State Overview: Virginia

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

Plans may not require prior authorization for at least one FDA-approved MAT medication that is covered by the plan, does not exceed label dosage and is prescribed consistent with Board of Medicine regulations. Va. Code Ann. § 38.2-3407.15:2(B)(12)

Virginia credentials three types of addiction counselors. A Certified Substance Abuse Counselor Assistant must hold a high school diploma, complete 300 hours of relevant education courses and have 180 hours of experience. A Certified Substance Abuse Counselor requires a bachelor's degree, 400 hours of relevant education courses and training and 2,000 hours of experience. A Licensed Substance Abuse Treatment Practitioner requires a master's degree related to substance abuse or counseling, a 600-hour internship and 4,000 hours of a supervised residency. Va. Code §54.1-3507 and Virginia Board of Counseling

Licensed professional counselors (LPCs) conduct assessments and diagnoses for the purpose of establishing treatment goals and objectives for patients. LPCs plan, implement and evaluate treatment plans using treatment interventions to facilitate human development. Va. Code §54.1-3500

The Department of Behavioral Health and Developmental Services is tasked with establishing the qualifications, education and experience of peer recovery specialists. . The standards and requirements for certification of a peer recovery specialists are administered through a collaborative effort between the state and a third-party, non-profit certification provider. Va. Admin. Code tit. 12 § 30-130-5190

Transition to independent practice and prescriptive period required.

Prior to full independent practice authority, CNMs must practice in consultation with a CNM who has practice for at least two years or a licensed physician for routine and urgent consultation on patient care. A CNM who has completed 1,000 hours of practice as a CNM may practice without a practice agreement. A NM without a practice agreement shall consult and collaborate with and refer patients to other healthcare providers as may be appropriate. Va. Code §54.1-2957(H)

A NM who has a license for prescriptive authority may prescribe Schedules II-VI controlled substances. If they are still pursuant to a practice agreement, prescribing shall take place within that practice agreement. Va. Code §54.1-2957.01(G)

Transition to independent practice and prescriptive period required.

Before allowed full independent practice authority, NPs must complete three years of full-time experience as a licensed NP under practice agreement with a physician. Va. Code §54.1-2957

NPs may prescribe Schedule II-VI controlled substances without a collaborative agreement if certain conditions are met. Va. Code §54.1-2957.01(A)

NPs are authorized to sign physician orders for scope of treatment forms as qualified emergency services personnel. Va. Code §54.1-2987.1

NPs are not recognized in state policy as primary care providers.

Physician relationship required to practice and prescribe.

A CRNA is defined as an APRN certified in the specialty of nurse anesthesia who practices under the supervision of a doctor of medicine, osteopathy, podiatry or dentistry but is not subject to practice agreement requirements. Va. Admin. Code tit. 18 § 90-30-10

CRNAs have the authority to prescribe Schedules II-VI controlled substances and devices to a patient requiring anesthesia as part of the periprocedural care of such patient. Va. Code §54.1-2957.01(H)

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Additional allowable procedures may be authorized by statute and/or rule. Va. Code §54.1-3200

Appropriately qualified optometrists may apply for additional certification to perform laser surgery. These optometrists must meet certain advanced qualifications in order to be certified. Va. Code §54.1-3225

Optometrists may administer injections and use epinephrine for treatment of emergency cases of anaphylactic shock as well as administer the COVID-19 vaccine. Va. Code §54.1-3201

Optometrists may prescribe Schedule III-V controlled substances and Schedule II controlled substances containing hydrocodone combinations. Va. Code §54.1-3200

Dental hygienists employed by the Virginia Department of Health can enter into a remote supervision agreement with a dentist allowing the dental hygienist to provide dental hygiene services outside the dentist's presence and without an initial patient examination by the dentist at a community health center, charitable safety net facility, free clinic, long-term care facility, elementary or secondary school, Head Start program, or women, infants, and children program. Local anesthesia or nitrous oxide may not be administered under remote supervision. The dental hygienist must have two years of experience and regular, periodic communications with the dentist. Va. Code §54.1-2722

Dental therapists are not recognized in state policy as an oral health provider.

Virginia allows for the practice of teledentistry. Va. Code §54.1-2711

Pharmacists may administer vaccines included on the Immunization Schedule published by the Centers for Disease Control and Prevention or that have a current emergency use authorization from the U.S. Food and Drug Administration. Va. Code §54.1-3303.1

Virginia does not allow pharmacists to modify prescriptions.

A pharmacist may initiate treatment with, dispense, or administer injectable or self-administered hormonal contraceptives if the patient completes a self-assessment. A pharmacist must notify the patient's primary health care provider as long as the patient consents to such notification. If the patient does not have a primary health care provider, the pharmacist must counsel the patient regarding the benefits of establishing a relationship with a primary health care provider. A pharmacist must counsel the patient regarding seeking preventative care, including routine well-woman visits, testing for sexually transmitted infections and pap smears. Va. Code §54.1-3303.1

Virginia does not allow pharmacists to prescribe tobacco cessation aids.

Collaboration allowed with a physician for practice and prescriptive authority.

Every PA shall practice as part of a patient care team and shall provide care in accordance with a written or electronic practice agreement with one or more patient care team physicians or patient care team podiatrists. Va. Code Ann. § 54.1-2951.1(C),(D)

PAs may practice medicine to the extent and in the manner authorized by the board. […]. Each patient care team shall identify the relevant PA's scope of practice and an evaluation process for the PA's performance. Va. Code Ann. § 54.1-2952

A licensed PA shall have the authority to prescribe controlled substances and devices as set forth in Chapter 34 and as provided in the practice agreement. Va. Code Ann. § 54.1-2952.1

Statute limits the number of PAs a physician may supervise.

No patient care team physician or patient care team podiatrist shall be allowed to collaborate or consult with more than six (6) PAs on a patient care team at any one time. Va. Code Ann. § 54.1-2952(A)

Chart co-signatures may be determined at the practice level.

A practice agreement shall include […] provisions for the periodic review of patient charts or electronic health records […]. Va. Code Ann. § 54.1-2951.1(C)

Statute allows adaptable proximity.

A practice agreement shall include […] guidelines for collaboration and consultation among the parties to the agreement and the patient, periodic joint evaluation of the services delivered, and provisions for appropriate physician input in complex clinical cases, in patient emergencies, and for referrals. A practice agreement may include provisions for periodic site visits by a patient care team physician or patient care team podiatrist who is part of the patient care team at a location other than where the licensee regularly practices. Such visits shall be in the manner and at the frequency as determined by the patient care team physician or patient care team podiatrist who is part of the patient care team. Va. Code Ann. § 54.1-2951.1(C)

The collaborating physician and the PA identify the PA's scope of practice, including the delegation of medical tasks as appropriate to the PA's level of competence. Va. Code §54.1-2952