CORRECTIVE REPRINT PRIOR PRINTER'S NO. 776 PRINTER'S NO. 802
No. 704 Session of 2007
INTRODUCED BY VANCE, WASHINGTON, BAKER, BOSCOLA, BROWNE, EARLL, ERICKSON, FOLMER, FUMO, KITCHEN, LOGAN, MELLOW, MUSTO, O'PAKE, ORIE, PICCOLA, PIPPY, PUNT, RAFFERTY, STACK, STOUT, TOMLINSON, WAUGH, D. WHITE, M. WHITE, C. WILLIAMS, WONDERLING, WOZNIAK, SCARNATI, REGOLA, RHOADES, MADIGAN AND McILHINNEY, MARCH 29, 2007
REFERRED TO PUBLIC HEALTH AND WELFARE, MARCH 29, 2007
AN ACT 1 Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An 2 act to consolidate, editorially revise, and codify the public 3 welfare laws of the Commonwealth," further providing for 4 rules and regulations for personal care homes and assisted 5 living residences. 6 The General Assembly of the Commonwealth of Pennsylvania 7 hereby enacts as follows: 8 Section 1. Section 213 heading and (c) of the act of June 9 13, 1967 (P.L.31, No.21), known as the Public Welfare Code, 10 added December 21, 1988 (P.L.1883, No.185), are amended and the 11 section is amended by adding a subsection to read: 12 Section 213. Personal Care Home [Administrator] and Assisted 13 Living Residence Administrators.--* * * 14 (a.1) All assisted living residences shall identify and 15 appoint an administrator or administrators who meet the 16 qualifications provided in this section for personal care home 17 administrators and any additional standards pertaining to the
1 operations of assisted living residences as the department may 2 establish by regulation. 3 * * * 4 (c) The department may promulgate regulations requiring 5 orientation and training for all direct care staff in a personal 6 care home or assisted living residence. 7 * * * 8 Section 2. The definition of "facility" in section 1001 of 9 the act, amended December 21, 1988 (P.L.1883, No.185), is 10 amended and the section is amended by adding definitions to 11 read: 12 Section 1001. Definitions.--As used in this article-- 13 * * * 14 "Assisted living residence" means any premises in which food, 15 shelter, personal care, assistance or supervision and 16 supplemental health care services are provided for a period 17 exceeding twenty-four hours or four or more adults who are not 18 relatives of the operator, who require assistance or supervision 19 in such matters as dressing, bathing, diet, financial 20 management, evacuation from the residence in the event of an 21 emergency or medication prescribed for self-administration. 22 "Assisted living residence administrator" means an individual 23 who is charged with the general administration of an assisted 24 living residence, whether or not such individual has an 25 ownership interest in the residence or his function and duties 26 are shared with other individuals. 27 * * * 28 "Facility" means an adult day care center, child day care 29 center, family day care home, boarding home for children, mental 30 health establishment, personal care home, assisted living 20070S0704B0802 - 2 -
1 residence, nursing home, hospital or maternity home, as defined 2 herein, [and shall not include those] except to the extent that 3 such a facility is operated by the State or Federal governments 4 or those supervised by the department[.], or licensed pursuant 5 to the act of July 19, 1979 (P.L.130, No.48), known as the 6 "Health Care Facilities Act." 7 * * * 8 "Supplemental health care service" means the provision by an 9 assisted living residence of any type of health care service, 10 either directly or through contractors, subcontractors, agents 11 or designated providers, except for any service that is required 12 by law to be provided by a health care facility pursuant to the 13 act of July 19, 1979 (P.L.130, No.48), known as the "Health Care 14 Facilities Act." 15 Section 3. Section 1006 of the act, amended December 21, 16 1988 (P.L.1883, No.185), is amended to read: 17 Section 1006. Fees.--Annual licenses shall be issued when 18 the proper fee, if required, is received by the department and 19 all the other conditions prescribed in this act are met. For 20 personal care homes and assisted living residences, the fee 21 shall be an application fee. The fees shall be: 22 Facility Annual Fee 23 Adult day care center $ 15 24 Mental health establishment 50 25 Personal care home 26 or assisted 27 living residence -- [0] 4 - 20 beds 15 28 -- 21 - 50 beds 20 29 -- 51 - 100 beds 30 30 --101 beds and above 50 20070S0704B0802 - 3 -
1 No fee shall be required for the annual license in the case 2 of day care centers, family day care homes, boarding homes for 3 children or for public or nonprofit mental institutions. 4 Section 4. The definition of "private institution" in 5 section 1051 of the act, amended December 21, 1988 (P.L.1883, 6 No.185), is amended to read: 7 Section 1051. Definition.--As used in this subarticle-- 8 "Private institution" means any of the following facilities 9 by whatever term known and irrespective of the age group served: 10 Mental hospital, institution for the mentally defective, day 11 care center, nursing home, hospital, personal care home, 12 assisted living residence and other similar institution which is 13 operated for profit and which requires a license issued by the 14 department. 15 Section 5. Sections 1057.1, 1057.2(a), 1057.3, 1085 16 introductory paragraph, 1086(e) and 1087 of the act, added 17 December 21, 1988 (P.L.1883, No.185), are amended to read: 18 Section 1057.1. Appeals.--(a) An appeal from the decision 19 of the department relating to the licensure or revocation of a 20 personal care home or assisted living residence shall not act as 21 a supersedeas but, upon cause shown and where circumstances 22 require it, the reviewing authority shall have the power to 23 grant a supersedeas. 24 (b) If, without good cause, one or more Class I or Class II 25 violations remain uncorrected or when the home or residence has 26 demonstrated a pattern of episodes of noncompliance alternating 27 with compliance over a period of at least two years such as 28 would convince a reasonable person that any correction of 29 violations would be unlikely to be maintained, the department 30 may petition the court to appoint a master designated as 20070S0704B0802 - 4 -
1 qualified by the department to assume operation of the home or 2 residence at the [home's] operator's expense for a specified 3 period of time or until all violations are corrected and all 4 applicable laws and regulations are complied with. 5 Section 1057.2. Relocation.--(a) The department, in 6 conjunction with appropriate local authorities, shall relocate 7 residents from a personal care home or assisted living residence 8 if any of the following conditions exist: 9 (1) The home or residence is operating without a license. 10 (2) The licensee is voluntarily closing a home or residence 11 and relocation is necessary for the health and welfare of the 12 resident or residents. 13 * * * 14 Section 1057.3. Rules and Regulations for Personal Care Home 15 and Assisted Living Residences.--(a) The rules and regulations 16 for the licensing of personal care homes and assisted living 17 residences promulgated by the department shall require that: 18 (1) Prior to a resident's admission to a personal care home 19 or assisted living residence, an initial standardized screening 20 instrument be completed for that resident by the [personal care 21 home] provider or a human service agency. Such standardized 22 screening instrument shall be developed by the department. 23 [This] 24 (i) For a personal care home, the screening will be done to 25 determine that the potential resident does not require the 26 services in or of a long-term care facility [or] and whether the 27 potential resident requires the services of a personal care 28 [services] home and, if so, the nature of the services and 29 supervision necessary. 30 (ii) For an assisted living residence, the screening will be 20070S0704B0802 - 5 -
1 done to determine whether the potential resident requires the 2 services provided by an assisted living residence. A resident 3 who currently does not require assistance in obtaining 4 supplemental health care service, but who may require such 5 services in the future or who wishes to obtain assistance in 6 obtaining such services or reside in a facility in which such 7 services are available, may be admitted to the assisted living 8 residence, provided the resident is only provided service 9 required or requested by the resident. 10 (iii) An initial screening shall not be required to commence 11 supplemental health care services to a resident of an assisted 12 living facility who was not receiving such services at the time 13 of the resident's admission; to transfer a resident from a 14 portion of an assisted living residence that does not provide 15 supplemental health care service to a portion of the residence 16 that provides such service; or to transfer a resident from a 17 personal care home to an assisted living residence licensed by 18 the same operator. 19 (2) In addition to the screening, each resident receive a 20 complete medical examination by a physician prior to, or within 21 thirty days of, admission and that, once admitted, each resident 22 receive a screening and medical evaluation at least annually. 23 (3) A personal care home or assisted living residence 24 administrator refer an applicant whose needs cannot be met by [a 25 personal care home] the home or residence to an appropriate 26 assessment agency. 27 (4) Each resident be provided by the administrator with 28 notice of any Class I or Class II violations uncorrected after 29 five days. 30 (5) All residents sign a standard written admission 20070S0704B0802 - 6 -
1 agreement which shall include the disclosure to each resident of 2 the actual rent and other charges for services provided by the 3 personal care home or assisted living residence. 4 (6) For residents eligible for Supplemental Security Income 5 (SSI) benefits, actual rent and other charges not exceed the 6 resident's actual current monthly income reduced by a personal 7 needs allowance for the resident in an amount to be determined 8 by the department, but not less than twenty-five dollars ($25). 9 (7) A personal care home or assisted living residence not 10 seek or accept any payments from a resident who is a 11 Supplemental Security Income (SSI) recipient in excess of one- 12 half of any funds received by the resident under the act of 13 March 11, 1971 (P.L.104, No.3), known as the "Senior Citizens 14 Rebate and Assistance Act." 15 (8) A personal care home or assisted living residence not 16 seek or accept from a resident who is eligible for Supplemental 17 Security Income (SSI) benefits any payment from any funds 18 received as lump sum awards, gifts or inheritances, gains from 19 the sale of property, or retroactive government benefits: 20 Provided, however, That an owner or operator may seek and accept 21 payments from funds received as retroactive awards of Social 22 Security or Supplemental Security Income (SSI) benefits, but 23 only to the extent that the retroactive awards cover periods of 24 time during which the resident actually resided in the personal 25 care home or assisted living residence. 26 (9) Each resident who is a recipient of, or an eligible 27 applicant for, Supplemental Security Income (SSI) benefits be 28 provided, at no additional charge to the resident, necessary 29 personal hygiene items and personal laundry services. This 30 requirement does not include cosmetic items. 20070S0704B0802 - 7 -
1 (10) All residents may leave and return to [the] a personal 2 care home or assisted living residence, receive visitors, have 3 access to a telephone and mail and participate in religious 4 activities. 5 (11) Personal care home and assisted living residence 6 owners, administrators or employes be prohibited from being 7 assigned power of attorney or guardianship for any resident. 8 (12) Each assisted living residence demonstrate the ability 9 to provide supplemental health care services in a manner duly 10 protective of the health, safety and well-being of its residents 11 utilizing employes, independent contractors or contractual 12 arrangements with other health care facilities or practitioners 13 licensed, registered or certified to the extent required by law 14 to provide such service. To the extent prominently disclosed in 15 a written admission agreement, an assisted living residence may 16 require residents to use providers of supplemental health care 17 services designated by the facility. 18 (13) A personal care home not provide supplemental health 19 care services to residents, provided, however, that a personal 20 care home may assist residents in obtaining health care services 21 in the manner provided by 55 Pa. Code §§ 2600.29 (relating to 22 hospice care and services), 2600.142 (relating to assistance 23 with health care) and 2600.181 (relating to self-administration) 24 through 2600.191 (relating to medications) or as otherwise 25 provided by regulations adopted by the department not 26 inconsistent with the requirements of this section. 27 (b) [The] Subject to subsection (a)(13), the department 28 shall not prohibit immobile persons who do not require the 29 services of a licensed long-term care facility[, but who require 30 personal care services,] from residing in a personal care home, 20070S0704B0802 - 8 -
1 provided that appropriate personal care services and health care 2 services are available to the resident and the design, 3 construction, staffing or operation of the personal care home 4 allows for safe emergency evacuation. Persons requiring the 5 services of a licensed long-term care facility, including 6 immobile persons, may reside in an assisted living residence, 7 provided that appropriate supplemental health care services are 8 provided such residents and the design, construction, staffing 9 and operation of the assisted living residence allows for their 10 safe emergency evacuation. 11 (c) An assisted living residence may not admit, retain or 12 serve a consumer with any of the following conditions or health 13 care needs: 14 (1) Ventilator dependency. 15 (2) Stage III and IV, or multiple stage II decubiti and 16 vascular ulcers that are not in a healing stage. 17 (3) Continuous intravenous fluids. 18 (4) Reportable infectious diseases, such as tuberculosis, in 19 a communicable state that require isolation of the consumer or 20 require special precautions by a caretaker to prevent 21 transmission of the disease unless the Department of Health 22 directs that isolation be established within the assisted living 23 residence. 24 (5) Nasogastric tubes. 25 (6) Gastric tubes, except when the consumer is capable of 26 self-care of the tube. 27 (7) Physical restraints. 28 (8) Tracheostomy except when the consumer is independently 29 capable of self-care of the tracheostomy. 30 (9) Other conditions for which care cannot be provided in a 20070S0704B0802 - 9 -
1 safe and effective manner in an assisted living residence as 2 determined by regulations adopted by the department. 3 (10) A consumer for whom an assisted living residence 4 administrator, acting in consultation with supplemental health 5 care providers, or whose physician or the medical director of 6 the facility, certifies is not appropriate for admission or 7 retention in an assisted living residence. 8 (11) A consumer for whom a determination is made that the 9 consumer's health care needs cannot be met by a provider of 10 personal care or assisted living services or within an assisted 11 living residence, including a consumer requiring: 12 (i) skilled nursing care twenty-four hours per day; 13 (ii) a sliding scale insulin administration unless the 14 consumer is capable of self-administration or a licensed health 15 care professional or other individual qualified to do so 16 administers the insulin; 17 (iii) intermittent intravenous therapy unless a licensed 18 health care professional manages the therapy; 19 (iv) insertions, sterile irrigation and replacement of a 20 catheter, except for routine maintenance of a urinary catheter, 21 unless the consumer is capable of self-administration or a 22 licensed health care professional administers the catheter; 23 (v) oxygen, unless the consumer is capable of self- 24 administration or a licensed health care professional 25 administers the oxygen; 26 (vi) inhalation therapy, unless the consumer is capable of 27 self-administration or a licensed health care professional 28 administers the therapy; or 29 (vii) other types of supplemental health care services that 30 an assisted living residence administrator, acting in 20070S0704B0802 - 10 -
1 consultation with supplemental health care providers, determines 2 cannot be provided in a safe and effective manner by the 3 assisted living residence. 4 (d) (i) Subject to subsection (a)(12), an assisted living 5 residence may admit or retain a resident who does not require 6 supplemental health care services or who, subject to any 7 restrictions provided in the written resident agreement, makes 8 alternative arrangements for such services. 9 (ii) Portions or sections of an assisted living residence 10 may be designated for use by residents not requiring 11 supplemental health care services, or for a facility may provide 12 services both to residents receiving supplemental health care 13 service and to residents not receiving such service within the 14 same portions or sections of its residence. 15 Section 1085. Classification of Violations.--The department 16 shall classify each violation of its regulations [on] by 17 personal care homes or assisted living residences into one of 18 the following categories: 19 * * * 20 Section 1086. Penalties.--* * * 21 (e) A personal care home or assisted living residence found 22 to be operating without a license shall be assessed a penalty of 23 five hundred dollars ($500). If, after fourteen days, a provider 24 [of a personal care home] cited for operating without a license 25 fails to file an application for a license, the department shall 26 assess an additional twenty dollars ($20) for each resident for 27 each day in which the home or residence fails to make such 28 application. 29 * * * 30 Section 1087. Revocation or Nonrenewal of License.--(a) (1) 20070S0704B0802 - 11 -
1 The department shall temporarily revoke the license of a 2 personal care home or assisted living residence if, without good 3 cause, one or more Class I violations remain uncorrected twenty- 4 four hours after the [personal care home] operator has been 5 cited for such violation or if, without good cause, one or more 6 Class II violations remain uncorrected fifteen days after being 7 cited for such violation. 8 (2) Upon the revocation of a license pursuant to this 9 subsection, all residents shall be relocated. 10 (3) The revocation may terminate upon the department's 11 determination that its violation is corrected. 12 (4) If, after three months, the department does not issue a 13 new license for a personal care home or assisted living 14 residence license revoked pursuant to this section: 15 (i) Such revocation or nonrenewal pursuant to this section 16 shall be for a minimum period of five years. 17 (ii) No provider of a personal care home or assisted living 18 residence who has had a license revoked or not renewed pursuant 19 to this section shall be allowed to operate or staff or hold an 20 interest in a home or residence that applies for a license for a 21 period of five years after such revocation or nonrenewal. 22 (b) The department shall revoke or refuse to renew the 23 license of a personal care home or assisted living residence if, 24 during any two-year period, the home or residence, without good 25 cause, on two or more separate occasions, has been found to have 26 violated a regulation of the department which has been 27 categorized as Class I. 28 (c) The power of the department to revoke or refuse to renew 29 or issue a license pursuant to this section is in addition to 30 the powers and duties of the department pursuant to section 20070S0704B0802 - 12 -
1 1026. 2 Section 6. The following transitional provisions shall 3 apply: 4 (1) A facility licensed as a personal care home upon the 5 effective date of this section shall not provide supplemental 6 health care services to its residents until the facility 7 submits an application to the department to operate an 8 assisted living residence and the department issues a license 9 to the facility to operate as an assisted living residence. 10 (2) Prior to the issuance of application forms and the 11 adoption of regulations pertaining to assisted living 12 residences, the department shall issue licenses to operators 13 of personal care homes to operate assisted living residences 14 based upon the review of plans submitted by the operator 15 demonstrating the ability of a facility to safely and 16 effectively operate as an assisted living residence pursuant 17 to the requirements of this act. 18 (3) Unless the department, pursuant to section 213(a.1) 19 of the act, promulgates final regulations establishing 20 additional qualifications for assisted living residence 21 administrators, a personal care home administrator may serve 22 as an assisted living residence administrator, and unless the 23 department, pursuant to section 213(a.1) of the act, 24 promulgates final regulations establishing additional 25 orientation or training requirements for direct care staff in 26 an assisted living residence, direct care staff who have 27 received orientation and training required for a personal 28 care home may serve as direct care staff in an assisted 29 living residence. 30 (4) Except to the extent inconsistent with this act, a 20070S0704B0802 - 13 -
1 reference in another statute to a personal care home, a 2 personal care boarding home, personal care housing or a 3 personal care home administrator shall be construed to also 4 include an assisted living residence or an assistant living 5 residence administrator, including, but not limited to, the 6 use of such terms in: 7 (i) the definition of "caretaker" in 18 Pa.C.S. § 8 2713; 9 (ii) the definition of "health care provider" in 42 10 Pa.C.S. § 5101.1; 11 (iii) the definition of "health center" in 53 12 Pa.C.S. § 5602; 13 (iv) the authorization to conduct studies and 14 evaluations and to develop community housing options by 15 the Department of Aging as provided by section 2203-A of 16 the act of April 9, 1929 (P.L.177, No.175), known as The 17 Administrative Code of 1929; 18 (v) the authorization to develop community-based 19 service and housing options for impaired and chronically 20 ill older persons provided to area agencies on aging by 21 section 2207-A of The Administrative Code of 1929; 22 (vi) the term "residence" in section 2201-A of the 23 act of July 28, 1953 (P.L.723, No.230), known as the 24 Second Class County Code, 25 (vii) the authorization to provide tax exempt bond 26 allocations pursuant to Chapter 27 of the act of June 29, 27 1996 (P.L.434, No.67), known as the Job Enhancement Act; 28 (viii) the definition of "exempt facility" in 29 section 2702 of the Job Enhancement Act; 30 (ix) the definition of "facility" in section 103 of 20070S0704B0802 - 14 -
1 the act of November 6, 1987 (P.L.381, No.79), known as 2 the Older Adults Protective Services Act; 3 (x) establishing the qualifications for a pediatric 4 extended care center administrator pursuant to section 5 15(b)(2) of the act of November 24, 1999 (P.L.884, 6 No.54), known as the Prescribed Pediatric Extended Care 7 Centers Act; 8 (xi) the definition of "health care provider" in 9 section 503 of the act of March 20, 2002 (P.L.154, 10 No.13), known as the Medical Care Availability and 11 Reduction of Error (Mcare) Act; 12 (xii) the definition of "facility" in section 2 of 13 the act of December 9, 2002 (P.L.1388, No.171), known as 14 the Elder Care Payment Restitution Act; 15 (xiii) the list of facilities required to make 16 refunds pursuant to section 3 of the Elder Care Payment 17 Restitution Act; or 18 (xiv) the definition of "family" as excluding 19 persons residing in a personal care boarding home in 20 section 3 of the act of November 30, 2004 (P.L.1561, 21 No.198), known as the Family Support for Persons with 22 Disabilities Act. 23 Section 7. This act shall take effect in 60 days. C1L67DMS/20070S0704B0802 - 15 -