PRINTER'S NO. 1791
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1442
Session of
2019
INTRODUCED BY MENTZER, GREINER, PICKETT, FEE, HICKERNELL, PYLE,
ZIMMERMAN, B. MILLER, READSHAW, STEPHENS, NELSON AND HARKINS,
MAY 13, 2019
REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES,
MAY 13, 2019
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in departmental powers and
duties as to licensing, providing for waiver of physical site
requirements and further providing for regulations and for
rules and regulations for personal care home and assisted
living residences.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding a section to
read:
Section 1010. Prelicensure Waiver of Physical Site
Requirements.--(a) Each waiver submitted by an entity
interested in assisted living residence licensure shall be
considered on a case-by-case basis based on the specific merits.
In evaluating a physical site waiver request, the department
shall consider the following:
(1) The commensurate benefit to the consumers if the waiver
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is approved.
(2) Whether the entity will meet the needs of the residents
as their acuity and care needs increase.
(3) Consumer choice as it relates to the waiver request.
(4) Appropriate policies and procedures the entity has or
will put in place to ensure an equivalent level of health,
safety and well-being for the protection of the residents.
(5) Up to three years of compliance history of the entity
making the waiver request, if available.
(b) A physical site waiver shall remain valid until such
time as the assisted living residence completes a structural
renovation project impacting the existing waiver. If the
assisted living residence undergoes a change of ownership, the
existing physical site waiver shall remain valid and be
transferred to the new owner. If the new owner completes a
structural renovation project impacting the existing waiver, the
waiver shall be deemed invalid.
(c) Physical site waiver requests include, but are not
limited to, requests relating to:
(1) Living unit square footage.
(2) Living units that share a bathroom.
(3) Other physical site components.
(d) A copy of the approved waiver request and the
department's written decision shall be posted in a conspicuous
and public place within the residence.
Section 2. Section 1021(a)(2) of the act is amended and the
subsection is amended by adding a paragraph to read:
Section 1021. Regulations.--(a) * * *
(2) Regulations for assisted living residences shall:
(i) Meet or exceed standards established in 55 Pa. Code §
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2600 (relating to personal care homes). Residents' rights in
those or subsequent regulations shall not be subject to waiver.
(ii) Require an assisted living residence to provide a
resident with the resident's own living unit. Two residents may
voluntarily agree to share one unit, provided that the agreement
is in writing and contained in each of the residency agreements
of those residents. A licensee shall not require residents to
share a unit.
(iii) Provide that supplemental health care services shall
be packaged, contracted and priced separately from the resident
agreement.
(iv) Require that each living unit contain a private
bathroom, living and bedroom space, kitchen capacity, which may
mean electrical outlets to have small appliances such as a
microwave and refrigerator, closets and adequate space for
storage and a door with a lock, except where a lock or
appliances in a unit under special care designation would pose a
risk or be unsafe. A living unit shall not be required to have a
bathtub or shower in the bathroom, but an assisted living
residence shall maintain adequate bathing facilities to
accommodate all residents residing in the residence with at
least one bathtub or shower for every ten residents. Bathing
facilities shall allow for resident privacy and independence.
(v) Establish minimum square footage requirements for
individual living units [which excludes bathrooms and closet
space]. Exceptions to the size of the living unit may be made at
the discretion of the department.
(vi) Establish a special care designation for assisted
living residences and units that require specialized staff
training, service planning, activity programming and security
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measures for residents receiving cognitive support services.
(vii) Create standards for informed consent agreements that
promote aging in place which include written acknowledgment of
the risks that residents assume while directing their own care
and which release the facility from liability for adverse
outcomes resulting from actions consistent with the terms of the
informed consent agreement. Such informed consent agreements
shall only be entered into upon the mutual agreement of the
resident and the assisted living residence.
(viii) Create standards for transfer and discharge that
require the assisted living residence to make a reasonable
accommodation for aging in place and that may include services
from outside providers.
(3) Within sixty days of the effective date of this
paragraph, the department shall take all necessary actions,
including the submission of required documents to the Centers
for Medicare and Medicaid Services, to include assisted living
services and supplemental health care services as covered
medical assistance services in the Community HealthChoices
Program and to allow licensed assisted living residences to be
certified as a medical assistance provider for these services.
* * *
Section 3. Section 1057.3(a)(12), (e) and (g) of the act are
amended to read:
Section 1057.3. Rules and Regulations for Personal Care Home
and Assisted Living Residences.--(a) The rules and regulations
for the licensing of personal care homes and assisted living
residences promulgated by the department shall require that:
* * *
(12) Each assisted living residence demonstrate the ability
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to provide supplemental health care services in a manner duly
protective of the health, safety and well-being of its residents
utilizing employes or other qualified individuals certified
pursuant to subsection (f), independent contractors or
contractual arrangements with other health care facilities or
practitioners licensed, registered or certified to the extent
required by law to provide such service. To the extent
prominently disclosed in a written admission agreement, an
assisted living residence may require residents to use providers
of supplemental health care services designated by the assisted
living residence.
* * *
(e) An assisted living residence may not admit, retain or
serve a consumer with any of the following conditions or health
care needs unless an exception, upon the written request of the
assisted living residence, is granted by the department:
(1) Ventilator dependency.
(2) Stage III and IV decubiti and vascular ulcers that are
not in a healing stage.
(3) Continuous intravenous fluids.
(4) Reportable infectious diseases, such as tuberculosis, in
a communicable state that require isolation of the consumer or
require special precautions by a caretaker to prevent
transmission of the disease unless the Department of Health
directs that isolation be established within the assisted living
residence.
[(5) Nasogastric tubes.]
[(6)] (5) Physical restraints.
[(7)] (6) Continuous skilled nursing care twenty-four hours
a day.
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* * *
(g) An assisted living residence may admit, retain or serve
a consumer for whom a determination is made by the department,
upon the written request of the assisted living residence, that
the consumer's specific health care needs can be met by a
provider of assisted living services or within an assisted
living residence, in conformity with standards set by the
department through regulation, including a consumer requiring:
(1) gastric tubes, except that a determination shall not be
required if the consumer is capable of self-care of the gastric
tube or a licensed health care professional or other qualified
individual certified pursuant to subsection (f) cares for the
gastric tube;
(2) tracheostomy, except that a determination shall not be
required if the consumer is independently capable of self-care
of the tracheostomy;
(3) skilled nursing care twenty-four hours a day, except
that a determination shall not be required if the skilled
nursing care is provided on a temporary or intermittent basis;
[(4) a sliding scale insulin administration, except that a
determination shall not be required if the consumer is capable
of self-administration or a licensed health care professional or
other qualified individual administers the insulin;
(5) intermittent intravenous therapy, except that a
determination shall not be required if a licensed health care
professional manages the therapy;
(6) insertions, sterile irrigation and replacement of a
catheter, except that a determination shall not be required for
routine maintenance of a urinary catheter if the consumer is
capable of self-administration or a licensed health care
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professional administers the catheter;
(7) oxygen, except a determination shall not be required if
the consumer is capable of self-administration or a licensed
health care professional or other qualified individual
administers the oxygen;
(8) inhalation therapy, except that a determination shall
not be required if the consumer is capable of self-
administration or a licensed health care professional or other
qualified individual administers the therapy;]
[(9)] (4) other types of supplemental health care services
that an assisted living residence administrator, acting in
consultation with supplemental health care providers, determines
can be provided in a safe and effective manner by the assisted
living residence; or
[(10)] (5) other types of care that can be provided in a
safe and effective manner in an assisted living residence as
determined by regulations adopted by the department.
* * *
Section 4. This act shall take effect immediately.
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