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                                                       PRINTER'S NO. 148



No. 136 Session of 2003

           FEBRUARY 3, 2003


                                     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
    23     credentialed staff.

     1         (3)  Assisted living residences and home-based and
     2     community-based assisted living services are widely accepted
     3     by the general public because they allow people to age in
     4     place, maintain their independence and exercise decision
     5     making and personal choice.
     6         (4)  Consumers continue to say if they should need long-
     7     term care services, the four things they want most are:
     8             (i)  To stay independent and live at home or in their
     9         community as long as possible.
    10             (ii)  To be treated with respect and dignity.
    11             (iii)  To have a choice of long-term care and
    12         supportive services options.
    13             (iv)  If they can no longer be maintained at home,
    14         they want to be in as residential a setting as possible
    15         where they can have their own private living unit.
    16         (5)  Medicare, Medicaid State plan services and most
    17     private insurance pay for very little home-based and
    18     community-based assisted living services or assisted living
    19     residences and many Pennsylvanians cannot afford to pay for
    20     themselves.
    21         (6)  It is often far less expensive to provide publicly
    22     funded assisted living services in the home or in an assisted
    23     living residence than to provide such services in a nursing
    24     facility.
    25         (7)  Presently, Pennsylvania lags behind other states in
    26     the imbalance of its public funding for nursing facility care
    27     versus home-based and community-based services.
    28         (8)  Pennsylvania's publicly funded programs for home-
    29     based and community-based services have complicated
    30     application forms, delays for assessment and approval and
    20030S0136B0148                  - 2 -     

     1     inadequate assisted living services available for
     2     Pennsylvanians needing long-term care services who wish to
     3     remain in the community.
     4         (9)  Although Pennsylvanians wish to remain in the
     5     community when they are in need of long-term care services,
     6     they are generally unaware of what assisted living services
     7     are available or of the availability of public funding for
     8     those services other than in a nursing facility.
     9         (10)  Publicly funded home-based and community-based
    10     services should meet consumers' needs, assist family
    11     caregivers, permit consumers to live independently in the
    12     residential environment of their choice, promote integration
    13     of consumers into the community, maximize consumer choice to
    14     promote and support the consumer's changing needs, be
    15     consumer oriented and meet professional standards of quality.
    16         (11)  It is in the best interest of all Pennsylvanians
    17     that the Commonwealth license assisted living residences and
    18     services and establish a wider range of publicly funded home-
    19     based and community-based assisted living services, make
    20     information about these services widely available, streamline
    21     and simplify the application and publicly funded services in
    22     the community rather than a nursing facility and make these
    23     services available in residential settings with the
    24     availability of 24-hour services, if the consumer lives alone
    25     and needs to move to such a setting.
    26     The General Assembly of the Commonwealth of Pennsylvania
    27  hereby enacts as follows:
    28  Section 1.  Short title.
    29     This act shall be known and may be cited as the Pennsylvania
    30  Assisted Living Act.
    20030S0136B0148                  - 3 -     

     1  Section 2.  Definitions.
     2     The following words and phrases when used in this act shall
     3  have the meanings given to them in this section unless the
     4  context clearly indicates otherwise:
     5     "Abuse."  One or more of the following acts:
     6         (1)  infliction of injury, unreasonable confinement,
     7     intimidation or punishment with resulting physical harm, pain
     8     or mental anguish;
     9         (2)  willful deprivation of goods or services by a
    10     caretaker or assisted living provider or direct service staff
    11     which are necessary to maintain physical or mental health;
    12         (3)  sexual harassment, rape or abuse as defined in 23
    13     Pa.C.S. Ch. 61 (relating to protection from abuse);
    14         (4)  exploitation by an act or a course of conduct,
    15     including misrepresentation or failure to obtain informed
    16     consent which results in monetary, personal or other benefit,
    17     gain or profit for the perpetrator or monetary or personal
    18     loss to the consumer;
    19         (5)  neglect of the consumer which results in physical
    20     harm, pain or mental anguish; or
    21         (6)  abandonment or desertion by a caretaker.
    22     "Activities of daily living."  Activities including eating,
    23  bathing, dressing, toileting, transferring in and out of bed or
    24  in and out of a chair and personal hygiene.
    25     "Adult."  A person who is 18 year of age or older.
    26     "Aging in place."  The process of providing increased or
    27  adjusted services to a person to compensate for the physical or
    28  mental decline that occurs with the aging process in order to
    29  maximize individual dignity and independence and permit the
    30  person to remain in a familiar, noninstitutional, residential
    20030S0136B0148                  - 4 -     

     1  environment for as long as possible. Such services may be
     2  provided through residence staff, a third party, volunteers,
     3  friends or family.
     4     "Applicant."  An individual who has expressed interest in
     5  applying for residence in an assisted living residence or
     6  obtaining services from an assisted living services provider.
     7     "Area agency on aging."  The local agency designated by the
     8  Department of Aging within each planning and service area to
     9  administer the delivery of a comprehensive and coordinated plan
    10  of social and other services and activities.
    11     "Assisted living."  Services as determined and self-directed
    12  by a consumer or by a legal representative that permit and
    13  assist the consumer to live in a community, including such
    14  housing assistance or residency in an assisted living residence
    15  that permits the consumer to safely be supported in a residence
    16  in which the consumer's independence, dignity and ability to
    17  make choices are maintained, to the extent of the consumer's
    18  capabilities.
    19     "Assisted living residence."  A residential setting that:
    20         (1)  Offers, provides and/or coordinates a combination of
    21     personal care services, activities, whether scheduled or
    22     unscheduled, and 24-hour supervision and health-related
    23     services for four or more consumers who are not related to
    24     the operator.
    25         (2)  Has a service program and physical environment
    26     designed to minimize the need for residents to move within or
    27     from the setting to accommodate changing needs and
    28     preferences.
    29         (3)  Has an organized mission, service programs and a
    30     physical environment designed to maximize residents' dignity,
    20030S0136B0148                  - 5 -     

     1     autonomy, privacy and independence and encourages family and
     2     community involvement.
     3         (4)  Charges costs for housing and services which may be
     4     independent of one another and that provides consumers with
     5     the ability to choose their service provider and the services
     6     to be provided.
     7         (5)  Has a goal of fostering aging in place and promoting
     8     consumer self-direction and active participation in decision
     9     making while emphasizing an individual's privacy and dignity.
    10  The term does not include residential living units in continuing
    11  care providers certified by the Insurance Department or
    12  residential living units in subsidized housing apartments,
    13  unless required to be licensed under the United States
    14  Department of Housing and Urban Development Assisted Living
    15  Conversion Program.
    16     "Assisted living residency agreement."  The contract or
    17  contracts between a provider and a consumer regarding the
    18  consumer's residency at the assisted living residence. The term
    19  also includes the agreement between an assisted living residence
    20  and an entity contracting for assisted living residence for the
    21  consumer using public funding.
    22     "Assisted living services."  A combination of supportive
    23  services, personal care services, personalized assistance
    24  services, assistive technology and health-related services
    25  designed to respond to the individual needs of those who need
    26  assistance with activities of daily living (ADLs) and
    27  instrumental activities of daily living (IADLs).
    28     "Assisted living services agreement."  The contract or
    29  contracts between a provider or providers and the consumer
    30  needing assisted living services regarding the provision and
    20030S0136B0148                  - 6 -     

     1  terms of the assisted living services. The term includes
     2  contracts between assisted living service providers and entities
     3  contracting for services for consumers using public funding.
     4     "Assistive technology."  Those devices and services, whether
     5  medically necessary or not, that are used to increase, maintain
     6  or improve the functional capabilities of individuals with
     7  disabilities which may or may not be needed to permit the person
     8  to live independently. The term shall include, but not be
     9  limited to, hand reachers, adapted telephones, reading aids and
    10  other nonmedical devices.
    11     "Cognitive support services."  Services provided as part of a
    12  coordinated care plan to individuals who have memory impairments
    13  and other cognitive problems that significantly interfere with
    14  their ability to carry out activities of daily living without
    15  assistance and who require that supervision, monitoring and
    16  programming be available to them 24 hours a day, seven days a
    17  week in order for them to reside safely in setting of their
    18  choice, including assessment, service planning, ongoing
    19  monitoring, personal care services, health support services and
    20  a full range of dementia-capable activity programming and crisis
    21  management.
    22     "Compliance."  A residence or assisted living service
    23  provider will be found in compliance with the requirements of
    24  this act and its regulations where, but for isolated Class III
    25  violations for which the assisted living residence administrator
    26  has provided written certification of correction of the isolated
    27  Class III violations within 30 days of the date of the
    28  inspection, and has met all other requirements of this act and
    29  its regulations.
    30     "Comprehensive assessment."  A thorough review and analysis
    20030S0136B0148                  - 7 -     

     1  of a consumer's functional status. The term includes a personal
     2  history, assessment of physical and emotional health, ability to
     3  carry out activities of daily living, informal supports,
     4  environmental factors and cognitive functioning, including
     5  immobility assessment.
     6     "Consumer."  A person who receives assisted living services
     7  in an assisted living residence, a home or other location
     8  approved by the Department of Public Welfare.
     9     "Department."  The Department of Public Welfare of the
    10  Commonwealth.
    11     "Direct care staff."  A person who directly assists residents
    12  with activities of daily living, provides services or is
    13  otherwise responsible for the health, safety and welfare of the
    14  residents. Direct care staff must meet all training and testing
    15  requirements of this act.
    16     "Discharge."  Termination of the consumer's residency in the
    17  assisted living residence or of services from an assisted living
    18  services provider.
    19     "Federally Funded Home and Community Based Waiver Service
    20  Slots and Services."  The packages of services which are
    21  Federally funded, in part, pursuant to a waiver of Title XIX of
    22  the Social Security Act (49 Stat. 620, 42 U.S.C. § 1396 et seq.)
    23  and which are available in designated numbers to individuals
    24  eligible for Pennsylvania medical assistance who qualify for the
    25  nursing facility level of care but who elect home-based and
    26  community-based services in lieu of institutionalization in a
    27  nursing facility.
    28     "Financial management."  A service provided by an assisted
    29  living residence or assisted living services provider with
    30  budgeting and spending for the consumer's personal needs.
    20030S0136B0148                  - 8 -     

     1     "Fair share first-day-medical assistance access formulae."
     2  The percentage determined by the Department of Public Welfare of
     3  those qualifying for publicly funded assisted living services
     4  who were income eligible for medical assistance on the first day
     5  they met the functional eligibility for publicly funded assisted
     6  living services out of all those assessed as functionally
     7  qualifying for assisted living services.
     8     "Immobile person."  An individual who is unable to move from
     9  one location to another or has difficulty in understanding and
    10  carrying out instructions without the continued full assistance
    11  of another person or is incapable of independently operating a
    12  device, such as a wheelchair, prosthesis, walker or cane to exit
    13  to a point of safety.
    14     "Instrumental activities of daily living."  The term
    15  includes, but is not limited to, preparing meals, taking
    16  medication, using the telephone, handling finances, banking and
    17  shopping, light housekeeping, heavy housekeeping and getting to
    18  appointments.
    19     "Isolated Class III violations."  A finding by the Department
    20  of Public Welfare at the annual inspection of less than three
    21  Class III violations that had not been previously cited at the
    22  last inspection and that related to the services provided to an
    23  individual or did not present a threat to the health and well-
    24  being of consumers.
    25     "Isolated violations."  A finding by the Department of Public
    26  Welfare on any inspection of less than three Class I, II or III
    27  violations of separate and distinct provisions of the act or
    28  regulations or less than two Class I, II or III violations of
    29  the same provision of the act or regulations.
    30     "Legal representative."  A person duly authorized by law to
    20030S0136B0148                  - 9 -     

     1  take certain action on behalf of a consumer, including, but not
     2  limited to, legal counsel, a court-appoint guardian, an
     3  attorney-in-fact under a durable power of attorney, an agent
     4  under a health care proxy or a representative payee. In cases
     5  where the consumer has a cognitive impairment, this may include
     6  a responsible family member.
     7     "Level-of-care screening."  An assessment of a person's
     8  functional abilities and general health status and family-friend
     9  support system completed to determine the level of care and
    10  services appropriate for the individual.
    11     "Licensing information."  Information relating to the
    12  licensing agency, licensing process, and licensing status and
    13  history of a provider.
    14     "Living unit."  A room, apartment, cottage or other self-
    15  contained unit containing no fewer than 100 square feet per
    16  person, which need not be shared except by choice of the
    17  resident and which is capable of being locked by the resident,
    18  with a readily available bathroom, toilet and sink and shower or
    19  bath, space and electrical outlets for residents to have a small
    20  microwave and refrigerator and a sleeping and living area unless
    21  adjustments have been made to accommodate persons who are
    22  significantly cognitively impaired.
    23     "Long-term care ombudsperson/ombudsman."  An agent of the
    24  Department of Aging who investigates and seeks to resolve
    25  complaints made by or on behalf of older individuals or adults
    26  with disabilities who are consumers of assisted living services
    27  pursuant to section 2203-A of the act of April 9, 1929 (P.L.177,
    28  No.175), known as The Administrative Code of 1929. Complaints
    29  may relate to action, inaction or decisions of providers of
    30  assisted living services or residences, of public agencies or of
    20030S0136B0148                 - 10 -     

     1  social service agencies, or their representatives, which may
     2  adversely affect the health, safety, welfare, interests,
     3  preferences or rights of consumers.
     4     "Options."  The Long-Term Care Pre-admission Assessment
     5  Program administered by the Department of Aging and operated by
     6  the area agencies on aging.
     7     "PACE."  The Pharmaceutical Assistance Contract for the
     8  Elderly.
     9     "Pattern of violations."  A finding by the Department of
    10  Public Welfare at the annual inspection of any violations that
    11  had been cited at one or both of the last two annual or other
    12  consecutive inspections or of more than three distinct
    13  violations of the same requirement.
    14     "Pennsylvania Assisted Living Services Program" or "PALS."
    15  The array of publicly funded home-based and community-based
    16  assisted living services and other health and social services
    17  benefits available to eligible consumers who have applied for
    18  and been found to need these services.
    19     "Personal care home."  Any premises in which food, shelter
    20  and personal assistance or supervision are provided for a period
    21  exceeding 24 hours for four or more adults who are not relatives
    22  of the operator, who do not require the services in or of a
    23  licensed long-term care facility but who do require assistance
    24  or supervision in such matters as dressing, bathing, diet,
    25  financial management, evacuation of a residence in the event of
    26  an emergency or medication prescribed for self-administration.
    27     "Personal care services."  Assistance or supervision in
    28  matters such as dressing, bathing, diet, financial management,
    29  evacuation of the resident in the event of an emergency or
    30  medication prescribed for self-administration. Personal care
    20030S0136B0148                 - 11 -     

     1  services shall include prompting, cuing, monitoring and focusing
     2  on maintaining functioning.
     3     "Provider."  An assisted living residence, assisted living
     4  services provider, an approved personal care home or an approved
     5  domiciliary care home.
     6     "Publicly funded assisted living."  Includes bridging,
     7  medical assistance, HealthChoices, Options, waiver programs and
     8  other appropriate publicly funded services that assist
     9  individuals to remain in the community.
    10     "Qualified assessor."  A person approved by the Department of
    11  Public Welfare as qualified to conduct assessments of persons
    12  needing long-term care services and develop service plans based
    13  thereon. A qualified assessor may include an employee of an area
    14  agency on aging, an assisted living residence, an assisted
    15  living services provider or an independent entity, but may not
    16  include hospital discharge planners or other staff or employees
    17  of an insured's health or long-term care insurance company.
    18     "Qualified couple."  A qualified couple for cost-of-living
    19  increase is two qualified persons, living together, who are
    20  considered a couple under the Supplemental Security Income
    21  program, Title XVI of the Social Security Act (49 Stat. 620,
    22  U.S.C. 301 et seq.).
    23     "Qualified person."  A qualified person for cost-of-living
    24  increase includes persons meeting the nonfinancial, categorical
    25  eligibility requirements under Title XIX of the Social Security
    26  Act (49 Stat. 620, U.S.C. 301 et seq.) as aged, blind or
    27  disabled and receiving or applying for long-term care services
    28  under a special income level.
    29     "Resident."  An individual who resides in and may receive
    30  assisted living services from an assisted living residence or
    20030S0136B0148                 - 12 -     

     1  from a personal care home or domiciliary care home approved by
     2  the Department of Public Welfare.
     3     "Responsible family member."  A family member, such as a
     4  spouse or adult child, who has been assisting the consumer and
     5  to whom the consumer turns to for assistance.
     6     "Restraint."  A chemical or mechanical device used to
     7  restrict the movement or normal function of an individual or a
     8  portion of the individual's body, including geriatric chairs;
     9  posey; chest; waist, wrist or ankle restraints; locked
    10  restraints and locked doors to prevent egress. The term does not
    11  include devices used to provide support for the achievement of
    12  functional body position or proper balance as long as the device
    13  can easily be removed by the resident.
    14     "Restricted unit."  A unit within a licensed assisted living
    15  residence that has received a specialized license designation
    16  pursuant to the requirements of this section and regulations of
    17  the Department of Public Welfare to provide services to people
    18  with cognitive impairments.
    19     "Service plan."  A detailed plan based on a comprehensive
    20  assessment designed to meet the resident's individual physical,
    21  mental and psychosocial needs consistent with the resident's
    22  preferences and capabilities.
    23     "Specialty assisted living residence."  A licensed assisted
    24  living residence that has received a specialized license
    25  designation pursuant to the requirements of this section and the
    26  regulations of the Department of Public Welfare to provide
    27  services to people with cognitive impairments.
    28     "Stakeholders."  The Medical Assistance Advisory Committee,
    29  the Consumer and Long-Term Care Subcommittees of the Medical
    30  Assistance Advisory Committee, the Intra-Governmental Council on
    20030S0136B0148                 - 13 -     

     1  Long-Term Care, the Statewide Independent Living Council and the
     2  Council on Aging.
     3     "Transfer."  Movement of a consumer within the assisted
     4  living residence or to a hospital or other temporary placement.
     5  For consumers receiving assisted living services in their home,
     6  the term means movement between assisted living services
     7  providers.
     8  Section 3.  Assisted living residences.
     9     (a)  Licensure.--The department shall license and regulate
    10  living residences and shall establish an annual licensure fee
    11  schedule.
    12     (b)  Physical site standards.--The department shall require
    13  assisted living residences to meet all requirements of the act
    14  of November 10, 1999 (P.L.491, No.45), known as the Pennsylvania
    15  Construction Code Act.
    16     (c)  Level-of-care screening, assessment and comprehensive
    17  service plan.--
    18         (1)  Prior to admission to an assisted living residence
    19     or start of services by an assisted living services provider,
    20     a level-of-care screening to determine the level of care and
    21     services needed by the applicant shall be obtained. A
    22     standardized screening instrument developed by the Department
    23     of Aging in consultation with the Department of Public
    24     Welfare and the Department of Health shall be used for all
    25     screens. The area agency on aging shall be available to
    26     conduct level-of-care screenings for applicants. Qualified
    27     employees of assisted living residences or assisted living
    28     services providers may conduct level-of-care screening but
    29     shall inform individuals of the right to receive a screening
    30     by an area agency on aging.
    20030S0136B0148                 - 14 -     

     1         (2)  A medical evaluation, using a form developed by the
     2     Department of Public Welfare, the Department of Aging and the
     3     Department of Health, shall be obtained by all applicants
     4     prior to admission to an assisted living residence or start
     5     of services by an assisted living provider.
     6         (3)  A qualified assessor must assess an individual's
     7     care and service needs after the level-of-care screening has
     8     determined a need for assisted living services or residency.
     9             (i)  The department shall develop a training and
    10         certification program for qualified assessors.
    11             (ii)  Only those qualified assessors trained and
    12         certified by the Commonwealth shall be permitted to
    13         conduct assessments to identify the services an
    14         individual requires and that serve as the basis for a
    15         comprehensive service plan.
    16             (iii)  Assessors must certify that the assessment is
    17         true and correct to the best of their knowledge and
    18         skill. The department shall revoke the certification of
    19         any long-term care assessor that falsely certifies a need
    20         for services.
    21             (iv)  The qualified assessor must use a standardized
    22         assessment instrument that shall be developed by the
    23         Department of Public Welfare, the Department of Aging and
    24         the Department of Health, within six months of the
    25         effective date of this act.
    26             (v)  When the area agency on aging is the chosen
    27         assessor, the area agency on aging must complete an
    28         assessment within five business days or, if there is an
    29         expedited need, within one business day of the request
    30         for an assessment.
    20030S0136B0148                 - 15 -     

     1             (vi)  Consumers shall have choice of assisted living
     2         providers and be free to present a completed assessment
     3         to any provider to compare services and price.
     4             (vii)  The department shall review provider's
     5         compliance with the assessment provisions of this act as
     6         part of the annual licensure inspection.
     7             (viii)  The area agency on aging shall assist any
     8         assessed consumer found to need long-term care services
     9         to seek public funding, where eligible, and to set up the
    10         services if family members or friends are not available
    11         to do so.
    12         (4)  Following completion of a comprehensive assessment
    13     and prior to admission or start of services, an appropriately
    14     trained person employed by the provider shall work in
    15     cooperation with an interdisciplinary team that includes the
    16     consumer, the consumer's legal representative or the
    17     consumer's responsible family member, with the consumer's
    18     consent, to develop a written comprehensive services plan
    19     based on the comprehensive assessment and consistent with the
    20     consumer's unique physical and psychosocial needs, with
    21     recognition of the consumer's capabilities and preferences.
    22         (5)  Reassessment and revision of service plan, if
    23     necessary based on reassessment, will take place annually or
    24     when there is a significant change in a consumer's condition.
    25         (6)  The comprehensive assessment and comprehensive
    26     services plan shall be kept on file for each consumer by the
    27     provider and shall be available to the consumer or the
    28     consumer's legal representative.
    29     (d)  Assisted living residence administrator qualifications
    30  and training.--
    20030S0136B0148                 - 16 -     

     1         (1)  An assisted living residence administrator shall
     2     satisfy either of the following qualifications:
     3             (i)  Be at least 21 years of age and meet the
     4         requirements of Chapters 5 and 7 of the act of November
     5         6, 1987 (P.L.381, No.79), known as the Older Adults
     6         Protective Services Act, regarding criminal history.
     7             (ii)  Have a high school diploma or a general
     8         educational development diploma (GED).
     9             (iii)  Complete an education and training course
    10         which has been approved by the department of not less
    11         than 120 hours. The department shall establish a training
    12         curriculum that shall include comprehensive training in
    13         areas appropriate to the care and health of residents in
    14         an assisted living residence, including, but not limited
    15         to:
    16                 (A)  Training in assistive technology.
    17                 (B)  Training in working with persons with
    18             cognitive impairments.
    19                 (C)  Training in assisted living principles and
    20             laws.
    21                 (D)  Training in medication assistance.
    22                 (E)  Consumer rights.
    23         (2)  The department shall develop a shorter program of
    24     instruction for licensed nursing home administrators,
    25     nationally accredited retirement housing professionals or
    26     NAB-licensed assisted living administrators that does not
    27     duplicate areas where proficiency has been demonstrated but
    28     that is particular to assisted living in this Commonwealth.
    29         (3)  All administrators shall pass a test which has been
    30     approved by the department and is administered by an entity
    20030S0136B0148                 - 17 -     

     1     approved by the department at the end of training to
     2     demonstrate proficiency in the application of skills and
     3     knowledge.
     4         (4)  All administrators shall complete 36 hours of
     5     continuing education every two years that has been approved
     6     by the department and is applicable to the practice of
     7     assisted living administrator. Coordinating education program
     8     shall include training and competency testing.
     9         (5)  One year after the effective date of this act, no
    10     one shall be employed as an assisted living administrator
    11     unless they have completed the training and testing
    12     requirements herein.
    13     (e)  Direct care and other staff qualifications and
    14  training.--
    15         (1)  Direct care staff in an assisted living residence or
    16     of an assisted living services provider must meet the
    17     following qualifications:
    18             (i)  Be either at least 18 years of age with a high
    19         school diploma or 17 years of age with a high school
    20         diploma and meet the requirements of the Older Adult
    21         Protective Services Act regarding criminal history.
    22             (ii)  Complete an education and training course which
    23         has been approved by the department for a minimum of 40
    24         hours and obtain a certificate of completion. The
    25         department shall establish a training curriculum. Direct
    26         care staff of assisted living residences and assisted
    27         living services providers must demonstrate proficiency in
    28         a manner approved by the department in each component
    29         prior to start of independent work in that component.
    30         Approved coursework shall include comprehensive training
    20030S0136B0148                 - 18 -     

     1         in areas appropriate to the care and health of assisted
     2         living residents and recipients, including, but not
     3         limited to:
     4                 (A)  Training in assistive technology.
     5                 (B)  Training in working with persons with
     6             cognitive impairments.
     7                 (C)  Training in assisted living principles and
     8             laws.
     9                 (D)  Consumer rights.
    10         (2)  The department shall develop a shorter program of
    11     instruction for nurse assistants deemed competent that does
    12     not duplicate areas where proficiency has been demonstrated
    13     but that is particular to assisted living in this
    14     Commonwealth.
    15     (f)  Direct care staff assisting residents with medication.--
    16  Within six months of the effective date of this act, the
    17  department shall:
    18         (1)  Develop a special training and certification program
    19     or expand its current medications administration course for
    20     direct care staff that assist residents with medication. The
    21     program shall include testing and demonstrated proficiency.
    22         (2)  Establish regulations permitting only those who have
    23     completed and passed the training on assisting with the
    24     administration of medication to do so in assisted living
    25     residences or as an assisted living service provider.
    26     (g)  Other assisted living residence staff.--Within 30 days
    27  of employment or start of voluntary service, staff persons and
    28  volunteers shall receive orientation to the general operation of
    29  the assisted living residence, training in fire prevention,
    30  operation of safety equipment, emergency procedures and
    20030S0136B0148                 - 19 -     

     1  evacuation of residents.
     2     (h)  Exemptions.--Existing personal care home staff employed
     3  by personal care homes that apply for and become licensed as
     4  assisted living residences have one year from the date of
     5  application to complete the direct care staff training except
     6  that those who have been working as direct care staff for more
     7  than 24 months can opt not to take the training provided they
     8  demonstrate proficiency in each training component within one
     9  year of the personal care home becoming an assisted living
    10  residence.
    11     (i)  Staffing levels.--
    12         (1)  The department shall establish minimum staffing
    13     levels for assisted living residences, restricted units and
    14     specialty assisted living residences depending upon the
    15     residence population, mobility of residents and cognitive
    16     impairments to ensure adequate 24 hours a day awake direct
    17     care staff to meet the unplanned and unscheduled needs of
    18     residents.
    19         (2)  The department shall require each assisted living
    20     residence to maintain adequate additional direct care staff
    21     to meet the residents' planned and scheduled needs as
    22     required in their service plans as well as to ensure a safe
    23     and efficient evacuation to a place of safety in case of
    24     emergency. Each assisted living residence shall have as a
    25     minimum the staff necessary to meet the hours of care set
    26     forth in the service plans and the staffing requirements of
    27     paragraph (1).
    28         (3)  Additional staff or contracted services shall be
    29     provided as necessary to meet laundry, food service,
    30     housekeeping, transportation and maintenance needs of the
    20030S0136B0148                 - 20 -     

     1     assisted living residence.
     2     (j)  Supplemental services.--A resident receiving assisted
     3  living services in an assisted living residence may arrange for
     4  the receipt of supplemental services where:
     5         (1)  the supplemental services adequately meet the
     6     residents changing needs so that the assisted living
     7     residence is not required to fundamentally change its program
     8     or residence to accommodate the resident; and
     9         (2)  the supplemental services are provided by:
    10             (i)  a licensed entity or an area agency on aging; or
    11             (ii)  an unlicensed provider, permitted by specified
    12         criteria and conditions of the department to provide
    13         supplemental services agreed to by resident and assisted
    14         living services provider.
    15     (k)  Transfer and discharge.--
    16         (1)  A resident may not be transferred or discharged
    17     without consent, except for nonpayment of contractual fees
    18     after a good faith effort to obtain payment unless:
    19             (i)  the person has one of the conditions determined
    20         by the department;
    21             (ii)  to accommodate the consumer's needs would
    22         require the assisted living residence to fundamentally
    23         change the basic program or building modification;
    24             (iii)  the person is a danger to self or others; or
    25             (iv)  transfer to a hospital or treatment facility is
    26         necessary to meet the consumer's needs and the resident's
    27         needs cannot be maintained in the assisted living
    28         residence.
    29         (2)  The assisted living residence must insure that the
    30     transfer or discharge is safe, orderly and appropriate to the
    20030S0136B0148                 - 21 -     

     1     resident's needs.
     2     (l)  Notices.--The assisted living residence must provide 30
     3  days' advance written notice of changes in policies, services or
     4  costs and of intent to transfer or discharge a resident. Written
     5  notice must include the reason for the transfer or discharge,
     6  the effective date of the transfer or discharge, the location to
     7  which the consumer is being transferred or discharged, if known,
     8  a statement that the resident has the right to appeal to the
     9  department and the contact information for the Long-Term Care
    10  Ombudsman and the department's 24-hour hotline.
    11     (m)  Dispute resolution.--Consumers may seek resolution of
    12  disputes in the following ways and selection of one option does
    13  not preclude simultaneous or subsequent selection of the other:
    14         (1)  The department's hearing and appeals bureau will
    15     hear complaints and appeals through its fair hearing process.
    16             (i)  Appeal hearings must include notice, opportunity
    17         to be heard, impartial review and prompt decision.
    18             (ii)  Assisted living residents may appeal decisions
    19         regarding:
    20                 (A)  Whether discharge or transfer is
    21             appropriate.
    22                 (B)  Whether accommodations would fundamentally
    23             alter the program or residence.
    24                 (C)  Whether supplemental services provider is
    25             unsafe.
    26                 (D)  What level of care is appropriate.
    27         (2)  Each provider shall maintain an internal process for
    28     resolving consumer complaints and grievances.
    29         (3)  The department shall develop an expedited hearing
    30     process for review of department, consumer or provider
    20030S0136B0148                 - 22 -     

     1     actions.
     2     (n)  Written agreements.--The department shall require as a
     3  condition of licensure that all providers shall have an assisted
     4  living residency agreement in writing with each consumer. Each
     5  agreement should be signed prior to admission or start of
     6  services or no later than 24 hours after admission and shall
     7  include in clear and simple language the following:
     8         (1)  Standardized clauses provided by the department on:
     9             (i)  The consumer's rights.
    10             (ii)  Negotiated risk, if appropriate.
    11             (iii)  The Commonwealth's processes for resolving
    12         disputes under the contract.
    13             (iv)  Explanation of the screening, assessment and
    14         annual reassessment requirements.
    15             (v)  The available financial management services a
    16         provider may or may not provide.
    17             (vi)  A prohibition on resident assignment of assets
    18         for life to the assisted living residence.
    19             (vii)  If a resident is receiving publicly funded
    20         care and services, details about Social Security Income
    21         recipient protections, rent rebate programs and the
    22         personal needs allowance.
    23             (viii)  Explanation of the right to continued
    24         residency in an assisted living residence as provided in
    25         this act.
    26             (ix)  Applicant's right to cancel without penalty an
    27         assisted living residency agreement within 72 hours of
    28         signing.
    29             (x)  Requirement that consumer receive 30 days'
    30         advance written notice of changes to contract, to the
    20030S0136B0148                 - 23 -     

     1         charges of the provider and to the provider's policies.
     2             (xi)  The bases under which a consumer or provider
     3         may terminate the agreement.
     4             (xii)  Contractual enforcement rights of the parties.
     5         (2)  At a minimum, the provider shall include the
     6     following in the agreement:
     7             (i)  The provider's list of services offered.
     8             (ii)  By addendum or otherwise, individualized
     9         itemization of services that will be provided to the
    10         resident and costs thereof, separating housing costs from
    11         service costs.
    12             (iii)  Provider policies.
    13             (iv)  Internal dispute resolution process.
    14             (v)  Clear and specific occupancy criteria and
    15         procedures, based on Commonwealth requirements and
    16         assisted living residence's policies regarding bedholds
    17         and refunds.
    18  The department shall review contracts at site visits for
    19  compliance with this section and the provisions of this act and
    20  its regulations.
    21     (o)  Disclosure.--Each consumer or the consumer's legal
    22  representative or responsible family member shall receive an
    23  information packet at the time of application for admission or
    24  start of services which shall include the following items to be
    25  presented in a form able to be easily understood and read by the
    26  consumer:
    27         (1)  A standardized form developed by the department with
    28     information pertaining to:
    29             (i)  The use of advance directives during residency.
    30             (ii)  Information regarding how to contact and obtain
    20030S0136B0148                 - 24 -     

     1         what is required by the licensing agency for providers.
     2             (iii)  Information about availability and access to
     3         and contact information for the ombudsman and the
     4         department's 24-hour hotline.
     5             (iv)  Details about the department's external
     6         complaint mechanisms available to consumers.
     7             (v)  General information about the admission and
     8         application process.
     9             (vi)  Details about the applicant's rights to
    10         independent assessment and nondiscrimination in the
    11         application process.
    12             (vii)  Consumer rights.
    13         (2)  Documentation from the provider to provide the
    14     applicant with the following information:
    15             (i)  A copy of the provider's policies affecting
    16         consumers, including discharge or termination or
    17         bedholds.
    18             (ii)  Information regarding the department's
    19         inspections and inspection reports demonstrating
    20         provider's licensing status.
    21             (iii)  Complete copy of the assisted living residence
    22         agreement, including all attachments and all current
    23         rates that may be charged.
    24             (iv)  Details about the internal complaint mechanism
    25         used by the provider.
    26             (v)  Provider's specific admission and application
    27         process.
    28             (vi)  Information on discharge policies.
    29     (p)  Housing and services.--
    30         (1)  Assisted living residences shall separately charge
    20030S0136B0148                 - 25 -     

     1     for housing and services.
     2         (2)  Residents who have been assessed as needing personal
     3     care services may be required by the assisted living
     4     residence to receive those services from the assisted living
     5     residence as a condition of admission to the assisted living
     6     residence.
     7         (3)  No resident shall be required to pay for services
     8     not needed, as indicated in their initial or annual
     9     assessment.
    10         (4)  Services other than those identified in paragraph
    11     (2), including, but not limited to, home health, massage,
    12     physician services and physical therapy services, can be
    13     purchased by the resident from the assisted living residence
    14     or from an outside provider, unless to accommodate the person
    15     would require the assisted living residence to fundamentally
    16     change the basic program or building and to do so would put
    17     in jeopardy the life and safety of persons in the assisted
    18     living residence.
    19         (5)  If the resident arranges for services other than
    20     those identified in paragraph (2) from unlicensed persons or
    21     those not on the area agency provider list, the assisted
    22     living residence may screen providers but shall not
    23     unreasonably deny their access to the resident's living unit.
    24     (q)  Living unit.--Assisted living residences shall provide
    25  residents with their own individual living units, which shall
    26  include a sleeping and living area, shared only with the consent
    27  of the residents in the unit. A bathroom must be readily
    28  available for each resident. One bathroom can be shared between
    29  adjacent living units. Except for residents with cognitive
    30  impairments, each living unit must provide space and electrical
    20030S0136B0148                 - 26 -     

     1  outlets for residents to have small microwaves and
     2  refrigerators. Each living unit shall contain no fewer than 100
     3  square feet per resident. Each living unit shall have
     4  individually lockable doors, except where inappropriate for
     5  individuals with cognitive impairments.
     6     (r)  Department of Aging.--The Department of Aging shall take
     7  steps to extend the provisions of the Older Adults Protective
     8  Services Act to assisted living residences and consumers. The
     9  Department of Aging shall insure that the ombudsman program is
    10  made available to assisted living residences and recipients.
    11     (s)  Contact information.--The department shall require
    12  assisted living residences to post contact information for the
    13  local ombudsman and shall make available a 24-hour toll-free
    14  hotline for consumers to use in contacting the department with
    15  questions, concerns and complaints about their care and
    16  services.
    17  Section 4.  Assisted living residences providing cognitive
    18                 support services.
    19     (a)  Special designation.--Within six months of the effective
    20  date of this act, the department shall establish a special
    21  license designation for assisted living residences that wish to
    22  maintain restricted units or to be specialized for the purpose
    23  of serving individuals with cognitive impairments. Only those
    24  assisted living residences that receive this special license
    25  designation may have or hold themselves out as having
    26  specialized units or specialized purpose. This special
    27  designation shall require that the assisted living residences
    28  meet all the requirements for assisted living residences set
    29  forth in this act and resulting regulations and additional
    30  requirements that address:
    20030S0136B0148                 - 27 -     

     1         (1)  Special admission and transfer criteria.
     2         (2)  Adequate indoor and outdoor wandering space
     3     requirements.
     4         (3)  Requirements relating to provision of therapeutic
     5     activities that meet the scheduled and unscheduled individual
     6     needs of each resident, with such services focusing on
     7     maximizing independence and on the individual's strengths and
     8     abilities.
     9         (4)  Physical design and safety requirements.
    10         (5)  Additional and specialized training requirements.
    11         (6)  Prearranged procedures for notification of
    12     authorities should a resident wander away from the residence.
    13     (b)  Admission or transfer to specially designated unit or
    14  specialty assisted living residence.--Assisted living residences
    15  should be able to support residents with cognitive impairments
    16  if or until the person's needs are such that they are a danger
    17  to themselves or others and accommodation would require the
    18  assisted living residence to fundamentally change the basic
    19  program or building.
    20         (1)  When either of these conditions are met and if this
    21     is reflected in an annual or other assessment, the resident
    22     may be transferred to a specialized, restricted unit or
    23     specialty assisted living residence or may be requested to
    24     leave.
    25         (2)  Before a person may be transferred or admitted to a
    26     specially designated restricted unit or a specially
    27     designated specialty assisted living residence:
    28             (i)  The person, responsible family member or person
    29         with legal authority, if any, must be advised of the
    30         assisted living residence's intent to discharge or
    20030S0136B0148                 - 28 -     

     1         transfer with 30 days' advance written notice and of
     2         resident's right to seek an assessment from the area
     3         agency on aging or other individual who is independent
     4         from the assisted living residence and of the resident's
     5         right to appeal to the department or use the internal
     6         grievance process to address the appropriateness of
     7         restricted movement, or both. The 30-day notice
     8         requirement shall not apply, but the provider shall give
     9         as much advance notice as possible where transfer or
    10         discharge is necessary to meet a consumer's urgent or
    11         emergency medical needs or in emergency situations where
    12         there is a danger to consumers or others.
    13             (ii)  A physician must approve the transfer to a
    14         restricted unit or admission to a specialized assisted
    15         living residence, and the resident or individual with
    16         legal authority to act for the resident must sign off on
    17         the transfer or admission.
    18             (iii)  Where neither the resident, the resident's
    19         responsible family member nor anyone with legal authority
    20         signs to authorize the transfer or discharge, the
    21         assisted living residence must refer the matter to the
    22         local agency charged to administer the act of November 6,
    23         1987 (P.L.381, No.79), known as the Older Adults
    24         Protective Services Act, for review.
    25         (3)  The department shall, through its inspection
    26     process, review transfer and discharge cases that are based
    27     on cognitive impairments for compliance with this provision.
    28     (c)  Administer training.--Administrators working in special
    29  license designation restricted units or specialized assisted
    30  living residences must be trained and tested in a program
    20030S0136B0148                 - 29 -     

     1  approved by the department in training areas developed by the
     2  department in consultation with stakeholders on issues relating
     3  to providing care and services to cognitively impaired
     4  individuals. This training shall be in addition to that required
     5  under section 3.
     6     (d)  Staff training.--All direct care staff wishing to work
     7  in specially designated restricted units or specialty assisted
     8  living residences shall, in addition to the training required of
     9  direct care staff in section 3, receive additional specialized
    10  training approved by the department in training areas
    11  established by the department in consultation with stakeholders
    12  relating to providing care and services to cognitively impaired
    13  individuals.
    14     (e)  Disclosures.--Assisted living residences with specially
    15  designated restricted units or that are specialty assisted
    16  living residences must, in addition to the disclosures required
    17  under section 3:
    18         (1)  Provide each applicant with a standardized
    19     disclosure form designed by the department in consultation
    20     with stakeholders describing the requirements that must be
    21     met by a restricted unit or specialty assisted living
    22     residence which shall include, but not be limited to, the
    23     philosophy and mission of serving individuals with cognitive
    24     impairments, the requirements for physical space, wandering
    25     space, therapeutic activities, additional training and
    26     security, that must be met for special designation.
    27         (2)  A representation that the residence meets the
    28     special licensure designation, including a description of the
    29     frequency and types of individual and group activities,
    30     security measures and family support programs.
    20030S0136B0148                 - 30 -     

     1     (f)  Accreditation.--If national accreditation of specialty
     2  assisted living units becomes available with standards that
     3  equal or exceed those in this act and supporting regulations,
     4  the department may deem that an accredited assisted living
     5  residence meets the special licensing designations under this
     6  section.
     7     (g)  Staffing levels.--Staffing levels will be set in
     8  accordance with the staffing levels required under section 3.
     9  However, if an assisted living residence has national
    10  accreditation which has higher staffing requirements, the
    11  residence shall meet the higher requirements.
    12  Section 5.  Assisted living services providers.
    13     (a)  Licensure.--The Department of Health shall license
    14  entities that are not already licensed by the department that
    15  either coordinate and provide, or coordinate and subcontract for
    16  provisions of assisted living services.
    17     (b)  Application.--
    18         (1)  Within six months of the effective date of this act,
    19     the department shall license assisted living services
    20     providers. Assisted living services providers shall be
    21     licensed and bonded, and a licensure fee shall be applied.
    22         (2)  Direct care staff employed by assisted living
    23     services providers or providing direct care services to
    24     consumers in their homes shall meet all training and testing
    25     requirements of this act and present documentation from the
    26     State of completed training and testing to employers and
    27     consumers. Passing a criminal history check shall be a
    28     prerequisite to training and testing.
    29         (3)  Family or friend caregivers shall be exempt from the
    30     requirements of this act.
    20030S0136B0148                 - 31 -     

     1         (4)  Entities that do not provide personal care services,
     2     but that solely provide assistance with instrumental
     3     activities of daily living shall be exempt from the
     4     requirements of this act.
     5     (c)  Requirements.--
     6         (1)  Assisted living services providers shall be subject
     7     to the disclosure and contract requirements set forth in
     8     section 3 to the extent applicable to assisted living
     9     services providers.
    10         (2)  Direct care staff shall provide assisted living
    11     services consumers with 30 days' advance written notice,
    12     where possible, of interruption or termination of service
    13     delivery, except where the safety of the direct care staff is
    14     at risk. Direct care staff shall be included under the
    15     reporting requirements of older adult protective services
    16     review. Direct care staff found to be in violation of the
    17     advance notice provision of this section may be sanctioned by
    18     the department and have their documentation of training
    19     necessary for employment withdrawn.
    20         (3)  All consumer rights specified in section 6 shall
    21     apply to consumers of assisted living services providers
    22     unless the right is specific to residency. The department
    23     shall craft a standardized assisted living service disclosure
    24     from such as the one required in section 3 for assisted
    25     living residences. As a condition of licensure, all assisted
    26     living services providers must provide consumers and
    27     applicants with the department's standardized disclosure form
    28     of consumers rights.
    29     (d)  Inspection.--The department shall conduct annual
    30  unannounced inspections of assisted living services providers
    20030S0136B0148                 - 32 -     

     1  and shall include visits to and interviews of a random sample of
     2  consumers as part of the inspection process.
     3  Section 6.  Consumer rights.
     4     (a)  Regulations.--Consumers shall have the following rights
     5  which shall attach upon admission to an assisted living
     6  residence or start of service receipt from an assisted living
     7  services provider and the department shall promptly implement
     8  regulations to insure these rights:
     9         (1)  With respect to management of funds:
    10             (i)  There shall be no commingling of the residence's
    11         and residents' funds.
    12             (ii)  Assisted living residences shall maintain
    13         residents' funds in accounts separate from those of the
    14         residence.
    15             (iii)  When a residents' funds exceed $200, the
    16         assisted living residence must offer the resident an
    17         opportunity to have the funds placed in an interest-
    18         bearing account.
    19             (iv)  The assisted living residence must keep
    20         individual records of individual moneys.
    21             (v)  Residents are only required to deposit funds
    22         with an assisted living residence if they are accepting
    23         financial management services.
    24             (vi)  The department shall develop a means of
    25         safeguarding residents' funds and requiring prompt
    26         repayment by the assisted living residence of funds that
    27         are stolen by residence employees, subcontractors or
    28         otherwise mismanaged.
    29             (vii)  Residents shall have prompt access to funds.
    30             (viii)  Residents shall receive quarterly statements
    20030S0136B0148                 - 33 -     

     1         from assisted living residences holding their funds.
     2             (ix)  Upon death or discharge, the assisted living
     3         residence is required to repay funds to estate or
     4         resident within five business days.
     5             (x)  Assisted living residence staff must obtain
     6         written permission for expenditures from the consumer of
     7         legally responsible person and keep receipts of
     8         expenditures.
     9             (xi)  No provider or staff of provider or individual
    10         affiliated with the provider may assume power of attorney
    11         or guardianship over any resident. However, the
    12         department shall come up with a process for allowing
    13         guardianship in emergency situations where the consumer
    14         is unable to authorize and where there is no existing
    15         legal representative or the legal representative cannot
    16         be reached.
    17             (xii)  No resident may be required to endorse checks
    18         over to the assisted living residence.
    19         (2)  Each consumer has the right to:
    20             (i)  Be involved in service planning process and to
    21         receive services with reasonable accommodation of
    22         individual needs and preferences except where the health
    23         or safety of the individual or other residents would be
    24         endangered.
    25             (ii)  Have privacy, confidentiality and freedom from
    26         abuse, neglect and financial exploitation.
    27             (iii)  Refuse treatment or services under the plan.
    28             (iv)  Receive from the assisted living residence 30
    29         days' advance written notice of the assisted living
    30         residence's proposed changes to charges and policies and
    20030S0136B0148                 - 34 -     

     1         of the intent of the residence to transfer or discharge
     2         the resident, except where transfer is necessary to meet
     3         consumer's urgent or emergency medical needs or where
     4         immediate risk of harm to consumer or others warrants
     5         shorter notice.
     6             (v)  Be free from physical or chemical restraints.
     7             (vi)  Be free from unreasonable interference with
     8         right to leave and return, have visitors, send and
     9         receive mail, and participate or not participate in
    10         religious activities.
    11             (vii)  Receive a qualified assessment by someone not
    12         associated with the residence.
    13             (viii)  Be entitled to residency and services 365
    14         days a year, with no planned or intermittent
    15         interruptions.
    16             (ix)  Access the ombudsman and the department's 24-
    17         hour hotline.
    18             (x)  Be free from discrimination on the basis of
    19         race, color, religious creed, disability, handicap,
    20         ancestry, sexual orientation, national origin, age or
    21         sex.
    22             (xi)  Be free from any duration of stay requirements
    23         prior to public funding.
    24             (xii)  Select a doctor or other health care provider
    25         of the consumer's choice.
    26             (xiii)  Reside and receive services with reasonable
    27         accommodation of individual needs and preferences except
    28         where health, safety, or rights of individual or other is
    29         endangered and does not change the nature, etc., of the
    30         assisted living residence.
    20030S0136B0148                 - 35 -     

     1             (xiv)  Review inspection and complaint survey and
     2         inspection results conducted by the department.
     3             (xv)  Exercise all rights as a citizen, including,
     4         but not limited to, the right to vote, the right to voice
     5         grievances with respect to services without retaliation
     6         and to organize and participate in resident and family
     7         groups.
     8  Section 7.  Survey, inspection and enforcement process.
     9     (a)  Licensure and inspection.--The appropriate department
    10  shall license and inspect all assisted living residences and
    11  assisted living services providers at least annually. Licensure
    12  fees shall be established and funds from such fees shall be
    13  employed to defray the costs of enforcing the provisions of this
    14  act.
    15         (1)  The appropriate department shall establish and make
    16     public specific, objective guidelines for inspectors to
    17     employ in the inspection of assisted living residences and
    18     assisted living services providers. Inspectors shall be
    19     adequately trained in the intention and interpretation of
    20     inspection guidelines to ensure consistent application of
    21     legal requirements. Each department shall ensure adequate,
    22     trained staff and provide annual continuing education courses
    23     to inspection staff.
    24         (2)  There shall be four classes of licensure as follows:
    25             (i)  Exceptional quality licensure will be awarded to
    26         providers based on a finding by a panel established by
    27         each department that the provider is in compliance with
    28         licensure requirements and should be recognized for its
    29         use of best practices and high consumer satisfaction and
    30         positive outcomes. Providers with this licensure
    20030S0136B0148                 - 36 -     

     1         classification may advertise and each department shall
     2         post names of those providers with this licensure
     3         classification on its web site.
     4             (ii)  Compliance licensure will be provided to
     5         providers with either no violations or isolated Class III
     6         (minor) violations which the administrator or provider
     7         has certified in writing to the appropriate department
     8         have been corrected within 30 days of the date of the
     9         annual licensure inspection.
    10             (iii)  Provisional licensure will be given to
    11         providers with a pattern of Class III (minor) violations
    12         or isolated Class II violations for a period of six
    13         months. Substantial improvement must be demonstrated for
    14         a provider to receive a second six-month provisional
    15         license. Those providers which do not meet the standards
    16         for a compliance license at the next scheduled inspection
    17         shall have their license revoked by the appropriate
    18         department.
    19             (iv)  Provisional licensure with ban on admissions
    20         will be given for a six-month period to providers with a
    21         pattern of Class II, isolated Class I or a pattern of
    22         Class I violations such that new consumers may not be
    23         admitted or provided services by the provider with this
    24         licensure status.
    25         (3)  Before an assisted living residence is licensed and
    26     permitted to open, operate or admit residents and before an
    27     assisted living services provider is permitted to provide
    28     services to consumers, it shall be inspected by the
    29     appropriate department and must be found in compliance with
    30     the requirements set forth in this act and the resulting
    20030S0136B0148                 - 37 -     

     1     regulations.
     2         (4)  After initial licensure inspection, survey staff
     3     shall, at a minimum, conduct one onsite unannounced
     4     inspection per year. Each department shall develop a uniform
     5     survey tool to be used by inspectors.
     6         (5)  Within 24 hours, upon receipt of a complaint from
     7     any person alleging an immediate serious risk to the health
     8     or safety of a consumer, the appropriate department shall
     9     conduct an onsite unannounced inspection of the provider.
    10     Complaints prompting an inspection pursuant to this
    11     subsection may include severe injury or death of a consumer,
    12     reports of abuse or conditions or practices that cause an
    13     immediate and serious risk to a consumer. Complaints shall be
    14     investigated immediately but no later than 48 hours after
    15     receipt of the complaint.
    16         (6)  Each department shall develop requirements for the
    17     preinspection provision of information and documents by the
    18     provider on the annual anniversary of initial licensure, to
    19     be reviewed by the appropriate department's inspectors prior
    20     to the onsite inspection.
    21         (7)  Within six months of the passage of this act, each
    22     department shall develop a time line and work plan to be used
    23     to develop quality indicators of care and consumer
    24     satisfaction surveys that will be used as part of the annual
    25     inspection process. The quality indicators of care and
    26     consumer satisfaction surveys shall be developed in
    27     consultation with stakeholders and shall be placed within 24
    28     months of the passage of this act.
    29         (8)  Each department shall develop a provider survey
    30     instrument to obtain provider feedback on the inspection
    20030S0136B0148                 - 38 -     

     1     process. The survey instrument shall be sent in the
     2     preinspection submission information to be returned to the
     3     deputy secretary of the appropriate department by the
     4     provider after the onsite inspection.
     5         (9)  After three annual unannounced inspections resulting
     6     in compliance or exceptional quality licensure status, a
     7     provider shall receive abbreviated inspections for as long as
     8     it maintains compliance or exceptional quality licensure
     9     status. The appropriate department shall develop an
    10     abbreviated inspection process.
    11         (10)  As provided in section 7(b), assisted living
    12     residences not in compliance with the requirements of this
    13     act and its regulations shall be subject to intensified
    14     inspections which shall include intensified frequency,
    15     duration and scope.
    16         (11)  There shall be no transfer of license unless the
    17     appropriate department approves the transfer of license. The
    18     appropriate department may deny transfers to friends,
    19     relatives, business associates, etc., if it appears that
    20     purpose of transfer is to avoid licensure action or it
    21     appears that the previous owner will continue to have
    22     involvement in the residence or business.
    23     (b)  Violations.--
    24         (1)  Within six months of the effective date of this
    25     section, the Department of Public Welfare and the Department
    26     of Health shall classify each violation of its regulations
    27     into one of the following categories:
    28             (i)  Class I. A violation, including failure to or
    29         negligent provision of services in the service plan,
    30         which indicates a substantial probability that death or
    20030S0136B0148                 - 39 -     

     1         serious mental or physical harm to a consumer may result
     2         or death actually results.
     3             (ii)  Class II. A violation, including failure to or
     4         negligent provision of services in the service plan,
     5         which has a potential or actual substantial adverse
     6         effect upon the health, safety or well-being of a
     7         consumer.
     8             (iii)  Class III. A minor violation which has an
     9         adverse effect upon the health, safety or well-being of a
    10         consumer.
    11         (2)  The remedy and penalty for violations will depend on
    12     the violations.
    13             (i)  Isolated Class III violation. Within 30 days of
    14         the date of the citation, the assisted living residence
    15         administrator or assisted living services provider must
    16         correct the violation and certify in writing to the
    17         appropriate department that the violation has been
    18         corrected.
    19             (ii)  Pattern of Class III violations. Within ten
    20         days of the date of the citation, the assisted living
    21         residence administrator or assisted living services
    22         provider must submit a plan of correction for appropriate
    23         department approval. Within 30 days of the date of the
    24         citation, the assisted living residence administrator or
    25         assisted living services provider must correct the
    26         violations and certify in writing to the appropriate
    27         department that corrections have been made. The
    28         appropriate department shall issue fines and grant a
    29         provisional license, which shall be in effect only until
    30         written certification of corrections has been received by
    20030S0136B0148                 - 40 -     

     1         the appropriate department. Immediate correction of the
     2         violation to the inspector's satisfaction during the
     3         survey process will preclude the application of a penalty
     4         under this subsection.
     5             (iii)  Isolated Class II violations. Within ten days
     6         of the date of the citation, the assisted living
     7         residence administrator or assisted living services
     8         provider must submit a plan of correction for appropriate
     9         departmental approval. Within 30 days of the date of the
    10         citation, the assisted living residence administrator or
    11         assisted living services provider shall correct the
    12         violations and certify in writing to the appropriate
    13         department that corrections have been made. The
    14         appropriate department shall fine the assisted living
    15         residence or assisted living service provider and issue a
    16         provisional license until certification of corrections
    17         has been received by the appropriate department.
    18         Immediate correction of the violation to the inspector's
    19         satisfaction during the survey process will preclude the
    20         application of a penalty under this subsection.
    21             (iv)  Pattern of Class II violations. Within ten days
    22         of the date of the citation, the assisted living
    23         residence administrator or assisted living services
    24         provider shall submit a plan of correction for
    25         appropriate departmental approval. Within 30 days of the
    26         date of the citation, the assisted living residence
    27         administrator or assisted living services provider shall
    28         correct the violations and shall certify in writing to
    29         the appropriate department that all corrections have been
    30         made. The appropriate department shall fine the provider
    20030S0136B0148                 - 41 -     

     1         and issue a provisional license with a ban on admissions
     2         or service until written certification of corrections has
     3         been received and corrections have been verified by the
     4         appropriate department. The appropriate department shall
     5         conduct an onsite inspection to verify corrections within
     6         two business days of receipt of the certification of
     7         correction. The appropriate department shall conduct
     8         intensified inspections of the provider with more
     9         numerous unannounced inspections.
    10             (v)  Isolated Class I violations. Upon a finding by
    11         the appropriate department of a Class I violation, the
    12         appropriate department shall immediately decide whether:
    13                 (A)  to give a provisional license with a ban on
    14             admissions or services and allow the assisted living
    15             residence or assisted living services provider to
    16             correct the violation;
    17                 (B)  require the appointment of a master at the
    18             assisted living residence's expense to oversee the
    19             immediate correction of the violations; or
    20                 (C)  to revoke the license and arrange for the
    21             immediate relocation or transfer of consumers. The
    22             appropriate department shall fine the provider and
    23             should the provider remain in operation, subject it
    24             to intensified and more numerous unannounced
    25             inspections.
    26             (vi)  Pattern of Class I violations. Upon a finding
    27         by the appropriate department that a provider has a
    28         pattern of Class I violations, the appropriate department
    29         shall immediately revoke the provider's license and
    30         arrange for relocation or transfer of the consumers or
    20030S0136B0148                 - 42 -     

     1         appoint a master at the assisted living residence's
     2         expense to bring the assisted living residence into
     3         compliance within 30 days. The appropriate department
     4         shall issue a provisional license with a ban on
     5         admissions or service if the provider is permitted to
     6         continue in operation and shall fine the provider. Should
     7         the provider remain in operation, the appropriate
     8         department shall conduct intensified and more numerous
     9         inspections.
    10             (vii)  False certifications. Any administrator that
    11         falsely certifies to the appropriate department that
    12         violations have been corrected shall be fined by the
    13         appropriate department and shall lose his administrator
    14         license.
    15         (3)  Within six months of the effective date of this act,
    16     the appropriate department shall issue regulations pursuant
    17     to this section. The regulations shall ensure that
    18     inspections are not invasive of consumer's privacy or
    19     dignity, support the principles of assisted living and can be
    20     uniformly and consistently applied by the appropriate
    21     department.
    22         (4)  The appropriate department shall establish monetary
    23     penalties that relate to the severity of the violation. Money
    24     collected by the appropriate department under this section
    25     shall be first used to defray the expenses incurred by
    26     consumers relocated under this act. Any moneys remaining
    27     shall be used by the appropriate department for enforcing the
    28     provisions of this act. Fines collected pursuant to this act
    29     shall not be subject to the provisions of 42 Pa.C.S. § 3733
    30     (relating to deposits into account).
    20030S0136B0148                 - 43 -     

     1     (c)  Relocation, relocation assistance and transfer.--
     2         (1)  In addition to making all licensing surveys
     3     available, assisted living residences shall post all Class I
     4     and II licensing actions. The department shall inform all
     5     residents of their right to leave the assisted living
     6     residence and to receive relocation assistance.
     7             (i)  The department shall promptly relocate consumers
     8         from an assisted living residence if any of the following
     9         conditions exist:
    10                 (A)  The assisted living residence is operating
    11             without a license.
    12                 (B)  The licensee is voluntarily closing an
    13             assisted living residence and relocation is necessary
    14             for the health and welfare of the consumers.
    15                 (C)  The assisted living residence has engaged in
    16             conduct that endangers the health and safety of its
    17             residents, leading a reasonable consumer to be
    18             concerned for his or her safety.
    19                 (D)  When the assisted living resident wishes to
    20             leave.
    21             (ii)  The department shall offer relocation
    22         assistance to consumers of assisted living residences.
    23         This shall include:
    24                 (A)  Providing residents with pertinent
    25             information, such as referrals to nearby social
    26             service agencies or assisted living residences in
    27             complete compliance with governing regulations.
    28                 (B)  Determining other options for relocation;
    29             and assisting residents to make arrangements for
    30             relocation if family members are not available for
    20030S0136B0148                 - 44 -     

     1             this purpose.
     2             (iii)  Except in an emergency, the consumer shall be
     3         involved in planning his transfer to another placement
     4         and shall have the right to choose among the available
     5         alternative placements. The department may make temporary
     6         placement until final placement can be arranged.
     7         Consumers shall be provided with an opportunity to visit
     8         alternative placement before relocation or following
     9         temporary emergency relocation. Consumers shall choose
    10         their final placement and shall be given assistance in
    11         transferring to such place.
    12             (iv)  Consumers shall not be relocated pursuant to
    13         this section if the department determines in writing and
    14         consistent with consumer preference that such relocation
    15         is not in the best interest of the consumer.
    16         (2)  All consumers of assisted living services providers
    17     shall be notified by the Department of Health of its Class I
    18     and II licensing actions against their provider, informed of
    19     their right to switch providers and informed of their right
    20     to receive assistance in locating a new assisted living
    21     services provider. The Department of Health shall provide
    22     assistance to consumers of assisted living services providers
    23     who require assistance in transferring to other assisted
    24     living services providers. The assistance shall be consistent
    25     with the conditions for and forms of assistance stated in
    26     paragraph (1).
    27     (d)  Appeal of violations.--A provider appealing appropriate
    28  departmental ban on admissions and/or license revocation or
    29  nonrenewal shall be denied a supersedeas unless the provider
    30  demonstrates substantial likelihood of prevailing on the merits.
    20030S0136B0148                 - 45 -     

     1  Where a supersedeas is granted it shall be revoked if the
     2  department presents evidence of any intervening Class I or II
     3  violations. Where supersedeas is granted:
     4         (1)  The appropriate department shall inspect a residence
     5     or assisted living services provider at least monthly or more
     6     frequently to ensure residents' or recipients' safety and
     7     well-being. These inspection reports will be maintained as
     8     part of the public record for the assisted living residence
     9     or assisted living services provider.
    10         (2)  Where a supersedeas has been granted, a Class I or
    11     II violation cited after the granting of the supersedeas
    12     shall lead to a revocation of the supersedeas.
    13     (e)  Hearings.--The Department of Public Welfare and the
    14  Department of Health, respectively, shall make the assisted
    15  living residence or services consumer and provider appeals a
    16  priority, with no appeal outstanding more than 60 days beyond
    17  the date on which the appeal was filed.
    18     (f)  Expedited reconsideration.--The Secretary of Public
    19  Welfare shall rule on reconsiderations within 60 days.
    20     (g)  Definitions.--As used in this section, the following
    21  words and phrases shall have the meanings given to them in this
    22  subsection:
    23     "Appropriate department."  The appropriate department with
    24  respect to assisted living residences shall be the Department of
    25  Public Welfare and the appropriate department with respect to
    26  assisted living services providers shall be the Department of
    27  Health.
    28     "Each department."  The term shall mean both the Department
    29  of Public Welfare and the Department of Health acting
    30  independently but following the same instruction from the
    20030S0136B0148                 - 46 -     

     1  legislature.
     2  Section 8.  Expansion of availability of publicly funded home-
     3                 based and community-based assisted living
     4                 services.
     5     (a)  Categories and services.--Within the next fiscal year
     6  following the effective date of this act, the department shall:
     7         (1)  Immediately work with stakeholders to identify
     8     categories of persons qualifying for nursing facility care
     9     who do not presently fit in any of Pennsylvania's present
    10     Medicaid home-based and community-based waiver programs, such
    11     as persons with autism, persons who have suffered a stroke
    12     and others.
    13         (2)  Seek amendment of all present Medicaid home-based
    14     and community-based services waivers consistent with Federal
    15     requirements for the purposes of adding/increasing needed
    16     services not presently provided and covering populations
    17     identified in paragraph (1), to fill in the gaps in
    18     Pennsylvania's current Medicaid waivers and to maximize caps
    19     on payment, such as adding cognitive support services and
    20     assistive technology to the PDA waiver, amending the AIDS
    21     waiver and increasing the 80% cap on PDA waiver services.
    22         (3)  Amend, if permitted by Federal law, the State plan
    23     to include in medical assistance financial eligibility
    24     determination the following:
    25             (i)  In determining the countable resources of
    26         qualified persons for purposes of medical assistance
    27         eligibility, the department shall use a computation
    28         method which exempts an amount of otherwise countable
    29         resources which is equal to the difference between $2,000
    30         and an amount calculated as follows: $2,000 increased by
    20030S0136B0148                 - 47 -     

     1         each of the Social Security cost-of-living adjustments
     2         sequentially from January 1, 1990, to the present.
     3             (ii)  For qualified couples, the department shall use
     4         a computation method which exempts an amount of otherwise
     5         countable resources which is equal to the difference
     6         between $3,000 and the amount calculated as follows:
     7         $3,000 increased by each of the Social Security cost-of-
     8         living adjustments sequentially from January 1, 1990, to
     9         the present.
    10             (iii)  The department shall promptly adjust upward
    11         the exempted amounts each year as new Social Security
    12         cost-of-living adjustments go into effect.
    13         (4)  Change and, where necessary, seek Federal approval
    14     to liberalize eligibility requirements for nursing facility-
    15     eligible persons receiving Medicaid-funded services in the
    16     community to parallel the requirements for those receiving
    17     care in a nursing facility. Where permitted by Federal law,
    18     the department shall increase the resource level, adjust the
    19     spousal impoverishment level and revise spenddown allowances
    20     for those receiving services in their home and community to
    21     parallel the requirements for those persons receiving such
    22     services in a Medicaid-funded nursing facility.
    23     (b)  Housing.--Within nine months the Department of Aging and
    24  the Department of Public Welfare shall:
    25         (1)  Establish a presumptive eligibility program for
    26     immediately putting assisted living services in place for
    27     persons needing long-term care services who appear to be
    28     eligible for State-funded or Medicaid-funded programs, where
    29     the individual is at risk of imminent placement in a nursing
    30     facility. In so doing, the department shall attempt to
    20030S0136B0148                 - 48 -     

     1     maximize Federal matching funding but, if necessary, may use
     2     State funding exclusively.
     3         (2)  Establish rules and procedures for a program to
     4     provide payment for a housing supplement funded with State
     5     dollars to be used with Medicaid-funded home-based and
     6     community-based services to help keep the consumer at home,
     7     in an approved domiciliary care home, in an assisted living
     8     residence or in an approved personal care home where:
     9             (i)  the total State cost of the housing supplement
    10         and home-based and community-based services is less than
    11         the State cost for that consumer in a nursing facility;
    12         or
    13             (ii)  a housing supplement is necessary to avoid
    14         nursing facility placement unwanted by the consumer:
    15                 (A)  the person is certified for an available
    16             waiver slot in the Medicaid-funded home-based and
    17             community-based services waiver program; and
    18                 (B)  adequate State funds have been appropriated
    19             for the year for the payment of the supplement.
    20         (3)  Begin annual assessment of the availability of home-
    21     based and community-based assisted living services in all
    22     counties and assist counties to develop needed services, such
    23     as adult day care, where they are presently unavailable.
    24         (4)  Establish a program which allows persons with
    25     medical assistance countable assets of up to $40,000, but who
    26     are presently income eligible for Medicaid-funded home-based
    27     and community-based assisted living services to equally share
    28     the cost of those services with a State-funded program and
    29     provides State support to bridge the transition to Medicaid-
    30     funded services.
    20030S0136B0148                 - 49 -     

     1         (5)  Implement a quality assessment and improvement
     2     program, which includes consumer satisfaction surveys and
     3     quality-of-life outcome measures to ensure that publicly
     4     funded home-based and community-based services meet
     5     consumers' needs and permit consumers to live independently
     6     in the residential environment of their choice, promote
     7     integration of consumers into the community, maximize
     8     consumer choice to promote and support the consumer's
     9     changing needs, are consumer-oriented and meet professional
    10     standards of quality.
    11         (6)  Work with stakeholders to develop recommendations
    12     for the General Assembly for public funding and cost sharing
    13     for consumers needing assistance with activities of daily
    14     living whose income is higher than the Medicaid or
    15     Supplemental Security Income State supplement but less than
    16     the medical assistance home-based and community-based waiver
    17     income level, and who do not meet the functional eligibility
    18     for Medicaid home-based and community-based waiver services.
    19     (c)  Transition.--On a timely and ongoing basis, the
    20  department shall identify persons aging out of the Early and
    21  Periodic Screening, Diagnosis and Treatment (EPSDT) Program and
    22  other publicly funded programs who would be eligible for
    23  publicly funded home-based and community-based assisted living
    24  services and assist them to make a safe and uninterrupted
    25  transfer to those programs so that they may continue to remain
    26  in their communities.
    27     (d)  Report.--The Department of Public Welfare and the
    28  Department of Aging shall provide annually a public report
    29  including the following information:
    30         (1)  The types of home-based and community-based services
    20030S0136B0148                 - 50 -     

     1     funded through public sources by county, including
     2     descriptions of services, units of services, an unduplicated
     3     count of people served by service and consumer satisfaction
     4     information.
     5         (2)  The number of people who applied for home-based and
     6     community-based services, the number of people on waiting
     7     lists, the number of people denied home-based and community-
     8     based services because of financial ineligibility, the
     9     adequacy of access to providers funded under this act and
    10     choice of quality providers for first-day medical assistance
    11     beneficiaries qualifying for services under this act, an
    12     analysis of the adequacy of reimbursement to providers for
    13     publicly funded services under this act and the number of
    14     people denied home-based and community-based services because
    15     of functional ineligibility.
    16         (3)  The number, types and results of complaints,
    17     consumer satisfaction information, length of stay or service
    18     delivery, reasons for termination of service and development
    19     of evaluation tools for determining quality of life and care.
    20     (e)  Annual determination.--The department shall annually
    21  determine, on a county-by-county basis, the adequacy of access
    22  of first-day medical assistance beneficiaries who qualify for
    23  services under this act to a reasonable choice of quality
    24  providers funded for services under this act. In those counties
    25  where first-day Medicaid beneficiaries do not have adequate
    26  access and choice of quality providers, the department shall,
    27  after consultation with stakeholders, determine a fair share
    28  first-day medical assistance access formula to be applied to
    29  providers in that county who provide services under this act,
    30  for the purpose of providing access for first-day medical
    20030S0136B0148                 - 51 -     

     1  assistance beneficiaries. In such cases, the department shall
     2  only contract with those providers who agree to serve a fair
     3  share of first-day medical assistance consumers. However, no
     4  provider shall be penalized for not meeting the fair share
     5  requirements if it can demonstrate that access or services have
     6  not been denied to any first-day medical assistance recipient
     7  meeting the providers' admission/acceptance standards.
     8  Section 9.  Application, assessment and appeal process for
     9                 publicly funded home-based and community-based
    10                 assisted living services.
    11     (a)  Application form and application process.--Within six
    12  months of the effective date of this act, the Department of
    13  Public Welfare and the Department of Aging, working with the
    14  stakeholders, shall design and utilize a single, simple,
    15  consumer-friendly, attractive and readily available PALS
    16  application form for publicly funded services and benefits
    17  available in Pennsylvania for persons needing long-term care
    18  services, which will serve as a one-stop application for these
    19  services. The application shall be for all publicly funded
    20  assisted living services available in Pennsylvania and shall be
    21  known as the PALS Program Application.
    22     (b)  Duties of departments.--The departments shall:
    23         (1)  To the extent possible, rely primarily on income and
    24     asset verification that is independently available to the
    25     Commonwealth, with little burden placed on the applicant.
    26         (2)  Ensure swift and seamless application process for
    27     all PALS programs so that there are consistent income-
    28     eligibility periods and use of self-declaration of income for
    29     PACE and Medicaid so that Medicaid-eligible PACE applicants
    30     will receive the greater package of services through
    20030S0136B0148                 - 52 -     

     1     Medicaid, while helping the Commonwealth maximize Federal
     2     funding and free up State lottery funds.
     3         (3)  Permit PALS application submission to either the
     4     Department of Aging or the Department of Public Welfare and
     5     take other steps to ensure the prompt and seamless processing
     6     of applications and provision of services.
     7         (4)  Promptly assist and advise applicants and their
     8     family members in gathering necessary nonindependently
     9     available verification of income and assets and directly
    10     contact sources of information if the consumer requests.
    11         (5)  Ensure that the application is capable of swift
    12     determination on completeness and eligibility so that, upon
    13     submission, additional items necessary for processing the
    14     completed application will be identified to the applicant or
    15     their family members.
    16         (6)  Ensure that eligibility determinations made in one
    17     county shall be good for use in any county of this
    18     Commonwealth during the period of eligibility.
    19     (c)  Legislative Budget and Finance Committee.--Within six
    20  months of the effective date of this act, the Legislative Budget
    21  and Finance Committee shall evaluate the efficiency,
    22  responsiveness to consumers, consumer satisfaction with and
    23  effectiveness of the present staffing and application and
    24  verification process for publicly funded home-based and
    25  community-based assisted living services and make
    26  recommendations for improvements.
    27     (d)  Screening, assessment and eligibility determination.--
    28         (1)  The department shall immediately establish
    29     procedures requiring all persons seeking long-term care
    30     services in an assisted living residence or personal care
    20030S0136B0148                 - 53 -     

     1     home to obtain a level-of-care screening and comprehensive
     2     assessment from the area agency on aging program prior to
     3     admission to such residence.
     4         (2)  The procedures may permit an area agency on aging
     5     level-of-care screening and comprehensive assessment to be
     6     conducted by telephone based on representations made by the
     7     provider and applicant subject to retrospective face-to-face
     8     evaluation of the applicant thereafter.
     9         (3)  All persons may obtain level-of-care screenings and
    10     comprehensive assessments from the area agency on aging.
    11         (4)  All area agency on aging level-of-care screenings or
    12     comprehensive assessments must be completed within five
    13     business days of the request, except where an urgent
    14     situation requires that they be completed within one business
    15     day, and shall be valid for six months unless the resident's
    16     or recipient's condition changes.
    17         (5)  All area agency on aging determinations of need for
    18     publicly funded long-term care services shall be evaluated by
    19     the county assistance offices for financial eligibility
    20     within five business days generally or one day for emergency
    21     cases from date of receipt of completed Medicaid application.
    22         (6)  The departments, in consultation with stakeholders,
    23     shall establish the negotiated risk standards to be used in
    24     determining the consumer's eligibility for publicly funded
    25     assisted living services.
    26     (e)  Appeals.--The department shall promptly develop an
    27  expedited fair hearing process for addressing challenges to
    28  financial eligibility, level of care, service plan and
    29  Supplemental Security Income supplemental decisions where the
    30  denial has resulted in failure to provide long-term care
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     1  services. Hearing and decision must take place within 30 days of
     2  filing of fair hearing.
     3  Section 10.  Information on publicly funded assisted living
     4                 services.
     5     Within nine months of the effective date of this act, the
     6  Department of Public Welfare and the Department of Aging shall:
     7         (1)  Develop an extensive multimedia public information
     8     campaign to inform Pennsylvanians needing home-based and
     9     community-based long-term assisted living services of the
    10     range of options available, which list shall be updated and
    11     disseminated annually, and of the availability of the
    12     Pennsylvania Assisted Living Services (PALS) Program. The
    13     public information campaign shall be reviewed and updated
    14     every two years with reports to and an opportunity for input
    15     by the stakeholders.
    16         (2)  Establish a toll-free PALS Help Line for consumers
    17     needing home-based and community-based assisted living
    18     services to advise consumers of programs in their area and of
    19     public funding availability and to assist with the
    20     application process.
    21         (3)  Initiate a training program for hospital discharge
    22     planners, area aging personnel, nursing home staff,
    23     Department of Public Welfare caseworkers, HealthChoices
    24     special needs personnel and social service programs on the
    25     range of publicly funded home-based and community-based
    26     assisted living services and the new application process
    27     therefore.
    28  Section 11.  Information sharing.
    29     The department shall maintain a data base of licensed
    30  assisted living residences and assisted living services
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     1  providers and shall make available from the department and on
     2  its World Wide Web site, at a minimum, the following information
     3  for each licensed provider: name, address, licensing status,
     4  resident profiles, number of beds, payer sources, consumer
     5  satisfaction and quality indicators, and important links to
     6  related long-term care World Wide Web sites. This information
     7  must be regularly updated and it must be timely.
     8  Section 12.  Appropriation.
     9     The sum of $1,000,000 is hereby appropriated to the
    10  Department of Public Welfare for the housing supplement purposes
    11  set out in section 8(b)(2) for the fiscal year July 1, 2003, to
    12  June 30, 2004, to carry out the provisions of this act.
    13  Section 13.  Repeal.
    14     All acts and parts of acts are repealed insofar as they are
    15  inconsistent with this act.
    16  Section 14.  Effective date.
    17     This act shall take effect in 60 days.

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