Frequently Asked Questions

State law requires that a COPN be obtained for:

  • hospitals of any type, including general, outpatient surgical, psychiatric, and rehabilitative
  • nursing homes
  • intermediate care facilities for persons with intellectual disabilities
  • any specialized center or clinic or that portion of a physician's office developed for the provision of:
    • outpatient or ambulatory surgery
    • cardiac catheterization
    • computed tomographic (CT) scanning
    • magnetic resonance imaging (MRI)
    • positron emission tomographic (PET) scanning
    • radiation therapy
    • stereotactic radiotherapy other than radiotherapy performed using a linear accelerator
    • other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy
    • proton beam therapy

State law requires that a COPN be obtained prior to:

  • increasing the total number of beds or operating rooms in an existing medical care facility
  • relocating beds from an existing medical care facility to another existing medical care facility
  • adding any new nursing home service at an existing medical care facility
  • introducing into an existing medical care facility any of the following services services if it the service has not been provided in the previous 12 months:
    • cardiac catheterization
    • computed tomographic (CT) scanning
    • magnetic resonance imaging (MRI)
    • medical rehabilitation
    • neonatal special care
    • open heart surgery
    • positron emission tomographic (PET) scanning
    • psychiatric, organ or tissue transplant service
    • radiation therapy
    • stereotactic radiotherapy other than radiotherapy performed using a linear accelerator or other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy
    • proton beam therapy
    • substance abuse treatment
  • converting beds in an existing medical care facility to medical rehabilitation beds or psychiatric beds
  • adding in an existing medical care facility any new medical equipment for the provision of:
    • cardiac catheterization
    • computed tomographic (CT) scanning
    • magnetic resonance imaging (MRI)
    • open heart surgery
    • positron emission tomographic (PET) scanning
    • radiation therapy
    • stereotactic radiotherapy other than radiotherapy performed using a linear accelerator or other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy
    • proton beam therapy
  • capital expenditure of $15 million or more by or on behalf of a medical care facility other than a general hospital
  • converting in an existing medical care facility of psychiatric inpatient beds approved pursuant to a Request for Applications (RFA) to nonpsychiatric inpatient beds

The following medical care facilities and services are licensed or certified by the State Health Commissioner:

  • general and outpatient surgical hospitals
  • nursing homes
  • home care organizations
  • hospice programs and hospice facilities
  • managed care health insurance plans
  • private review agents

The Office of Licensure and Certificationhas the responsibility to investigate any state complaints regarding alleged violations of regulation or applicable law regarding the following facilities and services:

  • general and outpatient surgical hospitals
  • nursing homes
  • home care organizations
  • hospice programs and hospice facilities
  • quality of care provided by managed care health insurance plans

The Office of Licensure and Certification also serves as the state survey agency for the U.S. Centers for Medicare and Medicaid Services and has the responsibility to investigate any federal complaints regarding alleged violations of regulation or applicable law regarding the following facilities and services:

  • ambulatory surgical centers
  • community mental health centers
  • comprehensive outpatient rehabilitation facilities
  • critical access hospitals
  • end stage renal disease facilities
  • federally qualified health centers
  • home health agencies
  • hospice
  • hospitals
  • inpatient rehabilitation facility
  • intermediate care facilities for individuals with intellectual disabilities
  • laboratories and any location performing diagnostic testing on human specimens
  • nursing facilities and skilled nursing facilities
  • organ transplant programs
  • outpatient rehabilitation providers (physical therapy/speech pathology)
  • portable x-ray
  • psychiatric hospitals
  • psychiatric residential treatment facilities
  • rural health clinics

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 at 804-367-2106.

Yes, but if you would like to receive the results of our investigations, we will need contact information.

 

The Virginia Department of Health does not regulate assisted living facilities. All complaints regarding assisted living facilities should be filed with the Office of Licensure of the Department of Social Services at 804-662-9743.

 

All complaints regarding physicians, nurses, dentists and other licensed health care practitioners should be filed with the appropriate board of the Virginia Department of Health Professions at: 1-800-533-1560.

The Virginia Department of Health cannot discipline individual health care practitioners; however, if the alleged bad acts took place in a hospital, nursing home, home care organization, home health agency, hospice program, or hospice facility, please file a complaint via email at OLC-Complaints@vdh.virginia.gov, or by phone at 1-800-955-1819 or in the Richmond Metro Area at 804-367-2106.

 

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

 

The Virginia Department of Health accepts complaints about health insurance plans if a consumer:

  • has had a claim for a covered benefit was denied by the plan
  • 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 in the State Corporation Commission's Bureau of Insurance at 1-877-310-6560 or in the Richmond Metro area at 804-371-9746:

  • medical necessity denials and utilizations review denials
  • experimental/investigation denials
  • medication/pharmacy denials
  • pre-existing conditions
  • payment denials
  • increases in premiums
  • disability conditions