reglab/housing_qa huggingface dataset:
VA Code § 32.1-137.16 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-137.16. Records

Every entity subject to Article 1.1 (§ 32.1-137.1 et seq.) of Chapter 5 and this article shall maintain or cause to be maintained, in writing and at a location accessible to employees of the Department, records of review procedures; the health care qualifications of the entity's staff; the criteria used by the entity to make its determinations; records of complaints received, including the manner in which the complaints were resolved; the number and type of adverse determinations and reconsiderations; the number and outcome of final adverse determinations and appeals thereof, including a separate record for expedited appeals; and procedures to ensure confidentiality of medical records and personal information. Records of complaints under Article 1.1 (§ 32.1-137.1 et seq.) shall be maintained from the date of the entity's last examination and for no less than six years.Every entity subject to utilization review under this article shall provide, upon request of the Commissioner, data and records pertaining to utilization review from which patient and provider identifiers have been removed. Records shall be maintained or caused to be maintained by the utilization review entity for a period of six years, and all such records shall be subject to examination by the Commissioner or his designee.1998, c. 891; 2011, c. 788.
VA Code § 32.1-137.17 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-137.17. Limitation on Commissioner's jurisdiction

The Commissioner shall have the right to determine compliance with this article; however, the Commissioner shall have no jurisdiction to adjudicate individual controversies arising out of or incidental to this article.1998, c. 891.
VA Code § 32.1-138.1 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.1. Implementation of transfer and discharge policies

A. To implement and conform with the provisions of subdivision A 4 of § 32.1-138, a facility may discharge the patient, or transfer the patient, including transfer within the facility, only:1. If appropriate to meet that patient's documented medical needs;2. If appropriate to safeguard that patient or one or more other patients from physical or emotional injury;3. On account of nonpayment for his stay except as prohibited by Titles XVIII or XIX of the United States Social Security Act and the Virginia State Plan for Medical Assistance Services; or4. With the informed voluntary consent of the patient, or if incapable of providing consent, with the informed voluntary consent of the patient's authorized decision maker pursuant to § 54.1-2986 acting in the best interest of the patient, following reasonable advance written notice.B. Except in an emergency involving the patient's health or well being, no patient shall be transferred or discharged without prior consultation with the patient, the patient's family or responsible party and the patient's attending physician. If the patient's attending physician is unavailable, the facility's medical director in conjunction with the nursing director, social worker or another health professional, shall be consulted. In the case of an involuntary transfer or discharge, the attending physician of the patient or the medical director of the facility shall make a written notation in the patient's record approving the transfer or discharge after consideration of the effects of the transfer or discharge, appropriate actions to minimize the effects of the transfer or discharge, and the care and kind of service the patient needs upon transfer or discharge.C. Except in an emergency involving the patient's health or well being, reasonable advance written notice shall be given in the following manner. In the case of a voluntary transfer or discharge, notice shall be reasonable under the circumstances. In the case of an involuntary transfer or discharge, reasonable advance written notice shall be given to the patient at least five days prior to the discharge or transfer.D. Nothing in this section or in subdivision A 4 of § 32.1-138 shall be construed to authorize or require conditions upon a transfer within a facility that are more restrictive than Titles XVIII or XIX of the United States Social Security Act or by regulations promulgated pursuant to either title.1987, c. 221; 1993, c. 692.
VA Code § 32.1-138.2 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.2. Certain contract provisions prohibited

No contract or agreement for nursing home care shall contain any provisions which restrict or limit the ability of a resident to apply for and receive Medicaid or which require a specified period of residency prior to applying for Medicaid. The resident may be required to notify the facility when an application for Medicaid has been made. No contract or agreement may require a deposit or other prepayment from Medicaid recipients. No contract or agreement shall contain provisions authorizing the facility to refuse to accept retroactive Medicaid benefits.1987, c. 221.
VA Code § 32.1-138.3 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.3. Third party guarantor prohibition

Any facility certified under Title XVIII or XIX of the United States Social Security Act shall not require a third party guarantee of payment to the facility as a condition of admission or of expedited admission to, or continued stay in, the facility. This section shall not be construed to prevent a facility from requiring an individual who has legal access to a resident's income or resources which are available to pay for care in the facility to sign a contract without incurring personal financial liability except for breach of the duty to provide payment from the resident's income or resources for such care.For purposes of this section, the resident's income or resources shall include any amount deemed to be income or resources of the resident for purposes of Medicaid eligibility and any resources transferred by the resident to a third party if the transfer disqualifies the resident from Medicaid coverage for nursing facility services.1989, c. 193.
VA Code § 32.1-138.4 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.4. Retaliation or discrimination against complainants

No nursing facility may retaliate or discriminate in any manner against any person who (i) in good faith complains or provides information to, or otherwise cooperates with, the Department or any other agency of government or any person or entity operating under contract with an agency of government, having responsibility for protecting the rights of patients of nursing facilities or (ii) attempts to assert any right protected by state or federal law.1994, c. 941.
VA Code § 32.1-138.5 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.5. Confidentiality of complainant's identity

Whenever the Department conducts inspections and investigations in response to complaints received from the public, the identity of the complainant and the identity of any patient who is the subject of the complaint, or identified therein, shall be treated as confidential and shall not be open to inspection by members of the public. Identities of the complainant and patient who is the subject of the complaint shall be revealed only if a court order so requires. Nothing contained herein shall prevent the Department, in its discretion, from disclosing to the nursing facility the nature of the complaint or the identity of the patient who is the subject of the complaint. Nothing contained herein shall prevent the Department or its employees from making reports under § 63.2-1603 et seq. If the Department intends to rely, in whole or in part, on any statements made by the complainant, at any administrative hearing brought against the nursing facility, the Department shall disclose the identity of the complainant to the nursing facility a reasonable time in advance of such hearing.1994, c. 941.
VA Code § 32.1-138.6 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.6. Definitions

In this chapter the following terms have the meanings indicated:"Certificate of registration" means a certificate of registration granted by the Department of Health to a private review agent."Medical director" means a physician licensed to practice medicine in the Commonwealth of Virginia who is an employee of a utilization review organization responsible for compliance with the provisions of this article."Physician advisor" means a physician licensed to practice medicine in the Commonwealth of Virginia or under a comparable licensing law of a state of the United States who provides medical advice or information to a private review agent or a utilization review entity in connection with its utilization review activities."Private review agent" means a person or entity performing utilization reviews, except that the term shall not include the following entities or employees of any such entity so long as they conduct utilization reviews solely for subscribers, policyholders, members or enrollees:1. A health maintenance organization authorized to transact business in Virginia; or2. A health insurer, hospital service corporation, health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth."Utilization review" means a system for reviewing the necessity, appropriateness and efficiency of hospital, medical or other health care resources rendered or proposed to be rendered to a patient or group of patients for the purpose of determining whether such services should be covered or provided by an insurer, health services plan, health maintenance organization, or other entity or person. For purposes of this article, "utilization review" shall include, but not be limited to, preadmission, concurrent and retrospective medical necessity determination, and review related to the appropriateness of the site at which services were or are to be delivered. "Utilization review" shall not include (i) any review of issues concerning insurance contract coverage or contractual restrictions on facilities to be used for the provision of services, (ii) any review of patient information by an employee of or consultant to any licensed hospital for patients of such hospital, or (iii) any determination by an insurer as to the reasonableness and necessity of services for the treatment and care of an injury suffered by an insured for which reimbursement is claimed under a contract of insurance covering any classes of insurance defined in §§ 38.2-117, 38.2-118, 38.2-119, 38.2-124, 38.2-125, 38.2-126, 38.2-130, 38.2-131, 38.2-132 and 38.2-134."Utilization review program" means a program for conducting utilization reviews by a private review agent.1990, c. 826, § 38.2-5300; 1995, c. 745; 1996, c. 259; 1998, c. 129; 2000, c. 564.
VA Code § 32.1-138.7 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.7. Certificates of registration required; issuance; transferability; regulations

A private review agent may not conduct utilization reviews in the Commonwealth unless the Department has granted the private review agent a certificate of registration. The Department shall issue a certificate of registration to an applicant that has met the minimum standards required by this article and applicable regulations of the Department. A certificate of registration issued under this article is not transferable.1990, c. 826, § 38.2-5301; 1998, c. 129.
VA Code § 32.1-138.8 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.8. Consultation with health regulatory boards

If in the administration of this article a question concerning compliance with standards of practice governing any health care profession arises pursuant to Subtitle III (§ 54.1-2400 et seq.) of Title 54.1, the Commissioner or his designee shall consult with the appropriate health regulatory board within the Department of Health Professions.1998, c. 129.
VA Code § 32.1-138.9 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.9. Standards for approval

Each private review agent shall file an application with the Department which shall meet the following minimum standards and any additional standards established by regulation pursuant to § 32.1-138.15, and pay a filing fee established by the Department, in order to be approved by the Department:1. A description of the procedures to be used in evaluating proposed or delivered hospital, medical, or other health care services;2. The procedures by which patients or providers may seek reconsideration of determinations by private review agents;3. The type and qualifications of the personnel either employed or under contract to perform the utilization review;4. Procedures and policies which ensure that patient-specific medical records and information shall be kept strictly confidential except as authorized by the patient or by regulations adopted pursuant to this article; and5. Assurances that reviewers be readily accessible by telephone to patients and providers at least forty hours per week during normal business hours.1990, c. 826, § 38.2-5302; 1998, c. 129.
VA Code § 32.1-138.10 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.10. Expiration; renewal

Each certificate of registration shall expire on the second anniversary of its effective date unless the certificate of registration is renewed for a two-year term as provided in this section. The Department shall renew the certificate of registration for an additional two-year term if the applicant is otherwise entitled to the certificate of registration, pays to the Department the renewal fee set by regulations, submits to the Department a renewal application on a form prescribed by the Department, submits satisfactory assurances of compliance with the requirements of this article and updates information on file with the Department pursuant to this section.1990, c. 826, § 38.2-5303; 1998, c. 129.
VA Code § 32.1-138.11 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.11. Denial; revocation

A. The Department may deny a certificate of registration to any applicant if, upon review of the application, it finds that the applicant proposing to conduct utilization review does not meet the standards required by this article or by any regulations promulgated pursuant to this article.B. The Department may revoke a certificate of registration, or place the holder on probation with terms and conditions, if the holder demonstrates that it is unable or unwilling to meet the requirements of this chapter or of regulations adopted pursuant to this article.1990, c. 826, § 38.2-5304; 1998, c. 129.
VA Code § 32.1-138.12 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.12. Waiver of requirements of article

The Department shall waive the requirements of this article for a private review agent that operates under contract with the federal government for utilization review of patients eligible for hospital services under Title XVIII of the Social Security Act or under contract with a plan otherwise exempt from operation of this chapter pursuant to the Employee Retirement Income Security Act of 1974.1990, c. 826, § 38.2-5306; 1998, c. 129.
VA Code § 32.1-138.13 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.13. Access to and confidentiality of patient-specific medical records and information

Private review agents who have been granted a certificate of registration by the Department shall have reasonable access to patient-specific medical records and information to the extent and in the manner authorized by regulation.1990, c. 826, § 38.2-5307; 1998, c. 129.
VA Code § 32.1-138.14 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.14. No private right of action created

This article shall not be construed to create a private right of action against a private review agent on behalf of a subscriber, policyholder, member, enrollee or other person.1990, c. 826, § 38.2-5308; 1998, c. 129.
VA Code § 32.1-138.15 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-138.15. Regulations

The Department shall promulgate regulations, pursuant to the Administrative Process Act (§ 2.2-4000 et seq.), to implement the provisions of this article, which shall include, but not be limited to, the following items:1. Minimum qualifications to perform review;2. Procedures which require the private review agent to provide the attending physician an opportunity to consult with a physician advisor prior to issuance of a final denial in any case in which there is an initial recommendation to deny coverage;3. Guidelines regarding access to and confidentiality of patient-specific medical records and information; and4. Setting the amount of any fees required by this article, which shall be sufficient to pay for the administrative costs of regulation under this article.1990, c. 826, § 38.2-5309; 1998, c. 129.
VA Code § 32.1-162.2 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-162.2. Exemptions from article

The provisions of this article shall not be applicable to:1. A hospice established or operated for the practice of religious tenets of any recognized church or denomination which provides care and treatment for the sick by spiritual means without the use of any drug or material remedy, whether gratuitously or for compensation. Such a hospice shall comply with the statutes and regulations governing environmental protection and life safety.2. Any hospice located in the Commonwealth that after initial licensure is accredited by any organization recognized by the Centers for Medicare and Medicaid Services for the purposes of Medicare certification.1981, c. 346; 2010, c. 790.
VA Code § 32.1-162.3 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-162.3. License required for hospice programs; notice of denial of license; renewal thereof

A. No person shall establish or operate a hospice or a hospice facility without a license issued pursuant to this article unless he is exempt from licensure pursuant to § 32.1-162.2.B. The Commissioner shall issue or renew a license to establish or operate a hospice or a hospice facility upon application therefor on a form and accompanied by a fee prescribed by the Board if the Commissioner finds that the hospice or hospice facility is in compliance with the provisions of this article and regulations of the Board. The Commissioner shall notify by certified mail any applicant denied a license of the reasons for such denial.C. Every such license shall expire at midnight December 31 of the year issued, or as otherwise specified by the Board, and shall be required to be renewed annually.D. The activities and services of each applicant for issuance or renewal of a hospice license shall be subject to an inspection and examination by the Commissioner to determine if the hospice is in compliance with the provisions of this article and regulations of the Board.E. No license issued pursuant to this article may be transferred or assigned.1981, c. 346; 2003, c. 526; 2007, c. 397; 2010, c. 790.
VA Code § 32.1-162.4 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-162.4. Inspections

The Commissioner may cause each hospice licensed under this article to be periodically inspected at reasonable times. However, no hospice shall receive additional inspections until all other hospices in the Commonwealth have also been inspected, unless the additional inspections are (i) necessary to follow up on a preoperational inspection or one or more violations, (ii) required by a uniformly applied risk-based schedule established by the Department, (iii) necessary to investigate a complaint regarding the hospice, or (iv) otherwise deemed necessary by the Commissioner or his designee to protect the health and safety of the public.Notwithstanding the foregoing or any other provision of this article, any hospice organization that has obtained accreditation as provided in subdivision 2 of § 32.1-162.2, may be subject to inspection so long as such accreditation is maintained but only to the extent necessary to ensure the public health and safety. If any such hospice fails to comply with the provisions of this article or with the regulations of the Board relating to public health and safety, the Commissioner may revoke the exemption from licensure and require such hospice to be relicensed before it can again qualify for an exemption pursuant to § 32.1-162.2.1981, c. 346; 2010, c. 790; 2017, c. 465.
VA Code § 32.1-162.5:1 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-162.5:1. Notice to dispenser of patient's death; disposition of dispensed drugs

A. Any hospice licensed by the Department or exempt from licensure pursuant to § 32.1-162.2 with a hospice patient residing at home at the time of death shall notify every pharmacy that has dispensed partial quantities of a Schedule II controlled substance for a patient with a medical diagnosis documenting a terminal illness, as authorized by federal law, within 48 hours of the patient's death.B. Any hospice licensed by the Department or exempt from licensure pursuant to § 32.1-162.2 shall develop policies and procedures for the disposal of drugs, including opioids, dispensed as part of the hospice plan of care in accordance with the provisions of § 54.1-3411.2.2015, c. 668; 2018, c. 95; 2020, c. 739.
VA Code § 32.1-162.6 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-162.6. Revocation or suspension of license

A. The Commissioner is authorized to revoke or suspend any license issued hereunder if the holder of the license fails to comply with the provisions of this article or with the regulations of the Board.B. If a license is revoked as herein provided, the Commissioner may issue a new license upon application therefor if, when, and after the conditions upon which revocation was based have been corrected and all provisions of this article and applicable regulations have been complied with.C. Suspension of a license shall in all cases be for an indefinite time and the suspension may be lifted and rights under the license fully or partially restored at such time as the Commissioner determines that the rights of the licensee appear to so require and the interests of the public will not be jeopardized by resumption of operation.1981, c. 346.
VA Code § 32.1-162.6:1 (2021)
2021 Code of Virginia|Title 32.1 - Health|Chapter 5 - Regulation of Medical Care Facilities and Services|§ 32.1-162.6:1. Possession or administration of cannabis oil

Hospice and hospice facility employees who are authorized to possess, distribute, or administer medications to patients shall be permitted to store, dispense, or administer cannabis oil to a patient who has been issued a valid written certification for the use of cannabis oil in accordance with subsection B of § 54.1-3408.3 and has registered with the Board of Pharmacy.2020, c. 846.