PRINTER'S NO. 631
No. 568 Session of 2003
INTRODUCED BY SCHWARTZ, ERICKSON, O'PAKE, COSTA, MUSTO AND
TARTAGLIONE, APRIL 4, 2003
REFERRED TO PUBLIC HEALTH AND WELFARE, APRIL 4, 2003
AN ACT
1 Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
2 act relating to health care; prescribing the powers and
3 duties of the Department of Health; establishing and
4 providing the powers and duties of the State Health
5 Coordinating Council, health systems agencies and Health Care
6 Policy Board in the Department of Health, and State Health
7 Facility Hearing Board in the Department of Justice;
8 providing for certification of need of health care providers
9 and prescribing penalties," further providing for the
10 definition of "health care facility"; providing for the
11 definitions of "activities of daily living," "home care
12 agency," "home care registry," "home health aide,"
13 "inspection," "instrumental activities of daily living" and
14 "personal care worker"; further providing for licensure;
15 providing for home care agency and registry consumer rights
16 and protections, for home care agency and registry
17 inspections and plans of correction and for home care agency
18 and registry exemptions; further providing for application
19 for license; and providing for penalties.
20 The General Assembly finds and declares that the licensure of
21 home care agencies and registries that provide services that
22 allow consumers to maintain independent living shall provide for
23 specific consumer protections by establishing oversight, by
24 requiring criminal background checks and communicable disease
25 screenings for individuals referred by a home care agency or
26 registry to provide care and by ensuring the competency of
1 individuals referred by a home care agency or registry to
2 provide care.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. The definition of "health care facility" in
6 section 802.1 of the act of July 19, 1979 (P.L.130, No.48),
7 known as the Health Care Facilities Act, amended October 16,
8 1998 (P.L.777, No.95), is amended and the section is amended by
9 adding definitions to read:
10 Section 802.1. Definitions.
11 The following words and phrases when used in this chapter
12 shall have, unless the context clearly indicates otherwise, the
13 meanings given them in this section:
14 "Activities of daily living." The term includes, but is not
15 limited to, services furnished to a person by an employee
16 referred from a home care agency or an independent contractor
17 referred from a registry in the consumer's place of residence or
18 other independent living environment for compensation and which
19 provide assistance to the consumer with home management
20 activities, respite care, companionship services or with
21 personal care which includes, but is not limited to, assistance
22 with self-administered medications, feeding, oral, skin and
23 mouth care, shaving, assistance with ambulation, bathing, hair
24 care and grooming, dressing, toileting and transfer activities.
25 The term does not include services provided by a religious
26 organization for the purpose of providing services exclusively
27 to clergymen or other persons in a religious profession who are
28 members of a religious denomination.
29 * * *
30 "Health care facility." For purposes of Chapter 8, a health
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1 care facility includes, but is not limited to, a general,
2 chronic disease or other type of hospital, a home health care
3 agency, a home care agency, a home care registry, a hospice, a
4 long-term care nursing facility, cancer treatment centers using
5 radiation therapy on an ambulatory basis, an ambulatory surgical
6 facility, a birth center regardless of whether such health care
7 facility is operated for profit, nonprofit or by an agency of
8 the Commonwealth or local government. The department shall have
9 the authority to license other health care facilities as may be
10 necessary due to emergence of new modes of health care. When the
11 department so finds, it shall publish its intention to license a
12 particular type of health care facility in the Pennsylvania
13 Bulletin in accordance with the act of June 25, 1982 (P.L.633,
14 No.181), known as the "Regulatory Review Act." The term health
15 care facility shall not include an office used primarily for the
16 private practice of a health care practitioner, nor a program
17 which renders treatment or care for drug or alcohol abuse or
18 dependence unless located within a health facility, nor a
19 facility providing treatment solely on the basis of prayer or
20 spiritual means. The term health care facility shall not apply
21 to a facility which is conducted by a religious organization for
22 the purpose of providing health care services exclusively to
23 clergymen or other persons in a religious profession who are
24 members of a religious denomination.
25 "Home care agency." An organization or part of an
26 organization, exclusive of a home health care agency, that
27 supplies, arranges or schedules employees to provide activities
28 of daily living or instrumental activities of daily living or
29 skilled services on an hourly, shift or continual basis to any
30 consumer in the consumer's place of residence or other
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1 independent living environment for which the organization
2 receives a fee, consideration or compensation of any kind. The
3 term shall not include durable medical equipment providers or
4 volunteer providers.
5 "Home care registry." An organization or business entity or
6 part of an organization or business entity that supplies,
7 arranges or refers independent contractors to provide activities
8 of daily living or instrumental activities of daily living or
9 skilled services in the consumer's place of residence or other
10 independent living environment for which the registry receives a
11 fee, consideration or compensation of any kind.
12 "Home health aide." An individual, who in addition to
13 performing instrumental activities of daily living services, can
14 perform additional services including, but not limited to,
15 performing simple measurements and tests to monitor a consumer's
16 medical condition including vital signs, simple urine checks for
17 sugar and albumin and measuring intake and output, assisting
18 with ambulation when a consumer uses an ambulation aide,
19 changing and or reinforcing simple dressings and stable surface
20 wounds, monitoring of dietary habits and preparing special diet
21 meals and assisting in retraining a consumer in self-help
22 skills.
23 * * *
24 "Inspection." An examination by the Department of Health or
25 its representatives, including interviews with the office staff,
26 clients, individuals providing care and review of documents
27 pertinent to initial and continued licensure so that the
28 department may determine whether a home care agency or registry
29 is operating in compliance with licensure requirements.
30 "Instrumental activities of daily living" or "IADL." The
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1 term includes, but is not limited to, meal preparation, shopping
2 and errands, telephone use, light housework, laundry and
3 transportation.
4 * * *
5 "Personal care worker." An individual who can assist a
6 consumer with activities of daily living including, but not
7 limited to, bathing, skin care, mouth care, dressing, grooming,
8 toileting, ambulation and transfer, change of position or
9 turning of consumer, feeding and assistance with self-
10 administered medication.
11 Section 2. Section 806 of the act is amended by adding a
12 subsection to read:
13 Section 806. Licensure.
14 * * *
15 (d.1) Home care agency and registry regulations.--
16 (1) In developing rules and regulations for licensure of
17 home care agencies and registries, the department shall
18 ensure that an individual accepted for referral by a home
19 care agency or registry after the effective date of this
20 subsection shall have the following training or experience
21 prior to referral to consumers:
22 (i) valid nurses license;
23 (ii) successful completion of a nurse aide training
24 program approved by the Commonwealth;
25 (iii) successful completion of a home health aide
26 training program developed by the department or a
27 nonpublic organization and approved by the Commonwealth
28 or successful completion of a competency examination
29 approved by the Commonwealth;
30 (iv) successful completion of a personal care worker
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1 training credentialing program developed by the
2 department or a nonpublic organization and approved by
3 the Commonwealth or successful completion of an inclusive
4 competency examination or competency examination on those
5 topics necessary to meet the needs of the consumer
6 approved by the Commonwealth; or
7 (v) for persons performing only IADL services,
8 successful completion of a training program or written
9 skills examination developed by the Commonwealth or a
10 nonpublic organization, and approved by the Commonwealth.
11 Documentation of at least one of subparagraphs (i) through
12 (v) shall be kept in each individual's file in the home care
13 agency or registry office. In addition, documentation of
14 applicable State licensure for any health care practitioner
15 shall be kept on file in the home care agency or registry
16 office.
17 (2) Prior to licensing a home care agency or registry,
18 the department shall ensure that all individuals referred by
19 a home care agency or registry, office staff working for a
20 home care agency or registry and owners of each home care
21 agency or registry shall have criminal history record
22 information, in accordance with the requirements of section
23 503 of the act of November 6, 1987 (P.L.381, No.79), known as
24 the "Older Adults Protective Services Act," on file in the
25 office. If the agency or registry provides services to
26 minors, then prior to the licensing of a home care agency or
27 registry, the department shall ensure that all individuals
28 referred by a home care agency or registry, office staff
29 working for a home care agency or registry and owners of each
30 home care agency or registry shall obtain clearance from the
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1 child abuse registry.
2 (3) Prior to referral to consumers, all individuals and
3 any other office staff or contractors with consumer contact
4 shall have documentation in the home care agency or registry
5 files from a physician or other appropriate health care
6 professional that the individual is free of communicable
7 disease including, at a minimum, a tuberculosis screening as
8 outlined by the Department of Health screening guidelines.
9 (4) Ongoing supervision of an employee by a home care
10 agency shall be maintained to insure the employee has the
11 skills needed to provide the care required by the consumer.
12 Section 3. The act is amended by adding sections to read:
13 Section 806.2. Home care agency and registry consumer rights
14 and protections.
15 (a) Consumer protection.--As a condition of licensure, each
16 consumer or the consumer's legal representative or responsible
17 family member shall receive an information packet from the home
18 care agency or registry at the service initiation which shall
19 include the following items to be presented in a form able to be
20 easily understood and read by the consumer:
21 (1) A standardized form developed by the department with
22 information pertaining to:
23 (i) General information about the admission and
24 application process.
25 (ii) Information regarding how to contact and obtain
26 what is required by the department for home care
27 agencies.
28 (iii) Information about availability and access to
29 and contact information for the department's 24-hour
30 hotline.
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1 (iv) Details about the department's external
2 complaint mechanisms available to consumers.
3 (2) The consumer's rights as described in this section.
4 (3) A description of the services provided by the agency
5 or registry.
6 (4) A description of the relationship between the
7 consumer, the referred employee or independent contractor and
8 the agency or registry.
9 (5) Description of ongoing supervision maintained by a
10 home care agency to ensure the employee has the skills needed
11 to provide the care required by the consumer.
12 The home care agency or registry shall demonstrate documentation
13 of personal face-to-face interviews with all employees or
14 independent contractors referred by the home care agency or
15 registry and have documentation of at least two satisfactory
16 reference checks prior to referral to consumer.
17 (b) Consumer rights.--Consumers shall have the following
18 rights when receiving service:
19 (1) No individual as a result of their affiliation with
20 an agency or registry may assume power of attorney or
21 guardianship over any consumer.
22 (2) No consumer may be required to endorse checks over
23 to home care agencies or registries.
24 (3) (i) Be involved in a service planning process and
25 to receive services with reasonable accommodation of
26 individual needs and preferences except where the health
27 or safety of the individual direct care worker is at
28 risk.
29 (ii) Have privacy, confidentiality and freedom from
30 abuse, neglect and financial exploitation.
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1 (iii) Refuse treatment or services under the plan.
2 (iv) Receive from the home care agency or registry
3 and/or independent contractor five business days' advance
4 written notice of the intent of the home care agency or
5 registry and/or independent contractor to terminate
6 services with the consumer, except where immediate
7 jeopardy as determined by the department to consumers or
8 providers warrants shorter notice.
9 (v) Access the department's 24-hour hotline.
10 (vi) Be free from discrimination on the basis of
11 race, color, religious creed, disability, handicap,
12 ancestry, sexual orientation, national origin, age, sex
13 or protected class.
14 (4) This section shall not apply in any way to private
15 contracts or arrangements entered into by consumers and
16 caregivers as long as those caregivers were not supplied,
17 arranged, scheduled or referred to consumers by a home care
18 agency or registry.
19 Section 806.3. Home care agency and registry inspections and
20 plans of correction.
21 (a) Consent to entry and access.--An application for
22 licensure or the issuance and renewal of any license by the
23 department shall constitute consent by the applicant for the
24 home care agency or registry and the owner of the premises for
25 the department's representatives to enter the premises for the
26 purpose of conducting an inspection during regular business
27 hours.
28 (b) Violations and plan of correction.--If violations are
29 identified as a result of an inspection, the home care agency or
30 registry will be given a report of inspection that clearly
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1 outlines the nature of the violation. The home care agency or
2 registry shall submit a written plan of correction in response
3 to the report, stating actions to be taken by the agency or
4 registry to correct the violations and a time frame for those
5 corrective actions.
6 (c) Ensurance of correction.--The department shall ensure
7 that the home care agency or registry has taken steps to correct
8 the violation outlined in the department's report as described
9 in subsection (b).
10 (d) Penalties.--If the department finds after 30 days that
11 the plan of action is not followed and/or the violation not
12 corrected, it shall impose monetary penalties based on the
13 potential risk of harm to consumers, as determined and
14 promulgated by the department.
15 Section 806.4. Home care agency and registry applicability.
16 (a) Exceptions.--If an agency or registry or independent
17 contractor is only performing home and community-based services
18 under a Department of Public Welfare and/or Department of Aging
19 waiver program, it shall be exempt from the requirements of
20 sections 806(d.1), 806.2, 806.3, 807(b)(1) and 808(b), except
21 that it shall be required to have on file for each employee:
22 (1) Criminal history record information, in accordance
23 with the requirements of section 503 of the act of November
24 6, 1987 (P.L.381, No.79), known as the "Older Adults
25 Protective Services Act." If the agency or registry provides
26 services to minors, it shall obtain clearance from the child
27 abuse registry for its employees.
28 (2) Documentation from a physician or other appropriate
29 health care professional that the individual is free of
30 communicable disease, including, at a minimum, a tuberculosis
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1 screening as outlined by the Department of Health screening
2 guidelines.
3 (b) Compliance.--If an agency or registry or independent
4 contractor has satisfied subsection (a) pursuant to compliance
5 with waiver requirements, it shall be deemed in compliance with
6 this section.
7 Section 4. Section 807(b) of the act, amended December 18,
8 1992 (P.L.1602, No.179), is amended to read:
9 Section 807. Application for license.
10 * * *
11 (b) Fees.--Application for a license or for renewal of a
12 license shall be accompanied by the following fees:
13 (1) Regular or special license:
14 Home health agency $250.00
15 Home care agency 100.00
16 Registry 100.00
17 Ambulatory surgical facility 250.00
18 Birth center 70.00
19 Long-term care nursing facility 250.00
20 Plus per each long-term care bed in excess of
21 75 beds 2.00
22 Hospital
23 Every two years 500.00
24 Plus per each inpatient bed
25 every two years 4.00
26 Other health care facility 100.00
27 (2) Provisional license all facilities:
28 Provisional I $400.00
29 Plus per each inpatient bed 4.00
30 Provisional II 600.00
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1 Plus per each inpatient bed 6.00
2 Provisional III 800.00
3 Plus per each inpatient bed 8.00
4 Provisional IV 1,000.00
5 Plus per each inpatient bed 10.00
6 * * *
7 Section 5. Section 808(b) of the act, amended October 16,
8 1998 (P.L.777, No.95), is amended to read:
9 Section 808. Issuance of license.
10 * * *
11 (b) Separate and limited licenses.--Separate licenses shall
12 not be required for different services within a single health
13 care facility except that home health care, [hospice] home care,
14 hospice, registry or long-term nursing care will require
15 separate licenses. A limited license, excluding from its terms a
16 particular service or portion of a health care facility, may be
17 issued under the provisions of this act.
18 * * *
19 Section 6. This act shall take effect in 90 days.
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