Fish gotta swim. The General Assembly gotta do the bidding of the nursing home lobby. Patients be damned – literally.

Consider the fate of House Bill 2253 in the 2025 General Assembly.

• As introduced, it would have empowered the Health Commissioner to impose serious sanctions on our worst nursing homes; but
• As substituted, it gives her no authority to do anything likely to even inconvenience them.

That was not a substitution. It was an execution.

The substitute bill is objectively inhumane. It assures that Virginia will remain a prime target for people seeking the double-digit annual gains available from levels of understaffing far below federal minimum safe patient standards. Levels at which patients are proven to suffer and die without any pretense of adequate care.

It passed unanimously in both chambers. I doubt very many of them read the midnight substitute.

The governor should veto it.

HB 2253 was initiated by the Governor. The patrons were Delegates Wachsmann (R), Cherry (R) and Willett (D).

On 01/30/2025, the substitute was printed by the House Committee on Health and Human Services chaired by Mark Sickles (D). It completely re-wrote the initial proposal for § 32.1-27.3. Sanctions; civil penalty.

Those wondering about the source of the substitute can consider that Del. Sickles has been the recipient of $56,158 from the nursing home industry lobbyist Virginia Healthcare Association (VHCA), his fifth largest donor.

The last $10,000 contribution was on August 23 of 2024. Let’s look at the changes from the perspective of the original.

HB 2253 as submitted with deletions in the substitute struck through:

B. The sanctions that the Commissioner may impose pursuant to subsection A shall include the following:

1. Revoking, refusing to renew, or denying issuance of any license issued pursuant to Chapter 5 (§32.1-123 et seq.);

2. Suspending or refusing to reinstate any license issued pursuant to Chapter 5 (§ 32.1-123 et seq.);

3. Placing on probation any license issued pursuant to Chapter 5 (§ 32.1-123 et seq.);

4. Temporarily restricting or prohibiting new admissions to any nursing home that is licensed pursuant to Article 1 (§ 32.1-123 et seq.) of Chapter 5;

5. Requiring submission of and compliance with plans of corrective action, with or without any disciplinary actions directed by the Commissioner; and

6. Mandating training for the nursing home’s employees, with any costs to be borne by the facility, when the Commissioner concludes that the lack of training has led directly to noncompliance.

This addition from the substitute:

B. No sanctions under this section shall be imposed for violations deemed more severe than a level 2 deficiency under the Centers for Medicare and Medicaid Services deficiency severity definitions under federal law.

So, the Health Commissioner cannot sanction the most severe violations.

This addition: The sanctions may be levied only “in response to findings made during a state licensure inspection.”

Cute. That language killed two VHCA targets at once.

• they cannot be penalized for results of the federal surveys, including complaint responses, conducted by VDH for the feds; and, the big one
• they cannot be penalized for understaffing, no matter how extreme, reported quarterly to the Center for Medicare and Medicaid Services (CMS) and linked to payroll so thus auditable.

Then there is this change:

“D. A nursing home that is subject to the imposition of sanctions pursuant to subsection A shall also be subject to a civil penalty not to exceed $1,000 $500 per violation per day, capped at $100,000 $10,000 for a series of related incidents of noncompliance.”

Ten thousand dollars.

Where have we seen that figure before? Oh, yeah — the Sickles campaign donation from the nursing home lobby last summer. Sucker. If he had asked for ten times that, they would have paid.

Bottom line. This is exactly what it looks like.

Absolutely no one can find a hint of public interest, much less humanity, in the transaction fulfilled by the substitute bill.

The Governor should veto it for that reason.

And for the simple fact that the Health Commissioner has more authority without it.