HOUSE AMENDED
PRIOR PRINTER'S NOS. 726, 1237, 1441, PRINTER'S NO. 1502
1475
No. 670 Session of 1999
INTRODUCED BY MURPHY, WHITE, COSTA, BODACK, TOMLINSON, WAGNER,
BOSCOLA, BELL, KUKOVICH, WOZNIAK, STAPLETON, SCHWARTZ, MUSTO,
MADIGAN, LAVALLE, SLOCUM, BRIGHTBILL, HART AND STOUT,
MARCH 24, 1999
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES,
NOVEMBER 15, 1999
AN ACT
1 Relating to the licensure and regulation of pediatric extended
2 care centers in this Commonwealth.
3 TABLE OF CONTENTS
4 Section 1. Short title.
5 Section 2. Legislative intent.
6 Section 3. Definitions.
7 Section 4. PECC licensure.
8 Section 5. License required.
9 Section 6. Application for license; fees.
10 Section 7. Issuance of license.
11 Section 8. Provisional license.
12 Section 9. Expiration of license; renewal.
13 Section 10. Reasons for revocation or nonrenewal of license.
14 Section 11. Operator violation.
15 Section 12. Enforcement.
1 Section 13. Closing of PECC.
2 Section 14. Right of entry and inspection.
3 Section 15. Regulations.
4 Section 16. Interim license.
5 Section 17. Penalty.
6 Section 18. Effective date.
7 The General Assembly of the Commonwealth of Pennsylvania
8 hereby enacts as follows:
9 Section 1. Short title.
10 This act shall be known and may be cited as the Prescribed
11 Pediatric Extended Care Centers Act.
12 Section 2. Legislative intent.
13 It is the intent of the General Assembly to develop,
14 establish and enforce licensure and health and safety standards
15 for pediatric extended care centers in order to assure that the
16 centers provide appropriate care.
17 Section 3. Definitions.
18 The following words and phrases when used in this act shall
19 have the meanings given to them in this section unless the
20 context clearly indicates otherwise:
21 "Basic services." The term includes, but is not limited to,
22 development, implementation and monitoring of a comprehensive
23 plan of care, developed with the involvement of the parent or
24 legal guardian, which specifies the medical, nursing,
25 psychological and developmental therapies required by the
26 medically dependent or technologically dependent child served as
27 well as the caregiver training needs of the child's legal
28 guardian.
29 "Department." The Department of Health of the Commonwealth.
30 "Medical records." Data from all episodes of care and
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1 treatment of the child which contains:
2 (1) sufficient information to identify the patient
3 clearly, to justify the diagnosis and treatment and to
4 document the results accurately; and
5 (2) notes by authorized pediatric extended care center
6 staff or contract staff regarding the care and services
7 delivered to the patient while under the care of the
8 pediatric extended care center.
9 "Medically dependent" or "technologically dependent child."
10 A child eight years of age or younger who because of a medical
11 condition requires continuous therapeutic interventions or
12 skilled nursing supervision which must be prescribed by a
13 licensed physician and administered by or under the direct
14 supervision of, a licensed registered nurse.
15 "Operator." Any of the following that is responsible for the
16 overall operation of a pediatric extended care center:
17 (1) An individual.
18 (2) A trust or an estate.
19 (3) A partnership.
20 (4) An association.
21 (5) A corporation.
22 (6) A political subdivision or an instrumentality of a
23 political subdivision.
24 (7) An instrumentality of the Commonwealth.
25 "Owner." An operator.
26 "Pediatric extended care center." Any building or buildings,
27 or other place, whether operated for-profit or not-for-profit,
28 which undertakes through its ownership or management to provide
29 basic nonresidential services to more than six medically
30 dependent or technologically dependent children who are not
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1 related to the owner or operator by blood, marriage or adoption
2 and who require such services. Prerequisites for admission are a
3 prescription from the child's attending physician and consent of
4 a parent or legal guardian.
5 "PECC." A pediatric extended care center.
6 "Supportive services" or "contracted services." The term
7 includes, but is not limited to, speech therapy, occupational
8 therapy, physical therapy, pharmaceutical services, social work,
9 developmental, child life and psychological services.
10 Section 4. PECC licensure.
11 (a) Licensing.--The facilities to be licensed by the
12 department shall include all pediatric extended care centers
13 which are not otherwise exempt as provided by subsection (b).
14 (b) Exemption.--
15 (1) The following are not required to obtain a license
16 under this act:
17 (i) A facility licensed under:
18 (A) Article IX or X of the act of June 13, 1967
19 (P.L.31, No.21), known as the Public Welfare Code; or
20 (B) Chapter 8 of the act of July 19, 1979
21 (P.L.130, No.48), known as the Health Care Facilities
22 Act.
23 (ii) A school district.
24 (2) An entity which is exempt under paragraph (1)(i) is
25 not prohibited from obtaining a license under this act.
26 Section 5. License required.
27 The department is responsible for licensing pediatric
28 extended care centers in accordance with the provisions of this
29 act.
30 Section 6. Application for license; fees.
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1 (a) Submission to department.--Any person desiring to secure
2 a license to maintain and operate a PECC must submit an
3 application to the department upon forms prepared and furnished
4 by it, containing information the department considers necessary
5 to determine that the operator and the PECC meet the
6 requirements of licensure under this act and the regulations
7 relating to licensure. Application for renewal of a license must
8 be made upon forms prepared and furnished by the department in
9 accordance with the regulations of the department. The
10 application must include the license fee. The application must
11 include evidence that a bond has been posted by the applicant.
12 (b) Proof of insurance.--The applicant for licensure must
13 furnish proof of adequate liability insurance coverage or
14 protection.
15 (c) Fees.--
16 (1) The annual regular license fee required of a PECC
17 shall be in an amount determined by the department to be
18 sufficient to cover the department's costs in carrying out
19 its responsibilities under this act. Until the department
20 changes the fee by regulation, the annual license fee shall
21 be $500.
22 (2) The provisional license fee shall be as follows:
23 First provisional $500.
24 Second provisional $700.
25 Third provisional $900.
26 Fourth provisional $1,100.
27 Section 7. Issuance of license.
28 (a) Standards.--The department shall issue a license to an
29 operator when it is satisfied that the following standards have
30 been met:
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1 (1) The operator is a responsible person.
2 (2) The place to be used by a PECC is adequately
3 constructed, equipped, maintained and operated to safely and
4 efficiently render the services offered.
5 (3) The PECC provides safe and efficient services which
6 are adequate for the care, treatment and comfort of the
7 patients or residents of the facility.
8 (4) There is substantial compliance with the
9 requirements of this act and regulations promulgated by the
10 department under this act.
11 (b) Premises to be licensed.--Separate licenses are required
12 for pediatric extended care centers maintained on separate
13 premises, even though they are operated under the same
14 management. Separate licenses are required for separate
15 buildings on the same premises.
16 (c) Display of license.--The license shall be displayed in a
17 conspicuous place inside the pediatric extended care center.
18 (d) License transfer.--A license shall be valid only in the
19 possession of the operator to whom it is issued and shall not be
20 subject to sale, assignment or other transfer, voluntary or
21 involuntary nor shall a license be valid for any premises other
22 than that for which originally issued.
23 (e) Facility capacity.--Any license granted by the
24 department shall state the maximum capacity of the facility, the
25 date the license was issued, the expiration date of the license
26 and any other information deemed necessary by the department.
27 The department may determine, by regulation, a maximum patient
28 capacity which may not be exceeded by a PECC.
29 Section 8. Provisional license.
30 If there are numerous deficiencies or a serious specific
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1 deficiency in compliance with applicable statutes, regulations
2 or ordinances, the department may issue a provisional license
3 for a specified period of not more than six months, subject to
4 renewal three times at the discretion of the department, if the
5 department finds all of the following:
6 (1) The applicant is taking appropriate steps to correct
7 the deficiencies in accordance with a timetable submitted by
8 the applicant and agreed upon by the department.
9 (2) There is no cyclical pattern of deficiencies over a
10 period of two or more years.
11 Section 9. Expiration of license; renewal.
12 A license issued for the operation of a PECC, unless sooner
13 suspended or revoked, shall expire one year after the date of
14 issuance. At least 60 days before the expiration date, an
15 application for renewal must be submitted to the department. The
16 department shall renew the license, upon the filing of an
17 application on forms furnished by the department, if the
18 applicant has first met the requirements established under this
19 act and regulations promulgated pursuant to this act. The PECC
20 must file with the application satisfactory proof of financial
21 ability to operate and conduct the facility in accordance with
22 this act.
23 Section 10. Reasons for revocation or nonrenewal of license.
24 The department may refuse to renew a license or may suspend
25 or revoke or limit a license for all or any portion of a PECC,
26 or for any particular service offered by a facility, or may
27 suspend admissions for any of the following reasons:
28 (1) A serious violation of this act, of regulations for
29 licensure issued to this act or of Federal laws and
30 regulations. For the purpose of this paragraph a serious
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1 violation is one which poses a significant threat to the
2 health or safety of the children receiving services from the
3 PECC.
4 (2) Failure of a licensee to submit an acceptable plan
5 with a reasonable timetable to correct deficiencies.
6 (3) The existence of a cyclical pattern of deficiencies
7 over a period of two or more years.
8 (4) Failure, by the holder of a provisional license, to
9 correct deficiencies in accordance with a timetable submitted
10 by the applicant and agreed upon by the department.
11 (5) Fraud or deceit in obtaining or attempting to obtain
12 a license.
13 (6) Lending, borrowing or using the license of another,
14 or in any way knowingly aiding or abetting the improper
15 granting of a license.
16 (7) Incompetence, negligence or misconduct in operating
17 the PECC or in providing services to children.
18 (8) Mistreating or abusing children cared for by the
19 PECC.
20 (9) Serious violation of the laws relating to medical
21 assistance or Medicare reimbursement.
22 (10) Serious violation of other applicable Federal or
23 State laws.
24 Section 11. Operator violation.
25 If the department, upon inspection, investigation or
26 complaint, finds a violation of this act or regulations
27 promulgated by the department under this act or under Federal
28 law, it shall give written notice specifying the violation to
29 the PECC operator. The notice shall require the PECC operator to
30 take action or to submit a plan of correction that shall bring
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1 the PECC into compliance with applicable law or regulation
2 within a specified time. The plan of correction must be
3 submitted within ten days of receipt of the written notice or
4 sooner if directed to do so by the department. The department
5 may ban admissions or revoke a license before a plan of
6 correction is submitted if deficiencies pose a significant
7 threat to the health or safety of the children.
8 Section 12. Enforcement.
9 (a) Actions brought by the department.--If a person,
10 regardless of whether the person is a licensee, violates this
11 act or the regulations issued under this act, the department may
12 maintain an action in the name of the Commonwealth for an
13 injunction or other process restraining or prohibiting the
14 person from engaging in such activity.
15 (b) Civil penalty.--A person, regardless of whether the
16 person is a licensee, who has committed a violation of this act
17 or of a regulation issued under this act, including failure to
18 correct a serious licensure violation, as defined by regulation,
19 within the time specified in a deficiency citation, may be
20 assessed a civil penalty by an order of the department of up to
21 $500 for each deficiency for each day that the deficiency
22 continues. Civil penalties shall be collected from the date the
23 PECC receives notice of the violation until the department
24 confirms correction of such violation.
25 (c) Interest.--If a pediatric extended care center desires
26 to appeal any department action under this section, the PECC
27 shall pay the fine in order to receive the renewal license. If
28 the PECC wins the appeal and the fine is not upheld, the
29 department shall refund the fine plus interest at the legal
30 rate.
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1 (d) Amounts of fine.--In determining the amount of any fine,
2 the department shall consider the following factors:
3 (1) The gravity of the violation, including the
4 probability that death or serious physical or emotional harm
5 to a child will result or has resulted, the severity of the
6 actual or potential harm and the extent to which the
7 provisions of the applicable statutes or rules were violated.
8 (2) Actions taken by the owner operator to correct
9 violations.
10 (3) Any previous violations.
11 (4) The financial benefit to the pediatric extended care
12 center of committing or continuing the violation.
13 (5) Any other factor the department deems relevant.
14 Section 13. Closing of PECC.
15 (a) Notice.--Whenever a pediatric extended care center
16 voluntarily discontinues operation, it shall inform the
17 department in writing at least 30 60 days before the <--
18 discontinuance of operation. The pediatric extended care center
19 shall also, at such time, inform each child's parent or legal
20 guardian of the fact and the proposed time of such
21 discontinuance.
22 (b) Surrender license.--Immediately upon discontinuance of
23 the operation of a pediatric extended care center, the owner or
24 operator shall surrender the license therefor to the department,
25 and the license shall be canceled.
26 Section 14. Right of entry and inspection.
27 For the purpose of determining the suitability of the
28 applicants and of the premises or for determining the adequacy
29 of the care and treatment provided or the continuing conformity
30 of the licensees to this act and to applicable Federal, State
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1 and local regulations, an authorized agent of the department has
2 the right to enter, inspect and investigate the building,
3 grounds, equipment and supplies of a PECC licensed under this
4 act; to have access to the records of the PECC and to the
5 children and employees.
6 Section 15. Regulations.
7 (a) Standards.--Pursuant to the intention of the General
8 Assembly to provide safe and sanitary facilities and healthful
9 programs, the department may adopt and publish rules and
10 regulations to implement the provisions of this act, which shall
11 include reasonable and fair standards. Any conflict between
12 these standards and those that may be set forth in local, county
13 or city ordinances shall be resolved in favor of those having
14 Statewide effect. Such standards shall, at a minimum, include:
15 (1) Adoption and implementation of policies and
16 procedures which assure the health and safety of children.
17 (2) The maintenance of pediatric extended care centers
18 based upon the size of the structure and number of children,
19 relating to plumbing, heating, lighting, ventilation and
20 other building conditions, including adequate space, which
21 will ensure the health, safety, comfort and protection from
22 fire of the children served.
23 (3) The appropriate provisions of the "Life Safety Code"
24 (NFPA-101); the National Fire Protection Association
25 requirements and State building code requirements. This
26 paragraph applies to renovation and remodeling of a PECC.
27 (4) The number and qualifications of all personnel who
28 have responsibility for the care of the children served.
29 (5) All sanitary conditions within the pediatric
30 extended care center and its surroundings, including water
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1 supply, sewage disposal, food handling and general hygiene,
2 and maintenance thereof, which will ensure the health and
3 comfort of children served.
4 (6) Supportive, contracted, other operational and
5 transportation services. Staff providing transportation
6 services shall not be counted in direct caregiving staff
7 ratio under this paragraph.
8 (7) Maintenance of appropriate medical records, data and
9 information relative to the children and programs. Such
10 records shall be maintained in the facility for inspection by
11 the department.
12 (b) Requirements.--
13 (1) For emergency transportation, arrangements shall be
14 made with the county emergency transportation services. The
15 PECC shall assure that any child being placed in an ambulance
16 for transport for emergency services is accompanied by a
17 direct caregiver of the PECC who is familiar with the child's
18 treatment plan. The direct caregiver shall stay with the
19 child until the parent or legal guardian arrives to relieve
20 the direct caregiver of the PECC.
21 (2) The department shall require that the PECC has
22 employed an administrator whose qualifications are that of a
23 physician who has a current, active, unrestricted license in
24 this Commonwealth, a certified registered nurse practitioner
25 licensed to practice in this Commonwealth, a licensed nursing
26 home administrator, personal care home administrator, a child
27 day-care administrator or a registered nurse with five years
28 of documented experience in pediatric medicine. The
29 administrator shall be responsible for the operation of the
30 PECC.
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1 (3) The PECC shall employ or contract with a medical
2 director. The medical director's qualifications are that of a
3 physician who has a current, active, unrestricted license in
4 this Commonwealth with pediatric specialty board
5 certification or other postgraduate preparation acceptable to
6 the department or a certified registered nurse practitioner
7 licensed to practice in this Commonwealth with five years of
8 documented experience in pediatric medicine. The medical
9 director shall be responsible for the basic and supportive
10 services including medical, pharmaceutical and nursing
11 services provided by the PECC.
12 (4) A minimum of one supervisor shall be employed for
13 every six children. The supervisor may have direct caregiving
14 responsibilities and may be counted in the one direct
15 caregiving staff to every three children ratio. The
16 supervisor shall comply with all health care professional
17 licensing statutes and regulations promulgated by the
18 appropriate licensing boards. A supervisor shall hold a valid
19 professional license issued by the State Board of Medicine,
20 State Board of Nursing, State Board of Occupational Therapy
21 Education and Licensure, State Board of Osteopathic Medicine,
22 State Board of Pharmacy, State Board of Physical Therapy,
23 State Board of Podiatry or State Board of Examiners in
24 Speech-Language and Hearing.
25 (5) A minimum of one direct caregiving staff shall be
26 available for every three children at all times including the
27 transportation of the child for services not provided in the
28 PECC, but provided to the child while under the care of the
29 PECC. Direct caregiving staff must be a licensed practical
30 nurse, a registered nurse, a physical therapist, an
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1 occupational therapist, a speech language pathologist or an
2 individual who has a high school diploma or its equivalent
3 and at least one year of documented and supervised experience
4 in a health care or child-care setting. Additional staff may
5 provide other support services. Basic and supportive services
6 provided at a PECC shall comply with all health care
7 professional licensing statutes and any regulations
8 promulgated by the appropriate licensing boards.
9 (6) Each child shall have an individualized care plan
10 which is designed by the attending physician; the PECC
11 treatment team; a parent or legal guardian; and, when
12 appropriate, the child. The care plan shall be reviewed at
13 least monthly and revised as the child's care needs change.
14 Staffing shall be adequate to provide for the needs of each
15 child as identified on the child's care plan. For any child
16 enrolled in the early intervention program or the local
17 school district's program under the Individuals with
18 Disabilities Education Act (Public Law 91-230, 20 U.S.C. §
19 1400 et seq.), the PECC shall do all of the following:
20 (i) In the development of the care plan, consider
21 the components of the individualized family services plan
22 for children under four years of age or the
23 individualized education plan for children under nine
24 years of age. The PECC shall not duplicate services
25 already provided through the early intervention program
26 or the local school district.
27 (ii) Make available upon request by the early
28 intervention program or the local school district any
29 records necessary to develop, review or revise an
30 individualized family services plan or individualized
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1 education plan under Federal law.
2 (7) The PECC shall have a documented orientation program
3 which assures that employees and contract staff are
4 adequately trained to provide services to children.
5 (8) The PECC shall have a documented staff development
6 program that assures that employees and contract staff are
7 adequately trained to provide services to children.
8 (9) The PECC shall have a documented preventative
9 maintenance program with specific emphasis on assuring that
10 all durable medical equipment is functioning correctly and
11 safely so as to assure the health and safety of the children.
12 (10) The PECC shall have appropriate emergency services
13 readily available. These services may include an emergency
14 drug kit, a crash cart with a defibrillator appropriate for
15 children and any other emergency services as appropriate
16 based on the needs of the children served in the PECC.
17 (11) The PECC shall have arrangements with a licensed
18 pharmacist to provide consultation services for children
19 enrolled in the PECC.
20 (12) The director of the PECC shall assure that the
21 governing body has developed, approved and implemented
22 policies and procedures regarding the operation of the PECC.
23 At a minimum, the PECC shall have policies and procedures on
24 the prevention, reporting and investigation of abuse,
25 delivery of medical and therapeutic services, control and
26 delivery of pharmaceutical service and prevention of
27 incidents and accidents.
28 (13) The PECC shall have a written disaster plan which,
29 at a minimum, addresses natural disasters, financial
30 disasters, weather emergencies and bomb threats. A fire drill
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1 shall be conducted at least once every two months. A disaster
2 drill shall be practiced every month, and a full evacuation
3 shall occur at least once every six months.
4 (14) The PECC shall report any unusual incidents
5 immediately to the department. Unusual incidents include a
6 death, abuse or suspected abuse, rape, transfer to a hospital
7 as a result of injury or accident, child abduction or child
8 released to wrong family, fire on the premises, a need to
9 implement a disaster plan or receipt of a strike notice,
10 medical errors resulting in injury or harm to the child or
11 any knowledge of an unlicensed practice of a regulated
12 profession.
13 (15) The PECC shall maintain a log of all incidents and
14 accidents. At a minimum, the log shall include the date the
15 incident occurred, a description of the incident, the name of
16 the child involved in the incident and the name of the
17 employee involved in the incident. A system shall be
18 developed, documented and implemented to demonstrate evidence
19 that the incident or accident has been thoroughly
20 investigated and that any corrective action to avoid the
21 incident or accident in the future has been implemented.
22 (16) A PECC may not serve a child for more than 12 hours
23 within a 24-hour period.
24 (17) A PECC may only provide services to medically or
25 technologically dependent children.
26 (18) If, upon application to a PECC, the PECC has no
27 evidence of an application to the early intervention program
28 or the local school district, the PECC shall make a referral
29 for the family to the early intervention program or the local
30 school district, appropriate for the child's residence.
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1 (19) The operator and all employees and contract staff
2 of the PECC shall comply with 23 Pa.C.S. § 6344 (relating to
3 information relating to prospective child-care personnel).
4 (20) The PECC shall annually disclose to the department
5 and to the public the names of persons owning 5% or more of
6 the PECC as well as the PECC's officers and board members.
7 (21) All of the standards set forth in this section
8 shall apply at all times that the PECC is open and operating.
9 Section 16. Interim license.
10 Until such time as final rules and regulations are adopted
11 and published, the department shall operate the licensing
12 program pursuant to the standards established in this act.
13 Section 17. Penalty.
14 (a) Prohibited acts.--It is unlawful for any person or
15 public body to offer or advertise to the public, in any way or
16 by any medium, basic services as defined in this act without
17 obtaining a valid current license. It is unlawful for any holder
18 of a license issued pursuant to this act to advertise or hold
19 out to the public that it holds a license for a pediatric
20 extended care center other than that for which it actually holds
21 a license. Except as set forth in section 4(b)(1), it is
22 unlawful to operate or maintain a pediatric extended care center
23 without first obtaining from the department a license
24 authorizing such operation.
25 (b) Grading.--Any person who violates the provisions of
26 subsection (a) commits a misdemeanor of the second degree. Each
27 day of continuing violation shall be considered a separate
28 offense.
29 Section 18. Effective date.
30 This act shall take effect immediately.
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