[46 Pa.B. 3177]
[Saturday, June 18, 2016]
[Continued from previous Web Page]
CHAPTER 6211. ALLOWABLE COST REIMBURSEMENT FOR NON-STATE OPERATED INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY
GENERAL PROVISIONS § 6211.1. Purpose.
This chapter specifies the requirements for MA reimbursement and allowable costs for non-State operated intermediate care facilities for individuals with an intellectual disability.
§ 6211.2. Applicability.
(a) This chapter applies to non-State operated intermediate care facilities for persons with an intellectual disability and non-State operated intermediate care facilities for persons with other related conditions.
(b) The following chapters apply to non-State operated intermediate care facilities for persons with an intellectual disability and non-State operated intermediate care facilities for persons with other related conditions: Chapters 1101 and 6210 (relating to general provisions; and participation requirements for the intermediate care facilities for the intellectual disability program).
(c) In addition to this chapter, the Medicare Provider Reimbursement Manual (HIM-15) applies for costs that are included in this chapter as allowable and for reimbursable costs that are not specifically addressed in this chapter.
(d) If this subchapter is inconsistent with Chapter 6210 or HIM-15, this chapter prevails.
REIMBURSEMENT § 6211.45. Disclosure.
(a) If costs have been allocated between programs and supporting services, disclosure shall be made in accordance with generally accepted accounting principles.
(b) If the facility is a controlling organization, disclosure of the affiliate existence and its relationship to the established intermediate care facility for individuals with an intellectual disability shall be made, including the nature of any financial transaction between the affiliate and the facility.
ALLOWABLE COSTS § 6211.78. Staff development and training costs.
(a) Costs associated with staff development and training costs are allowable if the training and development is associated with the individual program goals and objectives of the intermediate care facilities for the intellectual disability program.
(b) Staff development and training costs are allowable in accordance with intermediate care facilities for individuals with an intellectual disability certification requirements.
§ 6211.79. Depreciation allowance.
* * * * * (n) The reasonable cost of depreciation will be recognized for the construction and renovation of buildings to meet applicable Federal, State or local laws and building codes for intermediate care facilities for individuals with an intellectual disability. Costs are allowable if the facility has either a certificate of need or a letter of nonreviewability for the project from the Department of Health under subsection (r)(1) and (2). In accordance with Federal and State regulations, the facility shall submit to the Department the certificate of need or letter of nonreviewability, as appropriate, or the provider will not receive reimbursement for interest on capital indebtedness, depreciation and operating expenses.
(o) If the purchase of a facility or improvements to the facility are financed by tax exempt bonds, the acquired property, plant or equipment shall be capitalized and depreciated over the life of the assets. The acquired property, plant or equipment are the only items that may be capitalized. If the principal amount of the bond issue was expended in whole or in part on capital assets that fail to meet the requirements of the subsections (m) and (n) regarding eligibility for depreciation, the includable depreciation will be proportionately reduced.
(p) The fixed asset records shall include all of the following:
(1) The depreciation method used.
(2) A description of the asset.
(3) The date the asset was acquired.
(4) The cost of the asset.
(5) The salvage value of the asset.
(6) The depreciation cost.
(7) The estimated useful life of the asset.
(8) The depreciation for the year.
(9) The accumulated depreciation.
(q) Effective July 1, 1984, for non-State ICF/ID providers, the funding of depreciation is recommended so that funds may be available for the acquisition and future replacement of assets by the facility. To qualify for treatment as a funded depreciation account, the funds shall be clearly designated in the provider's records as funded depreciation accounts and shall be maintained in accordance with the provisions of HIM-15.
* * * * * § 6211.87. Return on equity.
(a) The Department will not contribute to a return on equity for proprietary intermediate care facility for individuals with an intellectual disability programs.
(b) Excess funds shall be returned to the Department within 6 months from the close of an audit or cost settlement determination.
CHAPTER 6250. COMMITMENT AND ADMISSION PROCEDURES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY
GENERAL PROVISIONS § 6250.1. Purpose.
The purpose of this chapter is to specify commitment and admission procedures for individuals with an intellectual disability.
§ 6250.2. Applicability.
This chapter applies to State Intellectual Disability Centers and Intellectual Disability Units at State Mental Health Hospitals.
§ 6250.3. Legal base.
The legal authority for this chapter is Goldy v. Beal (C. A. No. 75—191, M. D. Pa., October 28, 1976) and section 201(2) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4201(2)).
INVOLUNTARY COMMITMENT PROCEDURES § 6250.11. Determination.
Until new legislation is enacted, and becomes effective, commitments of adults with an intellectual disability under section 406 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4406) may be processed provided that the Secretary of Human Services, his agents and assigns, those under his direction, and all facility directors may not receive a person committed under section 406 of the Mental Health and Intellectual Disability Act of 1966 except upon judicial determination that the standards in this section are met: A person shall be determined to be an individual with an intellectual disability in need of residency placement only upon the following findings:
(1) The person is impaired in adaptive behavior to a significant degree and is functioning at an intellectual level two standard deviation measurements below the norm as determined by acceptable psychological testing techniques.
(2) The impairment and the resultant disability were manifested before the person's 18th birthday and are likely to continue for an indefinite period.
(3) The person, because of his intellectual disability, presents a substantial risk of physical injury to himself or physical debilitation as demonstrated by behavior within 30 days of the petition which shows that he is unable to provide for, and is not providing for his most basic need for nourishment, personal and medical care, shelter, self-protection and safety and that provision for such needs is not available and cannot be developed or provided in his own home or in his own community without residential placement.
ADMISSION PROCEDURES FOR JUVENILES § 6250.21. Admission procedures.
(a) All juveniles 18 years of age and younger to be admitted to an institution must be referred from a recognized medical facility, intellectual disability therapist, pediatrician, general physician, or psychologist.
* * * * * § 6250.22. Notice.
Juveniles aged 13 and older shall be given the following notice:
RIGHTS OF CHILDREN UNDER
SECTIONS 402 AND 403 OF THE MENTAL HEALTH
AND INTELLECTUAL DISABILITY ACT OF 1966* * * * *
Subpart D. NONRESIDENTIAL AGENCIES/FACILITIES/SERVICES
ARTICLE II. FUNDING
CHAPTER 6350. FAMILY RESOURCE SERVICES
GENERAL PROVISIONS § 6350.1. Introduction.
The Family Resource Services (FRS) Program is designed to offer a variety of services to the family which has a family member with an intellectual disability living within the community, as well as to individuals with an intellectual disability who reside in community settings. The intent of the FRS Program is to reduce the need for institutionalization. The primary purpose of the FRS Program is:
(1) To provide adequate resources within the community to enable the family with a family member with an intellectual disability to maintain that member at home with minimal stress or disruption to the family unit.
(2) To provide adequate resources within the community to enable the individual with an intellectual disability to remain in a family context in a community setting, thus leading as normal a life as possible.
§ 6350.3. Applicability.
This chapter applies to county mental health and intellectual disability programs.
§ 6350.4. Legal base.
The legal authority for this chapter is sections 201, 301, 305, 506 and 509 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4201, 4301, 4305, 4506 and 4509).
§ 6350.5. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise.
Community Living Arrangements (CLA)—Apartments, group homes, developmental maximation units and foster homes.
Department—The Department of Human Services.
Family—A family exists in the following situations:
(i) Natural or adoptive parents who provide care for their child or adult with an intellectual disability in the home of the parents.
(ii) Foster parents who care for their child or adult with an intellectual disability in the home of the foster parents.
(iii) Related or unrelated persons who provide care for a child or adult with an intellectual disability within their home.
Family aid—A ''sitter-type'' service offered to parents who need a person to care for their family member with an intellectual disability for a few hours at a time.
Family education training—Programs offered to assist parents of a child or adult with an intellectual disability, individual with an intellectual disability who are parents, spouses and siblings or other family members in dealing appropriately with a family member with an intellectual disability. This may include education/training in family dynamics, parent-child relationships, behavior management, genetic counseling, family planning, or other type of program designed to maintain the family as a cohesive unit.
Homemaker services—Homemakers may be available to perform essential household duties when family members or individuals are unable to manage such tasks effectively. This type of service may be to maintain continuity of care of an individual with an intellectual disability within the home during a family illness or similar circumstance or to provide training in proper home management for the individual with an intellectual disability or his family or legal guardian with whom he resides.
Independent residence—Individuals with an intellectual disability who are residing in the community, usually in their own home or apartment, who are able to pay for their own room, board, and clothing-type expenses.
Individual—A child or adult who is deemed to have an intellectual disability by the county mental health/intellectual disability administrator responsible for the county in which the individual resides. The evaluation process for an intellectual disability shall be in compliance with the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §§ 4101—4704).
In-home therapy—This service insures that the family member with an intellectual disability will receive necessary treatment or therapy even when he is homebound. These therapies include but are not necessarily limited to the following:
(i) Visiting nurses.
(ii) Physical/occupational therapy.
(iii) Speech/language therapy/audiology.
(iv) Visual/mobility therapy.
(v) Vocational therapy.
(vi) Recreational therapy.
(vii) Dental hygienics.
(viii) Behavioral programming.
Recreation/leisure time activities—Services that allow the individual with an intellectual disability to experience normal community leisure time activities and increase his ability to participate more independently in similar activities.
Respite care—A temporary residence available to an individual with an intellectual disability when his family or legal guardian with whom he is residing is experiencing stress, personal crisis, or a need for a vacation.
Special innovative services—All services/opportunities considered for Family Resource Services (FRS) funding under this category must have written approval by the appropriate Department regional office prior to implementation. The expenditures for all services/opportunities funded under this category by a given County Mental Health/Intellectual Disability (MH/ID) Office may not exceed 10% of the total FRS allocation for that county office.
State centers—Residential facilities owned and operated by the Department for the care and treatment of individuals with an intellectual disability.
PROGRAM COSTS § 6350.11. Funding.
(a) Funding of the Family Resource Services (FRS) Program is based upon the 90% State/10% county matching formula.
(b) FRS funds may be utilized only to pay for eligible services.
(c) FRS funds may not be utilized to subsidize regular day programs, such as vocational, educational, day care.
(d) FRS funds may not be utilized to cover the direct costs of staff salaries; however, an agency which is program-funded by the County Mental Health/Intellectual Disability (MH/ID) Office to provide FRS-eligible services may include the costs of staff salaries in its charges to the County MH/ID Office for the provision of those services for which it is program-funded.
§ 6350.13. Collection of costs.
Payment for and collection of costs for Family Resource Services (FRS) Program services shall be made with county procedures consistent with section 506 of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4506).
§ 6350.14. Charges.
The charges to clients and legally responsible relatives shall not exceed the verified going rate for similar services to persons without a disability. In those situations in which no local prevailing fee exists, costs of such services may be negotiated between the County Mental Health/Intellectual Disability (MH/ID) Program and the service provider. The difference between the actual cost and liability, if any, shall be borne by the County MH/ID Program.
§ 6350.15. Liability insurance for service providers.
Liability insurance for providers of services funded through the Family Resource Services Program is handled under current Department policy which covers the issue of liability insurance for the provision of community-based mental health and intellectual disability services.
§ 6350.16. Waiver option.
(a) The Department's regional directors for the office of developmental programs may, in special situations, waive specific provisions within this chapter which govern the Family Resource Services (FRS) Program when an identified need for an FRS-eligible service cannot be met because of a restriction imposed by this chapter. This waiver option does not apply to Chapter 4305 (relating to liability for community mental health and intellectual disability services).
(b) The request for a waiver of a provision of this chapter shall be consistent with the philosophy and intent of the FRS Program and shall relate to an FRS-eligible service.
(c) The County Mental Health/Intellectual Disability (MH/ID) Administrator shall submit a written request to the appropriate Department's regional commissioner for intellectual disability to have a specific provision of this chapter waived for a specific situation.
(d) The written request shall include documentation which explains why it is necessary to have a provision of this chapter waived.
(e) The request shall be for a specific situation and involve a specific person or group of persons to be served for a specific period of time.
(f) The Department's regional commissioner for the office of developmental programs shall submit to the county mental health and intellectual disability administrator written notification of the approval or disapproval of the request for a waiver prior to the implementation of the service.
(g) Copies of requests and decisions related to the waiver option shall be submitted to the central office of developmental programs for review.
SERVICE AREAS § 6350.21. Respite care.
(a) The Family Resource Services (FRS) funds shall be made available for respite care services at the following places:
(1) The home or place of residence of an individual with an intellectual disability.
(2) The home of a family that the county mental health and intellectual disability office has approved. The ''host'' family may offer respite care to no more than two individuals with an intellectual disability at one time.
(3) If the individual with an intellectual disability is in need of medical care and supervision, an approved medical facility such as a general hospital or nursing home may be utilized. For a facility to be used for respite care, the county mental health and intellectual disability office or its designate shall document the medical needs of the individual with an intellectual disability, and the county mental health and intellectual disability administrator shall give approval of the placement in the medical facility of the individual with an intellectual disability.
(b) FRS funds may not be used to pay for respite care in the following situations:
(1) State centers for individuals with an intellectual disability. The county mental health and intellectual disability program is not responsible for paying for the care of individuals with an intellectual disability who are permanently or temporarily residing in State centers.
(2) County residential facilities which are not licensed by Chapter 6400 (relating to community homes for individuals with an intellectual disability).
(c) Allowable time periods for respite care are as follows:
(1) Respite care shall be considered relief care lasting between 24 hours and 4 weeks.
(2) Respite care for any individual shall not exceed 4 weeks within a given fiscal year, that is, July 1 of a given year through June 30 of the following year.
(d) Respite care is provided only for the individual with an intellectual disability family member and does not include caring for siblings who do not have an intellectual disability.
§ 6350.22. Family aid.
(a) This service shall provide relief lasting less than 24 hours in any one time period. This resource is available to families who previously have not been able to obtain ''sitter'' type service because the family member has an intellectual disability.
(b) Each family aide shall be approved by the county mental health and intellectual disability office after successful completion of a training program before working as a family aide.
(1) A portion of Family Resources Services (FRS) money may be set aside for basic training for those persons who will function as family aides.
(2) Follow-up training must be provided no less than once a year.
(3) The family aides may be paid while attending training sessions.
(4) The training program must be approved by the county mental health and intellectual disability office.
(c) If the county mental health and intellectual disability office contracts with another agency to provide this service, the following applies:
(1) The agency shall provide a training program approved by the County MH/ID Office.
(2) Each family must provide the Base Service Unit with information necessary for determining liability.
(d) Family aides should be recruited and screened.
(e) A list of approved aides will be kept in the County MH/ID Office or its designee, or both.
(f) Families must contact the County MH/ID Office, Base Service Unit, or the contracting agency to request the service. Unless the County MH/ID Office or its designate has made the appropriate arrangements, the family aide will not be eligible to receive payment with FRS funds.
(g) The family aide will be responsible for the care of every family member left in his charge. If any siblings are to be cared for other than the individual with an intellectual disability, the aide must be so advised before being given the assignment. The County MH/ID Office or its designate will determine the additional charge, if any, for the care of other siblings.
(h) At the end of each care period, the aide must submit to the County MH/ID Office or its designate a written report which should include remarks about any significant events, incidents, and the like, that occurred during the care period and which may prove beneficial to other aides when and if the family receives FRS in the future. Such reports must be treated within the context of the rules of confidentiality and privacy so as to protect the rights of the service recipients.
(i) Aides may not accept gifts from families for whom they are providing family aid.
(j) The maximum time allowed for family aid service will be 24 hours per session. This may be overnight but shall not exceed the maximum time limit.
(k) A recommended maximum of four sessions should be allowed per family per month. This may be adjusted by the County MH/ID Office based on individual needs and resources at a given time.
(l) This service shall not take the place of day programming for the individual with an intellectual disability.
(m) Family aid shall not be provided daily unless authorized in writing by the County MH/ID Administrator.
(n) Family aid can be provided in the home or place of residence of the individual with an intellectual disability, or the home of a family that the County MH/ID Office has approved.
(o) If there is an expressed need, this service should be made available on a group as well as an individual basis within a home or appropriate facility.
§ 6350.23. Homemaker services.
(a) The primary functions of homemaker services are to provide adult care and supervision for individuals with an intellectual disability and other members of the family within the home when the adults regularly responsible are unable to provide them, and to provide training in proper home management. The homemaker not only provides personal care but also insures that regular daily homemaking and housekeeping tasks are performed. These services are also available to adults with an intellectual disability who are living independently in the community.
(b) The homemaker's responsibilities may include, but are not limited to, any combination of the following:
(1) Household chores, such as cleaning, cooking, meal planning, laundry, ironing, and marketing.
(2) Personal care of dependent children—not limited to the family member with an intellectual disability.
(3) Budgeting or money management, or both.
(4) Instructing the family members or the individual with an intellectual disability, or both, in how to perform homemaking duties more effectively and efficiently.
(c) The homemaker will be given, in writing, a list of specific responsibilities before an assignment.
(d) The homemaker may assume live-in responsibilities if there is no other responsible adult who is able to care for the dependent children during the evening and night. This is allowable only if the homemaker is providing daytime duties within the same household. An example of this type of service would be a single parent who has no close relative and the parent is hospitalized, one parent is hospitalized and the other parent is out-of-town, or the parents are unable to care for the needs of their dependent children. The homemaker would then provide direct service, day and night, as well as instruction.
(e) The homemaker must be assigned for a specific period of time for specific duties and responsibilities:
(1) The initial time period may not be for more than 1 month. A mandatory 2-week interval must be observed for evaluation purposes prior to any extension of this service.
(2) All requests for extension must be evaluated by the Base Service Unit and approved in writing by the County Mental Health/Intellectual Disability (MH/ID) Administrator with a copy to the regional commissioner for the office of developmental programs.
(3) For an extension after 6 weeks from the beginning of the service, the County MH/ID Office must document the lack of feasibility of other alternatives. Specific goals must be determined, and reasonable time limits necessary to meet them must be established.
(f) A homemaker is not to be used for babysitting purposes only. This precludes the assignment of a homemaker, on an ongoing basis, to care for an individual with an intellectual disability while the adult family members work. A family aide may be assigned intermittently to a family for that purpose. Neither service should take the place of a ''day program'' for the individual with an intellectual disability.
§ 6350.24. Inhome therapy.
(a) This service should be available when the family member with an intellectual disability must receive therapy or a nonpublic school program in his own home. It insures the family that the family member with an intellectual disability will receive important treatment or therapy even in the event that he is ''homebound.'' This service is primarily directed to those individuals with an intellectual disability who have multiple disabilities or significant medical needs, or both. Except in unusual circumstances, it should not be utilized when the individual with an intellectual disability is capable of leaving his home to receive such needed therapy.
(1) Visiting nurses/related inhome medical therapy is an acceptable inhome therapy service. This service may include professional or paraprofessional personnel who perform such tasks as:
(i) Assisting the parents with special medically related problems and training these parents to perform these functions when possible.
(ii) Tube feeding, respiration control (oxygen), other special feeding techniques.
(iii) Administering medication.
(iv) Exercising.
(v) Dietetics.
(vi) Other medical treatment as directed by the physician.
(vii) General health care.
(viii) Caring for the convalescing individual with an intellectual disability after he has been hospitalized.
(2) Only a registered nurse or a licensed practical nurse may perform or direct inhome medical therapy.
(3) Inhome medical therapy will be paid for only if a physician has, in writing, prescribed the specific services required.
(4) The physician's written prescription must be available to the Base Service Unit and the County Mental Health/Intellectual Disability (MH/ID) Office.
(b) Physical/occupational therapy services may be vital to the individual with an intellectual disability and a physical disability whose family, because of these disabilities, will need additional assistance in physical care and in basic self-care skills development. This service not only will help the individual with an intellectual disability to be self-sufficient but will also provide relief to other family members.
(1) The following eligible persons are listed in order of priority:
(i) Persons who are ''homebound'' and not able to go out of the home for therapy.
(ii) Persons who are attending a day program where no formal physical or occupational therapy is provided.
(iii) Persons who have had a minimal amount of physical and occupational therapy, but professional evaluation indicates that the person needs a more consistent program than has been available.
(2) A licensed physical therapist must perform or direct physical therapy. A registered occupational therapist must perform or direct occupational therapy.
(3) Physical therapy or occupational therapy will be paid for only if a physician has, in writing, either documented the need for or prescribed a specific therapy program.
(4) The written therapy prescription and program plan must be available to the Base Service Unit and the County MH/ID Office.
(5) Responsible family members must receive instruction and be a part of the therapy program.
(6) If an individual with an intellectual disability is of school age, the public school system should provide the therapy service when it is a part of the person's individual prescriptive educational plan.
(c) Speech/language therapy/audiology services are acceptable Family Resource Service (FRS) Programs.
(1) The ''eligible persons'' listed in subsection (b)(1) apply equally to speech/language therapy/audiology.
(2) To be eligible, the individual with an intellectual disability must have been examined by a certified or certification-eligible audiologist for possible hearing deficiencies or a certified or certification-eligible speech therapist who have recommended a formal speech/language/audiology program. The ensuing program must be professionally prescribed and directed.
(3) A written program, including short- and long-range goals, must be available to both the Base Service Unit and the County MH/ID Office.
(4) There must be evidence of involvement of responsible family members in the speech/language/audiology program.
(5) If the individual with an intellectual disability is of school age, the public school system should provide this service.
(d) Visual/mobility therapy (training) service may be vital to the individual with an intellectual disability and a severe visual impairment, who because of these disabilities, is unable to navigate around his place of residence or in the community.
(1) The ''eligible persons'' listed in subsection (b)(1) apply equally to visual/mobility therapy (training).
(2) To be eligible, the individual with an intellectual disability must have been examined by a physician to determine the extent of visual impairment and to document the need for visual/mobility therapy (training).
(3) A trained mobility specialist/instructor must evaluate the individual with an intellectual disability and a visual impairment and develop a written visual/mobility training program plan specific to the service recipient.
(4) A trained mobility specialist/instructor must perform the visual/mobility therapy (training).
(5) The written therapy program plan, including short- and long-range goals, must be available to the Base Service Unit and the County MH/ID Office.
(6) There must be evidence of involvement by responsible family members in the visual/mobility training program.
(7) If an individual with an intellectual disability is of school age, the public school system should provide this service.
(e) Vocational therapy consists of the provision of vocationally oriented services in the home of an individual with an intellectual disability to help the individual with an intellectual disability become more self-sufficient, progress to an out-of-home setting, or maintain vocational skills previously acquired.
(1) The following are eligible persons for inhome vocational therapy:
(i) Persons who are engaged in community vocational programs but are temporarily ''homebound'' while convalescing from an illness, accident, or are receiving medical treatment related to a chronic handicapping condition.
(ii) Persons who are not currently engaged in a community vocational habilitation program and who are indefinitely ''homebound'' due to the severity of their mental or physical handicap. These persons could benefit from vocational services:
(A) To enhance their self-worth and self-sufficiency within the homebound situation.
(B) To assess their vocational potential and develop their social/vocational functioning to the point that they can enter an out-of-home vocationally-oriented setting.
(2) For eligible persons to participate inhome vocational therapy, the following procedures must be followed:
(i) There must be a written physician's statement that the person's medical condition permits him to participate in homebound employment and which includes an estimate of the time needed for convalescence.
(ii) There must be a written individual habilitation plan for the homebound work prepared and implemented by the community vocational program in which the person has been participating.
(iii) The written program must be available to the Base Service Unit and the County MH/ID Office.
(3) Homebound employment may be funded for an initial interval of 2 months. Extensions, in intervals of 2 months, or less, may also be funded, provided that a medical statement indicates the person may not yet return to the vocational program in the community. Homebound employment may not be utilized beyond the point when the individual with an intellectual disability is capable of leaving his home to participate in an out-of-home vocational program.
(4) There should be evidence that the family supports the homebound employment program in terms of available work space and time in the home but does not do the work for the individual with an intellectual disability.
(5) For eligible persons to participate in inhome vocational therapy:
(i) The individual with an intellectual disability must be evaluated initially by a qualified vocational evaluator who recommends an inhome vocational therapy program.
(ii) There must be evidence, preferably a physician's statement, that the person cannot participate in a vocational program at an out-of-home setting due to the severity of his mental or physical handicap with an estimate of the duration of the homebound state.
(iii) There must be an individual inhome vocational therapy plan prepared and directed by a recognized community vocational habilitation program.
(iv) Except in unusual circumstances, as determined by the County MH/ID Office, there should be evidence within the individual's program plan that the inhome program will result in the individual eventually entering an out-of-home vocationally oriented setting.
(v) This written program plan must be available to the Base Service Unit and the County MH/ID Office.
(vi) Quarterly status reports must be submitted to the Base Service Unit and County MH/ID Office as part of the program plan implementation.
(vii) Vocational therapy for eligible persons may be funded for an initial interval of 6 months).
(viii) The initial vocational evaluation in the home may also be funded through the FRS Program. Extensions, in intervals of 3 months or less, may also be funded, provided that the quarterly program status report indicates that extended service is an integral part of the individual's vocational habilitation plan.
(f) Recreational therapy/therapeutic recreation is for individuals with an intellectual disability who, due to the severity of their mental or physical handicap, or both, may be deprived of having their minimal socio-recreative needs met because of their homebound state and, consequently, may be showing signs of psycho-social regression or physical atrophy, or both.
(1) Inhome recreational therapy services may only be made available to those individuals with an intellectual disability who are ''homebound.''
(2) Recreational therapy/therapeutic recreation services should be provided or directed by an individual with training in recreation or an allied human services field. Appropriate training may be obtained from a formal academic education as well as participation in seminars, workshops, inservice training programs, and the like.
(3) Inhome recreational therapy services may be paid for through the FRS Program provided that the services result from a goal-oriented recreational therapy plan for the individual service recipient with an intellectual disability. This program plan must include the following:
(i) A statement which defines the needs of the individual with an intellectual disability for inhome recreational therapy service.
(ii) A statement of short- and long-term goals which serve as the rationale for the recreational therapy program.
(iii) A general description of the program.
(4) The written plan for the recreational therapy program must be available to the Base Service Unit and the County MH/ID Office.
(5) Responsible family members must receive instruction in and be a part of the recreational therapy program.
(g) Professional inhome dental hygiene services may be made available to those individuals with an intellectual disability who because of the mental or physical disabilities, or both, are ''homebound.''
(1) Only those inhome dental hygiene services provided by a dentist or licensed dental hygienist are eligible for FRS funding.
(2) The dental hygiene program must be approved by the County MH/ID Office.
(3) A copy of the dental hygiene treatment plan/program must be available to the Base Service Unit and the County MH/ID Office.
(4) Responsible family members must receive instruction in and be a part of the approved dental hygiene program.
(h) Behavioral programming and other related services may be provided through the FRS Program with the provision that they are consistent with the general intent of the FRS Program and the specific inhome therapy guidelines.
§ 6350.25. Family education/training.
(a) Family education/training services may be made available to parents of a child or adult with an intellectual disability, to individuals with an intellectual disability who are parents, and to spouses and siblings or other family members to assist them in dealing appropriately with a family member with an intellectual disability. Programs under this service may include education/training in family dynamics, parent/child relationships, behavior management, genetic counseling, family planning, or any other type of program designed to maintain the family as a cohesive unit.
(b) Family education training services may be funded through the Family Resource Services (FRS) Program provided that they are consistent with the following criteria:
(1) The nature and purpose of the training program must be consistent with the intent of the FRS Program.
(2) All education/training programs funded through the FRS Program must be approved by the County Mental Health/Intellectual Disability (MH/ID) Office.
(c) The County MH/ID Administrator has the following options in providing family education/training through the FRS Program:
(1) The education/training program may be provided directly through the County MH/ID Office.
(2) It may be provided indirectly by purchasing the education/training service from another individual or agency vendor.
(3) The education/training program may be provided indirectly by paying on a fee-for-service basis the charges incurred by a service recipient's participation in a family education/training program approved, but not sponsored directly, by the County MH/ID Office.
(d) FRS funds may be used to pay for education/training programs designed for families who have family members with an intellectual disability within the home as well as individuals with an intellectual disability who are parents. FRS funds may not be used to pay for inservice or staff training programs. Other resources should be utilized for those programs.
(e) FRS funds should be used for family education/training programs when all other applicable funding sources have been eliminated.
§ 6350.26. Recreation/leisure-time activities.
(a) Recreation programs should allow the individual with an intellectual disability to experience regular community leisure-time activities, increase his ability to participate in these activities independently, and enhance his physical or psycho-social development, or both.
(b) It is important that the individual with an intellectual disability is given every opportunity to interact with nonrelated people in the mainstream of activity within the community. The following eligible situations are listed in order of priority and should be considered when funding recreation programs through the Family Resource Services (FRS) Program:
(1) The individual with an intellectual disability is integrated into regular community facilities and programs, that is, the individual with an intellectual disability participates in a regular program designed for individuals without an intellectual disability.
(2) The individual with an intellectual disability is in a segregated program but in existing community facilities intended for the general population and where individuals without an intellectual disability are recreating at the same time, such as, a summer recreation program designed specifically for a group of individuals with an intellectual disability which takes place on a community playground where individuals without an intellectual disability are also recreating.
(3) The individual with an intellectual disability is in segregated programs in existing community facilities intended for the general population but regular recreation programs are not scheduled at the same time, such as, a scout troop with membership limited to individuals with an intellectual disability may hold its functions in a community facility during times when individuals without an intellectual disability are not scheduled to participate in programs at the facility.
(4) Special facilities and programs within the community serving only individuals with disabilities are used for recreation purposes, such as, a sheltered workshop which operates an evening recreation program.
(5) Segregated recreation programs are provided in isolated areas outside of the community which do not allow any socially integrative opportunities, such as, recreation programs designed for individuals with an intellectual disability living within the community which take place on State center grounds.
(c) The County Mental Health/Intellectual Disability (MH/ID) Office may arrange for or provide recreation services/opportunities which may be funded through the FRS Program preferably on a fee-for-service basis:
(1) Existing community recreation services should be utilized whenever they are available, such as, YMCA, municipal recreation programs, community parks and pools, and the like.
(2) Private agencies or organizations that serve only individuals with a disability, such as United Cerebral Palsy, The Arc, Easter Seal, and the like, should operate FRS funded programs only when alternatives are not and cannot be readily available.
(3) The charges for these services/opportunities should generally be based upon the number of persons served in the recreational program and shall include the cost of facilities, equipment, supplies, and staff; however, to assure maximum benefit for the individual service recipient, blanket program funding allocated to agencies or organizations for the provision of recreational services/opportunities must be considered the exception rather than the rule.
(d) Recreation programs should be ancillary to day programs which operate daily during the week.
(1) Evening programs which operate during the week, Monday through Friday.
(2) Day or evening programs which operate on Saturdays and Sundays.
(3) Day recreational services/opportunities may be provided for adults with an intellectual disability who are currently unemployed. This provision must be secondary to full day programming.
(4) Day or evening recreational services/opportunities may be provided during periods of time in which the individual with an intellectual disability is on vacation from employment or school.
(e) Programs must be recreational in nature. They should not take the place of educational programs but may substitute for family aid services.
(f) Recreational programs should encourage skill development, be designed to meet the socio-recreative needs of the individual, and be normal leisure-time activities, such as, bowling, swimming, dancing, camping.
(g) Each recreational program must be approved by the County MH/ID Office as being therapeutic for the service recipient.
(h) Whenever possible, the participants should assist in deciding on particular activities within the program. Services/opportunities designed for adults must provide for client involvement in the selection of activities.
(i) FRS funded recreation programs may not be a part of a regular day program. A portion of a day program—day care or vocational—may not be paid for with FRS recreation funds even though part of the day program provides recreational opportunities.
(j) FRS funds may be used for individual activities as well as for group recreation programs.
(k) Rationale for the use of FRS funds to pay for the service recipient's participation in individual or group recreational programs, or both, must be consistent with the overall FRS Program philosophy.
(l) The participation of service recipients in FRS funded individual or group recreation programs must be approved by the County MH/ID Office as being therapeutic for the individual service recipient.
(m) ''Therapeutic'' is defined here as that which is designed to meet the specific socio-recreative needs of the individual service recipient in the context of socially acceptable norms.
§ 6350.27. Special innovative services.
It is recognized that there may be instances in which a given County MH/ID Office may discover an unmet need for the provision of a new, innovative service/opportunity for individuals with an intellectual disability living in a community setting or for families who have a family member with an intellectual disability living within the home, and such a service/opportunity may not be specifically defined in this chapter. Such services/opportunities may only be funded through the Family Resources Services (FRS) Program if they meet the following criteria:
(1) The new, innovative program must conform to and be consistent with the definition and intent of the FRS Program.
(2) The new, innovative program must not contain provisions which are contradictory to any of the provisions specified in the existing FRS Program service areas as defined in this chapter.
(3) All services/opportunities considered for FRS funding under this category must have written approval by the appropriate Department's DHS regional office prior to implementation.
(4) The expenditures for all services/opportunities funded under this category by a given County MH/ID Office may not exceed 10% of the total FRS annual allocation for the County MH/ID Office.
Subpart E. RESIDENTIAL AGENCIES/FACILITIES/SERVICES
ARTICLE I. LICENSING/APPROVAL
CHAPTER 6400. COMMUNITY HOMES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY
GENERAL PROVISIONS § 6400.1. Introduction.
This chapter is based on the principle of integration and the right of the individual with an intellectual disability to live a life that is as close as possible in all aspects to the life which any member of the community might choose. For the individual with an intellectual disability who requires a residential service, the design of the service shall be made with the individual's unique needs in mind so that the service will facilitate the person's ongoing growth and development.
§ 6400.2. Purpose.
The purpose of this chapter is to protect the health, safety and well-being of individuals with an intellectual disability, through the formulation, implementation and enforcement of minimum requirements for the operation of community homes for individuals with an intellectual disability.
§ 6400.3. Applicability.
(a) This chapter applies to community homes for individuals with an intellectual disability, except as provided in subsection (f).
(b) This chapter contains the minimum requirements that shall be met to obtain a certificate of compliance. A certificate of compliance shall be obtained prior to operation of a community home for individuals with an intellectual disability.
(c) This chapter applies to profit, nonprofit, publicly funded and privately funded homes.
(d) Each home serving nine or more individuals shall be inspected by the Department each year and shall have an individual certificate of compliance specific for each building.
(e) Each agency operating one or more homes serving eight or fewer individuals shall have at least a sample of its homes inspected by the Department each year. The certificate of compliance issued to an agency shall specify the location and maximum capacity of each home the agency is permitted to operate.
(f) This chapter does not apply to the following:
(1) Private homes of persons providing care to a relative with an intellectual disability.
(2) Residential facilities operated by the Department.
(3) Intermediate care facilities for individuals with an intellectual disability licensed by the Department in accordance with Chapter 6600 (relating to intermediate care facilities for individuals with an intellectual disability).
(4) Foster family care homes licensed by the Office of Children, Youth and Families of the Department that serve only foster care children.
(5) Summer camps.
(6) Facilities serving exclusively personal care home, drug and alcohol, mental health or domiciliary care residents.
(7) Residential homes for three or fewer people with an intellectual disability who are 18 years of age or older and who need a yearly average of 30 hours or less direct staff contact per week per home.
(8) Child residential facilities which serve exclusively children, which are regulated under Chapter 3800 (relating to child residential and day treatment facilities).
(g) This chapter does not measure or assure compliance with other applicable Federal, State and local statutes, regulations, codes and ordinances. It is the responsibility of the home to comply with other applicable laws, regulations, codes and ordinances.
§ 6400.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Agency—A person or legally constituted organization operating one or more community homes for people with an intellectual disability serving eight or fewer individuals.
Community home for individuals with an intellectual disability (home)—A building or separate dwelling unit in which residential care is provided to one or more individuals with an intellectual disability, except as provided in § 6400.3(f) (relating to applicability). Each apartment unit within an apartment building is considered a separate home. Each part of a duplex, if there is physical separation between the living areas, is considered a separate home.
* * * * * Individual—An individual with an intellectual disability who resides, or receives residential respite care, in a home and who is not a relative of the owner of the home.
Intellectual disability—Subaverage general intellectual functioning which originates during the developmental period and is associated with impairment of one or more of the following:
(i) Maturation.
(ii) Learning.
(iii) Social adjustment.
Outcomes—Goals the individual and individual's plan team choose for the individual to acquire, maintain or improve.
* * * * *
GENERAL REQUIREMENTS § 6400.15. Self-assessment of homes.
(a) The agency shall complete a self-assessment of each home the agency operates serving eight or fewer individuals, within 3 to 6 months prior to the expiration date of the agency's certificate of compliance, to measure and record compliance with this chapter.
(b) The agency shall use the Department's licensing inspection instrument for the community homes for individuals with an intellectual disability regulations to measure and record compliance.
(c) A copy of the agency's self-assessment results and a written summary of corrections made shall be kept by the agency for at least 1 year.
§ 6400.18. Reporting of unusual incidents.
(a) An unusual incident is abuse or suspected abuse of an individual; injury, trauma or illness of an individual requiring inpatient hospitalization; suicide attempt by an individual; violation or alleged violation of an individual's rights; an individual who is missing for more than 24 hours or who could be in jeopardy if missing at all; alleged misuse or misuse of individual funds or property; outbreak of a serious communicable disease as defined in 28 Pa. Code § 27.2 (relating to specific identified reportable diseases, infections and conditions); an incident requiring the services of a fire department or law enforcement agency; and any condition that results in closure of the home for more than 1 day.
(b) Written policies and procedures on the prevention, reporting, investigation and management of unusual incidents shall be developed and kept at the home.
(c) The home shall orally notify the county intellectual disability program of the county in which the home is located, the funding agency and the appropriate regional office of the Department, 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.
(d) The home 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 to the county intellectual disability program of the county in which the home is located, the funding agency and the appropriate regional office of the Department, within 72 hours after an unusual incident occurs.
(e) The home shall send a copy of the final unusual incident report to the county intellectual disability program of the county in which the home is located, the funding agency and the appropriate regional office of the Department at the conclusion of the investigation.
(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 home itself, such as those requiring the services of a fire department, shall be kept.
(h) The individual's family or guardian shall be immediately notified in the event of an unusual incident relating to the individual, if appropriate.
§ 6400.19. Reporting of deaths.
(a) The home shall complete and send copies of a death report on a form specified by the Department to the county intellectual disability program of the county in which the home is located, the funding agency and the regional office of the Department, within 24 hours after a death of an individual occurs.
(b) The home shall investigate and orally notify the county intellectual disability program of the county in which the home is located, the funding agency and the appropriate regional office of the Department within 24 hours after an unusual or unexpected death occurs.
(c) A copy of death reports shall be kept in the individual's record.
(d) The individual's family or guardian shall be immediately notified in the event of a death of an individual.
STAFFING § 6400.44. Program specialist.
* * * * * (c) A program specialist shall have one of the following groups of qualifications:
(1) A master's degree or above from an accredited college or university and 1 year work experience working directly with individuals with an intellectual disability.
(2) A bachelor's degree from an accredited college or university and 2 years work experience working directly with individuals with an intellectual disability.
(3) An associate's degree or 60 credit hours from an accredited college or university and 4 years work experience working directly with individuals with an intellectual disability.
§ 6400.46. Staff training.
* * * * * (e) Program specialists and direct service workers shall have training in the areas of intellectual disability, the principles of integration, rights and program planning and implementation, within 30 calendar days after the day of initial employment or within 12 months prior to initial employment.
* * * * *
INDIVIDUAL HEALTH § 6400.143. Refusal of treatment.
(a) If an individual refuses routine medical or dental examination or treatment, the refusal and continued attempts to train the individual about the need for health care shall be documented in the individual's record.
(b) If an individual has a serious medical or dental condition, reasonable efforts shall be made to obtain consent from the individual or substitute consent in accordance with applicable law. See section 417(c) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4417(c)).
CHAPTER 6500. FAMILY LIVING HOMES
GENERAL PROVISIONS § 6500.1. Introduction.
Family living is based on the importance of enduring and permanent relationships as the foundation for learning life skills, developing self-esteem and learning to exist in interdependence with others; the opportunity for each individual with an intellectual disability to grow and develop to their fullest potential; the provision of individualized attention based on the needs of the individual with an intellectual disability; and the participation of the individual with an intellectual disability in everyday community activities. Family living offers an opportunity for an individual with an intellectual disability and a family to share their lives together.
§ 6500.2. Purpose.
The purpose of this chapter is to protect the health, safety and well-being of individuals with an intellectual disability, through the formulation, implementation and enforcement of minimum requirements for family living homes.
§ 6500.3. Applicability.
(a) This chapter applies to family living homes, except as provided in subsection (f).
(b) This chapter contains the minimum requirements that shall be met to obtain a certificate of compliance. A certificate of compliance shall be obtained prior to an individual with an intellectual disability living or receiving respite care in a family living home.
(c) This chapter applies to profit, nonprofit, publicly funded and privately funded family living homes.
(d) Each agency administering one or more family living homes shall have at least a sample of their homes inspected by the Department each year. Each new family living home administered by an agency shall be inspected by the Department prior to an individual with an intellectual disability living or receiving respite care in the home. The certificate of compliance issued to an agency shall specify the location and maximum capacity of each family living home.
(e) A family living home that is not administered by an agency will be inspected by the Department each year.
(f) This chapter does not apply to the following:
(1) Private homes of persons providing care to a relative with an intellectual disability.
(2) A community home for individuals with an intellectual disability licensed by the Department in accordance with Chapter 6400 (relating to community homes for individuals with an intellectual disability).
(3) A foster family care home licensed by the Office of Children, Youth and Families of the Department that serves only foster care children.
(4) A home serving exclusively personal care home, drug and alcohol, mental health or domiciliary care residents.
(5) A home providing room and board for one or two people with an intellectual disability who are 18 years of age or older and who need a yearly average of 30 hours or less direct training and assistance per week per home, from the agency, the county intellectual disability program or the family.
(6) A home providing 90 or fewer calendar days of respite care per calendar year.
§ 6500.4. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Family living home or home—
(i) The private home of an individual or a family in which residential care is provided to one or two individuals with an intellectual disability, except as provided in § 6500.3(f) (relating to applicability).
(ii) The term does not include a home if there are more than two individuals, including respite care individuals, living in the home at any one time who are not family members or relatives of the family members.
(iii) If relatives of the individual live in the home, the total number of people living in the home at any one time who are not family members or relatives of the family members may not exceed four.
ISP—Individual Support Plan—The comprehensive document that identifies services and expected outcomes for an individual.
Individual—
(i) A person with an intellectual disability who resides, or receives residential respite care, in a family living home and who is not a relative of the owner of the family members.
(ii) The term does not include family members.
Intellectual disability—Subaverage general intellectual functioning which originates during the developmental period and is associated with impairment of one or more of the following:
(i) Maturation.
(ii) Learning.
(iii) Social adjustment.
Outcomes—Goals the individual and individual's plan team choose for the individual to acquire, maintain or improve.
* * * * *
GENERAL REQUIREMENTS § 6500.12. Waivers.
A waiver of a specific section, subsection or paragraph of this chapter may be requested by writing to the appropriate Deputy Secretary of the Department. A waiver will be considered if the following criteria are met.
(1) The waiver does not jeopardize the health, safety or well-being of any of the individuals in the home.
(2) The waiver is based on the best interests and needs of the individuals.
(3) Noncompliance with the regulation is of greater benefit to the individuals than compliance with the regulation.
(4) There is an alternative method for meeting the intent of the regulation.
(5) There are special circumstances that make this home different from other homes complying with the regulation.
(6) The waiver does not violate any other State regulation or statute.
(7) The waiver is not requested for §§ 6500.1—6500.4 (relating to general provisions).
§ 6500.20. Reporting of unusual incidents.
(a) An unusual incident is abuse or suspected abuse of an individual; injury, trauma or illness of an individual requiring inpatient hospitalization; suicide attempt by an individual; violation or alleged violation of an individual's rights; an individual who is missing for more than 24 hours or could be in jeopardy if missing at all; misuse or alleged misuse of individual funds or property; outbreak of a serious communicable disease as defined in 28 Pa. Code § 27.2 (relating to specific identified reportable diseases, infections and conditions); or an incident requiring the services of a fire department or law enforcement agency.
(b) Written policies and procedures on the prevention, reporting, investigation and management of unusual incidents shall be kept.
(c) Oral notification of the county intellectual disability program of the county in which the home is located, the funding agency if applicable, and the appropriate regional office of the Department shall be given 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.
(d) An investigation of the unusual incident shall be initiated and an unusual incident report shall be completed on a form specified by the Department. Copies of the unusual incident report shall be sent to the county intellectual disability program of the county in which the home is located, the funding agency if applicable, and the appropriate regional office of the Department, within 72 hours after an unusual incident occurs.
(e) A copy of the final unusual incident report shall be sent to the county intellectual disability program of the county in which the home is located, the funding agency if applicable, and the appropriate regional office of the Department at the conclusion of the investigation.
(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 home itself, such as those requiring the services of a fire department, shall be kept.
(h) The individual's family or guardian shall be immediately notified in the event of an unusual incident relating to the individual, if appropriate.
§ 6500.21. Reporting of deaths.
(a) A death report shall be completed on a form specified by the Department and sent to the county intellectual disability program of the county in which the home is located, the funding agency and the regional office of the Department, within 24 hours after a death of an individual occurs.
(b) An investigation shall be initiated and oral notification of the county intellectual disability program of the county in which the facility is located, the funding agency and the appropriate regional office of the Department shall be given within 24 hours after an unusual or unexpected death occurs.
(c) A copy of death reports shall be kept.
(d) The individual's family or guardian shall be immediately notified of the death of an individual.
STAFFING § 6500.43. Family living specialist.
* * * * * (e) A family living specialist shall have one of the following groups of qualifications:
(1) A master's degree or above from an accredited college or university and 1 year work experience working directly with persons with an intellectual disability.
(2) A bachelor's degree from an accredited college or university and 2 years work experience working directly with persons with an intellectual disability.
(3) An associate's degree or 60 credit hours from an accredited college or university and 4 years work experience working directly with persons with an intellectual disability.
(4) A high school diploma or general education development certificate and 6 years work experience working directly with persons with an intellectual disability.
§ 6500.45. Training.
(a) The adult family member who will have primary responsibility for caring for and providing services to the individual shall have at least 24 hours of training related to intellectual disability, family dynamics, community participation, individual service planning and delivery, relationship building and the requirements specified in this chapter, prior to an individual living in the home.
(b) The primary caregiver shall be trained by an individual certified as a trainer by a hospital or other recognized health care organization, in first aid and Heimlich techniques prior to an individual living in the home and annually thereafter.
(c) The primary caregiver shall be trained and certified by an individual certified as a trainer by a hospital or other recognized health care organization, in cardiopulmonary resuscitation, if indicated by the medical needs of the individual, prior to the individual living in the home and annually thereafter.
§ 6500.46. Annual training.
(a) The adult family member who will have primary responsibility for caring for and providing services to the individual shall have at least 24 hours of training in the human services field annually.
(b) A family living specialist who is employed by an agency for more than 40 hours per month shall have at least 24 hours of training related to intellectual disability and the requirements specified in this chapter annually.
HEALTH § 6500.123. Refusal of treatment.
(a) If an individual refuses routine medical or dental examination or treatment, the refusal and continued attempts to train the individual about the need for health care shall be documented in the individual's record.
(b) If an individual has a serious medical or dental condition, reasonable efforts shall be made to obtain consent from the individual or substitute consent in accordance with applicable law. See section 417(c) of the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § 4417(c)).
CHAPTER 6600. INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY § 6600.1. Purpose.
This chapter protects the health, safety and well-being of residents living in intermediate care facilities for individuals with an intellectual disability.
§ 6600.2. Applicability.
This chapter applies to a residential facility receiving intermediate care facilities for individuals with an intellectual disability monies.
§ 6600.3. Requirements.
The Department incorporates by reference 53 FR 20494 (June 3, 1988) codified at 42 CFR 483.400—483.480 (relating to conditions of participation for intermediate care facilities for individuals with intellectual disabilities) as the licensing regulations for intermediate care facilities for individuals with an intellectual disability.
[Pa.B. Doc. No. 16-1054. Filed for public inspection June 17, 2016, 9:00 a.m.]
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