[46 Pa.B. 7061]
[Saturday, November 5, 2016]

[Continued from previous Web Page]

CHAPTER 2390. VOCATIONAL FACILITIES

GENERAL PROVISIONS

§ 2390.5. Definitions.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

 Abusive act—An act or omission of an act that willfully deprives a client of rights or which may cause or causes actual physical injury or emotional harm to a client.

 Certificate of compliance—A document issued to a legal entity permitting it to operate a vocational facility at a given location, for a specific period of time, according to appropriate regulations of the Commonwealth.

 Chief executive officer—The staff person responsible for the general management of the facility. Other terms such as ''program director'' or ''administrator'' may be used as long as the qualifications specified in § 2390.32 (relating to chief executive officer) are met.

 Client—A disabled adult receiving services in a vocational facility.

 Competitive employment—A job in a regular work setting with an employee-employer relationship, in which a disabled adult is hired to do a job that other nondisabled employees also do.

 [Content discrepancy—A difference between what was determined at the ISP meeting by the plan team and what is documented in the written ISP.]

 Criminal abuse—Crimes against the person such as assault and crimes against the property of the client such as theft or embezzlement.

 Department—The Department of Human Services of the Commonwealth.

 Direct service worker—A person whose primary job function is to provide services to a client who attends the provider's facility.

 Disabled adult—

 (i) A person who because of a disability requires special help or special services on a regular basis to function vocationally.

 (ii) The term includes persons who exhibit any of the following characteristics:

 (A) A physical disability, such as visual impairment, hearing impairment, speech or language impairment, or other physical handicap.

 (B) Social or emotional maladjustment.

 (C) A neurologically based condition such as cerebral palsy, autism or epilepsy.

 (D) An intellectual disability.

 [Documentation—Written statements that accurately record details, substantiate a claim or provide evidence of an event.]

 Handicapped employment—A vocational program in which the individual client does not require rehabilitation, habilitation or ongoing training to work at the facility.

 [ISP—Individual Support Plan—The comprehensive document that identifies services and expected outcomes for a client.

 Interdisciplinary team—A group of persons representing one or more service areas relevant to identifying a client's needs, including at a minimum the county case manager if the client is funded through the county mental health and intellectual disability program, the client and the program specialist.

 Outcomes—Goals the client and client's plan team choose for the client to acquire, maintain or improve.

 Plan lead—The program specialist or family living specialist, as applicable, when the client is not receiving services through an SCO.

 Plan team—The group that develops the ISP.]

 PSP—Person-centered support plan.

 Provider—An entity or person that enters into an agreement with the Department to deliver a service to a client.

 [Restrictive procedure—A practice that limits a client's movement, activity or function; interferes with a client's ability to acquire positive reinforcement; results in the loss of objects or activities that a client values; or requires a client to engage in a behavior that the client would not engage in given freedom of choice.]

 Restraint—A physical, chemical or mechanical intervention used to control acute, episodic behavior that restricts the movement or function of the individual or a portion of the individual's body, including an intervention approved as part of the PSP or used on an emergency basis.

 SC—Supports coordinator—An SCO employee whose primary job functions are to locate, coordinate and monitor services provided to a client when the client is receiving services from an SCO.

*  *  *  *  *

GENERAL REQUIREMENTS

§ 2390.18. [Unusual incident report.] Incident report and investigation.

 [(a) An unusual incident report shall be completed by the facility on a form specified by the Department for a serious event, including death of a client, injury or illness of a client requiring inpatient hospitalization, or a fire requiring the services of a fire department. The facility shall send copies of the report to the regional office of the Department and the funding agency within 24 hours after the event occurs. A copy of unusual incident reports shall be kept on file by the facility.

 (b) If an unusual incident occurs during a weekend, the regional office of the Department and the funding agency shall be notified within 24 hours after the event occurs and the unusual incident report shall be sent on the first business day following the event.]

 (a) The facility shall report the following incidents, alleged incidents and suspected incidents in the Department's information management system or on a form specified by the Department within 24 hours of discovery by a staff person:

 (1) Death.

 (2) Suicide attempt.

 (3) Inpatient admission to a hospital.

 (4) Visit to an emergency room.

 (5) Abuse.

 (6) Neglect.

 (7) Exploitation.

 (8) An individual who is missing for more than 24 hours or who could be in jeopardy if missing at all.

 (9) Law enforcement activity.

 (10) Injury requiring treatment beyond first aid.

 (11) Fire requiring the services of the fire department.

 (12) Emergency closure.

 (13) Use of a restraint.

 (14) Theft or misuse of individual funds.

 (15) A violation of individual rights.

 (b) The individual and the persons designated by the individual shall be notified immediately upon discovery of an incident relating to the individual.

 (c) The facility shall keep documentation of the notification in subsection (b).

 (d) The incident report, redacted to exclude information about another individual and the reporter, unless the reporter is the individual who receives the report, shall be available to the individual and persons designated by the individual, upon request.

 (e) The facility shall take immediate action to protect the health, safety and well-being of the individual following the initial knowledge or notice of an incident, alleged incident and suspected incident.

 (f) The facility shall initiate an investigation of an incident within 24 hours of discovery by a staff person.

 (g) A Department-certified incident investigator shall conduct the incident investigation of the incident listed in subsection (a).

 (h) The facility shall finalize the incident report in the Department's information management system or on a form specified by the Department within 30 days of discovery of the incident by a staff person.

 (i) The facility shall provide the following information to the Department as part of the final incident report:

 (1) Additional detail about the incident.

 (2) The results of the incident investigation.

 (3) A description of the corrective action taken in response to an incident.

 (4) Action taken to protect the health, safety and well-being of the individual.

 (5) The person responsible for implementing the corrective action.

 (6) The date the corrective action was implemented or is to be implemented.

§ 2390.19. [Abuse.] Incident procedures to protect the individual.

 [(a) Abusive acts against clients are prohibited.

 (b) Staff or clients witnessing or having knowledge of an abusive act to a client shall report it to the chief executive officer or designee within 24 hours.

 (c) The chief executive officer or designee shall investigate reports of abuse and prepare and send a report to the regional office of the Department and the funding agency within 24 hours of the initial report. If the initial report occurs during a weekend, the regional office of the Department and the funding agency shall be notified within 24 hours after the initial report and the abuse investigation report shall be sent on the first business day following the initial report. The report shall either support or deny the allegation and make recommendations for appropriate action. The chief executive officer or designee shall implement changes immediately to prevent abuse in the future.

 (d) Incidents of criminal abuse shall be reported immediately to law enforcement authorities.]

 (a) In investigating an incident, the facility shall review and consider the following needs of the affected individual:

 (1) Potential risks.

 (2) Health care information.

 (3) Medication history and current medication.

 (4) Behavioral health history.

 (5) Incident history.

 (6) Social needs.

 (7) Environmental needs.

 (8) Personal safety.

 (b) The facility shall monitor an individual's risk for recurring incidents and implement corrective action, as appropriate.

 (c) The facility shall work cooperatively with the PSP team to revise the PSP if indicated by the incident investigation.

 (d) The facility shall complete the following for each confirmed incident:

 (1) Analysis to determine the root cause of the incident.

 (2) Corrective action.

 (3) A strategy to address the potential risks to the affected individual.

 (e) The facility shall review and analyze incidents and conduct a trend analysis at least every 3 months.

 (f) The facility shall identify and implement preventive measures to reduce:

 (1) The number of incidents.

 (2) The severity of the risks associated with the incident.

 (3) The likelihood of an incident recurring.

 (g) The facility shall educate staff persons and the individual based on the circumstances of the incident.

 (h) The facility shall analyze incident data continuously and take actions to mitigate and manage risks.

§ 2390.21. [Civil] Individual rights.

 [(a) A client may not be discriminated against because of race, color, religious creed, disability, handicap, ancestry, national origin, age or sex, nor be deprived of civil or legal rights.

 (b) A facility shall develop and implement civil rights policies and procedures. Civil rights policies and procedures include the following:

 (1) Nondiscrimination in the provision of services, admissions, placement, facility usage, referrals and communication with non-English speaking clients.

 (2) Program accessibility and accommodation for disabled clients.

 (3) The opportunity to lodge civil rights complaints.

 (4) Orientation for clients on their rights to register civil rights complaints.]

 (a) An individual may not be deprived of rights as provided under subsections (b)—(s).

 (b) An individual shall be continually supported to exercise the individual's rights.

 (c) An individual shall be provided the support and accommodation necessary to be able to understand and actively exercise the individual's rights.

 (d) An individual may not be reprimanded, punished or retaliated against for exercising the individual's rights.

 (e) A court's written order that restricts an individual's rights shall be followed.

 (f) A court-appointed legal guardian may exercise rights and make decisions on behalf of an individual in accordance with a court order.

 (g) An individual who has a court-appointed legal guardian, or who has a court order restricting the individual's rights, shall be involved in decision making in accordance with the court order.

 (h) An individual has the right to designate persons to assist in decision making on behalf of the individual.

 (i) An individual may not be discriminated against because of race, color, creed, disability, religious affiliation, ancestry, gender, gender identity, sexual orientation, national origin or age.

 (j) An individual has the right to civil and legal rights afforded by law, including the right to vote, speak freely, and practice the religion of his choice or to practice no religion.

 (k) An individual may not be abused, neglected, mistreated, exploited, abandoned or subjected to corporal punishment.

 (l) An individual shall be treated with dignity and respect.

 (m) An individual has the right to make choices and accept risks.

 (n) An individual has the right to refuse to participate in activities and supports.

 (o) An individual has the right to privacy of person and possessions.

 (p) An individual has the right of access to and security of the individual's possessions.

 (q) An individual has the right to voice concerns about the supports the individual receives.

 (r) An individual has the right to participate in the development and implementation of the PSP.

 (s) An individual's rights shall be exercised so that another individual's rights are not violated.

 (t) Choices shall be negotiated by the affected individuals in accordance with the facility's procedures for the individuals to resolve differences and make choices.

 (u) The facility shall inform and explain individual rights to the individual, and persons designated by the individual, upon admission to the facility and annually thereafter.

 (v) The facility shall keep a copy of the statement signed by the individual, or the individual's court-appointed legal guardian, acknowledging receipt of the information on individual rights.

 (Editor's Note: The following section is new and printed in regular type to enhance readability.) 

§ 2390.24. Applicable laws and regulations.

 The facility shall comply with applicable Federal, State and local laws, regulations and ordinances.

STAFFING

§ 2390.33. Program specialist.

 (a) A minimum of [one] 1 program specialist for every 45 clients shall be available when clients are present at the facility.

 (b) The program specialist shall be responsible for the following:

 [(1) Coordinating and completing assessments.

 (2) Providing the assessment as required under § 2390.151(f) (relating to assessment).

 (3) Participating in the development of the ISP, including annual updates and revisions of the ISP.

 (4) Attending the ISP meetings.

 (5) Fulfilling the role of plan lead, as applicable, under §§ 2390.152 and 2390.156(f) and (g) (relating to development, annual update and revision to the ISP; and ISP review and revision).

 (6) Reviewing the ISP, annual updates and revisions for content accuracy.

 (7) Reporting content discrepancy to the SC or plan lead, as applicable, and plan team members.

 (8) Implementing the ISP as written.

 (9) Supervising, monitoring and evaluating services provided to the client.

 (10) Reviewing, signing and dating the monthly documentation of a client's participation and progress toward outcomes.

 (11) Reporting a change related to the client's needs to the SC or plan lead, as applicable, and plan team members.

 (12) Reviewing the ISP with the client as required under § 2390.156.

 (13) Documenting the review of the ISP as required under § 2390.156.

 (14) Providing documentation of the ISP review to the SC or plan lead, as applicable, and plan team members as required under § 2390.156(d).

 (15) Informing plan team members of the option to decline the ISP review documentation as required under § 2390.156(e).

 (16) Recommending a revision to a service or out- come in the ISP as provided under § 2390.156(c)(4).

 (17) Coordinating the services provided to a client.

 (18) Coordinating the training of direct service workers in the content of health and safety needs relevant to each client.

 (19) Developing and implementing provider services as required under § 2390.158 (relating to provider services).]

 (1) Coordinating the completion of assessments.

 (2) Participating in the PSP process, PSP development, PSP team reviews and the implementation of the PSP in accordance with this chapter.

 (3) Providing and supervising activities for the individuals in accordance with the PSPs.

 (4) Supporting the integration of individuals in the community.

 (5) Supporting individual communication and involvement with families and friends.

 (c) A program specialist shall meet one of the following groups of qualifications:

 (1) Possess a master's degree or above from an accredited college or university in Special Education, Psychology, Public Health, Rehabilitation, Social Work, Speech Pathology, Audiology, Occupational Therapy, Therapeutic Recreation or other human services field.

 (2) Possess a bachelor's degree from an accredited college or university in Special Education, Psychology, Public Health, Rehabilitation, Social Work, Speech Pathology, Audiology, Occupational Therapy, Therapeutic Recreation or other human services field; and 1 year experience working directly with disabled persons.

 (3) Possess an associate's degree or completion of a [2 year] 2-year program from an accredited college or university in Special Education, Psychology, Public Health, Rehabilitation, Social Work, Speech Pathology, Audiology, Occupational Therapy, Therapeutic Recreation or other human services field; and 3 years experience working directly with disabled persons.

 (4) Possess a license or certification by the State Board of Nurse Examiners, the State Board of Physical Therapists Examiners, or the Committee on Rehabilitation Counselor Certification or be a licensed psychologist or registered occupational therapist; and 1 year experience working directly with disabled persons.

§ 2390.39. Staffing.

 (a) A minimum of two staff shall be present at the facility when [10] ten or more clients are present at the facility.

 (b) A minimum of one staff shall be present at the facility when fewer than [10] ten clients are present at the facility.

 (c) If 20 or more clients are present at the facility, there shall be at least [one] 1 staff present at the facility who meets the qualifications of program specialist.

 (d) A client may be left unsupervised for specified periods of time if the absence of direct supervision is consistent with the client's assessment and is part of the client's [ISP] PSP, as an outcome which requires the achievement of a higher level of independence.

 (e) The staff qualifications and staff ratio as specified in the [ISP] PSP shall be implemented as written, including when the staff ratio is greater than required under subsections (a), (b) and (c).

 (f) A client may not be left unsupervised solely for the convenience of the facility or the direct service worker.

§ 2390.40. [Staff training.] Annual training plan.

 [(a) A facility shall provide orientation for staff relevant to their appointed positions. Staff shall be instructed in the daily operation of the facility and policies and procedures of the agency.

 (b) Staff in positions required by this chapter shall have at least 24 hours of training relevant to vocational or human services annually.

 (c) Records of orientation and training, including dates held and staff attending, shall be kept on file.]

 (a) The facility shall design an annual training plan based on the needs of the individuals as specified in the individuals' PSPs, other data and analysis indicating staff person training needs and as required under § 2390.49 (relating to annual training).

 (b) The annual training plan must include the orientation program as specified in § 2390.48 (relating to orientation program).

 (c) The annual training plan must include training aimed at improving the knowledge, skills and core competencies of the staff persons to be trained.

 (d) The annual training plan must include the following:

 (1) The title of the position to be trained.

 (2) The required training courses, including training course hours, for each position.

 (Editor's Note: Sections 2390.48 and 2390.49 are new and printed in regular type to enhance readability.) 

§ 2390.48. Orientation program.

 (a) Prior to working alone with individuals, and within 30 days after hire, the following shall complete the orientation program as described in subsection (b):

 (1) Management, program, administrative and fiscal staff persons.

 (2) Dietary, housekeeping, maintenance and ancillary staff persons.

 (3) Direct service workers, including full-time and part-time staff persons.

 (4) Volunteers who will work alone with individuals.

 (5) Paid and unpaid interns who will work alone with individuals.

 (6) Consultants who will work alone with individuals.

 (b) The orientation program must encompass the following areas:

 (1) The application of person-centered practices, including respecting rights, facilitating community integration, honoring choice and supporting individuals in maintaining relationships.

 (2) The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with sections 701—708 of the Older Adults Protective Services Act (35 P.S. §§ 10225.701—10225.708), 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law), the Adult Protective Services Act (35 P.S. §§ 10210.101—10210.704) and applicable protective services regulations.

 (3) Individual rights.

 (4) Recognizing and reporting incidents.

 (5) Job-related knowledge and skills.

§ 2390.49. Annual training.

 (a) The following staff persons, including full-time and part-time staff persons, shall complete 24 hours of training each year:

 (1) Floor supervisors.

 (2) Direct supervisors of floor supervisors.

 (3) Positions required by this chapter.

 (b) The following staff persons shall complete 12 hours of training each year:

 (1) Management, program, administrative and fiscal staff persons.

 (2) Dietary, housekeeping, maintenance and ancillary staff persons.

 (3) Consultants who work alone with individuals.

 (4) Volunteers who work alone with individuals.

 (5) Paid and unpaid interns who work alone with individuals.

 (c) A minimum of 8 hours of the annual training hours specified in subsections (a) and (b) must encompass the following areas:

 (1) The application of person-centered practices, including respecting rights, facilitating community integration, honoring choice and supporting individuals in maintaining relationships.

 (2) The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with sections 701—708 of the Older Adults Protective Services Act (35 P.S. §§ 10225.701—10225.708), 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law), the Adult Protective Services Act (35 P.S. §§ 10210.101—10210.704) and applicable protective services regulations.

 (3) Individual rights.

 (4) Recognizing and reporting incidents.

 (5) The safe and appropriate use of positive interventions if the staff person will provide a support to an individual with a dangerous behavior.

 (d) The balance of the annual training hours must be in areas identified by the facility in the facility's annual training plan as required under § 2390.40 (relating to annual training plan).

 (e) All training, including those training courses identified in subsections (c) and (d), must be included in the provider's annual training plan.

 (f) Records of orientation and training, including the training source, content, dates, length of training, copies of certificates received and persons attending, shall be kept.

 (g) A training record for each person trained shall be kept.

CLIENT RECORDS

§ 2390.124. Content of records.

 Each client's record must include the following information:

 (1) The name, sex, admission date, birthdate and place, [social security] Social Security number and dates of entry, transfer and discharge.

 (2) The name, address and telephone number of parents, legal guardian and a designated person to be contacted in case of an emergency.

 (3) The name and telephone number of a physician or source of health care.

 (4) Written consent from the client, parent or guardian for emergency medical treatment.

 (5) Physical examinations.

 (6) Assessments as required under § 2390.151 (relating to assessment).

 (7) A copy of the vocational evaluations, if applicable.

 [(8) A copy of the invitation to:

 (i) The initial ISP meeting.

 (ii) The annual update meeting.

 (iii) The ISP revision meeting.

 (9) A copy of the signature sheet for:

 (i) The initial ISP meeting.

 (ii) The annual update meeting.

 (iii) The ISP revision meeting.

 (10) A copy of the current ISP.

 (11) Documentation of ISP reviews and ISP revisions under § 2390.156 (relating to ISP review and revision), including the following:

 (i) ISP Review signature sheets.

 (ii) Recommendations to revise the ISP.

 (iii) ISP revisions.

 (iv) Notices that the plan team member may decline the ISP review documentation.

 (v) Requests from plan team members to not receive the ISP review documentation.

 (12) Content discrepancy in the ISP, the annual update or revision under § 2390.156.]

 (8) PSP documents as required by this chapter.

 [(13) Restrictive procedure protocols and] (9) Positive intervention records related to the client.

 [(14) Unusual incident] (10) Incident reports related to the client.

 [(15)] (11) Copies of psychological evaluations, if applicable.

 [(16)] (12) Vocational evaluations as required under § 2390.159 (relating to vocational evaluation).

PROGRAM

§ 2390.151. Assessment.

*  *  *  *  *

 (b) If the program specialist is making a recommendation to revise a service or outcome in the [ISP as provided under § 2390.156(c)(4) (relating to ISP review and revision)] PSP, the client shall have an assessment completed as required under this section.

*  *  *  *  *

 (f) The program specialist shall provide the assessment to the SC or plan lead, as applicable, and plan team members at least 30 calendar days prior to [an ISP] a PSP meeting for the development, annual update and revision of the [ISP] PSP under §§ 2380.182, 2390.152, 6400.182 and 6500.152 (relating to development[, annual update and revision of the ISP] of the PSP).

§ 2390.152. Development[, annual update and revision of the ISP] of the PSP.

 [(a) A client shall have one ISP.

 (b) When a client is not receiving services through an SCO and is not receiving services in a facility or home licensed under Chapters 2380, 6400 or 6500 (relating to adult training facilities; community homes for individuals with an intellectual disability; and family living homes), the vocational facility program specialist shall be the plan lead.

 (c) The plan lead shall be responsible for developing and implementing the ISP, including annual updates and revisions.

 (d) The plan lead shall develop, update and revise the ISP according to the following:

 (1) The ISP shall be initially developed, updated annually and revised based upon the client's current assessment as required under §§ 2380.181, 2390.151, 6400.181 and 6500.151 (relating to assessment).

 (2) The initial ISP shall be developed within 90 calendar days after the client's admission date to the facility.

 (3) The ISP, annual updates and revisions shall be documented on the Department-designated form located in the Home and Community Services Information System (HCSIS) and also on the Department's web site.

 (4) An invitation shall be sent to plan team members at least 30 calendar days prior to an ISP meeting.

 (5) Copies of the ISP, including annual updates and revisions under § 2390.156 (relating to ISP review and revision), shall be provided as required under § 2390.157 (relating to copies).]

 (a) An individual shall have one approved and authorized PSP at a given time.

 (b) An individual's service implementation plan must be consistent with the PSP in subsection (a).

 (c) The support coordinator, targeted support manager or program specialist shall coordinate the development of the PSP, including revisions, in cooperation with the individual and the individual's PSP team.

 (d) The initial PSP shall be developed based on the individual assessment within 60 days of the individual's date of admission to the facility.

 (e) The PSP shall be initially developed, revised annually and revised when an individual's needs change based upon a current assessment.

 (f) The individual and persons designated by the individual shall be involved in and supported in the development and revisions of the PSP.

 (g) The PSP, including revisions, shall be documented on a form specified by the Department.

§ 2390.153. [Content of the ISP.] The PSP team.

 [The ISP, including annual updates and revisions under § 2390.156 (relating to ISP review and revision) must include the following:

 (1) Services provided to the client and expected outcomes chosen by the client and client's plan team.

 (2) Services provided to the client to develop the skills necessary for promotion into a higher level of vocational programming or into competitive community-integrated employment as required under § 2390.158 (relating to provider services).

 (3) Current status in relation to an outcome and method of evaluation used to determine progress toward that expected outcome.

 (4) A protocol and schedule outlining specified periods of time for the client to be without direct supervision, if the client's current assessment states the client may be without direct supervision and if the client's ISP includes an expected outcome which requires the achievement of a higher level of independence. The protocol must include the current level of independence and the method of evaluation used to determine progress toward the expected outcome to achieve a higher level of independence.

 (5) A protocol to address the social, emotional and environmental needs of the client, if medication has been prescribed to treat symptoms of a diagnosed psychiatric illness.

 (6) A protocol to eliminate the use of restrictive procedures, if restrictive procedures are utilized, and to address the underlying causes of the behavior which led to the use of restrictive procedures including the following:

 (i) An assessment to determine the causes or antecedents of the behavior.

 (ii) A protocol for addressing the underlying causes or antecedents of the behavior.

 (iii) The method and timeline for eliminating the use of restrictive procedures.

 (iv) A protocol for intervention or redirection without utilizing restrictive procedures.

 (7) Assessment of the client's potential to advance in the following:

 (i) Vocational programming.

 (ii) Competitive community-integrated employment.]

 (a) The PSP shall be developed by an interdisciplinary team including the following:

 (1) The individual.

 (2) Persons designated by the individual.

 (3) The individual's direct care staff persons.

 (4) The program specialist.

 (5) The program specialist for the individual's residential program, if applicable.

 (6) Other specialists such as health care, behavior management, speech, occupational and physical therapy as appropriate for the individual needs.

 (b) At least three members of the PSP team, in addition to the individual and persons designated by the individual, shall be present at a PSP meeting at which the PSP is developed or revised.

 (c) Members of the PSP team who attend the meeting shall sign and date the PSP.

§ 2390.154. [Plan team participation.] The PSP process.

 [(a) The plan team shall participate in the development of the ISP, including the annual updates and revisions under § 2390.156 (relating to ISP review and revision).

 (1) A plan team must include as its members the following:

 (i) The client.

 (ii) A program specialist or family living specialist, as applicable, from each provider delivering a service to the client.

 (iii) A direct service worker who works with the client from each provider delivering a service to the client.

 (iv) Any other person the client chooses to invite.

 (2) If the following have a role in the client's life, the plan team may also include as its members, as applicable, the following:

 (i) Medical, nursing, behavior management, speech, occupational or physical therapy specialists.

 (ii) Additional direct service workers who work with the client from each provider delivering services to the client.

 (iii) The client's parent, guardian or advocate.

 (b) At least three plan team members, in addition to the client, if the client chooses to attend, shall be present for the ISP, annual update and ISP revision meetings.

 (c) A plan team member who attends an ISP meeting under subsection (b) shall sign and date the signature sheet.]

 The PSP process shall:

 (1) Provide necessary information and support to ensure that the individual directs the PSP process to the maximum extent possible.

 (2) Enable the individual to make informed choices and decisions.

 (3) Be conducted to reflect what is important to the individual to ensure that supports are delivered in a manner reflecting individual preferences and ensuring the individual's health, safety and well-being.

 (4) Be timely and occur at intervals, times and locations of choice and convenience to the individual and to persons designated by the individual.

 (5) Be communicated in clear and understandable language.

 (6) Reflect cultural considerations of the individual.

 (7) Include guidelines for solving disagreements among the PSP team members.

 (8) Include a method for the individual to request updates to the PSP.

§ 2390.155. [Implementation of the ISP.] Content of the PSP.

 [(a) The ISP shall be implemented by the ISP's start date.

 (b) The ISP shall be implemented as written.]

 The PSP, including revisions, must include the following:

 (1) The individual's strengths and functional abilities.

 (2) The individual's individualized clinical and support needs.

 (3) The individual's goals and preferences related to relationships, community participation, employment, income and savings, health care, wellness and education.

 (4) Individually identified, person-centered desired outcomes.

 (5) Supports to assist the individual to achieve desired outcomes.

 (6) The type, amount, duration and frequency for the support specified in a manner that reflects the assessed needs and choices of the individual. The schedule of support delivery shall be determined by the PSP team.

 (7) Communication mode, abilities and needs.

 (8) Opportunities for new or continued community participation.

 (9) Risk factors, dangerous behaviors and risk mitigation strategies, if applicable.

 (10) Modification of individual rights as necessary to mitigate risks, if applicable.

 (11) Health care information, including a health care history.

 (12) Financial information including how the individual chooses to use personal funds.

 (13) The person responsible for monitoring the implementation of the PSP.

§ 2390.156. [ISP review and revision.] Implementation of the PSP.

 [(a) The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the facility licensed under this chapter with the client every 3 months or more frequently if the client's needs change which impacts the services as specified in the current ISP.

 (b) The program specialist and client shall sign and date the ISP review signature sheet upon review of the ISP.

 (c) The ISP review must include the following:

 (1) A review of the monthly documentation of a client's participation and progress during the prior 3 months toward ISP outcomes supported by services provide by the facility licensed under this chapter.

 (2) A review of each section of the ISP specific to the facility licensed under this chapter.

 (3) The program specialist shall document a change in the client's needs, if applicable.

 (4) The program specialist shall make a recommendation regarding the following, if applicable:

 (i) The deletion of an outcome or service to support the achievement of an outcome which is no longer appropriate or has been completed.

 (ii) The addition of an outcome or service to support the achievement of an outcome.

 (iii) The modification of an outcome or service to support the achievement of an outcome in which no progress has been made.

 (5) If making a recommendation to revise a service or outcome in the ISP, the program specialist shall complete a revised assessment as required under § 2390.151(b) (relating to assessment).

 (d) The program specialist shall provide the ISP review documentation, including recommendations if applicable, to the SC or plan lead, as applicable, and plan team members within 30 calendar days after the ISP review meeting.

 (e) The program specialist shall notify the plan team members of the option to decline the ISP review documentation.

 (f) If a recommendation for a revision to a service or outcome in the ISP is made, the plan lead, as applicable, under §§ 2380.182(b) and (c), 2390.152(b) and (c), 6400.182(b) and (c), 6500.152(b) and (c) (relating to development, annual update and revision of the ISP), shall send an invitation for an ISP revision meeting to the plan team members within 30 calendar days of receipt of the recommendation.

 (g) A revised service or outcome in the ISP shall be implemented by the start date in the ISP as written.]

 The facility shall implement the PSP, including revisions.

§ 2390.157. [Copies.] (Reserved).

 [A copy of the ISP, ISP annual update and ISP revision, including the signature sheet, shall be provided to plan team members within 30 calendar days after the ISP, ISP annual update and ISP revision meetings.]

§ 2390.158. [Provider services.] (Reserved).

 [(a) The facility shall provide services including work experience and other developmentally oriented, vocational training designed to develop the skills necessary for promotion into a higher level of vocational programming or competitive community-integrated employment.

 (b) The facility shall provide opportunities and support to the client for participation in community life, including competitive community-integrated employment.

 (c) The facility shall provide services to the client as specified in the client's ISP.

 (d) The facility shall provide services that are age and functionally appropriate to the client.]

 (Editor's Note: Sections 2390.171—2390.176 and 2390.191—2930.199 are new and printed in regular type to enhance readability.) 

POSITIVE INTERVENTION

§ 2390.171. Use of a positive intervention.

 (a) A positive intervention shall be used to prevent, modify and eliminate a dangerous behavior when the behavior is anticipated or occurring.

 (b) The least intrusive method shall be applied when addressing a dangerous behavior. For each incidence of a dangerous behavior, every attempt shall be made to modify and eliminate the behavior.

 (c) As used in this section, the following words and terms have the following meanings, unless the context clearly indicates otherwise:

 Dangerous behavior—An action with a high likelihood of resulting in harm to the individual or others.

 Positive intervention—An action or activity intended to prevent, modify and eliminate a dangerous behavior. This includes improved communications, reinforcing appropriate behavior, an environmental change, recognizing and treating physical and behavioral health symptoms, voluntary physical exercise and other wellness practices, redirection, praise, modeling, conflict resolution and de-escalation.

§ 2390.172. PSP.

 If the individual has a dangerous behavior as identified in the PSP, the PSP must include the following:

 (1) The specific dangerous behavior to be addressed.

 (2) A functional analysis of the dangerous behavior and the plan to address the reason for the behavior.

 (3) The outcome desired.

 (4) A description of the positive intervention aimed at preventing, modifying or eliminating the dangerous behavior and the circumstances under which the intervention is to be used.

 (5) A target date to achieve the outcome.

 (6) Health conditions that require special attention.

§ 2390.173. Prohibition of restraints.

 The following procedures are prohibited:

 (1) Seclusion, defined as involuntary confinement of an individual in a room or area from which the individual is physically prevented or verbally directed from leaving.

 (2) Aversive conditioning, defined as the application of startling, painful or noxious stimuli.

 (3) Pressure point techniques, defined as the application of pain for the purpose of achieving compliance.

 (4) A chemical restraint, defined as use of drugs or chemicals for the specific and exclusive purpose of controlling acute or episodic aggressive behavior. A chemical restraint does not include a drug ordered by a health care practitioner or dentist to treat the symptoms of a specific mental, emotional or behavioral condition, or as pretreatment prior to a medical or dental examination or treatment.

 (5) A mechanical restraint, defined as a device that restricts the movement or function of an individual or portion of an individual's body. Mechanical restraints include a geriatric chair, handcuffs, anklets, wristlets, camisole, helmet with fasteners, muffs and mitts with fasteners, restraint vest, waist strap, head strap, papoose board, restraining sheet, chest restraint and other locked restraints.

 (i) The term does not include a device prescribed by a health care practitioner that is used to provide post-surgical care, proper balance or support for the achievement of functional body position.

 (ii) The term does not include a device prescribed by a health care practitioner to protect the individual in the event of a seizure, as long as the individual can easily remove the device.

 (6) A manual restraint, defined as a hands-on physical method that restricts, immobilizes or reduces an individual's ability to move his arms, legs, head or other body parts freely, on a nonemergency basis, or for more than 15 minutes within a 2-hour period. A manual restraint does not include physically prompting, escorting or guiding an individual to provide a support as specified in the individual's PSP.

 (7) A prone position manual restraint.

 (8) A manual restraint that inhibits digestion or respiration, inflicts pain, causes embarrassment or humiliation, causes hyperextension of joints, applies pressure on the chest or joints, or allows for a free fall to the floor.

§ 2390.174. Permitted interventions.

 (a) Voluntary exclusion, defined as an individual voluntarily removing himself from his immediate environment and placing himself alone to a room or area, is permitted in accordance with the individual's PSP.

 (b) A physical protective restraint may be used only in accordance with § 2390.173(6)—(8) (relating to prohibition of restraints).

 (c) A physical protective restraint may not be used until §§ 2390.49(c)(5) and 2390.155(9) (relating to annual training; and content of the PSP) are met.

 (d) A physical protective restraint may only be used in the case of an emergency to prevent an individual from injuring the individual's self or others.

 (e) A physical protective restraint may not be used as a behavioral intervention, consequence, retribution, punishment, for the convenience of staff persons or as a substitution for individual support.

 (f) A physical protective restraint may not be used for more than 15 minutes within a 2-hour period.

 (g) A physical protective restraint may only be used by a staff person who is trained as specified in § 2390.49.

 (h) As used in this section, a ''physical protective restraint'' is a hands-on hold of an individual.

§ 2390.175. Access to or the use of an individual's personal property.

 (a) Access to or the use of an individual's personal funds or property may not be used as a reward or punishment.

 (b) An individual's personal funds or property may not be used as payment for damages unless the individual consents to make restitution for the damages as follows:

 (1) A separate written consent by the individual is required for each incidence of restitution.

 (2) Consent shall be obtained in the presence of the individual, a person designated by the individual and in the presence of and with the support of the support coordinator or targeted support manager.

 (3) There may not be coercion in obtaining the consent of an individual.

 (4) The facility shall keep a copy of the individual's written consent.

§ 2390.176. Rights team.

 (a) The facility shall have a rights team. The facility may use a county mental health and intellectual disability program rights team that meets the requirements of this section.

 (b) The role of the rights team is to:

 (1) Review each incident, alleged incident and suspected incident of a violation of individual rights as specified in § 2390.21 (relating to individual rights).

 (2) Review each incidence of the use of a restraint as specified in §§ 2390.171—2390.174 to:

 (i) Analyze systemic concerns.

 (ii) Design positive supports as an alternative to the use of a restraint.

 (iii) Discover and resolve the reason for an individual's behavior.

 (c) Members of the rights team shall include the affected individual, persons designated by the individual, a family member or an advocate if the individual is unable to speak for himself, the individual's support coordinator, a representative from the funding agency, if applicable, and a facility representative.

 (d) Members of the rights team shall be comprised of a majority who do not provide direct support to the individual.

 (e) If a restraint was used, the individual's health care practitioner shall be consulted.

 (f) The rights team shall meet at least once every 3 months.

 (g) The rights team shall report its recommendations to the affected PSP.

 (h) The facility shall keep documentation of the rights team meetings and the decisions made at the meetings.

MEDICATION ADMINISTRATION

§ 2390.191. Self-administration.

 (a) The facility shall provide an individual who has a prescribed medication with assistance, as needed, for the individual's self-administration of the medication.

 (b) Assistance in the self-administration of medication includes helping the individual to remember the schedule for taking the medication, offering the individual the medication at the prescribed times, opening a medication container and storing the medication in a secure place.

 (c) The facility shall provide or arrange for assistive technology to support the individual's self-administration of medications.

 (d) The PSP must identify if the individual is unable to self-administer medications.

 (e) To be considered able to self-administer medications, an individual shall do all of the following:

 (1) Recognize and distinguish the individual's medication.

 (2) Know how much medication is to be taken.

 (3) Know when the medication is to be taken. This knowledge may include reminders of the schedule and offering the medication at the prescribed times as specified in subsection (b).

 (4) Take or apply the individual's own medication with or without the use of assistive technology.

§ 2390.192. Medication administration.

 (a) A facility whose staff persons are qualified to administer medications as specified in subsection (b) may provide medication administration for an individual who is unable to self-administer his prescribed medication.

 (b) A prescription medication that is not self-administered shall be administered by one of the following:

 (1) A licensed physician, licensed dentist, licensed physician's assistant, registered nurse, certified registered nurse practitioner, licensed practical nurse or licensed paramedic.

 (2) A person who has completed the medication administration training as specified in § 2390.199 (relating to medication administration training) for the medication administration of the following:

 (i) Oral medications.

 (ii) Topical medications.

 (iii) Eye, nose and ear drop medications.

 (iv) Insulin injections.

 (v) Epinephrine injections for insect bites or other allergies.

 (c) Medication administration includes the following activities, based on the needs of the individual:

 (1) Identify the correct individual.

 (2) Remove the medication from the original container.

 (3) Crush or split the medication as ordered by the prescriber.

 (4) Place the medication in a medication cup or other appropriate container, or into the individual's hand, mouth or other route as ordered by the prescriber.

 (5) If indicated by the prescriber's order, measure vital signs and administer medications according to the prescriber's order.

 (6) Injection of insulin or epinephrine in accordance with this chapter.

§ 2390.193. Storage and disposal of medications.

 (a) Prescription and nonprescription medications shall be kept in their original labeled containers.

 (b) A prescription medication may not be removed from its original labeled container more than 2 hours in advance of the scheduled administration.

 (c) If insulin or epinephrine is not packaged in an individual dose container, assistance with or the administration of the injection shall be provided immediately upon removal of the medication from its original labeled container.

 (d) Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.

 (e) Epinephrine and epinephrine auto-injectors shall be stored safely and kept easily accessible at all times. The epinephrine and epinephrine auto-injectors shall be easily accessible to the individual if the epinephrine is self-administered or to the staff person who is with the individual if a staff person will administer the epinephrine.

 (f) Prescription medications stored in a refrigerator shall be kept in an area or container that is locked.

 (g) Prescription medications shall be stored in an organized manner under proper conditions of sanitation, temperature, moisture and light and in accordance with the manufacturer's instructions.

 (h) Prescription medications that are discontinued or expired shall be destroyed in a safe manner according to the Department of Environmental Protection and applicable Federal and State regulations.

 (i) Subsections (a)—(d) and (f) do not apply for an individual who self-administers medication and stores the medication on his person or in the individual's private property, such as a purse or backpack.

§ 2390.194. Labeling of medications.

 The original container for prescription medications must be labeled with a pharmacy label that includes the following:

 (1) The individual's name.

 (2) The name of the medication.

 (3) The date the prescription was issued.

 (4) The prescribed dosage and instructions for administration.

 (5) The name and title of the prescriber.

§ 2390.195. Prescription medications.

 (a) A prescription medication shall be prescribed in writing by an authorized prescriber.

 (b) A prescription order shall be kept current.

 (c) A prescription medication shall be administered as prescribed.

 (d) A prescription medication shall be used only by the individual for whom the prescription was prescribed.

 (e) Changes in medication may only be made in writing by the prescriber or, in the case of an emergency, an alternate prescriber, except for circumstances in which oral orders may be accepted by a registered nurse in accordance with regulations of the Department of State. The individual's medication record shall be updated as soon as a written notice of the change is received.

§ 2390.196. Medication record.

 (a) A medication record shall be kept including the following for each individual for whom a prescription medication is administered:

 (1) Individual's name.

 (2) Name and title of the prescriber.

 (3) Drug allergies.

 (4) Name of medication.

 (5) Strength of medication.

 (6) Dosage form.

 (7) Dose of medication.

 (8) Route of administration.

 (9) Frequency of administration.

 (10) Administration times.

 (11) Diagnosis or purpose for the medication, including pro re nata.

 (12) Date and time of medication administration.

 (13) Name and initials of the person administering the medication.

 (14) Duration of treatment, if applicable.

 (15) Special precautions, if applicable.

 (16) Side effects of the medication, if applicable.

 (b) The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.

 (c) If an individual refuses to take a prescribed medication, the refusal shall be documented on the medication record. The refusal shall be reported to the prescriber within 24 hours, unless otherwise instructed by the prescriber. Subsequent refusals to take a prescribed medication shall be reported as required by the prescriber.

 (d) The directions of the prescriber shall be followed.

§ 2390.197. Medication errors.

 (a) Medication errors include the following:

 (1) Failure to administer a medication.

 (2) Administration of the wrong medication.

 (3) Administration of the wrong amount of medication.

 (4) Failure to administer a medication at the prescribed time, which exceeds more than 1 hour before or after the prescribed time.

 (5) Administration to the wrong person.

 (6) Administration through the wrong route.

 (b) Documentation of medication errors, follow-up action taken and the prescriber's response shall be kept in the individual's record.

§ 2390.198. Adverse reaction.

 (a) If an individual has a suspected adverse reaction to a medication, the facility shall immediately consult a health care practitioner or seek emergency medical treatment.

 (b) An adverse reaction to a medication, the health care practitioner's response to the adverse reaction and the action taken shall be documented.

§ 2390.199. Medication administration training.

 (a) A staff person who has successfully completed a Department-approved medications administration course, including the course renewal requirements, may administer the following:

 (1) Oral medications.

 (2) Topical medications.

 (3) Eye, nose and ear drop medications.

 (b) A staff person may administer insulin injections following successful completion of both:

 (1) The course specified in subsection (a).

 (2) A Department-approved diabetes patient education program within the past 12 months.

 (c) A staff person may administer an epinephrine injection by means of an auto-injection device in response to anaphylaxis or another serious allergic reaction following successful completion of both:

 (1) The course specified in subsection (a).

 (2) Training relating to the use of an auto-injection epinephrine injection device provided by a licensed, registered or certified health care professional within the past 12 months.

 (d) A record of the training shall be kept including the person trained, the date, source, name of trainer and documentation that the course was successfully completed.

PART VIII. INTELLECTUAL DISABILITY AND AUTISM MANUAL

Subpart C. ADMINISTRATION AND FISCAL MANAGEMENT

 (Editor's Note: The following chapter is new and printed in regular type to enhance readability.) 

CHAPTER 6100. SUPPORT FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM

GENERAL PROVISIONS

Sec.

6100.1.	Purpose.
6100.2.	Applicability.
6100.3.	Definitions.

GENERAL REQUIREMENTS

6100.41.	Appeals.
6100.42.	Monitoring compliance.
6100.43.	Regulatory waiver.
6100.44.	Innovation project.
6100.45.	Quality management.
6100.46.	Protective services.
6100.47.	Criminal history checks.
6100.48.	Funding, hiring, retention and utilization.
6100.49.	Child abuse history certification.
6100.50.	Communication.
6100.51.	Grievances.
6100.52.	Rights team.
6100.53.	Conflict of interest.
6100.54.	Recordkeeping.
6100.55.	Reserved capacity.

ENROLLMENT

6100.81.	HCBS provider requirements.
6100.82.	HCBS documentation.
6100.83.	Submission of HCBS qualification documentation.
6100.84.	Provision, update and verification of information.
6100.85.	Ongoing HCBS provider qualifications.
6100.86.	Delivery of HCBS.

TRAINING

6100.141.	Annual training plan.
6100.142.	Orientation program.
6100.143.	Annual training.
6100.144.	Natural supports.

INDIVIDUAL RIGHTS

6100.181.	Exercise of rights.
6100.182.	Rights of the individual.
6100.183.	Additional rights of the individual in a residential facility.
6100.184.	Negotiation of choices.
6100.185.	Informing of rights.
6100.186.	Role of family and friends.

PERSON-CENTERED SUPPORT PLAN

6100.221.	Development of the PSP.
6100.222.	The PSP process.
6100.223.	Content of the PSP.
6100.224.	Implementation of the PSP.
6100.225.	Support coordination and TSM.
6100.226.	Documentation of support delivery.

EMPLOYMENT, EDUCATION AND COMMUNITY PARTICIPATION

6100.261.	Access to the community.
6100.262.	Employment.
6100.263.	Education.

TRANSITION

6100.301.	Individual choice.
6100.302.	Transition to a new provider.
6100.303.	Reasons for a transfer or a change in a provider.
6100.304.	Written notice.
6100.305.	Continuation of support.
6100.306.	Transition planning.
6100.307.	Transfer of records.

POSITIVE INTERVENTION

6100.341.	Use of a positive intervention.
6100.342.	PSP.
6100.343.	Prohibition of restraints.
6100.344.	Permitted interventions.
6100.345.	Access to or the use of an individual's personal property.

INCIDENT MANAGEMENT

6100.401.	Types of incidents and timelines for reporting.
6100.402.	Incident investigation.
6100.403.	Individual needs.
6100.404.	Final incident report.
6100.405.	Incident analysis.

PHYSICAL ENVIRONMENT

6100.441.	Request for and approval of changes.
6100.442.	Physical accessibility.
6100.443.	Access to the bedroom and the home.
6100.444.	Lease or ownership.
6100.445.	Integration.
6100.446.	Facility characteristics relating to size of facility.
6100.447.	Facility characteristics relating to location of facility.

MEDICATION ADMINISTRATION

6100.461.	Self-administration.
6100.462.	Medication administration.
6100.463.	Storage and disposal of medications.
6100.464.	Labeling of medications.
6100.465.	Prescription medications.
6100.466.	Medication records.
6100.467.	Medication errors.
6100.468.	Adverse reaction.
6100.469.	Medication administration training.
6100.470.	Exception for family members.

GENERAL PAYMENT PROVISIONS

6100.481.	Departmental rates and classifications.
6100.482.	Payment.
6100.483.	Title of a residential building.
6100.484.	Provider billing.
6100.485.	Audits.
6100.486.	Bidding.
6100.487.	Loss or damage to property.

FEE SCHEDULE

6100.571. Fee schedule rates.

COST-BASED RATES AND ALLOWABLE COSTS

6100.641.	Cost-based rate.
6100.642.	Assignment of rate.
6100.643.	Submission of cost report.
6100.644.	Cost report.
6100.645.	Rate setting.
6100.646.	Cost-based rates for residential habilitation.
6100.647.	Allowable costs.
6100.648.	Donations.
6100.649.	Management fees.
6100.650.	Consultants.
6100.651.	Governing board.
6100.652.	Compensation.
6100.653.	Training.
6100.654.	Staff recruitment.
6100.655.	Travel.
6100.656.	Supplies.
6100.657.	Rental equipment and furnishing.
6100.658.	Communication.
6100.659.	Rental of administrative space.
6100.660.	Occupancy expenses for administrative buildings.
6100.661.	Fixed assets.
6100.662.	Motor vehicles.
6100.663.	Fixed assets of administrative buildings.
6100.664.	Residential habilitation vacancy.
6100.665.	Indirect costs.
6100.666.	Moving expenses.
6100.667.	Interest expense.
6100.668.	Insurance.
6100.669.	Other allowable costs.
6100.670.	Start-up cost.
6100.671.	Reporting of start-up cost.
6100.672.	Cap on start-up cost.

ROOM AND BOARD

6100.681.	Room and board applicability.
6100.682.	Support to the individual.
6100.683.	No delegation permitted.
6100.684.	Actual provider room and board cost.
6100.685.	Benefits.
6100.686.	Room and board rate.
6100.687.	Documentation.
6100.688.	Completing and signing the room and board residency agreement.
6100.689.	Modifications to the room and board residency agreement.
6100.690.	Copy of room and board residency agreement.
6100.691.	Respite care.
6100.692.	Hospitalization.
6100.693.	Exception.
6100.694.	Delay in an individual's income.

DEPARTMENT-ESTABLISHED FEE FOR
INELIGIBLE PORTION

6100.711.

Fee for the ineligible portion of residential habilitation.

ENFORCEMENT

6100.741.	Sanctions.
6100.742.	Array of sanctions.
6100.743.	Consideration as to type of sanction utilized.
6100.744.	Additional conditions and sanctions.

SPECIAL PROGRAMS

6100.801.	Adult autism waiver.
6100.802.	Agency with choice.
6100.803.	Support coordination, targeted support management and base-funded support coordination.
6100.804.	Organized health care delivery system.
6100.805.	Base-funded support.
6100.806.	Vendor goods and services.

GENERAL PROVISIONS

§ 6100.1. Purpose.

 (a) The purpose of this chapter is to specify the program and operational requirements for applicants and providers of HCBS and supports to individuals provided through base-funding.

 (b) This chapter supports individuals with an intellectual disability or autism to achieve greater independence, choice and opportunity in their lives through the effective and efficient delivery of HCBS and supports to individuals provided through base-funding.

§ 6100.2. Applicability.

 (a) This chapter applies to HCBS provided through waiver programs under section 1915(c) of the Social Security Act (42 U.S.C.A. § 1396n(c)) for individuals with an intellectual disability or autism.

 (b) This chapter applies to State plan HCBS for individuals with an intellectual disability or autism.

 (c) This chapter applies to intellectual disability programs, staffing and individual supports that are funded exclusively by grants to counties under the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101—4704) or Article XIV-B of the Human Services Code (62 P.S. §§ 1401-B—1410-B).

 (d) This chapter does not apply to the following:

 (1) Intermediate care facilities licensed in accordance with Chapter 6600 (relating to intermediate care facilities for individuals with an intellectual disability), except as provided under § 6100.447(d) (relating to facility characteristics relating to location of facility).

 (2) Hospitals licensed in accordance with 28 Pa. Code Chapters 101—158 (relating to general and special hospitals).

 (3) Nursing facilities licensed in accordance with 28 Pa. Code Chapters 201—211 (relating to long-term care facilities).

 (4) Personal care homes licensed in accordance with Chapter 2600 (relating to personal care homes).

 (5) Assisted living residences licensed in accordance with Chapter 2800 (relating to assisted living residences).

 (6) Mental health facilities licensed in accordance with Chapters 5200, 5210, 5221, 5230, 5300 and 5320.

 (7) Privately-funded programs, supports and placements.

 (8) Placements by other states into this Commonwealth.

 (9) A vendor fiscal employer agent model for an individual-directed financial management service.

 (10) The adult community autism program that is funded and provided in accordance with the Federally-approved 1915(a) waiver program.

§ 6100.3. Definitions.

 The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

 Allowable cost—Expenses considered reasonable, necessary and related to the support provided.

 Applicant—An entity that is in the process of enrolling in the Medical Assistance program as a provider of HCBS.

 Base-funded support—A support funded exclusively by a grant to a county under the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101—4704) or Article XIV-B of the Human Services Code (62 P.S. §§ 1401-B—1410-B).

 Corrective action plan—A document that specifies the following:

 (i) Action steps to be taken to achieve and sustain compliance.

 (ii) The time frame by which corrections will be made.

 (iii) The person responsible for taking the action step.

 (iv) The person responsible for monitoring compliance with the corrective action plan.

 Department—The Department of Human Services of the Commonwealth.

 Designated managing entity—An entity that enters into an agreement with the Department to perform administrative functions delegated by the Department, as the Department's designee. For base-funding, this includes the county mental health and intellectual disability program.

 Eligible cost—Expenses related to the specific procedure codes for which the Department receives Federal funding.

 Family—A natural person that the individual considers to be part of his core family unit.

 Fixed asset—A major item, excluding real estate, which is expected to have a useful life of more than 1 year or that can be used repeatedly without materially changing or impairing its physical condition through normal repairs, maintenance or replacement of components.

 HCBS—Home and community-based support—An activity, service, assistance or product provided to an individual that is funded through a Federally-approved waiver program or the State plan.

 Individual—A woman, man or child who receives a home and community-based intellectual disability or autism support or base-funded support.

 Natural support—An activity or assistance that is provided voluntarily to the individual instead of a reimbursed support.

 OVR—The Department of Labor and Industry's Office of Vocational Rehabilitation.

 PSP—Person-centered support plan.

 Provider—The person, entity or agency that is contracted or authorized to deliver the support to the individual.

 Restraint—A physical, chemical or mechanical intervention used to control acute, episodic behavior that restricts the movement or function of the individual or a portion of the individual's body, including an intervention approved as part of the PSP or used on an emergency basis.

 SSI—Supplemental security income.

 State plan—The Commonwealth's approved Title XIX State Plan.

 Support—An activity, service, assistance or product provided to an individual that is provided through a Federally-approved waiver program, the State plan or base-funding. A support includes an HCBS, support coordination, TSM, agency with choice, organized health care delivery system, vendor goods and services, and base-funding support, unless specifically exempted in this chapter.

 Vacancy factor—An adjustment to the full capacity rate to account for days when the residential habilitation provider cannot bill due to an individual not receiving supports.

GENERAL REQUIREMENTS

§ 6100.41. Appeals.

 Appeals related to this chapter shall be made in accordance with Chapter 41 (relating to Medical Assistance provider appeal procedures).

§ 6100.42. Monitoring compliance.

 (a) The Department and the designated managing entity may monitor compliance with this chapter at any time through an audit, provider monitoring or other monitoring method.

 (b) The provider's policies, procedures, records and invoices may be reviewed, and the provider may be required to provide an explanation of its policies, procedures, records and invoices, related to compliance with this chapter or applicable Federal or State statutes and regulations, during an audit, provider monitoring or other monitoring method.

 (c) The provider shall cooperate with the Department and the designated managing entity and provide the requested compliance documentation in the format required by the Department prior to, during and following an audit, provider monitoring or other monitoring method.

 (d) The provider shall cooperate with authorized Federal and State regulatory agencies and provide the requested compliance documentation in the format required by the regulatory agencies.

 (e) The provider shall complete a corrective action plan for a violation or an alleged violation of this chapter in the time frame required by the Department.

 (f) The provider shall complete the corrective action plan on a form specified by the Department.

 (g) The Department or the designated managing entity may issue a directed corrective action plan to direct the provider to complete a specified course of action to correct a violation or alleged violation of this chapter.

 (h) The directed corrective action plan in subsection (g) may include the following:

 (1) The acquisition and completion of an educational program, in addition to that required under §§ 6100.141—6100.144 (relating to training).

 (2) Technical consultation.

 (3) Monitoring.

 (4) Audit.

 (5) Oversight by an appropriate agency.

 (6) Another appropriate course of action to correct the violation.

 (i) The directed corrective action plan shall be completed by the provider at the provider's expense and is not eligible for reimbursement from the Department.

 (j) The provider shall comply with the corrective action plan and directed corrective action plan as approved by the Department or the designated managing entity.

 (k) The provider shall keep documentation relating to an audit, provider monitoring or other monitoring method, including supporting compliance documents.

§ 6100.43. Regulatory waiver.

 (a) A provider may submit a request for a waiver of a section, subsection, paragraph or subparagraph of this chapter, except for the following:

 (1) Sections 6100.1—6100.3 (relating to general provisions).

 (2) Sections 6100.41—6100.55 (relating to general requirements).

 (3) Sections 6100.181—6100.186 (relating to individual rights).

 (4) Sections 6100.341—6100.345 (relating to positive intervention).

 (b) The waiver shall be submitted on a form specified by the Department.

 (c) The Secretary of the Department or the Secretary's designee may grant a waiver if the following conditions are met:

 (1) There is no jeopardy to an individual's health, safety and well-being.

 (2) An individual or group of individuals benefit from the granting of the waiver through increased person-centeredness, integration, independence, choice or community opportunities for individuals.

 (3) There is not a violation of the Department's Federally-approved waivers and waiver amendments, or the State plan, as applicable.

 (4) Additional conditions deemed appropriate by the Department.

 (d) The Department will specify an effective date and an expiration date for a waiver that is granted.

 (e) At least 45 days prior to the submission of a request for a waiver the provider shall provide a written copy of the waiver request to the affected individuals, and to persons designated by the individuals, allowing at least 20 days for review and comment to the provider, the designated managing entity and the Department.

 (f) If the request for a waiver involves the immediate protection of an individual's health and safety, the provider shall provide a written copy of the waiver request to the affected individuals, and to persons designated by the individuals, at least 24 hours prior to the submission of the request for a waiver, allowing at least 20 hours for review and comment to the provider, the designated managing entity and the Department.

 (g) The provider shall discuss and explain the request for a waiver with the affected individuals, and with persons designated by the individuals.

 (h) The request for a waiver submitted to the Department must include copies of comments received by the individuals and by persons designated by the individuals.

 (i) The provider shall notify the affected individuals, and persons designated by the individuals, of the Department's waiver decision.

 (j) The provider shall submit a request for the renewal of a waiver at least 60 days prior to the expiration of the waiver.

 (k) A request for the renewal of a waiver shall follow the procedures in subsections (a)—(j).

 (l) The provider shall notify an individual not previously notified under this section of an existing waiver that affects the individual.

§ 6100.44. Innovation project.

 (a) A provider may submit a proposal to the Department to demonstrate an innovative project on a temporary basis.

 (b) The innovation project proposal must include the following:

 (1) A comprehensive description of how the innovation encourages best practice and promotes the mission, vision and values of person-centeredness, integration, independence, choice and community opportunities for individuals.

 (2) A description of the positive impact on the quality of life including the impact on individual choice, independence and person-centeredness.

 (3) A discussion of alternate health and safety protections, if applicable.

 (4) The number of individuals included in the innovation project.

 (5) The geographic location of the innovation project.

 (6) The proposed beginning and end date for the innovation project.

 (7) The name, title and qualifications of the manager who will oversee and monitor the innovation project.

 (8) A description of the advisory committee who will advise the innovation project.

 (9) A description of how individuals will be involved in designing and evaluating the success of the innovation project.

 (10) The community partners who will be involved in implementing the innovation project.

 (11) A request for a waiver form as specified in § 6100.43 (relating to regulatory waiver), if applicable.

 (12) Proposed changes to supports.

 (13) A detailed budget for the innovation project.

 (14) A description of who will have access to information on the innovation project.

 (15) The impact on living wage initiatives for direct support professionals, if applicable.

 (c) The innovation project must comply with the Department's Federally-approved waivers and waiver amendments, or the State plan, as applicable.

 (d) The Deputy Secretary for the Office of Developmental Programs of the Department will review a proposal for an innovation project in accordance with the following criteria:

 (1) The effect on an individual's health, safety and well-being.

 (2) The benefit from the innovation project to an individual or group of individuals by providing increased person-centeredness, integration, independence, choice and community opportunities for individuals.

 (3) Compliance with the Department's Federally-approved waivers and waiver amendments, or the State plan, as applicable.

 (4) The soundness and viability of the proposed budget.

 (5) Additional criteria the Department deems relevant to its review, funding or oversight of the specific innovation project proposal.

 (e) If the innovation project proposal is approved by the Deputy, the provider shall be subject to the fiscal procedures, reporting, monitoring and oversight as directed by the Department.

 (f) The provider shall submit a comprehensive annual report to the Department, to be made available to the public, at the Department's discretion.

 (g) The annual report must include the following:

 (1) The impact on the quality of life outcomes for individuals.

 (2) Budget.

 (3) Costs.

 (4) Cost benefit analysis.

 (5) Other relevant data, evaluation and analysis.

 (h) The Department may expand, renew or continue an innovation project, or a portion of the project, at its discretion.

§ 6100.45. Quality management.

 (a) The provider shall develop and implement a quality management plan on a form specified by the Department.

 (b) The provider shall conduct a review of performance data in the following areas to evaluate progress and identify areas for performance improvement:

 (1) Progress in meeting the desired outcomes of the PSP.

 (2) Incident management, to encompass a trend analysis of the incident data including the reporting, investigation, suspected causes and corrective action taken in response to incidents.

 (3) Performance in accordance with 42 CFR 441.302 (relating to state assurances).

 (4) Grievances, to encompass a trend analysis of the grievance data.

 (5) Individual and family satisfaction survey results and informal comments by individuals, families and others.

 (6) An analysis of the successful learning and application of training in relation to established core competencies.

 (7) Staff satisfaction survey results and suggestions for improvement.

 (8) Turnover rates by position and suspected causes.

 (9) Licensing and monitoring reports.

 (c) The quality management plan must identify the plans for systemic improvement and measures to evaluate the success of the plan.

 (d) The provider shall review and document progress on the quality management plan quarterly.

 (e) The provider shall analyze and revise the quality management plan every 2 years.

§ 6100.46. Protective services.

 (a) Abuse, suspected abuse and alleged abuse of an individual, regardless of the alleged location or alleged perpetrator of the abuse, shall be reported and managed in accordance with the following:

 (1) The Adult Protective Services Act (35 P.S. §§ 10210.101—10210.704) and applicable regulations.

 (2) 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law) and applicable regulations.

 (3) The Older Adults Protective Services Act (35 P.S. §§ 10225.101—10225.5102) and applicable regulations.

 (b) If there is an incident of abuse, suspected abuse or alleged abuse of an individual involving a staff person, consultant, intern or volunteer, the staff person, consultant, intern or volunteer may not have direct contact with an individual until the abuse investigation is concluded and the investigating agency has confirmed that no abuse occurred.

 (c) In addition to the reporting required under subsection (a), the provider shall immediately report the abuse, suspected abuse or alleged abuse to the following:

 (1) The individual.

 (2) Persons designated by the individual.

 (3) The Department.

 (4) The designated managing entity.

 (5) The county government office responsible for the intellectual disability program.

§ 6100.47. Criminal history checks.

 (a) Criminal history checks shall be completed for the following:

 (1) Full-time and part-time staff persons in any staff position.

 (2) Support coordinators, targeted support managers and base-funding support managers.

 (b) Criminal history checks shall be completed for the following persons who provide a support included in the PSP:

 (1) Household members who have direct contact with an individual.

 (2) Life sharers.

 (3) Consultants.

 (4) Paid or unpaid interns.

 (5) Volunteers.

 (c) Criminal history checks as specified in subsections (a) and (b) shall be completed in accordance with the following:

 (1) The Older Adults Protective Services Act (35 P.S. §§ 10225.101—10225.5102) and applicable regulations.

 (2) 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law) and applicable regulations.

 (d) This section does not apply to natural supports.

§ 6100.48. Funding, hiring, retention and utilization.

 (a) Funding, hiring, retention and utilization of persons who provide reimbursed support shall be in accordance with the applicable provisions of the Older Adults Protective Services Act (35 P.S. §§ 10225.101—10225.5102), 6 Pa. Code Chapter 15 (relating to protective services for older adults), 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law) and Chapter 3490 (relating to protective services). This subsection applies to the following:

 (1) Household members who have direct contact with an individual.

 (2) Full-time and part-time staff persons in any staff position.

 (3) Life sharers.

 (4) Consultants.

 (5) Paid or unpaid interns.

 (6) Volunteers.

 (7) Support coordinators, targeted support managers and base-funding support coordinators.

 (b) Subsection (a) does not apply to natural supports.

§ 6100.49. Child abuse history certification.

 A child abuse history certification shall be completed in accordance with 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law) and applicable regulations.

§ 6100.50. Communication.

 (a) Written, oral and other forms of communication with the individual, and persons designated by the individual, shall occur in a language and means of communication understood by the individual or a person designated by the individual.

 (b) The individual shall be provided with the assistive technology necessary to effectively communicate.

§ 6100.51. Grievances.

 (a) The provider shall develop procedures to receive, document and manage grievances.

 (b) The provider shall inform the individual, and persons designated by the individual, upon initial entry into the provider's program and annually thereafter of the right to file a grievance and the procedure for filing a grievance.

 (c) The provider shall permit and respond to oral and written grievances from any source, including an anonymous source, regarding the delivery of a support.

 (d) The provider shall assure that there is no retaliation or threat of intimidation relating to the filing or investigation of grievances.

 (e) If an individual indicates the desire to file a grievance in writing, the provider shall offer and provide assistance to the individual to prepare and submit the written grievance.

 (f) The providers shall document and manage grievances, including repeated grievances.

 (g) The provider shall document the following information for each grievance, including oral, written and anonymous grievances, from any source:

 (1) The name, position, telephone, e-mail address and mailing address of the initiator of the grievance, if known.

 (2) The date and time the grievance was received.

 (3) The date of the occurrence, if applicable.

 (4) The nature of the grievance.

 (5) The provider's investigation process and findings relating to the grievance.

 (6) The provider's actions to investigate and resolve the grievance, if applicable.

 (7) The date the grievance was resolved.

 (h) The grievance shall be resolved within 21 days from the date the grievance was received.

 (i) The initiator of the grievance shall be provided a written notice of the resolution or findings within 30 days from the date the grievance was received.

§ 6100.52. Rights team.

 (a) The provider shall have a rights team. The provider may use a county mental health and intellectual disability program rights team that meets the requirements of this section.

 (b) The role of the rights team is to:

 (1) Review each incident, alleged incident and suspected incident of a violation of individual rights as specified in §§ 6100.181—6100.186 (relating to individual rights).

 (2) Review each use of a restraint as defined in §§ 6100.341—6100.345 (relating to positive intervention) to:

 (i) Analyze systemic concerns.

 (ii) Design positive supports as an alternative to the use of a restraint.

 (iii) Discover and resolve the reason for an individual's behavior.

 (c) Members of the rights team shall include the affected individual, persons designated by the individual, a family member or an advocate appointed by the designated managing entity if the individual is unable to speak for himself, the individual's support coordinator or targeted support manager, a representative from the designated managing entity and a provider representative.

 (d) Members of the rights team shall be comprised of a majority who do not provide direct support to the individual.

 (e) If a restraint was used, the individual's health care practitioner shall be consulted.

 (f) The rights team shall meet at least once every 3 months.

 (g) The rights team shall report its recommendations to the affected PSP team.

 (h) The provider shall document the rights team meetings and the decisions made at the meetings.

§ 6100.53. Conflict of interest.

 (a) The provider shall develop a conflict of interest policy that is reviewed and approved by the provider's full governing board.

 (b) The provider shall comply with the provider's conflict of interest policy.

 (c) An individual or a friend or family member of an individual may serve on the governing board.

§ 6100.54. Recordkeeping.

 (a) The provider shall keep individual records confidential and in a secure location.

 (b) The provider may not make individual records accessible to anyone other than the Department, the designated managing entity, and the support coordinator, targeted support manager or base-funded support coordinator without the written consent of the individual, or persons designated by the individual.

 (c) Records, documents, information and financial books as required under this chapter shall be kept by the provider in accordance with the following:

 (1) For at least 4 years from the Commonwealth's fiscal year-end or 4 years from the provider's fiscal year-end, whichever is later.

 (2) Until any audit or litigation is resolved.

 (3) In accordance with Federal and State statutes and regulations.

 (d) If a program is completely or partially terminated, the records relating to the terminated program shall be kept for at least 5 years from the date of termination.

§ 6100.55. Reserved capacity.

 An individual has the right to return to the individual's residential habilitation location following hospital or therapeutic leave in accordance with reserved capacity timelines specified in the Department's Federally-approved waivers and waiver amendments.

ENROLLMENT

§ 6100.81. HCBS provider requirements.

 (a) The provider shall be qualified by the Department for each HCBS the provider intends to provide, prior to providing the HCBS.

 (b) Prior to enrolling as a provider of HCBS, and on an ongoing basis following provider enrollment, the applicant or provider shall comply with the following:

 (1) Chapter 1101 (relating to general provisions).

 (2) The Department's monitoring documentation requirements as specified in § 6100.42 (relating to monitoring compliance).

 (3) The Department's pre-enrollment provider training.

 (4) Applicable licensure regulations, including Chapters 2380, 2390, 3800, 5310, 6400, 6500 and 6600, Department of Health licensure regulations in 28 Pa. Code Chapters 51, 601 and 611 (relating to general information; home health care agencies; and home care agencies and home care registries) and any other applicable licensure regulations.

 (c) Evidence of compliance with applicable licensure regulations in subsection (b)(4) is the possession of a valid regular license issued by the Department or the Department of Health.

 (1) If the applicant possesses a provisional license for the specific HCBS for which the applicant is applying, the applicant is prohibited from enrolling in the HCBS program for that specific HCBS.

 (2) This subsection does not prohibit a provider that possesses a provisional license from continuing participation in the HCBS program once a provider is enrolled.

 (d) An applicant may not be enrolled as a provider of HCBS if the Department issued a sanction in accordance with §§ 6100.741—6100.744 (relating to enforcement).

§ 6100.82. HCBS documentation.

 An applicant who wishes to operate an HCBS in accordance with this chapter shall complete and submit the following completed documents to the Department:

 (1) A provider enrollment application on a form specified by the Department.

 (2) An HCBS waiver provider agreement on a form specified by the Department.

 (3) Copies of current licenses as specified in § 6100.81(b)(4) (relating to HCBS provider requirements).

 (4) Verification of compliance with § 6100.47 (relating to criminal history checks).

 (5) Verification of completion of the Department's monitoring documentation.

 (6) Verification of completion of the Department's pre-enrollment provider training.

 (7) Documents required in accordance with the Patient Protection and Affordable Care Act (Pub.L. No. 111-148).

§ 6100.83. Submission of HCBS qualification documentation.

 The provider of HCBS shall submit written qualification documentation to the designated managing entity or to the Department at least 60 days prior to the expiration of its current qualification.

§ 6100.84. Provision, update and verification of information.

 The provider of HCBS shall provide, update and verify information within the Department's system as part of the initial and ongoing qualification processes.

§ 6100.85. Ongoing HCBS provider qualifications.

 (a) The provider shall comply with the Department's Federally-approved waivers and waiver amendments, or the State plan, as applicable.

 (b) The provider's qualifications to continue providing HCBS will be verified at intervals specified in the Federally-approved waiver, including applicable Federally-approved waiver amendments, or the State plan, as applicable.

 (c) The Department may require a provider's qualifications to be verified for continued eligibility at an interval more frequent than the Federally-approved waiver, including applicable Federally-approved waiver amendments, or the Medical Assistance State plan, due to one of the following:

 (1) Noncompliance with this chapter as determined by monitoring as specified in § 6100.42 (relating to monitoring compliance).

 (2) Noncompliance with a corrective action plan, or a directed correction action plan, as issued or approved by the designated managing entity or the Department.

 (3) The issuance of a provisional license by the Department.

 (4) Improper enrollment in the HCBS program.

 (d) Neither a provider nor its staff persons who may come into contact with an individual may be listed on the Federal or State lists of excludable persons such as the following:

 (1) System for award management.

 (2) List of excludable persons, individuals and entities.

 (3) Medicheck list.

§ 6100.86. Delivery of HCBS.

 (a) The provider shall deliver only the HCBS for which the provider is determined to be qualified by the designated managing entity or the Department.

 (b) The provider shall deliver the HCBS in accordance with the Federally-approved waiver, including applicable Federally-approved waiver amendments, and the Medical Assistance State plan, as applicable.

 (c) The provider shall deliver only the HCBS to an individual who is authorized to receive that HCBS.

 (d) The provider shall deliver the support in accordance with the individual's PSP.

TRAINING

§ 6100.141. Annual training plan.

 (a) The provider shall design an annual training plan based on the needs of the individuals as specified in the individuals' PSPs, the provider's quality management plan and other data and analysis indicating training needs.

 (b) The annual training plan must include the provider's orientation program as specified in § 6100.142 (relating to orientation program).

 (c) The annual training plan must include training aimed at improving the knowledge, skills and core competencies of the staff persons and others to be trained.

 (d) The annual training plan must include the following:

 (1) The title of the position to be trained.

 (2) The required training courses, including training course hours, for each position.

 (e) Records of orientation and training, including the training source, content, dates, length of training, copies of certificates received and persons attending, shall be kept.

 (f) The provider shall keep a training record for each person trained.

§ 6100.142. Orientation program.

 (a) Prior to working alone with individuals, and within 30 days after hire or starting to provide support to an individual, the following shall complete the orientation program as described in subsection (b):

 (1) Management, program, administrative and fiscal staff persons.

 (2) Dietary, housekeeping, maintenance and ancillary staff persons.

 (3) Direct support staff persons, including full-time and part-time staff persons.

 (4) Household members who will provide a reimbursed support to the individual.

 (5) Life sharers.

 (6) Volunteers who will work alone with individuals.

 (7) Paid and unpaid interns who will work alone with individuals.

 (8) Consultants who will work alone with individuals.

 (b) The orientation program must encompass the following areas:

 (1) The application of person-centered practices, including respecting rights, facilitating community integration, honoring choice and supporting individuals in maintaining relationships.

 (2) The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act (35 P.S. §§ 10225.101—10225.5102), 6 Pa. Code Chapter 15 (relating to protective services for older adults), 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law), the Adult Protective Services Act (35 P.S. §§ 10210.101—10210.704) and applicable protective services regulations.

 (3) Individual rights.

 (4) Recognizing and reporting incidents.

 (5) Job-related knowledge and skills.

§ 6100.143. Annual training.

 (a) The following persons shall complete 24 hours of training each year:

 (1) Direct support staff persons, including household members and life sharers who provide a reimbursed support to the individual.

 (2) Direct supervisors of direct support staff persons.

 (b) The following staff persons and others shall complete 12 hours of training each year:

 (1) Management, program, administrative, fiscal, dietary, housekeeping, maintenance and ancillary staff persons.

 (2) Consultants who provide reimbursed supports to an individual and who work alone with individuals.

 (3) Volunteers who provide reimbursed supports to an individual and who work alone with individuals.

 (4) Paid and unpaid interns who provide reimbursed supports to an individual and who work alone with individuals.

 (c) A minimum of 8 hours of the annual training hours specified in subsections (a) and (b) must encompass the following areas:

 (1) The application of person-centered practices, including respecting rights, facilitating community integration, honoring choice and supporting individuals in maintaining relationships.

 (2) The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act (35 P.S. §§ 10225.101—10225.5102), 6 Pa. Code Chapter 15 (relating to protective services for older adults), 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law), the Adult Protective Services Act (35 P.S. §§ 10210.101—10210.704) and applicable protective services regulations.

 (3) Individual rights.

 (4) Recognizing and reporting incidents.

 (5) The safe and appropriate use of positive interventions if the person will provide a support to an individual with a dangerous behavior.

 (d) The balance of the annual training hours must be in areas identified by the provider in the provider's annual training plan in § 6100.141 (relating to annual training plan).

 (e) All training, including the training courses identified in subsections (c) and (d), must be included in the provider's annual training plan.

§ 6100.144. Natural supports.

 Sections 6100.141—6100.143 (relating to annual training plan; orientation program; and annual training) do not apply to natural supports.

INDIVIDUAL RIGHTS

§ 6100.181. Exercise of rights.

 (a) An individual may not be deprived of rights as provided under §§ 6100.182 and 6100.183 (relating to rights of the individual; and additional rights of the individual in a residential facility).

 (b) An individual shall be continually supported to exercise the individual's rights.

 (c) An individual shall be provided the support and accommodation necessary to be able to understand and actively exercise the individual's rights.

 (d) An individual may not be reprimanded, punished or retaliated against for exercising the individual's rights.

 (e) A court's written order that restricts an individual's rights shall be followed.

 (f) A court-appointed legal guardian may exercise rights and make decisions on behalf of an individual in accordance with a court order.

 (g) An individual who has a court-appointed legal guardian, or who has a court order restricting the individual's rights, shall be involved in decision making in accordance with the court order.

 (h) An individual has the right to designate persons to assist in decision making on behalf of the individual.

§ 6100.182. Rights of the individual.

 (a) An individual may not be discriminated against because of race, color, creed, disability, religious affiliation, ancestry, gender, gender identity, sexual orientation, national origin or age.

 (b) An individual has the right to civil and legal rights afforded by law, including the right to vote, speak freely, and practice the religion of his choice or to practice no religion.

 (c) An individual may not be abused, neglected, mistreated, exploited, abandoned or subjected to corporal punishment.

 (d) An individual shall be treated with dignity and respect.

 (e) An individual has the right to make choices and accept risks.

 (f) An individual has the right to refuse to participate in activities and supports.

 (g) An individual has the right to control the individual's own schedule and activities.

 (h) An individual has the right to privacy of person and possessions.

 (i) An individual has the right of access to and security of the individual's possessions.

 (j) An individual has the right to choose a willing and qualified provider.

 (k) An individual has the right to choose where, when and how to receive needed supports.

 (l) An individual has the right to voice concerns about the supports the individual receives.

 (m) An individual has the right to assistive devices and support to enable communication at all times.

 (n) An individual has the right to participate in the development and implementation of the PSP.

§ 6100.183. Additional rights of the individual in a residential facility.

 (a) An individual has the right to receive scheduled and unscheduled visitors, and to communicate and meet privately with persons of the individual's choice, at any time.

 (b) An individual has the right to unrestricted access to send and receive mail and other forms of communications, unopened and unread by others.

 (c) An individual has the right to unrestricted and private access to telecommunications.

 (d) An individual has the right to manage and access the individual's own finances.

 (e) An individual has the right to choose persons with whom to share a bedroom.

 (f) An individual has the right to furnish and decorate the individual's bedroom and the common areas of the home in accordance with §§ 6100.184 and 6100.444(b) (relating to negotiation of choices; and lease or ownership).

 (g) An individual has the right to lock the individual's bedroom door.

 (h) An individual has the right to access food at any time.

 (i) An individual has the right to make informed health care decisions.

§ 6100.184. Negotiation of choices.

 (a) An individual's rights shall be exercised so that another individual's rights are not violated.

 (b) Choices shall be negotiated by the affected individuals in accordance with the provider's procedures for the individuals to resolve differences and make choices.

§ 6100.185. Informing of rights.

 (a) The provider shall inform and explain individual rights to the individual, and persons designated by the individual, upon entry into the program and annually thereafter.

 (b) The provider shall keep a statement signed by the individual, or the individual's court-appointed legal guardian, acknowledging receipt of the information on individual rights.

§ 6100.186. Role of family and friends.

 (a) The provider shall facilitate and make the accommodations necessary to support an individual's visits with family, friends and others, at the direction of the individual.

 (b) The provider shall facilitate and make the accommodations necessary to involve the individual's family, friends and others in decision making, planning and other activities, at the direction of the individual.

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