PROPOSED RULEMAKING
DEPARTMENT OF HEALTH
[28 PA. CODE CHS. 701, 709, 711 AND 713]
Repeal of Hotline and Drop-In Shelter Regulations
[27 Pa.B. 1815] The Department of Health (Department) proposes to delete, in part, Part V (relating to drug and alcohol facilities and services) under the authority of the Pennsylvania Drug and Alcohol Abuse Control Act (act) (71 P. S. §§ 1690.101--1690.115), Reorganization Plan No. 2 of 1977 (71 P. S. § 751-25) and Reorganization Plan No. 4 of 1981 (71 P. S. § 751-31). The relevant portions of Part V set forth the activity matrix, provisions for licensure of shelter activities in free-standing and health care related facilities and the approval of drop-in activities and hotline activities.
Purpose
The Department was authorized by the General Assembly under Reorganization Plan No. 2 of 1977, Reorganization Plan No. 4 of 1981 and amendments to the act to assume the functions and responsibilities of the Governor's Council on Drug and Alcohol Abuse (Council). The Council's authority to regulate and promulgate rules and regulations was transferred to the Department through those reorganization plans. See Reorganization Plan No. 2 of 1977 (transferring duties under the Public Welfare Code with regard to regulation, supervision and licensing of drug and alcohol facilities to the Council), Reorganization Plan No. 4 of 1981 (transferring the functions of the Council to the Department and establishing it as an advisory council) and the act of December 20, 1985 (P. L. 529, No. 119) (amending the act to reference the Pennsylvania Advisory Council on Drug and Alcohol Abuse (Advisory Council)).
The relevant regulations in Part V, address the matrix definitions and the activity matrix and three areas of licensure or approval: (1) the licensure of shelter activities in free-standing and health care related facilities; (2) the approval of drop-in activities; and (3) the approval of hotline activities. In addition, the definitions relating to the previously mentioned activities will be deleted.
The purpose of the rescission is to delete the matrix and the regulation of various activities so that Department staff and other resources may be directed toward oversight of entities providing substance abuse treatment services. This will reduce the workload and allow for more efficient regulatory oversight of the substance abuse treatment delivery system. This should result in the redirection of State government costs in ensuring safe and effective substance abuse treatment.
The Department is proposing to delete these regulations because regulation of the substance abuse service delivery system has changed significantly over the past few years. Even more changes are predicted in the coming years based on current plans to change the health care delivery system at both the State and Federal levels. In point of fact, the present proposal involving HealthChoices indeed proposes a new system of managed care on a pilot basis in five counties in southeast Pennsylvania on both physical health and behavioral health sides. To better address the needs of the substance abuse service delivery system and maximize existing resources, it will be necessary to modify the regulatory process beginning with the cessation of licensing shelter, drop-in and hotline activities. This will reduce the overload on survey staff resources and enable the Department's attention to focus on the oversight of activities which actually provide treatment to the substance abusing client.
The activities that the Department proposes to cease licensing do not provide treatment to clients. Shelters provide beds for individuals to stay while they make arrangements to receive treatment elsewhere. Drop-in centers, similarly, provide a place for individuals to gather and make arrangements for referral to treatment providers. Hotlines, even less so, only provide referral to treatment providers over the telephone. No assessment is done by any staff of any of these three activities. As indicated, the most that occurs is that the substance abuse client is referred to a facility where an assessment can occur. The referral system carried out through these activities will not be diminished as a result of these proposed actions. The Department's specific resources will be better focused on activities by which specific substance abuse treatment services are being provided. Currently, the Department licenses ten shelters, and approves 17 drop-in centers and 28 hotlines.
Further, the matrix and definitions have no practical purpose. Not all the activities that are in the matrix are being performed. They are not necessary for licensure since any activity that is licensed is already defined in § 701.1 (relating to definitions) and has accompanying standards within the remainder of Part V. The activity matrix is not appropriate for regulation but merely shows levels, activities and approaches.
Requirements of the Regulations
A. § 701.1. Definitions.
The Department proposes to delete the definitions of ''shelter,'' ''drop-in center activity'' and ''hotline activity.''
B. Section 701.2. General Matrix Definitions.
Section 701.2 sets forth definitions and a matrix which categorizes drug and alcohol services. The matrix has no practical purpose. Some activities which are listed are not licensed, for example, driving while intoxicated activities. Other activities which are licensed have specific regulations elsewhere in Part V. This matrix is not part of the licensing process, nor is it necessary for licensing. It simply identifies levels and activities and is not regulatory in nature.
C. Sections 709.101, 709.102 and 711.101--711.106. Standards for Shelter Activities.
These sections set forth licensing standards for current shelter activities in free-standing facilities and health care facilities. Shelter activities are the provision to the client of food, clothing, hygienic facilities, referral services and overnight housing in a supportive atmosphere.
Facilities licensed for these activities do not actually provide substance abuse prevention, intervention or treatment services, but serve persons with multiservice needs in addition to or in conjunction with substance abuse problems. A shelter provides no substance abuse treatment services, rather, it provides a place for individuals to stay and avail themselves of referrals for other services related to their individual needs.
D. Sections 713.51--713.55. Standards for Drop-in Center Activities.
These sections set forth standards for approval of drop-in center activities. Drop-in center activities are the provision of information, referral and crisis intervention as well as the opportunity to discuss personal problems in an informal setting.
Drop-in activities fall within the intervention level of care which is aimed at assisting the client in decision making and supporting the client until the client can cope independently. Referral is provided if the need for a structured treatment regimen or other services is indicated. The drop-in center provides information, referral and crisis intervention as well as the opportunity to discuss problems in an informal setting, which are not treatment activities. Client records are maintained only when crisis intervention, short term counseling or referral services are rendered.
E. Sections 713.61--713.63. Standards for Hotline Activities.
These sections set forth standards for approval of hot-line activities. Hotline activities are the provision of information, referral, advice and crisis intervention through telephone service. Again, these activities are not treatment activities. Records are maintained on standardized forms which indicate the nature of the telephone call and the disposition of the call. The maintenance of client specific records is optional as the project deems appropriate and feasible.
Affected Persons
Shelters, drop-in and hotline activities holding Department license or approval at the time of the publication of this proposal in final-form will remain licensed or approved until the expiration of that license or approval. These activities will be affected in that no new shelter, drop-in or hotline activities will be licensed or approved as of the effective date of the adoption of this proposal. The lack of Department license or approval, however, will not prohibit the continuation of these activities. They will merely no longer be licensed or approved by the Department.
Cost and Paperwork Estimate
There will be neither additional costs nor additional paperwork to the Commonwealth, local governments or the private sector resulting from the proposed deletions of certain provisions of Part V.
Effective Date/Sunset Date
The proposed deletion of the relevant portions of Part V will be effective upon final publication in the Pennsylvania Bulletin. No sunset date is necessary.
Contact Person
Interested persons are invited to submit written comments, suggestions or objections regarding this proposal to John C. Hair, Director, Bureau of Community Program Standards, Quality Assurance and Health Planning, 132 Kline Plaza, Suite A, Harrisburg, PA 17104 (717) 783-8665, within 30 days of publication of this proposed rulemaking in the Pennsylvania Bulletin. Persons with a disability may submit comments, suggestions or objections regarding this proposal in alternative formats, such as by audio tape, braille or using TDD: (717) 783-6514. Persons with disabilities who require alternative formats of this document (such as, large print, audio tape, braille) should contact the Department so that necessary arrangements may be made.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the Department submitted a copy of this proposal on March 18, 1997, to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House Committee on Health and Human Services and the Senate Committee on Public Health and Welfare. In addition to submitting the proposal, the Department has provided IRRC and the Committees with a copy of a Regulatory Analysis Form prepared by the Department in compliance with Executive Order 1996-1, ''Regulatory Review and Promulgation.'' A copy of this material is available to the public upon request.
If IRRC has objections to any portion of the proposal, it will notify the Department within 30 days of the close of the public comment period. The notification shall specify the regulatory review criteria which have not been met by that portion. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the proposal, by the Department, the General Assembly and the Governor, of objections raised.
DANIEL F. HOFFMANN,
SecretaryFiscal Note: 10-147. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 28. HEALTH AND SAFETY
PART V. DRUG AND ALCOHOL FACILITIES AND SERVICES
CHAPTER 701. GENERAL PROVISIONS
Subchapter A. DEFINITIONS § 701.1 General definitions.
The following words and terms, when used in this part, have the following meanings, unless the context clearly indicates otherwise:
* * * * * [Drop-in center activity--The provision of information, referral and crisis intervention as well as the opportunity to discuss personal problems in an informal setting.]
* * * * * [Hotline activity--The provision of information, referral, advice, and crisis intervention through a telephone service.]
* * * * * [Shelter activity--The provision to the client of food, clothing, hygienic facilities, referral services, and overnight housing in a supportive atmosphere.]
* * * * * § 701.2. [General matrix definitions] (Reserved).
[(a) The Department has categorized its drug and alcohol services in a matrix outlined in subsection (b). This matrix outlines the four major levels and then lists the specific activities that are performed in each of these levels. These levels and activities are utilized for fiscal and data reporting and for licensing/approval purposes.
(1) Level. Categorization of drug and alcohol services into four major areas.
(2) Activity. The type of prevention or intervention service or the Treatment setting under which client services are provided.
(3) Approach. Principal method utilized in serving clients. Approaches are utilized for treatment activities.
(b) The drug and alcohol activity matrix is as follows:
Levels Activity Approaches Administration Administration (SCA) Training Research Evaluation Prevention Education/Information Alternative Activities Intervention Drop--in Center Hotline Driving While Intoxicated Occupational Program Treatment Intake Detoxification Referral Drug Free Inpatient Nonhospital Other Chemotherapy Experimental Inpatient Hospital Detoxification Drug Free Other Chemotherapy Experimental Correctional Institution Detoxification Drug Free Experimental Partial Hospitalization Detoxification Drug Free Other Chemotherapy Experimental Outpatient Detoxification Maintenance Drug Free Other Chemotherapy Experimental Shelter Detoxification Drug Free Experimental]
Subchapter J. [STANDARDS FOR SHELTER ACTIVITIES] (Reserved) § 709.101. [Intake and admissions] (Reserved).
[(a) A qualified staff member shall be available 24 hours a day to accept a client into the project.
(b) A client shall be observed upon intake for withdrawal symptoms from substances abused. If serious symptoms of drug/alcohol abuse or dependence or other physical problems are observed, prompt medical attention shall be obtained. Data obtained during the observation period shall be recorded.
(c) A client shall be provided with a shower or bath, food, clean clothing, and a clean bed with bedding.
(d) The shelter project shall have a written plan or description of its activities and services. The written plan shall include, but not be limited to the following:
(1) Client admission criteria.
(2) Documentation of services available, either through direct provision or agreement.
(3) Involuntary discharge/termination criteria.
(4) Client transportation to the selected referral agency/resource.
(e) The shelter project shall have written policies and procedures for communication with law enforcement authorities, local or State health, or welfare authorities, as appropriate, regarding clients whose condition or its cause is reportable; for example, persons having contagious diseases or victims of suspected criminal acts such as rape or gunshot wounds, 18 Pa.C.S. § 5106 (relating to failure to report injuries by firearm or criminal act) and child abuse under the Child Protective Services Law (11 P. S. §§ 2201--2224).
(f) The shelter project shall have written policies and procedures to address special issues regarding treatment of clients. These policies and procedures shall include, but not be limited to:
(1) Unconscious individuals.
(2) Minors.
(3) Individuals with communicable disease.
(4) Individuals requiring transfer to a hospital or other treatment facility.
(5) Individual being treated by another social service agency.
(6) Individuals requiring detoxification.]
§ 709.102. [Client records] (Reserved).
[(a) The shelter project shall maintain a client record on an individual receiving services which includes, but is not limited to:
(1) Basic personal data.
(2) Consent to treatment.
(3) Other consent forms.
(4) Progress notes.
(5) Record of services provided for the client.
(6) Discharge summary.
(7) Client-related correspondence.
(8) Follow-up information.
(b) The project shall develop and maintain client records on standardized project client record forms.]
Subchapter I. [STANDARDS FOR SHELTER ACTIVITIES] (Reserved) § 711.101. [Intake and admission] (Reserved).
[(a) A qualified staff member shall be available 24 hours a day to accept clients into the project.
(b) A client shall be observed upon intake for withdrawal symptoms from substances abused. If serious symptoms of drug/alcohol abuse, or dependence, or other physical problems are observed, prompt medical attention shall be obtained. Data obtained during the observation period shall be recorded.
(c) A client shall be provided with a shower or bath, food, clean clothing and a clean bed with bedding.
(d) The shelter project shall have a written plan or description of its activities and services. The written plan shall include, but not be limited to, the following:
(1) Client admission criteria.
(2) Services available, either through direct provision or agreement.
(3) Involuntary discharge/termination criteria.
(4) Client transportation to the selected referral agency/resource.
(e) The shelter project shall have written policies and procedures for communication with law enforcement authorities, local or State health or welfare authorities, as appropriate, regarding clients whose condition or its cause is reportable; for example, persons having contagious diseases or victims of suspected criminal acts such as rape or gunshot wounds; 18 Pa.C.S. § 5106 (relating to failure to report injuries by firearm or criminal act) and child abuse under the Child Protective Services Law (11 P. S. §§ 2201--2224).
(f) The shelter project shall have written policies and procedures to address special issues regarding treatment of clients. These policies and procedures shall include, but not be limited to:
(1) Unconscious individuals.
(2) Minors.
(3) Individuals with communicable diseases.
(4) Individuals requiring transfer to a hospital or other treatment facility.
(5) Individuals being treated by another social service agency.
(6) Individuals requiring detoxification.
(g) The project shall obtain written letters of agreement or understanding with primary referral sources.]
§ 711.102. [Client records] (Reserved).
[(a) Record requirements. In addition to the requirements in § 115.32 (relating to contents), the shelter project shall maintain a client record on an individual receiving services which shall include, but not be limited to:
(1) Basic personal data.
(2) Drug and alcohol consent forms.
(3) Progress notes.
(4) Record of services provided for the client.
(5) Follow-up information.
(b) Client access to records. A client has the right to inspect his own records. The project director may temporarily remove portions of the record, prior to the inspection by the client, if the director determines that the information may be detrimental if presented to the client. Reasons for removing sections shall be documented and kept on file.
(c) Confidentiality.
(1) A written procedure shall be developed by the project director which shall comply with 4 Pa. Code § 255.5 (relating to projects and coordinating bodies: disclosure of client-oriented information). The procedure shall include, but not be limited to:
(i) Confidentiality of client identity and records.
(ii) Staff access to client records.
(2) The project shall obtain an informed and voluntary consent from the client for the disclosure of information contained in the client record. The consent shall be in writing and shall include, but not be limited to:
(i) Name of the person, agency, or organization to whom disclosure is made.
(ii) Specific information disclosed.
(iii) Purpose of disclosure.
(iv) Dated signature of the client or guardian.
(v) Dated signature of a witness.
(vi) Expiration date of the consent.
(3) A copy of a client consent shall be offered to the client and a copy maintained in the client records.
(4) Where consent is not required, the project personnel shall:
(i) Fully document the disclosure in the client records.
(ii) Inform the client, as readily as possible, that the information was disclosed, for what purposes, and to whom.]
§ 711.103. [Uniform Data Collection System] (Reserved).
[(a) If a project utilizes Department funds, it shall comply with the Department's UDCS.
(b) A data collection system shall be developed that allows for the efficient retrieval of data needed to measure the project's performance.]
§ 711.104. [Notification of termination] (Reserved).
[(a) The project director shall notify the client, in writing, of a decision to involuntarily terminate the client's treatment at the project. The notice shall include the reason for termination.
(b) The client shall have the opportunity to request reconsideration of a decision terminating treatment.]
§ 711.105. [Medication control] (Reserved).
[When the drug and alcohol project is not physically located within the parent health care facility, it shall have a written policy regarding medications used by clients which shall include, but not be limited to:
(1) Administration of medication.
(2) Drug storage areas.
(3) Inspection of storage areas.
(4) Methods for control and accountability of drugs.
(5) Security of drugs.
(6) Inventories.
(7) Medication errors and drug reactions.]
§ 711.106. [Physical plant] (Reserved).
[When the project is not physically located within a health care facility, it shall be site visited annually for the following requirements:
(1) Counseling areas.
(2) Office space.
(3) Lavatories.
(4) Fire escapes/emergency exits.
(5) Fire extinguishers.
(6) General maintenance.
(7) Food service areas, if applicable.
(8) Certificate of Occupancy from the Department of Labor and Industry or it equivalent.
(9) Compliance with applicable local ordinances and regulations.]
CHAPTER 713. STANDARDS FOR APPROVAL OF PREVENTION AND INTERVENTION ACTIVITIES
Subchapter E. [STANDARDS FOR DROP--IN CENTER ACTIVITIES] (Reserved) § 713.51. [Services] (Reserved).
[The drop-in center shall provide the following services:
(1) Crisis intervention.
(2) Short-term counseling to provide guidance and advice to deal with the problems of the client.
(3) Referral of the client to another agency if the project does not deliver the needed services.]
§ 713.52. [Location] (Reserved).
[The facility shall be located so as to be easily accessible to clients.]
§ 713.53. [Hours of operation] (Reserved).
[(a) The drop-in center shall be open an appropriate number of hours. A minimum of 25 of its operating hours per week shall be scheduled during evenings or weekends, or both.
(b) The hours of operation and location of the project shall be made known to the public.]
§ 713.54. [Client records] (Reserved).
[(a) Recordkeeping system. A recordkeeping system shall be utilized to record drop-in center activities which includes, but is not limited to:
(1) The use of standardized recordkeeping forms.
(2) Signature and dating requirements.
(b) Record information required. Client records shall be maintained when crisis intervention, short term counseling and referral services are rendered. These records shall include, but not be limited to:
(1) Basic personal data.
(2) Appraisal of client needs.
(3) Progress/activity notes.
(4) Disposition.
(5) Follow-up.
(c) Record accessibility. If client specific records are maintained, the project shall comply with the following:
(1) A written policy statement shall be developed which includes, but is not limited to:
(i) Confidentiality of client identity and records.
(ii) Staff access to client records.
(iii) Client access to records.
(2) The project shall obtain an informed and voluntary consent from the client for the disclosure of information to a service provider to which the client is referred. The consent shall be in writing and shall include, but not be limited to:
(i) The name of the person, agency, or organization to whom disclosure is made.
(ii) The specific information disclosed.
(iii) The purpose of disclosure.
(iv) The dated signature of client or guardian.
(v) The dated signature of witness.
(vi) The expiration date of the consent.
(3) The project shall secure client specific records within locked storage containers.
(d) Retention of client records.
(1) Client records, whether original, reproductions or microfilm, shall be kept on file for a minimum of 4 years following the discharge of a client.
(2) If a project discontinues operation, it shall inform the Department where its records are stored.]
§ 713.55. [Personnel management] (Reserved). [Staff training and education shall be provided and include basic familiarization with:
(1) Pharmacology.
(2) Physical and behavioral aspects of substance abuse or dependence, or both.
(3) Legal aspects of substance abuse or dependence, or both.
(4) Crisis intervention techniques.
(5) Referral sources.
(6) Communication and counseling skills.]
Subchapter F. [STANDARDS FOR HOTLINE ACTIVITIES] (Reserved) § 713.61. [Hours of operation.] (Reserved).
[The project's hours of operation and telephone numbers shall be made known to the public.]
§ 713.62. [Client records] (Reserved).
[(a) Recordkeeping system. A system for maintaining a record of calls shall be established and utilized which includes, but is not limited to:
(1) Standardized recordkeeping forms.
(2) Entries on the nature of calls.
(3) Appraisal of client needs, if applicable.
(4) Dispositions.
(5) Signature and dating requirements.
(b) Record information required. If client specific records are maintained, the project shall comply with the following:
(1) A written policy statement shall be developed which includes, but is not limited to:
(i) Confidentiality of client identity and records.
(ii) Staff access to client records.
(iii) Client access to records.
(2) The project shall obtain a voluntary verbal consent from the client for the disclosure of information to a service provider to which the client is referred.
(3) The project shall secure client specific records within locked storage containers.
(c) Retention of client records.
(1) Client records, whether original, reproductions or microfilm, shall be kept on file for 4 years following the discharge of a client.
(2) If a project discontinues operation, it shall inform the Department where the records are stored.]
§ 713.63. [Personnel management] (Reserved).
[Staff training and education shall be provided and include basic familiarization with:
(1) Pharmacology.
(2) Physical and behavioral aspects of substance abuse or dependence, or both.
(3) Legal aspects of substance abuse or dependence, or both.
(4) Crisis intervention techniques.
(5) Referral sources.
(6) Communication and counseling skills.]
[Pa.B. Doc. No. 97-554. Filed for public inspection April 11, 1997, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
