RULES AND REGULATIONS
DEPARTMENT OF HUMAN SERVICES
[ 55 PA. CODE CHS. 13, 14, 20, 2380, 2390, 2600, 2800, 3800, 4200, 4210, 4215, 4220, 4230, 4300, 4305, 4310, 6201, 6210, 6211, 6250, 6350, 6400, 6500 AND 6600 ]
Intellectual Disability Terminology Update
[46 Pa.B. 3177]
[Saturday, June 18, 2016]The Department of Human Services (Department) adopts this final-omitted rulemaking under the authority of sections 201(2), 211, 213, 443.1(2) and (3) and Articles IX and X of the Human Services Code (62 P.S. §§ 201(2), 211, 213, 443.1(2) and (3), 901—922 and 1001—1088) and sections 201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4201(2) and (8) and 4202).
Omission of Proposed Rulemaking
Notice of proposed rulemaking is omitted under section 204(3) of the act of July 31, 1968 (P.L. 769, No. 240) (45 P.S. § 1204(3)), known as the Commonwealth Documents Law (CDL), and 1 Pa. Code § 7.4(3) (relating to omission of notice of proposed rulemaking) because the Department for good cause finds that proposed rulemaking is unnecessary and that a delay in the promulgation of these amendments is contrary to the public interest. Under Federal and State law, the terminology ''intellectual disability'' has replaced the archaic and offensive terminology ''mental retardation.'' See the act of November 22, 2011 (P.L. 429, No. 105) and Rosa's Law (Pub.L. No. 111-256). Further, the affected individuals with an intellectual disability, friends and family members of affected individuals, providers of services and supports for individuals with an intellectual disability, and county mental health/intellectual disability programs support the use of the up-to-date and appropriate terms ''intellectual disability'' and ''integration'' to replace the archaic terms ''the retarded,'' ''mentally retarded,'' ''retarded person,'' ''mental retardation'' and ''normalization'' in 55 Pa. Code (relating to human services).
Purpose
The purpose of this final-omitted rulemaking is to support Pennsylvanians with an intellectual disability by updating the language in 24 chapters of 55 Pa. Code to replace the terms ''the retarded,'' ''mentally retarded,'' ''retarded person'' and ''mental retardation'' with the up-to-date and appropriate term ''intellectual disability.'' This final-omitted rulemaking also replaces the term ''normalization'' with the up-to-date and appropriate term ''integration'' in Chapter 6400 (relating to community homes for individuals with an intellectual disability).
Requirements
Various chapters of licensing, State center, mental health/intellectual disability and intellectual disability regulations used the inappropriate and outdated terminology. These chapters apply to State-operated intellectual disability centers, intellectual disability programs funded through the Office of Developmental Programs and facilities licensed by the Department. Amendments to Chapters 51, 4226 and 6200 (relating to Office of Developmental Programs home and community-based services; early intervention services; and room and board charges) are not included in this final-omitted rulemaking, because rulemakings pertaining to these chapters are concurrently moving through the regulatory process.
The correct terminology of ''intellectual disability'' is updated in Chapters 13, 14, 20, 2380, 2390, 2600, 2800, 3800, 4200, 4210, 4215, 4220, 4230, 4300, 4305, 4310, 6201, 6210, 6211, 6250, 6350, 6400, 6500 and 6600.
Affected Individuals and Organizations
This final-omitted rulemaking affects individuals with an intellectual disability, and families of these individuals, who receive funded services and supports through the Office of Developmental Programs; State-operated intellectual disability centers; providers of State and Federally-funded intellectual disability services and supports and facilities licensed by the Department.
This final-omitted rulemaking was requested by and is very important to the intellectual disability self-advocacy and advocacy communities, families, providers, local government and others, as the terms ''the retarded,'' ''mentally retarded,'' ''retarded person,'' ''mental retardation'' and ''normalization'' are offensive and archaic. In July 2015, a draft of this final-omitted rulemaking was shared with and reviewed by external stakeholders that included self-advocacy, advocacy, provider and local government organizations. External stakeholders applaud this long overdue effort to update the language in 55 Pa. Code.
Accomplishments and Benefits
This final-omitted rulemaking promotes respect, community integration and an array of opportunities for an individual with an intellectual disability by using words that are positive and up-to-date.
Fiscal Impact
There is no fiscal impact to the Commonwealth, individuals, families, advocates, providers or local government.
Paperwork Requirements
There is no increase or decrease in paperwork requirements.
Public Comment
Although this rulemaking is being adopted without publication as a proposed rulemaking, interested persons are invited to submit written comments, suggestions or objections to Julie Mochon, Human Service Program Specialist Supervisor, Office of Developmental Programs, Department of Human Services, Room 502 Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120, jmochon@pa.gov. Comments will be reviewed and considered for any subsequent revision of these regulations.
Persons with a disability who require an auxiliary aid or service may submit comments by using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
Regulatory Review Act
Under section 5.1(c) of the Regulatory Review Act (71 P.S. § 745.5a(c)), on April 14, 2016, the Department submitted a copy of the final-omitted rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House Committee on Human Services and the Senate Committee on Public Health and Welfare. On the same date, the regulations were submitted to the Office of Attorney General for review and approval under the Commonwealth Attorneys Act (71 P.S. §§ 732-101—732-506).
Under section 5.1(j.2) of the Regulatory Review Act, on May 18, 2016, the final-omitted rulemaking was deemed approved by the House and Senate Committees. Under section 5.1(e) of the Regulatory Review Act, IRRC met on May 19, 2016, and approved the final-omitted rulemaking.
Findings
The Department finds that:
(1) Notice of proposed rulemaking is omitted under section 204(3) of the CDL and 1 Pa. Code § 7.4(3) because the Department for good cause finds that proposed rulemaking is unnecessary and that a delay in the promulgation of these amendments is contrary to the public interest. The affected individuals with an intellectual disability, friends and family members of affected individuals, providers of services and supports for individuals with an intellectual disability, and county mental health/intellectual disability programs support the use of the up-to-date and appropriate term ''intellectual disability.''
(2) The adoption of this final-omitted rulemaking in the manner provider by this order is necessary and appropriate for the administration and enforcement of the Human Services Code (62 P.S. §§ 101—1503).
Order
The Department, acting under the authorizing statutes, orders that:
(a) The regulations of the Department, 55 Pa. Code Chapters 13, 14, 20, 2380, 2390, 2600, 2800, 3800, 4200, 4210, 4215, 4220, 4230, 4300, 4305, 4310, 6201, 6210, 6211, 6250, 6350, 6400, 6500 and 6600, are amended by amending §§ 13.1, 13.8, 14.1, 20.42, 2380.2, 2380.3, 2380.17, 2380.18, 2380.182, 2390.5, 2390.18, 2390.19, 2390.152, 2600.4, 2600.64, 2600.65, 2600.222, 2600.224, 2600.228, 2800.4, 2800.64, 2800.65, 2800.222, 2800.228, 3800.3, 3800.5, 3800.20, 3800.56, 4200.1, 4200.2, 4200.3, 4200.4, 4200.11, 4200.24, 4200.32, 4200.33, 4210.1, 4210.2, 4210.4, 4210.5, 4210.6, 4210.11, 4210.12, 4210.26, 4210.32, 4210.42, 4210.51, 4210.52, 4210.62, 4210.71, 4210.91, 4210.92, 4210.93, 4210.101, 4210.113, 4210.123, 4210.141, 4210.142, 4210.143, 4210.144, 4210.151, 4210.153, 4210.182, 4210.191, 4215.1, 4215.2, 4215.3, 4215.4, 4215.21, 4215.22, 4215.23, 4215.24, 4215.25, 4215.26, 4220.1, 4220.2, 4220.3, 4220.11, 4220.12, 4220.13, 4220.14, 4230.1, 4230.2, 4230.3, 4230.11, 4230.12, 4230.14, 4230.15, 4230.16, 4230.17, 4300.1, 4300.2, 4300.3, 4300.4, 4300.21, 4300.22, 4300.23, 4300.25, 4300.26, 4300.45, 4300.46, 4300.48, 4300.56, 4300.63, 4300.68, 4300.83, 4300.86, 4300.94, 4300.95, 4300.106, 4300.117, 4300.118, 4300.132, 4300.134, 4300.135, 4300.136, 4300.137, 4300.139, 4300.148, 4300.155, 4300.158, 4300.159, 4300.161, 4305.1, 4305.2, 4305.3, 4305.4, 4305.5, 4305.11, 4305.13, 4305.15, 4305.17, 4305.21, 4305.31, 4305.33, 4305.42, 4305.43, 4305.51, 4305.52, 4305.61, 4305.66, 4310.1, 4310.3, 4310.4, 4310.6, 4310.9, 4310.17, 4310.20, 6201.1, 6201.2, 6201.3, 6201.4, 6201.11, 6201.12, 6201.13, 6201.14, 6210.1, 6210.2, 6210.3, 6210.11, 6210.13, 6210.21, 6210.22, 6210.32, 6210.33, 6210.34, 6210.35, 6210.42, 6210.43, 6210.44, 6210.46, 6210.61, 6210.62, 6210.63, 6210.64, 6210.65, 6210.71, 6210.72, 6210.75, 6210.76, 6210.78, 6210.79, 6210.81, 6210.93, 6210.101, 6210.108, 6211.1, 6211.2, 6211.45, 6211.78, 6211.79, 6211.87, 6250.1, 6250.2, 6250.3, 6250.11, 6250.21, 6250.22, 6350.1, 6350.3, 6350.4, 6350.5, 6350.11, 6350.13, 6350.14, 6350.15, 6350.16, 6350.21, 6350.22, 6350.23, 6350.24, 6350.25, 6350.26, 6350.27, 6400.1, 6400.2, 6400.3, 6400.4, 6400.15, 6400.18, 6400.19, 6400.44, 6400.46, 6400.143, 6500.1, 6500.2, 6500.3, 6500.4, 6500.12, 6500.20, 6500.21, 6500.43, 6500.45, 6500.46, 6500.123, 6600.1, 6600.2 and 6600.3 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(b) The Secretary of the Department shall submit this order and Annex A to the Offices of General Counsel and Attorney General for approval as to legality and form as required by law.
(c) The Secretary of the Department shall certify and deposit this order and Annex A with the Legislative Reference Bureau as required by law.
(d) This order shall take effect upon publication in the Pennsylvania Bulletin.
THEODORE DALLAS,
Secretary(Editor's Note: See 46 Pa.B. 2919 (June 4, 2016) for IRRC's approval order.)
Fiscal Note: Fiscal Note 14-539 remains valid for the final adoption of the subject regulations.
Annex A
TITLE 55. HUMAN SERVICES
PART I. DEPARTMENT OF HUMAN SERVICES
Subpart B. RIGHTS
CHAPTER 13. USE OF RESTRAINTS IN TREATING PATIENTS/RESIDENTS § 13.1. Scope.
This chapter is applicable in institutions operated by the Department, regardless of the type of facility, patient/resident composition or services covered. Facilities covered include Youth Development Centers, Youth Forestry Camps, Restoration Centers, State general hospitals and State-operated institutions for individuals with a mental illness or an intellectual disability.
§ 13.8. Seclusion.
(a) Definition.
(1) Seclusion.
(i) The placement of a patient/resident in a locked room may be used as a therapeutic technique only.
(ii) The patient's/resident's request to spend time in a private unlocked room is not to be considered seclusion and shall be granted if feasible and not therapeutically contra indicated. Quarantine or other preventive health measures are not considered seclusion.
(iii) In mental health facilities children under 14 years of age requiring seclusion shall be continuously monitored within or just outside the seclusion area by mental health personnel, and the room shall not be locked or otherwise secured. Soft inanimate objects shall be made available to the patient to permit the venting of aggression.
(iv) Seclusion shall be used only under the following conditions:
(A) When necessary to protect the patient/resident or others from physical injury.
(B) To decrease the level of stimulation when a patient/resident is in a state of hyperactivity.
(C) When less restrictive measures and techniques have proven ineffective.
(D) Seclusion as defined in this paragraph may not be employed in a State center for individuals with an intellectual disability.
(2) Exclusion. Within mental health/intellectual disability facilities the removing of the patient/resident from his immediate environment and restricting him to another area. Exclusion shall only be employed when it is clearly documented that another less restrictive method has been unsuccessful in controlling the unacceptable behavior. Exclusion shall be limited and documented as a therapeutic technique in the resident's individual treatment plan. In mental health facilities children under 14 years of age requiring seclusion or exclusion shall be continuously monitored within or just outside the exclusion area by mental health personnel, and the room may not be locked or otherwise secured. Soft inanimate objects shall be made available to the patient to permit the venting of aggression.
(b) Procedures.
(1) In mental health facilities if a patient/resident in voluntary treatment requires seclusion, will not consent to such and requests to be discharged, this request shall be granted unless the procedures and standards of section 302 of the Mental Health Procedures Act (50 P.S. § 7302) regarding emergency involuntary treatment and § 5100.76 (relating to notice of withdrawal) are followed. Similarly, the procedures of section 405 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4405) shall be followed for persons with an intellectual disability who have been voluntarily admitted, require seclusion, and request to be discharged.
(2) In the case of mental health facilities, authority for seclusion of a patient/resident rests with the Director or his designee. In intellectual disability facilities, authority for exclusion rests with the qualified intellectual disability professional. In the case of Youth Development Centers, Youth Forestry Camps and all other Departmental institutions authority for seclusion rests with the Superintendent/Assistant Superintendent. Normally, written orders shall precede the placement of a patient/resident in seclusion or exclusion. In emergencies, telephone orders may be accepted, but an order shall be properly countersigned within the time specified by the institution. In no case, however, shall this period exceed 24 hours.
(3) An order for seclusion or exclusion is good for only 24 hours. The time the order is received shall be recorded with the order on the order sheet.
(4) In mental health/intellectual disability facilities, telephone orders are not acceptable for continued seclusion or exclusion. The patient/resident shall be seen by a physician within 24 hours, and the order shall be rewritten and supported by a progress note. In Youth Development Centers and Youth Forestry Camps, the resident/patient must be seen by the Superintendent/Assistant Superintendent who will assess the resident's/patient's needs and seek professional consultation if indicated.
(5) In the absence of a written or telephone order, a patient/resident may be placed in seclusion or exclusion as a protective measure for no more than 1 hour when the action is immediately necessary.
(6) If a patient/resident is placed in seclusion or exclusion as an emergency procedure, the unit program supervisor or appropriate designated program specialist of the area shall be notified immediately.
(7) In mental health/intellectual disability facilities, if the nursing supervisor/designated program specialist, after visiting the patient/resident, deems seclusion or exclusion necessary, the attending physician or his delegate shall be notified immediately. In Youth Development Center or Youth Forestry Camp facilities, if the designated program specialist, after visiting the patient/resident, deems seclusion necessary, the Superintendent/Assistant Superintendent shall be notified immediately.
(8) In facilities, the nursing supervisor or designated program specialist shall document his observations fully on an appropriate progress report.
(9) The following procedure is to be followed when a patient/resident is in seclusion:
(i) Potentially dangerous articles will be removed from the patient/resident. This includes articles of clothing if there are reasonable grounds to believe such clothing constitutes a substantial threat to the health or safety of the patient/resident or others.
(ii) The patient/resident will be checked at no less than 15-minute intervals by personnel.
(iii) The physical needs of the patient/resident will be given prompt response.
(iv) Concise and informative written reports concerning the status of the patient/resident will be prepared and retained in the record of the patient/resident in seclusion or exclusion. Daily written reports concerning patient/residents in seclusion or exclusion shall be prepared and sent to appropriate designated staff of the facility. These reports shall include information as follows:
(A) Identifying data concerning name, age, location in building and record number of patient/resident.
(B) Reason for seclusion or exclusion.
(C) Period of time in seclusion or exclusion.
(D) Brief statement regarding status of patient/resident.
(E) Record of time given for attention to personal needs.
CHAPTER 14. ABUSE OF PATIENTS/RESIDENTS § 14.1. Scope.
(a) Applicability. This chapter is applicable in institutions operated by the Department, regardless of the type of facility, patient/resident composition or services provided. Facilities covered include Youth Development Centers, Youth Forestry Camps, Restoration Centers, State general hospitals and State-operated institutions for individuals with a mental illness or an intellectual disability. In those institutions serving children covered by 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law) the facility shall also comply with the Departmental reporting procedures applicable to this act and the procedures of § 7084, Administrative Manual, relating to management of incidents and deaths. Nothing in this chapter may be construed to limit or affect an employee's existing appeal rights under Civil Service statutes or collective bargaining agreements.
(b) Definitions. For purposes of this chapter, Department refers to the Department of Human Services of the Commonwealth.
Subpart C. LICENSING/APPROVAL
CHAPTER 20. LICENSURE OR APPROVAL OF FACILITIES AND AGENCIES
FEES § 20.42. Amount of fees.
(a) The following fees shall be paid for a regular certificate of compliance:
Type of Facility Profit Public or Nonprofit Adult Day Care Center $15 0 Maternity Home $15 0 Community Residential
Intellectual Disability
Facility or Agency$50 0 Psychiatric Clinic $50 0 Partial Hospitalization Programs $50 0 Private Psychiatric Hospital $50 0 Vocational Facility Serving
Primarily Individuals with
Mental Illness or an Intellectual
Disability, or Both$50 0 (b) No fee is required for a facility or agency not listed in subsection (a).
(c) The fee for a provisional certificate of compliance is 1/12 of the fee for the annual certificate of compliance multiplied by the number of months for which the certificate of compliance is issued.
(d) The application fee for personal care homes applies regardless of profit or nonprofit status and is based on the number of beds licensed, as follows:
Number of Beds Fee 0—20 $15 21—50 $20 51—100 $30 101 beds and over $50
PART IV. ADULT SERVICES MANUAL
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER 2380. ADULT TRAINING FACILITIES
GENERAL PROVISIONS § 2380.2. Applicability.
(a) This chapter applies to adult training facilities, except as provided in subsection (f).
(b) This chapter contains the minimum requirements that shall be met to obtain a certificate of compliance. Each adult training facility will be inspected by the Department each year and shall obtain a certificate of compliance to operate or continue to operate.
(c) This chapter applies to profit, nonprofit, publicly-funded and privately-funded facilities.
(d) This chapter applies to adult training facilities operated on the grounds of or in a community residential rehabilitation mental health facility or a community home for individuals with an intellectual disability if permitted in accordance with Chapter 6400 (relating to community homes for individuals with an intellectual disability).
(e) This chapter applies to adult training facilities operated on the grounds of or in a non-State operated intermediate care facility for individuals with an intellectual disability, unless it is medically necessary or in the individual's best interest to remain at home.
(f) This chapter does not apply to the following:
(1) Older adult daily living centers as defined in the Older Adult Daily Living Centers Licensing Act (62 P.S. §§ 1511.1—1511.22), serving four or more adults who are 60 years of age or older or adults who are 59 years of age or younger but have a dementia-related disease, such as Alzheimer's disease, as a primary diagnosis, but serving no more than three adults with disabilities who are 59 years of age or younger and who do not have a dementia-related disease as a primary diagnosis.
(2) Vocational facilities as defined in Chapter 2390 (relating to vocational facilities).
(3) Partial hospitalization facilities as defined in Chapter 5210 (relating to partial hospitalization).
(4) Summer recreation programs, camping programs and socialization clubs.
(5) Adult day care facilities located in nursing homes that serve only individuals who live in the nursing home.
(6) Adult training facilities operated by the Department or the Department of Education.
(7) Community homes for individuals with an intellectual disability licensed in accordance with Chapter 6400 and intermediate care facilities for individuals with an intellectual disability licensed in accordance with Chapter 6600 (relating to intermediate care facilities for individuals with an intellectual disability) that provide day services in the same building in which the individuals live to individuals who remain at home because they are medically unable to attend a community day program or because it is in the individual's best interest to remain at the home.
(8) Activities occurring at a location other than the facility and the facility grounds, during the time an individual is away from the facility.
§ 2380.3. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Individual—An adult with disabilities who receives care in an adult training facility and who has developmental needs that require assistance to meet personal needs and to perform basic daily activities. Examples of adults with disabilities include adults who exhibit one or more of the following:
(i) A physical disability such as blindness, visual impairment, deafness, hearing impairment, speech or language impairment, or a physical handicap.
(ii) A mental illness.
(iii) A neurological disability such as cerebral palsy, autism or epilepsy.
(iv) An intellectual disability.
(v) A traumatic brain injury.
* * * * *
GENERAL REQUIREMENTS § 2380.17. Reporting of unusual incidents.
(a) An unusual incident is:
(1) Abuse or suspected abuse of an individual.
(2) Injury, trauma or illness requiring inpatient hospitalization, that occurs while the individual is at the facility or under the supervision of the facility.
(3) A suicide attempt by an individual.
(4) A violation or alleged violation of an individual's rights.
(5) An individual whose absence is unaccounted for, and is therefore presumed to be at risk.
(6) The misuse or alleged misuse of an individual's funds or property.
(7) An outbreak of a serious communicable disease, as defined in 28 Pa. Code § 27.2 (relating to specific identified reportable diseases, infections and conditions) to the extent that confidentiality laws permit reporting.
(8) An incident requiring the services of a fire department or law enforcement agency.
(9) A condition, except for snow or ice conditions, that results in closure of the facility for more than 1 scheduled day of operation.
(b) Written policies and procedures on the prevention, reporting, investigation and management of unusual incidents shall be developed and kept at the facility.
(c) The facility shall orally notify, within 24 hours after abuse or suspected abuse of an individual or an incident requiring the services of a fire department or law enforcement agency occurs:
(1) The county mental health and intellectual disability program of the county in which the facility is located if the individual involved in the unusual incident has mental illness or an intellectual disability.
(2) The funding agency.
(3) The appropriate regional office of the Department.
(d) The facility shall initiate an investigation of the unusual incident and complete and send copies of an unusual incident report on a form specified by the Department, within 72 hours after an unusual incident occurs, to:
(1) The county mental health and intellectual disability program of the county in which the facility is located if the individual involved in the unusual incident has mental illness or an intellectual disability.
(2) The funding agency.
(3) The appropriate regional office of the Department.
(e) At the conclusion of the investigation the facility shall send a copy of the final unusual incident report to:
(1) The county mental health and intellectual disability program of the county in which the facility is located if the individual involved in the unusual incident has mental illness or an intellectual disability.
(2) The funding agency.
(3) The appropriate regional office of the Department.
(f) A copy of unusual incident reports relating to an individual shall be kept in the individual's record.
(g) A copy of unusual incident reports relating to the facility itself, such as those requiring the services of a fire department, shall be kept.
(h) The individual's family, if appropriate, and the residential services provider, if applicable, shall be immediately notified in the event of an unusual incident relating to the individual.
§ 2380.18. Reporting of deaths.
(a) The facility shall complete and send copies of a death report on a form specified by the Department, within 24 hours after a death of an individual that occurs at the facility or while under the supervision of the facility, to:
(1) The county mental health and intellectual disability program of the county in which the facility is located if the individual had mental illness or an intellectual disability.
(2) The funding agency.
(3) The regional office of the Department.
(b) The facility shall investigate and orally notify, within 24 hours after an unusual or unexpected death occurs:
(1) The county mental health and intellectual disability program of the county in which the facility is located if the individual had mental illness or an intellectual disability.
(2) The funding agency.
(3) The regional office of the Department.
(c) A copy of death reports shall be kept in the individual's record.
(d) The individual's family, and the residential service provider, if applicable, shall be immediately notified in the event of a death of an individual.
PROGRAM § 2380.182. Development, annual update and revision of the ISP.
* * * * * (b) When an individual is not receiving services through an SCO and does not reside in a home licensed under Chapter 6400 or 6500 (relating to community homes for individuals with an intellectual disability; and family living homes), the adult training facility program specialist shall be the plan lead when one of the following applies:
* * * * *
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:
* * * * * 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.
* * * * *
GENERAL REQUIREMENTS § 2390.18. Unusual incident report.
(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.
§ 2390.19. Abuse.
(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.
PROGRAM § 2390.152. Development, annual update and revision of the ISP.
(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).
Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES
CHAPTER 2600. PERSONAL CARE HOMES
GENERAL PROVISIONS § 2600.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Appropriate assessment agency—An organization serving adults who are older or adults with disabilities, such as a county mental health/intellectual disability agency, a drug and alcohol agency, an area agency on aging or another human service agency, or an individual in an occupation maintaining contact with adults who are older and adults with disabilities, such as medicine, nursing or rehabilitative therapies.
* * * * *
STAFFING § 2600.64. Administrator training and orientation.
* * * * * (b) The standardized Department-approved administrator training course specified in subsection (a)(2) shall include the following:
* * * * * (11) Care for residents with an intellectual disability.
* * * * * § 2600.65. Direct care staff person training and orientation.
* * * * * (d) Direct care staff persons hired after April 24, 2006, may not provide unsupervised ADL services until completion of the following:
(1) Training that includes a demonstration of job duties, followed by supervised practice.
(2) Successful completion and passing the Department-approved direct care training course and passing of the competency test.
(3) Initial direct care staff person training to include the following:
(i) Safe management techniques.
(ii) ADLs and IADLs.
(iii) Personal hygiene.
(iv) Care of residents with dementia, mental illness, cognitive impairments, an intellectual disability and other mental disabilities.
* * * * * (f) Training topics for the annual training for direct care staff persons shall include the following:
(1) Medication self-administration training.
(2) Instruction on meeting the needs of the residents as described in the preadmission screening form, assessment tool, medical evaluation and support plan.
(3) Care for residents with dementia and cognitive impairments.
(4) Infection control and general principles of cleanliness and hygiene and areas associated with immobility, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration.
(5) Personal care service needs of the resident.
(6) Safe management techniques
(7) Care for residents with mental illness or an intellectual disability, or both, if the population is served in the home.
* * * * *
SERVICES § 2600.222. Community social services.
Residents shall be encouraged and assisted in the access to and use of social services in the community which may benefit the resident, including a county mental health and intellectual disability program, a drug and alcohol program, a senior citizens center, an area agency on aging or a home health care agency.
§ 2600.224. Preadmission screening.
(a) A determination shall be made within 30 days prior to admission and documented on the Department's preadmission screening form that the needs of the resident can be met by the services provided by the home.
(b) An applicant whose personal care service needs cannot be met by the home shall be referred to a local appropriate assessment agency.
(c) The preadmission screening shall be completed by the administrator or designee. If the resident is referred by a State-operated facility, a county mental health and intellectual disability program, a drug and alcohol program or an area agency on aging, a representative of the referral agent may complete the preadmission screening.
§ 2600.228. Notification of termination.
* * * * * (h) The only grounds for discharge or transfer of a resident from a home are for the following conditions:
(1) If a resident is a danger to himself or others.
(2) If the legal entity chooses to voluntarily close the home, or a portion of the home.
(3) If a home determines that a resident's functional level has advanced or declined so that the resident's needs cannot be met in the home. If a resident or the resident's designated person disagrees with the home's decision to discharge or transfer, consultation with an appropriate assessment agency or the resident's physician shall be made to determine if the resident needs a higher level of care. A plan for other placement shall be made as soon as possible by the administrator in conjunction with the resident and the resident's designated person, if any. If assistance with relocation is needed, the administrator shall contact appropriate local agencies, such as the area agency on aging, county mental health/intellectual disability program or drug and alcohol program, for assistance. The administrator shall also contact the Department's personal care home regional office.
(4) If meeting the resident's needs would require a fundamental alteration in the home's program or building site, or would create an undue financial or programmatic burden on the home.
(5) If the resident has failed to pay after reasonable documented efforts by the home to obtain payment.
(6) If closure of the home is initiated by the Department.
(7) Documented, repeated violation of the home rules.
CHAPTER 2800. ASSISTED LIVING RESIDENCES
GENERAL PROVISIONS § 2800.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Appropriate assessment agency—An organization serving adults who are older or adults with disabilities, such as a county mental health/intellectual disability agency, a drug and alcohol agency, an area agency on aging or another human service agency, or an individual in an occupation maintaining contact with adults who are older and adults with disabilities, such as medicine, nursing or rehabilitative therapies.
* * * * * Health care or human services field—Includes the following:
(i) Child welfare services.
(ii) Adult services.
(iii) Older adult services.
(iv) Mental health/intellectual disability services.
(v) Drug and alcohol services.
(vi) Services for individuals with disabilities.
(vii) Medicine.
(viii) Nursing.
(ix) Rehabilitative services.
(x) Any other human service or occupation that maintains contact with adults who are older or adults and children with disabilities.
* * * * *
STAFFING § 2800.64. Administrator training and orientation.
* * * * * (b) The standardized Department-approved administrator training course specified in subsection (a)(2) must include the following:
* * * * * (11) Care for residents with an intellectual disability.
* * * * * § 2800.65. Staff orientation and direct care staff person training and orientation.
* * * * * (g) Direct care staff persons may not provide unsupervised assisted living services until completion of 18 hours of training in the following areas:
(1) Training that includes a demonstration of job duties, followed by supervised practice.
(2) Successful completion and passing the Department-approved direct care training course and passing of the competency test.
(3) Initial direct care staff person training to include the following:
(i) Safe management techniques.
(ii) Assisting with ADLs and IADLs.
(iii) Personal hygiene.
(iv) Care of residents with mental illness, neurological impairments, an intellectual disability and other mental disabilities.
* * * * * (i) Training topics for the annual training for direct care staff persons must include the following:
(1) Medication self-administration training.
(2) Instruction on meeting the needs of the residents as described in the assessment tool, medical evaluation and support plan.
(3) Care for residents with dementia, cognitive and neurological impairments.
(4) Infection control and general principles of cleanliness and hygiene and areas associated with immobility, such as prevention of decubitus ulcers, incontinence, malnutrition and dehydration.
(5) Assisted living service needs of the resident.
(6) Safe management techniques.
(7) Care for residents with mental illness or an intellectual disability, or both, if the population is served in the residence.
* * * * *
SERVICES § 2800.222. Community social services.
Residents shall be encouraged and assisted in the access to and use of social services in the community which may benefit the resident, including a county mental health and intellectual disability program, a drug and alcohol program, a senior citizens center, an area agency on aging or a home health care agency.
§ 2800.228. Transfer and discharge.
* * * * * (h) The only grounds for transfer or discharge of a resident from a residence are for the following conditions:
(1) If a resident is a danger to himself or others and the behavior cannot be managed through interventions, services planning or informed consent agreements.
(2) If the legal entity chooses to voluntarily close the residence, or a portion of the residence.
(3) If a residence determines that a resident's functional level has advanced or declined so that the resident's needs cannot be met in the residence under § 2800.229 (relating to excludable conditions; exceptions) or within the scope of licensure for a residence. In that case, the residence shall notify the resident and the resident's designated person. The residence shall provide justification for the residence's determination that the needs of the resident cannot be met. In the event that there is no disagreement related to the transfer or discharge, a plan for other placement shall be made as soon as possible by the administrator in conjunction with the resident and the resident's designated person, if any. If assistance with relocation is needed, the administrator shall contact appropriate local agencies, such as the area agency on aging, county mental health/intellectual disability program or drug and alcohol program, for assistance. The administrator shall also contact the Department.
* * * * *
PART V. CHILDREN, YOUTH AND FAMILIES MANUAL
Subpart E. RESIDENTIAL AGENCIES, FACILITIES AND SERVICES
ARTICLE I. LICENSING/APPROVAL
CHAPTER 3800. CHILD RESIDENTIAL AND DAY TREATMENT FACILITIES
GENERAL PROVISIONS § 3800.3. Exemptions.
This chapter does not apply to the following:
(1) Child residential and child day treatment facilities operated directly by the Department.
(2) Transitional living residences which are located in freestanding private residences.
(3) Residential camps for children who are enrolled in a grade or educational level higher than kindergarten which operate for fewer than 90 days per year.
(4) Residential children's schools which are licensed and operated solely as private academic schools or registered and operated solely as nonpublic nonlicensed schools by the Department of Education.
(5) Foster care homes that are licensed under Chapter 3700 (relating to foster family care agency).
(6) Family living homes for children with an intellectual disability that are licensed under Chapter 6500 (relating to family living homes).
(7) Community homes for individuals with an intellectual disability that provide care to both children and adults in the same facility and that are licensed under Chapter 6400 (relating to community homes for individuals with an intellectual disability).
(8) Community residences for individuals with mental illness that provide care to both children and adults in the same facility or community residential host homes for individuals with mental illness that are certified under Chapter 5310 (relating to community residential rehabilitation services for the mentally ill).
(9) Drug and alcohol residential facilities that provide care exclusively to residents whose sole need is the treatment of drug and alcohol dependence and that are licensed under 28 Pa. Code Chapters 701, 704 and 709 (relating to general provisions; staffing requirements for drug and alcohol treatment activities; and standards for licensure of freestanding treatment facilities).
(10) Child day care facilities certified or registered under Chapter 3270, 3280 or 3290 (relating to child day care centers; group child day care homes; and family child day care homes).
(11) Private homes of persons providing care to a relative, except homes in which children live with their own children but no other relative, unless the home is a transitional living residence that is exempt from this chapter under paragraph (2).
§ 3800.5. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Child—An individual who meets one of the following conditions:
(i) Is under 18 years of age.
(ii) Is under 21 years of age and committed an act of delinquency before reaching 18 years of age and remains under the jurisdiction of the juvenile court.
(iii) Was adjudicated dependent before reaching 18 years of age and while engaged in instruction or treatment, requests the court to retain jurisdiction until the instruction or treatment is completed, but a child may not remain in a course of instruction or treatment past 21 years of age.
(iv) Has an intellectual disability, a mental illness or a serious emotional disturbance, with a transfer plan to move to an adult setting by 21 years of age.
* * * * *
GENERAL REQUIREMENTS § 3800.20. Confidentiality of records.
(a) The facility shall comply with the following statutes and regulations relating to confidentiality of records, to the extent applicable:
(1) 23 Pa.C.S. §§ 6301—6386 (relating to Child Protective Services Law).
(2) 23 Pa.C.S. §§ 2101—2938 (relating to Adoption Act).
(3) The Mental Health Procedures Act (50 P.S. §§ 7101—7503).
(4) Section 602(d) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4602(d)).
(5) The Confidentiality of HIV-Related Information Act (35 P.S. §§ 7601—7612).
(6) Sections 5100.31—5100.39 (relating to confidentiality of mental health records).
(7) Sections 3490.91—3490.95 (relating to confidentiality).
(8) Other applicable statutes and regulations.
(b) The following confidentiality requirements apply unless in conflict with the requirements of applicable statutes and regulations specified in subsection (a):
(1) A child's record, information concerning a child or family, and information that may identify a child or family by name or address, is confidential and may not be disclosed or used other than in the course of official facility duties.
(2) Information specified in paragraph (1) shall be released upon request only to the child's parent, the child's guardian or custodian, if applicable, the child's and parent's attorney, the court and court services, including probation staff, county government agencies, authorized agents of the Department and to the child if the child is 14 years of age or older. Information may be withheld from a child if the information may be harmful to the child. Documentation of the harm to be prevented by withholding of information shall be kept in the child's record.
(3) Information specified in paragraph (1) may be released to other providers of service to the child if the information is necessary for the provider to carry out its responsibilities. Documentation of the need for release of the information shall be kept in the child's record.
(4) Information specified in paragraph (1) may not be used for teaching or research purposes unless the information released does not contain information which would identify the child or family.
(5) Information specified in paragraph (1) may not be released to anyone not specified in paragraphs (2)—(4), without written authorization from the court, if applicable, and the child's parent and, if applicable, the child's guardian or custodian.
(6) Release of information specified in paragraph (1) may not violate the confidentiality of another child.
STAFFING § 3800.56. Exceptions for staff qualifications.
(a) The staff qualification requirements specified in §§ 3800.53(c), 3800.54(d), 3800.55(g) and 3800.283(1) do not apply to staff persons hired or promoted to the specified positions prior to October 26, 1999.
(b) For facilities previously certified under Chapter 5310 or 6400 (relating to community residential rehabilitation services for the mentally ill; and community homes for individuals with an intellectual disability), the age requirements specified in § 3800.55(h) (relating to child care worker) do not apply to staff persons hired, or counted in the worker to child ratio, prior to October 26, 1999.
PART VI. MENTAL HEALTH/INTELLECTUAL DISABILITY/AUTISM MANUAL
Subpart C. ADMINISTRATION AND FISCAL MANAGEMENT
CHAPTER 4200. COUNTY BOARD AND PROGRAM ADMINISTRATION
GENERAL PROVISIONS § 4200.1. Purpose.
The purpose of this chapter is to specify requirements for the county mental health and intellectual disability board and the county mental health and intellectual disability administrator.
§ 4200.2. Applicability.
This chapter applies to county mental health/intellectual disability (MH/ID) programs.
§ 4200.3. Legal base.
The legal authority for this chapter is section 201(2) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4201(2)).
§ 4200.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act—The Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101—4704).
Administrator—The county mental health and intellectual disability administrator appointed by the local authorities.
Board—The county mental health and intellectual disability board appointed by the local authorities.
County—A county or a first class city.
Department—The Department of Human Services of the Commonwealth.
Facility—A mental health establishment, hospital, clinic, institution, center, day care center or other organizational unit, or part thereof, which is devoted primarily to the diagnosis, treatment, care, rehabilitation or detention of individuals with a mental disability.
Intellectual disability—Subaverage general intellectual functioning which originates during the developmental period and is associated with impairment of maturation, learning or social adjustment.
Local authorities—The county commissioners of a county, or the city councils and the mayors of first class cities, or two or more of these acting in concert.
Mental disability—A mental illness, mental impairment, intellectual disability, or mental deficiency, which so lessens the capacity of a person to use his customary self-control, judgment and discretion in the conduct of his affairs and social relations as to make it necessary or advisable for him to be under care as provided in the act. The term includes conditions and terms heretofore defined as ''mental retardation,'' ''insanity,'' ''unsoundness of mind,'' ''lunacy,'' ''mental disease,'' ''mental disorder,'' ''feebleminded,'' ''moron,'' ''idiot'' and ''imbecile.'' The term does not include senility, unless mental illness or intellectual disability is superimposed.
Nurse—A person licensed by the State Board of Nursing to engage in the practice of professional nursing within the meaning of The Professional Nurse Law (63 P.S. §§ 211—225.5).
Physician—A physician licensed to practice in this Commonwealth.
Program—A mental health and intellectual disability program established by the local authorities and includes a complex of services providing a continuum of care in the community for the mentally disabled.
Psychiatrist—A physician who by years of study, training and experience has achieved professional recognition and standing in the field of psychiatry.
Psychologist—A person who by years of study, training and experience has achieved professional recognition and standing in the field of clinical psychology.
Secretary—The Secretary of the Department.
Social worker—A person who by years of study, training, and experience has achieved professional recognition and standing in the field of social work.
CONSTITUTION OF THE BOARD § 4200.11. Single county board.
Except in counties of the first class where the board will be appointed, and members will hold office under the provisions of the city charter, the local authorities of a county shall appoint a board which must consist of 13 resident members constituted as follows:
(1) One representative of the board of county commissioners.
(2) At least two physicians and, when possible, one shall be a psychiatrist and the other a pediatrician.
(3) There shall be appropriate representation drawn from the following groups:
(i) The professional fields of psychology, social work, nursing, education and religion.
(ii) Local citizens' organizations active in the field of mental health.
(iii) Local citizens' organizations active in the field of intellectual disability.
(iv) Local health and welfare planning organizations.
(v) Local general hospitals.
(vi) Community groups whose membership represents the economically, socially, and culturally disadvantaged.
(4) Appropriate representation shall be deemed to mean representation approved by the Secretary and shall include the following:
(i) At least two representatives from paragraph (3)(i).
(ii) At least one representative from paragraph (3)(ii) and (iii).
(iii) At least one from either paragraph (3)(iv) or (v).
(iv) At least one, two when possible, from paragraph (3)(vi).
DUTIES TO THE BOARD § 4200.24. Powers and duties.
The board shall have the power and its duty shall be:
(1) To review and evaluate mental health and intellectual disability needs, services, facilities, and special problems in relation to the local health and welfare needs, services and programs.
(2) Except in cities of the first class, to recommend to local authorities not less than two persons for the position of administrator. Persons shall meet the standards of professional skill and experience as defined in § 4200.33 (relating to qualifications).
(3) To develop, together with the administrator, annual plans for the program.
(4) To make recommendations to the local authorities regarding the program and other matters relating to mental health and intellectual disability services in the county, including purchase of service, contracts and funds required to implement the program.
(5) To review performance under the program and to recommend a system of program evaluation. The system of program evaluation recommended by the board, in accordance with this section, will be on file with the administrator, the local authorities, and the Department.
(6) To perform other functions as required.
ADMINISTRATOR § 4200.32. Powers and duties.
The administrator shall have the power and his duty shall be:
(1) To administer the program.
(2) To insure that mental health and intellectual disability services required by the act are available.
(3) To attend board meetings and to provide staff services to the board.
(4) To make reports to the Department in form and containing the information as may be required.
(5) To develop, together with the board annual plans for the program.
(6) To submit to local authorities annual plans and estimated costs for the provision of service, establishment and operation of facilities, and other related matters for review, approval and transmittal to the Department.
(7) To review and evaluate facilities and to cooperate with the Department in the maintenance of established standards.
(8) To maintain liaison with governmental and private community health and welfare agencies and organizations and State-operated facilities.
(9) To submit an annual report to the local authorities, the board and the Department reporting the activities of the program and his administration thereof.
(10) To analyze and evaluate mental health and intellectual disability needs and services in the county and recommend improvements to the board and local authorities, conduct research studies and take steps and adopt measures as are necessary for the proper discharge of his duties.
(11) To designate a competent person on his staff to act for him during his absence.
(12) To designate facilities for the purposes of the act or as places of reception.
(13) To perform other functions as required.
§ 4200.33. Qualifications.
The minimum requirements for the position of the administrator shall be 5 years' progressively responsible experience in fields as medicine, clinical psychology, social work, sociology, nursing, public health, education, hospital administration or public administration including 3 years' experience in the planning, development, or administration of mental health or intellectual disability services, and a bachelor's degree from an accredited college or university, supplemented by graduate study to the level of a master's degree. Appropriate experience may be substituted for the required graduate study on a year for year basis.
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