How to start a skilled nursing facility in Virginia

Virginia requires a Nursing facility license from Virginia Department of Health, Office of Licensure and Certification (OLC) to operate a skilled nursing facility.

License required

Yes

License

Nursing facility license

Issuing agency

Virginia Department of Health, Office of Licensure and Certification (OLC)

Certificate of need

Required

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

12VAC5-371-40; Code of Virginia Title 32.1, Chapter 4, Article 1.1 (COPN)

1. Obtain a Certificate of Public Need (COPN) under Code of Virginia §32.1-102.1 et seq. before licensure; COPN approval may carry conditions such as indigent care at reduced rates
2. Submit the OLC application with the application fee; the OLC deems it complete only when all information and the fee are received
3. Include any COPN-condition agreements in the initial application
4. Pass licensure inspection; renewals depend on meeting COPN conditions and paying any related civil penalties
5. For Medicare/Medicaid, complete federal certification and enroll with DMAS

Program

Virginia Medicaid / Cardinal Care (Department of Medical Assistance Services, DMAS)

Enrollment portal

Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal'

Fiscal agent

Gainwell Technologies (PRSS enrollment and revalidation support and notices)

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. DMAS's revalidation plan says every revalidation includes collecting the application fee. The enrollment page does not list a separate state fee.

Fingerprinting

DMAS designates nursing facilities, DME, hospice, home health, prosthetic devices and doula services as high categorical risk. Its revalidation plan includes background checks for these providers. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

DMAS's revalidation plan includes site visits for applicable provider types, including high-risk providers and the moderate-risk providers being revalidated off-cycle. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.

Revalidation

Fee-for-service and MCO network providers enroll in PRSS and revalidate at least every five years. DMAS sends a notice at least 90 days before the enrollment period ends, with Gainwell reminder emails at 60 and 30 days. Revalidation is electronic only, through PRSS (see the Manage Revalidation panel). Missing it ends participation in both fee-for-service and MCO networks. Under DMAS's June 2026 CMS strategy, high-risk types (nursing facilities, DME, hospice, home health, prosthetic devices, doula services) move to a 3-year cycle on July 1, 2027. The 808 high-risk providers will be revalidated off-cycle from August to December 2027, and some moderate-risk providers in early 2028.

Full Virginia Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Public Need (COPN)

Agency

Virginia Department of Health; the State Health Commissioner issues certificates after review by regional health planning agencies

Services covered

• hospitals, including DBHDS-licensed psychiatric hospitals
• nursing homes and new nursing home services
• intermediate care facilities for substance abuse treatment
• certain small ICFs for persons with developmental disabilities (not ICF/IID of 12 beds or fewer in need areas)
• outpatient/ambulatory surgery centers and physician-office surgery
• cardiac catheterization, CT, MRI, PET, radiation therapy, stereotactic radiotherapy (non-linear-accelerator), proton beam therapy
• bed or operating room increases and bed relocations
• new medical rehabilitation, neonatal special care, open heart surgery, psychiatric, and organ/tissue transplant services

Virginia certificate of need details →

State minimum wage

$12.77 an hour

Effective

2026-01-01

Scheduled increases

Rises to $13.75 on 2027-01-01 (Va. Code 40.1-28.10 as amended in 2026).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Skilled nursing facilities — active organization NPIs (NPPES)

639 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

289 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,635,168 (as of Jun 1, 2026)

All Virginia Skilled nursing Medicaid rates, ranked →