Frequently Asked Questions (OLC)

What medical care facilities and services require a COPN?

State law requires that the following medical care facility and services obtain a COPN:

cardiac services, diagnostic imaging services, general acute care services, general surgical services, lithotripsy services, medical rehabilitation services, mental retardation services, miscellaneous capital expenditures, nursing facility services, organ transplantation services, perinatal services and psychiatric/substance abuse services.

What is the process for obtaining a COPN?

The process for obtaining a COPN is described in the “Medical Care Facilities Certificate of Public Need rules and Regulations” (12VAC5-220), the State Medical Facilities Plan (SMFP) is used to determine public need. Both documents are available on the VDH/OLC web page at: www.vdh.virginia.gov/licensure-and-certification/the-certificate-of-public-need-program/.

How can I file a complaint against a health care facility or service?

The Office of Licensure and Certification of the Virginia Department of Health has the responsibility to investigate any complaints regarding alleged violations of regulation or applicable law regarding the following facilities and services:

    • Inpatient and outpatient hospitals
    • Nursing facilities
    • Home Care and Home Health Organizations
    • Hospice Programs
    • The quality of care provide by managed care health insurance plans

Complaints can be made in writing, via email at: OLC-Complaints@vdh.virginia.gov, or by phone at 1-800-955-1819 or in the Richmond Metro Area: 367-2106.

Can I file a complaint against an assisted living facility with the Department?

No, all complaints regarding assisted living facilities should be filed with the Office of Licensure of the Department of Social Services at: 804-662-9743.

Can I file a complaint against my health care practitioner with the Department?

No, all complaints regarding personal physicians, nurses, dentists and other licensed health care practitioners should be filed with the appropriate board of the Department of Health Professional at: 1-800-533-1560.

Can the department assist me with medical care services billing problems?

No, the department investigates consumer complaints regarding the quality of health care services. Consumers with questions regarding billing should contact the applicable health care facility or practitioner.

Can I file a complaint anonymously?

Of course. However, if you would like to receive the results of our investigations, we will need contact information.  All such information is confidential, unless you give us permission to release it.

What types of facilities and services does the department license?

The Office of Licensure and Certification of the Virginia Department of Health is charged with the responsibility for licensing”

    • Inpatient and outpatient hospitals
    • Nursing facilities
    • Home care organizations
    • Hospice programs

In addition, the office conducts the inspection activities for Medicare and Medicaid facilities and services. State and federal regulatory programs guard the health, safety and welfare of the public by establishing and enforcing minimum standards to assure quality health care.  The office’s medical care facility inspectors are health care professionals such as physicians, registered nurses, dietitians, social workers, and laboratory medical technologists.

How can I file a complaint against a health care facility or service?

The Office of Licensure and Certification of the Virginia Department of Health has the responsibility to investigate any complaints regarding alleged violations of regulation or applicable law regarding the following facilities and services:

  • Inpatient and outpatient hospitals
  • Nursing facilities
  • Home Care and Home Health Organizations
  • Hospice Programs
  • The quality of care provide by managed care health insurance plans

Complaints can be made in writing, via email at: OLC-Complaints@vdh.virginia.gov, or by phone at 1-800-955-1819 or in the Richmond Metro Area: 367-2106.

Can the department assist me with medical care services billing problems?

No, the department investigates consumer complaints regarding the quality of health care services. Consumers with questions regarding billing should contact the applicable health care facility or practitioner.

When should I contact the department about a problem with my health insurance plan?

Yes, when a consumer’s claim for a covered benefit was denied by the plan and when the consumer:

  • Is misinformed about medical coverage provided by the plan
  • Is not notified or properly notified of changes in the plan or in the plan’s network of health care practitioners
  • Cannot get timely access to care
  • Does not receive acknowledgement or resolution of a grievance filed with their health insurance plan.

The following types of complaints should be directed to the Office of the Managed

Care Ombudsman of the Bureau of Insurance at 1-877-310-6560 or in the Richmond Metro area 371-9746:

  • Medical necessity denials, utilizations review denials
  • Experimental/investigation denials
  • Medication/Pharmacy denials
  • Pre-existing conditions
  • Payment denials
  • Increases in premiums
  • Disability conditions