1Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
2act relating to health care; prescribing the powers and
3duties of the Department of Health; establishing and
4providing the powers and duties of the State Health
5Coordinating Council, health systems agencies and Health Care
6Policy Board in the Department of Health, and State Health
7Facility Hearing Board in the Department of Justice;
8providing for certification of need of health care providers
9and prescribing penalties," in licensing of health care
10facilities, further providing for definitions, for licensure, 
11for term and content of license and for reliance on
12accrediting agencies and Federal Government; and providing 
13for reliance on national accreditation organizations for 
14hospitals.

15The General Assembly of the Commonwealth of Pennsylvania
16hereby enacts as follows:

17Section 1. Section 802.1 of the act of July 19, 1979
18(P.L.130, No.48), known as the Health Care Facilities Act, is
19amended by adding definitions to read:

20Section 802.1. Definitions.

1The following words and phrases when used in this chapter
2shall have, unless the context clearly indicates otherwise, the
3meanings given them in this section:

4* * *

5"Deemed" or "deemed status." A process under which a
6hospital may be exempt from routine licensure renewal surveys
7conducted by the Department of Health.

8* * *

9"National accreditation organization." A nongovernmental
10organization that has been authorized by the Centers for
11Medicare and Medicaid Services (CMS) to conduct hospital surveys
12to ensure compliance with the CMS Conditions of Participation.

13Section 2. Section 806 of the act is amended by adding a
14subsection to read:

15Section 806. Licensure.

16* * *

17(i) Hospitals.--

18(1) In issuing a license to a hospital, the department
19shall, at the request of the hospital, rely on the reports of
20national accreditation organizations designated as acceptable
21to the department pursuant to the requirements set forth in
22section 810.1 and shall issue a license to a hospital that
23received approval or accreditation from the designated
24organization.

25(2) A hospital that is not accredited by a national
26accreditation organization or does not request that the
27department rely on the accreditation shall be required to
28comply with 28 Pa. Code Chs. 51 (relating to general
29information) and 101 (relating to general information).

30(3) This subsection shall not be construed as a

1limitation on the department's right of inspection permitted
2under section 813, including the right to inspect in response
3to complaints or other reports made to the department.

4(4) A hospital that is deemed shall comply with the
5standards established by a national accreditation
6organization that accredits the hospital. Any licensure
7inspection of a deemed hospital shall be based on the
8standards established by the national accreditation
9organization that accredits the hospital and State law.

10(5) All hospitals, whether licensed through
11accreditation or compliance with the department's
12regulations, shall submit plans for new construction and
13renovation of facilities to the department and must receive
14approval from the department before providing services in the
15newly constructed or renovated areas.

16Section 3. Sections 809 and 810 heading and (a) of the act,<-
17amended December 18, 1992 (P.L.1602, No.179), are amended to
18read:

19Section 809. Term and content of license.

20(a) Contents.--All licenses issued by the department under
21this chapter shall:

22(1) be issued for a specified length of time as follows,
23including the provision of section 804(b):

24(i) all health care facilities other than hospitals
25for a period of one year[, and for hospitals for a period
26of two years] with the expiration date to be the last day
27of the month in which license is issued;

28(ii) provisional licenses for the length of time to
29be determined by the department upon issuance of the
30provisional license;

1(iii) all deemed hospitals for the duration of the
2accreditation cycle in good standing with the expiration
3date to be the last day of the month in which the license
4is issued; and

5(iv) all hospitals licensed by compliance with the
6department's regulations for a period of three years,
7with the expiration date to be the last day of the month
8in which the license is issued;

9(2) be on a form prescribed by the department;

10(3) not be transferable except upon prior written
11approval of the department;

12(4) be issued only to the health care provider and for
13the health care facility or facilities named in the
14application;

15(5) specify the maximum number of beds, if any, to be
16used for the care of patients in the facility at any one
17time; and

18(6) specify limitations which have been placed on the
19facility.

20(b) Posting.--The license shall at all times be posted in a
21conspicuous place on the provider's premises.

22(c) Visitation.--Whenever practicable, the department shall
23make its visitations and other reviews necessary for licensure
24contemporaneously with similar visitations and other reviews
25necessary for provider certification in the Medicare and medical
26assistance programs and the department shall endeavor to avoid
27duplication of effort by the department and providers in the
28[certificate of need,] medical assistance and Medicare provider
29certification and licensure procedures. This shall not preclude
30the department from unannounced visits.

1(d) Use of beds in excess of maximum.--Except in case of
2[extreme emergency] natural disasters, catastrophes, acts of 
3bio-terrorism, epidemics or other emergencies, no license shall
4permit the use of beds for inpatient use in the licensed
5facility in excess of the maximum number set forth in the
6license without first obtaining written permission from the
7department: Provided, That during the period of a license, a
8health care facility may without the prior approval of the
9department increase the total number of beds by not more than
10ten beds or 10% of the total bed capacity, whichever is less.

11Section 810. Reliance on accrediting agencies and Federal
12Government for health care facilities other than 
13hospitals.

14(a) Reports of other agencies.--After a provider has been
15licensed or approved to operate a health care facility other 
16than a hospital for at least two years under this or prior acts,
17none of which has been pursuant to a provisional license, the
18department may rely on the reports of the Federal Government or
19nationally recognized accrediting agencies to the extent those
20standards are determined by the department to be similar to
21regulations of the department and if the provider agrees to:

22(1) direct the agency or government to provide a copy of
23its findings to the department; and

24(2) permit the department to inspect those areas or
25programs of the health care facility not covered by the
26agency or government inspection or where the agency or
27government report discloses more than a minimal violation of
28department regulations.

29* * *

30Section 4. The act is amended by adding a section to read:

1Section 810.1. Reliance on national accreditation organizations
2for hospitals.

3(a) Report of other agencies.--After a provider has been
4licensed or approved to operate a hospital for at least three
5years under this or a prior act, no portion of which has been
6pursuant to a provisional or other restricted license, if
7requested by the facility, the department shall rely on the
8report of an acceptable accreditation organization authorized
9pursuant to this section and section 806.

10(b) Application and approval process.--An accreditation
11organization shall apply to the department for approval. Prior
12to approval, the department shall:

13(1) determine that the standards of the accreditation
14organization are equal to or more stringent than existing
15licensure survey requirements;

16(2) evaluate the survey or inspection process of the
17accreditation organization to ensure the integrity of the
18survey or inspection process; and

19(3) enter into a written agreement with the
20accreditation organization that includes requirements for:

21(i) notice of all surveys and inspections;

22(ii) sharing of complaints and other relevant
23information;

24(iii) participation of the department in
25accreditation organization activities if determined to be
26appropriate by the department;

27(iv) protection of the confidentiality of medical
28and personal records;

29(v) all licensure inspections of deemed hospitals
30shall be based on the standards established by the

1national accreditation organization and State law; and

2(vi) any other provision necessary to ensure the
3integrity of the accreditation and licensure process.

4(c) Finding of substantial compliance of hospital.--

5(1) If an approved accreditation organization has issued
6a final report finding a hospital to be in substantial
7compliance with the accreditation organization's standards,
8the department shall accept the report as evidence that the
9hospital has met the department's licensure requirements and
10shall grant the hospital deemed status<-, if the hospital 
11provides a copy of the final report to the department within 
12ten business days of the hospital receiving it from the 
13approved accreditation organization. The final report must
14have been issued no more than one year prior to the
15expiration date of the hospital's license.

16(2) A hospital that receives <-a conditional
17accreditation, provisional accreditation, preliminary or
18final denial of <-anything less than full accreditation shall
19be subject to full licensure survey by the department.

20(d) Reports to department.--

<-21(1) An approved accreditation organization shall send
22the department all final accreditation reports of each
23inspection and survey at the time it is sent to the hospital.

24(2) <-(1) A final report of an approved accreditation
25organization shall be made immediately available to the
26public in accordance with department practice.

<-27(3) (2) A preliminary or final report of an approved
28accreditation organization shall not be admissible as
29evidence in a civil action or proceeding.

30(e) Inspection by department.--The department may inspect an

1accredited hospital to:

2(1) follow up on a systemic concern or event identified
3by an approved accreditation organization or by report filed
4by the facility;

5(2) investigate a complaint;

6(3) validate the findings of an approved accreditation
7organization that determined that a hospital is in compliance
8with conditions of participation issued by the Centers for
9Medicare and Medicaid Services and State licensure
10requirements; or

11(4) comply with the request of any Federal or State
12regulatory entity.

13(f) Participation or observation of surveys or inspections
14by accreditation organization by the department.--The department
15may participate in or observe a survey or inspection of a
16hospital conducted by an approved accreditation organization.

17(g) Actions by the department on accreditation
18organization's failure to meet obligations.--

19(1) Upon determination by the department that an
20approved accreditation organization has failed to meet its
21obligations under this section, the department shall have 30
22days from the time it notifies the accreditation organization
23to resolve any issues that are resulting in the accrediting
24agency's not meeting its obligations.

25(2) If, after 30 days, the department and the
26accrediting organization have not reached an agreement that
27brings the accrediting organization back into compliance with
28this act, the department shall provide notice in the
29Pennsylvania Bulletin that it intends to take action to
30withdraw the approval of the accreditation organization, list

1the reasons the action is being taken, make available the
2accreditation organization's response to the department and
3receive public comment regarding the decision for a period of
4not less than 30 days.

5(3) If, after the conclusion of the public comment
6period, the department's determination is that the approved
7accreditation organization has failed to meet its obligation
8under this section, the department may withdraw approval of
9the accreditation organization granted under sections 806 and
10810 and immediately terminate the agreement between the
11department and the accreditation organization.

12(4) Any hospital that has achieved deemed status as a
13result of being accredited by the accreditation organization
14terminated by the department shall keep the deemed status
15until the end of the current licensure period. To renew a
16license, the hospital shall either be accredited by another
17department-approved accreditation organization or shall be
18subject to the department's licensure regulations as provided
19for in section 806(i)(2).

20Section 5. This act shall take effect in 180 days.