PRIOR PRINTER'S NO. 148 PRINTER'S NO. 1641
No. 136 Session of 2003
INTRODUCED BY MOWERY, BOSCOLA, EARLL, ERICKSON, GREENLEAF, KASUNIC, KITCHEN, KUKOVICH, LEMMOND, MADIGAN, ORIE, TARTAGLIONE, THOMPSON, WAGNER, C. WILLIAMS, STACK AND PIPPY, FEBRUARY 3, 2003
SENATOR MOWERY, PUBLIC HEALTH AND WELFARE, AS AMENDED, MAY 18, 2004
AN ACT 1 Providing for the licensure of assisted living residences and <-- 2 services, for expansion of publicly funded home-based and 3 community-based assisted living services and for greater 4 information to the public about long-term care options; 5 expanding Medicaid-funded services under the Pennsylvania 6 State plan and through the expansion of home-based and 7 community-based services waivers; establishing a new State- 8 funded program of assisted living services to help consumers 9 bridge to eligibility under Medicaid; eliminating barriers 10 and financial disincentives to receiving home-based and 11 community-based assisted living services; conferring powers 12 and duties on the Department of Public Welfare, the 13 Department of Health and the Department of Aging; and making 14 an appropriation. 15 The General Assembly finds and declares as follows: 16 (1) Assisted living residences and community-based 17 assisted living services are a rapidly growing long-term care 18 alternative across the nation. 19 (2) Whereas there have been a number of instances of 20 consumer harm due to inadequate training or staffing, 21 Pennsylvanians want to know that they will receive quality 22 care from adequately and appropriately trained and
1 credentialed staff. 2 (3) Assisted living residences and home-based and 3 community-based assisted living services are widely accepted 4 by the general public because they allow people to age in 5 place, maintain their independence and exercise decision 6 making and personal choice. 7 (4) Consumers continue to say if they should need long- 8 term care services, the four things they want most are: 9 (i) To stay independent and live at home or in their 10 community as long as possible. 11 (ii) To be treated with respect and dignity. 12 (iii) To have a choice of long-term care and 13 supportive services options. 14 (iv) If they can no longer be maintained at home, 15 they want to be in as residential a setting as possible 16 where they can have their own private living unit. 17 (5) Medicare, Medicaid State plan services and most 18 private insurance pay for very little home-based and 19 community-based assisted living services or assisted living 20 residences and many Pennsylvanians cannot afford to pay for 21 themselves. 22 (6) It is often far less expensive to provide publicly 23 funded assisted living services in the home or in an assisted 24 living residence than to provide such services in a nursing 25 facility. 26 (7) Presently, Pennsylvania lags behind other states in 27 the imbalance of its public funding for nursing facility care 28 versus home-based and community-based services. 29 (8) Pennsylvania's publicly funded programs for home- 30 based and community-based services have complicated 20030S0136B1641 - 2 -
1 application forms, delays for assessment and approval and 2 inadequate assisted living services available for 3 Pennsylvanians needing long-term care services who wish to 4 remain in the community. 5 (9) Although Pennsylvanians wish to remain in the 6 community when they are in need of long-term care services, 7 they are generally unaware of what assisted living services 8 are available or of the availability of public funding for 9 those services other than in a nursing facility. 10 (10) Publicly funded home-based and community-based 11 services should meet consumers' needs, assist family 12 caregivers, permit consumers to live independently in the 13 residential environment of their choice, promote integration 14 of consumers into the community, maximize consumer choice to 15 promote and support the consumer's changing needs, be 16 consumer oriented and meet professional standards of quality. 17 (11) It is in the best interest of all Pennsylvanians 18 that the Commonwealth license assisted living residences and 19 services and establish a wider range of publicly funded home- 20 based and community-based assisted living services, make 21 information about these services widely available, streamline 22 and simplify the application and publicly funded services in 23 the community rather than a nursing facility and make these 24 services available in residential settings with the 25 availability of 24-hour services, if the consumer lives alone 26 and needs to move to such a setting. 27 PROVIDING FOR THE LICENSURE OF ASSISTED LIVING RESIDENCES AND <-- 28 SERVICES; AND CONFERRING POWERS AND DUTIES ON THE DEPARTMENT 29 OF PUBLIC WELFARE AND THE DEPARTMENT OF AGING. 30 THE GENERAL ASSEMBLY FINDS AND DECLARES AS FOLLOWS: 31 (1) ASSISTED LIVING RESIDENCES ARE A RAPIDLY GROWING 20030S0136B1641 - 3 -
1 LONG-TERM CARE ALTERNATIVE. 2 (2) LICENSING IS NEEDED TO ENSURE THAT PENNSYLVANIANS 3 RECEIVE QUALITY CARE FROM TRAINED AND CREDENTIALED STAFF. 4 The General Assembly of the Commonwealth of Pennsylvania 5 hereby enacts as follows: 6 Section 1. Short title. <-- 7 This act shall be known and may be cited as the Pennsylvania 8 Assisted Living Act. 9 Section 2. Definitions. 10 The following words and phrases when used in this act shall 11 have the meanings given to them in this section unless the 12 context clearly indicates otherwise: 13 "Abuse." One or more of the following acts: 14 (1) infliction of injury, unreasonable confinement, 15 intimidation or punishment with resulting physical harm, pain 16 or mental anguish; 17 (2) willful deprivation of goods or services by a 18 caretaker or assisted living provider or direct service staff 19 which are necessary to maintain physical or mental health; 20 (3) sexual harassment, rape or abuse as defined in 23 21 Pa.C.S. Ch. 61 (relating to protection from abuse); 22 (4) exploitation by an act or a course of conduct, 23 including misrepresentation or failure to obtain informed 24 consent which results in monetary, personal or other benefit, 25 gain or profit for the perpetrator or monetary or personal 26 loss to the consumer; 27 (5) neglect of the consumer which results in physical 28 harm, pain or mental anguish; or 29 (6) abandonment or desertion by a caretaker. 30 "Activities of daily living." Activities including eating, 20030S0136B1641 - 4 -
1 bathing, dressing, toileting, transferring in and out of bed or 2 in and out of a chair and personal hygiene. 3 "Adult." A person who is 18 year of age or older. 4 "Aging in place." The process of providing increased or 5 adjusted services to a person to compensate for the physical or 6 mental decline that occurs with the aging process in order to 7 maximize individual dignity and independence and permit the 8 person to remain in a familiar, noninstitutional, residential 9 environment for as long as possible. Such services may be 10 provided through residence staff, a third party, volunteers, 11 friends or family. 12 "Applicant." An individual who has expressed interest in 13 applying for residence in an assisted living residence or 14 obtaining services from an assisted living services provider. 15 "Area agency on aging." The local agency designated by the 16 Department of Aging within each planning and service area to 17 administer the delivery of a comprehensive and coordinated plan 18 of social and other services and activities. 19 "Assisted living." Services as determined and self-directed 20 by a consumer or by a legal representative that permit and 21 assist the consumer to live in a community, including such 22 housing assistance or residency in an assisted living residence 23 that permits the consumer to safely be supported in a residence 24 in which the consumer's independence, dignity and ability to 25 make choices are maintained, to the extent of the consumer's 26 capabilities. 27 "Assisted living residence." A residential setting that: 28 (1) Offers, provides and/or coordinates a combination of 29 personal care services, activities, whether scheduled or 30 unscheduled, and 24-hour supervision and health-related 20030S0136B1641 - 5 -
1 services for four or more consumers who are not related to 2 the operator. 3 (2) Has a service program and physical environment 4 designed to minimize the need for residents to move within or 5 from the setting to accommodate changing needs and 6 preferences. 7 (3) Has an organized mission, service programs and a 8 physical environment designed to maximize residents' dignity, 9 autonomy, privacy and independence and encourages family and 10 community involvement. 11 (4) Charges costs for housing and services which may be 12 independent of one another and that provides consumers with 13 the ability to choose their service provider and the services 14 to be provided. 15 (5) Has a goal of fostering aging in place and promoting 16 consumer self-direction and active participation in decision 17 making while emphasizing an individual's privacy and dignity. 18 The term does not include residential living units in continuing 19 care providers certified by the Insurance Department or 20 residential living units in subsidized housing apartments, 21 unless required to be licensed under the United States 22 Department of Housing and Urban Development Assisted Living 23 Conversion Program. 24 "Assisted living residency agreement." The contract or 25 contracts between a provider and a consumer regarding the 26 consumer's residency at the assisted living residence. The term 27 also includes the agreement between an assisted living residence 28 and an entity contracting for assisted living residence for the 29 consumer using public funding. 30 "Assisted living services." A combination of supportive 20030S0136B1641 - 6 -
1 services, personal care services, personalized assistance 2 services, assistive technology and health-related services 3 designed to respond to the individual needs of those who need 4 assistance with activities of daily living (ADLs) and 5 instrumental activities of daily living (IADLs). 6 "Assisted living services agreement." The contract or 7 contracts between a provider or providers and the consumer 8 needing assisted living services regarding the provision and 9 terms of the assisted living services. The term includes 10 contracts between assisted living service providers and entities 11 contracting for services for consumers using public funding. 12 "Assistive technology." Those devices and services, whether 13 medically necessary or not, that are used to increase, maintain 14 or improve the functional capabilities of individuals with 15 disabilities which may or may not be needed to permit the person 16 to live independently. The term shall include, but not be 17 limited to, hand reachers, adapted telephones, reading aids and 18 other nonmedical devices. 19 "Cognitive support services." Services provided as part of a 20 coordinated care plan to individuals who have memory impairments 21 and other cognitive problems that significantly interfere with 22 their ability to carry out activities of daily living without 23 assistance and who require that supervision, monitoring and 24 programming be available to them 24 hours a day, seven days a 25 week in order for them to reside safely in setting of their 26 choice, including assessment, service planning, ongoing 27 monitoring, personal care services, health support services and 28 a full range of dementia-capable activity programming and crisis 29 management. 30 "Compliance." A residence or assisted living service 20030S0136B1641 - 7 -
1 provider will be found in compliance with the requirements of 2 this act and its regulations where, but for isolated Class III 3 violations for which the assisted living residence administrator 4 has provided written certification of correction of the isolated 5 Class III violations within 30 days of the date of the 6 inspection, and has met all other requirements of this act and 7 its regulations. 8 "Comprehensive assessment." A thorough review and analysis 9 of a consumer's functional status. The term includes a personal 10 history, assessment of physical and emotional health, ability to 11 carry out activities of daily living, informal supports, 12 environmental factors and cognitive functioning, including 13 immobility assessment. 14 "Consumer." A person who receives assisted living services 15 in an assisted living residence, a home or other location 16 approved by the Department of Public Welfare. 17 "Department." The Department of Public Welfare of the 18 Commonwealth. 19 "Direct care staff." A person who directly assists residents 20 with activities of daily living, provides services or is 21 otherwise responsible for the health, safety and welfare of the 22 residents. Direct care staff must meet all training and testing 23 requirements of this act. 24 "Discharge." Termination of the consumer's residency in the 25 assisted living residence or of services from an assisted living 26 services provider. 27 "Federally Funded Home and Community Based Waiver Service 28 Slots and Services." The packages of services which are 29 Federally funded, in part, pursuant to a waiver of Title XIX of 30 the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.) 20030S0136B1641 - 8 -
1 and which are available in designated numbers to individuals 2 eligible for Pennsylvania medical assistance who qualify for the 3 nursing facility level of care but who elect home-based and 4 community-based services in lieu of institutionalization in a 5 nursing facility. 6 "Financial management." A service provided by an assisted 7 living residence or assisted living services provider with 8 budgeting and spending for the consumer's personal needs. 9 "Fair share first-day-medical assistance access formulae." 10 The percentage determined by the Department of Public Welfare of 11 those qualifying for publicly funded assisted living services 12 who were income eligible for medical assistance on the first day 13 they met the functional eligibility for publicly funded assisted 14 living services out of all those assessed as functionally 15 qualifying for assisted living services. 16 "Immobile person." An individual who is unable to move from 17 one location to another or has difficulty in understanding and 18 carrying out instructions without the continued full assistance 19 of another person or is incapable of independently operating a 20 device, such as a wheelchair, prosthesis, walker or cane to exit 21 to a point of safety. 22 "Instrumental activities of daily living." The term 23 includes, but is not limited to, preparing meals, taking 24 medication, using the telephone, handling finances, banking and 25 shopping, light housekeeping, heavy housekeeping and getting to 26 appointments. 27 "Isolated Class III violations." A finding by the Department 28 of Public Welfare at the annual inspection of less than three 29 Class III violations that had not been previously cited at the 30 last inspection and that related to the services provided to an 20030S0136B1641 - 9 -
1 individual or did not present a threat to the health and well- 2 being of consumers. 3 "Isolated violations." A finding by the Department of Public 4 Welfare on any inspection of less than three Class I, II or III 5 violations of separate and distinct provisions of the act or 6 regulations or less than two Class I, II or III violations of 7 the same provision of the act or regulations. 8 "Legal representative." A person duly authorized by law to 9 take certain action on behalf of a consumer, including, but not 10 limited to, legal counsel, a court-appoint guardian, an 11 attorney-in-fact under a durable power of attorney, an agent 12 under a health care proxy or a representative payee. In cases 13 where the consumer has a cognitive impairment, this may include 14 a responsible family member. 15 "Level-of-care screening." An assessment of a person's 16 functional abilities and general health status and family-friend 17 support system completed to determine the level of care and 18 services appropriate for the individual. 19 "Licensing information." Information relating to the 20 licensing agency, licensing process, and licensing status and 21 history of a provider. 22 "Living unit." A room, apartment, cottage or other self- 23 contained unit containing no fewer than 100 square feet per 24 person, which need not be shared except by choice of the 25 resident and which is capable of being locked by the resident, 26 with a readily available bathroom, toilet and sink and shower or 27 bath, space and electrical outlets for residents to have a small 28 microwave and refrigerator and a sleeping and living area unless 29 adjustments have been made to accommodate persons who are 30 significantly cognitively impaired. 20030S0136B1641 - 10 -
1 "Long-term care ombudsperson/ombudsman." An agent of the 2 Department of Aging who investigates and seeks to resolve 3 complaints made by or on behalf of older individuals or adults 4 with disabilities who are consumers of assisted living services 5 pursuant to section 2203-A of the act of April 9, 1929 (P.L.177, 6 No.175), known as The Administrative Code of 1929. Complaints 7 may relate to action, inaction or decisions of providers of 8 assisted living services or residences, of public agencies or of 9 social service agencies, or their representatives, which may 10 adversely affect the health, safety, welfare, interests, 11 preferences or rights of consumers. 12 "Options." The Long-Term Care Pre-admission Assessment 13 Program administered by the Department of Aging and operated by 14 the area agencies on aging. 15 "PACE." The Pharmaceutical Assistance Contract for the 16 Elderly. 17 "Pattern of violations." A finding by the Department of 18 Public Welfare at the annual inspection of any violations that 19 had been cited at one or both of the last two annual or other 20 consecutive inspections or of more than three distinct 21 violations of the same requirement. 22 "Pennsylvania Assisted Living Services Program" or "PALS." 23 The array of publicly funded home-based and community-based 24 assisted living services and other health and social services 25 benefits available to eligible consumers who have applied for 26 and been found to need these services. 27 "Personal care home." Any premises in which food, shelter 28 and personal assistance or supervision are provided for a period 29 exceeding 24 hours for four or more adults who are not relatives 30 of the operator, who do not require the services in or of a 20030S0136B1641 - 11 -
1 licensed long-term care facility but who do require assistance 2 or supervision in such matters as dressing, bathing, diet, 3 financial management, evacuation of a residence in the event of 4 an emergency or medication prescribed for self-administration. 5 "Personal care services." Assistance or supervision in 6 matters such as dressing, bathing, diet, financial management, 7 evacuation of the resident in the event of an emergency or 8 medication prescribed for self-administration. Personal care 9 services shall include prompting, cuing, monitoring and focusing 10 on maintaining functioning. 11 "Provider." An assisted living residence, assisted living 12 services provider, an approved personal care home or an approved 13 domiciliary care home. 14 "Publicly funded assisted living." Includes bridging, 15 medical assistance, HealthChoices, Options, waiver programs and 16 other appropriate publicly funded services that assist 17 individuals to remain in the community. 18 "Qualified assessor." A person approved by the Department of 19 Public Welfare as qualified to conduct assessments of persons 20 needing long-term care services and develop service plans based 21 thereon. A qualified assessor may include an employee of an area 22 agency on aging, an assisted living residence, an assisted 23 living services provider or an independent entity, but may not 24 include hospital discharge planners or other staff or employees 25 of an insured's health or long-term care insurance company. 26 "Qualified couple." A qualified couple for cost-of-living 27 increase is two qualified persons, living together, who are 28 considered a couple under the Supplemental Security Income 29 program, Title XVI of the Social Security Act (49 Stat. 620, 30 U.S.C. 301 et seq.). 20030S0136B1641 - 12 -
1 "Qualified person." A qualified person for cost-of-living 2 increase includes persons meeting the nonfinancial, categorical 3 eligibility requirements under Title XIX of the Social Security 4 Act (49 Stat. 620, U.S.C. 301 et seq.) as aged, blind or 5 disabled and receiving or applying for long-term care services 6 under a special income level. 7 "Resident." An individual who resides in and may receive 8 assisted living services from an assisted living residence or 9 from a personal care home or domiciliary care home approved by 10 the Department of Public Welfare. 11 "Responsible family member." A family member, such as a 12 spouse or adult child, who has been assisting the consumer and 13 to whom the consumer turns to for assistance. 14 "Restraint." A chemical or mechanical device used to 15 restrict the movement or normal function of an individual or a 16 portion of the individual's body, including geriatric chairs; 17 posey; chest; waist, wrist or ankle restraints; locked 18 restraints and locked doors to prevent egress. The term does not 19 include devices used to provide support for the achievement of 20 functional body position or proper balance as long as the device 21 can easily be removed by the resident. 22 "Restricted unit." A unit within a licensed assisted living 23 residence that has received a specialized license designation 24 pursuant to the requirements of this section and regulations of 25 the Department of Public Welfare to provide services to people 26 with cognitive impairments. 27 "Service plan." A detailed plan based on a comprehensive 28 assessment designed to meet the resident's individual physical, 29 mental and psychosocial needs consistent with the resident's 30 preferences and capabilities. 20030S0136B1641 - 13 -
1 "Specialty assisted living residence." A licensed assisted 2 living residence that has received a specialized license 3 designation pursuant to the requirements of this section and the 4 regulations of the Department of Public Welfare to provide 5 services to people with cognitive impairments. 6 "Stakeholders." The Medical Assistance Advisory Committee, 7 the Consumer and Long-Term Care Subcommittees of the Medical 8 Assistance Advisory Committee, the Intra-Governmental Council on 9 Long-Term Care, the Statewide Independent Living Council and the 10 Council on Aging. 11 "Transfer." Movement of a consumer within the assisted 12 living residence or to a hospital or other temporary placement. 13 For consumers receiving assisted living services in their home, 14 the term means movement between assisted living services 15 providers. 16 Section 3. Assisted living residences. 17 (a) Licensure.--The department shall license and regulate 18 living residences and shall establish an annual licensure fee 19 schedule. 20 (b) Physical site standards.--The department shall require 21 assisted living residences to meet all requirements of the act 22 of November 10, 1999 (P.L.491, No.45), known as the Pennsylvania 23 Construction Code Act. 24 (c) Level-of-care screening, assessment and comprehensive 25 service plan.-- 26 (1) Prior to admission to an assisted living residence 27 or start of services by an assisted living services provider, 28 a level-of-care screening to determine the level of care and 29 services needed by the applicant shall be obtained. A 30 standardized screening instrument developed by the Department 20030S0136B1641 - 14 -
1 of Aging in consultation with the Department of Public 2 Welfare and the Department of Health shall be used for all 3 screens. The area agency on aging shall be available to 4 conduct level-of-care screenings for applicants. Qualified 5 employees of assisted living residences or assisted living 6 services providers may conduct level-of-care screening but 7 shall inform individuals of the right to receive a screening 8 by an area agency on aging. 9 (2) A medical evaluation, using a form developed by the 10 Department of Public Welfare, the Department of Aging and the 11 Department of Health, shall be obtained by all applicants 12 prior to admission to an assisted living residence or start 13 of services by an assisted living provider. 14 (3) A qualified assessor must assess an individual's 15 care and service needs after the level-of-care screening has 16 determined a need for assisted living services or residency. 17 (i) The department shall develop a training and 18 certification program for qualified assessors. 19 (ii) Only those qualified assessors trained and 20 certified by the Commonwealth shall be permitted to 21 conduct assessments to identify the services an 22 individual requires and that serve as the basis for a 23 comprehensive service plan. 24 (iii) Assessors must certify that the assessment is 25 true and correct to the best of their knowledge and 26 skill. The department shall revoke the certification of 27 any long-term care assessor that falsely certifies a need 28 for services. 29 (iv) The qualified assessor must use a standardized 30 assessment instrument that shall be developed by the 20030S0136B1641 - 15 -
1 Department of Public Welfare, the Department of Aging and 2 the Department of Health, within six months of the 3 effective date of this act. 4 (v) When the area agency on aging is the chosen 5 assessor, the area agency on aging must complete an 6 assessment within five business days or, if there is an 7 expedited need, within one business day of the request 8 for an assessment. 9 (vi) Consumers shall have choice of assisted living 10 providers and be free to present a completed assessment 11 to any provider to compare services and price. 12 (vii) The department shall review provider's 13 compliance with the assessment provisions of this act as 14 part of the annual licensure inspection. 15 (viii) The area agency on aging shall assist any 16 assessed consumer found to need long-term care services 17 to seek public funding, where eligible, and to set up the 18 services if family members or friends are not available 19 to do so. 20 (4) Following completion of a comprehensive assessment 21 and prior to admission or start of services, an appropriately 22 trained person employed by the provider shall work in 23 cooperation with an interdisciplinary team that includes the 24 consumer, the consumer's legal representative or the 25 consumer's responsible family member, with the consumer's 26 consent, to develop a written comprehensive services plan 27 based on the comprehensive assessment and consistent with the 28 consumer's unique physical and psychosocial needs, with 29 recognition of the consumer's capabilities and preferences. 30 (5) Reassessment and revision of service plan, if 20030S0136B1641 - 16 -
1 necessary based on reassessment, will take place annually or 2 when there is a significant change in a consumer's condition. 3 (6) The comprehensive assessment and comprehensive 4 services plan shall be kept on file for each consumer by the 5 provider and shall be available to the consumer or the 6 consumer's legal representative. 7 (d) Assisted living residence administrator qualifications 8 and training.-- 9 (1) An assisted living residence administrator shall 10 satisfy either of the following qualifications: 11 (i) Be at least 21 years of age and meet the 12 requirements of Chapters 5 and 7 of the act of November 13 6, 1987 (P.L.381, No.79), known as the Older Adults 14 Protective Services Act, regarding criminal history. 15 (ii) Have a high school diploma or a general 16 educational development diploma (GED). 17 (iii) Complete an education and training course 18 which has been approved by the department of not less 19 than 120 hours. The department shall establish a training 20 curriculum that shall include comprehensive training in 21 areas appropriate to the care and health of residents in 22 an assisted living residence, including, but not limited 23 to: 24 (A) Training in assistive technology. 25 (B) Training in working with persons with 26 cognitive impairments. 27 (C) Training in assisted living principles and 28 laws. 29 (D) Training in medication assistance. 30 (E) Consumer rights. 20030S0136B1641 - 17 -
1 (2) The department shall develop a shorter program of 2 instruction for licensed nursing home administrators, 3 nationally accredited retirement housing professionals or 4 NAB-licensed assisted living administrators that does not 5 duplicate areas where proficiency has been demonstrated but 6 that is particular to assisted living in this Commonwealth. 7 (3) All administrators shall pass a test which has been 8 approved by the department and is administered by an entity 9 approved by the department at the end of training to 10 demonstrate proficiency in the application of skills and 11 knowledge. 12 (4) All administrators shall complete 36 hours of 13 continuing education every two years that has been approved 14 by the department and is applicable to the practice of 15 assisted living administrator. Coordinating education program 16 shall include training and competency testing. 17 (5) One year after the effective date of this act, no 18 one shall be employed as an assisted living administrator 19 unless they have completed the training and testing 20 requirements herein. 21 (e) Direct care and other staff qualifications and 22 training.-- 23 (1) Direct care staff in an assisted living residence or 24 of an assisted living services provider must meet the 25 following qualifications: 26 (i) Be either at least 18 years of age with a high 27 school diploma or 17 years of age with a high school 28 diploma and meet the requirements of the Older Adult 29 Protective Services Act regarding criminal history. 30 (ii) Complete an education and training course which 20030S0136B1641 - 18 -
1 has been approved by the department for a minimum of 40 2 hours and obtain a certificate of completion. The 3 department shall establish a training curriculum. Direct 4 care staff of assisted living residences and assisted 5 living services providers must demonstrate proficiency in 6 a manner approved by the department in each component 7 prior to start of independent work in that component. 8 Approved coursework shall include comprehensive training 9 in areas appropriate to the care and health of assisted 10 living residents and recipients, including, but not 11 limited to: 12 (A) Training in assistive technology. 13 (B) Training in working with persons with 14 cognitive impairments. 15 (C) Training in assisted living principles and 16 laws. 17 (D) Consumer rights. 18 (2) The department shall develop a shorter program of 19 instruction for nurse assistants deemed competent that does 20 not duplicate areas where proficiency has been demonstrated 21 but that is particular to assisted living in this 22 Commonwealth. 23 (f) Direct care staff assisting residents with medication.-- 24 Within six months of the effective date of this act, the 25 department shall: 26 (1) Develop a special training and certification program 27 or expand its current medications administration course for 28 direct care staff that assist residents with medication. The 29 program shall include testing and demonstrated proficiency. 30 (2) Establish regulations permitting only those who have 20030S0136B1641 - 19 -
1 completed and passed the training on assisting with the 2 administration of medication to do so in assisted living 3 residences or as an assisted living service provider. 4 (g) Other assisted living residence staff.--Within 30 days 5 of employment or start of voluntary service, staff persons and 6 volunteers shall receive orientation to the general operation of 7 the assisted living residence, training in fire prevention, 8 operation of safety equipment, emergency procedures and 9 evacuation of residents. 10 (h) Exemptions.--Existing personal care home staff employed 11 by personal care homes that apply for and become licensed as 12 assisted living residences have one year from the date of 13 application to complete the direct care staff training except 14 that those who have been working as direct care staff for more 15 than 24 months can opt not to take the training provided they 16 demonstrate proficiency in each training component within one 17 year of the personal care home becoming an assisted living 18 residence. 19 (i) Staffing levels.-- 20 (1) The department shall establish minimum staffing 21 levels for assisted living residences, restricted units and 22 specialty assisted living residences depending upon the 23 residence population, mobility of residents and cognitive 24 impairments to ensure adequate 24 hours a day awake direct 25 care staff to meet the unplanned and unscheduled needs of 26 residents. 27 (2) The department shall require each assisted living 28 residence to maintain adequate additional direct care staff 29 to meet the residents' planned and scheduled needs as 30 required in their service plans as well as to ensure a safe 20030S0136B1641 - 20 -
1 and efficient evacuation to a place of safety in case of 2 emergency. Each assisted living residence shall have as a 3 minimum the staff necessary to meet the hours of care set 4 forth in the service plans and the staffing requirements of 5 paragraph (1). 6 (3) Additional staff or contracted services shall be 7 provided as necessary to meet laundry, food service, 8 housekeeping, transportation and maintenance needs of the 9 assisted living residence. 10 (j) Supplemental services.--A resident receiving assisted 11 living services in an assisted living residence may arrange for 12 the receipt of supplemental services where: 13 (1) the supplemental services adequately meet the 14 residents changing needs so that the assisted living 15 residence is not required to fundamentally change its program 16 or residence to accommodate the resident; and 17 (2) the supplemental services are provided by: 18 (i) a licensed entity or an area agency on aging; or 19 (ii) an unlicensed provider, permitted by specified 20 criteria and conditions of the department to provide 21 supplemental services agreed to by resident and assisted 22 living services provider. 23 (k) Transfer and discharge.-- 24 (1) A resident may not be transferred or discharged 25 without consent, except for nonpayment of contractual fees 26 after a good faith effort to obtain payment unless: 27 (i) the person has one of the conditions determined 28 by the department; 29 (ii) to accommodate the consumer's needs would 30 require the assisted living residence to fundamentally 20030S0136B1641 - 21 -
1 change the basic program or building modification; 2 (iii) the person is a danger to self or others; or 3 (iv) transfer to a hospital or treatment facility is 4 necessary to meet the consumer's needs and the resident's 5 needs cannot be maintained in the assisted living 6 residence. 7 (2) The assisted living residence must insure that the 8 transfer or discharge is safe, orderly and appropriate to the 9 resident's needs. 10 (l) Notices.--The assisted living residence must provide 30 11 days' advance written notice of changes in policies, services or 12 costs and of intent to transfer or discharge a resident. Written 13 notice must include the reason for the transfer or discharge, 14 the effective date of the transfer or discharge, the location to 15 which the consumer is being transferred or discharged, if known, 16 a statement that the resident has the right to appeal to the 17 department and the contact information for the Long-Term Care 18 Ombudsman and the department's 24-hour hotline. 19 (m) Dispute resolution.--Consumers may seek resolution of 20 disputes in the following ways and selection of one option does 21 not preclude simultaneous or subsequent selection of the other: 22 (1) The department's hearing and appeals bureau will 23 hear complaints and appeals through its fair hearing process. 24 (i) Appeal hearings must include notice, opportunity 25 to be heard, impartial review and prompt decision. 26 (ii) Assisted living residents may appeal decisions 27 regarding: 28 (A) Whether discharge or transfer is 29 appropriate. 30 (B) Whether accommodations would fundamentally 20030S0136B1641 - 22 -
1 alter the program or residence. 2 (C) Whether supplemental services provider is 3 unsafe. 4 (D) What level of care is appropriate. 5 (2) Each provider shall maintain an internal process for 6 resolving consumer complaints and grievances. 7 (3) The department shall develop an expedited hearing 8 process for review of department, consumer or provider 9 actions. 10 (n) Written agreements.--The department shall require as a 11 condition of licensure that all providers shall have an assisted 12 living residency agreement in writing with each consumer. Each 13 agreement should be signed prior to admission or start of 14 services or no later than 24 hours after admission and shall 15 include in clear and simple language the following: 16 (1) Standardized clauses provided by the department on: 17 (i) The consumer's rights. 18 (ii) Negotiated risk, if appropriate. 19 (iii) The Commonwealth's processes for resolving 20 disputes under the contract. 21 (iv) Explanation of the screening, assessment and 22 annual reassessment requirements. 23 (v) The available financial management services a 24 provider may or may not provide. 25 (vi) A prohibition on resident assignment of assets 26 for life to the assisted living residence. 27 (vii) If a resident is receiving publicly funded 28 care and services, details about Social Security Income 29 recipient protections, rent rebate programs and the 30 personal needs allowance. 20030S0136B1641 - 23 -
1 (viii) Explanation of the right to continued 2 residency in an assisted living residence as provided in 3 this act. 4 (ix) Applicant's right to cancel without penalty an 5 assisted living residency agreement within 72 hours of 6 signing. 7 (x) Requirement that consumer receive 30 days' 8 advance written notice of changes to contract, to the 9 charges of the provider and to the provider's policies. 10 (xi) The bases under which a consumer or provider 11 may terminate the agreement. 12 (xii) Contractual enforcement rights of the parties. 13 (2) At a minimum, the provider shall include the 14 following in the agreement: 15 (i) The provider's list of services offered. 16 (ii) By addendum or otherwise, individualized 17 itemization of services that will be provided to the 18 resident and costs thereof, separating housing costs from 19 service costs. 20 (iii) Provider policies. 21 (iv) Internal dispute resolution process. 22 (v) Clear and specific occupancy criteria and 23 procedures, based on Commonwealth requirements and 24 assisted living residence's policies regarding bedholds 25 and refunds. 26 The department shall review contracts at site visits for 27 compliance with this section and the provisions of this act and 28 its regulations. 29 (o) Disclosure.--Each consumer or the consumer's legal 30 representative or responsible family member shall receive an 20030S0136B1641 - 24 -
1 information packet at the time of application for admission or 2 start of services which shall include the following items to be 3 presented in a form able to be easily understood and read by the 4 consumer: 5 (1) A standardized form developed by the department with 6 information pertaining to: 7 (i) The use of advance directives during residency. 8 (ii) Information regarding how to contact and obtain 9 what is required by the licensing agency for providers. 10 (iii) Information about availability and access to 11 and contact information for the ombudsman and the 12 department's 24-hour hotline. 13 (iv) Details about the department's external 14 complaint mechanisms available to consumers. 15 (v) General information about the admission and 16 application process. 17 (vi) Details about the applicant's rights to 18 independent assessment and nondiscrimination in the 19 application process. 20 (vii) Consumer rights. 21 (2) Documentation from the provider to provide the 22 applicant with the following information: 23 (i) A copy of the provider's policies affecting 24 consumers, including discharge or termination or 25 bedholds. 26 (ii) Information regarding the department's 27 inspections and inspection reports demonstrating 28 provider's licensing status. 29 (iii) Complete copy of the assisted living residence 30 agreement, including all attachments and all current 20030S0136B1641 - 25 -
1 rates that may be charged. 2 (iv) Details about the internal complaint mechanism 3 used by the provider. 4 (v) Provider's specific admission and application 5 process. 6 (vi) Information on discharge policies. 7 (p) Housing and services.-- 8 (1) Assisted living residences shall separately charge 9 for housing and services. 10 (2) Residents who have been assessed as needing personal 11 care services may be required by the assisted living 12 residence to receive those services from the assisted living 13 residence as a condition of admission to the assisted living 14 residence. 15 (3) No resident shall be required to pay for services 16 not needed, as indicated in their initial or annual 17 assessment. 18 (4) Services other than those identified in paragraph 19 (2), including, but not limited to, home health, massage, 20 physician services and physical therapy services, can be 21 purchased by the resident from the assisted living residence 22 or from an outside provider, unless to accommodate the person 23 would require the assisted living residence to fundamentally 24 change the basic program or building and to do so would put 25 in jeopardy the life and safety of persons in the assisted 26 living residence. 27 (5) If the resident arranges for services other than 28 those identified in paragraph (2) from unlicensed persons or 29 those not on the area agency provider list, the assisted 30 living residence may screen providers but shall not 20030S0136B1641 - 26 -
1 unreasonably deny their access to the resident's living unit. 2 (q) Living unit.--Assisted living residences shall provide 3 residents with their own individual living units, which shall 4 include a sleeping and living area, shared only with the consent 5 of the residents in the unit. A bathroom must be readily 6 available for each resident. One bathroom can be shared between 7 adjacent living units. Except for residents with cognitive 8 impairments, each living unit must provide space and electrical 9 outlets for residents to have small microwaves and 10 refrigerators. Each living unit shall contain no fewer than 100 11 square feet per resident. Each living unit shall have 12 individually lockable doors, except where inappropriate for 13 individuals with cognitive impairments. 14 (r) Department of Aging.--The Department of Aging shall take 15 steps to extend the provisions of the Older Adults Protective 16 Services Act to assisted living residences and consumers. The 17 Department of Aging shall insure that the ombudsman program is 18 made available to assisted living residences and recipients. 19 (s) Contact information.--The department shall require 20 assisted living residences to post contact information for the 21 local ombudsman and shall make available a 24-hour toll-free 22 hotline for consumers to use in contacting the department with 23 questions, concerns and complaints about their care and 24 services. 25 Section 4. Assisted living residences providing cognitive 26 support services. 27 (a) Special designation.--Within six months of the effective 28 date of this act, the department shall establish a special 29 license designation for assisted living residences that wish to 30 maintain restricted units or to be specialized for the purpose 20030S0136B1641 - 27 -
1 of serving individuals with cognitive impairments. Only those 2 assisted living residences that receive this special license 3 designation may have or hold themselves out as having 4 specialized units or specialized purpose. This special 5 designation shall require that the assisted living residences 6 meet all the requirements for assisted living residences set 7 forth in this act and resulting regulations and additional 8 requirements that address: 9 (1) Special admission and transfer criteria. 10 (2) Adequate indoor and outdoor wandering space 11 requirements. 12 (3) Requirements relating to provision of therapeutic 13 activities that meet the scheduled and unscheduled individual 14 needs of each resident, with such services focusing on 15 maximizing independence and on the individual's strengths and 16 abilities. 17 (4) Physical design and safety requirements. 18 (5) Additional and specialized training requirements. 19 (6) Prearranged procedures for notification of 20 authorities should a resident wander away from the residence. 21 (b) Admission or transfer to specially designated unit or 22 specialty assisted living residence.--Assisted living residences 23 should be able to support residents with cognitive impairments 24 if or until the person's needs are such that they are a danger 25 to themselves or others and accommodation would require the 26 assisted living residence to fundamentally change the basic 27 program or building. 28 (1) When either of these conditions are met and if this 29 is reflected in an annual or other assessment, the resident 30 may be transferred to a specialized, restricted unit or 20030S0136B1641 - 28 -
1 specialty assisted living residence or may be requested to 2 leave. 3 (2) Before a person may be transferred or admitted to a 4 specially designated restricted unit or a specially 5 designated specialty assisted living residence: 6 (i) The person, responsible family member or person 7 with legal authority, if any, must be advised of the 8 assisted living residence's intent to discharge or 9 transfer with 30 days' advance written notice and of 10 resident's right to seek an assessment from the area 11 agency on aging or other individual who is independent 12 from the assisted living residence and of the resident's 13 right to appeal to the department or use the internal 14 grievance process to address the appropriateness of 15 restricted movement, or both. The 30-day notice 16 requirement shall not apply, but the provider shall give 17 as much advance notice as possible where transfer or 18 discharge is necessary to meet a consumer's urgent or 19 emergency medical needs or in emergency situations where 20 there is a danger to consumers or others. 21 (ii) A physician must approve the transfer to a 22 restricted unit or admission to a specialized assisted 23 living residence, and the resident or individual with 24 legal authority to act for the resident must sign off on 25 the transfer or admission. 26 (iii) Where neither the resident, the resident's 27 responsible family member nor anyone with legal authority 28 signs to authorize the transfer or discharge, the 29 assisted living residence must refer the matter to the 30 local agency charged to administer the act of November 6, 20030S0136B1641 - 29 -
1 1987 (P.L.381, No.79), known as the Older Adults 2 Protective Services Act, for review. 3 (3) The department shall, through its inspection 4 process, review transfer and discharge cases that are based 5 on cognitive impairments for compliance with this provision. 6 (c) Administer training.--Administrators working in special 7 license designation restricted units or specialized assisted 8 living residences must be trained and tested in a program 9 approved by the department in training areas developed by the 10 department in consultation with stakeholders on issues relating 11 to providing care and services to cognitively impaired 12 individuals. This training shall be in addition to that required 13 under section 3. 14 (d) Staff training.--All direct care staff wishing to work 15 in specially designated restricted units or specialty assisted 16 living residences shall, in addition to the training required of 17 direct care staff in section 3, receive additional specialized 18 training approved by the department in training areas 19 established by the department in consultation with stakeholders 20 relating to providing care and services to cognitively impaired 21 individuals. 22 (e) Disclosures.--Assisted living residences with specially 23 designated restricted units or that are specialty assisted 24 living residences must, in addition to the disclosures required 25 under section 3: 26 (1) Provide each applicant with a standardized 27 disclosure form designed by the department in consultation 28 with stakeholders describing the requirements that must be 29 met by a restricted unit or specialty assisted living 30 residence which shall include, but not be limited to, the 20030S0136B1641 - 30 -
1 philosophy and mission of serving individuals with cognitive 2 impairments, the requirements for physical space, wandering 3 space, therapeutic activities, additional training and 4 security, that must be met for special designation. 5 (2) A representation that the residence meets the 6 special licensure designation, including a description of the 7 frequency and types of individual and group activities, 8 security measures and family support programs. 9 (f) Accreditation.--If national accreditation of specialty 10 assisted living units becomes available with standards that 11 equal or exceed those in this act and supporting regulations, 12 the department may deem that an accredited assisted living 13 residence meets the special licensing designations under this 14 section. 15 (g) Staffing levels.--Staffing levels will be set in 16 accordance with the staffing levels required under section 3. 17 However, if an assisted living residence has national 18 accreditation which has higher staffing requirements, the 19 residence shall meet the higher requirements. 20 Section 5. Assisted living services providers. 21 (a) Licensure.--The Department of Health shall license 22 entities that are not already licensed by the department that 23 either coordinate and provide, or coordinate and subcontract for 24 provisions of assisted living services. 25 (b) Application.-- 26 (1) Within six months of the effective date of this act, 27 the department shall license assisted living services 28 providers. Assisted living services providers shall be 29 licensed and bonded, and a licensure fee shall be applied. 30 (2) Direct care staff employed by assisted living 20030S0136B1641 - 31 -
1 services providers or providing direct care services to 2 consumers in their homes shall meet all training and testing 3 requirements of this act and present documentation from the 4 State of completed training and testing to employers and 5 consumers. Passing a criminal history check shall be a 6 prerequisite to training and testing. 7 (3) Family or friend caregivers shall be exempt from the 8 requirements of this act. 9 (4) Entities that do not provide personal care services, 10 but that solely provide assistance with instrumental 11 activities of daily living shall be exempt from the 12 requirements of this act. 13 (c) Requirements.-- 14 (1) Assisted living services providers shall be subject 15 to the disclosure and contract requirements set forth in 16 section 3 to the extent applicable to assisted living 17 services providers. 18 (2) Direct care staff shall provide assisted living 19 services consumers with 30 days' advance written notice, 20 where possible, of interruption or termination of service 21 delivery, except where the safety of the direct care staff is 22 at risk. Direct care staff shall be included under the 23 reporting requirements of older adult protective services 24 review. Direct care staff found to be in violation of the 25 advance notice provision of this section may be sanctioned by 26 the department and have their documentation of training 27 necessary for employment withdrawn. 28 (3) All consumer rights specified in section 6 shall 29 apply to consumers of assisted living services providers 30 unless the right is specific to residency. The department 20030S0136B1641 - 32 -
1 shall craft a standardized assisted living service disclosure 2 from such as the one required in section 3 for assisted 3 living residences. As a condition of licensure, all assisted 4 living services providers must provide consumers and 5 applicants with the department's standardized disclosure form 6 of consumers rights. 7 (d) Inspection.--The department shall conduct annual 8 unannounced inspections of assisted living services providers 9 and shall include visits to and interviews of a random sample of 10 consumers as part of the inspection process. 11 Section 6. Consumer rights. 12 (a) Regulations.--Consumers shall have the following rights 13 which shall attach upon admission to an assisted living 14 residence or start of service receipt from an assisted living 15 services provider and the department shall promptly implement 16 regulations to insure these rights: 17 (1) With respect to management of funds: 18 (i) There shall be no commingling of the residence's 19 and residents' funds. 20 (ii) Assisted living residences shall maintain 21 residents' funds in accounts separate from those of the 22 residence. 23 (iii) When a residents' funds exceed $200, the 24 assisted living residence must offer the resident an 25 opportunity to have the funds placed in an interest- 26 bearing account. 27 (iv) The assisted living residence must keep 28 individual records of individual moneys. 29 (v) Residents are only required to deposit funds 30 with an assisted living residence if they are accepting 20030S0136B1641 - 33 -
1 financial management services. 2 (vi) The department shall develop a means of 3 safeguarding residents' funds and requiring prompt 4 repayment by the assisted living residence of funds that 5 are stolen by residence employees, subcontractors or 6 otherwise mismanaged. 7 (vii) Residents shall have prompt access to funds. 8 (viii) Residents shall receive quarterly statements 9 from assisted living residences holding their funds. 10 (ix) Upon death or discharge, the assisted living 11 residence is required to repay funds to estate or 12 resident within five business days. 13 (x) Assisted living residence staff must obtain 14 written permission for expenditures from the consumer of 15 legally responsible person and keep receipts of 16 expenditures. 17 (xi) No provider or staff of provider or individual 18 affiliated with the provider may assume power of attorney 19 or guardianship over any resident. However, the 20 department shall come up with a process for allowing 21 guardianship in emergency situations where the consumer 22 is unable to authorize and where there is no existing 23 legal representative or the legal representative cannot 24 be reached. 25 (xii) No resident may be required to endorse checks 26 over to the assisted living residence. 27 (2) Each consumer has the right to: 28 (i) Be involved in service planning process and to 29 receive services with reasonable accommodation of 30 individual needs and preferences except where the health 20030S0136B1641 - 34 -
1 or safety of the individual or other residents would be 2 endangered. 3 (ii) Have privacy, confidentiality and freedom from 4 abuse, neglect and financial exploitation. 5 (iii) Refuse treatment or services under the plan. 6 (iv) Receive from the assisted living residence 30 7 days' advance written notice of the assisted living 8 residence's proposed changes to charges and policies and 9 of the intent of the residence to transfer or discharge 10 the resident, except where transfer is necessary to meet 11 consumer's urgent or emergency medical needs or where 12 immediate risk of harm to consumer or others warrants 13 shorter notice. 14 (v) Be free from physical or chemical restraints. 15 (vi) Be free from unreasonable interference with 16 right to leave and return, have visitors, send and 17 receive mail, and participate or not participate in 18 religious activities. 19 (vii) Receive a qualified assessment by someone not 20 associated with the residence. 21 (viii) Be entitled to residency and services 365 22 days a year, with no planned or intermittent 23 interruptions. 24 (ix) Access the ombudsman and the department's 24- 25 hour hotline. 26 (x) Be free from discrimination on the basis of 27 race, color, religious creed, disability, handicap, 28 ancestry, sexual orientation, national origin, age or 29 sex. 30 (xi) Be free from any duration of stay requirements 20030S0136B1641 - 35 -
1 prior to public funding. 2 (xii) Select a doctor or other health care provider 3 of the consumer's choice. 4 (xiii) Reside and receive services with reasonable 5 accommodation of individual needs and preferences except 6 where health, safety, or rights of individual or other is 7 endangered and does not change the nature, etc., of the 8 assisted living residence. 9 (xiv) Review inspection and complaint survey and 10 inspection results conducted by the department. 11 (xv) Exercise all rights as a citizen, including, 12 but not limited to, the right to vote, the right to voice 13 grievances with respect to services without retaliation 14 and to organize and participate in resident and family 15 groups. 16 Section 7. Survey, inspection and enforcement process. 17 (a) Licensure and inspection.--The appropriate department 18 shall license and inspect all assisted living residences and 19 assisted living services providers at least annually. Licensure 20 fees shall be established and funds from such fees shall be 21 employed to defray the costs of enforcing the provisions of this 22 act. 23 (1) The appropriate department shall establish and make 24 public specific, objective guidelines for inspectors to 25 employ in the inspection of assisted living residences and 26 assisted living services providers. Inspectors shall be 27 adequately trained in the intention and interpretation of 28 inspection guidelines to ensure consistent application of 29 legal requirements. Each department shall ensure adequate, 30 trained staff and provide annual continuing education courses 20030S0136B1641 - 36 -
1 to inspection staff. 2 (2) There shall be four classes of licensure as follows: 3 (i) Exceptional quality licensure will be awarded to 4 providers based on a finding by a panel established by 5 each department that the provider is in compliance with 6 licensure requirements and should be recognized for its 7 use of best practices and high consumer satisfaction and 8 positive outcomes. Providers with this licensure 9 classification may advertise and each department shall 10 post names of those providers with this licensure 11 classification on its web site. 12 (ii) Compliance licensure will be provided to 13 providers with either no violations or isolated Class III 14 (minor) violations which the administrator or provider 15 has certified in writing to the appropriate department 16 have been corrected within 30 days of the date of the 17 annual licensure inspection. 18 (iii) Provisional licensure will be given to 19 providers with a pattern of Class III (minor) violations 20 or isolated Class II violations for a period of six 21 months. Substantial improvement must be demonstrated for 22 a provider to receive a second six-month provisional 23 license. Those providers which do not meet the standards 24 for a compliance license at the next scheduled inspection 25 shall have their license revoked by the appropriate 26 department. 27 (iv) Provisional licensure with ban on admissions 28 will be given for a six-month period to providers with a 29 pattern of Class II, isolated Class I or a pattern of 30 Class I violations such that new consumers may not be 20030S0136B1641 - 37 -
1 admitted or provided services by the provider with this 2 licensure status. 3 (3) Before an assisted living residence is licensed and 4 permitted to open, operate or admit residents and before an 5 assisted living services provider is permitted to provide 6 services to consumers, it shall be inspected by the 7 appropriate department and must be found in compliance with 8 the requirements set forth in this act and the resulting 9 regulations. 10 (4) After initial licensure inspection, survey staff 11 shall, at a minimum, conduct one onsite unannounced 12 inspection per year. Each department shall develop a uniform 13 survey tool to be used by inspectors. 14 (5) Within 24 hours, upon receipt of a complaint from 15 any person alleging an immediate serious risk to the health 16 or safety of a consumer, the appropriate department shall 17 conduct an onsite unannounced inspection of the provider. 18 Complaints prompting an inspection pursuant to this 19 subsection may include severe injury or death of a consumer, 20 reports of abuse or conditions or practices that cause an 21 immediate and serious risk to a consumer. Complaints shall be 22 investigated immediately but no later than 48 hours after 23 receipt of the complaint. 24 (6) Each department shall develop requirements for the 25 preinspection provision of information and documents by the 26 provider on the annual anniversary of initial licensure, to 27 be reviewed by the appropriate department's inspectors prior 28 to the onsite inspection. 29 (7) Within six months of the passage of this act, each 30 department shall develop a time line and work plan to be used 20030S0136B1641 - 38 -
1 to develop quality indicators of care and consumer 2 satisfaction surveys that will be used as part of the annual 3 inspection process. The quality indicators of care and 4 consumer satisfaction surveys shall be developed in 5 consultation with stakeholders and shall be placed within 24 6 months of the passage of this act. 7 (8) Each department shall develop a provider survey 8 instrument to obtain provider feedback on the inspection 9 process. The survey instrument shall be sent in the 10 preinspection submission information to be returned to the 11 deputy secretary of the appropriate department by the 12 provider after the onsite inspection. 13 (9) After three annual unannounced inspections resulting 14 in compliance or exceptional quality licensure status, a 15 provider shall receive abbreviated inspections for as long as 16 it maintains compliance or exceptional quality licensure 17 status. The appropriate department shall develop an 18 abbreviated inspection process. 19 (10) As provided in section 7(b), assisted living 20 residences not in compliance with the requirements of this 21 act and its regulations shall be subject to intensified 22 inspections which shall include intensified frequency, 23 duration and scope. 24 (11) There shall be no transfer of license unless the 25 appropriate department approves the transfer of license. The 26 appropriate department may deny transfers to friends, 27 relatives, business associates, etc., if it appears that 28 purpose of transfer is to avoid licensure action or it 29 appears that the previous owner will continue to have 30 involvement in the residence or business. 20030S0136B1641 - 39 -
1 (b) Violations.-- 2 (1) Within six months of the effective date of this 3 section, the Department of Public Welfare and the Department 4 of Health shall classify each violation of its regulations 5 into one of the following categories: 6 (i) Class I. A violation, including failure to or 7 negligent provision of services in the service plan, 8 which indicates a substantial probability that death or 9 serious mental or physical harm to a consumer may result 10 or death actually results. 11 (ii) Class II. A violation, including failure to or 12 negligent provision of services in the service plan, 13 which has a potential or actual substantial adverse 14 effect upon the health, safety or well-being of a 15 consumer. 16 (iii) Class III. A minor violation which has an 17 adverse effect upon the health, safety or well-being of a 18 consumer. 19 (2) The remedy and penalty for violations will depend on 20 the violations. 21 (i) Isolated Class III violation. Within 30 days of 22 the date of the citation, the assisted living residence 23 administrator or assisted living services provider must 24 correct the violation and certify in writing to the 25 appropriate department that the violation has been 26 corrected. 27 (ii) Pattern of Class III violations. Within ten 28 days of the date of the citation, the assisted living 29 residence administrator or assisted living services 30 provider must submit a plan of correction for appropriate 20030S0136B1641 - 40 -
1 department approval. Within 30 days of the date of the 2 citation, the assisted living residence administrator or 3 assisted living services provider must correct the 4 violations and certify in writing to the appropriate 5 department that corrections have been made. The 6 appropriate department shall issue fines and grant a 7 provisional license, which shall be in effect only until 8 written certification of corrections has been received by 9 the appropriate department. Immediate correction of the 10 violation to the inspector's satisfaction during the 11 survey process will preclude the application of a penalty 12 under this subsection. 13 (iii) Isolated Class II violations. Within ten days 14 of the date of the citation, the assisted living 15 residence administrator or assisted living services 16 provider must submit a plan of correction for appropriate 17 departmental approval. Within 30 days of the date of the 18 citation, the assisted living residence administrator or 19 assisted living services provider shall correct the 20 violations and certify in writing to the appropriate 21 department that corrections have been made. The 22 appropriate department shall fine the assisted living 23 residence or assisted living service provider and issue a 24 provisional license until certification of corrections 25 has been received by the appropriate department. 26 Immediate correction of the violation to the inspector's 27 satisfaction during the survey process will preclude the 28 application of a penalty under this subsection. 29 (iv) Pattern of Class II violations. Within ten days 30 of the date of the citation, the assisted living 20030S0136B1641 - 41 -
1 residence administrator or assisted living services 2 provider shall submit a plan of correction for 3 appropriate departmental approval. Within 30 days of the 4 date of the citation, the assisted living residence 5 administrator or assisted living services provider shall 6 correct the violations and shall certify in writing to 7 the appropriate department that all corrections have been 8 made. The appropriate department shall fine the provider 9 and issue a provisional license with a ban on admissions 10 or service until written certification of corrections has 11 been received and corrections have been verified by the 12 appropriate department. The appropriate department shall 13 conduct an onsite inspection to verify corrections within 14 two business days of receipt of the certification of 15 correction. The appropriate department shall conduct 16 intensified inspections of the provider with more 17 numerous unannounced inspections. 18 (v) Isolated Class I violations. Upon a finding by 19 the appropriate department of a Class I violation, the 20 appropriate department shall immediately decide whether: 21 (A) to give a provisional license with a ban on 22 admissions or services and allow the assisted living 23 residence or assisted living services provider to 24 correct the violation; 25 (B) require the appointment of a master at the 26 assisted living residence's expense to oversee the 27 immediate correction of the violations; or 28 (C) to revoke the license and arrange for the 29 immediate relocation or transfer of consumers. The 30 appropriate department shall fine the provider and 20030S0136B1641 - 42 -
1 should the provider remain in operation, subject it 2 to intensified and more numerous unannounced 3 inspections. 4 (vi) Pattern of Class I violations. Upon a finding 5 by the appropriate department that a provider has a 6 pattern of Class I violations, the appropriate department 7 shall immediately revoke the provider's license and 8 arrange for relocation or transfer of the consumers or 9 appoint a master at the assisted living residence's 10 expense to bring the assisted living residence into 11 compliance within 30 days. The appropriate department 12 shall issue a provisional license with a ban on 13 admissions or service if the provider is permitted to 14 continue in operation and shall fine the provider. Should 15 the provider remain in operation, the appropriate 16 department shall conduct intensified and more numerous 17 inspections. 18 (vii) False certifications. Any administrator that 19 falsely certifies to the appropriate department that 20 violations have been corrected shall be fined by the 21 appropriate department and shall lose his administrator 22 license. 23 (3) Within six months of the effective date of this act, 24 the appropriate department shall issue regulations pursuant 25 to this section. The regulations shall ensure that 26 inspections are not invasive of consumer's privacy or 27 dignity, support the principles of assisted living and can be 28 uniformly and consistently applied by the appropriate 29 department. 30 (4) The appropriate department shall establish monetary 20030S0136B1641 - 43 -
1 penalties that relate to the severity of the violation. Money 2 collected by the appropriate department under this section 3 shall be first used to defray the expenses incurred by 4 consumers relocated under this act. Any moneys remaining 5 shall be used by the appropriate department for enforcing the 6 provisions of this act. Fines collected pursuant to this act 7 shall not be subject to the provisions of 42 Pa.C.S. § 3733 8 (relating to deposits into account). 9 (c) Relocation, relocation assistance and transfer.-- 10 (1) In addition to making all licensing surveys 11 available, assisted living residences shall post all Class I 12 and II licensing actions. The department shall inform all 13 residents of their right to leave the assisted living 14 residence and to receive relocation assistance. 15 (i) The department shall promptly relocate consumers 16 from an assisted living residence if any of the following 17 conditions exist: 18 (A) The assisted living residence is operating 19 without a license. 20 (B) The licensee is voluntarily closing an 21 assisted living residence and relocation is necessary 22 for the health and welfare of the consumers. 23 (C) The assisted living residence has engaged in 24 conduct that endangers the health and safety of its 25 residents, leading a reasonable consumer to be 26 concerned for his or her safety. 27 (D) When the assisted living resident wishes to 28 leave. 29 (ii) The department shall offer relocation 30 assistance to consumers of assisted living residences. 20030S0136B1641 - 44 -
1 This shall include: 2 (A) Providing residents with pertinent 3 information, such as referrals to nearby social 4 service agencies or assisted living residences in 5 complete compliance with governing regulations. 6 (B) Determining other options for relocation; 7 and assisting residents to make arrangements for 8 relocation if family members are not available for 9 this purpose. 10 (iii) Except in an emergency, the consumer shall be 11 involved in planning his transfer to another placement 12 and shall have the right to choose among the available 13 alternative placements. The department may make temporary 14 placement until final placement can be arranged. 15 Consumers shall be provided with an opportunity to visit 16 alternative placement before relocation or following 17 temporary emergency relocation. Consumers shall choose 18 their final placement and shall be given assistance in 19 transferring to such place. 20 (iv) Consumers shall not be relocated pursuant to 21 this section if the department determines in writing and 22 consistent with consumer preference that such relocation 23 is not in the best interest of the consumer. 24 (2) All consumers of assisted living services providers 25 shall be notified by the Department of Health of its Class I 26 and II licensing actions against their provider, informed of 27 their right to switch providers and informed of their right 28 to receive assistance in locating a new assisted living 29 services provider. The Department of Health shall provide 30 assistance to consumers of assisted living services providers 20030S0136B1641 - 45 -
1 who require assistance in transferring to other assisted 2 living services providers. The assistance shall be consistent 3 with the conditions for and forms of assistance stated in 4 paragraph (1). 5 (d) Appeal of violations.--A provider appealing appropriate 6 departmental ban on admissions and/or license revocation or 7 nonrenewal shall be denied a supersedeas unless the provider 8 demonstrates substantial likelihood of prevailing on the merits. 9 Where a supersedeas is granted it shall be revoked if the 10 department presents evidence of any intervening Class I or II 11 violations. Where supersedeas is granted: 12 (1) The appropriate department shall inspect a residence 13 or assisted living services provider at least monthly or more 14 frequently to ensure residents' or recipients' safety and 15 well-being. These inspection reports will be maintained as 16 part of the public record for the assisted living residence 17 or assisted living services provider. 18 (2) Where a supersedeas has been granted, a Class I or 19 II violation cited after the granting of the supersedeas 20 shall lead to a revocation of the supersedeas. 21 (e) Hearings.--The Department of Public Welfare and the 22 Department of Health, respectively, shall make the assisted 23 living residence or services consumer and provider appeals a 24 priority, with no appeal outstanding more than 60 days beyond 25 the date on which the appeal was filed. 26 (f) Expedited reconsideration.--The Secretary of Public 27 Welfare shall rule on reconsiderations within 60 days. 28 (g) Definitions.--As used in this section, the following 29 words and phrases shall have the meanings given to them in this 30 subsection: 20030S0136B1641 - 46 -
1 "Appropriate department." The appropriate department with 2 respect to assisted living residences shall be the Department of 3 Public Welfare and the appropriate department with respect to 4 assisted living services providers shall be the Department of 5 Health. 6 "Each department." The term shall mean both the Department 7 of Public Welfare and the Department of Health acting 8 independently but following the same instruction from the 9 legislature. 10 Section 8. Expansion of availability of publicly funded home- 11 based and community-based assisted living 12 services. 13 (a) Categories and services.--Within the next fiscal year 14 following the effective date of this act, the department shall: 15 (1) Immediately work with stakeholders to identify 16 categories of persons qualifying for nursing facility care 17 who do not presently fit in any of Pennsylvania's present 18 Medicaid home-based and community-based waiver programs, such 19 as persons with autism, persons who have suffered a stroke 20 and others. 21 (2) Seek amendment of all present Medicaid home-based 22 and community-based services waivers consistent with Federal 23 requirements for the purposes of adding/increasing needed 24 services not presently provided and covering populations 25 identified in paragraph (1), to fill in the gaps in 26 Pennsylvania's current Medicaid waivers and to maximize caps 27 on payment, such as adding cognitive support services and 28 assistive technology to the PDA waiver, amending the AIDS 29 waiver and increasing the 80% cap on PDA waiver services. 30 (3) Amend, if permitted by Federal law, the State plan 20030S0136B1641 - 47 -
1 to include in medical assistance financial eligibility 2 determination the following: 3 (i) In determining the countable resources of 4 qualified persons for purposes of medical assistance 5 eligibility, the department shall use a computation 6 method which exempts an amount of otherwise countable 7 resources which is equal to the difference between $2,000 8 and an amount calculated as follows: $2,000 increased by 9 each of the Social Security cost-of-living adjustments 10 sequentially from January 1, 1990, to the present. 11 (ii) For qualified couples, the department shall use 12 a computation method which exempts an amount of otherwise 13 countable resources which is equal to the difference 14 between $3,000 and the amount calculated as follows: 15 $3,000 increased by each of the Social Security cost-of- 16 living adjustments sequentially from January 1, 1990, to 17 the present. 18 (iii) The department shall promptly adjust upward 19 the exempted amounts each year as new Social Security 20 cost-of-living adjustments go into effect. 21 (4) Change and, where necessary, seek Federal approval 22 to liberalize eligibility requirements for nursing facility- 23 eligible persons receiving Medicaid-funded services in the 24 community to parallel the requirements for those receiving 25 care in a nursing facility. Where permitted by Federal law, 26 the department shall increase the resource level, adjust the 27 spousal impoverishment level and revise spenddown allowances 28 for those receiving services in their home and community to 29 parallel the requirements for those persons receiving such 30 services in a Medicaid-funded nursing facility. 20030S0136B1641 - 48 -
1 (b) Housing.--Within nine months the Department of Aging and 2 the Department of Public Welfare shall: 3 (1) Establish a presumptive eligibility program for 4 immediately putting assisted living services in place for 5 persons needing long-term care services who appear to be 6 eligible for State-funded or Medicaid-funded programs, where 7 the individual is at risk of imminent placement in a nursing 8 facility. In so doing, the department shall attempt to 9 maximize Federal matching funding but, if necessary, may use 10 State funding exclusively. 11 (2) Establish rules and procedures for a program to 12 provide payment for a housing supplement funded with State 13 dollars to be used with Medicaid-funded home-based and 14 community-based services to help keep the consumer at home, 15 in an approved domiciliary care home, in an assisted living 16 residence or in an approved personal care home where: 17 (i) the total State cost of the housing supplement 18 and home-based and community-based services is less than 19 the State cost for that consumer in a nursing facility; 20 or 21 (ii) a housing supplement is necessary to avoid 22 nursing facility placement unwanted by the consumer: 23 (A) the person is certified for an available 24 waiver slot in the Medicaid-funded home-based and 25 community-based services waiver program; and 26 (B) adequate State funds have been appropriated 27 for the year for the payment of the supplement. 28 (3) Begin annual assessment of the availability of home- 29 based and community-based assisted living services in all 30 counties and assist counties to develop needed services, such 20030S0136B1641 - 49 -
1 as adult day care, where they are presently unavailable. 2 (4) Establish a program which allows persons with 3 medical assistance countable assets of up to $40,000, but who 4 are presently income eligible for Medicaid-funded home-based 5 and community-based assisted living services to equally share 6 the cost of those services with a State-funded program and 7 provides State support to bridge the transition to Medicaid- 8 funded services. 9 (5) Implement a quality assessment and improvement 10 program, which includes consumer satisfaction surveys and 11 quality-of-life outcome measures to ensure that publicly 12 funded home-based and community-based services meet 13 consumers' needs and permit consumers to live independently 14 in the residential environment of their choice, promote 15 integration of consumers into the community, maximize 16 consumer choice to promote and support the consumer's 17 changing needs, are consumer-oriented and meet professional 18 standards of quality. 19 (6) Work with stakeholders to develop recommendations 20 for the General Assembly for public funding and cost sharing 21 for consumers needing assistance with activities of daily 22 living whose income is higher than the Medicaid or 23 Supplemental Security Income State supplement but less than 24 the medical assistance home-based and community-based waiver 25 income level, and who do not meet the functional eligibility 26 for Medicaid home-based and community-based waiver services. 27 (c) Transition.--On a timely and ongoing basis, the 28 department shall identify persons aging out of the Early and 29 Periodic Screening, Diagnosis and Treatment (EPSDT) Program and 30 other publicly funded programs who would be eligible for 20030S0136B1641 - 50 -
1 publicly funded home-based and community-based assisted living 2 services and assist them to make a safe and uninterrupted 3 transfer to those programs so that they may continue to remain 4 in their communities. 5 (d) Report.--The Department of Public Welfare and the 6 Department of Aging shall provide annually a public report 7 including the following information: 8 (1) The types of home-based and community-based services 9 funded through public sources by county, including 10 descriptions of services, units of services, an unduplicated 11 count of people served by service and consumer satisfaction 12 information. 13 (2) The number of people who applied for home-based and 14 community-based services, the number of people on waiting 15 lists, the number of people denied home-based and community- 16 based services because of financial ineligibility, the 17 adequacy of access to providers funded under this act and 18 choice of quality providers for first-day medical assistance 19 beneficiaries qualifying for services under this act, an 20 analysis of the adequacy of reimbursement to providers for 21 publicly funded services under this act and the number of 22 people denied home-based and community-based services because 23 of functional ineligibility. 24 (3) The number, types and results of complaints, 25 consumer satisfaction information, length of stay or service 26 delivery, reasons for termination of service and development 27 of evaluation tools for determining quality of life and care. 28 (e) Annual determination.--The department shall annually 29 determine, on a county-by-county basis, the adequacy of access 30 of first-day medical assistance beneficiaries who qualify for 20030S0136B1641 - 51 -
1 services under this act to a reasonable choice of quality 2 providers funded for services under this act. In those counties 3 where first-day Medicaid beneficiaries do not have adequate 4 access and choice of quality providers, the department shall, 5 after consultation with stakeholders, determine a fair share 6 first-day medical assistance access formula to be applied to 7 providers in that county who provide services under this act, 8 for the purpose of providing access for first-day medical 9 assistance beneficiaries. In such cases, the department shall 10 only contract with those providers who agree to serve a fair 11 share of first-day medical assistance consumers. However, no 12 provider shall be penalized for not meeting the fair share 13 requirements if it can demonstrate that access or services have 14 not been denied to any first-day medical assistance recipient 15 meeting the providers' admission/acceptance standards. 16 Section 9. Application, assessment and appeal process for 17 publicly funded home-based and community-based 18 assisted living services. 19 (a) Application form and application process.--Within six 20 months of the effective date of this act, the Department of 21 Public Welfare and the Department of Aging, working with the 22 stakeholders, shall design and utilize a single, simple, 23 consumer-friendly, attractive and readily available PALS 24 application form for publicly funded services and benefits 25 available in Pennsylvania for persons needing long-term care 26 services, which will serve as a one-stop application for these 27 services. The application shall be for all publicly funded 28 assisted living services available in Pennsylvania and shall be 29 known as the PALS Program Application. 30 (b) Duties of departments.--The departments shall: 20030S0136B1641 - 52 -
1 (1) To the extent possible, rely primarily on income and 2 asset verification that is independently available to the 3 Commonwealth, with little burden placed on the applicant. 4 (2) Ensure swift and seamless application process for 5 all PALS programs so that there are consistent income- 6 eligibility periods and use of self-declaration of income for 7 PACE and Medicaid so that Medicaid-eligible PACE applicants 8 will receive the greater package of services through 9 Medicaid, while helping the Commonwealth maximize Federal 10 funding and free up State lottery funds. 11 (3) Permit PALS application submission to either the 12 Department of Aging or the Department of Public Welfare and 13 take other steps to ensure the prompt and seamless processing 14 of applications and provision of services. 15 (4) Promptly assist and advise applicants and their 16 family members in gathering necessary nonindependently 17 available verification of income and assets and directly 18 contact sources of information if the consumer requests. 19 (5) Ensure that the application is capable of swift 20 determination on completeness and eligibility so that, upon 21 submission, additional items necessary for processing the 22 completed application will be identified to the applicant or 23 their family members. 24 (6) Ensure that eligibility determinations made in one 25 county shall be good for use in any county of this 26 Commonwealth during the period of eligibility. 27 (c) Legislative Budget and Finance Committee.--Within six 28 months of the effective date of this act, the Legislative Budget 29 and Finance Committee shall evaluate the efficiency, 30 responsiveness to consumers, consumer satisfaction with and 20030S0136B1641 - 53 -
1 effectiveness of the present staffing and application and 2 verification process for publicly funded home-based and 3 community-based assisted living services and make 4 recommendations for improvements. 5 (d) Screening, assessment and eligibility determination.-- 6 (1) The department shall immediately establish 7 procedures requiring all persons seeking long-term care 8 services in an assisted living residence or personal care 9 home to obtain a level-of-care screening and comprehensive 10 assessment from the area agency on aging program prior to 11 admission to such residence. 12 (2) The procedures may permit an area agency on aging 13 level-of-care screening and comprehensive assessment to be 14 conducted by telephone based on representations made by the 15 provider and applicant subject to retrospective face-to-face 16 evaluation of the applicant thereafter. 17 (3) All persons may obtain level-of-care screenings and 18 comprehensive assessments from the area agency on aging. 19 (4) All area agency on aging level-of-care screenings or 20 comprehensive assessments must be completed within five 21 business days of the request, except where an urgent 22 situation requires that they be completed within one business 23 day, and shall be valid for six months unless the resident's 24 or recipient's condition changes. 25 (5) All area agency on aging determinations of need for 26 publicly funded long-term care services shall be evaluated by 27 the county assistance offices for financial eligibility 28 within five business days generally or one day for emergency 29 cases from date of receipt of completed Medicaid application. 30 (6) The departments, in consultation with stakeholders, 20030S0136B1641 - 54 -
1 shall establish the negotiated risk standards to be used in 2 determining the consumer's eligibility for publicly funded 3 assisted living services. 4 (e) Appeals.--The department shall promptly develop an 5 expedited fair hearing process for addressing challenges to 6 financial eligibility, level of care, service plan and 7 Supplemental Security Income supplemental decisions where the 8 denial has resulted in failure to provide long-term care 9 services. Hearing and decision must take place within 30 days of 10 filing of fair hearing. 11 Section 10. Information on publicly funded assisted living 12 services. 13 Within nine months of the effective date of this act, the 14 Department of Public Welfare and the Department of Aging shall: 15 (1) Develop an extensive multimedia public information 16 campaign to inform Pennsylvanians needing home-based and 17 community-based long-term assisted living services of the 18 range of options available, which list shall be updated and 19 disseminated annually, and of the availability of the 20 Pennsylvania Assisted Living Services (PALS) Program. The 21 public information campaign shall be reviewed and updated 22 every two years with reports to and an opportunity for input 23 by the stakeholders. 24 (2) Establish a toll-free PALS Help Line for consumers 25 needing home-based and community-based assisted living 26 services to advise consumers of programs in their area and of 27 public funding availability and to assist with the 28 application process. 29 (3) Initiate a training program for hospital discharge 30 planners, area aging personnel, nursing home staff, 20030S0136B1641 - 55 -
1 Department of Public Welfare caseworkers, HealthChoices 2 special needs personnel and social service programs on the 3 range of publicly funded home-based and community-based 4 assisted living services and the new application process 5 therefore. 6 Section 11. Information sharing. 7 The department shall maintain a data base of licensed 8 assisted living residences and assisted living services 9 providers and shall make available from the department and on 10 its World Wide Web site, at a minimum, the following information 11 for each licensed provider: name, address, licensing status, 12 resident profiles, number of beds, payer sources, consumer 13 satisfaction and quality indicators, and important links to 14 related long-term care World Wide Web sites. This information 15 must be regularly updated and it must be timely. 16 Section 12. Appropriation. 17 The sum of $1,000,000 is hereby appropriated to the 18 Department of Public Welfare for the housing supplement purposes 19 set out in section 8(b)(2) for the fiscal year July 1, 2003, to 20 June 30, 2004, to carry out the provisions of this act. 21 Section 13. Repeal. 22 All acts and parts of acts are repealed insofar as they are 23 inconsistent with this act. 24 Section 14. Effective date. 25 This act shall take effect in 60 days. 26 SECTION 1. SHORT TITLE. <-- 27 THIS ACT SHALL BE KNOWN AND MAY BE CITED AS THE ASSISTED 28 LIVING ACT. 29 SECTION 2. DEFINITIONS. 30 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ACT SHALL 20030S0136B1641 - 56 -
1 HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE 2 CONTEXT CLEARLY INDICATES OTHERWISE: 3 "ABUSE." ONE OR MORE OF THE FOLLOWING ACTS: 4 (1) INFLICTION OF INJURY, UNREASONABLE CONFINEMENT, 5 INTIMIDATION OR PUNISHMENT WITH RESULTING PHYSICAL HARM, PAIN 6 OR MENTAL ANGUISH. 7 (2) WILLFUL DEPRIVATION OF GOODS OR SERVICES BY A 8 PROVIDER OR ITS EMPLOYEES WHICH ARE NECESSARY TO MAINTAIN 9 PHYSICAL OR MENTAL HEALTH. 10 (3) SEXUAL HARASSMENT, RAPE OR ABUSE AS DEFINED IN 23 11 PA.C.S. § 6102 (RELATING TO DEFINITIONS). 12 (4) EXPLOITATION BY AN ACT OR A COURSE OF CONDUCT, 13 INCLUDING MISREPRESENTATION OR FAILURE TO OBTAIN INFORMED 14 CONSENT, WHICH RESULTS IN MONETARY, PERSONAL OR OTHER 15 BENEFIT, GAIN OR PROFIT FOR THE PERPETRATOR OR MONETARY OR 16 PERSONAL LOSS TO AN INDIVIDUAL. 17 (5) NEGLECT OF AN INDIVIDUAL WHICH RESULTS IN PHYSICAL 18 HARM, PAIN OR MENTAL ANGUISH. 19 (6) ABANDONMENT OR DESERTION BY A PROVIDER OR ITS 20 EMPLOYEES. 21 "ACTIVITIES OF DAILY LIVING." ACTIVITIES INCLUDING EATING, 22 BATHING, DRESSING, TOILETING, TRANSFERRING IN AND OUT OF BED OR 23 IN AND OUT OF A CHAIR AND PERSONAL HYGIENE. 24 "APPLICANT." AN INDIVIDUAL WHO HAS EXPRESSED INTEREST IN 25 APPLYING FOR RESIDENCE IN AN ASSISTED LIVING RESIDENCE OR 26 OBTAINING SERVICES FROM AN ASSISTED LIVING RESIDENCE. 27 "AREA AGENCY ON AGING." THE LOCAL AGENCY DESIGNATED BY THE 28 DEPARTMENT OF AGING AS DEFINED IN SECTION 2202-A OF THE ACT OF 29 APRIL 9, 1929 (P.L.177, NO.175), KNOWN AS THE ADMINISTRATIVE 30 CODE OF 1929. 20030S0136B1641 - 57 -
1 "ASSESSMENT." A COMPREHENSIVE REVIEW AND ANALYSIS OF AN 2 INDIVIDUAL'S FUNCTIONAL STATUS THAT INCLUDES A PERSONAL HISTORY; 3 AN ASSESSMENT OF PHYSICAL AND EMOTIONAL HEALTH, INCLUDING AN 4 EVALUATION OF THE ABILITY TO CARRY OUT ACTIVITIES OF DAILY 5 LIVING, OF MOBILITY AND OF COGNITIVE FUNCTIONING; AND A REVIEW 6 OF INFORMAL SUPPORTS AVAILABLE TO THE INDIVIDUAL AND 7 ENVIRONMENTAL FACTORS AFFECTING THE INDIVIDUAL. 8 "ASSISTED LIVING." SERVICES AS DETERMINED AND SELF-DIRECTED 9 BY AN INDIVIDUAL OR HIS REPRESENTATIVE THAT PERMIT AND ASSIST 10 THE INDIVIDUAL TO LIVE IN A COMMUNITY, INCLUDING SUCH HOUSING 11 ASSISTANCE OR RESIDENCY IN AN ASSISTED LIVING RESIDENCE THAT 12 PERMITS THE INDIVIDUAL TO SAFELY BE SUPPORTED IN A RESIDENCE IN 13 WHICH THE INDIVIDUAL'S INDEPENDENCE, DIGNITY AND ABILITY TO MAKE 14 CHOICES ARE MAINTAINED, TO THE EXTENT OF THE INDIVIDUAL'S 15 CAPABILITIES. 16 "ASSISTED LIVING RESIDENCE." A RESIDENTIAL SETTING THAT DOES 17 ALL OF THE FOLLOWING: 18 (1) OFFERS, PROVIDES OR COORDINATES A COMBINATION OF 19 PERSONAL CARE SERVICES AND HEALTH-RELATED SERVICES, WHETHER 20 SCHEDULED OR UNSCHEDULED, ACTIVITIES, AND PROVIDES 24-HOUR 21 SUPERVISION FOR TWO OR MORE INDIVIDUALS WHO ARE NOT RELATED 22 TO THE OPERATOR. 23 (2) HAS A SERVICE PROGRAM AND PHYSICAL ENVIRONMENT 24 DESIGNED TO ADJUST SERVICES TO ACCOMMODATE A RESIDENT'S 25 CHANGING NEEDS AND PREFERENCES TO PERMIT RESIDENTS TO REMAIN 26 IN A FAMILIAR ENVIRONMENT AND MINIMIZE THE NEED FOR RESIDENTS 27 TO MOVE CONSISTENT WITH PREVAILING LAW. 28 (3) HAS A MISSION, SERVICE PROGRAMS AND A PHYSICAL 29 ENVIRONMENT DESIGNED TO FOSTER RESIDENTS' DIGNITY, AUTONOMY, 30 PRIVACY AND INDEPENDENCE; PROMOTE SELF-DIRECTION; AND 20030S0136B1641 - 58 -
1 ENCOURAGE FAMILY AND COMMUNITY INVOLVEMENT. 2 (4) CHARGES COSTS FOR HOUSING AND SERVICES WHICH SHALL 3 BE INDEPENDENT OF ONE ANOTHER AND WHICH PROVIDE RESIDENTS 4 WITH THE ABILITY TO CHOOSE THEIR SERVICES AND PROVIDERS 5 CONSISTENT WITH THE PROVISIONS OF THIS ACT. 6 THE TERM DOES NOT INCLUDE A PERSONAL CARE HOME, DOMICILIARY CARE 7 HOME, ANY PUBLICLY FINANCED HOUSING, INDEPENDENT LIVING 8 COMMUNITIES OR HOUSING UNITS IN CONTINUING CARE COMMUNITIES 9 CERTIFIED BY THE INSURANCE DEPARTMENT, WHERE SUPPORTIVE SERVICES 10 ARE MADE AVAILABLE TO RESIDENTS AT THEIR OPTION, AS LONG AS THE 11 PROPERTY OWNER OR MANAGER DOES NOT PROVIDE OR CONTRACT FOR 12 SERVICES THAT PROVIDE ASSISTANCE WITH ACTIVITIES OF DAILY 13 LIVING. THE PROPERTY OWNER OR MANAGER MAY COORDINATE OR HELP 14 RESIDENTS GAIN ACCESS TO SUPPORTIVE SERVICES EITHER DIRECTLY OR 15 THROUGH A SERVICE COORDINATOR. THE TERM INCLUDES HOUSING 16 REQUIRED TO BE LICENSED UNDER THE DEPARTMENT OF HOUSING AND 17 URBAN DEVELOPMENT ASSISTED LIVING CONVERSION PROGRAM. 18 "ASSISTED LIVING RESIDENCY AGREEMENT." THE CONTRACT BETWEEN 19 A PROVIDER AND A RESIDENT OR RESIDENT'S REPRESENTATIVE REGARDING 20 THE RESIDENCY AND SERVICES PROVIDED AT THE ASSISTED LIVING 21 RESIDENCE. THE TERM INCLUDES THE AGREEMENT BETWEEN AN ASSISTED 22 LIVING RESIDENCE AND AN ENTITY CONTRACTING FOR ASSISTED LIVING 23 RESIDENCE FOR THE RESIDENT USING PUBLIC FUNDING. 24 "ASSISTED LIVING SERVICES." SUPPORTIVE SERVICES, PERSONAL 25 CARE SERVICES, PERSONALIZED ASSISTANCE SERVICES, ASSISTIVE 26 TECHNOLOGY AND HEALTH-RELATED SERVICES, OR A COMBINATION OF SUCH 27 SERVICES, DESIGNED TO RESPOND TO THE INDIVIDUAL'S NEEDS. 28 "ASSISTIVE TECHNOLOGY." DEVICES AND SERVICES, WHETHER 29 MEDICALLY NECESSARY OR NOT, THAT ARE USED TO INCREASE, MAINTAIN 30 OR IMPROVE THE FUNCTIONAL CAPABILITIES OF INDIVIDUALS WITH 20030S0136B1641 - 59 -
1 DISABILITIES WHICH MAY OR MAY NOT BE NEEDED TO PERMIT THE 2 INDIVIDUAL TO LIVE INDEPENDENTLY. THE TERM INCLUDES HAND 3 REACHERS, ADAPTED TELEPHONES, READING AIDS AND OTHER NONMEDICAL 4 DEVICES. 5 "COGNITIVE SUPPORT SERVICES." SERVICES PROVIDED AS PART OF A 6 COORDINATED CARE PLAN TO INDIVIDUALS WHO HAVE MEMORY IMPAIRMENTS 7 AND OTHER COGNITIVE PROBLEMS THAT SIGNIFICANTLY INTERFERE WITH 8 THEIR ABILITY TO CARRY OUT ACTIVITIES OF DAILY LIVING WITHOUT 9 ASSISTANCE AND WHO REQUIRE THAT SUPERVISION, MONITORING AND 10 PROGRAMMING BE AVAILABLE TO THEM 24 HOURS A DAY, SEVEN DAYS A 11 WEEK IN ORDER FOR THEM TO RESIDE SAFELY IN A SETTING OF THEIR 12 CHOICE. THE TERM INCLUDES ASSESSMENT, SERVICE PLANNING, ONGOING 13 MONITORING, PERSONAL CARE SERVICES, HEALTH SUPPORT SERVICES AND 14 A FULL RANGE OF DEMENTIA-CAPABLE ACTIVITY PROGRAMMING AND CRISIS 15 MANAGEMENT. 16 "DEPARTMENT." THE DEPARTMENT OF PUBLIC WELFARE OF THE 17 COMMONWEALTH. 18 "DIRECT CARE STAFF." AN INDIVIDUAL WHO DIRECTLY ASSISTS 19 RESIDENTS WITH ASSISTED LIVING SERVICES. 20 "DISCHARGE." TERMINATION OF AN INDIVIDUAL'S RESIDENCY IN THE 21 ASSISTED LIVING RESIDENCE. 22 "FINANCIAL MANAGEMENT." A SERVICE PROVIDED BY AN ASSISTED 23 LIVING RESIDENCE OR A PROVIDER TO ASSIST THE RESIDENT WITH 24 BUDGETING AND SPENDING FOR PERSONAL NEEDS. 25 "INSTRUMENTAL ACTIVITIES OF DAILY LIVING." INCLUDES 26 ASSISTANCE IN PREPARING MEALS, TAKING MEDICATION, USING THE 27 TELEPHONE, HANDLING FINANCES, BANKING AND SHOPPING, HOUSEKEEPING 28 AND GETTING TO APPOINTMENTS. 29 "LEVEL-OF-CARE SCREENING." AN EVALUATION OF AN INDIVIDUAL'S 30 FUNCTIONAL ABILITIES, GENERAL HEALTH STATUS, AND INFORMAL 20030S0136B1641 - 60 -
1 SUPPORT SYSTEM TO DETERMINE AN APPROPRIATE PLACEMENT OF THE 2 INDIVIDUAL FOR SERVICES. 3 "LICENSE." AN ASSISTED LIVING RESIDENCE LICENSE. THE TERM 4 INCLUDES A PROVISIONAL LICENSE. 5 "LONG-TERM CARE OMBUDSMAN." AN AGENT OF THE DEPARTMENT OF 6 AGING WHO INVESTIGATES AND SEEKS TO RESOLVE COMPLAINTS PURSUANT 7 TO SECTION 2203-A OF THE ACT OF APRIL 9, 1929 (P.L.177, NO.175), 8 KNOWN AS THE ADMINISTRATIVE CODE OF 1929. 9 "PERSONAL CARE HOME." PREMISES IN WHICH FOOD, SHELTER AND 10 PERSONAL ASSISTANCE OR SUPERVISION ARE PROVIDED FOR A PERIOD 11 EXCEEDING 24 HOURS FOR FOUR OR MORE ADULTS WHO: 12 (1) ARE NOT RELATIVES OF THE OPERATOR; 13 (2) DO NOT REQUIRE THE SERVICES IN OR OF A LICENSED 14 LONG-TERM CARE FACILITY; AND 15 (3) DO REQUIRE ASSISTANCE OR SUPERVISION IN SUCH MATTERS 16 AS DRESSING, BATHING, DIET, FINANCIAL MANAGEMENT, EVACUATION 17 OF A RESIDENCE IN THE EVENT OF AN EMERGENCY OR MEDICATION 18 PRESCRIBED FOR SELF-ADMINISTRATION. 19 "PERSONAL CARE SERVICES." ASSISTANCE OR SUPERVISION IN 20 MATTERS SUCH AS DRESSING, BATHING, DIET, FINANCIAL MANAGEMENT, 21 EVACUATION OF THE RESIDENT IN THE EVENT OF AN EMERGENCY OR 22 MEDICATION PRESCRIBED FOR SELF-ADMINISTRATION. THE TERM INCLUDES 23 PROMPTING, CUING, MONITORING AND FOCUSING ON MAINTAINING 24 FUNCTIONING. 25 "PROVIDER." AN ASSISTED LIVING RESIDENCE OR AN ENTITY 26 OFFERING ASSISTED LIVING SERVICES IN AN ASSISTED LIVING 27 RESIDENCE. 28 "QUALIFIED ASSESSOR." AN INDIVIDUAL APPROVED BY THE 29 DEPARTMENT OF PUBLIC WELFARE AS QUALIFIED TO CONDUCT ASSESSMENTS 30 OF INDIVIDUALS NEEDING LONG-TERM CARE SERVICES AND TO DEVELOP 20030S0136B1641 - 61 -
1 SERVICE PLANS. THE TERM INCLUDES AN EMPLOYEE OF AN AREA AGENCY 2 ON AGING, A PROVIDER OR AN INDEPENDENT ENTITY. THE TERM DOES NOT 3 INCLUDE HOSPITAL DISCHARGE PLANNERS OR OTHER STAFF OR EMPLOYEES 4 OF AN INSURED'S HEALTH OR LONG-TERM CARE INSURANCE COMPANY. 5 "REPRESENTATIVE." A RESPONSIBLE INDIVIDUAL OR AN INDIVIDUAL 6 AUTHORIZED BY LAW TO TAKE CERTAIN ACTION ON BEHALF OF AN 7 INDIVIDUAL. THE TERM INCLUDES LEGAL COUNSEL, A COURT-APPOINTED 8 GUARDIAN, AN ATTORNEY IN FACT UNDER A DURABLE POWER OF ATTORNEY, 9 AN AGENT UNDER A HEALTH CARE PROXY AND A REPRESENTATIVE PAYEE. 10 "RESIDENT." AN INDIVIDUAL WHO RESIDES IN AN ASSISTED LIVING 11 RESIDENCE. 12 "RESPONSIBLE INDIVIDUAL." AN INDIVIDUAL RESPONSIBLE FOR 13 MAKING DECISIONS ON BEHALF OF A RESIDENT AS DESIGNATED BY THE 14 RESIDENT. 15 "RESTRAINT." A CHEMICAL OR MECHANICAL DEVICE USED TO 16 RESTRICT THE MOVEMENT OR NORMAL FUNCTION OF AN INDIVIDUAL OR A 17 PORTION OF THE INDIVIDUAL'S BODY. THE TERM INCLUDES GERIATRIC 18 CHAIRS; POSEY, CHEST, WAIST, WRIST OR ANKLE RESTRAINTS; LOCKED 19 RESTRAINTS AND LOCKED DOORS TO PREVENT EGRESS. THE TERM DOES NOT 20 INCLUDE DEVICES USED TO PROVIDE SUPPORT FOR THE ACHIEVEMENT OF 21 FUNCTIONAL BODY POSITION OR PROPER BALANCE AS LONG AS THE DEVICE 22 CAN EASILY BE REMOVED BY THE RESIDENT. 23 "SECRETARY." THE SECRETARY OF PUBLIC WELFARE OF THE 24 COMMONWEALTH. 25 "SECURED ASSISTED LIVING RESIDENCE." A LICENSED ASSISTED 26 LIVING RESIDENCE THAT HAS RECEIVED A SPECIALIZED LICENSE 27 DESIGNATION PURSUANT TO THE REQUIREMENTS OF THIS ACT AND THE 28 REGULATIONS OF THE DEPARTMENT OF PUBLIC WELFARE TO PROVIDE 29 SERVICES TO PEOPLE WITH COGNITIVE IMPAIRMENTS. 30 "SECURED UNIT." A UNIT WITHIN A LICENSED ASSISTED LIVING 20030S0136B1641 - 62 -
1 RESIDENCE THAT HAS RECEIVED A SPECIALIZED LICENSE DESIGNATION 2 PURSUANT TO THE REQUIREMENTS OF THIS ACT AND REGULATIONS OF THE 3 DEPARTMENT OF PUBLIC WELFARE TO PROVIDE SERVICES TO PEOPLE WITH 4 COGNITIVE IMPAIRMENTS. 5 "SELF-CARE." SERVICES ADMINISTERED BY A RESIDENT OR A 6 RESPONSIBLE INDIVIDUAL IN A MANNER THAT MANAGES THE HEALTH CARE 7 NEED. 8 "SERVICE PLAN." A DETAILED PLAN BASED ON AN ASSESSMENT 9 DESIGNED TO MEET THE RESIDENT'S INDIVIDUAL PHYSICAL, MENTAL AND 10 PSYCHOSOCIAL NEEDS CONSISTENT WITH THE RESIDENT'S PREFERENCES 11 AND CAPABILITIES. 12 "STAKEHOLDER." A PERSON WITH AN INTEREST IN THE 13 IMPLEMENTATION OF THIS ACT. THE TERM INCLUDES ALL OF THE 14 FOLLOWING: 15 (1) PERSONS NECESSARY TO ENSURE A BALANCE OF RESIDENT 16 AND PROVIDER INTERESTS. 17 (2) PERSONS WITH CLINICAL, PROFESSIONAL, PERSONAL OR 18 FINANCIAL INTERESTS. 19 "SUPPLEMENTAL SERVICES." ASSISTED LIVING SERVICES THAT ARE 20 PROVIDED BY SOMEONE OTHER THAN AN ASSISTED LIVING RESIDENCE. 21 "TRANSFER." MOVEMENT OF A RESIDENT WITHIN THE ASSISTED 22 LIVING RESIDENCE OR TO A HOSPITAL OR OTHER TEMPORARY PLACEMENT. 23 SECTION 3. ASSISTED LIVING RESIDENCES. 24 (A) LEVEL-OF-CARE SCREENING, ASSESSMENT AND SERVICE PLAN.-- 25 (1) SCREENING: 26 (I) PRIOR TO ADMISSION TO AN ASSISTED LIVING 27 RESIDENCE OR START OF SERVICES BY A PROVIDER, AN 28 APPLICANT SHALL OBTAIN A LEVEL-OF-CARE SCREENING TO 29 DETERMINE IF THE APPLICANT IS ELIGIBLE FOR ADMISSION 30 PURSUANT TO SUBSECTION (I). IF THE APPLICANT RECEIVES 20030S0136B1641 - 63 -
1 PUBLIC FUNDING FOR SERVICES, THE LEVEL-OF-CARE SCREENING 2 SHALL BE CONDUCTED BY THE AREA AGENCY ON AGING. THE 3 PROVIDER SHALL INFORM ALL APPLICANTS OF THIS RIGHT. 4 (II) A SCREENING FORM INDICATING THE MINIMUM 5 STANDARDIZED ELEMENTS REQUIRED FOR ALL SCREENS SHALL BE 6 DEVELOPED BY THE DEPARTMENT OF AGING FOR USE IN 7 IMPLEMENTING THIS SECTION. THE DEPARTMENT OF AGING SHALL 8 CONSULT WITH THE DEPARTMENT AND STAKEHOLDERS, AS 9 DETERMINED BY THE DEPARTMENT. 10 (2) A MEDICAL EVALUATION, USING A FORM DEVELOPED BY THE 11 DEPARTMENT, IN CONSULTATION WITH THE DEPARTMENT OF AGING 12 SHALL BE OBTAINED BY ALL APPLICANTS PRIOR TO ADMISSION TO AN 13 ASSISTED LIVING RESIDENCE OR START OF SERVICES BY A PROVIDER 14 OR WHEN CIRCUMSTANCES MAKE THIS REQUIREMENT IMPRACTICABLE, 15 WITHIN 72 HOURS OF ADMISSION. 16 (3) A QUALIFIED ASSESSOR SHALL ASSESS AN INDIVIDUAL'S 17 CARE AND SERVICE NEEDS AFTER THE LEVEL-OF-CARE SCREENING HAS 18 DETERMINED A NEED FOR ASSISTED LIVING SERVICES OR RESIDENCY. 19 (I) THE DEPARTMENT, IN CONSULTATION WITH THE 20 DEPARTMENT OF AGING, SHALL DEVELOP A TRAINING AND 21 CERTIFICATION PROGRAM FOR QUALIFIED ASSESSORS. 22 (II) ONLY THOSE QUALIFIED ASSESSORS TRAINED AND 23 CERTIFIED BY THE COMMONWEALTH SHALL BE PERMITTED TO 24 CONDUCT ASSESSMENTS TO IDENTIFY THE SERVICES THAT AN 25 INDIVIDUAL REQUIRES AND THAT SERVE AS THE BASIS FOR A 26 SERVICE PLAN. 27 (III) QUALIFIED ASSESSORS MUST CERTIFY THAT THE 28 ASSESSMENT IS TRUE AND CORRECT TO THE BEST OF THEIR 29 KNOWLEDGE AND SKILL. THE DEPARTMENT SHALL REVOKE THE 30 CERTIFICATION OF ANY QUALIFIED ASSESSOR WHO FALSELY 20030S0136B1641 - 64 -
1 CERTIFIES A NEED FOR SERVICES. 2 (IV) THE QUALIFIED ASSESSOR SHALL USE AN ASSESSMENT 3 INSTRUMENT THAT INCLUDES, AT A MINIMUM, INFORMATION 4 DETERMINED NECESSARY BY THE DEPARTMENT, IN CONSULTATION 5 WITH THE DEPARTMENT OF AGING AND STAKEHOLDERS, AS 6 DETERMINED BY THE DEPARTMENT. 7 (V) RESIDENTS SHALL HAVE CHOICE OF PROVIDERS EXCEPT 8 AS PROVIDED FOR IN SUBSECTION (N) AND BE FREE TO PRESENT 9 A COMPLETED ASSESSMENT TO ANY PROVIDER TO COMPARE 10 SERVICES AND PRICE. 11 (VI) THE DEPARTMENT SHALL REVIEW PROVIDERS' 12 COMPLIANCE WITH THE ASSESSMENT PROVISIONS OF THIS ACT AS 13 PART OF THE ANNUAL LICENSURE INSPECTION. 14 (VII) THE AREA AGENCY ON AGING SHALL ASSIST ANY 15 ASSESSED RESIDENT FOUND TO NEED PUBLICLY FUNDED LONG-TERM 16 CARE SERVICES, WHERE ELIGIBLE, AND TO ARRANGE THE 17 SERVICES IF FAMILY MEMBERS OR FRIENDS ARE NOT AVAILABLE 18 TO DO SO. 19 (4) A WRITTEN SERVICE PLAN SHALL BE DEVELOPED FOLLOWING 20 COMPLETION OF AN ASSESSMENT. AN APPROPRIATELY TRAINED 21 INDIVIDUAL, AS DETERMINED BY THE DEPARTMENT, EMPLOYED BY THE 22 PROVIDER SHALL WORK IN COOPERATION WITH A TEAM THAT INCLUDES 23 THE RESIDENT. IF THE RESIDENT HAS A COGNITIVE IMPAIRMENT OR 24 IF THE RESIDENT REQUESTS, THE TEAM MAY ALSO INCLUDE THE 25 RESIDENT'S REPRESENTATIVE WHEN APPROPRIATE. THE ASSISTED 26 LIVING RESIDENCE SHALL COORDINATE OR PROVIDE ALL KNOWN 27 SERVICE NEEDS IDENTIFIED ON THE ASSESSMENT UPON ADMISSION 28 AND, PRIOR TO OR WITHIN 14 DAYS OF ADMISSION, DEVELOP A 29 WRITTEN SERVICE PLAN BASED ON THE ASSESSMENT AND CONSISTENT 30 WITH THE RESIDENT'S UNIQUE PHYSICAL AND PSYCHOSOCIAL NEEDS, 20030S0136B1641 - 65 -
1 WITH RECOGNITION OF THE RESIDENT'S CAPABILITIES AND 2 PREFERENCES. 3 (5) REASSESSMENT AND REVISION OF SERVICE PLAN, IF 4 NECESSARY BASED ON REASSESSMENT, SHALL TAKE PLACE ANNUALLY 5 AND WHEN THE PROVIDER IS AWARE OF A SIGNIFICANT CHANGE IN THE 6 RESIDENT'S NEED FOR PERSONAL CARE SERVICES OR HEALTH CARE 7 SERVICES. 8 (6) THE ASSESSMENT AND SERVICE PLAN SHALL BE KEPT ON 9 FILE FOR EACH RESIDENT WHO RECEIVES SERVICES BY THE PROVIDER 10 AND SHALL BE AVAILABLE TO THE RESIDENT OR THE RESIDENT'S 11 REPRESENTATIVE OR RESPONSIBLE INDIVIDUAL. 12 (B) ASSISTED LIVING RESIDENCE ADMINISTRATOR QUALIFICATIONS 13 AND TRAINING.-- 14 (1) AN ASSISTED LIVING RESIDENCE ADMINISTRATOR MUST HAVE 15 THE FOLLOWING QUALIFICATIONS: 16 (I) BE AT LEAST 21 YEARS OF AGE AND MEET THE 17 REQUIREMENTS OF CHAPTERS 5 AND 7 OF THE ACT OF NOVEMBER 18 6, 1987 (P.L.381, NO.79), KNOWN AS THE OLDER ADULTS 19 PROTECTIVE SERVICES ACT, REGARDING CRIMINAL HISTORY. 20 (II) BE OF GOOD MORAL CHARACTER AND FREE OF MEDICAL 21 CONDITIONS THAT WOULD INTERFERE WITH ESSENTIAL JOB 22 FUNCTIONS. 23 (III) SATISFY ONE OF THE FOLLOWING: 24 (A) HAVE AN ASSOCIATE DEGREE OF 60 CREDIT HOURS 25 AT A COLLEGE AND ONE YEAR EXPERIENCE IN A RELATED 26 FIELD. 27 (B) HAVE A VALID LICENSE AS A LICENSED PRACTICAL 28 NURSE (LPN) AND ONE YEAR RELATED WORK EXPERIENCE. 29 (C) HAVE A VALID NURSING HOME ADMINISTRATOR 30 LICENSE. 20030S0136B1641 - 66 -
1 (D) HAVE OPERATED A PERSONAL CARE HOME FOR AT 2 LEAST TWO YEARS PRIOR TO THE EFFECTIVE DATE OF THIS 3 SECTION AND HAVE NO PREVIOUS CLASS I VIOLATIONS OR 4 MULTIPLE CLASS II VIOLATIONS THAT POSED A SERIOUS 5 DANGER TO THE HEALTH, SAFETY OR WELFARE OF RESIDENTS. 6 AUTHORIZATION UNDER THIS CLAUSE SHALL BE ONE TIME; 7 AND PROBATIONARY STATUS SHALL BE DEEMED FULL STATUS 8 IF THE ADMINISTRATOR DOES NOT HAVE CLASS I OR 9 MULTIPLE CLASS II VIOLATIONS DURING THE PROBATIONARY 10 PERIOD THAT POSE A SERIOUS DANGER TO THE HEALTH, 11 SAFETY OR WELFARE OF RESIDENTS. 12 (IV) COMPLETE AN EDUCATION AND TRAINING COURSE WHICH 13 HAS BEEN APPROVED BY THE DEPARTMENT OF NOT LESS THAN 120 14 HOURS. THE DEPARTMENT SHALL ESTABLISH A TRAINING 15 CURRICULUM THAT SHALL INCLUDE COMPREHENSIVE TRAINING IN 16 AREAS APPROPRIATE TO THE CARE AND HEALTH OF RESIDENTS IN 17 AN ASSISTED LIVING RESIDENCE, INCLUDING: 18 (A) TRAINING IN ASSISTIVE TECHNOLOGY. 19 (B) TRAINING IN WORKING WITH INDIVIDUALS WITH 20 COGNITIVE IMPAIRMENTS. 21 (C) TRAINING IN ASSISTED LIVING PRINCIPLES AND 22 LAWS. 23 (D) TRAINING IN MEDICATION ASSISTANCE. 24 (E) RESIDENT RIGHTS AS DEFINED IN SECTION 5. 25 (2) THE DEPARTMENT SHALL DEVELOP A SHORTER PROGRAM OF 26 INSTRUCTION FOR LICENSED NURSING HOME ADMINISTRATORS, 27 NATIONALLY ACCREDITED RETIREMENT HOUSING PROFESSIONALS OR 28 INDIVIDUALS WHO HAVE SUCCESSFULLY PASSED THE ASSISTED LIVING 29 ADMINISTRATORS EXAMINATION OF THE NATIONAL ASSOCIATION OF 30 BOARD OF EXAMINERS OF LONG TERM CARE ADMINISTRATORS, THAT 20030S0136B1641 - 67 -
1 DOES NOT DUPLICATE AREAS WHERE PROFICIENCY HAS BEEN 2 DEMONSTRATED BUT THAT IS PARTICULAR TO ASSISTED LIVING IN 3 THIS COMMONWEALTH. 4 (3) ALL ADMINISTRATORS MUST PASS A TEST WHICH HAS BEEN 5 APPROVED BY THE DEPARTMENT AND IS ADMINISTERED BY AN ENTITY 6 APPROVED BY THE DEPARTMENT AT THE END OF TRAINING TO 7 DEMONSTRATE PROFICIENCY IN THE APPLICATION OF SKILLS AND 8 KNOWLEDGE. 9 (4) ALL ADMINISTRATORS MUST COMPLETE 36 HOURS OF 10 CONTINUING EDUCATION EVERY TWO YEARS THAT HAS BEEN APPROVED 11 BY THE DEPARTMENT AND IS APPLICABLE TO THE PRACTICE OF 12 ASSISTED LIVING ADMINISTRATOR. 13 (5) ONE YEAR AFTER THE EFFECTIVE DATE OF THIS SECTION, 14 AN INDIVIDUAL MAY NOT BE EMPLOYED AS AN ASSISTED LIVING 15 ADMINISTRATOR UNLESS THE INDIVIDUAL HAS COMPLETED THE 16 TRAINING AND TESTING REQUIREMENTS IN THIS SUBSECTION. 17 (C) DIRECT CARE AND OTHER STAFF QUALIFICATIONS AND 18 TRAINING.-- 19 (1) DIRECT CARE STAFF IN AN ASSISTED LIVING RESIDENCE 20 MUST MEET THE FOLLOWING QUALIFICATIONS: 21 (I) BE AT LEAST 18 YEARS OF AGE OR BE AT LEAST 17 22 YEARS OF AGE WITH A HIGH SCHOOL DIPLOMA OR GENERAL 23 EDUCATION DIPLOMA. 24 (II) BE AT LEAST 16 YEARS OF AGE AND ACTIVELY 25 ENROLLED IN A SCHOOL-TO-WORK CAREGIVER OR NURSE AIDE 26 TRAINING PROGRAM. 27 (III) MEET THE REQUIREMENTS OF THE OLDER ADULTS 28 PROTECTIVE SERVICES ACT REGARDING CRIMINAL HISTORY. 29 (IV) HAVE A CERTIFICATE OF COMPLETING AN EDUCATION 30 AND TRAINING COURSE OF AT LEAST 40 HOURS WHICH HAS BEEN 20030S0136B1641 - 68 -
1 APPROVED BY THE DEPARTMENT. THE DEPARTMENT SHALL 2 ESTABLISH QUALIFICATIONS FOR TRAINERS AND A TRAINING 3 CURRICULUM WHICH MAY BE OFFERED IN-HOUSE BY ASSISTED 4 LIVING RESIDENCES. ASSISTED LIVING RESIDENCES SHALL 5 DOCUMENT TRAINING. DIRECT CARE STAFF OF ASSISTED LIVING 6 RESIDENCES MUST DEMONSTRATE PROFICIENCY IN A MANNER 7 APPROVED BY THE DEPARTMENT IN EACH COMPONENT OF THE 8 TRAINING CURRICULUM PRIOR TO START OF INDEPENDENT WORK IN 9 THAT COMPONENT. APPROVED COURSEWORK SHALL INCLUDE 10 COMPREHENSIVE TRAINING IN AREAS APPROPRIATE TO THE CARE 11 AND HEALTH OF ASSISTED LIVING, INCLUDING: 12 (A) TRAINING IN ASSISTIVE TECHNOLOGY. 13 (B) TRAINING IN WORKING WITH INDIVIDUALS WITH 14 COGNITIVE IMPAIRMENTS. 15 (C) TRAINING IN ASSISTED LIVING PRINCIPLES AND 16 LAWS RELEVANT TO THEIR JOB FUNCTIONS. 17 (D) RESIDENT RIGHTS AS DEFINED IN SECTION 5. 18 (2) THE DEPARTMENT SHALL DEVELOP A SHORTER PROGRAM OF 19 INSTRUCTION FOR NURSE ASSISTANTS DEEMED COMPETENT THAT DOES 20 NOT DUPLICATE AREAS WHERE PROFICIENCY HAS BEEN DEMONSTRATED 21 BUT THAT IS PARTICULAR TO ASSISTED LIVING IN THIS 22 COMMONWEALTH. THIS PROGRAM OF INSTRUCTION SHALL BE LIMITED TO 23 THOSE HOURS NECESSARY TO DEMONSTRATE PROFICIENCY. 24 (D) DIRECT CARE STAFF ASSISTING RESIDENTS WITH MEDICATION.-- 25 WITHIN SIX MONTHS OF THE EFFECTIVE DATE OF THIS SECTION, THE 26 DEPARTMENT SHALL: 27 (1) DEVELOP A SPECIAL TRAINING AND CERTIFICATION PROGRAM 28 OR EXPAND ITS CURRENT MEDICATIONS ADMINISTRATION COURSE FOR 29 DIRECT CARE STAFF THAT ASSIST RESIDENTS WITH MEDICATION. THE 30 PROGRAM SHALL INCLUDE TESTING AND DEMONSTRATED PROFICIENCY. 20030S0136B1641 - 69 -
1 (2) ESTABLISH REGULATIONS PERMITTING ONLY THOSE WHO HAVE 2 COMPLETED AND PASSED THE TRAINING ON ASSISTING WITH THE 3 ADMINISTRATION OF MEDICATION TO DO SO IN ASSISTED LIVING 4 RESIDENCES. 5 (E) OTHER ASSISTED LIVING RESIDENCE STAFF.--WITHIN 30 DAYS 6 OF EMPLOYMENT OR START OF VOLUNTARY SERVICE, STAFF PERSONS AND 7 VOLUNTEERS SHALL RECEIVE ORIENTATION TO THE GENERAL OPERATION OF 8 THE ASSISTED LIVING RESIDENCE, TRAINING IN FIRE PREVENTION, 9 OPERATION OF SAFETY EQUIPMENT, EMERGENCY PROCEDURES AND 10 EVACUATION OF RESIDENTS. 11 (F) EXEMPTIONS.-- 12 (1) EXCEPT AS SET FORTH IN PARAGRAPH (2), EXISTING 13 PERSONAL CARE HOME STAFF EMPLOYED BY PERSONAL CARE HOMES THAT 14 APPLY FOR AND BECOME LICENSED AS ASSISTED LIVING RESIDENCES 15 HAVE ONE YEAR FROM THE DATE OF APPLICATION TO COMPLETE THE 16 DIRECT CARE STAFF TRAINING. 17 (2) EXISTING PERSONAL CARE HOME STAFF WHO HAVE BEEN 18 WORKING AS DIRECT CARE STAFF FOR MORE THAN 24 MONTHS CAN OPT 19 NOT TO TAKE THE TRAINING IF THEY DEMONSTRATE PROFICIENCY IN 20 EACH TRAINING COMPONENT WITHIN ONE YEAR OF THE PERSONAL CARE 21 HOME BECOMING AN ASSISTED LIVING RESIDENCE. 22 (G) STAFFING LEVELS.-- 23 (1) THE DEPARTMENT SHALL ESTABLISH MINIMUM STAFFING 24 LEVELS FOR ASSISTED LIVING RESIDENCES, SECURED UNITS AND 25 SECURED ASSISTED LIVING RESIDENCES. STAFFING LEVELS SHALL BE 26 BASED UPON THE RESIDENCE POPULATION, MOBILITY AND COGNITIVE 27 IMPAIRMENT OF RESIDENTS AND BE ADEQUATE TO ENSURE 24 HOURS A 28 DAY AWAKE DIRECT CARE STAFF TO MEET THE UNSCHEDULED NEEDS OF 29 RESIDENTS. 30 (2) THE DEPARTMENT SHALL REQUIRE EACH ASSISTED LIVING 20030S0136B1641 - 70 -
1 RESIDENCE TO MAINTAIN ADEQUATE ADDITIONAL DIRECT CARE STAFF 2 TO MEET THE RESIDENTS' PLANNED AND SCHEDULED NEEDS AS 3 REQUIRED IN THEIR SERVICE PLANS AS WELL AS TO ENSURE A SAFE 4 AND EFFICIENT EVACUATION TO A PLACE OF SAFETY IN CASE OF 5 EMERGENCY. EACH ASSISTED LIVING RESIDENCE SHALL HAVE AS A 6 MINIMUM THE STAFF NECESSARY TO MEET THE HOURS OF CARE SET 7 FORTH IN THE SERVICE PLANS AND THE STAFFING REQUIREMENTS OF 8 PARAGRAPH (1). 9 (3) ADDITIONAL STAFF OR CONTRACTED SERVICES SHALL BE 10 PROVIDED AS NECESSARY TO MEET LAUNDRY, FOOD SERVICE, 11 HOUSEKEEPING, TRANSPORTATION AND MAINTENANCE NEEDS OF THE 12 ASSISTED LIVING RESIDENCE. 13 (H) SUPPLEMENTAL SERVICES.-- 14 (1) A RESIDENT RECEIVING ASSISTED LIVING SERVICES IN AN 15 ASSISTED LIVING RESIDENCE MAY ARRANGE FOR THE RECEIPT OF 16 SUPPLEMENTAL SERVICES IF THE SUPPLEMENTAL SERVICES ADEQUATELY 17 MEET THE RESIDENTS CHANGING NEEDS SO THAT: 18 (I) THE ASSISTED LIVING RESIDENCE IS NOT REQUIRED TO 19 FUNDAMENTALLY CHANGE ITS PROGRAM OR RESIDENCE TO 20 ACCOMMODATE THE RESIDENT; AND 21 (II) THE RESIDENT'S RECEIPT OF SUPPLEMENTAL SERVICES 22 DOES NOT CREATE AN UNDUE BURDEN ON THE ASSISTED LIVING 23 RESIDENCE. 24 (2) THE ASSISTED LIVING RESIDENCE MAY SCREEN 25 SUPPLEMENTAL SERVICES PROVIDERS. AN ASSISTED LIVING RESIDENCE 26 SHALL NOT UNREASONABLY DENY A SUPPLEMENTAL SERVICES PROVIDER 27 ACCESS TO A RESIDENT'S LIVING UNIT. 28 (3) EXCEPT AS SET FORTH IN PARAGRAPH (4), THE FOLLOWING 29 ARE IMMUNE FROM CIVIL LIABILITY FOR A CLAIM ARISING FROM AN 30 ACT OR OMISSION RELATED TO SUPPLEMENTAL SERVICES: 20030S0136B1641 - 71 -
1 (I) AN ASSISTED LIVING RESIDENCE. 2 (II) THE OWNER OF AN ASSISTED LIVING RESIDENCE WHICH 3 IS A SOLE PROPRIETORSHIP. 4 (III) THE PARTNERS OF AN ASSISTED LIVING RESIDENCE 5 WHICH IS A PARTNERSHIP. 6 (IV) THE MEMBERS OF AN ASSISTED LIVING RESIDENCE 7 WHICH IS AN UNINCORPORATED ASSOCIATION. 8 (V) THE STOCKHOLDERS, OFFICERS AND DIRECTORS OF AN 9 INCORPORATED ASSISTED LIVING RESIDENCE. 10 (VI) A PARENT OR SUBSIDIARY OF AN INCORPORATED 11 ASSISTED LIVING RESIDENCE. 12 (4) PARAGRAPH (3) DOES NOT APPLY IF ANY OF THE FOLLOWING 13 APPLY: 14 (I) THE PERSON CHARGED WITH THE ACT OR OMISSION ACTS 15 IN BAD FAITH. 16 (II) THE PERSON CHARGED WITH THE ACT OR OMISSION 17 KNOWS OR HAS REASON TO KNOW THAT THE ACT OR OMISSION 18 POSES A SUBSTANTIAL DANGER TO THE HEALTH, SAFETY OR 19 WELFARE OF THE RESIDENT. 20 (I) ADMISSION, TRANSFER AND DISCHARGE.-- 21 (1) AN ASSISTED LIVING RESIDENCE MAY NOT ADMIT OR RETAIN 22 AN INDIVIDUAL WITH ANY OF THE FOLLOWING CONDITIONS OR HEALTH 23 CARE NEEDS UNLESS THE INDIVIDUAL RECEIVES HOSPICE CARE OR THE 24 DEPARTMENT, UPON THE REQUEST OF THE PROVIDER, PERMITS THE 25 ADMITTANCE OR RETENTION OF THE INDIVIDUAL: 26 (I) VENTILATOR DEPENDENCY. 27 (II) STAGE III AND IV, OR MULTIPLE STAGE II 28 DECUBITUS AND VASCULAR ULCERS THAT ARE NOT IN A HEALING 29 STAGE. 30 (III) CONTINUOUS INTRAVENOUS FLUIDS OR INJECTIONS 20030S0136B1641 - 72 -
1 DIRECTLY INTO THE VEIN, EXCEPT FOR INDIVIDUALS RECEIVING 2 HOSPICE SERVICES. 3 (IV) REPORTABLE INFECTIOUS DISEASE, SUCH AS 4 TUBERCULOSIS, IN A COMMUNICABLE STATE THAT REQUIRES 5 ISOLATION OF THE APPLICANT OR RESIDENT OR REQUIRES 6 SPECIAL PRECAUTIONS BY THE CARETAKER TO PREVENT 7 TRANSMISSION OF THE DISEASE. 8 (V) NASOGASTRIC TUBES. 9 (VI) PHYSICAL RESTRAINTS. 10 (VII) A CONDITION OR HEALTH CARE NEED IDENTIFIED BY 11 THE DEPARTMENT IN A REGULATION. 12 (2) AN ASSISTED LIVING RESIDENCE MAY NOT ADMIT OR RETAIN 13 AN APPLICANT OR A RESIDENT WHOSE PHYSICIAN CERTIFIES THAT 14 PLACEMENT IN THE ASSISTED LIVING RESIDENCE IS NOT 15 APPROPRIATE. 16 (3) AN ASSISTED LIVING RESIDENCE MAY NOT ADMIT OR RETAIN 17 AN INDIVIDUAL WHOSE HEALTH CARE NEEDS CANNOT BE MET IN THE 18 SPECIFIC ASSISTED LIVING RESIDENCE. THE DETERMINATION OF 19 WHETHER THE NEEDS CAN BE MET SHALL BE MADE BY THE ASSISTED 20 LIVING RESIDENCE, THE INDIVIDUAL OR THE INDIVIDUAL'S 21 REPRESENTATIVE AND THE INDIVIDUAL'S PHYSICIAN, EXCEPT THAT NO 22 ASSISTED LIVING RESIDENCE SHALL BE REQUIRED TO RETAIN A 23 RESIDENT OR ADMIT AN APPLICANT IF DOING SO WOULD REQUIRE A 24 FUNDAMENTAL ALTERATION OF THE ASSISTED LIVING RESIDENCE'S 25 BASIC PROGRAM OR BUILDING OR CREATE AN UNDUE BURDEN ON THE 26 ASSISTED LIVING RESIDENCE. THE HEALTH CARE NEEDS MAY INCLUDE: 27 (I) AN APPLICANT OR A RESIDENT REQUIRING SLIDING 28 SCALE INSULIN ADMINISTRATION UNLESS SELF-PERFORMED OR 29 ADMINISTERED BY A LICENSED HEALTH CARE PROFESSIONAL. 30 (II) AN APPLICANT OR A RESIDENT REQUIRING 20030S0136B1641 - 73 -
1 INTERMITTENT INTRAVENOUS THERAPY UNLESS MANAGED BY A 2 LICENSED HEALTH CARE PROFESSIONAL. 3 (III) AN APPLICANT OR A RESIDENT REQUIRING 4 INSERTION, STERILE IRRIGATION AND REPLACEMENT OF CATHETER 5 EXCEPT FOR ROUTINE MAINTENANCE OF URINARY CATHETER UNLESS 6 THE CATHETER CARE IS SELF-ADMINISTERED OR ADMINISTERED BY 7 A LICENSED HEALTH CARE PROFESSIONAL. 8 (IV) AN APPLICANT OR A RESIDENT REQUIRING OXYGEN 9 UNLESS SELF-CARE OR ADMINISTERED BY A LICENSED HEALTH 10 CARE PROFESSIONAL. 11 (V) AN APPLICANT OR A RESIDENT REQUIRING INHALATION 12 THERAPY UNLESS SELF-CARE OR IF ADMINISTERED BY A LICENSED 13 HEALTH CARE PROFESSIONAL. 14 (VI) GASTRIC TUBES, EXCEPT WHEN THE APPLICANT OR 15 RESIDENT IS INDEPENDENTLY CAPABLE OF SELF-CARE OF THE 16 TUBE. 17 (VII) TRACHEOSTOMY EXCEPT WHEN THE APPLICANT OR 18 RESIDENT IS INDEPENDENTLY CAPABLE OF SELF-CARE OF THE 19 TRACHEOSTOMY. 20 (4) AN ASSISTED LIVING RESIDENCE MAY ALSO DISCHARGE A 21 RESIDENT IF THE FOLLOWING CIRCUMSTANCES EXIST: 22 (I) THE RESIDENT PRESENTS AN IMMINENT PHYSICAL 23 THREAT OR DANGER TO SELF OR OTHERS. 24 (II) THE RESIDENT PERSISTENTLY AND SUBSTANTIALLY 25 VIOLATES THE RIGHTS OR NEGATIVELY IMPACTS THE QUALITY OF 26 LIFE OF OTHERS. 27 (III) THE RESIDENT DOES NOT PAY APPROPRIATE FEES 28 WITHIN 30 DAYS FOLLOWING A DOCUMENTED EFFORT TO OBTAIN 29 PAYMENT BY THE RESIDENCE. 30 (IV) THE RESIDENT OR RESIDENT'S REPRESENTATIVE OR 20030S0136B1641 - 74 -
1 RESPONSIBLE INDIVIDUAL FAILS TO COOPERATE WITH THE 2 RESIDENCE IN ITS EFFORTS TO OBTAIN PUBLIC FUNDING. 3 (5) EXCEPT AS PROVIDED IN THIS SUBSECTION, A RESIDENT 4 MAY NOT BE TRANSFERRED OR DISCHARGED. THE ASSISTED LIVING 5 RESIDENCE SHALL ENSURE THAT THE TRANSFER IS SAFE AND ORDERLY 6 AND SHALL MAKE A REASONABLE EFFORT TO ENSURE THE TRANSFER IS 7 APPROPRIATE TO MEET THE RESIDENT'S NEEDS. IF THERE IS NO 8 APPROPRIATE PLACE TO TRANSFER THE RESIDENT, THE ASSISTED 9 LIVING RESIDENCE SHALL CONTACT THE AREA AGENCY ON AGING AS 10 DEFINED IN THE OLDER ADULTS PROTECTIVE SERVICES ACT FOR 11 PROTECTIVE SERVICES OR PENNSYLVANIA PROTECTION AND ADVOCACY, 12 WHEN APPROPRIATE. 13 (J) NOTICES.--THE ASSISTED LIVING RESIDENCE SHALL PROVIDE 30 14 DAYS' ADVANCE WRITTEN NOTICE OF CHANGES IN RESIDENT-RELATED 15 POLICIES, SERVICES OR COSTS AND OF INTENT TO TRANSFER OR 16 DISCHARGE A RESIDENT. WRITTEN NOTICE MUST BE PROVIDED TO THE 17 RESIDENT, THE RESIDENT'S REPRESENTATIVE AND THE LONG-TERM HEALTH 18 CARE OMBUDSMAN RESPONSIBLE FOR THE COUNTY OF THE RESIDENT. 19 WRITTEN NOTICE MUST INCLUDE: 20 (1) THE REASON FOR THE TRANSFER OR DISCHARGE; 21 (2) THE EFFECTIVE DATE OF THE TRANSFER OR DISCHARGE; 22 (3) THE LOCATION TO WHICH THE RESIDENT IS BEING 23 TRANSFERRED OR DISCHARGED, IF KNOWN; 24 (4) A STATEMENT THAT THE RESIDENT HAS THE RIGHT TO 25 APPEAL TO THE DEPARTMENT; AND 26 (5) THE CONTACT INFORMATION FOR THE LONG-TERM CARE 27 OMBUDSMAN AND THE DEPARTMENT'S 24-HOUR HOTLINE. 28 (K) DISPUTE RESOLUTION.--RESIDENTS MAY SEEK RESOLUTION OF 29 DISPUTES IN THE FOLLOWING WAYS, AND SELECTION OF ONE OPTION DOES 30 NOT PRECLUDE SIMULTANEOUS OR SUBSEQUENT SELECTION OF THE OTHER: 20030S0136B1641 - 75 -
1 (1) EACH PROVIDER SHALL MAINTAIN AN INTERNAL PROCESS FOR 2 RESOLVING RESIDENT COMPLAINTS AND GRIEVANCES. 3 (2) THE DEPARTMENT'S HEARING AND APPEALS BUREAU SHALL 4 HEAR DISPUTES THROUGH ITS FAIR HEARING PROCESS. 5 (I) APPEAL HEARINGS MUST INCLUDE NOTICE, OPPORTUNITY 6 TO BE HEARD, IMPARTIAL REVIEW AND PROMPT DECISION. 7 (II) ASSISTED LIVING RESIDENTS MAY APPEAL DECISIONS 8 REGARDING: 9 (A) WHETHER DISCHARGE OR TRANSFER IS APPROPRIATE 10 BASED ON THE PROVISIONS OF SUBSECTION (I) OR SECTION 11 4(A)(2) AND APPLICABLE LAWS. 12 (B) WHETHER THE ASSISTED LIVING RESIDENCE'S 13 DENIAL OF A SUPPLEMENTAL SERVICES PROVIDER IS 14 REASONABLE PURSUANT TO SUBSECTION (H)(2). 15 (C) WHAT LEVEL OF CARE IS APPROPRIATE. 16 (3) THE DEPARTMENT SHALL DEVELOP AN EXPEDITED HEARING 17 PROCESS FOR REVIEW OF DEPARTMENT, RESIDENT OR PROVIDER 18 ACTIONS. 19 (4) THIS SUBSECTION IS SUBJECT TO 2 PA.C.S. CH. 5 SUBCH. 20 A (RELATING TO PRACTICE AND PROCEDURE OF COMMONWEALTH 21 AGENCIES) AND CH. 7 SUBCH. A (RELATING TO JUDICIAL REVIEW OF 22 COMMONWEALTH AGENCY ACTION). THE DEPARTMENT SHALL NOT BE 23 DEEMED A PARTY TO AN ACTION UNDER THIS SUBSECTION BUT HAS THE 24 RIGHT TO INTERVENE IN A JUDICIAL APPEAL OF A DETERMINATION 25 UNDER THIS SUBSECTION. 26 (L) WRITTEN AGREEMENTS.--THE DEPARTMENT SHALL REQUIRE AS A 27 CONDITION OF LICENSURE THAT ALL ASSISTED LIVING RESIDENCES HAVE 28 AN ASSISTED LIVING RESIDENCY AGREEMENT IN WRITING WITH EACH 29 RESIDENT. AT SITE VISITS, THE DEPARTMENT SHALL REVIEW AGREEMENTS 30 UNDER THIS SUBSECTION FOR COMPLIANCE WITH THIS SUBSECTION AND 20030S0136B1641 - 76 -
1 APPLICABLE REGULATIONS. EACH AGREEMENT SHALL BE SIGNED PRIOR TO 2 ADMISSION OR START OF SERVICES AND SHALL BE SIGNED NO LATER THAN 3 24 HOURS AFTER ADMISSION AND SHALL INCLUDE IN CLEAR AND SIMPLE 4 LANGUAGE ALL OF THE FOLLOWING: 5 (1) STANDARDIZED CLAUSES PROVIDED BY THE DEPARTMENT ON 6 ALL OF THE FOLLOWING: 7 (I) THE RESIDENT'S RIGHTS. 8 (II) THE DEPARTMENT'S APPEAL PROCESS. 9 (III) EXPLANATION OF THE SCREENING, ASSESSMENT AND 10 ANNUAL REASSESSMENT REQUIREMENTS. 11 (IV) THE AVAILABLE FINANCIAL MANAGEMENT SERVICES A 12 PROVIDER MAY OR MAY NOT PROVIDE. 13 (V) A PROHIBITION ON RESIDENT ASSIGNMENT OF ASSETS 14 FOR LIFE TO THE ASSISTED LIVING RESIDENCE. CONTINUING 15 CARE COMMUNITIES THAT HAVE OBTAINED A CERTIFICATE OF 16 AUTHORITY FROM THE INSURANCE DEPARTMENT SHALL PROVIDE A 17 COPY OF THE CERTIFICATE TO THE DEPARTMENT. UPON RECEIPT 18 OF THE CERTIFICATE BY THE DEPARTMENT, THE CONTINUING CARE 19 COMMUNITY SHALL NOT BE REQUIRED TO INCLUDE THE 20 STANDARDIZED CLAUSE REQUIRED UNDER THIS SUBPARAGRAPH. 21 (VI) IF A RESIDENT IS RECEIVING PUBLICLY FUNDED CARE 22 AND SERVICES, DETAILS ABOUT SUPPLEMENTAL SECURITY INCOME 23 RECIPIENT PROTECTIONS, RENT REBATE PROGRAMS AND ANY 24 PERSONAL NEEDS ALLOWANCE AS DETERMINED BY THE DEPARTMENT. 25 (VII) EXPLANATION OF THE RIGHT TO CONTINUED 26 RESIDENCY IN AN ASSISTED LIVING RESIDENCE. 27 (VIII) APPLICANT'S RIGHT TO CANCEL WITHOUT PENALTY 28 AN ASSISTED LIVING RESIDENCY AGREEMENT WITHIN THREE 29 BUSINESS DAYS OF SIGNING. 30 (IX) REQUIREMENT THAT A RESIDENT RECEIVE 30 DAYS' 20030S0136B1641 - 77 -
1 ADVANCE WRITTEN NOTICE OF CHANGES TO CONTRACT, TO THE 2 CHARGES OF THE PROVIDER AND TO THE PROVIDER'S RESIDENT- 3 RELATED POLICIES. 4 (X) THE BASES UNDER WHICH A RESIDENT OR PROVIDER MAY 5 TERMINATE THE AGREEMENT. 6 (XI) CONTRACTUAL ENFORCEMENT RIGHTS OF THE PARTIES. 7 (2) THE FOLLOWING STATEMENTS BY THE PROVIDER: 8 (I) THE PROVIDER'S LIST OF SERVICES OFFERED. 9 (II) INDIVIDUALIZED ITEMIZATION OF SERVICES THAT 10 WILL BE PROVIDED TO THE RESIDENT AND COSTS OF THE 11 SERVICES, SEPARATING HOUSING COSTS FROM SERVICE COSTS. 12 (III) PROVIDER POLICIES REGARDING RESIDENTS. 13 (IV) INTERNAL DISPUTE RESOLUTION PROCESS. 14 (V) CLEAR AND SPECIFIC OCCUPANCY CRITERIA AND 15 PROCEDURES, BASED ON THE DEPARTMENT'S REQUIREMENTS AND 16 ASSISTED LIVING RESIDENCE'S POLICIES REGARDING BEDHOLDS 17 AND REFUNDS. 18 (M) DISCLOSURE.--EACH RESIDENT OR THE RESIDENT'S 19 REPRESENTATIVE SHALL RECEIVE AN INFORMATION PACKET AT THE TIME 20 OF APPLICATION FOR ADMISSION OR START OF SERVICES. THE PACKET 21 SHALL INCLUDE THE FOLLOWING ITEMS TO BE PRESENTED IN A FORM ABLE 22 TO BE EASILY UNDERSTOOD AND READ BY THE RESIDENT: 23 (1) A STANDARDIZED FORM DEVELOPED BY THE DEPARTMENT WITH 24 INFORMATION PERTAINING TO ALL OF THE FOLLOWING: 25 (I) THE USE OF ADVANCE DIRECTIVES DURING RESIDENCY. 26 (II) HOW TO CONTACT THE DEPARTMENT AND OBTAIN 27 INFORMATION ON THE LICENSING REQUIREMENTS AND LICENSING 28 STATUS OF PROVIDERS. 29 (III) INFORMATION ABOUT AVAILABILITY AND ACCESS TO 30 AND CONTACT INFORMATION FOR THE LONG-TERM CARE OMBUDSMAN 20030S0136B1641 - 78 -
1 AND THE DEPARTMENT'S 24-HOUR HOTLINE. 2 (IV) DETAILS ABOUT THE DEPARTMENT'S COMPLAINT 3 INVESTIGATION PROCESS, INCLUDING INFORMATION ON HOW A 4 RESIDENT CAN FILE A COMPLAINT WITH THE DEPARTMENT. 5 (V) GENERAL INFORMATION ABOUT THE ADMISSION AND 6 APPLICATION PROCESS. 7 (VI) DETAILS ABOUT THE APPLICANT'S RIGHTS TO 8 INDEPENDENT ASSESSMENT AND NONDISCRIMINATION IN THE 9 APPLICATION PROCESS. 10 (VII) RESIDENT RIGHTS AS DETAILED IN SECTION 5. 11 (2) DOCUMENTATION FROM THE PROVIDER TO PROVIDE THE 12 APPLICANT WITH THE FOLLOWING INFORMATION: 13 (I) A COPY OF THE PROVIDER'S POLICIES AFFECTING 14 RESIDENTS, INCLUDING DISCHARGE OR TERMINATION OR 15 BEDHOLDS. 16 (II) INFORMATION REGARDING THE DEPARTMENT'S 17 INSPECTIONS AND INSPECTION REPORTS DEMONSTRATING 18 PROVIDER'S LICENSING STATUS. 19 (III) COMPLETE COPY OF THE ASSISTED LIVING RESIDENCE 20 AGREEMENT, INCLUDING ALL ATTACHMENTS AND ALL CURRENT 21 RATES THAT MAY BE CHARGED. 22 (IV) DETAILS ABOUT THE INTERNAL COMPLAINT MECHANISM 23 USED BY THE PROVIDER. 24 (V) PROVIDER'S SPECIFIC ADMISSION AND APPLICATION 25 PROCESS. 26 (VI) INFORMATION ON DISCHARGE POLICIES. 27 (N) HOUSING AND SERVICES.-- 28 (1) ASSISTED LIVING RESIDENCES SHALL SEPARATELY CHARGE 29 FOR HOUSING AND SERVICES. 30 (2) RESIDENTS WHO HAVE BEEN ASSESSED AS NEEDING PERSONAL 20030S0136B1641 - 79 -
1 CARE SERVICES MAY BE REQUIRED BY THE ASSISTED LIVING 2 RESIDENCE TO RECEIVE THOSE SERVICES FROM THE ASSISTED LIVING 3 RESIDENCE AS A CONDITION OF ADMISSION TO AND CONTINUING 4 RESIDENCE IN THE ASSISTED LIVING RESIDENCE. 5 (3) NO RESIDENT SHALL BE REQUIRED TO PAY FOR ASSISTED 6 LIVING SERVICES NOT NEEDED, OR REQUESTED, AS INDICATED IN 7 THEIR MOST RECENT ASSESSMENT, EXCEPT FOR THE COSTS ASSOCIATED 8 WITH MEETING UNSCHEDULED CARE NEEDS. 9 (4) SERVICES OTHER THAN THOSE IDENTIFIED IN PARAGRAPH 10 (2), INCLUDING, BUT NOT LIMITED TO, HOME HEALTH, MASSAGE, 11 PHYSICIAN SERVICES AND PHYSICAL THERAPY SERVICES CAN BE 12 PURCHASED BY THE RESIDENT FROM THE ASSISTED LIVING RESIDENCE 13 OR FROM AN OUTSIDE PROVIDER, UNLESS ACCOMMODATING THE 14 INDIVIDUAL WOULD REQUIRE A FUNDAMENTAL ALTERATION OF THE 15 ASSISTED LIVING RESIDENCE'S BASIC PROGRAM OR BUILDING, WOULD 16 CREATE AN UNDUE BURDEN ON THE ASSISTED LIVING RESIDENCE OR 17 WOULD PUT IN JEOPARDY THE HEALTH, SAFETY OR WELFARE OF 18 INDIVIDUALS IN THE ASSISTED LIVING RESIDENCE. THE ASSISTED 19 LIVING RESIDENCE MAY SCREEN SERVICE PROVIDERS WHO PROVIDE A 20 SERVICE PURSUANT TO THIS PARAGRAPH. AN ASSISTED LIVING 21 RESIDENCE SHALL NOT UNREASONABLY DENY SERVICE PROVIDERS 22 ACCESS TO A RESIDENT'S LIVING UNIT. 23 (O) LIVING UNIT.-- 24 (1) ASSISTED LIVING RESIDENCES SHALL PROVIDE RESIDENTS 25 WITH THEIR OWN INDIVIDUAL LIVING UNITS, WHICH SHALL INCLUDE A 26 SLEEPING AND LIVING AREA, SHARED ONLY WITH THE CONSENT OF THE 27 RESIDENTS IN THE UNIT. 28 (2) EACH LIVING UNIT MUST PROVIDE A BATHROOM READILY 29 AVAILABLE FOR EACH RESIDENT. ONE BATHROOM CAN BE SHARED 30 BETWEEN ADJACENT LIVING UNITS. LICENSED PERSONAL CARE HOMES 20030S0136B1641 - 80 -
1 IN OPERATION ON THE EFFECTIVE DATE OF THIS SECTION, WHICH 2 MEET ALL OTHER REQUIREMENTS OF AN ASSISTED LIVING RESIDENCE, 3 MAY SEEK A WAIVER FROM THE DEPARTMENT TO PERMIT BATHING 4 FACILITIES IN CLOSE PROXIMITY, BUT NOT LOCATED IN, THE 5 INDIVIDUAL RESIDENT BATHROOM SHARED BY TWO ADJACENT 6 RESIDENTS. THIS WAIVER SHALL BE REVOCABLE BY THE DEPARTMENT 7 IF THE ASSISTED LIVING RESIDENCE FAILS TO MEET THE WAIVER 8 REQUIREMENTS. 9 (3) EXCEPT FOR RESIDENTS WITH COGNITIVE IMPAIRMENTS, 10 EACH LIVING UNIT MUST PROVIDE SPACE AND ELECTRICAL OUTLETS 11 FOR RESIDENTS TO HAVE SMALL APPLIANCES SUCH AS MICROWAVES AND 12 REFRIGERATORS. 13 (4) EACH LIVING UNIT SHALL CONTAIN NO FEWER THAN 100 14 SQUARE FEET PER RESIDENT. 15 (5) EACH LIVING UNIT SHALL HAVE INDIVIDUALLY LOCKABLE 16 DOORS, EXCEPT WHERE INAPPROPRIATE FOR INDIVIDUALS WITH 17 COGNITIVE IMPAIRMENTS. 18 (P) DEPARTMENT OF AGING.--THE DEPARTMENT OF AGING SHALL 19 ENSURE THAT THE LONG-TERM CARE OMBUDSMAN PROGRAM IS MADE 20 AVAILABLE TO ASSISTED LIVING RESIDENTS OVER 59 YEARS OF AGE. 21 (Q) CONTACT INFORMATION.--THE DEPARTMENT SHALL REQUIRE 22 ASSISTED LIVING RESIDENCES TO POST CONTACT INFORMATION FOR THE 23 LONG-TERM CARE OMBUDSMAN AND SHALL MAKE AVAILABLE A 24-HOUR 24 TOLL-FREE HOTLINE FOR RESIDENTS TO USE IN CONTACTING THE 25 DEPARTMENT WITH QUESTIONS, CONCERNS AND COMPLAINTS ABOUT THEIR 26 CARE AND SERVICES. DOCUMENTATION OF THE DESIGNATION OF A 27 RESPONSIBLE INDIVIDUAL SHALL BE KEPT IN THE RESIDENT'S RECORD. 28 SECTION 4. SPECIALLY DESIGNATED ASSISTED LIVING RESIDENCES. 29 (A) COGNITIVE SUPPORT SERVICES.-- 30 (1) WITHIN SIX MONTHS OF THE EFFECTIVE DATE OF THIS 20030S0136B1641 - 81 -
1 SECTION, THE DEPARTMENT SHALL ESTABLISH A SPECIAL LICENSE 2 DESIGNATION FOR ASSISTED LIVING RESIDENCES THAT WISH TO 3 MAINTAIN SECURED UNITS OR WISH TO BE SECURED FOR THE PURPOSE 4 OF SERVING INDIVIDUALS WITH COGNITIVE IMPAIRMENTS. ONLY THOSE 5 ASSISTED LIVING RESIDENCES THAT RECEIVE SPECIAL LICENSE 6 DESIGNATION MAY HAVE OR HOLD THEMSELVES OUT AS HAVING SECURED 7 UNITS OR AS BEING A SECURED ASSISTED LIVING RESIDENCE. THE 8 DEPARTMENT SHALL REQUIRE THAT IN ORDER TO RECEIVE A SPECIAL 9 LICENSE DESIGNATION THE ASSISTED LIVING RESIDENCES MEET ALL 10 OF THE REQUIREMENTS FOR ASSISTED LIVING RESIDENCES THAT 11 ADDRESS: 12 (I) SPECIAL ADMISSION AND TRANSFER CRITERIA. 13 (II) ADEQUATE INDOOR AND OUTDOOR WANDERING SPACE. 14 (III) THE PROVISION OF THERAPEUTIC ACTIVITIES THAT 15 MEET THE SCHEDULED AND UNSCHEDULED INDIVIDUAL NEEDS OF 16 EACH RESIDENT, WITH THE SERVICES FOCUSING ON FOSTERING 17 INDEPENDENCE AND ON THE INDIVIDUAL'S STRENGTHS AND 18 ABILITIES. 19 (IV) PHYSICAL DESIGN AND SAFETY. 20 (V) TRAINING SPECIFIC TO A SECURED UNIT OR SECURED 21 ASSISTED LIVING RESIDENCE. 22 (VI) PREARRANGED PROCEDURES FOR NOTIFICATION OF 23 AUTHORITIES SHOULD A RESIDENT WANDER AWAY FROM THE 24 RESIDENCE. 25 (2) THE FOLLOWING APPLY TO ADMISSION OR TRANSFER TO 26 SPECIALLY DESIGNATED SECURED UNIT OR SECURED ASSISTED LIVING 27 RESIDENCE: 28 (I) ASSISTED LIVING RESIDENCES MAY SUPPORT RESIDENTS 29 WITH COGNITIVE IMPAIRMENTS IF OR UNTIL THE INDIVIDUAL'S 30 NEEDS ARE SUCH THAT THEY ARE A DANGER TO THEMSELVES OR 20030S0136B1641 - 82 -
1 OTHERS OR ACCOMMODATION WOULD REQUIRE A FUNDAMENTAL 2 ALTERATION OF THE ASSISTED LIVING RESIDENCE'S BASIC 3 PROGRAM OR BUILDING OR CREATE AN UNDUE BURDEN ON THE 4 ASSISTED LIVING RESIDENCE. WHEN THESE CONDITIONS ARE MET 5 AND IF THIS IS REFLECTED IN AN ANNUAL OR OTHER 6 ASSESSMENT, THE RESIDENT MAY BE TRANSFERRED TO A SECURED 7 UNIT OR SECURED ASSISTED LIVING RESIDENCE. 8 (II) BEFORE AN INDIVIDUAL MAY BE TRANSFERRED OR 9 ADMITTED TO A SPECIALLY DESIGNATED SECURED UNIT OR A 10 SPECIALLY DESIGNATED SECURED ASSISTED LIVING RESIDENCE: 11 (A) THE RESIDENT AND THE RESIDENT'S 12 REPRESENTATIVE, IF ANY, SHALL BE ADVISED OF THE 13 ASSISTED LIVING RESIDENCE'S INTENT TO DISCHARGE OR 14 TRANSFER THE INDIVIDUAL WITH 30 DAYS' ADVANCE WRITTEN 15 NOTICE. THE WRITTEN NOTICE MUST INCLUDE INFORMATION 16 REGARDING A RESIDENT'S RIGHT TO SEEK AN ASSESSMENT OR 17 REASSESSMENT FROM THE AREA AGENCY ON AGING OR OTHER 18 INDIVIDUAL WHO IS INDEPENDENT FROM THE ASSISTED 19 LIVING RESIDENCE AND OF THE RESIDENT'S RIGHT TO 20 APPEAL TO THE DEPARTMENT OR USE THE INTERNAL 21 GRIEVANCE PROCESS TO ADDRESS THE APPROPRIATENESS OF 22 MOVEMENT TO A SECURED UNIT. THE 30-DAY NOTICE 23 REQUIREMENT SHALL NOT APPLY, BUT THE PROVIDER SHALL 24 GIVE AS MUCH ADVANCE NOTICE AS POSSIBLE WHERE 25 TRANSFER OR DISCHARGE IS NECESSARY TO MEET A 26 RESIDENT'S URGENT OR EMERGENCY MEDICAL NEEDS OR IN 27 EMERGENCY SITUATIONS WHERE THERE IS A DANGER TO 28 RESIDENTS OR OTHERS. 29 (B) A PHYSICIAN MUST APPROVE THE TRANSFER TO A 30 SECURED UNIT OR ADMISSION TO A SECURED ASSISTED 20030S0136B1641 - 83 -
1 LIVING RESIDENCE. 2 (C) THE RESIDENT OR RESIDENT'S REPRESENTATIVE 3 MUST CONSENT IN WRITING TO THE TRANSFER OR ADMISSION. 4 IF NEITHER THE RESIDENT NOR THE RESIDENT'S 5 REPRESENTATIVE AUTHORIZES THE TRANSFER OR DISCHARGE, 6 THE ASSISTED LIVING RESIDENCE MUST REFER THE MATTER 7 TO THE LOCAL AGENCY WHICH IS CHARGED TO ADMINISTER 8 THE ACT OF NOVEMBER 6, 1987 (P.L.381, NO.79), KNOWN 9 AS THE OLDER ADULTS PROTECTIVE SERVICES ACT, FOR 10 REVIEW. 11 (III) THE DEPARTMENT SHALL, THROUGH ITS INSPECTION 12 PROCESS, REVIEW TRANSFER AND DISCHARGE CASES THAT ARE 13 BASED ON COGNITIVE IMPAIRMENTS FOR COMPLIANCE WITH THIS 14 PROVISION. 15 (3) ADMINISTRATORS WORKING IN SPECIAL LICENSE 16 DESIGNATION SECURED UNITS OR SECURED ASSISTED LIVING 17 RESIDENCES MUST BE TRAINED AND TESTED IN A PROGRAM APPROVED 18 BY THE DEPARTMENT IN TRAINING AREAS DEVELOPED BY THE 19 DEPARTMENT IN CONSULTATION WITH STAKEHOLDERS, DESIGNATED BY 20 THE DEPARTMENT, ON ISSUES RELATING TO PROVIDING CARE AND 21 SERVICES TO COGNITIVELY IMPAIRED INDIVIDUALS. THIS TRAINING 22 SHALL BE IN ADDITION TO THAT REQUIRED UNDER SECTION 3. 23 (4) ALL DIRECT CARE STAFF WISHING TO WORK IN SPECIALLY 24 DESIGNATED SECURED UNITS OR SECURED ASSISTED LIVING 25 RESIDENCES SHALL, IN ADDITION TO THE TRAINING REQUIRED OF 26 DIRECT CARE STAFF IN SECTION 3, RECEIVE ADDITIONAL SECURED 27 TRAINING APPROVED BY THE DEPARTMENT IN TRAINING AREAS 28 ESTABLISHED BY THE DEPARTMENT IN CONSULTATION WITH 29 STAKEHOLDERS, DESIGNATED BY THE DEPARTMENT, ON ISSUES 30 RELATING TO PROVIDING CARE AND SERVICES TO COGNITIVELY 20030S0136B1641 - 84 -
1 IMPAIRED INDIVIDUALS. 2 (5) ASSISTED LIVING RESIDENCES WITH SPECIALLY DESIGNATED 3 SECURED UNITS OR THAT ARE SECURED ASSISTED LIVING RESIDENCES, 4 IN ADDITION TO THE DISCLOSURES REQUIRED UNDER SECTION 3 SHALL 5 DO ALL OF THE FOLLOWING: 6 (I) PROVIDE EACH APPLICANT WITH A STANDARDIZED 7 DISCLOSURE FORM DESIGNED BY THE DEPARTMENT IN 8 CONSULTATION WITH STAKEHOLDERS, DESIGNATED BY THE 9 DEPARTMENT, DESCRIBING THE REQUIREMENTS THAT MUST BE MET 10 BY A SECURED UNIT OR SECURED ASSISTED LIVING RESIDENCE 11 WHICH SHALL INCLUDE THE PHILOSOPHY AND MISSION OF SERVING 12 INDIVIDUALS WITH COGNITIVE IMPAIRMENTS, THE REQUIREMENTS 13 FOR PHYSICAL SPACE, WANDERING SPACE, THERAPEUTIC 14 ACTIVITIES AND ADDITIONAL TRAINING AND SECURITY, THAT 15 MUST BE MET FOR SPECIAL DESIGNATION. 16 (II) A REPRESENTATION THAT THE RESIDENCE MEETS THE 17 SPECIAL LICENSURE DESIGNATION, INCLUDING A DESCRIPTION OF 18 THE FREQUENCY AND TYPES OF INDIVIDUAL AND GROUP 19 ACTIVITIES, SECURITY MEASURES AND FAMILY SUPPORT 20 PROGRAMS. 21 (6) IF NATIONAL ACCREDITATION OF SECURED ASSISTED LIVING 22 RESIDENCES BECOMES AVAILABLE THE DEPARTMENT SHALL DEEM ALL 23 ASSISTED LIVING RESIDENCES ACCREDITED BY ACCREDITING BODIES 24 THAT HAVE STANDARDS THAT EQUAL OR EXCEED THOSE IN THIS ACT 25 AND REGULATIONS AS MEETING THE SPECIAL LICENSING DESIGNATIONS 26 UNDER THIS SECTION. 27 (7) STAFFING LEVELS SHALL BE SET IN ACCORDANCE WITH THE 28 STAFFING LEVELS REQUIRED UNDER SECTION 3, EXCEPT THAT IF AN 29 ASSISTED LIVING RESIDENCE HAS NATIONAL ACCREDITATION WHICH 30 HAS HIGHER STAFFING REQUIREMENTS, THE RESIDENCE SHALL MEET 20030S0136B1641 - 85 -
1 THE HIGHER REQUIREMENTS. 2 (B) OTHER DESIGNATIONS.--THE DEPARTMENT MAY RECOGNIZE AND 3 ESTABLISH OTHER SPECIAL DESIGNATIONS FOR ASSISTED LIVING 4 RESIDENCES. THE DEPARTMENT SHALL ESTABLISH STANDARDS AND 5 REQUIREMENTS NECESSARY FOR SPECIAL DESIGNATION. 6 SECTION 5. RESIDENT RIGHTS. 7 RESIDENTS SHALL HAVE THE FOLLOWING RIGHTS AND THE DEPARTMENT 8 SHALL PROMPTLY IMPLEMENT REGULATIONS TO ENSURE THESE RIGHTS: 9 (1) IF THE ASSISTED LIVING RESIDENCE PROVIDES MANAGEMENT 10 OF FUNDS ALL OF THE FOLLOWING APPLY: 11 (I) ASSISTED LIVING RESIDENCES SHALL MAINTAIN 12 RESIDENTS' FUNDS IN ACCOUNTS SEPARATE FROM THOSE OF THE 13 RESIDENCE. 14 (II) WHEN A RESIDENT'S FUNDS EXCEED $200, THE 15 ASSISTED LIVING RESIDENCE SHALL OFFER THE RESIDENT AN 16 OPPORTUNITY TO HAVE THE FUNDS PLACED IN AN INTEREST- 17 BEARING ACCOUNT. 18 (III) THE ASSISTED LIVING RESIDENCE SHALL KEEP 19 INDIVIDUAL RECORDS OF RESIDENTS' FUNDS. 20 (IV) RESIDENTS SHALL ONLY BE REQUIRED TO DEPOSIT 21 FUNDS WITH AN ASSISTED LIVING RESIDENCE IF THEY ARE 22 ACCEPTING FINANCIAL MANAGEMENT SERVICES. 23 (V) THE ASSISTED LIVING RESIDENCE SHALL DEVELOP AND 24 IMPLEMENT WRITTEN POLICIES AND PROCEDURES THAT PROHIBIT 25 MISAPPROPRIATION OF RESIDENT FUNDS OR PROPERTY. 26 (A) THE ASSISTED LIVING RESIDENCE SHALL ENSURE 27 THAT ALL REASONABLE ALLEGATIONS OF MISAPPROPRIATION 28 OF RESIDENT PROPERTY OR FUNDS ARE REPORTED 29 IMMEDIATELY TO THE ADMINISTRATOR OF THE ASSISTED 30 LIVING RESIDENCE AND TO THE DEPARTMENT AND OTHER 20030S0136B1641 - 86 -
1 OFFICIALS IN ACCORDANCE WITH STATE LAW. 2 (B) THE ASSISTED LIVING RESIDENCE SHALL 3 INVESTIGATE ALL REASONABLE ALLEGATIONS OF 4 MISAPPROPRIATION OF PROPERTY OR FUNDS AND UNDERTAKE 5 CORRECTIVE MEASURES WHERE APPROPRIATE. 6 (C) THE RESULTS OF ALL INVESTIGATIONS SHALL BE 7 REPORTED TO THE ADMINISTRATOR OR HIS DESIGNATED 8 REPRESENTATIVE, TO THE RESIDENT AND, IF APPROPRIATE, 9 THE RESIDENT'S REPRESENTATIVE, AND TO THE DEPARTMENT 10 AND OTHER OFFICIALS IN ACCORDANCE WITH STATE LAW. IF 11 THE ALLEGED VIOLATION IS VERIFIED, APPROPRIATE 12 CORRECTIVE ACTION MUST BE TAKEN. 13 (VI) RESIDENTS SHALL HAVE PROMPT ACCESS TO FUNDS. 14 (VII) RESIDENTS SHALL RECEIVE QUARTERLY STATEMENTS 15 FROM ASSISTED LIVING RESIDENCES HOLDING THEIR FUNDS. 16 (VIII) UPON DISCHARGE, THE ASSISTED LIVING RESIDENCE 17 SHALL REPAY FUNDS FROM THE PERSONAL NEEDS ACCOUNT TO THE 18 RESIDENT WITHIN FIVE BUSINESS DAYS. THE AMOUNT OF THE 19 DIFFERENCE BETWEEN ANY PAYMENT MADE, INCLUDING ANY UNPAID 20 INTEREST THEREON, AND THE COST OF SERVICES ACTUALLY 21 PROVIDED TO THE RESIDENT SHALL BE REPAID BY THE ASSISTED 22 LIVING RESIDENCE WITHIN 15 DAYS. 23 (IX) ASSISTED LIVING RESIDENCE STAFF SHALL OBTAIN 24 WRITTEN PERMISSION FOR EXPENDITURES FROM THE RESIDENT OR 25 THE RESIDENT'S REPRESENTATIVE AND SHALL KEEP RECEIPTS OF 26 EXPENDITURES. 27 (X) NO PROVIDER, ITS STAFF OR INDIVIDUAL AFFILIATED 28 WITH THE PROVIDER MAY ASSUME POWER OF ATTORNEY OR 29 GUARDIANSHIP OVER ANY RESIDENT, EXCEPT THAT THE 30 DEPARTMENT SHALL DEVISE A PROCESS FOR ALLOWING 20030S0136B1641 - 87 -
1 GUARDIANSHIP IN EMERGENCY SITUATIONS IF THE RESIDENT IS 2 UNABLE TO AUTHORIZE A REPRESENTATIVE AND IF THERE IS NO 3 EXISTING REPRESENTATIVE OR THE REPRESENTATIVE CANNOT BE 4 REACHED. 5 (XI) NO RESIDENT MAY BE REQUIRED TO ENDORSE CHECKS 6 OVER TO THE ASSISTED LIVING RESIDENCE. 7 (2) THE BASIC RIGHT TO: 8 (I) BE INVOLVED IN THE SERVICE PLANNING PROCESS AND 9 TO RECEIVE SERVICES WITH REASONABLE ACCOMMODATION OF 10 INDIVIDUAL NEEDS AND PREFERENCES EXCEPT WHERE THE HEALTH, 11 SAFETY OR WELFARE OF THE INDIVIDUAL OR OTHER RESIDENTS 12 WOULD BE ENDANGERED. 13 (II) HAVE PRIVACY, CONFIDENTIALITY AND FREEDOM FROM 14 ABUSE, NEGLECT AND FINANCIAL EXPLOITATION. 15 (III) REFUSE TREATMENT OR SERVICES UNDER THE PLAN. 16 IF A RESIDENT REFUSES TREATMENT OR SERVICES UNDER THE 17 PLAN, THE ASSISTED LIVING RESIDENCE MAY, IN ITS SOLE 18 DISCRETION, PROPOSE THE USE OF A SHARED RISK AGREEMENT 19 WITH THE RESIDENT DOCUMENTING THE REASON THE TREATMENT OR 20 SERVICES HAVE BEEN RECOMMENDED, THE POTENTIAL ADVERSE 21 CONSEQUENCES OF REFUSING THE TREATMENT OR SERVICES AND 22 THE RESIDENT'S REFUSAL OF THE TREATMENT OR SERVICES. 23 (IV) RECEIVE FROM THE ASSISTED LIVING RESIDENCE 30 24 DAYS' ADVANCE WRITTEN NOTICE OF THE ASSISTED LIVING 25 RESIDENCE'S PROPOSED CHANGES TO CHARGES AND POLICIES AND 26 OF THE INTENT OF THE RESIDENCE TO TRANSFER OR DISCHARGE 27 THE RESIDENT, EXCEPT WHERE TRANSFER IS NECESSARY TO MEET 28 THE RESIDENT'S URGENT OR EMERGENCY MEDICAL NEEDS OR WHERE 29 IMMEDIATE RISK OF HARM TO THE RESIDENT OR OTHERS WARRANTS 30 SHORTER NOTICE. 20030S0136B1641 - 88 -
1 (V) BE FREE FROM PHYSICAL OR CHEMICAL RESTRAINTS, 2 EXCEPT AS SET FORTH IN SECTION 4, RELATING TO SECURED 3 UNITS AND SECURED ASSISTED LIVING RESIDENCE. 4 (VI) BE FREE FROM UNREASONABLE INTERFERENCE WITH THE 5 RIGHT TO LEAVE AND RETURN, HAVE VISITORS, SEND AND 6 RECEIVE MAIL AND PARTICIPATE OR NOT PARTICIPATE IN 7 RELIGIOUS ACTIVITIES. 8 (VII) RECEIVE AN ASSESSMENT BY SOMEONE NOT 9 ASSOCIATED WITH THE RESIDENCE. 10 (VIII) RESIDENCY AND SERVICES EVERY DAY OF THE YEAR. 11 (IX) ACCESS THE LONG-TERM CARE OMBUDSMAN AND THE 12 DEPARTMENT'S 24-HOUR HOTLINE. 13 (X) BE FREE FROM DISCRIMINATION ON THE BASIS OF 14 RACE, COLOR, RELIGIOUS CREED, DISABILITY, HANDICAP, 15 ANCESTRY, SEXUAL ORIENTATION, NATIONAL ORIGIN, AGE OR 16 SEX. 17 (XI) SELECT A DOCTOR OR OTHER HEALTH CARE PROVIDER 18 OF THE RESIDENT'S CHOICE. 19 (XII) RESIDE AND RECEIVE SERVICES WITH REASONABLE 20 ACCOMMODATION OF INDIVIDUAL NEEDS AND PREFERENCES EXCEPT 21 IF CONTINUED RESIDENCE OR RECEIPT OF SERVICES WOULD: 22 (A) ENDANGER THE HEALTH, SAFETY OR RIGHTS OF THE 23 INDIVIDUAL OR OTHERS; 24 (B) CAUSE A FUNDAMENTAL ALTERATION OF THE 25 ASSISTED LIVING RESIDENCE'S BASIC PROGRAM OR 26 BUILDING; OR 27 (C) CREATE AN UNDUE BURDEN UPON THE ASSISTED 28 LIVING RESIDENCE. 29 (XIII) REVIEW INSPECTION AND COMPLAINT SURVEY AND 30 RESULTS CONDUCTED BY THE DEPARTMENT. 20030S0136B1641 - 89 -
1 (XIV) EXERCISE ALL RIGHTS AS A CITIZEN, INCLUDING 2 THE RIGHT TO VOTE, THE RIGHT TO VOICE GRIEVANCES WITH 3 RESPECT TO SERVICES WITHOUT RETALIATION AND TO ORGANIZE 4 AND PARTICIPATE IN RESIDENT AND FAMILY GROUPS. 5 (XV) RECEIVE AND REVIEW COPIES OF RESIDENT RECORDS 6 FOR A REASONABLE COST. 7 SECTION 6. LICENSURE. 8 (A) REQUIREMENT.-- 9 (1) AN ENTITY MAY NOT HOLD ITSELF OUT AS AN ASSISTED 10 LIVING RESIDENCE UNLESS THE ENTITY HAS A LICENSE. 11 (2) THE DEPARTMENT SHALL LICENSE ASSISTED LIVING 12 RESIDENCES. 13 (3) THE DEPARTMENT, IN CONSULTATION WITH STAKEHOLDERS, 14 SHALL ANNUALLY PUBLISH IN THE PENNSYLVANIA BULLETIN A FEE 15 SCHEDULE FOR LICENSES BASED ON THE SIZE OF THE ASSISTED 16 LIVING RESIDENCE WITH RESPECT TO BEDS. FEES SHALL BE 17 REASONABLY SUFFICIENT TO OFFSET THE REGULATORY COSTS OF THE 18 DEPARTMENT UNDER THIS ACT. 19 (4) COMPLIANCE WITH THE ACT OF NOVEMBER 10, 1999 20 (P.L.491, NO.45), KNOWN AS THE PENNSYLVANIA CONSTRUCTION CODE 21 ACT, IS A CONDITION OF LICENSURE. 22 (B) PROVISIONAL LICENSE.-- 23 (1) THE DEPARTMENT SHALL ISSUE A PROVISIONAL LICENSE IF 24 ALL OF THE FOLLOWING APPLY: 25 (I) THERE IS SUBSTANTIAL BUT NOT COMPLETE COMPLIANCE 26 WITH ALL APPLICABLE STATUTES, REGULATIONS AND ORDINANCES. 27 (II) THE APPLICANT HAS TAKEN APPROPRIATE STEPS TO 28 CORRECT DEFICIENCIES. 29 (2) A PROVISIONAL LICENSE SHALL BE FOR A PERIOD 30 SPECIFIED BY THE DEPARTMENT NOT TO EXCEED SIX MONTHS. 20030S0136B1641 - 90 -
1 (3) A PROVISIONAL LICENSE MAY BE RENEWED NO MORE THAN 2 THREE TIMES. 3 (4) UPON COMPLETE COMPLIANCE WITH ALL APPLICABLE 4 STATUTES, ORDINANCES AND REGULATIONS, A REGULAR LICENSE SHALL 5 BE ISSUED. 6 (C) INITIAL LICENSURE.-- 7 (1) BEFORE AN ASSISTED LIVING RESIDENCE IS LICENSED AND 8 PERMITTED TO OPEN, OPERATE OR ADMIT RESIDENTS, IT SHALL BE 9 INSPECTED BY THE DEPARTMENT AND MUST BE FOUND IN COMPLIANCE 10 WITH THE REQUIREMENTS SET FORTH IN THIS ACT AND THE 11 APPLICABLE REGULATIONS. THE DEPARTMENT MAY REFUSE TO ISSUE A 12 LICENSE IF ANY OF THE FOLLOWING APPLY: 13 (I) THERE WAS A CLASS I VIOLATION BY THE APPLICANT. 14 (II) THERE WERE MULTIPLE SERIOUS CLASS II VIOLATIONS 15 BY THE APPLICANT. 16 (2) NEW LICENSES SHALL BE VALID FOR SIX MONTHS OR UNTIL 17 THE DATE OF REINSPECTION, WHICHEVER IS LATER, AND SHALL BE 18 MARKED WITH A NOTATION THAT THE LICENSE IS NEW. 19 (3) THE DEPARTMENT SHALL REINSPECT NEWLY OPENED 20 FACILITIES WITHIN THREE MONTHS OF THE DATE OF LICENSE 21 ISSUANCE TO CHECK FOR COMPLIANCE WITH REQUIREMENTS WHICH 22 BECOME EFFECTIVE ONCE AN ASSISTED LIVING RESIDENCE IS IN 23 OPERATION AND HAS ADMITTED RESIDENTS. THIS PARAGRAPH DOES NOT 24 APPLY TO CURRENTLY LICENSED ENTITIES IN GOOD STANDING, 25 INCLUDING PERSONAL CARE HOMES, NURSING FACILITIES AND OTHER 26 ENTITIES DESIGNATED BY THE DEPARTMENT, WHICH ARE APPLYING FOR 27 A LICENSE 28 (4) A NEW ASSISTED LIVING RESIDENCE MUST BE IN 29 COMPLIANCE AT THE END OF THE FIRST SIX MONTHS OF OPERATION IN 30 ORDER TO RECEIVE A LICENSE. 20030S0136B1641 - 91 -
1 (5) EXCEPT AS SET FORTH IN PARAGRAPH (6), THE TERM OF A 2 LICENSE SHALL BE ONE YEAR. 3 (6) THE DEPARTMENT MAY ISSUE A LICENSE FOR 18 MONTHS. 4 THIS PARAGRAPH EXPIRES DECEMBER 31, 2006. 5 (D) LICENSE RENEWAL.-- 6 (1) AN ASSISTED LIVING RESIDENCE SEEKING TO RENEW A 7 LICENSE MUST APPLY AND SUBMIT PREINSPECTION DOCUMENTS AND ALL 8 INFORMATION REQUIRED BY THE DEPARTMENT NO LESS THAN THREE 9 MONTHS PRIOR TO THE EXPIRATION OF THE CURRENT LICENSE. 10 (2) IF AN ASSISTED LIVING RESIDENCE IS IN COMPLIANCE AT 11 THE TIME OF LICENSURE INSPECTION, ITS LICENSE SHALL BE 12 RENEWED. 13 (3) EXCEPT AS SET FORTH IN PARAGRAPH (4), AN ASSISTED 14 LIVING RESIDENCE WHICH CORRECTS ALL VIOLATIONS PRIOR TO THE 15 EXPIRATION OF ITS CURRENT LICENSE SHALL HAVE ITS LICENSE 16 RENEWED. 17 (4) THE DEPARTMENT MAY REFUSE TO ISSUE A LICENSE IF ANY 18 OF THE FOLLOWING APPLY: 19 (I) THERE WAS A CLASS I VIOLATION BY THE APPLICANT. 20 (II) THERE WERE MULTIPLE SERIOUS CLASS II VIOLATIONS 21 BY THE APPLICANT. 22 (5) AN ASSISTED LIVING RESIDENCE WITH UNCORRECTED MINOR 23 CLASS II OR CLASS III VIOLATIONS SHALL NOT BE ISSUED A 24 LICENSE BUT SHALL BE ISSUED A PROVISIONAL LICENSE IF THE 25 DEPARTMENT APPROVES ITS PLAN OF CORRECTION. AN ASSISTED 26 LIVING RESIDENCE WITH A PROVISIONAL LICENSE MUST CORRECT 27 VIOLATIONS PRIOR TO THE EXPIRATION OF THE PROVISIONAL LICENSE 28 PERIOD. IF THE ASSISTED LIVING RESIDENCE DOES NOT CORRECT THE 29 VIOLATIONS PRIOR TO THE EXPIRATION OF ITS LICENSURE PERIOD, 30 IT SHALL NOT BE ELIGIBLE FOR LICENSE RENEWAL. 20030S0136B1641 - 92 -
1 (6) THE DEPARTMENT MAY NOT ISSUE A SECOND OR SUBSEQUENT 2 PROVISIONAL LICENSE TO AN ASSISTED LIVING RESIDENCE IF A 3 VIOLATION WHICH RESULTED IN PREVIOUS PROVISIONAL LICENSURE 4 HAS NOT BEEN CORRECTED OR IF THE SAME VIOLATION HAS BEEN 5 REPEATED. EXCEPT AS SET FORTH IN PARAGRAPH (7), THE 6 DEPARTMENT MAY ISSUE A SECOND OR SUBSEQUENT PROVISIONAL 7 LICENSE IF A DIFFERENT CLASS III VIOLATION HAS BEEN FOUND. 8 (7) IF AN ASSISTED LIVING RESIDENCE WHICH HAS HAD FOUR 9 CONSECUTIVE PROVISIONAL LICENSES IS NOT IN FULL COMPLIANCE 10 PRIOR TO THE BEGINNING OF THE NEXT LICENSING PERIOD, NO 11 LICENSE MAY BE ISSUED. 12 (E) COMPLIANCE DURING APPEAL PERIOD.--THE DEPARTMENT SHALL 13 NOT ISSUE A LICENSE TO AN ASSISTED LIVING RESIDENCE IF IT COMES 14 INTO COMPLIANCE WITH LICENSING REQUIREMENTS DURING AN APPEAL OF 15 A CEASE AND DESIST ORDER. 16 (F) PROCEDURE.--THIS SECTION IS SUBJECT TO 2 PA.C.S. CH 5 17 SUBCH. A (RELATING TO PRACTICE AND PROCEDURE OF COMMONWEALTH 18 AGENCIES). 19 SECTION 7. INSPECTION PROCESS. 20 (A) INSPECTIONS.-- 21 (1) AFTER INITIAL LICENSURE INSPECTION, SURVEY STAFF 22 SHALL, AT LEAST 45 DAYS PRIOR TO EXPIRATION OF THE LICENSE, 23 CONDUCT AN ONSITE UNANNOUNCED LICENSURE INSPECTION. 24 ADDITIONAL INSPECTIONS MAY BE CONDUCTED. 25 (2) THE DEPARTMENT SHALL DEVELOP AN ABBREVIATED 26 INSPECTION PROCESS FOR ASSISTED LIVING RESIDENCES WHICH HAVE 27 HAD NO VIOLATIONS DURING THREE UNANNOUNCED CONSECUTIVE 28 INSPECTIONS. AN ABBREVIATED INSPECTION PROCESS SHALL CONTINUE 29 FOR AN ASSISTED LIVING RESIDENCE AS LONG AS NO VIOLATIONS ARE 30 CITED. 20030S0136B1641 - 93 -
1 (3) DURING LICENSING INSPECTIONS, THE DEPARTMENT SHALL 2 CONSIDER ISSUES WHICH HAVE BEEN THE SUBJECT OF COMPLAINTS IN 3 AN ASSISTED LIVING RESIDENCE. 4 (B) INSPECTORS.-- 5 (1) AN INSPECTOR OF THE DEPARTMENT HAS THE RIGHT TO 6 ENTER AND INSPECT AN ASSISTED LIVING RESIDENCE. THE INSPECTOR 7 SHALL HAVE ACCESS TO THE RECORDS OF THE ASSISTED LIVING 8 RESIDENCE AND OF THE RESIDENTS. THE INSPECTOR SHALL HAVE THE 9 OPPORTUNITY TO INTERVIEW RESIDENTS. 10 (2) THE DEPARTMENT SHALL ESTABLISH AND MAKE PUBLIC 11 SPECIFIC, OBJECTIVE GUIDELINES FOR INSPECTORS TO EMPLOY IN 12 THE INSPECTION OF ASSISTED LIVING RESIDENCES. 13 (3) INSPECTORS SHALL BE TRAINED IN THE INTENTION AND 14 INTERPRETATION OF INSPECTION GUIDELINES, INCLUDING CARE AND 15 SERVICES PROVIDED TO ENSURE CONSISTENT APPLICATION OF LEGAL 16 REQUIREMENTS. 17 (4) THE DEPARTMENT SHALL ENSURE ADEQUATE, TRAINED STAFF 18 AND PROVIDE ANNUAL CONTINUING EDUCATION COURSES TO INSPECTION 19 STAFF. STAKEHOLDERS DETERMINED BY THE DEPARTMENT SHALL HAVE 20 INPUT INTO THE CONTINUING EDUCATION CURRICULUM FOR 21 INSPECTORS. 22 (C) INSPECTION SURVEY.-- 23 (1) THE DEPARTMENT SHALL DEVELOP A UNIFORM SURVEY TO BE 24 USED BY INSPECTORS IN THE INSPECTION PROCESS. 25 (2) WITHIN SIX MONTHS OF THE EFFECTIVE DATE OF THIS 26 SECTION, THE DEPARTMENT SHALL DEVELOP A TIME LINE AND WORK 27 PLAN, COMPATIBLE WITH THE OBJECTIVE GUIDELINES FOR LICENSURE, 28 TO DEVELOP QUALITY INDICATORS OF CARE AND RESIDENT 29 SATISFACTION SURVEYS, WHICH WILL BE USED AS PART OF THE 30 ANNUAL INSPECTION PROCESS AND TO DEVELOP BEST PRACTICES. THE 20030S0136B1641 - 94 -
1 QUALITY INDICATORS OF CARE AND RESIDENT SATISFACTION SURVEYS 2 SHALL BE DEVELOPED IN CONSULTATION WITH STAKEHOLDERS 3 DETERMINED BY THE DEPARTMENT, AND SHALL BE IN PLACE WITHIN 24 4 MONTHS OF THE EFFECTIVE DATE OF THIS SECTION. 5 (D) PROVIDER FEEDBACK.--THE DEPARTMENT SHALL DEVELOP A 6 PROVIDER SURVEY TO OBTAIN PROVIDER FEEDBACK ON THE INSPECTION 7 PROCESS. THE SURVEY SHALL BE SENT IN THE PREINSPECTION 8 SUBMISSION INFORMATION TO BE RETURNED TO THE DEPARTMENT BY THE 9 PROVIDER AFTER THE ONSITE INSPECTION. THE SECRETARY SHALL 10 DESIGNATE AN ENTITY NOT DIRECTLY INVOLVED IN THE REGULATION OF 11 ASSISTED LIVING RESIDENCES TO RECEIVE AND EVALUATE THE SURVEYS. 12 THE DESIGNATED ENTITY SHALL PROVIDED INFORMATION TO THE 13 INSPECTION STAFF IN A MANNER WHICH ASSURES THE CONFIDENTIALITY 14 OF THE PROVIDERS SUBMITTING FEEDBACK. 15 SECTION 8. COMPLAINTS. 16 (A) PROCEDURE.-- 17 (1) THE DEPARTMENT SHALL ESTABLISH A STANDARD PROCEDURE 18 FOR CONDUCTING A PROMPT ONSITE INVESTIGATION FOLLOWING THE 19 REPORT OF A VIOLATION OF THE COMPLAINT. THIS PARAGRAPH 20 INCLUDES ANALYSIS OF COMPLIANCE WITH RELATED LICENSURE AT AN 21 ASSISTED LIVING RESIDENCE. 22 (2) THE DEPARTMENT SHALL ESTABLISH STANDARD PROTOCOLS, 23 INCLUDING STANDARD FORMS, ARTICULATING WHAT STEPS A COMPLAINT 24 INVESTIGATION SHALL INCLUDE, HOW IT IS TO PROCEED AND AT WHAT 25 POINT IT WILL BE DEEMED COMPLETE. THE PROTOCOLS SHALL SPECIFY 26 THE TYPES OF INDIVIDUALS WHO MUST BE INTERVIEWED IN THE 27 INVESTIGATION AND INCLUDE THE REQUIREMENT THAT ALL 28 INDIVIDUALS WITH INFORMATION PERTINENT TO THE COMPLAINT SHALL 29 BE INTERVIEWED, INCLUDING OTHER RESIDENTS, FAMILY MEMBERS AND 30 PHYSICIANS. 20030S0136B1641 - 95 -
1 (3) INTERVIEWS SHALL BE CONDUCTED CONFIDENTIALLY. IF A 2 VIOLATION OF A RESIDENT'S RIGHTS IS ALLEGED, CONFIDENTIAL 3 INTERVIEWS SHALL BE CONDUCTED WITH OTHER RESIDENTS IN ORDER 4 TO DETERMINE WHETHER THE ALLEGED VIOLATIONS ARE OCCURRING. 5 (B) TIME FRAMES.-- 6 (1) EXCEPT AS SET FORTH IN PARAGRAPH (2), THE FOLLOWING 7 APPLY: 8 (I) THE DEPARTMENT SHALL INVESTIGATE A COMPLAINT 9 WITHIN 48 HOURS OF RECEIPT OF THE COMPLAINT. 10 (II) IF THE DEPARTMENT DETERMINES IT NECESSARY, AN 11 UNANNOUNCED INSPECTION SHALL BE CONDUCTED. 12 (2) IF A COMPLAINT ALLEGES AN IMMEDIATE SERIOUS RISK TO 13 THE HEALTH OR SAFETY OF A RESIDENT, THE DEPARTMENT SHALL 14 CONDUCT AN ONSITE UNANNOUNCED INSPECTION OF THE PROVIDER 15 WITHIN 24 HOURS OF RECEIPT OF THE COMPLAINT. 16 (C) SCOPE.--COMPLAINT INVESTIGATIONS SHALL FOCUS ON THE 17 INDIVIDUAL CIRCUMSTANCES OF THE COMPLAINANT AND ON WHETHER A 18 SYSTEMIC PROBLEM EXISTS WHICH THREATENS HARM TO ADDITIONAL 19 RESIDENTS. IF A SYSTEMIC PROBLEM EXISTS, THE PROBLEM SHALL BE 20 CONSIDERED AN IMMEDIATE OR POTENTIAL THREAT TO RESIDENTS 21 REGARDLESS OF WHETHER THE COMPLAINANT IS PRESENTLY RESIDING AT 22 THE ASSISTED LIVING RESIDENCE. 23 (D) ONSITE VISITS.--ONSITE VISITS FOR COMPLAINT 24 INVESTIGATIONS SHALL BE UNANNOUNCED EXCEPT IF IMMEDIATE 25 TELEPHONE CONTACT WITH THE PROVIDER IS NECESSARY TO AVERT AN 26 IMMINENT RISK TO THE RESIDENT. 27 (E) FOLLOW-UP.-- 28 (1) AFTER INVESTIGATION OF A SUBSTANTIATED COMPLAINT, 29 THE DEPARTMENT SHALL PROMPTLY FOLLOW UP WITH THE RESIDENT OR, 30 IF APPROPRIATE, THE RESIDENT'S REPRESENTATIVE TO VERIFY THAT 20030S0136B1641 - 96 -
1 THE CONDITIONS COMPLAINED OF HAVE BEEN CORRECTED. 2 (2) THE DEPARTMENT SHALL NOTIFY THE COMPLAINANT IN 3 WRITING OF ALL OF THE FOLLOWING: 4 (I) THE FINDINGS OF THE INVESTIGATION. 5 (II) WHETHER THE COMPLAINT WAS FOUNDED. 6 (III) RESULTING ACTIONS. 7 (F) COMPLAINT TRACKING SYSTEM.--THE DEPARTMENT SHALL UTILIZE 8 A DATABASE TO TRACK COMPLAINTS REGARDING FACILITIES MORE 9 EFFECTIVELY AND MAKE THE COMPLAINT TRACKING SYSTEM AVAILABLE TO 10 LICENSING STAFF. COMPLAINT RECORDS SHALL DOCUMENT, IN A 11 RETRIEVABLE FORM, THE NATURE OF EACH COMPLAINT, WHETHER IT WAS 12 SUBSTANTIATED, ACTIONS AND FOLLOW-UP MONITORING PERFORMED BY THE 13 DEPARTMENT AND ISSUES TO BE MONITORED AT THE NEXT INSPECTION. 14 SECTION 9. VIOLATIONS. 15 (A) CLASSIFICATION.--WITHIN SIX MONTHS OF THE EFFECTIVE DATE 16 OF THIS SECTION, THE DEPARTMENT SHALL CLASSIFY EACH VIOLATION OF 17 THE REGULATIONS INTO ONE OF THE FOLLOWING CATEGORIES: 18 (1) CLASS I.A VIOLATION, INCLUDING FAILURE TO PROVIDE OR 19 NEGLIGENTLY PROVIDING SERVICES IN THE SERVICE PLAN, WHICH 20 INDICATES A SUBSTANTIAL PROBABILITY THAT DEATH OR SERIOUS 21 MENTAL OR PHYSICAL HARM TO A RESIDENT MAY OR DID RESULT. 22 (2) CLASS II.A VIOLATION, INCLUDING FAILURE TO PROVIDE 23 OR NEGLIGENTLY PROVIDING SERVICES IN THE SERVICE PLAN, WHICH 24 HAS A PROBABLE OR ACTUAL SUBSTANTIAL ADVERSE EFFECT UPON THE 25 HEALTH, SAFETY OR WELFARE OF A RESIDENT. 26 (3) CLASS III.A VIOLATION, WHICH HAS AN ADVERSE EFFECT 27 UPON THE HEALTH, SAFETY OR WELFARE OF A RESIDENT. 28 (B) NOTIFICATION OF VIOLATION.--IF THE DEPARTMENT, UPON 29 INSPECTION OR INVESTIGATION, LEARNS OF A VIOLATION OF THIS ACT 30 OR OF REGULATIONS PURSUANT TO THIS ACT, THE DEPARTMENT SHALL 20030S0136B1641 - 97 -
1 GIVE WRITTEN NOTICE OF THE VIOLATION TO THE ASSISTED LIVING 2 RESIDENCE ADMINISTRATOR OR DESIGNEE. UNLESS ONE OF THE 3 CONDITIONS IN SUBSECTION (A)(1) IS PRESENT, THE NOTICE SHALL 4 REQUIRE THE ASSISTED LIVING RESIDENCE TO COMPLY WITH THIS ACT OR 5 WITH THE RELEVANT REGULATION WITHIN A SPECIFIED TIME. 6 SECTION 10. PLANS OF CORRECTION. 7 (A) REQUIREMENT.-- 8 (1) THE DEPARTMENT SHALL PROMULGATE REGULATIONS 9 DETAILING REQUIREMENTS FOR AN ASSISTED LIVING RESIDENCE PLAN 10 OF CORRECTION. 11 (2) THE DEPARTMENT SHALL PROVIDE A REASONABLE 12 OPPORTUNITY FOR AN ASSISTED LIVING RESIDENCE TO DEVELOP, 13 SUBMIT AND RECEIVE APPROVAL OF A PLAN OF CORRECTION DURING AN 14 INSPECTION VISIT DURING WHICH A VIOLATION IS FOUND. 15 (3) A PLAN OF CORRECTION MUST ADDRESS THE UNDERLYING 16 CAUSE OF A VIOLATION AND PROVIDE A DETAILED PLAN FOR THE 17 PROMPT CORRECTION OF EACH VIOLATION. 18 (4) AN INSPECTOR MAY APPROVE A PLAN OF CORRECTION ONSITE 19 IF THE PLANNED CORRECTION COMPORTS WITH CORRECTION MEASURES 20 DEVELOPED BY THE DEPARTMENT FOR CLASS III AND SELECTED CLASS 21 II VIOLATIONS. IF THE CORRECTION MEASURES DO NOT COMPORT WITH 22 THOSE DEVELOPED BY THE DEPARTMENT, THE PLAN MUST BE REVIEWED 23 AND APPROVED BY THE DEPARTMENT. 24 (5) IF A PLAN OF CORRECTION IS NOT APPROVED ONSITE UNDER 25 PARAGRAPH (4) AND IS SUBSEQUENTLY SUBMITTED, THE DEPARTMENT 26 SHALL, WITHIN THREE BUSINESS DAYS OF SUBMITTAL, DETERMINE AND 27 NOTIFY THE ASSISTED LIVING RESIDENCE WHETHER THE PLAN IS 28 ACCEPTABLE. 29 (6) IF A PLAN OF CORRECTION IS APPROVED BY THE 30 DEPARTMENT, THE ASSISTED LIVING RESIDENCE MUST DEMONSTRATE 20030S0136B1641 - 98 -
1 IMPLEMENTATION OF THE PLAN AND PROVIDE CERTIFICATION TO THE 2 DEPARTMENT THAT COMPLIANCE HAS BEEN ACHIEVED. VERIFICATION 3 MUST BE PROVIDED BEFORE EXPIRATION OF THE ASSISTED LIVING 4 RESIDENCE'S LICENSE FOR THE LICENSE TO BE RENEWED AND WITHIN 5 THE TIME FRAMES FOR CORRECTION SET FORTH BY THE DEPARTMENT TO 6 AVOID A CONTINUING VIOLATION FINE. DEMONSTRATION THAT A 7 VIOLATION HAS BEEN CORRECTED MUST BE CONSISTENT WITH THE 8 NATURE AND SERIOUSNESS OF THE VIOLATION, INCLUDING: 9 (I) REVISITATION BY AN INSPECTOR, WHICH SHALL BE 10 REQUIRED FOR ALL CLASS I AND CLASS II VIOLATIONS PRIOR TO 11 EXPIRATION OF THE LICENSE. 12 (II) SUBMISSION OF RECEIPTS OR PHOTOGRAPHS. 13 (III) CERTIFICATION BY THE ADMINISTRATOR. 14 (B) RECURRENCE.--IF A VIOLATION ADDRESSED AND RESOLVED BY A 15 PLAN OF CORRECTION RECURS, THE DEPARTMENT SHALL MAKE ITS 16 REQUIREMENTS FOR FURTHER PLANS OF CORRECTION MORE PRESCRIPTIVE 17 AND STRINGENT TO ENSURE THAT THE VIOLATION DOES NOT RECUR. THE 18 STEPS OUTLINED IN THE FIRST PLAN OF CORRECTION SHALL NOT BE 19 CONSIDERED SUFFICIENT IN A SUBSEQUENT PLAN OF CORRECTION FOR THE 20 SAME VIOLATION. 21 (C) CORRECTIVE MEASURES.--THE DEPARTMENT SHALL DEVELOP 22 UNIFORM ACCEPTABLE CORRECTIVE MEASURES FOR EACH TYPE OF 23 VIOLATION, WHICH FACILITIES MAY SELECT UPON A FIRST VIOLATION 24 AND WHICH FACILITIES MUST FOLLOW ON A SUBSEQUENT VIOLATION. 25 THESE MEASURES SHALL INCLUDE PROTOCOLS FOR CORRECTING THE 26 VIOLATION, THE ANTICIPATED EFFECT ON RESIDENTS AND PERIODS FOR 27 COMPLETION. 28 (D) REVOCATION.--ASSISTED LIVING RESIDENCE FAILURE TO MEET 29 DEADLINES FOR COMPLIANCE WITH PLANS OF CORRECTION SHALL RESULT 30 IN REVOCATION OF LICENSURE STATUS. IF COMPLIANCE WITH A PLAN OF 20030S0136B1641 - 99 -
1 CORRECTION IS NOT WITHIN THE DIRECT CONTROL OF AN ASSISTED 2 LIVING RESIDENCE, PROOF OF ACCEPTABLE EFFORTS TO COMPLY SHALL BE 3 TREATED AS COMPLIANCE. IF AT THE NEXT INSPECTION THE VIOLATION 4 REMAINS UNCORRECTED, ADDITIONAL COMPLIANCE EFFORTS SHALL BE 5 REQUIRED OF THE ASSISTED LIVING RESIDENCE. 6 (E) FOLLOW-UP.--THE DEPARTMENT SHALL CONDUCT PROMPT FOLLOW- 7 UP VISITS AFTER VIOLATIONS HAVE BEEN VERIFIED AND PLANS OF 8 CORRECTIONS APPROVED. 9 SECTION 11. QUALITY MANAGEMENT PROGRAM. 10 (A) DEVELOPMENT.--THE DEPARTMENT SHALL DEVELOP A QUALITY 11 MANAGEMENT PROGRAM TO ASSIST PROVIDERS TO DO ALL OF THE 12 FOLLOWING: 13 (1) IDENTIFY BEST PRACTICES. 14 (2) IMPROVE QUALITY. 15 (3) PROVIDE TECHNICAL ASSISTANCE. 16 (4) MANAGE RISK. 17 (B) TRAINING.--DEPARTMENT EMPLOYEES RESPONSIBLE FOR QUALITY 18 MANAGEMENT SHALL RECEIVE TRAINING AS INSPECTORS BUT SHALL NOT BE 19 RESPONSIBLE FOR THE LICENSURE OR INSPECTION UNDER THIS ACT. 20 SECTION 12. PENALTIES. 21 (A) CRIMINAL.-- 22 (1) A PERSON THAT OPERATES AN ASSISTED LIVING RESIDENCE 23 WITHOUT A LICENSE COMMITS A SUMMARY OFFENSE AND SHALL UPON 24 CONVICTION BE SENTENCED TO PAY A FINE OF $300. EACH DAY OF 25 VIOLATION CONSTITUTES A SEPARATE OFFENSE. THE DEPARTMENT IS 26 AUTHORIZED TO PROSECUTE VIOLATIONS OF THIS PARAGRAPH. 27 (2) THE PROVISIONS OF 18 PA.C.S. § 2713 (RELATING TO 28 NEGLECT OF CARE-DEPENDENT PERSON) SHALL APPLY TO ASSISTED 29 LIVING RESIDENCES LICENSED UNDER THIS ACT. 30 (B) ADMINISTRATIVE PENALTIES.-- 20030S0136B1641 - 100 -
1 (1) THE DEPARTMENT SHALL, IN CONSULTATION WITH 2 STAKEHOLDERS, ANNUALLY DEVELOP AND PUBLISH A FINE SCHEDULE 3 WHICH PROVIDES FOR A FINE TO BE LEVIED FOR A VIOLATION OF 4 THIS ACT OR A REGULATION PROMULGATED UNDER THIS ACT. 5 (2) EXCEPT AS SET FORTH IN PARAGRAPH (3), A FINE SHALL 6 BE IMPOSED IF A VIOLATION OF A REGULATORY REQUIREMENT IS 7 FOUND AND FOR EACH DAY THAT A CITED VIOLATION REMAINS 8 UNCORRECTED, AS FOLLOWS: 9 (I) THE DEPARTMENT SHALL IMPOSE A FINE ON AN 10 ASSISTED LIVING RESIDENCE FOR FAILURE TO COMPLY WITH A 11 PLAN OF CORRECTION OR FOR FALSE DOCUMENTATION OF 12 COMPLIANCE WITH A PLAN OF CORRECTION. 13 (II) THE FINE FOR EACH DAY A CITED VIOLATION REMAINS 14 UNCORRECTED SHALL ACCUMULATE UNTIL THE ASSISTED LIVING 15 RESIDENCE SATISFACTORILY DEMONSTRATES TO THE DEPARTMENT 16 THAT THE VIOLATION HAS BEEN CORRECTED. 17 (III) THE DEPARTMENT SHALL ESTABLISH ADMINISTRATIVE 18 FINES THAT RELATE TO THE SEVERITY OF THE VIOLATION. 19 (3) A FINE SHALL NOT BE IMPOSED FOR A MINOR VIOLATION 20 WHICH DOES NOT HAVE AN ADVERSE EFFECT ON THE HEALTH, SAFETY 21 OR WELFARE OF A RESIDENT. 22 (4) THIS SUBSECTION IS SUBJECT TO 2 PA.C.S. CH. 5 SUBCH. 23 A (RELATING TO PRACTICE AND PROCEDURE OF COMMONWEALTH 24 AGENCIES). 25 (5) NOTWITHSTANDING 42 PA.C.S. § 3733 (RELATING TO 26 DEPOSITS INTO ACCOUNT): 27 (I) MONEY COLLECTED BY THE DEPARTMENT UNDER THIS 28 SUBSECTION SHALL BE FIRST USED TO DEFRAY THE EXPENSES 29 INCURRED BY RESIDENTS RELOCATED UNDER THIS ACT; AND 30 (II) MONEY REMAINING SHALL BE USED BY THE DEPARTMENT 20030S0136B1641 - 101 -
1 FOR ENFORCING THE PROVISIONS OF THIS ACT. 2 (C) REVOCATION OR NONRENEWAL OF LICENSE.-- 3 (1) THE DEPARTMENT SHALL REFUSE TO ISSUE A LICENSE OR 4 SHALL REVOKE A LICENSE FOR ANY OF THE FOLLOWING: 5 (I) A CLASS I VIOLATION OR REPEATED CLASS II 6 VIOLATIONS. 7 (II) FRAUD OR DECEIT IN OBTAINING OR ATTEMPTING TO 8 OBTAIN A LICENSE. 9 (III) LENDING, BORROWING OR USING THE LICENSE OF 10 ANOTHER, OR IN ANY WAY KNOWINGLY AIDING OR ABETTING THE 11 IMPROPER GRANTING OF A LICENSE. 12 (IV) NEGLIGENCE OR MISCONDUCT IN OPERATING THE 13 ASSISTED LIVING RESIDENCE. 14 (V) MISTREATING OR ABUSING INDIVIDUALS CARED FOR IN 15 THE ASSISTED LIVING RESIDENCE. 16 (2) THE PROVIDER SHALL, WITHIN THREE BUSINESS DAYS OF 17 RECEIPT OF A DEPARTMENTAL NOTICE, NOTIFY RESIDENTS OF 18 DEPARTMENT REVOCATION AND NONRENEWAL ACTIONS. 19 (3) A LICENSURE REVOCATION NOTICE SHALL INCLUDE A BAN ON 20 NEW ADMISSIONS. 21 SECTION 13. TRANSFER OF LICENSE. 22 (A) GENERAL RULE.--THERE SHALL BE NO TRANSFER OF LICENSE 23 UNLESS APPROVED BY THE DEPARTMENT. THE DEPARTMENT MAY DENY 24 TRANSFERS TO FRIENDS, RELATIVES OR BUSINESS ASSOCIATES IF IT 25 APPEARS THAT THE PURPOSE OF TRANSFER IS TO AVOID LICENSURE 26 ACTION OR THAT THE PREVIOUS OWNER WILL CONTINUE TO HAVE 27 INVOLVEMENT IN THE RESIDENCE OR BUSINESS. 28 (B) TRANSFER DURING DISCIPLINARY ACTION.--IF AN OWNER OF AN 29 ASSISTED LIVING RESIDENCE WITH AN APPEAL PENDING SELLS THE 30 ASSISTED LIVING RESIDENCE TO AVOID CLOSURE, THE RESIDENTS OF THE 20030S0136B1641 - 102 -
1 ASSISTED LIVING RESIDENCE SHALL BE RELOCATED; AND THE NEW ENTITY 2 SHALL REAPPLY AND MEET ALL LICENSURE REQUIREMENTS BEFORE 3 REOPENING. 4 SECTION 14. RELOCATION, RELOCATION ASSISTANCE AND TRANSFER. 5 (A) RELOCATION DUE TO VIOLATION.-- 6 (1) A RESIDENT HAS THE RIGHT TO RELOCATE AND RECEIVE 7 RELOCATION ASSISTANCE FROM THE DEPARTMENT AND OTHER 8 COOPERATING COMMONWEALTH AGENCIES IF ANY OF THE FOLLOWING 9 APPLY: 10 (I) AN ASSISTED LIVING RESIDENCE IS CITED FOR A 11 CLASS I VIOLATION. 12 (II) AN ACTION IS INITIATED TO REDUCE THE LICENSURE 13 STATUS OF THE ASSISTED LIVING RESIDENCE TO PROVISIONAL 14 STATUS. 15 (2) IN THE EVENT OF A LICENSURE REVOCATION, LICENSURE 16 DENIAL OR NONRENEWAL OR VOLUNTARY PROVIDER CLOSURE, RESIDENTS 17 HAVE THE RIGHT TO BE RELOCATED BY THE DEPARTMENT AND OTHER 18 COOPERATING COMMONWEALTH AGENCIES; AND THE DEPARTMENT HAS THE 19 OBLIGATION TO RELOCATE THESE RESIDENTS. 20 (3) THE RIGHTS PROVIDED UNDER PARAGRAPHS (1) AND (2) 21 SHALL INURE TO THE RESIDENT AND MAY NOT BE STAYED BY AN 22 APPEAL. 23 (4) A RESIDENT RELOCATED BY THE DEPARTMENT MAY NOT BE 24 PLACED INTO A FACILITY WHICH IS NOT LICENSED OR WHICH HAS A 25 PROVISIONAL LICENSE. 26 (B) RELOCATION DUE TO CERTAIN CONDITIONS.-- THE DEPARTMENT 27 SHALL PROMPTLY RELOCATE RESIDENTS FROM AN ASSISTED LIVING 28 RESIDENCE IF ANY OF THE FOLLOWING CONDITIONS EXIST: 29 (1) THE ASSISTED LIVING RESIDENCE IS OPERATING WITHOUT A 30 LICENSE. 20030S0136B1641 - 103 -
1 (2) THE LICENSEE IS VOLUNTARILY CLOSING AN ASSISTED 2 LIVING RESIDENCE AND RELOCATION IS NECESSARY FOR THE HEALTH 3 AND WELFARE OF THE RESIDENTS. 4 (3) THE ASSISTED LIVING RESIDENCE HAS ENGAGED IN CONDUCT 5 WHICH ENDANGERS THE HEALTH AND SAFETY OF ITS RESIDENTS, 6 LEADING A REASONABLE RESIDENT TO BE CONCERNED FOR HIS SAFETY. 7 (C) RELOCATION ASSISTANCE.-- 8 (1) THE DEPARTMENT SHALL OFFER RELOCATION ASSISTANCE TO 9 RESIDENTS OF ASSISTED LIVING RESIDENCES. THIS ASSISTANCE 10 SHALL INCLUDE: 11 (I) PROVIDING RESIDENTS WITH PERTINENT INFORMATION, 12 SUCH AS REFERRALS TO NEARBY SOCIAL SERVICE AGENCIES OR 13 ASSISTED LIVING RESIDENCES IN COMPLETE COMPLIANCE WITH 14 GOVERNING REGULATIONS. 15 (II) DETERMINING OTHER OPTIONS FOR RELOCATION AND 16 ASSISTING RESIDENTS IN MAKING ARRANGEMENTS FOR RELOCATION 17 IF FAMILY MEMBERS ARE NOT AVAILABLE FOR THIS PURPOSE. 18 (2) EXCEPT IN AN EMERGENCY, THE RESIDENT SHALL BE 19 INVOLVED IN PLANNING TRANSFER TO ANOTHER PLACEMENT AND HAS 20 THE RIGHT TO CHOOSE AMONG THE AVAILABLE ALTERNATIVE 21 PLACEMENTS. 22 (3) THE DEPARTMENT MAY MAKE TEMPORARY PLACEMENT UNTIL 23 FINAL PLACEMENT CAN BE ARRANGED. 24 (4) A RESIDENT SHALL BE PROVIDED WITH AN OPPORTUNITY TO 25 VISIT ALTERNATIVE PLACEMENT BEFORE RELOCATING OR FOLLOWING 26 TEMPORARY EMERGENCY RELOCATION. 27 (5) A RESIDENT SHALL CHOOSE FINAL PLACEMENT AND SHALL BE 28 GIVEN ASSISTANCE IN TRANSFERRING TO SUCH PLACE. 29 (D) BEST INTERESTS.--A RESIDENT SHALL NOT BE RELOCATED 30 PURSUANT TO THIS SECTION IF THE DEPARTMENT DETERMINES IN WRITING 20030S0136B1641 - 104 -
1 AND CONSISTENT WITH THE RESIDENT'S PREFERENCE THAT RELOCATION IS 2 NOT IN THE BEST INTEREST OF THE RESIDENT AND THAT REMAINING IN 3 PLACE IS POSSIBLE. 4 SECTION 15. INFORMAL DISPUTE RESOLUTION. 5 (A) ESTABLISHMENT.--THE DEPARTMENT SHALL ESTABLISH AN 6 INFORMAL DISPUTE RESOLUTION PROCESS WHICH ALLOWS ASSISTED LIVING 7 RESIDENCES TO CONTEST A DETERMINATION BY THE DEPARTMENT OF A 8 VIOLATION OF THIS ACT OR A REGULATION PROMULGATED UNDER THIS 9 ACT. THE DEPARTMENT SHALL ENSURE THAT THE ARBITER RESPONSIBLE 10 FOR REVIEWING AN INFORMAL DISPUTE IS AN EMPLOYEE OF THE 11 DEPARTMENT AND RECEIVES TRAINING AS AN INSPECTOR BUT IS NOT 12 RESPONSIBLE FOR LICENSURE OR INSPECTION UNDER THIS ACT. 13 (B) PROCEDURE.-- 14 (1) TO UTILIZE INFORMAL DISPUTE RESOLUTION, AN ASSISTED 15 LIVING RESIDENCE MUST DO ALL OF THE FOLLOWING: 16 (I) MAKE A REQUEST WITHIN TEN DAYS FOLLOWING RECEIPT 17 OF A STATEMENT OF VIOLATION OF THIS ACT OR A REGULATION 18 PROMULGATED UNDER THIS ACT. 19 (II) SUBMIT A TIMELY WRITTEN CERTIFICATION OR PLAN 20 OF CORRECTION UNDER THIS ACT. 21 (III) PAY A REASONABLE FEE SET BY THE DEPARTMENT. 22 (2) AN ASSISTED LIVING RESIDENCE HAS THE OPPORTUNITY TO 23 BE HEARD, INCLUDING PRESENTATION OF WRITTEN INFORMATION, AND 24 THE OPTION OF A FACE-TO-FACE CONFERENCE WITH THE ARBITER 25 PRIOR TO ISSUANCE OF A DECISION REGARDING A DISPUTE. 26 (3) THE DEPARTMENT SHALL RESOLVE A DISPUTE WITHIN 30 27 DAYS OF A REQUEST UNDER PARAGRAPH (1)(I). 28 (C) EFFECT.--IF THE INFORMAL DISPUTE RESOLUTION PROCESS 29 RESOLVES AN ISSUE IN FAVOR OF THE ASSISTED LIVING RESIDENCE, THE 30 DEPARTMENT SHALL AMEND ITS STATEMENT OF VIOLATION WITHIN TEN 20030S0136B1641 - 105 -
1 DAYS FOLLOWING THE RESOLUTION. 2 (D) CONFIDENTIALITY.-- 3 (1) EXCEPT AS SET FORTH IN PARAGRAPH (2), DURING THE 4 DISPUTE RESOLUTION PROCESS, THE DEPARTMENT SHALL NOT 5 DISSEMINATE INFORMATION CONCERNING INSPECTION RESULTS, 6 INCLUDING A STATEMENT OF VIOLATION OF THIS ACT OR A 7 REGULATION PROMULGATED UNDER THIS ACT. 8 (2) PARAGRAPH (1) DOES NOT APPLY IF ANY OF THE FOLLOWING 9 APPLY: 10 (I) THE DISCLOSURE IS REQUIRED BY LAW. 11 (II) THE DEPARTMENT IS TAKING ACTION UNDER SECTION 12 12(C). 13 SECTION 16. APPEALS. 14 (A) ADMINISTRATIVE AGENCY LAW.--A PROVIDER MAY APPEAL A 15 DEPARTMENTAL DECISION IMPOSING A FINE OR REVOKING OR FAILING TO 16 RENEW A LICENSE IN ACCORDANCE WITH 2 PA.C.S. CH. 7 SUBCH. A 17 (RELATING TO JUDICIAL REVIEW OF COMMONWEALTH AGENCY ACTION). 18 (B) ACTION PENDING APPEAL.--IF AN ASSISTED LIVING RESIDENCE 19 APPEALS THE REVOCATION OR NONRENEWAL OF ITS LICENSE, THE 20 DEPARTMENT HAS THE AUTHORITY UNDER SECTION 12(C)(3) TO TAKE 21 ACTIONS AS NECESSARY TO PROTECT THE RESIDENTS AND APPOINT A 22 MASTER. 23 (C) SUPERSEDEAS.-- 24 (1) THE APPEAL BY THE ASSISTED LIVING RESIDENCE OF THE 25 REVOCATION OR NONRENEWAL OF ITS LICENSE SHALL NOT ACT AS AN 26 AUTOMATIC SUPERSEDEAS. THE ASSISTED LIVING RESIDENCE MAY 27 REQUEST A SUPERSEDEAS FROM THE SECRETARY OR THE SECRETARY'S 28 DESIGNEE. 29 (2) TO OBTAIN A SUPERSEDEAS, THE ASSISTED LIVING 30 RESIDENCE MUST SHOW: 20030S0136B1641 - 106 -
1 (I) A SUBSTANTIAL LIKELIHOOD OF PREVAILING ON THE 2 MERITS; AND 3 (II) THAT THE RESIDENTS WILL BE SAFE AND RECEIVE 4 ADEQUATE CARE PENDING A DECISION ON THE MERITS. 5 (3) DURING THE TIME THE SUPERSEDEAS IS IN EFFECT, THE 6 DEPARTMENT SHALL INSPECT A RESIDENCE AT LEAST MONTHLY OR MORE 7 FREQUENTLY TO ENSURE RESIDENTS' SAFETY AND WELL-BEING. 8 INSPECTION REPORTS SHALL BE MAINTAINED AS PART OF THE PUBLIC 9 RECORD FOR THE ASSISTED LIVING RESIDENCE. 10 (4) IF A SUPERSEDEAS HAS BEEN GRANTED, A CLASS I OR 11 CLASS II VIOLATION CITED AFTER THE GRANTING OF THE 12 SUPERSEDEAS SHALL LEAD TO A REVOCATION OF THE SUPERSEDEAS. 13 (D) GROUNDS FOR SUSTAINING APPEAL.--A REVIEWING COURT SHALL 14 NOT SUSTAIN AN APPEAL ON THE GROUND THAT AN ASSISTED LIVING 15 RESIDENCE, ALTHOUGH OUT OF COMPLIANCE AT THE TIME IT WAS CITED, 16 IS, AT THE TIME OF THE APPEAL, IN COMPLIANCE UNLESS THE ASSISTED 17 LIVING RESIDENCE CAN SHOW BY A PREPONDERANCE OF THE EVIDENCE 18 THAT ITS PROCEDURES, POLICIES AND STAFF RESOURCES WILL CONTINUE 19 TO ENSURE FULL COMPLIANCE IN THE FUTURE. 20 SECTION 37. REGULATIONS. 21 (A) INITIAL REGULATIONS.-- 22 (1) THE DEPARTMENT SHALL PROMULGATE TEMPORARY 23 REGULATIONS WITHIN 180 DAYS OF THE EFFECTIVE DATE OF THIS 24 SECTION TO IMPLEMENT THE PROVISIONS OF THIS ACT. THE 25 DEPARTMENT SHALL SEEK COMMENTS ON DRAFT REGULATIONS FROM 26 INTERESTED PARTIES PRIOR TO PUBLICATION OF THESE TEMPORARY 27 REGULATIONS BUT REGULATIONS IMPLEMENTED PURSUANT TO THIS 28 SUBSECTION SHALL NOT BE SUBJECT TO: 29 (I) THE ACT OF JULY 31, 1968 (P.L.769, NO.240), 30 REFERRED TO AS THE COMMONWEALTH DOCUMENTS LAW; 20030S0136B1641 - 107 -
1 (II) THE ACT OF OCTOBER 15, 1980 (P.L.950, NO.164), 2 KNOWN AS THE COMMONWEALTH ATTORNEYS ACT; OR 3 (III) THE ACT OF JUNE 25, 1982 (P.L.633, NO.181), 4 KNOWN AS THE REGULATORY REVIEW ACT. 5 (2) THE REGULATIONS IMPLEMENTED PURSUANT TO THIS 6 SUBSECTION SHALL BE EFFECTIVE UPON PUBLICATION IN THE 7 PENNSYLVANIA BULLETIN. 8 (3) REGULATIONS PROMULGATED UNDER THIS SUBSECTION SHALL 9 EXPIRE TWO YEARS AFTER THEIR EFFECTIVE DATE. 10 (B) SUBSEQUENT REGULATIONS.-- 11 (1) THE DEPARTMENT SHALL PROMULGATE REGULATIONS TO 12 REPLACE THE REGULATIONS PROMULGATED PURSUANT TO SUBSECTION 13 (A) WITHIN TWO YEARS OF THE EFFECTIVE DATE OF THIS SECTION. 14 REGULATIONS PROMULGATED UNDER THIS SUBSECTION SHALL BE 15 SUBJECT TO: 16 (I) THE COMMONWEALTH DOCUMENTS LAW; 17 (II) THE COMMONWEALTH ATTORNEYS ACT; AND 18 (III) THE REGULATORY REVIEW ACT. 19 (2) NOTICE OF PROPOSED RULEMAKING SHALL NOT BE OMITTED 20 PURSUANT TO SECTION 204 OF THE COMMONWEALTH DOCUMENTS LAW, 21 AND NO FINAL-FORM REGULATION SUBJECT TO THIS SUBSECTION MAY 22 TAKE EFFECT PURSUANT TO EMERGENCY CERTIFICATION BY THE 23 GOVERNOR UNDER SECTION 6(D) OF THE REGULATORY REVIEW ACT. 24 SECTION 38. REPEAL. 25 ALL ACTS AND PARTS OF ACTS ARE REPEALED INSOFAR AS THEY ARE 26 INCONSISTENT WITH THIS ACT. 27 SECTION 39. EFFECTIVE DATE. 28 THIS ACT SHALL TAKE EFFECT AS FOLLOWS: 29 (1) THE FOLLOWING PROVISIONS SHALL TAKE EFFECT 30 IMMEDIATELY: 20030S0136B1641 - 108 -
1 (I) SECTION 37. 2 (II) THIS SECTION. 3 (2) THE REMAINDER OF THIS ACT SHALL TAKE EFFECT IN 180 4 DAYS. A3L35MSP/20030S0136B1641 - 109 -