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                                                       PRINTER'S NO. 776

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE BILL

No. 704 Session of 2007


        INTRODUCED BY VANCE, WASHINGTON, BAKER, BOSCOLA, BROWNE, EARLL,
           ERICKSON, FOLMER, FUMO, KITCHEN, LOGAN, MELLOW, MUSTO,
           O'PAKE, ORIE, PICCOLA, PIPPY, PUNT, RAFFERTY, STACK, STOUT,
           TOMLINSON, WAUGH, D. WHITE, M. WHITE, C. WILLIAMS,
           WONDERLING, WOZNIAK, SCARNATI, REGOLA, RHOADES AND MADIGAN,
           MARCH 29, 2007

        REFERRED TO PUBLIC HEALTH AND WELFARE, MARCH 29, 2007

                                     AN ACT

     1  Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
     2     act to consolidate, editorially revise, and codify the public
     3     welfare laws of the Commonwealth," further providing for
     4     rules and regulations for personal care homes and assisted
     5     living residences.

     6     The General Assembly of the Commonwealth of Pennsylvania
     7  hereby enacts as follows:
     8     Section 1.  Section 213 heading and (c) of the act of June
     9  13, 1967 (P.L.31, No.21), known as the Public Welfare Code,
    10  added December 21, 1988 (P.L.1883, No.185), are amended and the
    11  section is amended by adding a subsection to read:
    12     Section 213.  Personal Care Home [Administrator] and Assisted
    13  Living Residence Administrators.--* * *
    14     (a.1)  All assisted living residences shall identify and
    15  appoint an administrator or administrators who meet the
    16  qualifications provided in this section for personal care home
    17  administrators and any additional standards pertaining to the


     1  operations of assisted living residences as the department may
     2  establish by regulation.
     3     * * *
     4     (c)  The department may promulgate regulations requiring
     5  orientation and training for all direct care staff in a personal
     6  care home or assisted living residence.
     7     * * *
     8     Section 2.  The definition of "facility" in section 1001 of
     9  the act, amended December 21, 1988 (P.L.1883, No.185), is
    10  amended and the section is amended by adding definitions to
    11  read:
    12     Section 1001.  Definitions.--As used in this article--
    13     * * *
    14     "Assisted living residence" means any premises in which food,
    15  shelter, personal care, assistance or supervision and
    16  supplemental health care services are provided for a period
    17  exceeding twenty-four hours or four or more adults who are not
    18  relatives of the operator, who require assistance or supervision
    19  in such matters as dressing, bathing, diet, financial
    20  management, evacuation from the residence in the event of an
    21  emergency or medication prescribed for self-administration.
    22     "Assisted living residence administrator" means an individual
    23  who is charged with the general administration of an assisted
    24  living residence, whether or not such individual has an
    25  ownership interest in the residence or his function and duties
    26  are shared with other individuals.
    27     * * *
    28     "Facility" means an adult day care center, child day care
    29  center, family day care home, boarding home for children, mental
    30  health establishment, personal care home, assisted living
    20070S0704B0776                  - 2 -     

     1  residence, nursing home, hospital or maternity home, as defined
     2  herein, [and shall not include those] except to the extent that
     3  such a facility is operated by the State or Federal governments
     4  or those supervised by the department[.], or licensed pursuant
     5  to the act of July 19, 1979 (P.L.130, No.48), known as the
     6  "Health Care Facilities Act."
     7     * * *
     8     "Supplemental health care service" means the provision by an
     9  assisted living residence of any type of health care service,
    10  either directly or through contractors, subcontractors, agents
    11  or designated providers, except for any service that is required
    12  by law to be provided by a health care facility pursuant to the
    13  act of July 19, 1979 (P.L.130, No.48), known as the "Health Care
    14  Facilities Act."
    15     Section 3.  Section 1006 of the act, amended December 21,
    16  1988 (P.L.1883, No.185), is amended to read:
    17     Section 1006.  Fees.--Annual licenses shall be issued when
    18  the proper fee, if required, is received by the department and
    19  all the other conditions prescribed in this act are met. For
    20  personal care homes and assisted living residences, the fee
    21  shall be an application fee. The fees shall be:
    22       Facility                              Annual Fee
    23     Adult day care center                      $  15
    24     Mental health establishment                   50
    25     Personal care home
    26     or assisted
    27     living residence  -- [0] 4 - 20 beds          15
    28                       -- 21 -  50 beds            20
    29                       -- 51 - 100 beds            30
    30                       --101 beds and above        50
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     1     No fee shall be required for the annual license in the case
     2  of day care centers, family day care homes, boarding homes for
     3  children or for public or nonprofit mental institutions.
     4     Section 4.  The definition of "private institution" in
     5  section 1051 of the act, amended December 21, 1988 (P.L.1883,
     6  No.185), is amended to read:
     7     Section 1051.  Definition.--As used in this subarticle--
     8     "Private institution" means any of the following facilities
     9  by whatever term known and irrespective of the age group served:
    10  Mental hospital, institution for the mentally defective, day
    11  care center, nursing home, hospital, personal care home,
    12  assisted living residence and other similar institution which is
    13  operated for profit and which requires a license issued by the
    14  department.
    15     Section 5.  Sections 1057.1, 1057.2(a), 1057.3, 1085
    16  introductory paragraph, 1086(e) and 1087 of the act, added
    17  December 21, 1988 (P.L.1883, No.185), are amended to read:
    18     Section 1057.1.  Appeals.--(a)  An appeal from the decision
    19  of the department relating to the licensure or revocation of a
    20  personal care home or assisted living residence shall not act as
    21  a supersedeas but, upon cause shown and where circumstances
    22  require it, the reviewing authority shall have the power to
    23  grant a supersedeas.
    24     (b)  If, without good cause, one or more Class I or Class II
    25  violations remain uncorrected or when the home or residence has
    26  demonstrated a pattern of episodes of noncompliance alternating
    27  with compliance over a period of at least two years such as
    28  would convince a reasonable person that any correction of
    29  violations would be unlikely to be maintained, the department
    30  may petition the court to appoint a master designated as
    20070S0704B0776                  - 4 -     

     1  qualified by the department to assume operation of the home or
     2  residence at the [home's] operator's expense for a specified
     3  period of time or until all violations are corrected and all
     4  applicable laws and regulations are complied with.
     5     Section 1057.2.  Relocation.--(a)  The department, in
     6  conjunction with appropriate local authorities, shall relocate
     7  residents from a personal care home or assisted living residence
     8  if any of the following conditions exist:
     9     (1)  The home or residence is operating without a license.
    10     (2)  The licensee is voluntarily closing a home or residence
    11  and relocation is necessary for the health and welfare of the
    12  resident or residents.
    13     * * *
    14     Section 1057.3.  Rules and Regulations for Personal Care Home
    15  and Assisted Living Residences.--(a)  The rules and regulations
    16  for the licensing of personal care homes and assisted living
    17  residences promulgated by the department shall require that:
    18     (1)  Prior to a resident's admission to a personal care home
    19  or assisted living residence, an initial standardized screening
    20  instrument be completed for that resident by the [personal care
    21  home] provider or a human service agency. Such standardized
    22  screening instrument shall be developed by the department.
    23  [This]
    24     (i)  For a personal care home, the screening will be done to
    25  determine that the potential resident does not require the
    26  services in or of a long-term care facility [or] and whether the
    27  potential resident requires the services of a personal care
    28  [services] home and, if so, the nature of the services and
    29  supervision necessary.
    30     (ii)  For an assisted living residence, the screening will be
    20070S0704B0776                  - 5 -     

     1  done to determine whether the potential resident requires the
     2  services provided by an assisted living residence. A resident
     3  who currently does not require assistance in obtaining
     4  supplemental health care service, but who may require such
     5  services in the future or who wishes to obtain assistance in
     6  obtaining such services or reside in a facility in which such
     7  services are available, may be admitted to the assisted living
     8  residence, provided the resident is only provided service
     9  required or requested by the resident.
    10     (iii)  An initial screening shall not be required to commence
    11  supplemental health care services to a resident of an assisted
    12  living facility who was not receiving such services at the time
    13  of the resident's admission; to transfer a resident from a
    14  portion of an assisted living residence that does not provide
    15  supplemental health care service to a portion of the residence
    16  that provides such service; or to transfer a resident from a
    17  personal care home to an assisted living residence licensed by
    18  the same operator.
    19     (2)  In addition to the screening, each resident receive a
    20  complete medical examination by a physician prior to, or within
    21  thirty days of, admission and that, once admitted, each resident
    22  receive a screening and medical evaluation at least annually.
    23     (3)  A personal care home or assisted living residence
    24  administrator refer an applicant whose needs cannot be met by [a
    25  personal care home] the home or residence to an appropriate
    26  assessment agency.
    27     (4)  Each resident be provided by the administrator with
    28  notice of any Class I or Class II violations uncorrected after
    29  five days.
    30     (5)  All residents sign a standard written admission
    20070S0704B0776                  - 6 -     

     1  agreement which shall include the disclosure to each resident of
     2  the actual rent and other charges for services provided by the
     3  personal care home or assisted living residence.
     4     (6)  For residents eligible for Supplemental Security Income
     5  (SSI) benefits, actual rent and other charges not exceed the
     6  resident's actual current monthly income reduced by a personal
     7  needs allowance for the resident in an amount to be determined
     8  by the department, but not less than twenty-five dollars ($25).
     9     (7)  A personal care home or assisted living residence not
    10  seek or accept any payments from a resident who is a
    11  Supplemental Security Income (SSI) recipient in excess of one-
    12  half of any funds received by the resident under the act of
    13  March 11, 1971 (P.L.104, No.3), known as the "Senior Citizens
    14  Rebate and Assistance Act."
    15     (8)  A personal care home or assisted living residence not
    16  seek or accept from a resident who is eligible for Supplemental
    17  Security Income (SSI) benefits any payment from any funds
    18  received as lump sum awards, gifts or inheritances, gains from
    19  the sale of property, or retroactive government benefits:
    20  Provided, however, That an owner or operator may seek and accept
    21  payments from funds received as retroactive awards of Social
    22  Security or Supplemental Security Income (SSI) benefits, but
    23  only to the extent that the retroactive awards cover periods of
    24  time during which the resident actually resided in the personal
    25  care home or assisted living residence.
    26     (9)  Each resident who is a recipient of, or an eligible
    27  applicant for, Supplemental Security Income (SSI) benefits be
    28  provided, at no additional charge to the resident, necessary
    29  personal hygiene items and personal laundry services. This
    30  requirement does not include cosmetic items.
    20070S0704B0776                  - 7 -     

     1     (10)  All residents may leave and return to [the] a personal
     2  care home or assisted living residence, receive visitors, have
     3  access to a telephone and mail and participate in religious
     4  activities.
     5     (11)  Personal care home and assisted living residence
     6  owners, administrators or employes be prohibited from being
     7  assigned power of attorney or guardianship for any resident.
     8     (12)  Each assisted living residence demonstrate the ability
     9  to provide supplemental health care services in a manner duly
    10  protective of the health, safety and well-being of its residents
    11  utilizing employes, independent contractors or contractual
    12  arrangements with other health care facilities or practitioners
    13  licensed, registered or certified to the extent required by law
    14  to provide such service. To the extent prominently disclosed in
    15  a written admission agreement, an assisted living residence may
    16  require residents to use providers of supplemental health care
    17  services designated by the facility.
    18     (13)  A personal care home provide supplemental health care
    19  services to residents, provided, however, that a personal care
    20  home may assist residents in obtaining health care services in
    21  the manner provided by 55 Pa. Code §§ 2600.29 (relating to
    22  hospice care and services), 2600.142 (relating to assistance
    23  with health care) and 2600.181 (relating to self-administration)
    24  through 2600.191 (relating to medications) or as otherwise
    25  provided by regulations adopted by the department not
    26  inconsistent with the requirements of this section.
    27     (b)  [The] Subject to subsection (a)(13), the department
    28  shall not prohibit immobile persons who do not require the
    29  services of a licensed long-term care facility[, but who require
    30  personal care services,] from residing in a personal care home,
    20070S0704B0776                  - 8 -     

     1  provided that appropriate personal care services and health care
     2  services are available to the resident and the design,
     3  construction, staffing or operation of the personal care home
     4  allows for safe emergency evacuation. Persons requiring the
     5  services of a licensed long-term care facility, including
     6  immobile persons, may reside in an assisted living residence,
     7  provided that appropriate supplemental health care services are
     8  provided such residents and the design, construction, staffing
     9  and operation of the assisted living residence allows for their
    10  safe emergency evacuation.
    11     (c)  An assisted living residence may not admit, retain or
    12  serve a consumer with any of the following conditions or health
    13  care needs:
    14     (1)  Ventilator dependency.
    15     (2)  Stage III and IV, or multiple stage II decubiti and
    16  vascular ulcers that are not in a healing stage.
    17     (3)  Continuous intravenous fluids.
    18     (4)  Reportable infectious diseases, such as tuberculosis, in
    19  a communicable state that require isolation of the consumer or
    20  require special precautions by a caretaker to prevent
    21  transmission of the disease unless the Department of Health
    22  directs that isolation be established within the assisted living
    23  residence.
    24     (5)  Nasogastric tubes.
    25     (6)  Gastric tubes, except when the consumer is capable of
    26  self-care of the tube.
    27     (7)  Physical restraints.
    28     (8)  Tracheostomy except when the consumer is independently
    29  capable of self-care of the tracheostomy.
    30     (9)  Other conditions for which care cannot be provided in a
    20070S0704B0776                  - 9 -     

     1  safe and effective manner in an assisted living residence as
     2  determined by regulations adopted by the department.
     3     (10)  A consumer for whom an assisted living residence
     4  administrator, acting in consultation with supplemental health
     5  care providers, or whose physician or the medical director of
     6  the facility, certifies is not appropriate for admission or
     7  retention in an assisted living residence.
     8     (11)  A consumer for whom a determination is made that the
     9  consumer's health care needs cannot be met by a provider of
    10  personal care or assisted living services or within an assisted
    11  living residence, including a consumer requiring:
    12     (i)  skilled nursing care twenty-four hours per day;
    13     (ii)  a sliding scale insulin administration unless the
    14  consumer is capable of self-administration or a licensed health
    15  care professional or other individual qualified to do so
    16  administers the insulin;
    17     (iii)  intermittent intravenous therapy unless a licensed
    18  health care professional manages the therapy;
    19     (iv)  insertions, sterile irrigation and replacement of a
    20  catheter, except for routine maintenance of a urinary catheter,
    21  unless the consumer is capable of self-administration or a
    22  licensed health care professional administers the catheter;
    23     (v)  oxygen, unless the consumer is capable of self-
    24  administration or a licensed health care professional
    25  administers the oxygen;
    26     (vi)  inhalation therapy, unless the consumer is capable of
    27  self-administration or a licensed health care professional
    28  administers the therapy; or
    29     (vii)  other types of supplemental health care services that
    30  an assisted living residence administrator, acting in
    20070S0704B0776                 - 10 -     

     1  consultation with supplemental health care providers, determines
     2  cannot be provided in a safe and effective manner by the
     3  assisted living residence.
     4     (d)  (i)  Subject to subsection (a)(12), an assisted living
     5  residence may admit or retain a resident who does not require
     6  supplemental health care services or who, subject to any
     7  restrictions provided in the written resident agreement, makes
     8  alternative arrangements for such services.
     9     (ii)  Portions or sections of an assisted living residence
    10  may be designated for use by residents not requiring
    11  supplemental health care services, or for a facility may provide
    12  services both to residents receiving supplemental health care
    13  service and to residents not receiving such service within the
    14  same portions or sections of its residence.
    15     Section 1085.  Classification of Violations.--The department
    16  shall classify each violation of its regulations [on] by
    17  personal care homes or assisted living residences into one of
    18  the following categories:
    19     * * *
    20     Section 1086.  Penalties.--* * *
    21     (e)  A personal care home or assisted living residence found
    22  to be operating without a license shall be assessed a penalty of
    23  five hundred dollars ($500). If, after fourteen days, a provider
    24  [of a personal care home] cited for operating without a license
    25  fails to file an application for a license, the department shall
    26  assess an additional twenty dollars ($20) for each resident for
    27  each day in which the home or residence fails to make such
    28  application.
    29     * * *
    30     Section 1087.  Revocation or Nonrenewal of License.--(a)  (1)
    20070S0704B0776                 - 11 -     

     1  The department shall temporarily revoke the license of a
     2  personal care home or assisted living residence if, without good
     3  cause, one or more Class I violations remain uncorrected twenty-
     4  four hours after the [personal care home] operator has been
     5  cited for such violation or if, without good cause, one or more
     6  Class II violations remain uncorrected fifteen days after being
     7  cited for such violation.
     8     (2)  Upon the revocation of a license pursuant to this
     9  subsection, all residents shall be relocated.
    10     (3)  The revocation may terminate upon the department's
    11  determination that its violation is corrected.
    12     (4)  If, after three months, the department does not issue a
    13  new license for a personal care home or assisted living
    14  residence license revoked pursuant to this section:
    15     (i)  Such revocation or nonrenewal pursuant to this section
    16  shall be for a minimum period of five years.
    17     (ii)  No provider of a personal care home or assisted living
    18  residence who has had a license revoked or not renewed pursuant
    19  to this section shall be allowed to operate or staff or hold an
    20  interest in a home or residence that applies for a license for a
    21  period of five years after such revocation or nonrenewal.
    22     (b)  The department shall revoke or refuse to renew the
    23  license of a personal care home or assisted living residence if,
    24  during any two-year period, the home or residence, without good
    25  cause, on two or more separate occasions, has been found to have
    26  violated a regulation of the department which has been
    27  categorized as Class I.
    28     (c)  The power of the department to revoke or refuse to renew
    29  or issue a license pursuant to this section is in addition to
    30  the powers and duties of the department pursuant to section
    20070S0704B0776                 - 12 -     

     1  1026.
     2     Section 6.  The following transitional provisions shall
     3  apply:
     4         (1)  A facility licensed as a personal care home upon the
     5     effective date of this section shall not provide supplemental
     6     health care services to its residents until the facility
     7     submits an application to the department to operate an
     8     assisted living residence and the department issues a license
     9     to the facility to operate as an assisted living residence.
    10         (2)  Prior to the issuance of application forms and the
    11     adoption of regulations pertaining to assisted living
    12     residences, the department shall issue licenses to operators
    13     of personal care homes to operate assisted living residences
    14     based upon the review of plans submitted by the operator
    15     demonstrating the ability of a facility to safely and
    16     effectively operate as an assisted living residence pursuant
    17     to the requirements of this act.
    18         (3)  Unless the department, pursuant to section 213(a.1)
    19     of the act, promulgates final regulations establishing
    20     additional qualifications for assisted living residence
    21     administrators, a personal care home administrator may serve
    22     as an assisted living residence administrator, and unless the
    23     department, pursuant to section 213(a.1) of the act,
    24     promulgates final regulations establishing additional
    25     orientation or training requirements for direct care staff in
    26     an assisted living residence, direct care staff who have
    27     received orientation and training required for a personal
    28     care home may serve as direct care staff in an assisted
    29     living residence.
    30         (4)  Except to the extent inconsistent with this act, a
    20070S0704B0776                 - 13 -     

     1     reference in another statute to a personal care home, a
     2     personal care boarding home, personal care housing or a
     3     personal care home administrator shall be construed to also
     4     include an assisted living residence or an assistant living
     5     residence administrator, including, but not limited to, the
     6     use of such terms in:
     7             (i)  the definition of "caretaker" in 18 Pa.C.S. §
     8         2713;
     9             (ii)  the definition of "health care provider" in 42
    10         Pa.C.S. § 5101.1;
    11             (iii)  the definition of "health center" in 53
    12         Pa.C.S. § 5602;
    13             (iv)  the authorization to conduct studies and
    14         evaluations and to develop community housing options by
    15         the Department of Aging as provided by section 2203-A of
    16         the act of April 9, 1929 (P.L.177, No.175), known as The
    17         Administrative Code of 1929;
    18             (v)  the authorization to develop community-based
    19         service and housing options for impaired and chronically
    20         ill older persons provided to area agencies on aging by
    21         section 2207-A of The Administrative Code of 1929;
    22             (vi)  the term "residence" in section 2201-A of the
    23         act of July 28, 1953 (P.L.723, No.230), known as the
    24         Second Class County Code,
    25             (vii)  the authorization to provide tax exempt bond
    26         allocations pursuant to Chapter 27 of the act of June 29,
    27         1996 (P.L.434, No.67), known as the Job Enhancement Act;
    28             (viii)  the definition of "exempt facility" in
    29         section 2702 of the Job Enhancement Act;
    30             (ix)  the definition of "facility" in section 103 of
    20070S0704B0776                 - 14 -     

     1         the act of November 6, 1987 (P.L.381, No.79), known as
     2         the Older Adults Protective Services Act;
     3             (x)  establishing the qualifications for a pediatric
     4         extended care center administrator pursuant to section
     5         15(b)(2) of the act of November 24, 1999 (P.L.884,
     6         No.54), known as the Prescribed Pediatric Extended Care
     7         Centers Act;
     8             (xi)  the definition of "health care provider" in
     9         section 503 of the act of March 20, 2002 (P.L.154,
    10         No.13), known as the Medical Care Availability and
    11         Reduction of Error (Mcare) Act;
    12             (xii)  the definition of "facility" in section 2 of
    13         the act of December 9, 2002 (P.L.1388, No.171), known as
    14         the Elder Care Payment Restitution Act;
    15             (xiii)  the list of facilities required to make
    16         refunds pursuant to section 3 of the Elder Care Payment
    17         Restitution Act; or
    18             (xiv)  the definition of "family" as excluding
    19         persons residing in a personal care boarding home in
    20         section 3 of the act of November 30, 2004 (P.L.1561,
    21         No.198), known as the Family Support for Persons with
    22         Disabilities Act.
    23     Section 7.  This act shall take effect in 60 days.





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