2026 SESSION

HOUSE SUBSTITUTE

26107435D

HOUSE BILL NO. 1357

AMENDMENT IN THE NATURE OF A SUBSTITUTE

(Proposed by the House Committee on Appropriations

on February 9, 2026)

(Patron Prior to Substitute—Delegate McQuinn)

A BILL to direct the Virginia Department for Aging and Rehabilitative Services to convene a work group for the purpose of conducting a comprehensive study of the quality of care, resident safety, and operational practices of nursing facilities in the Commonwealth. Report.

Be it enacted by the General Assembly of Virginia:

1. § 1. That The Department for Aging and Rehabilitative Services (the Department) shall convene a work group to be known as the Nursing Facility Quality and Operations Commission (the Commission) for the purpose of conducting a comprehensive study of the quality of care, resident safety, and operational practices of nursing facilities in the Commonwealth.

The work group shall examine nursing facilities licensed by the Virginia Department of Health and nursing facilities certified to participate in Medicaid or Medicare.

The work group shall further conduct a statewide study and make recommendations to improve nursing facility quality, safety, transparency, accountability, and resident experience. In conducting the study, the work group shall evaluate, at a minimum: (i) quality and safety outcomes, including trends in preventable harms, avoidable hospitalizations, infection prevention and control, medication management, and management of other adverse events; (ii) staffing levels and stability, including staffing patterns by shift, turnover and vacancy rates, use of agency staffing, training, competency, and supervision, and the relationship between staffing and resident outcomes; (iii) complaint, survey, and enforcement systems, including the timeliness and effectiveness of inspections, complaint response, corrective action plans, sanctions, and repeat deficiencies; (iv) resident rights and protections, including admissions and discharge practices, involuntary transfers and discharges, grievance procedures, family communication, and access to ombudsman services; (v) care coordination and transitions, including coordination with hospitals and community providers and discharge planning practices; (vi) ownership and operational models, including ownership structures, related-party transactions, management agreements, real estate arrangements, and transparency of controlling interests, and how such practices affect staffing and quality; (vii) financial and payment policy, including Medicaid reimbursement structure, the extent to which payments support direct care, and opportunities to align payment with quality outcomes; (viii) emergency preparedness and continuity of operations, including outbreak response, staffing surge capacity, and readiness for severe weather and power disruptions; (ix) data reporting and transparency, including public access to facility performance information and the availability of understandable information for residents and families; and (x) disparities in quality and access, including differences across regions and resident populations.

The work group shall include representatives from relevant stakeholders, including nursing home residents and their families, nursing home administrators, advocacy organizations, health care professionals, regulatory bodies responsible for regulating nursing homes, and any other relevant individual or entity as selected by the Department.

The Department shall submit the work group's findings and recommendations to the Governor, the Chairs of the House Committees on Appropriations and Health and Human Services and the Senate Committees on Finance and Appropriations and Rehabilitation and Social Services, and the Joint Subcommittee for Health and Human Resources Oversight by September 15, 2027.