Virginia Regulatory Town Hall
Virginia Department of Health
State Board of Health
Home Care Organization Regulations [12 VAC 5 ‑ 381]
Action Amend the Regulation after Assessment and Receipt of Public Comment
Comment Period Ended on 11/13/2019


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11/5/19  10:13 am
Commenter: Marcia A Tetterton, Virginia Association for Home Care and Hospice

Modernizing Recommendations Part I

Part I. Definitions and General Information

12VAC5-381-10. Definitions.

"Branch office" means a geographically separate office of the home care organization that performs all or part of the primary functions of the home care organization on a smaller scale.

12VAC5-381-120. Variances.

A. The OLC  Commissioner can authorize variances only to its own licensing regulations, not to regulations of another agency or to any requirements in federal, state, or local laws.


12VAC5-381-160. Governing Body.

A. The organization shall have a governing body that is legally responsible for the management, operation and fiscal affairs of the organization. The governing body of a hospital that operates a home care organization shall include in its internal organization structure an identified unit of home care services.

B. The governing body shall:

1. Determine which services are to be provided by the organization;

2. Ensure that the organization is staffed and adequately equipped to provide the services it offers to clients, whether provided directly by the organization or through contract;

3. Comply with federal and state laws, regulations and local ordinances governing operations of the organization; and

4. Establish a quality improvement committee.

C. The governing body shall review annually and approve the written policies and procedures of the organization.

D. The governing body shall review annually and approve the recommendations of the quality improvement committee, when appropriate.


12VAC5-381-180. Written Policies and Procedures.

C. Administrative and operational policies and procedures shall include, but are not limited to:

10. Communicable and reportable diseases pursuant to guidelines established by the Virginia Department of Health;

18. CBD oil and THC-A oil for medical treatment, prescription or illegal drug abuse by client in the aide’s presence; and  

12VAC5-381-190. Financial Controls.

D. All financial records shall be audited at least triennially by an independent certified public accountant (CPA) or audited as otherwise provided by law.. A copy of most recent tax return prepared by an independent financial organization, or an audit, or a balance sheet, or a financial statement prepared by a certified public accounting firm.  


12VAC5-381-280. Client Record System.

G. Signed and dated notes on the care or services provided by each individual delivering service shall be written on the day the service is delivered and incorporated in the client record within seven ten working days.


12VAC5-381-290. Home Attendants.

Home attendants shall be able to speak, read and write English and shall meet one of the following qualifications:

6. Have satisfactorily completed a 20-hour training program and competency tested by a licensed nurse.  Completion of the 20-hour training program and competency testing shall be documented in the home health aide’s personnel record.  Other individuals may be used to provide instruction under the supervision of a licensed nurse.  The 20-hour training program shall address each of the following subject areas:

(i) Communications skills, including the ability to read, write and verbally report information to the person receiving services, representatives, other caregivers and supervisor. 

(ii) Observation, reporting and documentation of patient status and the care or service furnished.

(iii) Reading and recording temperature, pulse, and respiration.

(iv) Basic infection control procedures.

(v) Basic elements of body functioning and changes in body function that must be reported to an aide's supervisor.

(vi) Maintenance of a clean, safe, and healthy environment.

(vii) Recognizing emergencies and knowledge of emergency procedures.

(viii) The physical, emotional, and developmental needs of and ways to work with the populations served including the need for respect for the patient, his or her privacy and his or her property.

(ix) Appropriate and safe techniques in personal hygiene and grooming that include

(A) Bed bath.

(B) Sponge, tub, or shower bath.

(C) Hair shampoo, sink, tub, or bed.

(D) Nail and skin care.

(E) Oral hygiene.

(F) Toileting and elimination.

(x) Safe transfer techniques and ambulation.

(xi) Normal range of motion and positioning.

(xii) Adequate nutrition and fluid intake.

(xiii) Recognizing and reporting changes in skin condition, including pressure ulcer.

(xiv) Any other task that home care organization may choose to provider as permitted under state law.

using the "Personal Care Aide Training Curriculum," 2003 edition, of the Department of Medical Assistance Services. However, this training is permissible for home attendants of personal care services only.

CommentID: 76841

11/5/19  10:14 am
Commenter: Marcia A Tetterton,Virginia Association for Home Care and Hospice

Modernizing Recommendations Part III

Part III. Skilled Services

12VAC5-381-300. Skilled Services.

B. All skilled services delivered shall be prescribed in a medical plan of care that contains at least the following information:

1. Diagnosis and prognosis;

2. Functional limitations;

3. Orders for all skilled services, including: (i) specific procedures, (ii) treatment modalities, and (iii) frequency and duration of the services ordered;

4. Orders for medications, when applicable; and

5. Orders for special dietary or nutritional needs, when applicable.

The medical plan of care shall be approved and signed by the client's primary care ordering physician.

E. The medical plan of care shall be reviewed and approved, and signed by the primary care ordering physician at least every 60 days.

12VAC5-381-310. Nursing Services.

B. Supervision of services shall be provided as often as necessary as determined by the client's needs, the assessment by the registered nurse, and the organization's written policies not to exceed 90 days.

12VAC5-381-340. Medical Social Services.

A. Medical social services shall be provided according to the medical plan of care by or under the direction of a qualified social worker who holds, at a minimum, a bachelor's degree with major studies in social work, sociology, or psychology from a four-year college or university accredited by the Council on Social Work Education and has at least two years experience in case work or counseling in a health care or social services delivery system. that has master’s or doctoral degree from a school of social work accredited by the Council on Social Work Education, and has 1 year of social work experience in a health care setting.

The organization shall have one year from January 1, 2006, to ensure the designated individual meets the qualifications of this standard.

CommentID: 76842

11/5/19  10:15 am
Commenter: Marcia A Tetterton, Virginia Association For Home Care and Hospice

Modernizing Recommendations Part V

Part V. Personal Care Services

12VAC5-381-360. Personal Care Services.

A. An organization may provide personal care services in support of the client's health and safety in his home. The organization shall designate a registered licensed nurse responsible for the supervision of personal care services.

B. The personal care services shall include:

5. Documenting the services delivered in the client's record service plan.

C. Such services shall be delivered based on a written plan of services developed by a licensed health care provider registered nurse, in collaboration with the client and client's family. The plan shall include at least the following:

1. Assessment Evaluation of the client's needs;

D. The service plan shall be retained in the client's record. Copies of the service plan shall be provided to the client receiving services and reviewed with the assigned home attendant prior to delivering services.

E. Supervision of services home attendants shall be provided as often as necessary as determined by the client's needs service plan by a the assessment of the registered licensed health care professional nurse, and the organization's written policies not to exceed 90 120 days.

F. A registered nurse or licensed practical nurse shall be available during all hours that personal care services are being provided.


CommentID: 76843