This report is submitted pursuant to Acts of Assembly Chapter 929, as passed by the 2020 Session of the General Assembly, requiring the Commissioner of the Department of Social Services (VDSS) to convene a work group for the purpose of developing a plan for the licensure of Prescribed Pediatric Extended Care Centers (PPECC) in the Commonwealth (see Appendix A). The work group included representatives from the Department of Health Professions, the Department of Medical Assistance Services, and the Department of Social Services; pediatric health care providers; and other stakeholders as the Commissioner deemed appropriate, such as the parent of a child with medical complexities that would likely qualify for Prescribed Pediatric Extended Care (PPEC) if it were available in Virginia (see Appendix B). This report summarizes the work group’s findings and provides a plan for the licensure of PPECC in Virginia.

Recommendations

1. The workgroup recommends that the General Assembly create PPECCs in statute and direct state agency regulatory oversight based on a needs assessment conducted by the Virginia Department of Medical Assistance Services (DMAS). The needs assessment estimated that there are approximately 14,000 children in the Commonwealth who would be eligible for PPECC.

2. The workgroup did not make a recommendation as to which state agency should have regulatory control and oversight over PPECCs. States with PPECCs generally placed licensing authority with the Department of Health or Department of Social Services (see Appendix C). Both the Virginia Department of Health and the Virginia Department of Social Services already have a licensing division that could be expanded to oversee PPECCs. However, the General Assembly would still need to provide new financial resources in order to create a new licensing program for PPECCs at either agency.

3. The workgroup recommends the General Assembly consider the following provisions for the construction, maintenance, operation, staffing, and management of PPECC and for the nature and scope of services to be provided.

A. Construction

The construction or renovation of a PPECC building should comply with all state and local requirements pertaining to building construction standards, including plumbing, electrical code, glass, and accessibility for the physically disabled. PPECCs should also comply with the minimum facility standards.

B. Maintenance

To provide safe and sanitary facilities and healthful programs, the licensing agency should adopt facility standards pertaining to the facilities that prioritize:

(a) The adoption and implementation of policies and procedures that assure the health and safety of children;

(b) Maintenance, based upon the size of the structure and the number of children, relating to plumbing, heating, lighting, ventilation, and other building conditions. Providing adequate space will ensure the children’s health, safety, comfort, and protection from fire and other hazardous conditions;

(c) Sanitary conditions, including the water supply, sewage disposal, food handling, and general hygiene; and

(d) Contract and other operational and transportation services.

C. Operation and Management

The nature and scope of the operation and management of PPECC services should include the following:

• The coordination of emergency transportation arrangements with the city/county emergency operation services. The PPECC should ensure an adult staff member accompanies the child on any emergency transport.

• A documented preventative maintenance program with specific emphasis on ensuring that all durable medical equipment functions correctly and safely.

• The PPECC should maintain medical records, data, and information relative to the children and programs in the facility for inspection by the licensing agency.

• Appropriate and readily available emergency services that include an emergency drug kit, a crash cart with a defibrillator appropriate for children, and any other emergency services appropriate to the needs of the children at the center.

• A written disaster plan that addresses natural disasters, weather emergencies, bomb threats, emergency drills, manufactured disasters, and financial disasters.

• Infection control policies

• Policies for the prevention of incidents and accidents.

• Immediate reporting to the licensing agency of any incidents and accidents that affect the health, safety and welfare of a child.

• Documentation of all incidents and accidents.

• Coordination and collaboration with other agencies that may serve the child, such as early intervention and the local school district.

D. Staffing Recommendations

The licensing agency should establish appropriate staffing requirements. The staff responsible for providing basic and supportive services should comply with all health professional licensing statutes and regulations promulgated by the appropriate licensing board. Staffing recommendations include:

• An administrator who is either a physician with a current license, a nurse practitioner, a licensed nursing home administrator, a child daycare director, or a registered nurse with at least five years of service in pediatric medicine.

• A medical director who is responsible for basic and supportive services, including medical, pharmaceutical, and nursing services. The medical director should ensure that the governing body has developed, approved, and implemented policies and procedures regarding the operations of the PPECC. These policies and procedures should include the prevention, reporting, and investigation of abuse; the delivery of medical and therapeutic services; and the control and delivery of pharmaceutical services.

• A supervisor that holds a valid professional license issued by the Virginia Board of Medicine, Virginia Board of Nursing, Occupational Therapy Advisory Board, Virginia Board of Pharmacy, Virginia Board of Physical Therapy, or the Virginia Board of Audiology and Speech-Language Pathology.

• A direct care staff member that is one of the following: licensed professional nurse, registered nurse, physical therapist, occupational therapist, speech-language pathologist, or an individual who has a high school diploma or equivalent and at least one year of documented and supervised experience in a health care or child care setting.

• Staffing/caregiver ratios should be established to ensure safe and appropriate care.

• A documented orientation and staff development program should be mandated to ensure employees and contracted staff are adequately trained to provide services to children.

E. Services

The services provided should include skilled nursing, physical therapy, occupational therapy, speech therapy, education, meals, snacks, transportation, and family education. These services will promote and maintain the children’s health and development and will assist with the training of the children’s parents or legal guardians. Each child attending the PPECC will have an individualized plan of care designated by the child’s attending physician, the PPECC treatment team, a parent or legal guardian, and, when appropriate, the child. No child should attend a PPECC for more than 12 hours within a 24-hour period. A PPECC should not provide services other than those typically provided to medically dependent or technologically dependent children.