Nursing homes; periodic medical visits and resident assessments.

Removed specific requirements for monthly physician visits and in-person visits. The substitute version defers to federal physician visit schedules (42 CFR § 483.30(c)) rather than mandating Virginia-specific monthly visit requirements.

Modified the comprehensive plan of care delivery requirement from automatic delivery to 'upon request,' giving facilities more flexibility in how they share care plans with residents and families.

Changed participation language from 'meaningful opportunity to participate' to 'meaningful opportunity to participate in developing the plan of care,' slightly narrowing the scope of resident/family involvement.

Removed the requirement that two of twelve monthly physician visits must be completed in person by a physician, allowing all visits to potentially be conducted via telehealth or electronic means.

Removed the specific requirement that nursing homes send notice when monthly physician visits do not occur, replacing it with notice only when federal schedule requirements are not met.

Changed assessment frequency from every 12 months to every 366 days, and assessment review from every 3 months to every 92 days. These changes align with federal regulatory standards.