                                 CODE OF VIRGINIA

(EFFECTIVE JULY 1, 2028) AUTHORITY OF COMMISSIONER FOR CERTAIN HEALTH PLANNING
ACTIVITIES; RURAL HEALTH PLAN; DESIGNATION AS A RURAL HOSPITAL (§ 32.1-122.07)

A. The Commissioner, with the approval of the Board, is authorized to make
application for federal funding and to receive and expend such funds in
accordance with state and federal regulations.

B. The Commissioner shall administer section 1122 of the United States Social
Security Act if the Commonwealth has made an agreement with the United States
Secretary of Health and Human Services pursuant to such section.

C. In compliance with the provisions of the Balanced Budget Act of 1997, P.L.
105-33, and any amendments to such provisions, the Commissioner shall submit to
the appropriate regional administrator of the Centers for Medicare &amp;
Medicaid Services (CMS) an application to establish a Medicare Rural Hospital
Flexibility Program in Virginia.

D. The Commissioner shall develop and the Board of Health shall approve a rural
health care plan for the Commonwealth to be included with the application to
establish a Medicare Rural Hospital Flexibility Program. In cooperation and
consultation with the Virginia Hospital and Health Care Association, the Medical
Society of Virginia, representatives of rural hospitals, and experts within the
Department of Health on rural health programs, the plan shall be developed and
revised as necessary or as required by the provisions of the Balanced Budget Act
of 1997, P.L. 105-33, and any amendments to such provisions. In the development
of the plan, the Commissioner may also seek the assistance of the regional
health planning agencies. The plan shall verify that the Commonwealth is in the
process of designating facilities located in Virginia as critical access
hospitals, shall note that the Commonwealth wishes to certify facilities as
&#8220;necessary providers&#8221; of health care in rural areas, and shall
describe the process, methodology, and eligibility criteria to be used for such
designations or certifications. Virginia&#8217;s rural health care plan shall
reflect local needs and resources and shall, at minimum, include, but need not
be limited to, a mechanism for creating one or more rural health networks, ways
to encourage rural health service regionalization, and initiatives to improve
access to health services, including hospital services, for rural Virginians.

E. Notwithstanding any provisions of this chapter or the Board&#8217;s
regulations to the contrary, the Commissioner shall, in the rural health care
plan, (i) use as minimum standards for critical access hospitals, the
certification regulations for critical access hospitals promulgated by the
Centers for Medicare &amp; Medicaid Services (CMS) pursuant to Title XVIII of
the Social Security Act, as amended; and (ii) authorize critical access
hospitals to utilize a maximum of ten beds among their inpatient hospital beds
as swing beds for the furnishing of services of the type which, if furnished by
a nursing home or certified nursing facility, would constitute skilled care
services without complying with nursing home licensure requirements or retaining
the services of a licensed nursing home administrator. Such hospital shall
include, within its plan of care, assurances for the overall well-being of
patients occupying such beds.

F. Nothing herein or set forth in Virginia&#8217;s rural health care plan shall
prohibit any hospital designated as a critical access hospital from leasing the
unused portion of its facilities to other health care organizations or
reorganizing its corporate structure to facilitate the continuation of the
nursing home beds that were licensed to such hospital prior to the designation
as a critical access hospital. The health care services delivered by such other
health care organizations shall not be construed as part of the critical access
hospital&#8217;s services or license to operate.

G. Any medical care facility licensed as a hospital shall be considered a rural
hospital on and after September 30, 2004, pursuant to 42 U.S.C. &#xA7;
1395ww(d)(8)(E)(ii)(II), if (i) the hospital is located in an area defined as
rural by federal statute or regulation; (ii) the Board of Health defines, in
regulation, the area in which the hospital is located as a rural health area or
the hospital as a rural hospital; or (iii) the hospital was designated, prior to
October 1, 2004, as a Medicare-dependent small rural health hospital, as defined
in 42 U.S.C. &#xA7; 1395ww(d)(5)(G)(iv).

HISTORY: 1989, cc. 617, 633; 2000, c. 903; 2002, c. 83; 2006, c. 378; 2025, cc.
114, 135.