The Virginia Assisted Living Association (VALA) represents licensed assisted living communities throughout Virginia of varying organizational structures and resident capacities. We thank Governor Youngkin and the Board of Long-Term Care Administrators for recognizing that Virginia has burdensome regulations that hinder the credentialling of qualified individuals. This results in individuals seeking employment in other states or industries creating significant workforce shortages, especially in the field of assisted living facility administrators. We strongly encourage the Virginia Board of Long-Term Care Administrators to reduce regulations not mandated by federal or state statutes and to eliminate regulations that should be business choice practices instead of regulatory mandates.

VALA previously submitted many of the below comments during the proposed stage of the Regulatory Reduction 2023 process, and after consulting with licensed administrators, administrators-in-training, prospective administrators, assisted living providers, and similar stakeholders in other states, we have additional comments that we request to be considered. Below is the combination of the original comments and the additional comments. We ask the Board to take time to thoroughly consider each recommendation regarding the Board’s proposed amendments to the Regulations Governing the Practice of Assisted Living Facility Administrators.

• 18VAC95-30-40 – Required Fees – VALA supports the establishment of a new licensure category of “Inactive License”; however, we recommend a fee lower than $150 to be assigned to this category, as the individual would not be utilizing this license to earn income. Also, the $35 fee for late renewal of an inactive license should not exceed that of the preceptor late renewal $25 fee.

• 18VAC95-30-70-C-2 – Continuing education requirements – VALA supports the removal of the requirement to have a signature on documentation of continuing education, as many certificates are issued electronically.

• 18VAC95-30-80-A – Late renewal – “A person who fails to renew his a license or preceptor registration by the expiration date shall may, within one year of the initial expiration date:”    
  VALA supports flexibility of the regulation by utilizing the word may instead of shall.

• 18VAC95-30-91 – Inactive Licensure – VALA supports the establishment of a new licensure category of “Inactive License”; however, the requirement of “providing proof of completion of the number of continuing competency hours required for the period in which the license has been inactive, not to exceed three years” is excessive and may substantially discourage individuals from returning to full licensed status. For example, having to complete three years of CEUs would equate to 60 hours, which is a significant burden to someone reentering the profession while maintaining additional employment to financially maintain their families. VALA recommends the following reinstatement requirement:  
  “Providing proof of completion of 30 hours of approved continuing education of which at least two hours shall relate to regulatory updates and compliance.”

• 18VAC95-30-130-C – Application Package – VALA has received concerns about delays in the processing of applications by several Boards within the Department of Health Professions. With that, VALA is concerned that removing the exception for delayed school transcripts, employer verifications, examination scores, as well verifications from other state boards will cause additional delays in processing applications while awaiting those items. With the ability to digitize information, we ask the Board to retain the incomplete materials for a period of two years, as it may take the applicant that long to acquire some of the materials from other entities.

• 18VAC95-30-200 – Interruption or termination of program – VALA supports the removal of the requirement to obtain a new preceptor within 60 days.

We encourage the Board to further reduce the barriers to licensure by amending or eliminating additional regulatory changes that are referenced below. The recommended changes would further promote the efficiency of the application process and oversight of the Regulations Governing the Practice of Assisted Living Facility Administrators by reducing barriers for initial or continued licensure of an Assisted Living Facility Administrator and would make Virginia more competitive in recruiting, training, and retaining highly qualified administrators.

• 18VAC95-30-10-B – Definitions –“"National eExamination" means a test used by the board to determine the competence of candidates for licensure as administered by NAB or any other examination approved by the board.”      
  Regulations should provide broader terminology to allow for flexibility in examination options application by the Commonwealth.    
• 18VAC95-30-100-A-1 – Educational and Training requirements for initial licensure – Virginia should not exclude an individual with a Doctorate level of education from being considered similarly to individuals with a baccalaureate or master’s degree. Below are proposed changes to Virginia initial licensure requirements.  
   

“e. Hold a master's or a baccalaureate or higher degree in health care-related field or a comparable field that meets the requirements of subsection B of this section… 
f. Hold a master's or a baccalaureate or higher degree in an unrelated field…”

• 18VAC95-30-100-A-1 – Educational and Training requirements for initial licensure – After a detailed comparison of Virginia’s educational and training requirements to other states, VALA often hears from interested AITs and employers that the number of hours required create significant barriers to licensure. With the significant workforce shortages that currently exist VALA recommends a reduction in the number of training hours required to make Virginia more competitive and receptive to new licensees. Removing the outliers of the least and greatest number of hours required in other states resulted in an average of 180-hours training requirement. Below are proposed changes to Virginia initial licensure requirements.    
   

“e. Hold a master's or a baccalaureate or higher degree in health care-related field or a comparable field that meets the requirements of subsection B of this section with no internship or practicum and 320 240 hours in an ALF AIT program; 
f. Hold a master's or a baccalaureate or higher degree in an unrelated field and 480 320 hours in an ALF AIT program; or          
Certificate program.    
…have completed not less that a 320 240 hour internship or practicum …      
Degree and practical experience.       
…have completed not less that a 320 240 hour internship or practicum…”      

• 18VAC95-30-100-A-1 – Educational and Training requirements for initial licensure – Virginia’s requirements for initial licensure do not authorize someone without managerial or supervisory experience to be trained to become an assisted living administrator. Managerial experience may sufficiently be achieved in a training program; therefore, VALA recommends creating an additional pathway to licensure that does not require college credits nor having held a managerial/supervisory title of employment. Below is proposed language to add an additional pathway to initial licensure.      
  “h. Have at least five years of health care experience, to include at three years in a long-term care setting within the ten years prior to application and 640 hours in an ALF AIT program. For purposes of this qualification, these definitions shall apply: (i) "health care experience" means full-time equivalency experience in providing care to residents or patients in a health care setting; (ii) "health care setting" means a licensed home health organization, licensed hospice program, licensed hospital, licensed nursing home, licensed assisted living facility, licensed adult day program, or licensed mental health or developmental services facility.”

• 18VAC95-30-110 – Examination requirement for initial licensure – Virginia’s requirements for passage of the NAB exam creates a barrier to licensure and satisfactory practice as it does not test the applicant’s knowledge of applicable regulations that would be required for compliance of an assisted living facility administrator. Virginia’s use of a national exam also encourages portability of licensure to other states instead of encouraging administrators to remain in and practice in Virginia. ALF AITs train on meeting compliance with applicable regulations, which are primarily state based yet are required to take a test on national practices that can conflict with state regulations; this is not a reasonable expectation. Several professions offer licensee candidates the option of a state or national based examination. VALA recommends Virginia to offer a licensure option of a national exam OR a state-based exam to be decided on by the applicant as to whether they seek portability options with their licensure. VALA would be willing to help create the state-based exam and would welcome collaboration with higher education institutions as has been done in other states to create state-based exams. In order to authorize the future creation and utilization of a state-based exam, VALA recommends the changes below to the regulations.
  “To be licensed under 18VAC95-30-95 or 18VAC95-30-100, an applicant shall provide evidence of a passing grade on one of the national credentialing examinations for administrators of assisted living facilities approved by the board.          
  1. NAB National Core Knowledge Exam for Long Term Care Administrators and the National Residential Care/Assisted Living Administrators Line of Service Examination
  2. Virginia Assisted Living Administrator Examination”

• 18VAC95-30-120-B-4 – Qualifications for licensure by endorsement or credentials – VALA recommends removing the word “national.” Regulations should provide broader terminology to allow for flexibility in examination options application by the Commonwealth.    

• 18VAC95-30-140-A-2 – Training qualifications – It is very difficult for many interested AITs to find a registered preceptor. VALA recommends eliminating “Obtain a registered preceptor to provide training.” As a prerequisite to be approved as an ALF AIT. Setting a window of time for obtaining a preceptor would be more reasonable. Potential language change could be “Obtain a registered preceptor to provide training as within 60 days of approval.”

• 18VAC95-30-170-B-4 – Training facilities – The elimination of smaller ALFs from eligible training facilities has created significant discrimination and workforce barriers for small ALFs. This restriction is not required in nursing homes, which have higher acuity requirements and stricter regulations. VALA recommends allowing smaller ALFs to serve as training facilities. VALA encourages Virginia to thoroughly analyze and reconsider the impact this prohibition has created on small businesses, as approximately 26% of all licensed ALFs have a capacity of 20 or fewer residents. If the small ALF operates at a level to warrant a licensed administrator, then the entity should be authorized to train their staff to meet the licensure status. The following statement is the proposed regulatory change to eliminate the inequitable prohibition:
  “4. An assisted living facility with a licensed resident capacity of fewer than 20 residents.”
• 18VAC95-30-180-B-2 – Preceptors – The requirement of preceptor applicants to “be employed full time as an administrator… or be a regional administrator with on-site supervisory responsibilities” excludes many qualified ALFAs from becoming preceptors. Especially with the COVID-19 pandemic, many administrators temporarily left the profession or changed positions within the industry, and some became consultants. Below is the proposed regulatory change to allow for contracted administrators to become preceptors.
  
  “2. Be employed full time as an administrator in a training facility for a minimum of two of the past four years immediately prior to registration, have a written agreement with a training facility that authorizes on-site supervisory responsibilities, or be a regional administrator with on-site supervisory responsibilities for a training facility.”

• 18VAC95-30-180-C – Preceptors – VALA recommends allowing preceptors to supervise up to three trainees at any one time.

Again, we thank the Board for considering additional options to eliminate or reduce the unnecessary regulatory burdens currently imposed by the Regulations Governing the Practice of Assisted Living Administrators.