[27 Pa.B. 3609] Additionally, policies shall be established regarding written orders for appropriate usage of all drugs.
[Continued from previous Web Page]
Chapter 563: Medical Records Section 563.8 (relating to automation or computerization of medical records) would be amended to state that no requirements of this subpart should be construed to prohibit the computerization of medical records. In fact, computerization of medical records is encouraged.
Chapter 565: Laboratory and Radiology Services Section 565.15 (relating to records) would be amended to require that entries of laboratory and radiologic tests or services performed shall be made a part of the patient's medical record within 24 hours of the provision of the service. The current language requires that these entries be made in a timely manner.
Chapter 567: Environmental Services No major changes are proposed to this chapter.
Chapter 569: Fire and Safety Services Section 569.33(a) (relating to smoking) would be amended to ban all smoking in an ASF.
Chapter 571: Construction Standards No major changes are proposed to this chapter.
Chapter 573: Statement of Policy Section 573.1 is a statement of policy discussing criteria for ambulatory surgical facilities. This section would be deleted as this material is now set forth is Chapter 551. Section 573.2 is a statement of policy concerning criteria for ambulatory surgical procedures. This section would be deleted as it has been incorporated into and superseded by proposed § 551.21.
Fiscal Impact These proposed amendments, to ensure the quality of services being provided at licensed health care facilities, will result in some additional costs to the Department. Increased staffing may be necessary to implement the expanded quality assessment process. These resources would be needed to review submitted documentation supporting the licensure requests, to conduct onsite surveys of health care facilities and process licensure applications. Additional costs may also include stipends/fees or expenses, or both, for persons not part of the Department staff who may assist the Department in the licensure and quality assurance assessment process.
The proposed amendments to the Department's licensure regulations will impose additional costs on health care providers to some degree. The proposed amendments require that medical directors of particular health care services must now receive certification from a specialty board. The employment of these individuals could increase the cost of these services. Additionally, costs may be incurred for some minor construction/renovation, equipment or supply costs to meet new requirements. However, in most instances, the standards being adopted are those which the Department expects that the vast majority of health care facilities are already meeting if they provide these services.
In reviewing the fiscal impact, it should be remembered that the reason for many of these amendments is the sunset of the CON Program. A proposal to construct either a long term care facility or an ambulatory surgical facility previously had to undergo CON review prior to commencement of their activity. This review involved expenses for the Department in the employment of an entire division to process and review CON applications. For CON applicants, the actual costs involved the preparation of the application, hiring health care consultants to assist with the CON process, a fee to the Department which could be as much as $20,000 and the time and resources of the facility's staff. Indirect costs included the time which the facility had to wait until its application went through the often lengthy CON process. Although these proposed amendments will not eliminate all of the costs which health care facilities experienced under CON, the overall effect should be a reduced fiscal impact.
Paperwork Requirements The Department will experience some increase in paperwork related to reviews in processing licensure requests and additional regulatory requirements. In general, there will not be a significant paperwork burden on providers to comply with the expanded licensure requirements.
As with fiscal impact, most of these paperwork requirements should be compared with those previously required under the CON Program. Applicants were required to submit detailed applications which, depending on the health care service proposed to be offered, could be quite lengthy and require extensive documentation.
Effective Date/Sunset Date The proposed amendments will become effective upon final publication in the Pennsylvania Bulletin.
Statutory Authority Section 803(2) of the act (35 P. S. § 448.803(2)) authorizes the Department to promulgate, after consultation with the Health Policy Board, regulations necessary to carry out the purposes and provisions of the act. Section 801.1 of the act (35 P. S. § 448.801a) provides that a purpose of the act is to promote the public health and welfare through the establishment of regulations setting minimum standards for the operation of health care facilities. The same section provides that the minimum standards are to assure safe, adequate and efficient facilities and services, and are also to promote the health, safety and adequate care of patients or residents of these facilities. These provisions, in combination with the Department's express authority under the definition of ''health care facility'' in section 802.1 of the act (35 P. S. § 448.802a) employ regulations to create new categories of health care facilities as may be required due to the emergence of new modes of health care, confer upon the Department the necessarily implied authority to employ regulations to restrict certain modes of health care services to specified health care facilities to ensure the health, safety and adequate care of patients.
Regulatory Review Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on July 3, 1997, a copy of the proposed amendments was submitted 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 proposed amendments, the Department has provided IRRC and the Committees with a copy of a detailed 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 proposed amendments, it will notify the Department by September 17, 1997 (30 days after 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 regulations, by the Department, the General Assembly and the Governor, of objections raised.
Contact Person Interested persons are invited to submit written comments, suggestions or objections to or regarding the proposed amendments within 30 days of the date of publication of this notice in the Pennsylvania Bulletin. These comments should be directed to: James T. Steele, Jr., Assistant Counsel, Department of Health, P.O. Box 90, Harrisburg, PA 17108-0090, (717) 783-2500. If you are a person with a disability, comments, suggestions or objections regarding the proposed amendments may also be submitted to Mr. Steele in alternative formats, such as by audio tape, braille or by using TDD: (717) 783-6514. If you are a person with a disability and require an alternative format of this document (that is, large print, audio tape, braille) please contact Mr. Steele so that he can make the necessary arrangements.
DANIEL F. HOFFMANN,
SecretaryFiscal Note: 10-149. (1) General Fund;
(GGO) Revenue Increased Loss Costs (2) Implementing Year 1996-97 is $750,000 $10,000 (3) 1st Succeeding Year 1997-98 is $750,000 $10,000 2nd Succeeding Year 1998-99 is $750,000 $10,000 3rd Succeeding Year 1999-00 is $750,000 $10,000 4th Succeeding Year 2000-01 is $750,000 $10,000 5th Succeeding Year 2001-02 is $750,000 $10,000 (4) Fiscal Year 1995-96 $1.9 million; Fiscal Year 1994-95 $1.5 million; Fiscal Year 1993-94 $1.2 million;
(7) General Government Operations; (8) recommends adoption.
Annex A
TITLE 28. HEALTH AND SAFETY
PART IV. HEALTH FACILITIES
Subpart [B]C. LONG TERM CARE FACILITIES
CHAPTER 201. APPLICABILITY, DEFINITIONS, OWNERSHIP AND GENERAL OPERATION ON LONG TERM CARE NURSING FACILITIES
GENERAL PROVISIONS § 201.1. Applicability.
[(a)] * * *
[(b) Except where minimum standards in this subpart are waived, an existing facility is required to meet the same standards as a facility or section constructed, converted or remodeled in the future.]
§ 201.2. [Exceptions] Requirements.
[(a) The Department may, for good reason, when the health and safety of the patients will not be endangered, grant exceptions to this subpart when the policy objective of this subpart is met. The facility shall request the exceptions in writing. The reason for granting the exceptions and the time period for the exceptions will be made in writing by the Department and incorporated as part of the permanent record of the nursing facility maintained on file in the Department. A note will be placed on the license when exceptions are granted.
(b) Exceptions may be granted to this subpart for physical plant and environment, if the facility is unable to comply because of structural features which preclude modification and if the health and safety of the patients would not be endangered.
(c) Exceptions will not be granted for a situation for which a provisional license would be appropriate or for § 201.29 (relating to patient rights).
(d) Exceptions will be granted for a fixed period of time not to exceed the expiration date of the license unless otherwise approved by the Department.]
The Department incorporates by reference Subpart B of the Federal requirements for long term care facilities, 42 CFR 483.1--483.75 (relating to requirements for long term care facilities) as licensing regulations for long term care nursing facilities with the exception of the following sections and subsections:
(1) Section 483.1 (relating to basis and scope).
(2) Section 483.5 (relating to definitions).
(3) Section 483.10(b)(5)(i)(A)(10); (c)(3)(i)(7) and (8); and (o) (relating to level A requirement: Resident rights).
(4) Section 483.12(a)(1), (b), (c)(1) and (d)(1) and (3) (relating to admission, transfer and discharge rights).
(5) Section 483.20(b)(1)(i), (4)(ii) and (iii); (c)(1)(ii), (2)--(4); and (f) (relating to resident assessment).
(6) Section 483.30(b)--(d) (relating to nursing services).
(7) Section 483.40(e) and (f) (relating to physician services).
(8) Section 483.55 (relating to dental services).
(9) Section 483.70(d)(1)(iv) and (3) (relating to physical environment).
(10) Section 483.75(e), (h) and (p) (relating to administration).
§ 201.3. Definitions.
The following words and terms, when used in this subpart, have the following meanings, unless the context clearly indicates otherwise:
Abuse--The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm or pain or mental anguish, or deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental and psychosocial well-being. This presumes that instances of abuse of all residents, even those in a coma, cause physical harm, or pain or mental anguish. The term includes the following:
(i) Verbal abuse--Any use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance, regardless of their age, ability to comprehend or disability. Examples of verbal abuse include: threats of harm; and saying things to frighten a resident, such as telling a resident that the resident will never be able to see his family again.
(ii) Sexual abuse--Includes sexual harassment, sexual coercion or sexual assault.
(iii) Physical abuse--Includes hitting, slapping, pinching and kicking. The term also includes controlling behavior through corporal punishment.
(iv) Mental abuse--Includes humiliation, harassment, threats of punishment or deprivation.
(v) Involuntary seclusion--Separation of a resident from other residents or from his room or confinement to his room (with/without roommates) against the resident's will, or the will of the resident's legal representative. Emergency or short term monitored separation from other residents will not be considered involuntary seclusion and may be permitted if used for a limited period of time as a therapeutic intervention to reduce agitation until professional staff can develop a plan of care to meet the resident's needs.
(vi) Neglect--The willful deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health.
* * * * * Activities coordinator--A person who meets one of the following requirements:
(i) Is a qualified therapeutic recreation specialist.
(ii) Has 2 years of experience in a social or recreational program, within the last 5 years, 1 year of which was full-time in a resident activities program in a health care setting.
* * * * * Administrator--An individual who is charged with the general administration of a [nursing] facility, whether or not the individual has an ownership interest in the home and whether or not the individual's functions and duties are shared with one or more other individuals. [The term applies to skilled and intermediate care facilities.] The administrator [of an intermediate care facility, a skilled nursing facility or a dual facility] shall be currently licensed and registered by the Department of State under the Nursing Home Administrators License Act (63 P. S. §§ 1101--1114.2).
* * * * * Ambulatory [patient] resident--* * *
* * * * * Authorized person to administer drugs and medications--Persons qualified to administer drugs and medications in [long term care] facilities are as follows:
* * * * * Certified Registered Nurse Practitioner (CRNP)--* * *
Charge nurse--A person designated by the facility who is experienced in nursing service administration and supervision and in areas such as rehabilitative or geriatric nursing or who acquires the preparation through formal staff development programs and who is licensed by the Commonwealth as one of the following:
* * * * * [(ii) A practical nurse who is a graduate of a Commonwealth recognized school of practical nursing or who has 2 years of appropriate experience following licensure by waiver as a practical nurse and who has achieved a satisfactory grade on a proficiency examination conducted, approved or sponsored by the United States Public Health Service. The determinations of proficiency will not apply with respect to persons initially licensed by a state or seeking initial qualifications as a practical nurse after December 31, 1977.]
[(iii)] (ii) * * *
(iii) A practical nurse who is a graduate of a Commonwealth recognized school of practical nursing or who has 2 years of appropriate experience following licensure by waiver as a practical nurse.
(iv) A practical nurse shall be designated by the facility as a charge nurse only on the night tour of duty in a facility with a census of 59 or less.
Clinical laboratory--A place, establishment or institution, organized and operated primarily for the performance of bacteriological, biochemical, hematological, microscopical, serological or parasitological or other tests by the practical application of one or more of the fundamental sciences to material originating from the human body, by the use of specialized apparatus, equipment and methods, for the purpose of obtaining scientific data which may be used as an aid to ascertain the state of health. The tests are conducted using specialized apparatus, equipment and methods, for the purpose of obtaining scientific data which may be used as an aid to ascertain the state of health. [The term includes, but is not limited to, independent, hospital, industrial, state, county and municipal laboratories and laboratory facilities operated in private offices and clinics of practitioners of the healing arts except for those issued a Certificate of Exemption.]
Clinical records--All facility records, whether or not automated, pertaining to a resident, including medical records, social records and records dealing with resident fund accounts.
* * * * * Dietitian--A person who [meets one of the following requirements:
(i) Is eligible for registration by the American Dietetic Association. To be eligible, one of the following shall be met:
(A) Coordinated undergraduate program--Completion of clinical and didactic area--Plan III or IV--conferral of the baccalaureate and endorsement of the Program Director.
(B) Dietetic internship--Baccalaureate, completion of Plan III or IV requirements, successful completion of the internship and the endorsement of the Program Director.
(C) Three year preplanned associate membership--Baccalaureate, completion of Plan III or IV requirements, two endorsements and completion of 3 years of approved experience.
(D) Master's degree--Baccalaureate and master's in dietetics or a related field, plus the completion of Plan III or IV requirements, two endorsements and 6 months' full-time--12 months' half-time--experience in the area of dietetics. A half-time graduate assistantship which includes a variety of experiences related to the practice of dietetics and which has been reviewed by the membership department will also be accepted.
(E) Doctorate--Specific requirements are available from the membership department.
(ii) Has a baccalaureate degree with major studies in food and nutrition, dietetics or food service management, has 1 year of supervisory experience in the dietetic service of a health care institution and participates annually in continuing dietetic education. An individual retaining an Associate Membership in ADA meets the educational requirements and shall have 1 year of supervisory experience. A major in food studies means that the person has at least 25 credit hours in food and nutrition, dietetics or food service management.] is either:
(i) Registered by the Commission on Dietetic Registration of the American Dietetic Association.
(ii) Has appropriate education, training or experience in identification of dietary needs, planning and implementation of dietary programs.
* * * * * [Dispenser--A practitioner or a person who is licensed in this Commonwealth to dispense drugs under the Pharmacy Act (63 P. S. §§ 390-1--390-13).]
* * * * * Drug dispensing--An act by a practitioner or a person who is licensed in this Commonwealth to dispense drugs under the Pharmacy Act (63 P. S. §§ 390-1--390-13) entailing the interpretation of an order for a drug or biological and, under that order, the proper selecting, measuring, labeling, packaging and issuance of the drug or biological for a patient or for a service unit of the facility.
[Drugs] Drug or medication--* * *
Existing facility--A long term care nursing facility or section [of a facility] thereof which was constructed and licensed as [a skilled or intermediate care facility or has been approved and is in the process of construction] such on or before July 1, 1987.
* * * * * Facility--A licensed long term care nursing facility [that provides either skilled or intermediate nursing care or both levels of care to two or more patients, who are unrelated to the nursing home administrator, for a period exceeding 24 hours] as defined in Chapter 8 of the Health Care Facilities Act (35 P. S. §§ 448.801--448.821).
* * * * * [Intermediate care--Health related care and services, above the level of room and board, provided on a regular basis to resident individuals who do not require hospital or skilled nursing care, but who, because of mental or physical condition, require the services under a plan of care supervised by licensed and qualified personnel.]
Interdisciplinary team--A team including the resident's attending physician, a registered nurse with responsibility for the resident and other appropriate staff in disciplines as determined by the resident's needs, and to the extent practicable, the participation of the resident, the resident's family or the resident's legal representative.
* * * * * [Long term care nursing facility--A facility that provides either skilled or intermediate nursing care or both levels of care to two or more patients, who are unrelated to the nursing home administrator, for a period exceeding 24 hours.]
Mantoux tuberculin skin test [(intermediate strength)--Intracutaneous] The intradermal injection of 0.1 ml of PPD--tuberculin containing 5 tuberculin units (TU), using a [26 or 27 gauge needle with a] disposable tuberculin syringe.
[Medical record practitioner--A person who meets one of the following requirements:
(i) Is eligible for certification as a registered record administrator (RRA), or an accredited record technician (ART), by the American Medical Record Association under its requirements in effect January 4, 1975.
(ii) Is a graduate of a school of medical record science that is accredited jointly by the Council on Medical Education of the American Medical Association and the American Medical Record Association.
Medication--A substance meeting one of the following qualifications:
(i) Is recognized in the official United States Pharmacopeia, or official National Formulary or a supplement to either of them.
(ii) Is intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or other animals.
(iii) Is other than food and intended to affect the structure or a function of the human body or other animal body.
(iv) Is intended for use as a component of an article specified in subparagraphs (i), (ii) or (iii), but not including devices or their components, parts or accessories.]
* * * * * Nonambulatory [patient] resident--A [patient] resident who is not physically [and] or mentally capable of getting in and out of bed and walking a normal path to safety in a reasonable period of time, including the ascent and descent of stairs, without the aid of another person.
* * * * * Nurse aide--A person who does not possess a license to practice professional or practical nursing in this Commonwealth, but has received training on the job or through other planned nursing programs [to enable him] to perform nursing care functions which do not require the skills and judgment of a professional or practical nurse[, or both].
* * * * * Nursing service personnel--Registered nurses, licensed practical nurses[,] and nurse aides [and orderlies].
* * * * * [Patient abuse--The occurrence of any of the following acts:
(i) The infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.
(ii) The willful deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health.
(iii) Sexual harassment, rape or abuse as defined in section 2 of the Protection from Abuse Act (35 P. S. § 10182) (Repealed).
Patient activities coordinator--A person who meets one of the following requirements:
(i) Is a qualified therapeutic recreation specialist.
(ii) Has 2 years of experience in a social or recreational program, within the last 5 years, 1 year of which was full-time in a patient activities program in a health care setting.
Patient or resident--A person who is admitted to a long term care nursing facility for observation, treatment or care for illness, disease, injury or other disability.]
* * * * * Prescription--A written or verbal order for drugs issued by a licensed medical practitioner in the course of his professional practice.
* * * * * Resident--A person who is admitted to a licensed long term care nursing facility for observation, treatment, or care for illness, disease, injury or other disability.
Residential unit--A section or area where persons [not requiring nursing care or nursing supervision are residing] reside who do not require long term nursing facility care.
Responsible person--A person who is not an employe of the facility and is responsible for making decisions on behalf of the [patient] resident. The person shall be so designated by the [patient] resident or the court and documentation shall be available on the [patient's medicine] resident's clinical record to this effect. An employe of the facility will be permitted to be a responsible person only if appointed the [patient's] resident's legal guardian by the court.
Restraint--[An apparatus, article, device or garment applied to a patient which interferes with the free movement of the patient and which cannot easily be removed by the patient.] A restraint can be physical or chemical. A physical restraint includes any apparatus, appliance, device or garment applied to or adjacent to a resident's body, which restricts or diminishes the resident's level of independence or freedom. A chemical restraint includes psychopharmacologic drugs that are used for discipline or convenience and not required to treat medical symptoms.
[Serious violation--An action which poses a significant threat to the health of patients.]
Skilled or intermediate nursing care--Professionally supervised nursing care and related medical and other health services provided for a period exceeding 24 hours to an individual not in need of hospitalization, but whose needs are [such that they] above the level of room and board and can only be met in a long term care nursing facility on an inpatient basis[, and who needs the care] because of age, illness, disease, injury, convalescence or physical or mental infirmity. The term includes the provision of [daily] inpatient services that are needed on a daily basis by the [patient] resident, ordered by and provided under the direction of a physician, and which require the skills of [and are furnished directly by or under the supervision of technical or] professional personnel, such as, [but not limited to,] registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech pathologists or audiologists. [The care would include skilled nursing, skilled rehabilitation or a personal care service that because of a special medical complication of the patient require that the personal care services be performed by or under the direct supervision of skilled nursing or rehabilitative personnel.]
Social worker--[A graduate of a school of social work approved by the Council on Social Work Education prior to July 1, 1975 or accredited by the Council on Social Work Education who has 1 year of social work experience in a health care setting] An individual with the following qualifications:
(i) A bachelor's degree in social work or a bachelor's degree in a human services field including sociology, special education, rehabilitation counseling and psychology.
(ii) One year of supervised social work experience in a health care setting working directly with individuals.
* * * * * [Therapeutic recreation specialists--A person licensed or registered, if applicable, by the state in which practicing, and eligible for registration as a therapeutic recreation specialist by the National Therapeutic Recreation Society--Branch of National Recreation and Park Association--under its requirements in effect on January 4, 1975.]
OWNERSHIP AND MANAGEMENT § 201.12. Application for license.
* * * * * (b) [If required by the Department, Division of Need Review, the facility shall have an approved certificate of need.
(c)] * * *
* * * * * § 201.13. Issuance of license.
(a) No person may maintain or operate a facility for skilled or intermediate care [patients] residents without first obtaining a license issued by the Department.
* * * * * (c) The required fee for a license is:
Regular Licenses (new or renewal) [$100]$250 Each inpatient bed in excess of 75 beds $2[.00]
[First] Provisional I License [100]$400 Each inpatient bed [2.00]$4 [Second] Provisional II License [200]$600 Each inpatient bed [2.00]$6 [Third] Provisional III License [300]$800 Each inpatient bed [2.00]$8 [Fourth] Provisional IV License [400]$1,000 Each inpatient bed [2.00]$10 * * * * * § 201.14. Responsibility of licensee.
* * * * * (c) The licensee [or] through the administrator shall [immediately] report [in writing] to the [Department's Long Term Care Field Office] appropriate Nursing Care Facilities field office serious incidents involving [patients] residents, including [but not limited to] the following:
(1) Deaths due to injuries, accidents or suicide.
(2) Deaths occurring in the facility or following a hospital admission, due to malnutrition [or], dehydration or sepsis.
(3) Elopements[, that is, when a patient leaves the facility without the knowledge of the facility].
(4) Transfers or admissions to hospitals as a result of injuries or accidents.
(5) Complaints of [patient] resident abuse whether or not confirmed by the facility.
(6) Temporary disruptions of services due to a disaster such as a fire, storm, flood or other interruption of services which affect the health and safety of residents. Fires, regardless of whether services are disrupted, shall be reported to the appropriate Division of Nursing Care Facilities field office.
(d) [The Department's Long Term Care Field Office shall be notified if services in the facility are temporarily disrupted due to a disaster, such as fire, storm, flood or other interruption of services which affect the health and safety of the patients. Fires, regardless of whether services are disrupted, shall be reported to the Department's Long Term Care Field Office] The administrator shall notify the Department as soon as possible within 24 hours of the incidents listed in subsection (c).
(e) Upon receipt of a strike notice, the licensee or administrator shall promptly notify the [Department's Long Term] appropriate Division of Nursing Care [Field Office] Facilities field office and keep the Department apprised of the strike status and the measures being taken to provide [patient] resident care during the strike.
* * * * * § 201.15. Restrictions on license.
* * * * * (c) [A serious violation of this subpart may result in the nonissuance, nonrenewal or revocation of a license.
(d)] A final order or determination by the Department relating to licensure may be appealed by the provider of services to the [State Health Facility Hearing Board under section 805 of the act (35 P. S. § 448.805). The issuance of a provisional license may also be appealed] Health Policy Board under section 2102(n) of The Administrative Code of 1929 (71 P. S. § 532(n)).
§ 201.16 [Change in ownership, structure or name] (Reserved).
[(a) The Department shall be notified in writing at least 90 days in advance of a potential change in ownership, licensee or name of the facility. The license is not transferable without prior approval of the Department.
(b) If a license is issued to a partnership and one or more of the partners dies, the executor or administrator of the deceased's estate, together with the surviving partner, may apply for a license. A complete list of names and addresses of the administrator and partners responsible for the management of the facility shall be submitted with the application.
(c) If a person dies who was the sole owner of a facility, the executor or administrator of the estate may apply for, and the Department may grant, a license for the facility.
(d) The terms ''hospital,'' ''medicare,'' ''Medicaid,'' ''extended care,'' ''intensive care,'' ''convalescent home,'' ''skilled nursing home,'' ''intermediate care facility'' or ''long term care nursing facility'' may not be used as a part of, or within the name of the facility, unless the facility has had prior approval by the Department that the facility is in fact providing the care.
(e) The Department shall be notified in writing if there is a transfer of stock of 5% or more. This notification shall be made within 30 days of the effective date of the change.
(f) A corporation shall file an exact copy of the articles of incorporation with the Division of Long Term Care.
(g) Copies of a fictitious name approval and a charter approval, if applicable, shall be filed with the Division of Long Term Care.]
§ 201.18. Management.
* * * * * (b) The governing body shall adopt and enforce rules relative to:
(1) The health care and safety of the [patients] residents.
(2) Protection of personal and property rights of the [patients] residents, while in the facility, and upon discharge or after death.
* * * * * (e) [The governing body shall cooperate in an effective program which provides for a regular evaluation of the patients in the facility by personnel of the Department to the extent required by the programs in which the facility participates.
(f)] The governing body shall appoint a full-time administrator who is currently licensed and registered in this Commonwealth and who is responsible for the overall management of the facility. The Department may, by exception, permit a long term care facility of 25 beds or less to share the services of an administrator in keeping with section 3(b) of the Nursing Home Administrators License Act (63 P. S. § 1103(b)). The sharing of an administrator shall be limited to two facilities. The schedule of the currently licensed administrator shall be publicly posted in each facility. The administrator's responsibilities shall include, [but not be limited to,] the following:
(1) Enforcing the regulations relative to the level of health care and safety of [patients] residents and to the protection of their personal and property rights.
* * * * * (7) Developing a written plan to assure the continuity of [patient] resident care and services in the event of a strike.
[(g) The governing body shall develop a written institutional plan that reflects the operating budget and capital expenditures plan that meets the following requirements:
(1) Provides for an annual operating budget which includes anticipated income and expenses related to items which would, under generally accepted accounting principles, be considered income and expense items. Nothing in this paragraph requires that there be prepared, in connection with a budget, an item-by-item identification of the components of each type of anticipated expenditure or income.
(2) Provides for an annual capital expenditure plan which includes and identifies in detail the anticipated sources of financing for the objectives of each anticipated expenditures related to the acquisition of land; the improvement of land, buildings and equipment; and the replacement, modernization and expansion of the buildings and equipment which would, under generally accepted accounting principles, be considered capital items.
(3) Is prepared, under the direction of the governing body of the institution, by a committee consisting of representatives of the governing body, the administrative staff and the organized medical staff of the institution, if any.
(h)] (f) A written record shall be maintained on a current basis for each [patient] resident with written receipts for personal possessions and funds received or deposited with the facility and for expenditures and disbursements made on behalf of the patient. The record shall be available for review by the patient or patient's responsible person upon request.
[(i)] (g) The governing body shall disclose, upon request, to be made available to the public, the licensee's current daily [cost] reimbursement under Blue Cross, Medical Assistance and Medicare as well as the average daily charge to other insured and noninsured private pay [patients] residents.
[(j) If] (h) When the facility accepts the responsibility for the [patient's] resident's financial affairs, the [patient] resident or [patient's] resident's responsible person shall designate, in writing, the transfer of the responsibility. [Further, the] The facility shall [establish and maintain policies and procedures that:
(1) Assure a complete written account of each patient's personal funds is given to the patient or patient's responsible person at least quarterly. A current accounting report shall be available for review upon reasonable request of the patient or patient's responsible person.
(2) Prohibit the commingling of patient funds with facility funds.
(3) Allocate investment income, if any is earned on patients' funds, to the patients' accounts.
(4) Transfer the patient's funds, in the event of the patient's death, to the patient's estate or person designated in writing by the patient.
(5) Notify the patient of the location and account number of the account; designate this account as the patient fund account at the financial institution, if one is used.
(6) Provide] provide the [patients] residents with access to their money within [7] 3 bank business days of the request and in the form--cash or check--requested by the [patient] resident.
§ 201.19. Personnel policies and procedures.
[(a) The governing body, through the administrator, is responsible for implementing and maintaining written personnel policies, procedures and job descriptions that support sound patient care and personnel practices.
(b)] Personnel records shall be kept current and available for each employe and contain sufficient information to support placement in the position to which assigned.
[(c) Written policies for control of communicable disease shall be in effect to ensure that employes with symptoms of communicable disease or infected skin lesions are not permitted to work.
(d) Incidents and accidents to patients, personnel and visitors shall be reviewed by the administrator to identify health and safety hazards and to correct or eliminate the hazards as quickly as possible.
(e) A potential employe who will work in the facility shall have a pre-employment examination to determine that the employe is free of communicable diseases in the communicable stage and is able to function in the capacity in which application is made. The physical examination shall be completed and the report shall be available within 48 hours after the employe reports for work. If the information required in this subsection was completed by a physician within the 30 days prior to the employment date, it shall be acceptable.
(f) The pre-employment physical examination shall be completed by a physician currently licensed to practice in this Commonwealth.
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