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                                                      PRINTER'S NO. 3843

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 2700 Session of 2000


        INTRODUCED BY O'BRIEN, VEON, LEDERER, NAILOR, ORIE, DeWEESE,
           CAPPABIANCA, DAILEY, M. COHEN, WILT, TIGUE, BROWNE, BARRAR,
           CORRIGAN, MELIO, E. Z. TAYLOR, GODSHALL, STABACK, FEESE,
           J. TAYLOR, VAN HORNE, WOJNAROSKI, HERMAN, SCRIMENTI, SURRA,
           SCHRODER, HALUSKA, BUNT, LaGROTTA, WILLIAMS, FLICK, SOLOBAY,
           READSHAW, DeLUCA, L. I. COHEN, B. SMITH, SHANER, COY, HARHAI,
           HERSHEY, THOMAS, MUNDY, BEBKO-JONES, MYERS, BASTIAN, HORSEY,
           COLAFELLA, TRELLO, DALLY, BELARDI, MICOZZIE, WOGAN, BELFANTI,
           BARD, BISHOP, CLARK, CLYMER, CORNELL, CURRY, DALEY, FICHTER,
           FRANKEL, FREEMAN, GANNON, GEORGE, HARHART, HENNESSEY,
           JOSEPHS, KAISER, KENNEY, LAUGHLIN, LAWLESS, LESCOVITZ, MAHER,
           MANDERINO, MANN, McILHATTAN, McILHINNEY, MICHLOVIC, PESCI,
           PETRARCA, PIPPY, RAMOS, ROBERTS, ROEBUCK, RUBLEY, SANTONI,
           SAYLOR, SNYDER, STEELMAN, STEVENSON, TANGRETTI, WALKO,
           YOUNGBLOOD AND YUDICHAK, AUGUST 2, 2000

        REFERRED TO COMMITTEE ON AGING AND YOUTH, AUGUST 2, 2000

                                     AN ACT

     1  Relating to assisted living; promoting availability of
     2     affordable and safe assisted living services; and making
     3     repeals.

     4     The General Assembly finds and declares as follows:
     5         (1)  Assisted living is an integral part of the continuum
     6     of long-term care and the availability of long-term care
     7     options must be increased to meet the growing demand. The
     8     General Assembly is committed to ensuring that all citizens
     9     have access to services that encourage and support
    10     individuals to live independently, provide individuals with
    11     privacy and dignity, support individuals living in the
    12     residential environment of their choice, promote the

     1     integration of individuals into the community and
     2     participation in mainstream activities and maximize
     3     individual choice to promote and support changing needs and
     4     preferences, including the right of individuals to make
     5     decisions about their own care and to take responsibility for
     6     certain risks that may result from their decisions,
     7     consistent with the individual's capacity to make decisions
     8     and the provider's exercise of prudent risk management
     9     through negotiated risk agreements.
    10         (2)  This act promotes availability of affordable and
    11     safe assisted living services, makes such services available
    12     in a variety of housing settings and directs the Department
    13     of Health, Department of Public Welfare and Department of
    14     Aging to take necessary steps for the development and
    15     availability of such services.
    16         (3)  Adequate and accurate information about assisted
    17     living is essential for consumers. This act creates a clear
    18     and flexible statutory structure for assisted living to meet
    19     the needs of elderly persons and persons with disabilities of
    20     all income levels, regardless of payment source.
    21         (4)  Nationally and in this Commonwealth, a general
    22     concept of assisted living has emerged in recent years as an
    23     important link in the continuum of care for the elderly and
    24     adults with disabilities.
    25         (5)  Consumers needing assistance with activities of
    26     daily living prefer to age in place in a residential setting
    27     of their choice, supported by self-directed services
    28     responsive to their needs.
    29         (6)  Numerous establishments are operating in this
    30     Commonwealth that call themselves assisted living but which
    20000H2700B3843                  - 2 -

     1     provide disparate services and living arrangements and which
     2     may or may not be licensed by the Commonwealth.
     3         (7)  Low-income elderly and adults with disabilities are
     4     largely excluded from being able to receive assisted living
     5     services and from being served in such establishments due to
     6     their inability to privately pay for them.
     7         (8)  Due to the lack of standardized statutory and
     8     regulatory definition and agency oversight, frail and
     9     vulnerable elderly persons and adults with disabilities are
    10     confused by the many terms and names to promote adult
    11     residential services and are at risk.
    12         (9)  The Intra-Governmental Council on Long-Term Care has
    13     considered and evaluated the concept of assisted living and
    14     has recently issued a report on assisted living that includes
    15     recommendations that the Commonwealth define, license, fund
    16     and regulate assisted living services and residences.
    17         (10)  This act defines, licenses, funds and regulates
    18     assisted living services and assisted living residences to
    19     create a better balance of availability and public funding
    20     between institutional and community-based long-term care for
    21     the elderly and adults with disabilities.
    22     The General Assembly of the Commonwealth of Pennsylvania
    23  hereby enacts as follows:
    24  Section 1.  Short title.
    25     This act shall be known and may be cited as the Assisted
    26  Living Reform Act.
    27  Section 2.  Definitions.
    28     The following words and phrases when used in this act shall
    29  have the meanings given to them in this section unless the
    30  context clearly indicates otherwise:
    20000H2700B3843                  - 3 -

     1     "Abuse."  One or more of the following acts:
     2         (1)  infliction of injury, unreasonable confinement,
     3     intimidation or punishment with resulting physical harm, pain
     4     or mental anguish;
     5         (2)  willful deprivation of services by a caretaker or
     6     assisted living provider or direct service staff which are
     7     necessary to maintain physical or mental health;
     8         (3)  sexual harassment, rape or abuse, as defined in 23
     9     Pa.C.S. Ch.61 (relating to protection from abuse);
    10         (4)  exploitation by an act or a course of conduct,
    11     including misrepresentation or failure to obtain informed
    12     consent which results in monetary, personal or other benefit,
    13     gain or profit for the perpetrator or monetary or personal
    14     loss to the consumer;
    15         (5)  neglect of the consumer which results in physical
    16     harm, pain or mental anguish; or
    17         (6)  abandonment or desertion by a caretaker.
    18     "Activities of daily living."  Activities, including, but not
    19  limited to, eating, bathing, dressing, toileting, transferring
    20  in and out of bed or in and out of a chair and personal hygiene.
    21     "Adult."  A person who is 18 years of age or older.
    22     "Aging in place."  The process of providing increased or
    23  adjusted services to a person to compensate for the physical or
    24  mental decline that occurs with the aging process in order to
    25  maximize individual dignity and independence and permit the
    26  person to remain in a familiar, residential environment for as
    27  long as possible. Such services may be provided through facility
    28  staff, a third party, volunteers, friends or family.
    29     "Areas of severe nursing facility bed shortage."  A county
    30  which has a nursing bed shortage of more than 75 beds, as
    20000H2700B3843                  - 4 -

     1  determined by the Department of Health.
     2     "Assisted living."  Those assisted living services as
     3  determined and self-directed by the consumer or legal
     4  representative that permit and assist the consumer to live in
     5  the community. The term may also include such housing assistance
     6  or residency in an assisted living residence that permits
     7  consumers to safely be supported in residences in which their
     8  independence, dignity and ability to make choices are
     9  maintained, to the extent of their capabilities.
    10     "Assisted living residence."  A residential setting that:
    11         (1)  offers, provides or coordinates a combination of
    12     personal care services, activities, 24-hour supervision and
    13     assisted living services, whether scheduled or unscheduled,
    14     and health-related services for consumers;
    15         (2)  has a service program and physical environment
    16     designed to minimize the need for residents to move within or
    17     from the setting to accommodate changing needs and
    18     preferences; and
    19         (3)  has an organized mission, service programs and a
    20     physical environment designed to maximize residents' dignity,
    21     autonomy, privacy and independence and encourages family and
    22     community involvement.
    23  Costs for housing and services are independent of one another
    24  and residents may choose their service provider and the services
    25  to be provided. Living units are single occupancy, except in
    26  situations where two residents choose to share a unit, and
    27  include, at a minimum, a private bathroom, bedroom, living
    28  space, kitchenette and food preparation area and lockable door.
    29  Assisted living residences have a goal of fostering aging in
    30  place and promoting resident self-direction and active
    20000H2700B3843                  - 5 -

     1  participation in decision making while emphasizing an
     2  individual's privacy and dignity through negotiated risk
     3  agreements.
     4     "Assisted living residency agreement."  The contract or
     5  contracts between a provider and a consumer regarding the
     6  consumer's residency at the assisted living residence. The term
     7  also includes the agreement between an assisted living residence
     8  and an entity contracting for assisted living residency for the
     9  consumer using public funding.
    10     "Assisted living services."  A combination of supportive
    11  services, personal care services, personalized assistance
    12  services, assistive technology and health-related services
    13  designed to respond to the individual needs of those who need
    14  assistance with activities of daily living and instrumental
    15  activities of daily living. The term includes publicly funded
    16  home-based services and community-based services available
    17  through the medical assistance program and the Federal Medicaid
    18  waiver program. The term also includes State-funded options for
    19  home-based services and community-based services funded through
    20  the Pennsylvania Department of Aging as defined in this act.
    21     "Assisted living services agreement."  The contract or
    22  contracts between a provider and a consumer regarding the
    23  provision and the terms of assisted living services, including
    24  contracts between assisted living service providers and entities
    25  contracting for services for consumers using public funding.
    26     "Assisted Living Trust Account."  All funds collected from
    27  the licensure and renewal fees shall be deposited into an
    28  Assisted Living Trust Account which shall be established to fund
    29  the enforcement and oversight required under this act. All fines
    30  collected under sections 7(b) and 8(b)(4) shall also be
    20000H2700B3843                  - 6 -

     1  deposited into this Assisted Living Trust Account and shall be
     2  used for the same purpose.
     3     "Assistive technology."  Those devices and services, whether
     4  medically necessary or not, that are used to increase, maintain,
     5  or improve the functional capabilities of individuals with
     6  disabilities which may or may not be needed to permit the person
     7  to live independently. The term shall include, but not be
     8  limited to, reachers, adapted telephones, reading aides and
     9  other nonmedical devices.
    10     "Cognitive support services."  Services provided as part of a
    11  coordinated care plan to individuals who have memory impairments
    12  and other cognitive problems that significantly interfere with
    13  their ability to carry out activities of daily living without
    14  assistance and who require that supervision, monitoring and
    15  programming be available to them 24 hours per day, seven days
    16  per week in order for them to reside safely in the setting of
    17  their choice, including the following:  assessment, health
    18  support services and a full range of dementia-capable activity
    19  programming and crisis management.
    20     "Complete compliance."  When there are no Class I, II or III
    21  violations, an Assisted Living Residence or Assisted Living
    22  Services Provider shall be deemed in complete compliance.
    23     "Comprehensive assessment."  A thorough review of a
    24  consumer's status in a number of functional areas, including a
    25  brief personal history. The term includes physical health,
    26  emotional health, cognitive functioning, physical functioning,
    27  ability to carry out activities of daily living, informal
    28  supports, environmental factors and finances. Comprehensive
    29  assessment will be completed by options or the local area agency
    30  on aging. Comprehensive assessment will only be completed where
    20000H2700B3843                  - 7 -

     1  a consumer needs or is contracting for personal care services
     2  from an assisted living residence or assisted living services
     3  provider.
     4     "Consumer."  A person who receives or is in need of assisted
     5  living services, who lives in an assisted living residence or
     6  who is in need of supportive housing to remain in the community.
     7     "Coordinated care plan."  A plan designed to meet a
     8  resident's individual physical, mental, assistive technology,
     9  and psychosocial needs. They are to be completed within 15 days
    10  of admission or the start of service delivery and are reviewed
    11  every 3 months and, if necessary, revised. Care planning is done
    12  by an interdisciplinary team that includes the resident, the
    13  resident's legal representative, and/or the resident's family
    14  member; and services necessary shall be provided the consumer
    15  until the plan is finalized and in operation.
    16     "Direct care staff."  A person who directly assists residents
    17  with activities of daily living, provides services or is
    18  otherwise responsible for the health, safety and welfare of
    19  residents.
    20     "EPSDT."  Early and periodic screening diagnosis and
    21  treatment which is Federally mandated and medically necessary
    22  for medical assistance beneficiaries under 21 years of age.
    23     "Federally funded home and community-based services waiver
    24  slots and services."  The packages of services which are
    25  federally funded, in part, pursuant to a waiver of Title XIX of
    26  the Social Security Act (42 U.S.C. § 1396 et seq.) and which are
    27  available in designated numbers to individuals eligible for
    28  Pennsylvania medical assistance who qualify for the nursing
    29  facility level of care but who elect home and community-based
    30  services in lieu of institutionalization in a nursing facility.
    20000H2700B3843                  - 8 -

     1     "Financial management."  A service provided by a
     2  representative payee or a guardian or power of attorney for a
     3  consumer or when a consumer needs assistance in budgeting and
     4  spending for his or her personal needs. Where funds are kept for
     5  the consumer by one of these people, written receipts must be
     6  obtained for all cash disbursements, including those to the
     7  consumer.
     8     "Health Choices."  The Pennsylvania medical assistance
     9  mandatory managed care program.
    10     "Home Health Care."  Intermittent or part-time nursing
    11  services or other therapeutic services furnished by a home
    12  health agency lawfully permitted to do so.
    13     "Immobile person."  An individual who is unable to move from
    14  one location to another or who has difficulty in understanding
    15  and carrying out instructions without the continual and full
    16  assistance of other persons or who is incapable of independently
    17  operating a device such as a wheelchair, prosthesis, walker or
    18  cane to exit a building.
    19     "Instrumental activities of daily living."  The term
    20  includes, but is not limited to, meal preparation, taking
    21  medication, using the telephone, handling finances, banking and
    22  shopping, light housekeeping, heavy housekeeping and getting to
    23  appointments.
    24     "Legal representative."  A person duly authorized by law to
    25  take certain action on behalf of a consumer, including, but not
    26  limited to, legal counsel, a court-appointed guardian, an
    27  attorney-in-fact under a durable power of attorney, an agent
    28  under a health care proxy or a representative payee, a spouse or
    29  an adult child of the consumer.
    30     "Living unit."  A room, apartment, cottage or other self-
    20000H2700B3843                  - 9 -

     1  contained unit which need not be shared except by choice of the
     2  resident and which is capable of being locked by the resident
     3  and which has its own bathroom, including a toilet, sink, shower
     4  or bath; its own kitchenette or food preparation area, including
     5  counter space, microwave, refrigerator, cabinet and sink or
     6  other food provision determined by choice of the resident; its
     7  own sleeping area and its own living area, unless adjustments
     8  have been made to accommodate persons who are significantly
     9  cognitively impaired.
    10     "Long-term care nursing facility."  A licensed facility that
    11  provides either skilled or intermediate nursing care or both
    12  levels of care to two or more patients unrelated to the licensee
    13  for a period exceeding 24 hours. Intermediate care facilities
    14  exclusively for the mentally retarded, commonly referred to as
    15  ICF/MR or ICF/ORC, personal care homes, domiciliary care homes
    16  and assisted living residences as defined by statute shall not
    17  be considered long-term care nursing facilities for the purpose
    18  of this act.
    19     "Long-term care ombudsman."  An agent of the Department of
    20  Aging who investigates and seeks to resolve complaints made by
    21  or on behalf of older individuals or adults with disabilities
    22  who are consumers of assisted living services, pursuant to
    23  section 2203-A of the act of April 9, 1929 (P.L.177, No.175),
    24  known as The Administrative Code of 1929. Complaints may relate
    25  to action, inaction or decisions of providers of assisted living
    26  services or residences, of public agencies or of social service
    27  agencies, or their representatives, which may adversely affect
    28  the health, safety, welfare, interests, preferences or rights of
    29  consumers.
    30     "Managed care plan."  A health care plan that uses a
    20000H2700B3843                 - 10 -

     1  gatekeeper to manage the utilization of health care services;
     2  integrates the financing and delivery of health care services to
     3  enrollees by arrangements with health care providers selected to
     4  participate on the basis of specific standards; and provides
     5  financial incentives for enrollees to use the participating
     6  health care providers in accordance with procedures established
     7  by the plan as is defined in section 2102 of the act of May 17,
     8  1921 (P.L.682, No.284), known as The Insurance Company Law of
     9  1921. The term includes an entity, including a municipality,
    10  whether licensed or unlicensed, that contracts with or functions
    11  as a managed care plan to provide health care services to
    12  enrollees. The term does not include ancillary service plans or
    13  an indemnity arrangement which is primarily based upon a fee for
    14  service method of payment.
    15     "Medical assistance consumer."  An individual who receives or
    16  is eligible to receive assisted living services through home and
    17  community-based services waivers funded by the Department of
    18  Public Welfare.
    19     "Mobile person."  An individual who is physically and
    20  mentally capable of vacating the home on the individual's own
    21  power or with limited assistance in the case of an emergency,
    22  including the capability to ascend or descend stairs if present
    23  on the exit path. The term includes a person who is able to
    24  effectively operate a device required for moving from one place
    25  to another and to understand and carry out instructions for
    26  vacating premises.
    27     "Negotiated or shared risk."  The process by which a consumer
    28  or his or her legal representative formally negotiates with
    29  assisted living providers about the risks he or she is willing
    30  to assume in providing services and in the resident's living
    20000H2700B3843                 - 11 -

     1  environment.
     2     "Omission of a material fact."  Failure to state a material
     3  fact required to be stated in any disclosure statement or
     4  filing.
     5     "Options."  The Long Term Care Pre-admission Assessment
     6  Program and the community services for nursing facility eligible
     7  persons administered by the Department of Aging and operated by
     8  Area Agencies on Aging.
     9     "Personal care home" or "PCH."  Premises on which food,
    10  shelter and personal assistance or supervision are provided for
    11  a period exceeding 24 hours for four or more adults who are not
    12  relatives of the operator, who do not require the services of a
    13  licensed long-term care nursing facility, except as provided in
    14  section 6(b), and who do require assistance or supervision in
    15  matters such as dressing, bathing, diet, financial management,
    16  evacuation of a residence in the event of an emergency or
    17  medication prescribed for self-administration.
    18     "Personal care services."  Assistance or supervision in
    19  matters such as dressing, bathing, diet, financial management,
    20  evacuation of the resident in the event of an emergency or
    21  medication prescribed for self-administration. For cognitively
    22  impaired individuals, personal care services shall include
    23  monitoring and routinely assessing individuals' health status
    24  with a focus on preventing unnecessary comorbidities.
    25     "Providers."  Individuals, organizations or entities who
    26  assume responsibility and contract with a consumer to provide
    27  assisted living services either in the consumer's home or in an
    28  assisted living residence. The term also includes individuals,
    29  organizations or entities who provide cognitive support
    30  services.
    20000H2700B3843                 - 12 -

     1     "Publicly funded assisted living" or "publicly funded home
     2  and community-based services."  Assisted living funded through
     3  federally funded home and community-based services waiver slots,
     4  state-funded options home and community-based services slots,
     5  the supplemental security income paid to personal care boarding
     6  homes or publicly funded housing costs needed to avoid nursing
     7  facility placement as defined in section 9.
     8     "Qualified couple for cost of living increase."  Two
     9  qualified persons, living together, who are considered a couple
    10  under the Supplemental Security Income program, Title XVI of the
    11  Social Security Act (49 Stat. 620, U.S.C. § 301 et seq.).
    12     "Qualified persons for cost of living increase."  Persons
    13  meeting the nonfinancial, categorical eligibility requirements
    14  under Title XIX of the Social Security Act (49 Stat. 620, U.S.C.
    15  § 301 et seq.) as aged, blind or disabled and receiving or
    16  applying for long-term care services under a special income
    17  level.
    18     "Restraint."  A chemical or mechanical device used to
    19  restrict the movement or normal function of an individual or a
    20  portion of the individual's body, including geriatric chairs;
    21  posey; chest, waist, wrist or ankle restraints; locked
    22  restraints; and locked doors to prevent egress. The term does
    23  not include devices used to provide support for the achievement
    24  of functional body position or proper balance as long as the
    25  device can easily be removed by the resident.
    26     "Skilled or intermediate nursing care."  Professionally
    27  supervised nursing care and related medical and other health
    28  services provided directly or under the direction of the
    29  licensed entity for a period exceeding 24 hours to an individual
    30  not in need of hospitalization, but whose needs can only be met
    20000H2700B3843                 - 13 -

     1  in a long-term care nursing facility on an inpatient basis
     2  because of illness, disease, injury, convalescence or physical
     3  or mental infirmity. The term includes, but is not limited to,
     4  the provision of inpatient services that are needed on a daily
     5  basis by the resident, ordered by and provided under the
     6  direction of a physician, which require the skills of
     7  professional personnel, such as registered nurses, licensed
     8  practical nurses, physical therapists, occupational therapists,
     9  speech pathologists or audiologists.
    10     "State-funded assisted living."  State-funded options home
    11  and community-based services or publicly funded housing needed
    12  to avoid nursing facility placement as described in section
    13  5(o).
    14     "State-funded options home and community-based services
    15  slots" and "State-funded home and community-based services."
    16  Packages of services funded without Federal money which are
    17  available in designated budgeted numbers to individuals with
    18  incomes under 400% of the Federal Supplemental Security Income
    19  (SSI) level who qualify for the nursing facility level of care.
    20     "Substantial compliance."  When there are no Class I or II
    21  violations and the number and nature of individual Class III
    22  violations when considered together do not comprise a
    23  substantial adverse risk to health, safety and well-being, an
    24  assisted living residence or assisted living services provider
    25  shall be deemed to be in substantial compliance.
    26  Section 3.  Assisted living services and residences authorized.
    27     Assisted living services are authorized under this act
    28  subject to the standards set in section 4 and in the settings
    29  authorized under section 5. Not included in this act are adult
    30  residential facilities administered, approved and/or licensed by
    20000H2700B3843                 - 14 -

     1  agencies whose primary purpose is related to mental health,
     2  mental retardation or drug and alcohol.
     3  Section 4.  Standards for assisted living services.
     4     The following standards for assisted living services shall
     5  apply:
     6         (1)  Assisted living encourages and supports individuals
     7     to live independently in the residential environment of their
     8     choice with privacy and dignity.
     9         (2)  Assisted living promotes integration of individuals
    10     into the community and participation in the mainstream of
    11     activities.
    12         (3)  Assisted living maximizes consumer choice to promote
    13     and support the consumer's changing needs and preferences.
    14     Consumer choice includes the right of individuals to make
    15     decisions about their own care and to take responsibility for
    16     certain risks that may result from their decisions,
    17     consistent with the individual's capacity to make decisions
    18     and the provider's exercise of prudent risk management
    19     through negotiated assisted living service and/or residency
    20     agreements.
    21         (4)  Assisted living services must be consumer oriented
    22     and meet professional standards of quality.
    23  Section 5.  Assisted living services.
    24     (a)  Licensure requirements.--An entity not already licensed
    25  by the Department of Health that either coordinates and provides
    26  or coordinates and subcontracts for assisted living services for
    27  payment must be licensed by the Department of Health as an
    28  assisted living service provider before it can and for so long
    29  as it does provide such services to call itself an assisted
    30  living provider or to otherwise hold itself out as providing
    20000H2700B3843                 - 15 -

     1  assisted living services. State-designated agency programs, such
     2  as Area Agencies on Aging and centers for Independent Living,
     3  guardians and family members and low-income housing as is
     4  described in section 9(b) are entities which are exempt from
     5  this requirement. Other entities providing separate components
     6  of assisted living services must be licensed by the appropriate
     7  authority to provide that care, as is required by law. Complete
     8  compliance with all regulations, including all training
     9  requirements, is required prior to licensure. Applications for
    10  licensure as an assisted living service provider shall include a
    11  fee of $300 payable to the Commonwealth which shall be deposited
    12  into the Assisted Living Trust Account. Applications for bi-
    13  annual renewal of licensure shall include a fee of $150 payable
    14  to the Commonwealth which shall be deposited into the Assisted
    15  Living Trust Account.
    16     (b)  Agreement.--All assisted living services provided by
    17  licensed assisted living service providers shall be provided
    18  pursuant to an assisted living service agreement. The Department
    19  of Health shall ensure the adequate staffing and training of
    20  personnel at the State, regional and county level necessary to
    21  adequately inspect assisted living residences and monitor and
    22  enforce final rules and regulations adopted by the Department of
    23  Health.
    24     (c)  Disclosure.--The Department of Health shall require full
    25  and fair advance disclosure of all terms and conditions of the
    26  provider-consumer assisted living services agreement to all
    27  consumers, including those whose services are publicly funded.
    28  Omission or misrepresentation of a material fact in the
    29  disclosure shall be a complete defense for the consumer against
    30  any claims for payment by the provider.
    20000H2700B3843                 - 16 -

     1     (d)  Outcome measures.--The Department of Health shall
     2  establish outcome measures which shall include consumer
     3  satisfaction, quality of life and other measures consistent with
     4  the standards set forth in section 4(a) to utilize in oversight
     5  of entities with assisted living licenses.
     6     (e)  Regulations.--The Department of Health shall promptly
     7  develop regulations which shall apply to all assisted living
     8  services licensed providers without regard to whether their
     9  services are publicly funded. The regulations shall reflect the
    10  importance of the consumer in determining quality and shall set
    11  forth standards for shared risk consistent with this act. The
    12  regulations shall also require assisted living providers to
    13  submit information for the long-term care data base as is set
    14  forth in section 10.
    15     (f)  Services available.--Consumers who receive assisted
    16  living services may utilize the services of the Department of
    17  Aging Ombudsperson Program and the Department of Health's Long-
    18  Term Care 24-Hour Complaint Hot Line and shall be so notified in
    19  writing at the outset of their assisted living services
    20  agreement and then annually in writing by those providing
    21  assisted living services. Assisted living residences must
    22  prominently display notice of the availability of these services
    23  in common areas of the assisted living residence.
    24     (g)  Assisted living services.--Publicly funded assisted
    25  living services shall follow the individual to his/her residence
    26  of choice. Whether public payment is made in the form of
    27  subsidies to the individual or payment to the provider will
    28  depend on the circumstances and the funding constraints, but
    29  preference should be to empower the individual whenever
    30  possible.
    20000H2700B3843                 - 17 -

     1     (h)  Medical assistance.--Assisted living services funded by
     2  the Pennsylvania Medical Assistance program shall be provided
     3  via federally funded home and community-based services slots.
     4     (i)  Limitation.--To provide the funds necessary to enhance
     5  the ability of Medical Assistance beneficiaries to receive
     6  assisted living services in locations other than nursing
     7  facilities, until section 5(j) is implemented, the Secretary of
     8  Public Welfare may only approve medical assistance payment of
     9  capital costs for new nursing facility beds or enter into new
    10  medical assistance provider agreements with nursing facilities
    11  in areas of severe nursing facility bed shortage. Although an
    12  adequate supply of nursing facility beds needs to be part of the
    13  continuum of long-term care services available to medical
    14  assistance providers, priority shall be given to creating a
    15  better balance of public funding between institutional and home
    16  and community-based services.
    17     (j)  Program expansion.--To expand the availability of
    18  community-based long-term care options for long-term care, the
    19  Department of Public Welfare shall undertake an expansion of
    20  publicly funded assisted living services through expansion of
    21  federally funded waiver slots. The Secretary of Public Welfare
    22  shall develop and implement a plan to provide increased access
    23  to federally funded home and community-based service slots by
    24  increasing the availability of these services by an additional
    25  5,000 slots in fiscal year 2000-2001; and by at least an
    26  additional 3,500 slots each year thereafter so that no fewer
    27  than 36,000 federally funded home and community-based waiver
    28  slots are available by fiscal year 2009-2010. These slots should
    29  be funded through intergovernmental transfers, or if these slots
    30  cannot be funded through intergovernmental transfers, then they
    20000H2700B3843                 - 18 -

     1  shall be funded through traditional Federal/State Medicaid
     2  funding.
     3     (k)  Mandatory choices.--The federally funded home and
     4  community-based services waiver slots shall, consistent with
     5  Federal cost caps, permit a medical assistance beneficiary to
     6  select from a full menu of assisted living services, including,
     7  but not limited to, cognitive support services, depending on the
     8  service needs of the consumer.
     9     (l)  Young adults.--The Secretary of Public Welfare shall
    10  ensure that young adults who age out of expanded EPSDT (Early
    11  and Periodic Screening Diagnosis and Treatment) services at age
    12  21 shall, consistent with Federal cost caps, have access to
    13  federally funded home and community-based waiver slots to permit
    14  them to remain at home in the community.
    15     (m)  Ceiling.--The financial eligibility ceiling for
    16  federally funded assisted living services shall be at 300% of
    17  the Federal SSI income level and satisfy other Department of
    18  Public Welfare income and asset requirements. If the Federal
    19  Government permits higher financial eligibility standards and
    20  the secretary determines that it would save State funding to
    21  provide federally funded assisted living services to those
    22  consumers with higher incomes as compared to the State cost of
    23  paying for that care in a nursing facility, the secretary shall
    24  seek approval from the Federal Government to increase the
    25  financial eligibility for those services.
    26     (n)  Criteria.--Functional eligibility criteria for federally
    27  funded assisted living services shall be measured by the same
    28  standard as is eligibility for nursing facility services.
    29     (o)  Assessment.--Mandatory assessment of any person who may
    30  need publicly funded nursing facility care within the next 18
    20000H2700B3843                 - 19 -

     1  months from the date of their admission to a long-term care
     2  facility shall be conducted by the Options Program as a
     3  condition of public funding of those services. Each person so
     4  assessed and found eligible for nursing facility care shall be
     5  provided information on the full range of long-term care options
     6  available, including assisted living services and home and
     7  community-based services. In addition, those consumers who may
     8  be eligible shall be provided with information on housing
     9  options, including the housing supplement described in section
    10  9, an SSI personal care boarding home supplement or payment for
    11  an assisted living residence to avoid nursing facility
    12  placement. If assisted living services are chosen and are
    13  available, consumers shall be given prompt assistance by their
    14  area agency on aging to put the services in place in order to
    15  avoid families turning to nursing facilities to meet the need.
    16  Options Program assessment staff shall be trained in the need,
    17  uses and benefits of assistive technology, including, but not
    18  limited to, the assistive technology options and the extent to
    19  which assistive technology can limit the need for attendant care
    20  services.
    21     (p)  Speed of options assessment, determination of medical
    22  assistance eligibility and receipt of assisted living
    23  services.--The General Assembly recognizes that prompt Options
    24  assessment, medical assistance eligibility determination and
    25  arrangement of home and community-based services are necessary
    26  to avoid unwanted nursing facility placement for consumers being
    27  discharged from hospitals or needing prompt assistance to remain
    28  in the community. Consumers seeking options assessment and/or
    29  determination of medical assistance eligibility shall be
    30  promptly assisted and assessed by the Options program and shall
    20000H2700B3843                 - 20 -

     1  have an eligibility determination made by the Department of
     2  Public Welfare within three business days of submission of the
     3  completed application containing all necessary verification. If
     4  it appears that the consumer meets or will meet the functional
     5  and financial eligibility requirement for publicly funded home
     6  and community-based services within the next 30 days, those
     7  services should be immediately arranged and provided at State
     8  cost pending final determination of eligibility. Prompt
     9  assistance with completion of the application, securing
    10  verification and provision of services based on presumptive
    11  eligibility should be given to consumers facing imminent
    12  discharge from a hospital.
    13     (q)  Nursing facility care.--The Secretary of Public Welfare
    14  shall require all managed care plans enrolled as medical
    15  assistance providers which participate as Health Choice
    16  providers to do the following if nursing facility care is
    17  prescribed for an enrollee:
    18         (1)  Arrange at once for the enrollee to be assessed by
    19     the Options program if it appears that a nursing facility
    20     admission is necessary for more than 30 days.
    21         (2)  If the enrollee wishes to receive federally funded
    22     home and community-based services, provide those needed
    23     services in the amount determined by the Options program if
    24     applicable, or in the amount needed to safely maintain the
    25     person in his or her residence as determined by the
    26     Department of Public Welfare until home and community-based
    27     services are in place and help arrange and coordinate those
    28     services. The department shall arrange for payment to the
    29     plans for the cost of such care not covered by the plan
    30     capitation agreement.
    20000H2700B3843                 - 21 -

     1         (3)  If the enrollee wishes to be in a nursing facility,
     2     make all reasonable efforts to arrange placement in the
     3     nursing facility that the enrollee chooses, including
     4     offering to pay at least the medical assistance fee-for-
     5     service daily rate for the enrollee.
     6     (r)  Income levels.--The Department of Aging shall provide
     7  assisted living services/HCBS services for individuals found
     8  functionally eligible for nursing facility care who have incomes
     9  between 300% and 400% of the Federal SSI level, where the
    10  absence of such funding would require the person to be placed in
    11  a nursing facility at a greater cost to the State than the State
    12  cost of the assisted living services. The Department of Aging
    13  shall develop and implement a reasonable cost-sharing and
    14  sliding-scale fee schedule, not to exceed 35% of the cost of the
    15  services, for those individuals in this income level who are
    16  unable to pay the full cost of assisted living services.
    17     (s)  Payments.--The Department of Aging shall, consistent
    18  with funding levels, pay for assisted living services for
    19  consumers with incomes below 400% of the Federal poverty level
    20  who do not yet meet the functional definition for nursing
    21  facility placement, as determined by the Options program, but
    22  who need assistance with more than one activity of daily living,
    23  if it appears that it will be cost effective for the State to
    24  support the consumer in the community with assisted living
    25  services and prevent future nursing facility placement. In
    26  determining cost effectiveness, the Department of Aging should
    27  consider whether the consumer can be supported in the community
    28  with the consumer partially paying for the assisted living
    29  services as opposed to having the consumer's resources more
    30  quickly exhausted through payment for nursing facility care.
    20000H2700B3843                 - 22 -

     1  These services shall be provided based on a sliding-fee scale.
     2     (t)  Cost-of-living adjustments to countable resources for
     3  Medicaid eligibles.--In determining the countable resources of
     4  qualified persons for purposes of medical assistance
     5  eligibility, the Department of Public Welfare shall use a
     6  computation method which exempts an amount of otherwise
     7  countable resources which is equal to the difference between
     8  $2000 and the amount of $2000 multiplied by all the Social
     9  Security cost-of-living adjustments from January 1, 1990 to the
    10  present. For qualified couples, the Department of Public Welfare
    11  shall use a computation method which exempts an amount of
    12  otherwise countable resources which is equal to the difference
    13  between $3000 and the amount of $3000 multiplied by all the
    14  Social Security cost-of-living adjustments from January 1, 1990
    15  to present. These exempted amounts shall be adjusted annually
    16  when the new Social Security cost-of-living adjustments go into
    17  effect. In addition, if the consumer is receiving or will be
    18  receiving publicly funded assisted living services in his or her
    19  own home, he or she shall be eligible for an additional $5,000
    20  exemption for home maintenance from otherwise countable
    21  resources.
    22     (u)  Case management.--The Department of Aging shall develop
    23  a process for providing each resident or recipient whose
    24  assisted living is publicly funded with a comprehensive case
    25  manager who is not an employee of or agent for the assistive
    26  living residence. Case management will also be provided to
    27  private pay residents or recipients who require assistance with
    28  three or more activities of daily living.
    29  Section 6.  Settings for assisted living services.
    30     (a)  General rule.--All assisted living services, including
    20000H2700B3843                 - 23 -

     1  publicly funded assisted living services, may be provided in the
     2  following settings:
     3         (1)  A consumer's home/residence.
     4         (2)  A family member's home.
     5         (3)  A friend's home.
     6         (4)  A licensed assisted living residence as defined in
     7     this act.
     8     (b)  Criteria.--Publicly funded assisted living services may
     9  also be provided in a personal care home (PCH) or a domiciliary
    10  care home where the Department of Aging has found that:
    11         (1)  The assisted living services are not required to be
    12     provided by the personal care home provider or domiciliary
    13     care home provider.
    14         (2)  The consumer has a choice of provider services.
    15         (3)  There are actually multiple providers available.
    16         (4)  The individual is not residing in the personal care
    17     home or domiciliary care home because he has been unable to
    18     obtain another appropriate placement.
    19         (5)  An outside agency, such as the Area Agency on Aging,
    20     is responsible for assessment and care management.
    21         (6)  The home and community-based services and the
    22     services provided by the personal care home or domiciliary
    23     care home are provided pursuant to a coordinated care plan
    24     based on the assessment and the individual needs and desires
    25     of the consumer, which are monitored by the Department of
    26     Aging.
    27         (7)  The waiver services supplement and do not supplant
    28     the personal care home or domiciliary care home services.
    29         (8)  Appropriate oversight and protections are in place,
    30     including an assessment by the Department of Aging of the
    20000H2700B3843                 - 24 -

     1     entity to determine capability to provide adequate care to
     2     individuals requiring higher acuity needs, including those
     3     with cognitive impairments.
     4         (9)  The personal care home or domiciliary care home
     5     provides consumer choice, independence, privacy and dignity
     6     to its residents.
     7         (10)  No restraints or locking the residents in a room or
     8     the building is permitted, under any circumstance.
     9     (c)  Regulations.--Within three months of the effective date
    10  of this act, the Department of Health shall determine if
    11  additional services, quality standards, staffing needs and
    12  qualifications or consumer protections need to be provided at
    13  personal care boarding homes or domiciliary care homes housing
    14  nursing facility eligible consumers, in addition to those
    15  routinely provided by the home and community-based service
    16  provider. If improvements are necessary, the Department of
    17  Health shall promptly implement regulations requiring such
    18  service requirements, standards and protections. The Department
    19  of Public Welfare shall establish a supplemental payment for
    20  personal care boarding homes reflecting the additional
    21  requirements imposed by the Department of Health for housing
    22  nursing facility eligible consumers at the personal care home.
    23  The Department of Aging shall establish a supplemental payment
    24  for domiciliary care homes reflecting the additional
    25  requirements imposed by the Department of Health for housing
    26  nursing facility eligible consumers at the domiciliary care
    27  home.
    28     (d)  Medical assistance consumers.--The Secretary of Public
    29  Welfare shall determine if it would be cost efficient and would
    30  further the goals of this act to permit medical assistance
    20000H2700B3843                 - 25 -

     1  consumers to remain in their communities, to amend the State
     2  plan to remove monthly limits on home health visits and to
     3  provide for personal care services in the menu of services
     4  available under medical assistance. The secretary shall issue a
     5  draft report for public comment within six months of the
     6  effective date of this act and provide it to the General
     7  Assembly within nine months of the effective date of this act.
     8  In so determining, the secretary shall review the experience of
     9  other states that have used these services more broadly to help
    10  Medicaid consumers remain in the community in lieu of placement
    11  in a nursing facility.
    12     (e)  Nursing homes.--The Department of Public Welfare shall
    13  evaluate the CCAP Nursing Home Diversification Project and
    14  develop and implement a plan within one year of the effective
    15  date of this act, which encourages nursing facilities in areas
    16  without a shortage of such facilities to take beds offline and
    17  replace them with home and community-based services and assisted
    18  living services.
    19  Section 7.  Assisted living residences.
    20     (a)  Licensure and fee requirements.--The Department of
    21  Health shall develop licensure requirements consistent with the
    22  definitions of assisted living services and assisted living
    23  residences and the assisted living standards set forth in
    24  section 4(a). Complete compliance with all regulations,
    25  including all training requirements, is required prior to
    26  licensure. A facility that is licensed as an assisted living
    27  residence need not also obtain a license as a personal care
    28  boarding home. Applications for licensure as an assisted living
    29  residence shall include a fee of:
    30         (1)  $300 for residences with fewer than 10 residents,
    20000H2700B3843                 - 26 -

     1     with a $150 biannual license renewal fee;
     2         (2)  $500 for residences with at least 10 but fewer than
     3     25 residents, with a $250 biannual license renewal fee;
     4         (3)  $1000 for residences with at least 25 but fewer than
     5     100 residents, with a $500 biannual license renewal fee; or
     6         (4)  $2000 for residences with 100 or more residents,
     7     with a $1000 biannual license renewal feel
     8  payable to the Commonwealth which shall be deposited into the
     9  Assisted Living Trust Account.
    10     (b)  Unlicensed operation.--No place shall call itself an
    11  assisted living residence unless it is licensed as such. Any
    12  unlicensed residence or provider that holds itself out as an
    13  assisted living residence or purports to offer or does offer
    14  assisted living services shall be fined $500 for each day it
    15  remains so labeled or continues to make such representations
    16  without an assisted living residence license unless otherwise
    17  exempt from such licensing requirements. The Department of
    18  Health shall seek to enjoin operation of any unlicensed
    19  residence until licensure requirements are met and license has
    20  been granted.
    21     (c)  Billing.--Housing services and assisted living services
    22  must be billed separately.
    23     (d)  Regulations.--Consistent with this act, the Department
    24  of Health shall establish health and safety regulations for
    25  assisted living residences to become effective within one year
    26  of the effective date of this act that include the following:
    27  physical accommodations and equipment, heat and air
    28  conditioning, sanitation, ventilation, lighting, communication
    29  systems, handrails and railings, indoor activity space, fire
    30  safety, staff hiring, including qualifications and background
    20000H2700B3843                 - 27 -

     1  checks, retention and utilization, supervision, staff training,
     2  reportable and recordable incidents, confidentiality of records,
     3  notification of rights and grievance procedures, prohibition
     4  against deprivation of rights, inspections, admissions,
     5  evictions under this section, involuntary or voluntary absence,
     6  medications, nutrition, staff health, services, residents'
     7  funds, staffing requirements and qualifications, administrator
     8  training and qualifications and other areas determined by the
     9  department.
    10     (e)  Restraints.--The Department of Health shall prohibit use
    11  of restraints. Restricting a person to the building or section
    12  of the building shall also be prohibited except under the
    13  following conditions:
    14         (1)  To restrict a consumer to the assisted living
    15     facility or a section thereof, the facility must have
    16     obtained legal authorization to do so from a court or
    17     guardian or legally responsible individual and so doing must
    18     be necessary in accordance with the coordinated care plan's
    19     identification of concerns about wandering or self-harm.
    20         (2)  Staff providing services to consumers who are
    21     restricted to the facility shall have completed Department of
    22     Health approved training within the current year on working
    23     with consumers who need to be so restricted.
    24     (f)  Written agreements.--The Department of Health shall
    25  require as a condition of licensure that all assisted living
    26  residences shall have an assisted living residence agreement in
    27  writing with each resident prior to admission, the resident's
    28  legal representative or the entity providing public funding for
    29  the consumer that in clear and simple language sets forth the
    30  following:
    20000H2700B3843                 - 28 -

     1         (1)  The mutually agreed to acceptance of shared risk, if
     2     applicable, which is documented and made knowingly and freely
     3     and which maximizes consumer autonomy. The assisted living
     4     service provider or assisted living residence provider shall
     5     make no attempt to use the shared risk portion of the service
     6     agreement to abridge a consumer's rights, including those in
     7     section 8, or to avoid liability for harm caused to a
     8     consumer by the negligence of the assisted living provider
     9     and any such abridgment or disclaimer shall be void. If the
    10     agreement is between the entity providing public funding for
    11     the consumer, the consumer or his or her legal representative
    12     shall also sign the agreement indicating acceptance of the
    13     shared risk arrangement.
    14         (2)  Clear and specific occupancy criteria and
    15     procedures, including admission, transfer and right to
    16     legally enforce the terms of the agreement or of this act in
    17     eviction.
    18         (3)  The cost of the housing, services and any other
    19     charges and the method of payment, including the following:
    20             (i)  Regular and extra fees.
    21             (ii)  Fees and payment arrangement for any third-
    22         party providers.
    23             (iii)  The provision of at least 60 days' written
    24         notice of any rate increases or fee changes.
    25             (iv)  The minimum notification a consumer or legal
    26         representative, if the consumer is incapable of making a
    27         decision, must furnish when he or she plans to move out
    28         of the setting for reasons other than health emergencies.
    29         Notification requirements shall not exceed 60 days.
    30             (v)  The provisions regarding payment during
    20000H2700B3843                 - 29 -

     1         unavoidable or optional absences such as hospitalization,
     2         recuperation in a nursing facility or a vacation.
     3         (4)  A provision that consumers may void without penalty
     4     an assisted living residence agreement within 72 hours of
     5     signing. All agreements shall contain the following language
     6     prominently displayed:
     7             You are not required to sign this agreement or accept
     8             this responsibility unless you wish to do so. You may
     9             change your mind within 72 hours of signing this
    10             agreement by notifying the facility that you wish to
    11             revoke this agreement. You may call the Long-Term
    12             Care Ombudsman Program at (insert telephone number
    13             here) for an explanation of your rights.
    14         (5)  Rights and responsibilities of the parties.
    15         (6)  Consumers' recourse if there are disputes or
    16     problems, including assistance from the Ombudsman Program,
    17     the Department of Health Long-Term Care Hot Line and court
    18     proceedings.
    19     (g)  Information to residents.--An information packet that
    20  includes the following information must be given to the consumer
    21  or the consumer's legal representative at the time of
    22  application:
    23         (1)  A copy of the assisted living residence's policies.
    24         (2)  Advance directive information including information
    25     on the right to have or not have an advance directive.
    26         (3)  Information regarding licensing status.
    27         (4)  Telephone number of the local Long-Term Care
    28     Ombudsman Program and of the Department of Health 24-hour hot
    29     line.
    30         (5)  A copy of the assisted living resident agreement
    20000H2700B3843                 - 30 -

     1     used by the assisted living residence and all rates charged.
     2         (6)  A copy of the internal complaint resolution
     3     mechanism used by the facility.
     4         (7)  A copy of the last inspection report and information
     5     on how to access prior and future inspection reports through
     6     the Department of Health.
     7         (8)  For consumers with Alzheimer's or dementia or where
     8     the assisted living residence holds itself out to the public
     9     as providing cognitive support services and/or housing for
    10     persons with cognitive impairments, the following shall be
    11     provided:
    12             (i)  The residence's written statement of its
    13         philosophy and mission that reflects the needs of
    14         individuals with cognitive impairments.
    15             (ii)  A description of the residence's physical
    16         environment and design features to support the
    17         functioning of adults with cognitive impairments.
    18             (iii)  A description of the frequency and types of
    19         individual and group activities designed specifically to
    20         meet the needs of residents with cognitive impairments.
    21             (iv)  A description of security measures provided by
    22         the residence.
    23             (v)  A description of training provided to staff
    24         regarding provision of care to consumers with cognitive
    25         impairments.
    26             (vi)  A description of availability of family support
    27         programs and family involvement.
    28             (vii)  The process used for assessment and
    29         establishment of a plan of services for the consumer,
    30         including methods by which the plan of services will
    20000H2700B3843                 - 31 -

     1         remain responsive to changes in the consumer's condition.
     2     (h)  Discharge.--
     3         (1)  Discharge of a consumer from an assisted living
     4     residence shall be allowed after at least 30 days' advance
     5     written notice to the consumer, his or her legally
     6     responsible party and the ombudsperson and only under the
     7     following circumstances:
     8             (i)  The eviction is necessary for the consumer's
     9         welfare and the consumer's needs cannot be met at the
    10         assisted living residence, even with additional assisted
    11         living services as confirmed in writing by the consumer's
    12         physician.
    13             (ii)  The consumer or legally responsible person has
    14         failed, after 30 days' written notice to pay for charges
    15         agreed to in the assisted living residency agreement.
    16             (iii)  The safety of other consumers in the assisted
    17         living residence is endangered.
    18             (iv)  The facility ceases to operate.
    19             (v)  The consumer's eviction would not put the
    20         consumer's health or safety in danger.
    21         (2)  A consumer shall not be discharged for exercise of
    22     his or her rights under this act or under any other Federal
    23     or State laws.
    24         (3)  Eviction of a consumer from an assisted living
    25     residence for one of the reasons under subsection (a) shall
    26     occur by the assisted living residence through a safe and
    27     appropriate means of discharge.
    28     (i)  Supplemental Security Income Recipients.--
    29         (1)  For residents eligible for Supplemental Security
    30     Income (SSI) benefits, actual rent and other charges shall
    20000H2700B3843                 - 32 -

     1     not exceed the residents' actual current monthly income
     2     reduced by a personal needs allowance for the resident in an
     3     amount to be determined by the Department of Public Welfare,
     4     but not less than $75.
     5         (2)  An assisted living residence shall not seek or
     6     accept any payments from a resident who is an SSI recipient
     7     in excess of one-half of any funds received by the resident
     8     under the act of March 11, 1971 (P.L.104, No.3), known as the
     9     Senior Citizens Rebate and Assistance Act.
    10         (3)  An assisted living residence shall not seek or
    11     accept from a resident who is eligible for SSI benefits any
    12     payment from any funds received as lump sum awards, gifts or
    13     inheritance, gains from the sale of property or retroactive
    14     government benefits, provided, however, that an owner or
    15     operator may seek and accept payments from funds received as
    16     retroactive awards of Social Security or Supplemental
    17     Security Income (SSI) benefits, but only to the extent that
    18     the retroactive awards cover periods of time during which the
    19     resident actually resided in the assisted living residence.
    20         (4)  Each resident who is a recipient of, or an eligible
    21     applicant for, SSI benefits shall be provided, at no
    22     additional charge to the resident, necessary personal hygiene
    23     items and personal laundry services. This requirement does
    24     not include cosmetic items.
    25     (j)  Staffing.--Assisted living residences shall maintain a
    26  sufficient number of trained staff persons to provide the
    27  necessary level of care required by residents, as well as to
    28  ensure a safe and efficient evacuation of the facility in case
    29  of an emergency. The direct services staff persons who meet the
    30  training requirements and who work on the premises according to
    20000H2700B3843                 - 33 -

     1  a specific established schedule shall be sufficient to provide
     2  one and one-half hours per day of assisted living services to
     3  each mobile resident and three hours to each immobile resident
     4  for each resident who has contracted to receive personal care
     5  services. All assisted living services hours shall be provided
     6  during waking hours. All assisted living residences shall
     7  maintain coverage by awake, direct service staff on the premises
     8  24 hours a day. Additional staff hours, or contractual services,
     9  shall be provided as necessary to meet laundry, food service,
    10  housekeeping and maintenance needs of the assisted living
    11  residence.
    12  Section 8.  Requirements of all assisted living providers.
    13     (a)  Consumer protection.--The Department of Health shall
    14  promptly implement regulations prohibiting all assisted living
    15  providers from the following:
    16         (1)  Commingling consumers' personal funds with its own
    17     funds, obtaining power of attorney or guardianship from a
    18     consumer or requiring consumers to endorse checks over to the
    19     residence or provider, however, financial management by
    20     assisted living residence administrators for residents shall
    21     be permitted. The Department of Health shall develop a means
    22     of safeguarding residents' funds and requiring prompt
    23     repayment of funds that are stolen or otherwise mismanaged.
    24         (2)  Abusing, threatening, harassing or subjecting a
    25     consumer to corporal punishment.
    26         (3)  Discriminating against a consumer because of race,
    27     color, religious creed, disability, handicap, ancestry,
    28     sexual orientation, national origin, age or sex or source of
    29     payment.
    30         (4)  Retaliating against residents who have exercised
    20000H2700B3843                 - 34 -

     1     their rights under this act and the Department of Health
     2     regulations or under Federal or State law.
     3         (5)  Interfering with the consumer's rights to do the
     4     following:
     5             (i)  Leave and return to the consumer's residence,
     6         except in cases of consumers with cognitive impairments
     7         where freedom of egress could be dangerous for the
     8         consumer and the care plan allows for this restriction.
     9             (ii)  Receive visitors.
    10             (iii)  Receive or send mail.
    11             (iv)  Participate or refuse to participate in
    12         religious activities.
    13             (v)  Be unrestrained physically and chemically.
    14  In addition to the requirements for assisted living residence
    15  agreements set forth in section 7, assisted living services and
    16  assisted living residence agreements shall be written in easy to
    17  understand, plain language; be available in the primary language
    18  of the consumer and in alternative formats for consumers with
    19  disabilities; contain the complete agreement between the parties
    20  thereto with no omission of material terms; use bold or larger
    21  font to make conspicuous material terms to the agreement as well
    22  as any exclusion or limitations of services from the agreement;
    23  not waive any of the requirements of this act or its
    24  regulations; state that for consumers with publicly funded
    25  assisted living services, assisted living residences or housing,
    26  the consumer is an intended third-party beneficiary of the
    27  agreement, who may seek to enforce their rights under the
    28  contract; and not be and state that it is not assignable absent
    29  consent of the consumer following full and fair disclosure and
    30  reasonable notice.
    20000H2700B3843                 - 35 -

     1     (b)  Regulations.--The Department of Health shall establish
     2  regulations concerning training and staffing requirements for
     3  assisted living providers, including administrators for a
     4  minimum of 75 hours and for a minimum of 40 hours for direct
     5  care staff, as follows:
     6         (1)  Administrators and direct care staff must be
     7     educated and trained in matters relating to dementia,
     8     including normal aging, cognitive, psychological, and
     9     functional abilities of older persons; definition and
    10     diagnosis of dementia, description of reversible and
    11     irreversible causes, and explanations of differences between
    12     dementia, delirium and depression; explanation of dementia
    13     and related disorders, progression, stages and individual
    14     variability; communications techniques; description of
    15     behavioral symptoms of dementia and how to approach residents
    16     when they display challenging behaviors including conflict
    17     avoidance and conflict resolution techniques; the role of
    18     personality, culture and environmental factors in behavioral
    19     symptoms and dementia care; the assisted living residence
    20     philosophy of dementia care, including mission statement,
    21     goals policies and procedures; working with family members;
    22     community-based resources for consumers with dementia and
    23     their families; team building and stress reduction for
    24     assisted living residence staff; use and benefits of
    25     assistive technology and awareness, identification,
    26     prevention and reporting of abuse and neglect. Administrators
    27     must be over 21 years of age and have a high school diploma
    28     or a G.E.D. Direct care staff must be at least 18 years of
    29     age, have a high school diploma or a G.E.D. or have
    30     satisfactorily demonstrated a sixth grade reading level and
    20000H2700B3843                 - 36 -

     1     an ability to follow written instructions, particularly
     2     medication dispensing instructions.
     3         (2)  All cognitive support service providers must be
     4     educated and trained in the mission and purpose of services
     5     to individuals with cognitive impairments, consumer rights;
     6     fire and safety; first aid and CPR; basic
     7     nutrition/medication training; assisted living
     8     philosophy/mission; assessment and reporting of health
     9     problems; understanding dementia, including causes, symptoms,
    10     treatments and management techniques; changes in condition
    11     and appropriate responses; dementia-capable activity
    12     programming, communication skills and management of
    13     behavioral challenges; mental health issues; and awareness,
    14     identification, prevention and reporting of abuse and
    15     neglect.
    16         (3)  Within 90 days of the effective date of this act,
    17     the Department of Health shall determine what additional
    18     training, certification or accreditation shall be required
    19     for assisted living residence administrators; what additional
    20     training, certification or accreditation shall be required
    21     for in home care providers, what staffing levels and other
    22     requirements should be imposed for assisted living residences
    23     with immobile consumers and what components should be in the
    24     individualized service plan for each consumer and which of
    25     them should be reviewed and updated at least quarterly.
    26     Thereafter, the Department of Health shall issue draft
    27     regulations for public comment within six months of the
    28     effective date of this act and shall promptly finalize the
    29     regulations.
    30         (4)  Administrators and direct services staff shall meet
    20000H2700B3843                 - 37 -

     1     all the above requirements and qualifications prior to
     2     beginning work as administrators or direct services staff.
     3     The Department of Health shall develop objective measures of
     4     administrator and direct service staff knowledge of the
     5     required areas. Mere attendance at training sessions will not
     6     suffice. The objective measurement shall take the form of an
     7     oral, written and/or practical exam.
     8     (c)  Quality indicators.--Quality indicators to measure
     9  quality of life outcomes, including autonomy, independence and
    10  dignity, health and safety, should account for differences among
    11  settings and residents while accurately reflecting how well the
    12  facility provides for the autonomy, independence, dignity,
    13  integration with the community, food service, health and basic
    14  safety of residents. Those assisted living residences
    15  demonstrating the highest quality with no violations of
    16  regulations and basic standards shall be listed on the
    17  Department of Health's World Wide Web site pursuant to section
    18  8(f).
    19     (d)  Consumer information.--The Department of Health shall
    20  publish regional performance profiles of all assisted living
    21  residences and providers, listing the quality indicators, cost
    22  information, resident profile from the common data set, staff-
    23  to-consumer ratios, staff composition and violations of
    24  applicable acts and regulations, if any, for the public. This
    25  information shall be readily available through the options
    26  program and on the Department of Health World Wide Web site as
    27  set forth in section 10.
    28  Section 9.  Publicly funded housing.
    29     (a)  Subsidy of housing costs to avoid nursing facility
    30  placement.--The Department of Aging, through the options
    20000H2700B3843                 - 38 -

     1  program, may provide State-funded monthly housing and board
     2  subsidies, not to exceed PHFA's regional standards for operating
     3  costs for low-income housing, to individuals found eligible for
     4  nursing facility care, where:
     5         (1)  the total State cost of both a consumer's home and
     6     community-based services and his or her housing subsidy would
     7     not exceed the dollar amount which would represent the
     8     State's cost if the person were in a nursing facility;
     9         (2)  the housing subsidy is financially necessary to
    10     permit the person to remain in his or her current residence,
    11     live in the community or relocate to an assisted living
    12     residence; or
    13         (3)  a person is eligible for available publicly funded
    14     home and community-based services. In determining the amount
    15     of the subsidy, the Department of Aging shall ensure that
    16     consumers may retain an amount of not less than $75 per month
    17     for personal needs, exclusive of housing, food or other
    18     related costs. Where home modifications are needed for
    19     Medicaid eligible individuals, in excess of the home and
    20     community-based services waiver cap, they may be paid for out
    21     of the subsidy if in the long term it would be more cost-
    22     effective to have the consumer supported in his or her
    23     modified residence.
    24     (b)  Low-income housing tax credits and loans.--
    25         (1)  Beginning in fiscal year 2001-2002 and continuing
    26     until fiscal year 2005-2006, at least 10% of the low income
    27     tax credits allocated to Pennsylvania for each of those years
    28     shall be earmarked to permit the development of at least 200
    29     assisted living residence units per year.
    30         (2)  Each year, the Pennsylvania Housing Financing
    20000H2700B3843                 - 39 -

     1     Authority, in consultation with the Department of Public
     2     Welfare, the Department of Aging and the Department of
     3     Community and Economic Development shall issue a request for
     4     proposals for assisted living residence units for persons
     5     qualifying for publicly funded home and community-based
     6     services and shall seek to facilitate the funding of the
     7     projects with moneys from low-income tax credits, community
     8     development block grants funds, neighborhood assistance
     9     program, the penn homes program, the home investments
    10     partnerships program, the Federal home loan bank affordable
    11     housing program, the mortgage insurance foundation or other
    12     funding.
    13         (3)  Within six weeks of the effective date of this act,
    14     the Department of Community and Economic Development shall
    15     develop and implement an education campaign focused on
    16     housing developers, which explains and promotes the use of
    17     existing housing financing programs for the development of
    18     assisted living residences for low-income and moderate-income
    19     persons.
    20         (4)  Housing funded through low-income tax credits does
    21     not require the operator to obtain a personal care or
    22     assisted living license.
    23         (5)  The Department of Community and Economic Development
    24     shall establish, within six months of the effective date of
    25     this act, a revolving loan fund to assist existing personal
    26     care home providers to make renovations and modifications to
    27     become assisted living residences and to assist existing home
    28     owners to renovate or modify their homes, where the lack of
    29     doing so would be the primary reason for someone in the
    30     household needing to go to a nursing facility. Loans to
    20000H2700B3843                 - 40 -

     1     personal care homes under this section shall require those
     2     newly renovated facilities to give priority for admission to
     3     the units to consumers who will receive publicly funded
     4     assisted living services while living there.
     5         (6)  A revolving loan program shall be established to
     6     assist persons who are otherwise ineligible for Medicaid or
     7     housing subsidies for home modifications to modify their
     8     personal residences where the financial inability to do so
     9     would be the primary reason for their needing to go to a
    10     nursing home.
    11     (c)  Minimum requirements for publicly funded housing.--Where
    12  public funds are used to develop or modify existing units to
    13  become assisted living residences, those units shall be designed
    14  and built to allow each person to live independently. Each
    15  residence shall:
    16         (1)  Include a self-contained unit, capable of being
    17     locked by the resident, which can be modified for persons
    18     with cognitive impairment.
    19         (2)  Allow sharing of units by residents only where both
    20     residents wish it; and
    21         (3)  Contain its own bathroom, kitchenette or food
    22     preparation area, sleeping area and living area.
    23     (d)  Equal opportunity for residency.--Any assisted living
    24  residence or personal care boarding home receiving housing
    25  subsidy payments pursuant to this act shall accept residents on
    26  a first-come-first-served basis, except where this provision is
    27  waived in writing by the options program because of an emergency
    28  need such as homelessness or medical need or where preference is
    29  to be given to low-income residents. The facilities shall
    30  maintain written records of applications, keep all applications
    20000H2700B3843                 - 41 -

     1  for admission in the order received for a period of five years
     2  and shall comply with all Federal and State laws prohibiting
     3  discrimination on the basis of race, religion, handicap or
     4  disability, ethnicity, national origin, gender or sexual
     5  orientation.
     6  Section 10.  Long-term care data base.
     7     (a)  Development of long-term care data system.--The Intra-
     8  governmental Long-Term Care Council shall develop a long-term
     9  care data system within six months of the effective date of this
    10  act, based on a common data set so that care can be tracked at
    11  each level of the long-term care continuum. Within nine months
    12  of the effective date of this act, all providers of home and
    13  community-based services or assisted living shall provide the
    14  common long-term data set information on every consumer to the
    15  Department of Health at intervals specified by the department.
    16  This information shall be integrated with the minimum data set
    17  information provided to the Department of Public Welfare with
    18  respect to nursing facilities.
    19     (b)  Confidentiality.--All information available to
    20  regulatory agencies shall be promptly available to consumers,
    21  providers, legislators and the general public, except that each
    22  department shall develop procedures to protect proprietary and
    23  confidential information and to protect the privacy of
    24  individuals receiving long-term care services.
    25     (c)  World Wide Web site.--The Department of Health shall
    26  include on its World Wide Web site information about the quality
    27  of assisted living services provided by assisted living service
    28  providers or assisted living residences, personal care homes and
    29  domiciliary homes. Information shall include available consumer
    30  satisfaction information, inspection data by the departments and
    20000H2700B3843                 - 42 -

     1  other relevant information that could assist consumers in
     2  choosing assisted living service providers, residences and other
     3  housing arrangements. All information available on the
     4  Department of Health World Wide Web site shall also be printed
     5  and made available to the public including those who do not have
     6  Internet access.
     7  Section 11.  Inspections.
     8     (a)  Initial licensure inspection.--Before a facility is
     9  licensed and permitted to open, operate or admit residents, and
    10  before an assisted living services provider is permitted to
    11  operate, it shall be inspected by the Department of Health and
    12  must be found in complete compliance with the requirements set
    13  forth in this act and the resulting regulations.
    14     (b)  Annual inspections.--After initial licensure inspection,
    15  assisted living residences and assisted living services
    16  providers shall, at a minimum, be inspected six months after
    17  initial licensure and annually thereafter on an unannounced
    18  basis. The Department of Health shall establish criteria for
    19  additional inspections as deemed necessary. When there is
    20  complete compliance, the Department of Health shall issue a full
    21  license for a period of one year.
    22     (c)  Classification of violations.--Within six months of the
    23  effective date of this section the Department of Health shall
    24  classify each violation of its regulations into one of the
    25  following categories:
    26         (1)  Class I. A violation which indicates a substantial
    27     probability that death or serious mental or physical harm to
    28     a consumer may result.
    29         (2)  Class II. A violation which has a substantial
    30     adverse effect upon the health, safety or well-being of a
    20000H2700B3843                 - 43 -

     1     consumer.
     2         (3)  Class III. A minor violation which has an adverse
     3     effect upon the health, safety or well-being of a consumer.
     4  Upon classifying the violations, the Department of Health shall
     5  publish the proposed classifications in the Pennsylvania
     6  Bulletin for public comment on the classifications prior to
     7  finalizing them. Final regulations and classifications shall be
     8  in effect within one year of passage of this act.
     9     (d)  Provisional licenses.--When there has been substantial
    10  compliance, but not complete compliance with all applicable
    11  statutes, ordinances and regulations, and, when the licensee has
    12  taken appropriate steps to correct deficiencies, the Department
    13  of Health shall issue a provisional license for a specified
    14  period of not more than six months which may be renewed one time
    15  if there has been substantial improvement since the last
    16  inspection. Upon complete compliance with respect to all prior
    17  violations and no additional Class I or Class II violations, a
    18  regular license shall be issued immediately. Newly discovered
    19  Class III violations will not prevent regular licensure provided
    20  an acceptable plan of correction has been submitted and the
    21  Department of Health has confirmed by onsite inspection that the
    22  correction steps outlined in the plan of correction have been
    23  taken.
    24     (e)  Notice.--Whenever the Department of Health, upon
    25  inspection or investigation, shall learn of violation of this
    26  act or of regulations adopted by the Department of Health
    27  pursuant to this act, they shall give notice thereof to the
    28  offending licensee. Such notice shall require the offending
    29  licensee to take action to bring a facility or service provider
    30  company into compliance with this act or with the relevant
    20000H2700B3843                 - 44 -

     1  regulations within a specified time.
     2     (f)  Plans of correction.--Within ten days of citation for
     3  any violations, an offending entity shall submit to the
     4  Department of Health a plan of correction outlining the action
     5  steps the person or entity will take to bring the facility or
     6  service provider company into compliance with this act or with
     7  the relevant regulations. The offending person or entity shall
     8  comply with the plan of correction and shall submit
     9  documentation of current compliance with the Department of
    10  Health within 20 days of citation for violation.
    11         (1)  Documentation of compliance shall include, but not
    12     be limited to:
    13             (i)  Receipts for work completed or items purchased.
    14             (ii)  Contracts for work to be completed or items to
    15         be delivered and/or installed.
    16             (iii)  Affidavit under penalty of perjury that
    17         violation has been corrected and how it has been
    18         corrected or that violation will be corrected and
    19         specific steps that have been taken to arrange the
    20         correction.
    21             (iv)  Certificate of completion of required
    22         education, training, first aid and CPR courses.
    23         (2)  The Department of Health shall verify that all
    24     promised corrections have actually been made within the time
    25     promised. If the corrections have not been made, the
    26     Department of Health shall initiate licensing action,
    27     including assessment of penalties and change of licensure
    28     status, for failure to comply with the plan of correction.
    29     (g)  No supersedeas.--An appeal from the decision of the
    30  Department of Health relating to the revocation or nonrenewal of
    20000H2700B3843                 - 45 -

     1  a license of an assisted living residence or assisted living
     2  services provider shall not act as a supersedeas, but, upon
     3  cause shown of substantial likelihood of prevailing on the
     4  merits and where circumstances require it, the reviewing
     5  authority shall have the power to grant a supersedeas. The
     6  supersedeas shall be revoked if the Department of Health
     7  presents evidence of any intervening Class I or II violations.
     8     (h)  Ban on new admissions.--While an assisted living
     9  residence or assisted living services provider may be permitted
    10  to continue operating with a supersedeas pending the outcome of
    11  the appeal, there shall be no new admissions to the assisted
    12  living residence and no new consumers contracted to receive
    13  services from an assisted living services provider pending the
    14  outcome of the appeal.
    15     (i)  Relocation and relocation assistance.--All residents of
    16  assisted living residences shall be notified by the Department
    17  of Health of its licensing actions, informed of their right to
    18  leave the assisted living residence and informed of their right
    19  to receive relocation assistance.
    20         (1)  The Department of Health shall relocate consumers
    21     from an assisted living residence if any of the following
    22     conditions exist:
    23             (i)  Shall immediately relocate consumers from an
    24         assisted living residence if the assisted living
    25         residence is operating without a license.
    26             (ii)  Shall immediately relocate consumers from an
    27         assisted living residence if the licensee is voluntarily
    28         closing an assisted living residence and relocation is
    29         necessary for the health and welfare of the consumers.
    30             (iii)  Shall immediately provide relocation
    20000H2700B3843                 - 46 -

     1         assistance where the assisted living residence has
     2         engaged in conduct that endangers the health and safety
     3         of its residents, leading a reasonable consumer to be
     4         concerned for his or her safety.
     5             (iv)  Shall promptly provide relocation assistance
     6         where the assisted living resident wishes to leave.
     7         (2)  The Department of Health shall offer relocation
     8     assistance to consumers of assisted living residences. This
     9     shall include:
    10             (i)  notifying residents of the availability of
    11         relocation assistance;
    12             (ii)  notifying residents of licensing violations
    13         that endanger resident health and safety and licensing
    14         actions taken by the Department of Health;
    15             (iii)  offering residents the opportunity to
    16         relocate;
    17             (iv)  providing residents with pertinent information,
    18         such as referrals to nearby social service agencies or
    19         assisted living residences in complete compliance with
    20         governing regulations;
    21             (v)  determining other options for relocation; and
    22             (vi)  assisting residents to make arrangements for
    23         relocation if family members are not available for this
    24         purpose.
    25         (3)  Except in an emergency, the consumer shall be
    26     involved in planning his transfer to another placement and
    27     shall have the right to choose among the available
    28     alternative placements. The department may make temporary
    29     placement until final placement can be arranged. Consumers
    30     shall be provided with an opportunity to visit alternative
    20000H2700B3843                 - 47 -

     1     placement before relocation or following temporary emergency
     2     relocation. Consumers shall choose their final placement and
     3     shall be given assistance in transferring to such place.
     4         (4)  Consumers shall not be relocated pursuant to this
     5     section if the Department of Health determines, in writing,
     6     and consistent with consumer preference, that such relocation
     7     is not in the best interest of the consumer.
     8     (j)  Transfer.--All consumers of assisted living services
     9  providers shall be notified by the Department of Health of its
    10  licensing actions, informed of their right to switch providers,
    11  and informed of their right to receive assistance in locating a
    12  new assisted living services provider. The Department of Health
    13  shall provide assistance to consumers of assisted living
    14  services providers who require assistance in transferring to
    15  other assisted living services providers. This assistance shall
    16  be consistent with the conditions for and forms of assistance
    17  stated in subsection (i).
    18     (k)  Interim inspection.--The Department of Health shall
    19  inspect a facility or assisted living services provider that has
    20  received a supersedeas at least monthly or more frequently to
    21  ensure residents' or recipients' safety and well-being. These
    22  inspection reports will be maintained as part of the public
    23  record for the assisted living residence or assisted living
    24  services provider.
    25     (l)  Interim violation.--Where a supersedeas has been
    26  granted, a Class I or II violation cited after the granting of
    27  the supersedeas shall lead to a revocation of the supersedeas.
    28     (m)  Appointment of master by court.--If, without good cause,
    29  one or more Class I or II violations remain uncorrected for more
    30  than 60 days from date of citation or when the assisted living
    20000H2700B3843                 - 48 -

     1  residence or assisted living services provider has demonstrated
     2  a pattern of episodes of noncompliance alternating with
     3  compliance over a period of at least two years such as would
     4  convince a reasonable person that any correction of violations
     5  would be unlikely to be maintained, the Department of Health may
     6  petition the court to appoint a master designated as qualified
     7  by the Department of Health to assume operation of the assisted
     8  living residence or assisted living services provider at the
     9  assisted living residence's or assisted living services
    10  provider's expense for a specified period of time or until all
    11  violations are corrected and all applicable laws and regulations
    12  are complied with. The fee for the master shall be set by the
    13  court.
    14     (n)  Expedited hearings.--The Department of Health shall make
    15  the assisted living residence or services provider appeals a
    16  priority, with no appeal outstanding more than 60 days beyond
    17  the date on which the appeal was filed.
    18     (o)  Expedited reconsideration.--The Secretary of Health
    19  shall complete reconsiderations within 60 days.
    20     (p)  Penalties.--The Department of Health shall assess a
    21  penalty for each violation of this act or regulations of the
    22  department. Penalties shall be assessed on a daily basis from
    23  the date on which the citation was issued until the date such
    24  violation is corrected except in the case of a Class II
    25  violation. In the case of a Class II violation, assessment of a
    26  penalty shall be suspended for a period of five days from the
    27  date of citation provided that, except for good cause, the
    28  provider has corrected the violation. If the violation has not
    29  been corrected within the five-day period, the fine shall be
    30  retroactive to the date of citation.
    20000H2700B3843                 - 49 -

     1         (1)  The amount of penalties shall be as follows:
     2             (i)  The Department of Health shall assess a minimum
     3         penalty of $50 per consumer per day for each Class I
     4         violation.
     5             (ii)  The Department of Health shall assess a minimum
     6         penalty of $15 per consumer per day, up to a maximum of
     7         $40 per consumer per day, for each Class II violation.
     8             (iii)  There shall be no monetary penalty for Class
     9         III violations unless the provider fails to correct the
    10         Class III violation within 15 days. Failure to correct
    11         the violation within 15 days may result in an assessment
    12         of up to $10 per consumer per day for each Class III
    13         violation, retroactive to the date of citation.
    14             (iv)  An assisted living residence found to be
    15         operating without a license shall be assessed a penalty
    16         of $1000. If, after 14 days, a provider of an assisted
    17         living residence cited for operating without a license
    18         fails to file an application for a license, the
    19         Department of Health shall assess an additional $50 for
    20         each consumer for each day in which the assisted living
    21         residence fails to makes such application.
    22             (v)  An assisted living services provider shall be
    23         charged $500 per day for each Class I violation, between
    24         $200 and $400 per day for each Class II violation and
    25         $100 per day per Class III violation in accordance with a
    26         time frame as that in paragraph (3).
    27         (2)  A provider charged with a violation of this act
    28     shall have 30 days to pay the assessed penalty in full, or,
    29     if the provider wishes to contest either the amount of the
    30     penalty or the fact of the violation, the party shall forward
    20000H2700B3843                 - 50 -

     1     the assessed penalty to the Department of Health for
     2     placement in the assisted living trust account.
     3             (i)  If, through administrative hearing or judicial
     4         review of the proposed penalty, it is determined that no
     5         violation occurred or that the amount of the penalty
     6         should be reduced, the Secretary of Health shall within
     7         30 days remit the appropriate amount to the provider with
     8         any interest accumulated by the escrow deposit.
     9             (ii)  Failure to forward the payment to the
    10         Department of Health within 30 days shall result in a
    11         waiver of rights to contest the fact of the violation or
    12         the amount of the penalty.
    13             (iii)  The amount assessed after administrative
    14         hearing or a waiver of the administrative hearing shall
    15         be payable to the Commonwealth's Assisted Living Trust
    16         Account and shall be collectible in any manner provided
    17         by law for the collection of debts. If any provider
    18         liable to pay such penalty neglects or refuses to pay the
    19         same after demand, such failure to pay shall constitute a
    20         judgment in favor of the Commonwealth in the amount of
    21         the penalty, together with the interest and any costs
    22         that may accrue.
    23         (3)  Money collected by the Department of Health under
    24     this section shall be placed in the assisted living trust
    25     account and shall be first used to defray the expenses
    26     incurred by consumers relocated under this act. Any moneys
    27     remaining in this account shall annually be remitted to the
    28     Department of Health for enforcing the provisions of this
    29     act. Fines collected pursuant to this act shall not be
    30     subject to the provisions of 42 Pa.C.S. § 3733 (relating to
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     1     deposits into account).
     2     (q)  Revocation or nonrenewal of license.--
     3         (1)  The Department of Health shall temporarily revoke
     4     the license of or appoint a master to manage and operate an
     5     assisted living residence or assisted living provider if,
     6     without good cause, one or more Class I violations remain
     7     uncorrected 24 hours after the assisted living residence or
     8     assisted living services provider has been cited for such
     9     violation or if, without good cause, one or more Class II
    10     violations remain uncorrected 15 days after being cited for
    11     violation. Correction of violations shall be demonstrated by
    12     documentation of compliance. Where necessary, reinspections
    13     shall occur 15 days after citation to determine whether the
    14     violation has been corrected.
    15         (2)  Upon the revocation of a license pursuant to this
    16     subsection, all consumers shall be relocated.
    17         (3)  The revocation may terminate upon the Department of
    18     Health's determination that violations are corrected.
    19         (4)  If, after three months, the Department of Health
    20     does not issue a new license for an assisted living residence
    21     or assisted living services provider license revoked pursuant
    22     to this section:
    23             (i)  Such revocation or nonrenewal pursuant to this
    24         section shall be for a minimum period of five years.
    25             (ii)  No provider of an assisted living residence or
    26         assisted living services provider who has had a license
    27         revoked or not renewed pursuant to this section shall be
    28         allowed to operate or staff or hold an interest in an
    29         assisted living residence that applies for a license for
    30         a period of five years after such revocation or
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     1         nonrenewal. No provider who has had its license revoked
     2         or not renewed may transfer the assisted living residence
     3         or assisted living services company to a family member or
     4         member of their household for the five-year period.
     5         (5)  The Department of Health shall revoke or refuse to
     6     renew the license of an assisted living residence if, during
     7     any two-year period, the assisted living residence or
     8     assisted living services provider, without good cause, on two
     9     or more separate occasions, has been found to have violated a
    10     regulation of the Department of Health which has been
    11     categorized as Class I or has multiple Class II violations.
    12  Section 12.  Repeals.
    13     The following acts and parts of acts are repealed insofar as
    14  they are inconsistent with this act:
    15     Section 2102 of the act of May 17, 1921 (P.L.682, No.284),
    16  known as The Insurance Company Law of 1921.
    17     Section 2203-A of the act of April 9, 1929 (P.L.177, No.175),
    18  known as The Administrative Code of 1929.
    19     The definition of "personal care home" in section 1001 of the
    20  act of June 13, 1967 (P.L.31, No.21), known as the Public
    21  Welfare Code.
    22     The definition of "long-term care nursing facility" in
    23  section 802.1 of the act of July 19, 1979 (P.L.130, No.48),
    24  known as the Health Care Facilities Act.
    25  Section 13.  Effective date.
    26     This act shall take effect in 60 days.



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