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COMMITTEE ON HEALTH, HOSPITALS AND HUMAN SERVICES 07/07/2025-AMENDED AND REPORTED OUT TO THE COMMITTEE ON RULES AND JUDICIARY BILL NO. 36-0003 Thirty-Sixth Legislature of the Virgin Islands February 27, 2025 An act amending title 19 Virgin Islands Code relating to nursing homes and assisted living facilities by adding a new chapter 76 to establish the services that nursing homes and assisted living facilities are required to provide; establishing limitations on financial charges, requirements for visitation, and the rights of a resident PROPOSED BY: Senators Angel L. Bolques, Jr. and Marvin A. Blyden Co-sponsor: Ray Fonseca WHEREAS the seniors in the Virgin Islands have a right to a dignified existence with 1 access to the necessary facilities for their care; and 2 WHEREAS, without adequate senior assisted living facilities in the Virgin Islands, 3 seniors will not receive necessary care and treatment in the territory; and 4 WHEREAS, the Virgin Islands must develop the necessary policies to ensure that 5 seniors receive adequate care and support; Now, Therefore, 6 Be it enacted by the Legislature of the Virgin Islands: 7 SECTION 1. Title 19 Virgin Islands Code is amended by adding the following Part IX: 8 “Part IX. Nursing homes and related health care facilities 9 Chapter 76. Nursing homes and assisted living facilities 10 § 4120. Definitions. 11 2 As used in this chapter, unless it is otherwise provided or the context requires a different 1 construction, application, or meaning— 2 (a) “Assisted Living Facility” means a facility providing residential 3 accommodations for the elderly and the disabled who require assistance with activities 4 of daily living as provided for in section 4121 (a)(2). 5 (b) “Facility” means either a nursing home or assisted living facility. 6 (c) “Nursing Home” means a facility providing residential accommodations and 7 a high level of long-term continuous healthcare treatment for the elderly and the disabled. 8 (d) “Resident” means a person who is at least 60 years of age or older, or a person 9 with a disability, who permanently resides at either a nursing home or assisted living 10 facility. 11 § 4121. Services to be provided by a facility 12 (a) (1) A facility must provide the necessary care and services, based on a 13 comprehensive assessment of a resident and consistent with the resident's needs and choices, 14 to ensure that a resident's abilities in activities of daily living do not diminish unless 15 circumstances of the individual's clinical condition demonstrate that such diminution was 16 unavoidable. This includes a facility ensuring that: 17 (A) a resident is given the appropriate treatment and services to maintain or 18 improve their ability to carry out the activities of daily living. 19 (B) the necessary services to maintain good nutrition, grooming, and personal 20 and oral hygiene are given to a resident who is unable to carry out activities of daily 21 living, 22 (2) A facility must provide care and services in accordance with paragraph (1) for the 23 following activities of daily living: 24 3 (A) Hygiene—bathing, dressing, grooming, and oral care; 1 (B) Mobility—transfer and ambulation, including walking; 2 (C) Elimination—toileting; 3 (D) Dining—eating, including meals and snacks; 4 (E) Communication, including; 5 (i) Speech; 6 (ii) Language; and 7 (iii) Other functional communication systems. 8 (b) A facility must provide basic life support, including CPR, to a resident requiring 9 such emergency care prior to the arrival of emergency medical personnel and subject to related 10 physician orders and the resident's advance directives. 11 (c) A facility must provide an ongoing program to support residents in their choice of 12 activities, both facility-sponsored group and individual activities and independent activities, 13 designed to meet the interests of and support the physical, mental, and psychosocial well-being 14 of each resident, encouraging both independence and interaction in the community. 15 § 4122. Facility charges and limitations 16 (a) A facility may not exclude a resident based solely on the resident’s income. 17 (b) A facility may not impose a charge against the personal funds of a resident for any 18 item or service for which payment is made under Medicaid or Medicare. 19 (c) A facility may not condition admission on prepayment or other financial guarantees 20 for services covered under Medicaid or other public assistance programs. 21 (d) A facility may not charge a resident, during a covered Medicare or Medicaid stay, 22 for the following categories of items and services: 23 (1) Nursing services; 24 (2) Food and Nutrition services; 25 4 (3) An activities program; 1 (4) Room/bed maintenance services; 2 (5) Routine personal hygiene items and services including: hair hygiene 3 supplies; comb; brush; bath soap; disinfecting soaps or specialized cleansing agents when 4 indicated to treat special skin problems or to fight infection; razor; shaving cream; 5 toothbrush; toothpaste; denture adhesive; denture cleaner; dental floss; moisturizing 6 lotion; tissues; cotton balls; cotton swabs; deodorant; incontinence care and supplies; 7 sanitary napkins and related supplies; towels; washcloths; hospital gowns; over the 8 counter drugs; hair and nail hygiene services; bathing assistance; and basic personal 9 laundry; 10 (6) Medically-related social services; and 11 (7) Hospice services elected by the resident and paid for under the Medicare 12 Hospice Benefit or paid for by Medicaid. 13 (e) A facility may charge residents for the following items and services if payment is 14 not made by Medicare or Medicaid: 15 (1) Telephone, including a cellular phone; 16 (2) Television/radio, personal computer or other electronic device for personal 17 use; 18 (3) Personal comfort items, including smoking materials, notions and novelties, 19 and confections; 20 (4) Cosmetic and grooming items and services in excess of those for which 21 payment is made under Medicaid or Medicare; 22 (5) Personal clothing; 23 (6) Personal reading material; 24 5 (7) Gifts purchased on behalf of a resident; and 1 (8) Cost to participate in social events and entertainment outside the scope of the 2 activities program. 3 (f) A facility must not charge for special foods and meals, including medically 4 prescribed dietary supplements, ordered by the resident's physician, physician assistant, nurse 5 practitioner, or clinical nurse specialist. 6 (g) A facility must inform, orally and in writing, a resident requesting an item or 7 service for which there is a charge, that there will be a charge for the item or service and the 8 amount of the charge. 9 (h) For any item or service listed in subsection (d) that is not reimbursable under 10 Medicaid or Medicare, the facility shall: 11 (1) notify the resident or the resident’s representative, in writing, that the item or 12 service is not covered; 13 (2) provide the resident with an itemized list of the non-covered items or 14 services, including the cost and the reason for non-coverage; 15 (3) offer the resident a choice to opt in or out of receiving the noncovered item 16 or service without coercion or penalty; and 17 (4) ensure that the resident is not billed or financially burdened for noncovered 18 services without prior written consent. 19 (i) A facility shall: 20 (1) inform prospective residents and their representatives, in writing, of all 21 federal and territorial financial assistance programs available to help cover the cost of 22 care, including Medicaid, Medicare, and any applicable local subsidies or grant programs 23 administered by the Virgin Islands Department of Human Services; 24 6 (2) assist eligible residents in applying to the financial assistance programs as a 1 condition of admission or continued stay when requested by the resident or their 2 representative; and 3 (3) maintain a publicly accessible policy detailing the facility’s procedures for 4 admitting residents with limited financial means and submit the policy annually to the 5 Virgin Islands Department of Human Services for review. 6 (j) The Virgin Islands Department of Human Services shall develop and maintain a 7 current reference guide identifying items and services commonly reimbursable under Medicaid 8 and Medicare to aid facilities in compliance and transparency. 9 § 4123. Facility requirements for visitation 10 (a) A facility must meet the following requirements regarding visitors of residents: 11 (1) Inform each resident, or resident’s representative as the case may be, of the 12 resident’s visitation rights and the facility’s policies and procedures including any 13 clinical or safety restriction or limitation on such rights which are consistent with the 14 requirements of this section; the reasons for the restriction or limitation; and to whom the 15 restrictions apply. 16 (2) Inform each resident of the right, subject to the resident’s consent which 17 consent may be withdrawn at any time by the resident, to receive the visitors whom the 18 resident designates including a spouse; a domestic partner; a family member; or a friend; 19 and 20 (3) Ensure that all visitors enjoy full and equal visitation privileges consistent 21 with resident’s preferences. 22 § 4124. Rights of a Resident; responsibilities of a facility 23 (a) A resident has the right to organize and participate in resident groups in the facility. 24 7 (b) A facility must provide a resident or family group with private space and must take 1 reasonable steps to make residents and family members aware of upcoming meetings in a 2 timely manner. 3 (c) A resident has the right to participate in other activities including social, religious, 4 and community activities that do not interfere with the rights of other residents in the facility. 5 (d) Each resident must receive, and the facility must provide, the necessary care and 6 services to attain or maintain the highest practicable physical, mental, and psychosocial well- 7 being, consistent with the resident's comprehensive assessment and plan of care. 8 (e) A resident has a right to manage his or her financial affairs. This includes the right 9 to know, in advance, what charges a facility may impose against a resident's personal funds. 10 (f) In the case of a resident who has not been adjudged incompetent by a court of 11 competent jurisdiction, the resident has the right to designate a representative. 12 (1) A designation of a representative must be made in writing and supported by 13 valid legal documentation, including a notarized Power of Attorney, a court order of 14 guardianship, or a legally recognized healthcare proxy. 15 (2) The resident’s representative has the right to exercise the resident's rights to 16 the extent those rights are delegated to the resident’s representative. 17 (3) The resident retains the right to exercise rights not delegated to a resident’s 18 representative, including the right to revoke a delegation of rights. 19 (4) The facility must treat the decisions of a resident’s representative as the 20 decisions of the resident to the extent required by the court or delegated by the resident, 21 in accordance with applicable law. 22 (g) Every resident has the right to exercise his or her rights as a resident of a facility. 23 8 (h) A resident has the right to be free of interference, coercion, discrimination, and 1 reprisal from a facility in exercising his or her rights and to be supported by a facility in the 2 exercise of those rights as required under this section. 3 (i) A facility must ensure that residents can exercise their rights without interference, 4 coercion, discrimination, or reprisal from the facility.” 5 SECTION 2. (a) Section 1, internal section 4121 of this act becomes effective 12 months 6 after the effective date of this act. 7 (b) Within 90 days of the effective date of this act, a facility must submit a written 8 compliance plan to the Virgin Islands Department of Human Services (“Department”), 9 outlining steps and timelines for meeting each service requirement in section 1, internal section 10 4121. 11 (c) The Department shall provide technical assistance and monitoring to support 12 facilities in achieving compliance with section 1, internal section 4121 by the effective date in 13 subsection (a). 14 (d) Any facility that fails to comply with the effective date in subsection (a) shall be 15 subject to penalties as prescribed by regulations promulgated by the Department. 16 BILL SUMMARY 17 This bill amends title 19 Virgin Islands Code by establishing the services that nursing 18 homes and assisted living facilities are required to provide, limitations on financial charges, 19 requirements for visitation, and the rights of a resident. 20 BR25-0018/February 21, 2025/GC 21 ..\..\..\..\AMENDS\36th Legislature\BOLQUES, JR., ANGEL L\Amendment 36-406\36- 22 406- DRAFTED ON YELLOW.docx 23