requires, unless the vaccination is medically contraindicated or the resident declines the offer of the vaccination, that each nursing home and certified nursing facility 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. HB 1178; CH. 762.

§§ 32.1-127.1:03, 32.1-127.3, 54.1-105, 54.1-106, 54.1-111, 54.1-2400, 54.1-2400.2, 54.1-2401, 54.1-2403.01, 54.1-2403.1, 54.1-2403.2, 54.1-2408.1, 54.1-2409, 54.1-2409.1, 54.1-2906, 54.1-2907, 54.1-3000, 54.1-3005, 54.1-3008, 54.1-3009, 54.1-3016, 54.1-3019, and 63.2-1805 amended.
Nurse Licensure Compact; holder of multistate licensure privilege. Clarifies and reinforces the regulatory authority of the Board of Nursing and the Department of Health Professions over persons issued a multistate licensure privilege to practice nursing in Virginia. This bill renders provisions relating to discipline, practice protocols, and other scope of practice requirements applicable to any person holding a multistate licensure privilege issued under the Nurse Licensure Compact. The Compact will become effective on January 2005. The Board of Nursing is required to promulgate emergency regulations to implement the provisions of the Compact. HB 633; CH. 49 (effective - see bill).

§§ 2.2-3705, 8.01-413, 32.1-127.1:03, 37.1-230, and 38.2-608 amended.
Health records privacy; procedure for certain patients to obtain access to their records. Revises the various laws setting out an exception to the patient's traditional access to his own health records to provide consistency with a new procedure that must be used to ensure fair appraisal of the judgment of a treating physician or clinical psychologist concerning the potential harm to the patient or others that could result from such access. This provision revises the standard by which a patient can be denied access to his records to require the treating physician or clinical psychologist to find that a review of the individual's health records would be reasonably likely to endanger the life or physical safety of the individual or another person, or that a reference in the health records to another person would be reasonably likely to cause substantial harm to the referenced person. The individual may designate a reviewing physician or clinical psychologist at his own expense, or the relevant health care provider or insurance entity denying access to the health record will designate a reviewing physician or clinical psychologist at the expense of the relevant health care provider or insurance entity. The designated physician or clinical psychologist will make a judgment as to whether the health record should be made available to the individual. The access decision of the designated reviewing physician or clinical psychologist must be followed. HB 877; CH. 65.

§ 32.1-127.1:03. See § 37.1-67.3; HB 878.

§ 32.1-127.1:03 amended.
Health records privacy. Revises the Virginia patient privacy provision to comply more closely with the regulations promulgated pursuant to the federal Health Insurance Portability and Accountability Act of 1996, as amended, relating to health records. Closer compliance is achieved through various syntax changes in terminology, definitions, and forms, and revisions and additions to the definitions, e.g., "health care entity," as defined in this provision, includes all health care providers, health plans or health care clearinghouses. The bill refers to an "individual" instead of a "patient"; to "health records" instead of "medical records"; and "health care providers" or "health care entities" instead of providers. This provision also revises the standard by which a patient can be denied access to his records to require the treating physician or clinical psychologist to find that a review of the individual's health records would be reasonably likely to endanger the life or physical safety of the individual or another person, or that a reference in the health records to another person would be reasonably likely to cause substantial harm to the referenced person. The individual may designate a reviewing physician or clinical psychologist at his own expense or the health care entity denying access to the health record will designate a reviewing physician or clinical psychologist at the expense of the relevant health care entity. The designated physician or clinical psychologist will make a judgment as to whether the health record should be made available to the individual. HB 879; CH. 67.

§ 32.1-127.1:03. See § 40.1-8; SB 136.

§§ 2.2-3705, 8.01-413, 16.1-266, 16.1-343, 32.1-127.1:03, 37.1-67.3, 37.1-134.9, 37.1-134.12, 37.1-134.21, 37.1-226 37.1-230, and 38.2-608 amended.
Health records privacy; access to health records; compliance with federal Health Insurance Portability and Accountability Act regulations. Makes statutes relating to the Freedom of Information Act, civil procedure, denial of access to health records, juvenile and domestic court proceedings, health records privacy, involuntary commitment, court-appointed guardians and conservators, release of mental health information, and health insurance information consistent with federal regulations concerning disclosure and electronic transmission of protected health information promulgated pursuant to the Health Insurance Portability and Accountability Act. The bill provides a modified procedure for a patient to pursue obtaining his own records when a treating physician or clinical psychologist has placed a statement in his record denying such access. The standard for such statements is changed to reasonably likely to endanger the life or physical safety of the individual or another person, or that a reference in the health records to another person, who is not a health care provider, would be reasonably likely to cause substantial harm to the referenced person. The individual may, at his own expense, designate a reviewing physician or clinical psychologist with equivalent credentials to those of the physician or clinical psychologist denying him access to his records to determine whether he can have access to the information. In the alternative, the relevant health care entity is obligated to designate a physician or clinical psychologist, at its expense, to determine whether the individual will obtain access to his information. The decision of the designated physician or clinical psychologist must be followed. The bill also includes technical amendments to laws relating to disclosure of mental health information. The bill addresses access to health records and information for guardians ad litem and attorneys representing minors in juvenile and domestic court proceedings, proceedings to authorize treatment for patients incapable of providing consent to treatment, persons who are subject to petitions for involuntary commitment, and respondents who are the subjects of petitions to appoint guardians or conservators or both. SB 337; CH. 1014.

§ 32.1-164.1:1 amended.
Validity of septic tank permits. Grandfathers certain onsite sewage systems into the Board of Health's regulatory scheme. The bill provides that whenever any onsite sewage system is failing and the Board's regulations for repairing it impose (i) a requirement for treatment beyond the level of treatment provided by the existing onsite sewage system when operating properly or (ii) a new requirement for pressure dosing, the owner may request a waiver from such requirements. The Commissioner is required to grant such request, unless he finds that the failing system was installed illegally without a permit. Such waivers must be recorded in the land records of the clerk of the circuit court. Except between a husband and a wife, such waivers are not transferable and are null and void upon transfer or sale of the property. The owner of the property is required to disclose, in writing, to any and all potential purchasers or mortgage holders that any operating permit for the onsite sewage system that has been granted a waiver shall be null and void at the time of transfer or sale of the property and that the Board's regulatory requirements for additional treatment or pressure dosing are required before an operating permit may be reinstated. HB 930; CH. 916.

§ 32.1-170 amended.
Emergency plans for the safe handling of community public water supplies during any extended power outage. Authorizes the Board of Health to promulgate requirements and criteria for the development and maintenance of an emergency management plan for each community public water supply for the provision of pure water during any extended power outage. HB 1198; CH. 317.

§ 32.1-176.4 amended.
Private well construction; local standards. Adds Goochland County to those localities that may by ordinance establish their own standards, consistent with State Board of Health regulations, pertaining to location and testing of water from private wells, and more stringent than those adopted by the Board pertaining to construction and abandonment of such wells. SB 125; CH. 72.

§§ 32.1-262, 32.1-267, and 32.1-268 amended.
Health statistics and vital records. Deletes the requirement that any statement indicating racial designation be omitted from reports of divorces and annulments required to be filed by the clerk of court with the State Registrar regarding a final decree of divorce or annulment, and in marriage and adoption records. Information pertaining to racial designation is essential in establishing health histories, and in conducting anthropological, sociological, and genealogical research, particularly among racial and ethnic minority persons. SB 223; CH. 88.

§ 32.1-263 amended.
Vital records; filing of death certificates. Specifies that a licensed funeral director, funeral services licensee, office of the state anatomical program, or the next of kin can file the death certificate with the registrar of vital records. The bill addresses the problem encountered by the registrar of vital records under the present law when the surface transportation and removal companies that are registered with the Board of Funeral Directors and Embalmers or persons who are not licensed by the Board of Funeral Directors and Embalmers fail to file the death certificate with the registrar. This bill makes it quite clear that even the next of kin, if first to assume custody of the body, has an obligation to file the certificate of death with the registrar. HB 159; CH. 124.

§§ 32.1-283.1 and 32.1-283.2. See § 2.2-3703; SB 352.

§ 32.1-325 amended.
Medical assistance services; marriage and family therapy. Mandates Medicaid reimbursement to licensed marriage and family therapists for services covered by the state plan. This bill does not mandate any new services, but merely adds marriage and family therapists to the list of mandated Medicaid providers who may be reimbursed for services that are already covered by the state plan and Medicaid regulations. HB 224; CH. 125.

§ 32.1-325 amended.
Long-term care partnership plan. Requires the Board of Medical Assistance Services to establish, consistent with federal law, a long-term care partnership program that will encourage the private purchase of long-term care insurance as the primary source of funding the participant's long-term care. The program must provide protection from estate recovery as authorized by federal law. SB 266; CH. 246.

§ 32.1-351.2 amended.
Children's Health Insurance Program Advisory Committee. Revises the name, purpose, membership, and responsibilities of the current Outreach Oversight Committee to Family Access to Medical Insurance Security (FAMIS) to create the Children's Health Insurance Program Advisory Committee and declares the purpose of the committee to be to assess policies, operations and outreach for FAMIS and FAMIS Plus (Medicaid for children) and to evaluate various enrollment, utilization, and outcomes of children for these programs. The committee's membership is limited to 20 members and will include the Joint Commission on Health Care, the Department of Social Services, the Department of Health, the Department of Education, the Department of Mental Health, Mental Retardation and Substance Abuse Services, the Virginia Health Care Foundation, various provider associations and children's advocacy groups, and other individuals with significant knowledge and interest in children's health insurance. The committee will make recommendations on FAMIS and FAMIS Plus to the Director of the Department of Medical Assistance Services and the Secretary of Health and Human Resources. HB 836; CH. 301.
§§ 32.1-366 and 32.1-367. See § 58.1-302; HB 5018.