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Virginia · 12VAC5-381 · Pending, not in force
Virginia has two changes to its home care organization rules in progress: remote supervision of personal care aides, and a full rewrite. Neither has been published for comment, and the current rules stay in force. Here is where each stands, what the drafts would change, and how to get ready without changing anything you do today.
Quick answer
Nothing new is in force. Two actions to amend 12VAC5-381 are in progress, and neither has been published in the Virginia Register for public comment:
Remote supervision of personal care aides. The State Board of Health approved proposed text on March 23, 2023. In July 2026, Town Hall gave its status as "Secretary of Health and Human Resources review in progress." Town Hall, stage 9969 The draft would let an RN or LPN supervise by audio or video between in-person visits, with client consent.
A full rewrite of 12VAC5-381. Its 2022 proposed stage was withdrawn on April 7, 2022, and a later proposed stage has been returned to VDH. The 2022 draft would have required commercially zoned offices, moved inspections to every three years and the policy review to every two.
Until either is published, adopted and in effect, keep following the current rules, including face-to-face supervision at least every 90 days.
Status
Checked against official sources on October 1, 2026.
VDH’s Current Regulatory Projects page lists both actions as under Executive Branch Review, and notes that "any material hyperlinked on this page is not effective yet and may be subject to change". VDH OLC The Virginia Regulatory Town Hall, where each stage is tracked, has more detail. Town Hall was not reachable when we checked, so we read Internet Archive copies of its pages from July and September 2026 and link them below.
April 11, 2022
The Virginia Register published VDH’s notice that it would amend 12VAC5-381 to address remote supervision of personal care services, as Chapter 470 of the 2021 Acts of Assembly, Special Session I directs.
May 11, 2022
VDH reported that no comments were received.
March 23, 2023
The State Board of Health approved the proposed amendments.
July 21, 2023
The Attorney General certified the text, and the Department of Planning and Budget completed its review and economic impact analysis.
July 2026
Town Hall (archived July 26, 2026) showed review by the Secretary of Health and Human Resources in progress, with the Governor’s review and publication in the Register still to come.
October 14, 2019
VDH announced a review of all of 12VAC5-381, combined with a periodic review. Comments closed November 13, 2019.
December 10, 2021
The State Board of Health approved proposed amendments.
April 7, 2022
Town Hall shows the proposed stage was withdrawn before the Department of Planning and Budget finished its review. No comment period took place.
Later (date not shown)
Town Hall (archived September 15, 2026) lists a later proposed stage as returned to the agency requesting additional information. Its text is not public.
VDH’s projects page also still lists an "Update License Term and Fees" fast-track as under review. That change was published and took effect on May 22, 2025, so we treat that entry as out of date. Va. Reg. 41:17
We check the Virginia Register and VDH’s pages. Leave your email and we will tell you when either proposal is published for comment or adopted, and which of your policies it affects.
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Since 2021 the statute has said that the personal care rules "Regulations governing the delivery of personal care services shall provide for supervision of home care attendants providing personal care services by a licensed nurse through use of interactive audio or video technology." Va. Code § 32.1-162.12 The regulation has not caught up. This table compares the rule in force with the text VDH proposed in 2023 (stage 9969). The proposed text has not been published and could change before it is.
| Topic | Rule in force | Proposed (not in force) |
|---|---|---|
| Who supervises aides | A registered nurse the organization designates. 12VAC5-381-360 A | A registered nurse or a licensed practical nurse. Draft 360 B |
| How supervision happens | Regular, documented, face-to-face guidance and instruction. 12VAC5-381-10 | In person by default. Remote audio and video only if the RN decides it is appropriate and the client does not refuse. Stage 9969 Issues |
| How often | As often as needed, never more than 90 days apart. 12VAC5-381-360 E | Remote audio at least every 15 calendar days, audio and video at least every 30, and in person on site at least every 60. Draft 360 J |
| RN assessment of the client | An RN develops the plan of services with the client and family. 12VAC5-381-360 C | In person before care starts, at least every 60 calendar days, within 48 hours of coming home from a hospital stay of 24 hours or more, and at discharge. Draft 360 H |
| The plan | Six required items, from needs assessment to frequency of service. 12VAC5-381-360 C | Developed before any personal care is delivered, and adds the frequency of supervision, whether remote supervision is acceptable and why. Stage 9969 Substance |
| Client consent | Not addressed (supervision is face-to-face). 12VAC5-381-10 | Signed consent for remote supervision, with a written disclosure that the client may refuse or withdraw it. Care cannot be ended, or supervision reduced, because they do. Draft 360 I |
| Recordings | Not addressed. 12VAC5-381-10 | Separate consent to record or store audio or video, used only for the client’s care unless the client agrees or the law requires. Draft 360 I 4 |
| Records of supervision | Supervision is documented; visit notes are signed, dated and filed within seven working days. 12VAC5-381-10; -280 G | The time, date, duration and type of each supervision, written in the client record by the nurse who did it. Draft 360 J 1 d |
In VDH’s words: "In-person supervision remains the default supervision method, unless an RN determines that remote supervision is an appropriate alternative when assessing the client's or patient's care needs and the client or patient does not refuse or withdraw consent for remote supervision." Stage 9969 background document
The Department of Planning and Budget’s analysis estimated the proposal applies to 1,800 organizations offering personal care, and that moving in-person supervision to every 60 days "This change would add two additional visits/year." It also said "However, the regulatory language as presently drafted is unclear and raises some questions about how these new requirements will be implemented.", pointing to open questions about how long recordings are kept and whether a client can get a copy. DPB economic impact analysis, July 19, 2023
The rewrite reviews the whole of 12VAC5-381. The only version we can read is the draft VDH prepared in March 2022 for the proposed stage that was then withdrawn. The later version has been returned to VDH and is not public, so treat these items as a sign of VDH’s thinking, not as rules. VDH also said "the Board is not proposing changes to Section 360 in this regulatory action": personal care supervision is left to the remote supervision action above. Stage 9512 background document
2022 draft · withdrawn
The main office, branch offices and drop sites in a building or unit zoned for business or commercial use, inside the area served, with proof of occupancy. VDH said offices could not be in residential spaces.
2022 draft · withdrawn
Each application would name the area served: a single health planning region, or a single planning district plus the districts next to it.
2022 draft · withdrawn
Routine licensure inspections would move from at least every two years to at least every three.
2022 draft · withdrawn
Required policies gathered into one section, reviewed every two years instead of every year.
2022 draft · withdrawn
A new process to reinstate a license that lapsed because it was not renewed on time, instead of applying for a new one.
2022 draft · withdrawn
Complaint record retention would go from three years to five.
2022 draft · withdrawn
An independent CPA review in place of an audit, and a duty to tell VDH about a Medicaid fraud investigation.
2022 draft · withdrawn
A written organizational plan and bylaws, with minimum contents.
2022 draft · withdrawn
Orientation for staff would have to include fraud, abuse and neglect training.
2022 draft · withdrawn
Professional liability in place of malpractice insurance, with minimums that rise each year.
2022 draft · withdrawn
Added to the infection control requirements.
2022 draft · withdrawn
The obsolete curriculum reference replaced by a training program an organization may offer its home attendants and volunteers.
The draft also aimed to clear up branch offices and license changes: "Language was added to clarify points of ambiguity that have caused confusion and inconsistency for regulants, such as the issue of branch offices and changes to existing licenses." Stage 9512 background document
The rules below are the ones an OLC inspector uses today. The last change to take effect was the 2025 fast-track amendment: "Effective Date: May 22, 2025." Va. Reg. 41:17
| Topic | Rule in force | Source |
|---|---|---|
| License term and fee | Three years, $1,500 per initial or renewal application (a state fee), since the fast-track change effective May 22, 2025. | Va. Reg. 41:17; 12VAC5-381-70 A |
| Supervision of personal care | Face-to-face, documented guidance; as often as needed and never more than 90 days apart; an RN or LPN available whenever personal care is provided. | 12VAC5-381-10; -360 E-F |
| Remote supervision | The statute says the rules must provide for it, but the regulation has not been amended yet. | Va. Code § 32.1-162.12 |
| Inspections | Unannounced, as often as needed and at least every two years. | 12VAC5-381-80 A |
| Policy review | Every policy reviewed at least once a year, with changes approved by the governing body. | 12VAC5-381-180 B |
| Complaint records | Kept from the last inspection and for at least three years. | 12VAC5-381-240 D |
| Financial records | Audited by an independent CPA at least every three years. | 12VAC5-381-190 D |
| Office location | Not addressed. Follow applicable local laws, including zoning. Office rules → | 12VAC5-381-150 B 2 |
VDH reported about 2,061 licensed home care organizations in Virginia as of March 10, 2025, so these changes reach a lot of providers. Va. Reg. 41:17
You do not need to change anything today. These are CareRulebook’s suggestions for staying compliant now while being ready for either change, each linked to the text behind it.
That is the rule in force. Phone and video calls can add to it, but cannot replace it until the regulation changes.
The draft would require it, and doing it now costs little and makes your supervision easy to show an inspector under either version.
The draft moves in-person supervision to at least every 60 calendar days. DPB estimated that adds two visits a year per client, so it is worth knowing the cost before it arrives.
A home office is allowed today, but the withdrawn draft would have required commercial zoning. If you are choosing premises now, check local zoning and keep the setup simple to move.
The rule in force asks for it every year. The draft rewrite would have relaxed this, but it is not in force.
Town Hall can email you about regulatory actions, meetings and public hearings, and tells subscribers when a comment forum opens.
Supervision rules today, including the RN’s role, are on the Virginia administrator and RN page.
Virginia regulations change in three published steps. "The Virginia Register of Regulations is Virginia's official biweekly publication of regulations that are in the process of being created, amended or repealed." Virginia Register
The Register adds that "Typically, regulatory actions take about 18-24 months from start to finish.", and that "A regulatory action may be withdrawn by the promulgating agency at any time before it becomes effective." Regulatory Process in Virginia
The CareRulebook Virginia manual has 35 policies written to the regulation in force. These are the ones each change would touch. When a change is adopted, we update them and buyers can download the new version.
Policy 2.1
Client rights, conduct and responsibilities
the right to refuse or withdraw consent to remote supervision
Policy 2.6
Informed consent and advance directives, including DDNR orders
signed consent for remote supervision and separate consent for recordings
Policy 4.1
Orientation, job training and competency
in-service training alongside in-person on-site supervision
Policy 5.1
Initial assessment and plan of care
plan written before care starts, with supervision frequency and any remote rationale
Policy 5.2
Personal care services and home attendant duties
RN and LPN roles, and what is documented on each visit
Policy 5.5
Supervision of personnel
who supervises, how and how often, and what is recorded
Policy 5.6
Service records: completion and return
date, carer and type of care on each visit record
Policy 10.1
Client records: content and handling
supervision details and any recordings in the client record
Policy 1.1
Governing body, administrator and license
bylaws and a two-year policy review
Policy 1.3
Surveyor entry and survey cooperation
inspections every three years
Policy 1.5
Financial controls, billing and refunds
CPA review and Medicaid fraud notice
Policy 1.6
Malpractice and liability insurance
professional liability with rising minimums
Policy 2.2
Complaints, grievances and investigations
complaint records kept five years
Policy 4.1
Orientation, job training and competency
fraud, abuse and neglect training at orientation
Policy 5.7
Drop sites
commercial zoning for drop sites
Policy 7.1
Infection control
an employee health program
Policy 10.2
Records retention
complaint record retention
CareRulebook
CareRulebook writes every policy topic 12VAC5-381 lists, with your organization’s details and the rule quoted under each. The supervision policy already explains the pending remote supervision change, and when either change is adopted we update the affected policies.
$199CareRulebook founding price for the first 50 Virginia organizations, then $249. Not an OLC fee.
It depends. Not yet under the regulation. The statute says the rules must provide for supervision by interactive audio or video, but the amendment to do this is still under Executive Branch Review. The current regulation defines supervision as regular, documented, face-to-face guidance.
"Regulations governing the delivery of personal care services shall provide for supervision of home care attendants providing personal care services by a licensed nurse through use of interactive audio or video technology."
No. The 2025 change made licenses last three years, but the inspection rule did not change: the OLC still makes unannounced inspections as often as needed and at least every two years. A 2022 draft rewrite proposed moving to every three years, but it is not in force.
"An OLC representative shall make periodic unannounced on-site inspections of each home care organization as necessary but not less often than biennially."
No. Not under the rules in force. 12VAC5-381 does not say where your office must be. A 2022 draft rewrite would have required offices in buildings zoned for business or commercial use, but that proposed stage was withdrawn before review finished, and no new text has been published. Local zoning still applies, because the regulation requires you to follow applicable local laws.
"Stage withdrawn on 04/07/2022 before DPB completed its review."
No. Licenses are renewed every three years, at $1,500 per renewal application. The statute says each license expires on the third anniversary of its issue or renewal.
"Every such license shall expire on the third anniversary of its issuance or renewal."
Not yet. Two changes to 12VAC5-381 are in progress: remote supervision of personal care aides, and a full rewrite of the regulation. Neither has been published for public comment and neither is in force. The last change that did take effect was the fast-track amendment of May 22, 2025, which made licenses last three years at $1,500 per application.
Not under the regulation in force, which defines supervision as regular, documented, face-to-face guidance and instruction, at least every 90 days. The statute says the rules must provide for supervision by interactive audio or video, and VDH’s proposed text would allow it, but that text was still at Secretary review in July 2026.
In the text VDH proposed in 2023: an RN or LPN could supervise; remote audio supervision at least every 15 calendar days, audio and video at least every 30, and in-person on-site supervision at least every 60; in-person RN assessments before care starts and at least every 60 calendar days; signed client consent for remote supervision and separate consent for recordings. The text could change before it is published.
We do not know. A 2022 draft of the rewrite would have required offices, branch offices and drop sites to be in buildings zoned for business or commercial use, and VDH said they could not be in residential spaces. That draft was withdrawn on April 7, 2022. A later version has been returned to VDH and is not public. Today the regulation does not address home offices.
No dates are set. Each still has to be published in the Virginia Register as a proposed regulation, with a 60-day public comment period, and then adopted as a final regulation, which takes effect after a further 30-day wait. The Virginia Register says regulatory actions typically take 18 to 24 months from start to finish; both of these began in 2019 and 2022.
VDH’s Current Regulatory Projects page lists both as under Executive Branch Review, and says the material it links is not effective yet. Town Hall gives more detail: the remote supervision text is at Secretary review, while the rewrite’s 2022 proposed stage was withdrawn and a later one returned to VDH. We show both sources.
Once a proposed regulation is published in the Virginia Register, a 60-day comment period opens. You can comment in the Town Hall comment forum or send comments to VDH at regulatorycomment@vdh.virginia.gov. Sign up for Town Hall email alerts, or leave your email below and we will tell you when it opens.
The manual follows the regulation in force. The supervision policy explains that remote supervision is pending and not yet allowed in place of face-to-face supervision. When a change is adopted we update the affected policies, and buyers can download the new version free for 12 months.
Leave your email and we will tell you when either Virginia proposal is published for comment or adopted, and what it means for your policies.
No spam. Only emails about Virginia home care rule changes. How we use your email.
Virginia
How to start a home care agency in Virginia
The HCO license, RN supervision every 90 days and the policy topics.
Virginia
Running a Virginia home care organization from home
Office, records and premises rules, and the 2022 zoning draft.
Virginia
Virginia administrator and RN requirements
Who supervises personal care today, and how often.
Virginia
Virginia home care policies and procedures
Every rule that asks for a written policy, mapped to the policy that meets it.
Virginia
Virginia home care inspections
Unannounced OLC inspections at least every two years.
Texas
Texas HCSSA rule changes
The proposed rewrite of 26 TAC Chapter 558.
Georgia
Georgia’s 2026 private home care rule changes
The adopted Chapter 111-8-65 amendment, side by side.
Tracker
Rule change tracker
Every proposed and adopted change we follow, by state and nation.