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

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

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

20Section 802.1. Definitions.

21The following words and phrases when used in this chapter

1shall have, unless the context clearly indicates otherwise, the
2meanings given them in this section:

3* * *

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

7* * *

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

12Section 2. Section 806 of the act is amended by adding a
13subsection to read:

14Section 806. Licensure.

15* * *

16(i) Hospitals.--

17(1) In issuing a license to a hospital, the department
18shall, at the request of the hospital, rely on the reports of
19national accreditation organizations designated as acceptable
20to the department pursuant to the requirements set forth in
21section 810.1 and shall issue a license to a hospital that
22received approval or accreditation from the designated
23organization.

24(2) A hospital that is not accredited by a national
25accreditation organization or does not request that the
26department rely on the accreditation shall be required to
27comply with 28 Pa. Code Chs. 51 (relating to general
28information) and 101 (relating to general information).

29(3) This subsection shall not be construed as a
30limitation on the department's right of inspection permitted

1under section 813, including the right to inspect in response
2to complaints or other reports made to the department.

3(4) A hospital that is deemed shall comply with the
4standards established by a national accreditation
5organization that accredits the hospital. Any licensure
6inspection of a deemed hospital shall be based on the
7standards established by the national accreditation
8organization that accredits the hospital and State law.

9(5) All hospitals, whether licensed through
10accreditation or compliance with the department's
11regulations, shall submit plans for new construction and
12renovation of facilities to the department and must receive
13approval from the department before providing services in the
14newly constructed or renovated areas.

15Section 3. Sections 809 and 810(a) of the act, amended
16December 18, 1992 (P.L.1602, No.179), are amended to read:

17Section 809. Term and content of license.

18(a) Contents.--All licenses issued by the department under
19this chapter shall:

20(1) be issued for a specified length of time as follows,
21including the provision of section 804(b):

22(i) all health care facilities other than hospitals
23for a period of one year[, and for hospitals for a period
24of two years] with the expiration date to be the last day
25of the month in which license is issued;

26(ii) provisional licenses for the length of time to
27be determined by the department upon issuance of the
28provisional license;

29(iii) all deemed hospitals for the duration of the
30accreditation cycle in good standing with the expiration

1date to be the last day of the month in which the license
2is issued; and

3(iv) all hospitals licensed by compliance with the
4department's regulations for a period of three years,
5with the expiration date to be the last day of the month
6in which the license is issued;

7(2) be on a form prescribed by the department;

8(3) not be transferable except upon prior written
9approval of the department;

10(4) be issued only to the health care provider and for
11the health care facility or facilities named in the
12application;

13(5) specify the maximum number of beds, if any, to be
14used for the care of patients in the facility at any one
15time; and

16(6) specify limitations which have been placed on the
17facility.

18(b) Posting.--The license shall at all times be posted in a
19conspicuous place on the provider's premises.

20(c) Visitation.--Whenever practicable, the department shall
21make its visitations and other reviews necessary for licensure
22contemporaneously with similar visitations and other reviews
23necessary for provider certification in the Medicare and medical
24assistance programs and the department shall endeavor to avoid
25duplication of effort by the department and providers in the
26[certificate of need,] medical assistance and Medicare provider
27certification and licensure procedures. This shall not preclude
28the department from unannounced visits.

29(d) Use of beds in excess of maximum.--Except in case of
30[extreme emergency] natural disasters, catastrophes, acts of 

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

9Section 810. Reliance on accrediting agencies and Federal
10Government for health care facilities other than 
11hospitals.

12(a) Reports of other agencies.--After a provider has been
13licensed or approved to operate a health care facility other 
14than a hospital for at least two years under this or prior acts,
15none of which has been pursuant to a provisional license, the
16department may rely on the reports of the Federal Government or
17nationally recognized accrediting agencies to the extent those
18standards are determined by the department to be similar to
19regulations of the department and if the provider agrees to:

20(1) direct the agency or government to provide a copy of
21its findings to the department; and

22(2) permit the department to inspect those areas or
23programs of the health care facility not covered by the
24agency or government inspection or where the agency or
25government report discloses more than a minimal violation of
26department regulations.

27* * *

28Section 4. The act is amended by adding a section to read:

29Section 810.1. Reliance on national accreditation organizations
30for hospitals.

1(a) Report of other agencies.--After a provider has been
2licensed or approved to operate a hospital for at least three
3years under this or a prior act, no portion of which has been
4pursuant to a provisional or other restricted license, if
5requested by the facility, the department shall rely on the
6report of an acceptable accreditation organization authorized
7pursuant to this section and section 806.

8(b) Application and approval process.--An accreditation
9organization shall apply to the department for approval. Prior
10to approval, the department shall:

11(1) determine that the standards of the accreditation
12organization are equal to or more stringent than existing
13licensure survey requirements;

14(2) evaluate the survey or inspection process of the
15accreditation organization to ensure the integrity of the
16survey or inspection process; and

17(3) enter into a written agreement with the
18accreditation organization that includes requirements for:

19(i) notice of all surveys and inspections;

20(ii) sharing of complaints and other relevant
21information;

22(iii) participation of the department in
23accreditation organization activities if determined to be
24appropriate by the department;

25(iv) protection of the confidentiality of medical
26and personal records;

27(v) all licensure inspections of deemed hospitals
28shall be based on the standards established by the
29national accreditation organization and State law; and

30(vi) any other provision necessary to ensure the

1integrity of the accreditation and licensure process.

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

3(1) If an approved accreditation organization has issued
4a final report finding a hospital to be in substantial
5compliance with the accreditation organization's standards,
6the department shall accept the report as evidence that the
7hospital has met the department's licensure requirements and
8shall grant the hospital deemed status. The final report must
9have been issued no more than one year prior to the
10expiration date of the hospital's license.

11(2) A hospital that receives a conditional
12accreditation, provisional accreditation, preliminary or
13final denial of accreditation shall be subject to full
14licensure survey by the department.

15(d) Reports to department.--

16(1) An approved accreditation organization shall send
17the department all final accreditation reports of each
18inspection and survey at the time it is sent to the hospital.

19(2) A final report of an approved accreditation
20organization shall be made immediately available to the
21public in accordance with department practice.

22(3) A preliminary or final report of an approved
23accreditation organization shall not be admissible as
24evidence in a civil action or proceeding.

25(e) Inspection by department.--The department may inspect an
26accredited hospital to:

27(1) follow up on a systemic concern or event identified
28by an approved accreditation organization or by report filed
29by the facility;

30(2) investigate a complaint;

1(3) validate the findings of an approved accreditation
2organization that determined that a hospital is in compliance
3with conditions of participation issued by the Centers for
4Medicare and Medicaid Services and State licensure
5requirements; or

6(4) comply with the request of any Federal or State
7regulatory entity.

8(f) Participation or observation of surveys or inspections
9by accreditation organization by the department.--The department
10may participate in or observe a survey or inspection of a
11hospital conducted by an approved accreditation organization.

12(g) Actions by the department on accreditation
13organization's failure to meet obligations.--

14(1) Upon determination by the department that an
15approved accreditation organization has failed to meet its
16obligations under this section, the department shall have 30
17days from the time it notifies the accreditation organization
18to resolve any issues that are resulting in the accrediting
19agency's not meeting its obligations.

20(2) If, after 30 days, the department and the
21accrediting organization have not reached an agreement that
22brings the accrediting organization back into compliance with
23this act, the department shall provide notice in the
24Pennsylvania Bulletin that it intends to take action to
25withdraw the approval of the accreditation organization, list
26the reasons the action is being taken, make available the
27accreditation organization's response to the department and
28receive public comment regarding the decision for a period of
29not less than 30 days.

30(3) If, after the conclusion of the public comment

1period, the department's determination is that the approved
2accreditation organization has failed to meet its obligation
3under this section, the department may withdraw approval of
4the accreditation organization granted under sections 806 and
5810 and immediately terminate the agreement between the
6department and the accreditation organization.

7(4) Any hospital that has achieved deemed status as a
8result of being accredited by the accreditation organization
9terminated by the department shall keep the deemed status
10until the end of the current licensure period. To renew a
11license, the hospital shall either be accredited by another
12department-approved accreditation organization or shall be
13subject to the department's licensure regulations as provided
14for in section 806(i)(2).

15Section 5. This act shall take effect in 180 days.