6 Pa. Code | Title 6 Pa. Code — Aging

Part I Department of Aging

Chapter 3 Fair Hearings and Appeals

6 Pa. Code § 3.1 Purpose, scope and authority.

(a) This chapter sets forth a system of appeals and fair hearings which apply to grievances or complaints about services and activities funded by the Department.

(b) Provisions in this chapter include the following subjects:

(1) Parties who may request a fair hearing.

(2) Types of decisions or actions which are appealable.

(3) Procedures for filing complaints, appeals or requests for hearings.

(4) Procedures that area agencies on aging and the Department will follow for appeals and fair hearings.

(c) This chapter is adopted under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12) and in conformity with the Older Americans Act of 1965 (42 U.S.C.A. § § 3001—3057g) and 45 CFR Part 1321 (relating to grants for state and community programs on aging) to assure the continued eligibility of the Commonwealth and its political subdivisions for Federal grants-in-aid.

(d) Except where inconsistent with the procedures set forth in this chapter, appeals and hearings shall be governed by the rules set forth in 1 Pa. Code Part II (relating to general rules of administrative practice and procedure).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.2 Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise: Adverse action—An action or a decision not to act which directly affects an individual or organization who may disagree with the action and may wish to appeal it. Examples of adverse actions include all of the following:

(i) A decision by the Department to disapprove an area plan.

(ii) A decision by the Department to deny an eligible applicant’s request for designation as a planning and service area.

(iii) A decision by an area agency on aging not to award a contract to a service provider who has applied to provide a service under an area plan.

(iv) A decision by an area agency on aging to deny, reduce or terminate services under an area plan to an individual applicant. Applicant—In proceedings involving applications for permission or authorization which the Department, an area agency on aging, or a service provider may give under statutory or other authority delegated to it, the parties who make the applications or on whose behalf the applications are made. The term includes any recipient of, or applicant for, services available under an area plan. Area agency on aging—The single local agency designated within each planning and service area by the Department to develop and administer the delivery of a comprehensive and coordinated plan of social and other services and activities for older persons. Area plan—The plan submitted to the Department by an area agency on aging describing the methods by which it will ensure a coordinated and comprehensive system of social and other services and activities for older persons in the planning and service area. Department—The Department of Aging. Hearing—A proceeding as defined under 1 Pa. Code § 31.3 (relating to definitions). Planning and service area—The geographic unit within this Commonwealth, as designated by the Secretary, for the allocation of funds for the delivery of social services to older persons residing in that unit. Secretary—The Secretary of the Department. Service provider—An entity which provides, or intends to provide, services under an agreement with an area agency on aging.

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.3 Opportunities for appeals and fair hearings.

The Department provides the opportunity for a fair hearing to all of the following:

(1) Any Area Agency on Aging when the Department proposes to:

(i) Disapprove the area plan or plan amendment submitted by the Area Agency on Aging; or

(ii) Withdraw the agency’s designation as an Area Agency on Aging.

(2) Any applicant eligible for designation as a planning and service area whose application is denied.

(3) Any service provider whose application to provide services under an area plan is denied or whose subgrant or contract agreement is terminated or not renewed.

(4) Any applicant for, or recipient of, services provided under an area plan who has been denied a service, excluded from a service or terminated from a service.

This section cited in 6 Pa. Code § 3.5 (relating to informal complaints); and 6 Pa. Code § 3.6 (relating to request for a formal hearing).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.4 Notice of adverse action.

(a) The Department, Area Agencies on Aging, and service providers under area plans will provide written notice of any adverse action they have decided to take to the agency or person who will be directly affected by the decision.

(b) The notice of adverse action will be given in a timely manner and in no event will the notice be given more than 30 days after the decision has been made.

(d) The notice will advise the party affected by the decision of all the following:

(1) The decision may be appealed in accordance with the procedures set forth in this chapter.

(2) If an appeal is to be made it must be filed within 30 days following the receipt of the notice of adverse action.

(3) In the case of an appeal by an applicant for, or recipient of, services under an area plan, the Area Agency on Aging will, if requested, provide assistance in filing the appeal.

(e) Copies of all notices of adverse action shall be retained by the issuing agency and shall, where applicable, be made a part of the evidence taken in informal complaint proceedings and formal hearings.

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.5 Informal complaints.

(a) General requirement. Prior to arranging for any formal hearings on complaints or appeals, the Department will require all parties appealing under § 3.3 (relating to opportunities for appeals and fair hearings) to proceed through the informal complaint process provided for in this section.

(b) Submission, form and content of informal complaints.

(1) All informal complaints shall be filed in writing within 30 days following the receipt of the notice of adverse action.

(2) Parties appealing under § 3.3(3) and (4) shall send their informal complaints to the director of the local Area Agency on Aging.

(3) Parties appealing under § 3.3(1) and (2) shall send their informal complaints to the Department’s Bureau of Program and Field Operations.

(4) The complaint shall contain all of the following information:

(i) Name and address of the complainant.

(ii) Party against whom the complaint is made.

(iii) A copy of the notice of adverse action.

(iv) A statement of all relevant facts and the grounds upon which the complaint is based.

(v) A statement of all issues presented.

(vi) The relief or solution requested by the complainant.

(vii) While not required, the complaint may be accompanied by supporting papers.

(c) An informal complaint as an official request for a hearing. The filing of an informal complaint in accordance with subsection (b) shall constitute an official request for a hearing under 45 CFR 1321.51(b) (relating to confidentiality and disclosure of information).

(d) Local efforts to resolve informal complaints filed with Area Agencies on Aging.

(1) Each Area Agency on Aging shall establish a system for seeking local resolutions to informal complaints filed under subsection (b)(2).

(2) The Area Agency on Aging system required under subsection (d)(1) shall, as a minimum, provide for all of the following:

(i) The Area Agency on Aging shall confer with all parties directly involved in the adverse action to determine all pertinent facts, clarify all applicable statutes and regulations and develop an appropriate recommended resolution.

(ii) The Area Agency on Aging shall notify in writing the parties to the complaint of its recommended resolution within a period of not more than 10 working days from the date of its receipt of an informal complaint.

(iii) Written notification of a recommended local resolution shall include instructions for the response of the parties within an additional 10 days.

(iv) The Area Agency on Aging shall utilize the Domicilary Care Review Team to handle all complaints or appeals from domiciliary care providers and applicants for or recipients of domiciliary care services.

(v) The Area Agency on Aging shall place on file written documentation of all steps taken to resolve a complaint at the local level, the recommended resolution and the response to the recommended resolution made by the parties to the complaint.

(vi) If either party to an informal complaint handled under subsection (d) does not accept the resolution recommended by the Area Agency on Aging and so notifies the area agency within the required 10 days, the Area Agency on Aging shall forward a copy of the originally filed complaint to the Department’s Bureau of Program and Field Operations within 3 working days of the receipt of the notification of lack of acceptance. The copy of the complaint submitted to the Department shall be accompanied by a description of the Area Agency on Aging’s efforts to resolve the complaint locally, including the recommended resolution and the response of the parties.

(e) Handling informal complaints filed with the Department.

(1) Investigation by the Department. The Department’s Bureau of Program and Field Operations will investigate each informal complaint with a view toward informal resolution. The investigation will include, but not be limited to, discussions and negotiations with all parties involved. The investigation will be completed within 30 days of the Department’s receipt of the informal complaint.

(2) Notification of recommended resolution. Following the completion of the investigation, the Department will notify all parties concerned of its recommended resolution of the complaint.

(3) Appellate rights.

(i) The parties to the adverse action shall notify the Department of acceptance or rejection of the recommended resolution within 30 days following the receipt of the recommended resolution.

(ii) If either party rejects the recommended resolution, that party may request a formal hearing. All requests for a formal hearing must be made within 30 days following the receipt of the recommended resolution.

(iii) If the Department does not receive any response to the recommended resolution from a complainant within the specified time, the complaint will be declared abandoned and the case closed.

(4) Final report. A final report on each informal complaint transmitted to the Department through an Area Agency on Aging shall be sent by the Department to the Area Agency on Aging at the close of the response period. The report shall include a summary of the investigation, whether the complaint was resolved or not and its resolution.

(f) Cross reference. This section supplements 1 Pa. Code § § 35.5—35.7 (relating to informal complaints).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.6 Request for a formal hearing.

(a) Eligibility. A request for a formal hearing may be made by any of the parties indicated in § 3.3 (relating to opportunities for appeals and fair hearings).

(b) Time of filing. If either party to an adverse action wishes to have a formal hearing after completing the informal complaints process, that party shall file with the Secretary within 30 days following the receipt of the recommended resolution a request for a formal hearing.

(1) Name, address, and telephone number of the complainant.

(2) Name, address, and telephone number of the respondent.

(3) A copy of the notice of adverse action.

(4) A concise statement of the complaint.

(5) A statement of all relevant facts and the grounds upon which the complaint is based.

(6) The relief being sought.

(d) Cross reference. This section supplements 1 Pa. Code § 35.10 (relating to form and content of formal complaints).

This section cited in 6 Pa. Code § 11.292 (relating to written request for appeal).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.7 Appointment of a hearing examiner.

(a) Upon receipt of a request for a formal hearing, the Secretary will appoint a hearing examiner to preside over the hearing.

(b) It shall be the responsibility of the appointed hearing examiner to schedule the hearing and conduct it in accordance with this chapter and 1 Pa. Code Part II (relating to general rules of administrative practice and procedure).

This section cited in 6 Pa. Code § 11.292 (relating to written request for appeal).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.8 Scheduling formal hearings.

(a) General provisions.

(1) The hearing examiner shall notify the complainant and respondent of the date, time and location of the hearing at least 10 days prior to the selected date.

(2) The prehearing conference may be held at the discretion of the hearing examiner.

(3) The hearing examiner shall complete the hearing within 45 days of his receipt of the assignment at the time of his appointment by the Secretary.

(b) Continuances.

(1) Hearings shall commence on the first day scheduled and continuances may not be granted by the hearing examiner except for good cause shown. A hearing examiner may only grant a second continuance in extraordinary circumstances.

(2) Requests for a continuance shall be in writing and delivered to the hearing examiner and all parties or their representatives.

(3) The party requesting the continuance shall first consult the opposing party to seek agreement to the request. The written request should then state whether the request is unopposed.

(4) Objections to requests for a continuance shall be in writing and delivered to the hearing examiner and parties or their representatives. Objections shall be made immediately upon receipt of notification of a request for a continuance.

(1) If the complainant or complainant’s representative fails to appear at the scheduled hearing without good cause, as determined by the hearing examiner, the complaint shall be deemed abandoned and shall be dismissed with prejudice.

(2) If the respondent fails to appear at the hearing without good cause as determined by the hearing examiner, the hearing shall proceed in absentia.

(3) If another party or the party’s representative fails to appear at the hearing without good cause as determined by the hearing examiner, the hearing examiner shall dismiss the matter with prejudice as to that party.

This section cited in 6 Pa. Code § 11.292 (relating to written request for appeal).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.9 Purpose of formal hearings.

The purpose of a hearing is to:

(1) Give both complainant and respondent an opportunity to appear in person and present testimony, witnesses and documentary evidence relevant to the issue in question.

(2) Give both complainant and respondent an opportunity to cross examine the opposing party’s witnesses.

(3) Assure that documents and records presented or referred to during the course of the hearing are made part of the hearing transcript.

(4) Give the complainant an opportunity to review a pertinent evidence on which the adverse action was based. This may be done at the pre-hearing conference, if one is held.

This section cited in 6 Pa. Code § 11.292 (relating to written request for appeal).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.10 Hearing authority.

(a) The hearing authority is the Secretary.

(b) The Secretary will delegate to the hearing examiner the authority necessary to conduct the hearing proceedings and to:

(1) Determine the facts.

(2) Determine the appropriate regulations that apply.

(3) Interpret a regulation when the regulation is ambiguous.

(4) Interpret a directive of the Department when the directive is ambiguous.

(5) Apply the facts to the law to determine the correct result.

(6) Recommend that the Secretary adopt the result.

(c) The hearing examiner’s recommendation shall be submitted to the Secretary or his designee within 30 days of the conclusion of the hearing.

(d) Hearing examiners may not invalidate or modify a Departmental regulation.

(e) Subsection (b) supplements 1 Pa. Code § 35.187 (relating to authority delegated to presiding officers).

This section cited in 6 Pa. Code § 11.292 (relating to written request for appeal).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.11 Decision of the Secretary.

(a) The recommendation of the hearing examiner shall be reviewed by the Secretary or his designee.

(b) After a recommendation has been proposed by the hearing examiner, the parties will not be afforded an opportunity to submit oral or written statements of their position to the Secretary or his designees.

(c) Findings of fact made by the hearing examiner are subject to review and reversal by the Secretary. The Secretary or his designee may return the case to the hearing examiner for further findings of fact.

(d) The Secretary or his designee will issue an opinion and order following the conclusion of the hearing.

Where Department has promulgated specific regulations providing that the hearing officer shall issue only a recommendation as to the correct result and all recommendations must be reviewed by the Secretary or a designee, general provision for formal administrative proceedings is inapplicable. Reynolds v. Department of Aging, 570 A.2d 1373 (Pa. Cmwlth. 1990).

This section cited in 6 Pa. Code § 11.292 (relating to written request for appeal).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

6 Pa. Code § 3.12 Appellate rights.

An eligible applicant for designation as a planning and service area whose application is denied by the Secretary may appeal the denial to the United States Commissioner on Aging as provided for under section 305(b)(4) of the Older Americans Act of 1965 (42 U.S.C.A. § 3025(b)(4)) and 45 CFR 1321 (relating to grants to state and community programs on aging).

History

Authority: The provisions of this Chapter 3 issued under section 2203-A(19) of The Administrative Code of 1929 (71 P. S. § 581-3(19)), unless otherwise noted.
Source: The provisions of this Chapter 3 adopted February 3, 1984, effective February 4, 1984, 14 Pa.B. 375, unless otherwise noted.

Chapter 5 Age Preference

6 Pa. Code § 5.1 Purpose and authority.

(a) This chapter sets forth procedures to be followed by the Department and area agencies on aging regarding the preference to be afforded persons 60 years of age or older in recruitment, selection and training for positions in the Department and area agencies on aging.

(b) This chapter is adopted under the act and section 14 of the act of June 20, 1978 (P. L. 477, No. 70) and in conformity with the Older Americans Act of 1965 (42 U.S.C.A. § § 3001—3057g) and 45 CFR Part 1321 (relating to grants for state and community programs on aging) in order to assure the continued eligibility of the Commonwealth and its political subdivisions for Federal grants-in-aid.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.2 Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context indicates otherwise: Act—Section 6 of the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12) which created the Department and set forth its duties and responsibilities. Appointing authority—The Department and area agencies on aging, both public and private, and in their activities to select personnel to fill positions whether covered by civil service provisions or not.

(i) For the Department the appointing authority is the Secretary or designee.

(ii) For public area agencies on aging, the appointing authority is the chief elected officials of the county or designees.

(iii) For private nonprofit area agencies on aging, the appointing authority is the board of directors or its equivalent or designee. Area agency on aging—The single local agency designated within each planning and service area to administer the delivery of a comprehensive and coordinated plan of social and other services and activities. Department—The Department of Aging of the Commonwealth. Personnel selection—The acquisition of full-time or part-time staff. The term includes appointment, promotion, transfer, reinstatement, demotion, reassignment or other method of placing a person in a compensable status. Rule of three—Selection of an eligible person for appointment or promotion from among the three highest ranking available eligibles on a Certification of Eligibles following Certification of Eligibles for the Classified Service Manual published by the State Civil Service Commission, Directive # M580.1, Amended, October 7, 1980. Secretary—The Secretary of Aging.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.3 General preference requirement.

In the selection of personnel to fill vacant positions in the Department and area agencies on aging, preference, subject to this chapter, shall be given to available qualified persons 60 years of age or older.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.4 Preference in filling civil service positions.

With reference to positions subject to Articles V—VII of the Civil Service Act (71 P. S. § § 741.501—741.708) and 51 Pa.C.S. § § 7101—7109 (relating to veteran’s preference), the following apply:

(1) Available qualified persons 60 years of age or older are identified on Certifications of Eligibles issued by the State Civil Service Commission for use by appointing authorities.

(2) In order to receive preference, a person identified as being age 60 or older shall be placed among the three highest ranking, available eligibles in accordance with the rule of three.

(3) The preference to be granted to persons 60 years of age or older shall be equivalent to the preference granted to veterans of any age, with the exception that, in the case of age preference, the rule of three may not be eliminated at the discretion of the appointing authority as it may be for veterans. The Civil Service Commission has provided the following example to illustrate this equivalent preference:

In this example, candidates A, B and C are the top three eligibles available for appointment to a position with either the Department or an area agency on aging. Three candidates would be eligible for a preference of equal weight; the appointing authority would give equal consideration to all three individuals and could validly appoint any of the three; no additional preference would be available to individuals eligible for both types of preferences; no individual, either less than 60 or nonveteran would have a preference; the age preference would be nontransferable.

This section cited in 6 Pa. Code § 5.11 (relating to relevance of affirmative action plans to civil service positions).

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.5 Preference in filling positions not covered by civil service.

With reference to positions not subject to Articles V—VII of the Civil Service Act (71 P. S. § § 741.501—741.708), the following apply:

(1) Available qualified persons shall be those persons who:

(i) Have expressed their candidacy in writing.

(ii) Have met the minimum job requirements in accordance with the appointing authority’s public advertisement of the position vacancy.

(iii) Remain as finalists after the appointing authority has completed its formal candidate screening process.

(2) Clear preference shall be given to available qualified persons who are 60 years of age or older.

(Example No. 1—If, after the completion of the appointing authority’s candidate screening process, there remain four finalists and one of these is 60 or older, the appointing authority must select the one who is 60 or older.)

(Example No. 2—If, after completion of the appointing authority’s candidate screening process, there remain four finalists and two of these are 60 or older, either of the two who are 60 or older may be appointed.)

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.6 Precedence over collective bargaining agreements.

Under section 703 of the Public Employe Relations Act (43 P. S. § 1101.703) this chapter takes precedence over provisions of collective bargaining agreements or memoranda of understanding.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.7 Recruitment of persons 60 years of age or over.

(a) The Department and area agencies on aging, in cooperation with the Civil Service Commission and other State and Federal agencies and community groups, shall insure that effective recruitment programs are developed and implemented which will attract persons 60 years of age or older to service with the Department and area agencies on aging. Where appropriate and feasible, the recruitment efforts shall provide opportunities for persons 60 years of age or older to receive coaching or special preparation for the taking of civil service examinations.

(b) Department positions which become vacant will be advertised throughout the Commonwealth’s Aging Network.

(c) Area agency on aging positions which become vacant shall be advertised throughout the planning and service area in publications and locations widely accessible to older persons—for example, senior citizen newsletters, senior centers and church and civic groups.

(d) Advertisements of position vacancies shall include the following information:

(1) Job title and number of vacancies, if multiple.

(2) Location of the vacancy.

(3) Brief description of the job.

(4) Job requirements.

(5) Special requirements or conditions (shift work, travel, required licensure).

(6) Starting salary.

(7) Contact person.

(8) Final date for receiving applications.

(9) Identification as an ‘‘Equal Opportunity Employer.’’

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.8 Examination for persons 60 years of age or older.

Under the Civil Service Act (71 P. S. § § 741.1—741.1005) the Civil Service Commission will administer civil service examinations for the Department and participating area agencies on aging. The Department will work with the Civil Service Commission in order to assure that qualified applicants 60 years of age or older are tested in quarters which provide a suitable and convenient environment; that testing conditions will allow persons 60 years of age or older to perform to the best of their ability; and that an applicant’s final earned rating is weighted in such a manner as to reflect the applicant’s experience, where the experience is a valid requisite for a particular position. Area agencies on aging which become aware of older persons who have problems or concern in this regard should contact the Department’s Division of Personnel. The Division of Personnel will work with the Civil Service Commission to address these problems and concerns.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.9 Training programs for persons 60 years of age or older.

The Department and area agencies on aging shall arrange for and conduct training programs for persons 60 years of age or older in order to qualify them for positions of higher or expanded responsibility.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.10 Documentation required in area agency on agency affirmative action plans.

(a) Area agency on aging affirmative action plans and updates as required by the Department, include the following documentation of efforts to carry out the provisions of this chapter:

(1) Copies of advertisements of position vacancies.

(2) A record of where the advertisement was circulated.

(3) Application flow data on each vacancy filled by the agency, indicating each qualified candidate and his status, that is, age, sex, race and the like; screening process results; and final selection by placing an asterisk beside the name of the person selected.

(4) Narrative reports of special recruitment and training efforts carried out by the area agency on aging to attract or qualify persons 60 years of age or older to fill positions with the agency, for example, efforts to motivate older persons to seek qualification for positions subject to the Civil Service Act (71 P. S. § § 741.1—741.1005).

(b) With reference to subsection (a)(3), area agencies on aging shall retain applications on file for future reference or review by the Department for a period of 3 years.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.11 Relevance of affirmative action plans to civil service positions.

Notwithstanding the provisions of § 5.4(3) (relating to preference in filling civil service positions) area agencies on aging are expected to take advantage of reasonable opportunities to fill positions with persons 60 years of age or older in those situations where affirmative action plans clearly indicate a need to place more persons from this population subgroup in vacant positions.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

6 Pa. Code § 5.12 Applicability.

This chapter applies to the Department and to area agencies on aging, both public and nonpublic.

History

Authority: The provisions of this Chapter 5 issued under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 5 adopted April 29, 1983, effective April 30, 1983, 13 Pa.B. 1434, unless otherwise noted.

Chapter 15 Protective Services for Older Adults

6 Pa. Code § 15.1 Scope and authority.

(a) This chapter governs the administration and provision of protective services for older adults under the act, the mandatory reporting of the abuse of recipients of care and required criminal history record information reports for applicants, employees and administrators of facilities.

(b) This chapter applies to the Department, area agencies on aging, providers of protective services for older adults, parties to the making and investigation of reports of a need for protective services by older adults, subjects of reports and investigations and the facilities defined in this chapter.

(c) The Department will enforce this chapter and maintain responsibility for future revisions as the continuing operation of the program requires.

The provisions of this § 15.1 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228889).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.2 Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise: Abandonment—The desertion of an older adult by a caretaker. Abuse—

(i) The occurrence of one or more of the following acts:

(A) The infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.

(B) The willful deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health.

(ii) No older adult will be found to be abused solely on the grounds of environmental factors which are beyond the control of the older adult or the caretaker, such as inadequate housing, furnishings, income, clothing or medical care. Act—The Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102). Administrator—The person responsible for the administration of a facility. The term includes a person responsible for employment decisions or an independent contractor. Agency—The local provider of protective services, which is the area agency on aging or the agency designated by the area agency on aging to provide protective services in the area agency’s planning and service area. Applicant—An individual who submits an application, which is being considered for employment, to a facility. Area agency on aging—The single local agency designated within a planning and service area by the Department to develop and administer the delivery of a comprehensive and coordinated plan of social services and activities for older adults. Assessment—A determination based upon a comprehensive review of a client’s social, physical and psychological status along with a description of the person’s current resources and needs using the instruments and procedures established by the Department for this purpose. Care—Services provided to meet a person’s need for personal care or health care.

(i) Services may include homemaker services, assistance with activities of daily living, physical therapy, occupational therapy, speech therapy, social services, home-care aide services, companion-care services, private duty nursing services, respiratory therapy, intravenous therapy, in-home dialysis and durable medical equipment services, which are routinely provided unsupervised and which require interaction with the care-dependent person.

(ii) The term does not include durable medical equipment delivery. Care-dependent individual—An adult who, due to physical or cognitive disability or impairment, requires assistance to meet needs for food, shelter, clothing, personal care or health care. Caretaker—An individual or institution that has assumed the responsibility for the provision of care needed to maintain the physical or mental health of an older adult. This responsibility may arise voluntarily, by contract, by receipt of payment for care, as a result of family relationship or by order of a court of competent jurisdiction. It is not the intent of the act to impose responsibility on an individual if the responsibility would not otherwise exist in law. Case file, case record or record—A complete record of the information received and the actions taken by the agency on each report of need received. When applicable, it shall include the following elements:

(i) The report of need.

(ii) Records of agency investigative activities including related evidence and testimony.

(iii) Assessment.

(iv) Documentation of informed consent provided or agency efforts to obtain consent.

(v) Notifications of older adults, alleged perpetrators, police, agencies, organizations and individuals.

(vi) Records of court, intervention, petition or action.

(vii) Service plan. Conflict of interest—The conflict which may exist when the investigator of a report of the need for protective services has a personal or financial interest in, is responsible for, or is employed by others responsible for, the delivery of services which may be needed by an older adult to reduce or eliminate the need for protective services. A conflict of interest may also exist if an investigator has a specific personal or financial motivation to recommend services delivered by a specific agency or to allow referrals or case dispositions to be inappropriately influenced by the investigator’s knowledge of agency staff, resource limitations or by agency constraints which affect agency staff or resource allocations. Consumer attendant—An individual who is recruited, hired, trained, directed and supervised by the consumer for whom personal care services and other support activities are being provided. Court—A court of common pleas or a district magistrate, if applicable. Criminal history report—

(i) For an applicant or employee who is a resident of this Commonwealth, a State Police criminal history record.

(ii) For a nonresident applicant or employee, a State Police criminal history record and a Federal criminal history record.288584 Department—The Department of Aging of the Commonwealth. Desertion—The willful failure without just cause by the responsible caretaker to provide for the care and protection of an older adult who is in need of protective services. Direct contact—Touching of a recipient by an employee consistent with the professional responsibilities of the employee. Employee—Includes the following:

(i) An individual who is employed by a facility.

(ii) A facility contract employee who has direct contact with residents or unsupervised access to their living quarters.

(iii) An individual who is employed by, or who enters into a contractual relationship with, or who establishes any other agreement or arrangement with a home health care agency to provide care to a care-dependent person for a fee, stipend or monetary consideration of any kind in the person’s place of residence.

(iv) A student doing an internship or clinical rotation, or any other individual, who has been granted access to the facility to perform a clinical service for a fee.

(v) An individual, employed by an entity which supplies, arranges for, or refers personnel to provide care to care-dependent persons, who is employed to provide care to care-dependent persons in facilities or their places of residence. Exploitation—An act or course of conduct by a caretaker or other person against an older adult or an older adult’s resources, without the informed consent of the older adult or with consent obtained through misrepresentation, coercion or threats of force, that results in monetary, personal or other benefit, gain or profit for the perpetrator or monetary or personal loss to the older adult. Facility—Any of the following:

(i) A domiciliary care home as defined in sections 2201-A—2212-A of The Administrative Code of 1929 (71 P. S. § § 581-1—581-12).

(ii) A home health care agency.

(iii) A long-term care nursing facility as defined in the Health Care Facilities Act (35 P. S. § § 448.101—448.904b).

(iv) An older adult daily living center as defined in the Older Adult Daily Living Centers Licensing Act (62 P. S. § § 1511.1—1511.22).

(v) A personal care home as defined in section 1001 of the Public Welfare Code (62 P. S. § 1001). Federal criminal history record—A report of Federal criminal history record information under the Federal Bureau of Investigation’s appropriation under the Departments of State, Justice, and Commerce, the Judiciary, and Related Agencies Appropriation Act, 1973 (28 U.S.C.A. § 534). Home health care agency—

(i) Any of the following:

(A) A home health care organization or agency licensed by the Department of Health.

(B) A public or private agency or organization, or part of an agency or organization, which provides care to a care-dependent individual in the individual’s place of residence.

(ii) The term includes private duty home care providers, homemaker/home health aide providers, companion care providers, registry services or intravenous therapy providers. Incapacitated older adult—An older adult who, because of one or more functional limitations, needs the assistance of another person to perform or obtain services necessary to maintain physical or mental health. The definition of capacity or incapacity or competence or incompetence, as defined in 20 Pa.C.S. § § 5501—5555 (relating to guardianship), does not apply to this definition. Informed consent—Consent obtained for a proposed course of protective service provision. The consent shall be based on a reasonable attempt to provide information which conveys, at a minimum, the risks, alternatives and outcomes of the various modes of protective service provision available under the circumstances. Intimidation—An act or omission by a person or entity toward another person which is intended to, or with knowledge that the act or omission will, obstruct, impede, impair, prevent or interfere with the administration of the act or any law intended to protect older adults from mistreatment. Investigation—A systematic inquiry conducted by the agency to determine if allegations made in a report of need for protective services can be substantiated, or if the older adult referred to in the report of need is an older adult in need of protective services, or both. Law enforcement official—One of the following:

(i) A police officer.

(ii) A district attorney.

(iii) The State Police. Least restrictive alternative—The appropriate course of action on behalf of the older adult which least intrudes upon the personal autonomy, rights and liberties of the older adult in circumstances when an older adult lacks the capacity to decide on matters and take actions essential to maintaining physical and mental health. Neglect—The failure to provide for oneself or the failure of a caretaker to provide goods or services essential to avoid a clear and serious threat to physical or mental health. An older adult who does not consent to the provision of protective services will not be found to be neglected solely on the grounds of environmental factors which are beyond the control of the older adult or the caretaker, such as inadequate housing, furnishings, income, clothing or medical care. Older adult—A person within the jurisdiction of this Commonwealth who is 60 years of age or older. Older adult in need of protective services—An incapacitated older adult who is unable to perform or obtain services that are necessary to maintain physical or mental health, for which there is no responsible caretaker and who is at imminent risk of danger to his person or property. Operator—A person, society, corporation, governing authority or partnership legally responsible for the administration and operation of a facility. At licensed facilities, the licensee is the operator. Planning and service area—The geographic unit within this Commonwealth, as designated by the Secretary, for the allocation of funds for the delivery of social services to older adults residing in that unit. Police department—A public agency of the Commonwealth or of a political subdivision having general police powers and charged with making arrests in connection with the enforcement of the criminal or traffic laws, or both. Police officer—A full-time or part-time employee of the Commonwealth, a city, borough, town, township or county police department assigned to criminal or traffic or criminal and traffic law enforcement duties. The term does not include persons employed to check parking meters or to perform only administrative duties, auxiliary and fire police. Protective services—Activities, resources and supports provided to older adults under the act to detect, prevent, reduce or eliminate abuse, neglect, exploitation and abandonment. Protective services caseworker—A protective services agency employee, regardless of staff title, who meets the minimum standards in § § 15.121—15.127 (relating to staff training and experience standards) and is assigned by the agency under § 15.13(c) (relating to organization and structure of protective services functions) to perform the following protective services functions:

(i) To receive reports of a need for protective services when necessary.

(ii) To investigate reports received under this chapter.

(iii) To assess the needs of protective services clients under this chapter.

(iv) To develop and coordinate the implementation of service plans for protective services clients. Protective setting—A setting chosen by the agency where services can be provided in the least restrictive environment to protect the physical and mental well-being of the older adult. Public or private entitlement or resource—A publicly or privately funded health or human services program available either without charge or on a cost-sharing basis to persons who qualify on the basis of one or more criteria, such as age, need, income or condition.

(i) The term includes various established financial assistance programs under public or private sponsorship.

(ii) The term does not include individual personal income or financial assets. Recipient—An individual of any age who receives care, services or treatment in or from a facility. Report or report of need—The written report of an older adult in need of protective services received under § 15.23 (relating to receiving reports; general agency responsibility) and recorded on the standardized protective services report form. Responsible caretaker—A caretaker who is able and willing to provide the basic care and protection necessary to maintain the physical or mental health of an older adult. A caretaker reported to have abused, neglected, exploited or abandoned an older adult is presumed, subject to an investigation under this chapter, to be unable or unwilling to provide the necessary care and protection. Secretary—The Secretary of the Department. Serious bodily injury—Injury which creates a substantial risk of death or which causes serious permanent disfigurement or protracted loss or impairment of the function of a body member or organ. Serious physical injury—An injury that does one of the following:

(i) Causes a person severe pain.

(ii) Significantly impairs a person’s physical functioning, either temporarily or permanently. Service plan—A written plan developed by the agency on the basis of a comprehensive assessment of an older adult’s need which describes identified needs, goals to be achieved and specific services to support goal attainment, with regular follow-up and predetermined reassessment of progress. Specific services to support goal attainment may include homemaker services, home-delivered meals, attendant care, other in-home services, emergency shelter or food, legal aid services, transportation and other services. Service plans are cooperatively developed by the agency staff, the older adult or the older adult’s appointed guardian and other family members when appropriate. The plan shall also address, if applicable, special needs of other members of the household unit as they may affect the older adult’s need for protective services. Sexual abuse—Intentionally, knowingly or recklessly causing or attempting to cause rape, involuntary deviate sexual intercourse, sexual assault, statutory sexual assault, aggravated indecent assault, indecent assault or incest. State-licensed facility—For all purposes involved in the determination of whether an individual is an older adult in need of protective services, a State licensed facility is defined as an institution licensed by the Commonwealth to provide temporary or permanent residence to persons in need of personal care or medical care, including nursing homes, personal care homes, hospitals, State hospitals and mental retardation centers. State Police—The Pennsylvania State Police. State Police criminal history record—A report of criminal history record information from the State Police or a statement from the State Police that their central repository contains no information relating to that person. Unsupervised access—Access to personal living quarters of residents when not accompanied by or within direct supervision of an employee of the facility.

The provisions of this § 15.2 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228889) to (228890).

This section cited in 6 Pa. Code § 15.92 (relating to assessment); 6 Pa. Code § 15.96 (relating to termination of protective services); 6 Pa. Code § 15.101 (relating to general); and 6 Pa. Code § 15.111 (relating to coordination of available resources).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.11 Administrative functions and responsibilities of the Department.

(a) General responsibilities. The Department will establish and maintain a Statewide system of protective services for older adults who need them. These services will be available and accessible through local protective services agencies. In maintaining this system of protective services, the Department’s functions and responsibilities include the following:

(1) The review and approval of annual protective services plans submitted by area agencies under § 15.12(b) (relating to administrative functions and responsibilities of area agencies on aging).

(2) The allocation of funds appropriated for the implementation of the act to area agencies on aging to administer local protective services plans.

(3) The establishment of minimum standards of training and experience for protective services staff.

(4) The development and maintenance of a fiscal and service data collection system to collect information on local reports of a need for protective services, investigations, services provided and other relevant data on protective services activities.

(5) The monitoring of local protective services delivery for compliance with this chapter and approved area agency on aging protective services plans.

(6) The development and maintenance of an ongoing program of public information and education to promote general awareness of and informed responses to the needs of older adults for protective services available under this chapter.

(7) Ongoing coordination with State agencies.

(b) Local protective services plans. The Department will review the annual protective services plan submitted under § 15.12(b) by an area agency on aging and will notify the area agency of approval or disapproval within 60 days.

(c) Staff training and experience. The minimum standards of training and experience of protective services staff employed to carry out activities under this chapter are set forth in § § 15.121—15.127 (relating to staff training and experience standards).

(d) Public information and education. The Department will develop and maintain a campaign of public information and education about the needs for and availability of protective services under this chapter. The target of this campaign will be older adults and the general public, as well as professionals and others employed in situations where they are likely to have frequent contact with older adults who need protective services. In designing and implementing the ongoing public awareness campaign, the Department will consult with other Commonwealth agencies and consider the concerns of area agencies on aging and the local entities identified by area agencies as having substantial contact with potential victims or perpetrators of abuse, neglect, exploitation and abandonment.

The provisions of this § 15.11 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228893) to (228894).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.12 Administrative functions and responsibilities of area agencies on aging.

(a) General responsibilities. An area agency on aging shall administer the delivery of protective services under this chapter in its planning and service area. The functions and responsibilities of the area agency on aging in administering protective services include the following:

(1) The development and submission of a protective services plan under subsection (b).

(2) The oversight of the delivery of protective services for older adults, either directly or purchased under contract with another agency, in compliance with the area agency’s approved protective services plan, this chapter and other applicable State and Federal regulations or statutes. The plan shall assure that the agency will provide for the receipt of reports of need for protective services, the conduct of investigations of reports, the assessment of need and the development of service plans throughout the period covered by the plan. The plan shall also describe sources for specific services that may be required by older adults who have been assessed as needing them, and policies pertaining to arranging for specific services if and when needs for specific services exceed supply.

(3) The coordination of the protective services related activities of local agencies and organizations having substantial contact with potential victims or perpetrators of abuse, neglect, exploitation and abandonment. These agencies and organizations include the following:

(i) Local domestic violence agencies.

(ii) County assistance offices.

(iii) Local mental health/mental retardation programs.

(iv) County offices of children and youth.

(v) Law enforcement agencies.

(vi) Legal services agencies.

(vii) Emergency medical service agencies, hospital emergency rooms and social services staff.

(viii) Home health agencies.

(ix) Drug and alcohol prevention and treatment organizations.

(x) Clergy associations and councils of churches.

(4) The local extension of the Department’s ongoing campaign of public information and education about the need for, and availability of, protective services for older adults.

(5) The collection and submission to the Department of data on protective services activities. The data shall be recorded and reports submitted as required by the Department. At a minimum, the following information shall be included:

(i) The number of substantiated and unsubstantiated reports.

(ii) The number of reports made in various categories of need for protective services, such as physical abuse, financial exploitation, neglect, abandonment and the like.

(iii) The demographic information on persons reported to be in need of protective services and on alleged perpetrators of abuse, neglect, exploitation and abandonment.

(iv) The origins of reports.

(v) The remedies and referrals.

(b) Protective services plan. The area agency on aging shall submit, on an annual basis, its protective services plan to the Department. The protective services plan shall contain, at a minimum, the following information:

(1) An explanation of the organizational structure and staffing of the area agency’s protective services functions, including provisions for purchasing these services if applicable. For the purpose of advising the agency on medically related issues encountered during assessment and the development of service plans, the organizational structure shall include the consultation services of a registered nurse or physician licensed to practice in this Commonwealth.

(2) An explanation of how the area agency’s organizational structure and staffing of protective services will prevent a conflict of interest between the investigation of reports received under this chapter and the area agency’s service delivery functions. The explanation shall include assurances that the minimum criteria required under § 15.13 (relating to organization and structure of protective services functions) will be met.

(3) A description of the local process for delivering protective services to older adults who need them, including the 24-hour capability to receive reports, the investigation of reports and the necessary actions arising from investigations. The description shall focus on the specific local methodology to be implemented in activities for which this chapter allows for local differences and flexibility. The description of the plan for investigating reports shall include an explanation of steps to be taken to assure the standby capability required under § 15.41(c) (relating to reports required to be investigated). The description of the plan for seeking emergency court orders shall include the agency’s identification of the providers of legal assistance who may be notified under § 15.71(b) (relating to involuntary intervention by emergency court order) when the agency petitions the court for emergency involuntary intervention.

(4) A description of local funding for protective services which has, at the discretion of a county or local agency, been placed under the administrative control of the area agency on aging. There is no requirement by the Department that the area agency on aging obtain local funding for its protective services plan budget.

(5) Documentation of applicable interagency relations, interagency agreements, service referral mechanisms and the locus of responsibility for cases with multi-service needs. The documentation shall include assurances that the area agency on aging has taken steps to avoid unnecessary duplication of existing efforts by other agencies which may carry responsibilities for some protective services activities.

(6) A description of local methods to be used to assure the privacy and confidentiality of older adults receiving protective services as required under § § 15.101—15.105 (relating to confidentiality).

(7) A list of the entities, public and private, identified by the area agency on aging as having substantial contact with potential victims or perpetrators of abuse, neglect, exploitation and abandonment.

(c) Public awareness. The area agency on aging shall conduct within its planning and service area an ongoing campaign designed to inform and educate older adults, professionals and the general public about the need for and availability of protective services under this chapter. This ongoing campaign shall utilize materials and methodology developed by the Department and supplemented by the area agency with relevant information on the local protective services system. Special emphasis shall be placed on informing the community on how to make reports and request services.

(d) Department approval required. An area agency on aging, which has not received the Department’s approval for its protective services plan may not provide services under this chapter.

The provisions of this § 15.12 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228894) to (228897).

This section cited in 6 Pa. Code § 15.11 (relating to administrative functions and responsibilities of the Department); 6 Pa. Code § 15.102 (relating to maintenance of case files); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.13 Organization and structure of protective services functions.

(a) General organization. The area agency on aging may provide protective services directly or under a purchase of services contract with another provider agency. In either case, the area agency on aging is responsible for the compliance of protective services activities with this chapter. The area agency on aging shall assure that the agency meets the minimum standards of organization and structure set forth in this section.

(b) Protective services caseworkers.

(1) The agency shall designate as a protective services caseworker at least one caseworker who meets the minimum standards in § § 15.121—15.127 (relating to staff training and experience standards).

(2) The agency shall assign protective services cases to designated protective services caseworkers by allocating the anticipated agency caseload in a manner consistent with the agency’s plan for caseload distribution.

(3) The agency’s plan for caseload distribution shall be described in the agency’s protective services plan and shall include the following specific information:

(i) The rationale for the proposed caseload distribution.

(ii) How the subset of workers will be defined and selected, including an estimate of the anticipated caseload size to be assigned to each designated protective services caseworker.

(iii) How the cases within a designated protective services caseworker’s caseload will be prioritized.

(iv) How that prioritization system will be maintained.

(v) How the agency will develop and maintain the necessary specialized expertise required to fulfill protective services responsibilities.

(4) A protective services caseworker may not serve as the area agency on aging ombudsman on the same case.

(5) The protective services caseload assigned to a protective services caseworker may not be planned to exceed 30 ongoing protective services cases.

(6) The case assignment system of the agency shall encourage the appropriate transfer of cases into and out of protective services caseloads as provided under § 15.96 (relating to termination of protective services).

(c) Other staff. The immediate supervisor of a protective services caseworker is required to be trained as set forth in § § 15.121—15.127. An intake worker of the agency is permitted to discharge nonprotective service duties. An intake worker who receives a report of the need for protective services shall receive training as set forth in § § 15.121—15.127.

(d) Conflict of interest. The area agency on aging shall describe in its protective services plan the steps it will take to avoid or minimize the potential of a conflict of interest between the investigative and service delivery functions in the protective services caseload. The description shall identify points in the organization and structure of protective services delivery where a potential conflict of interest may exist and explain the specific organizational responses which the area agency on aging will make to avoid or minimize that potential. The responses may include provisions for assuring some separation between the investigative and service delivery functions. The description shall also include proposed steps for addressing an actual conflict of interest if one arises. Nothing in this chapter constitutes an absolute bar to an area agency from delivering protective services and other area agency on aging services itself or through the same provider solely because of the potential existence of a conflict of interest.

(e) Depth of agency capacity. The agency shall require sufficient staff of all categories to be trained under § § 15.121—15.127 to insure that routine staff absences will not compromise the agency’s ability to fulfill its responsibilities under the act. Trained standby staff members shall be available to provide protective services as required, but are not required to be regularly assigned to protective services duties.

The provisions of this § 15.13 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228897) to (228899).

This section cited in 6 Pa. Code § 15.2 (relating to definitions); and 6 Pa. Code § 15.12 (relating to administrative functions and responsibilities of area agencies on aging).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.21 General reporting provisions.

(a) A person who has reasonable cause to believe that an older adult needs protective services may report this to the local provider of protective services. An area agency on aging shall publicize, on an ongoing basis, the name, address and phone number of the agency where reports are to be made.

(b) When applicable, reports shall comply with § § 15.151—15.157 (relating to reporting suspected abuse).

The provisions of this § 15.21 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228899).

This section cited in 55 Pa. Code § 2600.15 (relating to abuse reporting covered by law); and 55 Pa. Code § 2800.15 (relating to abuse reporting covered by law).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.22 Safeguards for those who make or receive reports.

(a) Protection from retaliation. Under the act, a person or entity who takes discriminatory, retaliatory or disciplinary action against an employee or other person who makes a report, against a person who cooperates with the agency or the Department to provide testimony or other information about a report, or against a victim of abuse, commits a violation of the act. The person who takes the discriminatory, retaliatory or disciplinary action is subject to a civil lawsuit by the person who made the report, the victim of abuse named in the report, or the person who cooperated with the agency or the Department. If the court which hears the lawsuit decides in favor of the plaintiff, the plaintiff shall recover triple compensatory damages, compensatory and punitive damages or $5,000, whichever is greater, from the person or entity which committed the violation.

(b) Immunity from liability. As provided under the act, a person who participates in the making of a report or completion of an investigation or who provides testimony in an administrative or judicial proceeding arising out of a report shall be immune from civil or criminal liability because of these actions unless the person acted in bad faith or with malicious purpose. The act does not extend this immunity to liability for acts of abuse, neglect, exploitation or abandonment, even if the acts are the subject of the report or testimony.

(c) Intimidation; penalty. Any person, including the victim, with knowledge sufficient to justify making a report or cooperating with the agency, including possibly providing testimony in any administrative or judicial proceeding, shall be free from any intimidation by an employer or by any other person or entity. Any person who violates this subsection is subject to civil lawsuit by the person intimidated or the victim wherein the person intimidated or the victim shall recover treble compensatory damages, compensatory and punitive damages or $5,000, whichever is greater.

(d) Notification. The administrator of a facility shall post notices in conspicuous and accessible locations and use other appropriate means to notify employees, residents and other individuals of protections and obligations under the act, and keep them informed of the protections and obligations.

The provisions of this § 15.22 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228899).

This section cited in 55 Pa. Code § 2600.15 (relating to abuse reporting covered by law); and 55 Pa. Code § 2800.15 (relating to abuse reporting covered by law).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.23 Receiving reports; general agency responsibility.

(a) Twenty-four hour capability. The agency shall be capable of receiving reports of older adults in need of protective services 24-hours-a-day, 7 days-a-week-including holidays. This capability may include the use of a local emergency response system or a crisis intervention agency.

(b) Accessibility of professional staff. Regardless of the arrangements made by the agency to receive reports outside the normal business hours of the agency, the agency shall provide 24-hours-a-day, 7 days-a-week—including holidays-accessibility to a protective services caseworker by a person receiving reports so that referrals required under § 15.26(b) (relating to screening and referral of reports received) may be made for immediate attention. If this accessibility is provided by means of telephone, telephone paging device or other alternatives to direct physical presence, the protective services caseworker shall be capable of returning the call within 30 minutes.

(c) Toll-free public telephone access. To facilitate reporting of older adults in need of protective services, the agency shall provide toll-free telephone access to persons residing in the planning and service area served by the agency. If possible, the agency shall utilize the same telephone number everywhere in the planning and service area at all times. This number shall be extensively publicized throughout the planning and service area with special emphasis on older adults and persons likely to be in contact with victims or perpetrators of abuse, neglect, exploitation and abandonment.

(d) Reports from outside the planning and service area. The agency shall receive all reports made regardless of their place of origin or the location in this Commonwealth of the older adult in need of protective services. If the older adult who is the subject of a report does not reside in the planning and service area of the agency or, at that time, is not in the planning and service area, the agency shall notify the agency which provides protective services in the planning and service area where the older adult is located and relay to that agency the information received in the report.

The provisions of this § 15.23 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228899) to (228900).

This section cited in 6 Pa. Code § 15.2 (relating to definitions); 6 Pa. Code § 15.26 (relating to screening and referral of reports received); 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.44 (relating to resolution of substantiated reports); 6 Pa. Code § 15.105 (relating to limited access to records and disclosure of information); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); 55 Pa. Code § 2600.15 (relating to abuse reporting covered by law); and 55 Pa. Code § 2800.15 (relating to abuse reporting covered by law).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.24 Receiving reports; agency intake process.

(a) Personnel who may receive reports. A report shall be received only by persons who have received training on the minimum requirements and procedures for receiving, recording, screening and referring reports under § 15.124 (relating to protective services intake training curriculum). When the agency uses an answering service to receive calls from persons reporting a need for protective services, the agency shall have one of the following options:

(1) To provide the training for intake workers required under § 15.124 to appropriate staff of the answering service organization.

(2) To provide that all calls are forwarded directly to designated protective services intake workers or caseworkers of the agency for completion of a report of need form.

(b) Anonymity for reporters. A person who reports an older adult in need of protective services may remain anonymous, if desired. In an attempt to secure the reporter’s name if additional information or assistance is needed for investigation or service provision, a person who receives a report shall inform an anonymous reporter of the statutory protection from retaliation and liability.

The provisions of this § 15.24 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228900).

This section cited in 55 Pa. Code § 2600.15 (relating to abuse reporting covered by law); and 55 Pa. Code § 2800.15 (relating to abuse reporting covered by law).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.25 Report form and content.

(a) Standardized reports. An initial report received shall be committed to writing on the standardized report form required by the Department. Information subsequently obtained through investigations may be reported on other forms or sheets of paper for inclusion in the case record.

(b) Handling oral reports. A report may be received in writing or orally. A report received orally shall be committed immediately to writing on the standardized form.

(c) Minimum contents. The person receiving a report shall make every effort to obtain information necessary to complete the standardized report form. At a minimum, the completed report shall contain the following information:

(1) The date and time of the report.

(2) The name, address and phone number of the person making the report, unless withheld.

(3) The name, address and, if available, age and phone number of the person reported to need protective services.

(4) The nature of the incident which precipitated the report.

(5) The nature and extent of the need for protective services. Indicate if the person is in a life threatening situation.

(6) The physical and mental status of the person in need, to the extent obtainable.

The provisions of this § 15.25 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228901).

This section cited in 55 Pa. Code § 2600.15 (relating to abuse reporting covered by law); and 55 Pa. Code § 2800.15 (relating to abuse reporting covered by law).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.26 Screening and referral of reports received.

(a) Screening. A person meeting the qualifications in § 15.121(c)(3) (relating to protective services staff qualifications) who receives a report shall screen the report during and immediately following receipt of the report to assign it to one of the following referral categories:

(1) Emergency.

(2) Priority.

(3) Nonpriority.

(4) Another planning and service area.

(5) No need for protective services.

(b) Referral categories and actions.

(1) Emergency. A report placed in this category requires immediate attention because specific details in the report indicate the possibility that the older adult reported to need protective services is at imminent risk of death or serious physical harm. The person receiving an emergency report shall immediately contact a protective services caseworker designated under § 15.23(b) (relating to receiving reports; general agency responsibility) and provide that caseworker with the information contained in the report.

(2) Priority. A report placed in this category contains details which clearly suggest that the need for protective services is serious enough to require early intervention. The person receiving a priority report shall immediately contact a protective services caseworker designated under § 15.23(b) and provide that caseworker with the information in the report.

(3) Nonpriority. A report shall be placed in this category when it does not appropriately fall within the emergency or priority categories and, therefore, does not require immediate attention by the agency. A report in this category shall be referred to a protective services caseworker of the agency within the normal business hours of the agency’s current or next day of business under the agency’s established procedures for referring these reports.

(4) Another planning and service area. A report which is covered under § 15.23(d) shall be placed in this category. It shall be referred to the agency which has the designated responsibility for protective services in the planning and service area in which the older adult reported to need protective services is located at the time of the report. A report in this category will also meet the criteria for placement in one of the other categories in this subsection. The provisions for referral for the other category shall apply to a referral to another planning and service area.

(5) No need for protective services.

(i) A report shall be placed in this category when the person reported to be in need of protective services meets one or more of the following criteria:

(A) Is under 60 years of age.

(B) Has the capacity to perform or obtain, without help, services necessary to maintain physical or mental health.

(D) Is not at imminent risk of danger to his person or property.

(ii) A report in this category shall be referred to a protective services caseworker of the agency within the normal business hours of the agency’s current or next day of business. The protective services caseworker shall review the details of the report and take whatever steps necessary to confirm or reject the categorization of no need for protective services. If the caseworker confirms the screening categorization, appropriate referrals shall be made to the area agency on aging care management system or, if concerning an adult under 60 years of age, to another community agency. If the caseworker rejects the categorization, the report shall be placed in the appropriate category and be handled accordingly.

(iii) A report may not be placed in this category if the older adult is temporarily relocated to a safe environment and will return to the original abusive situation or to a new location which has not been determined to be safe.

The provisions of this § 15.26 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228901) to (228902).

This section cited in 6 Pa. Code § 15.23 (relating to receiving reports; general agency responsibility); 6 Pa. Code § 15.27 (relating to handling of completed reports); 6 Pa. Code § 15.41 (relating to reports required to be investigated); 55 Pa. Code § 2600.15 (relating to abuse reporting covered by law); and 55 Pa. Code § 2800.15 (relating to abuse reporting covered by law).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.27 Handling of completed reports.

(a) Reports to be signed. Completed report forms shall be signed by the person who received the report.

(b) Appropriate routing of reports. A completed report form shall be promptly routed to appropriate staff of the agency under § 15.26(b) (relating to screening and referral of reports received), and shall be handled in a manner which safeguards the confidentiality of information contained in the report. Sections 15.103 and 15.104 (relating to responsibilities of staff with access to confidential information; and penalties for violation of confidentiality requirements) also apply to staff of an emergency response agency under contract with the agency to receive reports during times when the agency is not open for business.

(c) State licensed facility. A report involving a State-licensed facility, and containing sufficient information to begin an investigation, shall be provided to the appropriate State licensing agency.

The provisions of this § 15.27 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228902) to (228903).

This section cited in 55 Pa. Code § 2600.15 (relating to abuse reporting covered by law); and 55 Pa. Code § 2800.15 (relating to abuse reporting covered by law).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.41 Reports required to be investigated.

(a) General. The agency shall provide for an investigation of a report received under § 15.23 (relating to receiving reports; general agency responsibility) and referred under § 15.26 (relating to screening and referral of reports received) to determine if the report can be substantiated and, if so, immediate steps that are necessary to remove or reduce an imminent risk to person or property. The investigation shall be initiated within 72 hours following the receipt of a report or sooner as provided under § 15.42 (relating to standards for initiating and conducting investigations) and include sufficient collateral information provided by interviews, documents, reports or other methods to determine if the older adult is in need of protective services. When applicable, reports and investigations shall comply with § § 15.141—15.147 (relating to criminal history record information reports).

(b) Trained and identified investigators. Only a person who has completed the minimum training required for protective services caseworkers by the Department under § § 15.121—15.127 (relating to staff training and experience standards) may conduct investigations under this section. When, for reasons unexpected and beyond the agency’s control, a trained staff person is not available to conduct investigations, the agency shall notify the Department and seek the Department’s approval for its proposed plan for carrying out its investigation responsibilities under this section. The agency shall provide each investigator with official credentials which document the identity of the investigator and the legal authority to implement this chapter.

(c) Agency responsibility. The agency is responsible for assuring that an investigation under this section can be conducted whenever circumstances require it. This responsibility includes the provision of standby capability for use if the agency’s regularly assigned staff is not available.

The provisions of this § 15.41 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228903).

This section cited in 6 Pa. Code § 15.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.155 (relating to investigation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.42 Standards for initiating and conducting investigations.

(a) Requirements by report category.

(1) Emergency report.

(i) The investigation of a report categorized as emergency shall be initiated immediately following the referral of the report. The protective services caseworker shall make every attempt to ensure the immediate safety of the older adult and to conduct a face to face visit as soon as possible. The agency shall assure that reasonable attempts will be made to conduct a face to face visit within 24 hours after the report is received.

(ii) When, after reasonable efforts to gain access to the older adult, the protective services caseworker is denied access, the caseworker shall document the efforts made and take action, as appropriate, under § 15.61 or § 15.71 (relating to access to persons; and involuntary intervention by emergency court order).

(2) Priority report. The investigation of a report categorized as priority shall be initiated as soon as possible. The agency shall assure that reasonable attempts to initiate the investigation will be made within 24 hours after the report is received. The investigation of a priority report is initiated only by contact with the older adult reported to need protective services. The protective services caseworker shall make every attempt to visit with the older adult face to face within the 24 hours provided. When, after reasonable efforts to gain access to the older adult, the caseworker is denied access, the caseworker shall document the efforts made and take action, as appropriate, under § 15.61 or § 15.71.

(3) Nonpriority report.

(i) The investigation of a report categorized as nonpriority shall be initiated in a timely manner but never later than 72 hours after the report was received. At the discretion of the agency, the initiation of an investigation of a nonpriority report shall include a visit to the older adult reported to need protective services when details in the report indicate a need to see and talk with the older adult face to face to secure or verify facts essential to the ongoing investigation.

(ii) The investigation of a report categorized as nonpriority shall include at least one visit to the older adult reported to need protective services at an appropriate point in the course of the investigation. Every attempt shall be made to visit with the older adult face to face. When, after reasonable efforts to gain access to the older adult, the protective services caseworker is denied access, the caseworker shall document the efforts made and, when appropriate, take action under § 15.61 or § 15.71.

(4) No need report. The investigation of a report categorized as no need for protective services shall consist of the protective services caseworker’s review of the report categorization. If the caseworker agrees with the initial categorization, appropriate referrals shall be made within 72 hours after the report was received, to the area agency on aging service management system or, if concerning an adult under 60 years of age to another community agency, if available. If the caseworker does not agree with the initial categorization, the report shall be placed in another category in this subsection and addressed under the applicable provisions for investigating a report in that category.

(b) Reports involving county or area agency on aging employees. If the agency is required to investigate a report which alleges that abuse, neglect, exploitation or abandonment has been perpetrated by an employee of the county, the area agency on aging or its subcontractor, the agency shall notify the Department as early as possible during the current or next day of normal business hours. The notification shall be made by phone to a person designated by the Department and shall include the pertinent details of the report. A copy of the completed report of need shall be immediately forwarded by mail to the Department. Copies of written records of investigative activities shall also be forwarded to the Department for review. The Department reserves the right to intervene in the agency’s investigation of a report under this subsection if it is determined appropriate to assure a fully objective investigation.

(c) Written records of investigative activities. The investigative activities, including home visits and other contacts with the older adult or other persons or organizations needed to facilitate the investigation, shall be documented in writing and placed in the case record. Documentation may include dated and signed photographs and statements related to suspected abuse.

(d) Completing investigations of reports. The agency shall make all reasonable efforts to complete an investigation of a report of need for protective services under this section as soon as possible and, in cases of abuse and neglect, at least within 20 days of the receipt of the report. The investigation of the report is completed only when the report has been determined to be substantiated or unsubstantiated and, if substantiated, after necessary steps have been taken to reduce an imminent risk to the older adult’s person or property.

(e) Department conducting its own investigation. If the Department determines that an agency is unable to conduct, or has not conducted, what the Department considers an acceptable protective services investigation, the Department may intervene in the agency’s investigation, or conduct its own investigation.

The provisions of this § 15.42 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228904) to (228905).

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.45 (relating to situations involving State-licensed facilities); 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.155 (relating to investigation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.43 Resolution of unsubstantiated reports.

(a) When, upon investigation of a report, it is determined that there is no need for protective services, the report shall be classified as unsubstantiated.

(b) A case opened by an unsubstantiated report shall be closed and information identifying the person who made the report and the alleged perpetrator of abuse, if applicable, shall be immediately deleted from the case record.

(c) For the purposes of substantiating a pattern of abuse, neglect, exploitation or abandonment, the name of the person reported to need protective services and other information relevant to the circumstances which led to the report may be maintained for 6 months in a separate locked file accessible only to limited authorized staff for review when it is necessary to establish that a previous report was made. At the end of 6 months, case records maintained under this subsection shall be destroyed unless additional reports lead to their being reopened.

(d) When an older adult who is the subject of an unsubstantiated report has needs for other services, the older adult shall be informed of the availability of services through the area agency on aging service management system or another appropriate community agency.

The provisions of this § 15.43 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228905) to (228906).

This section cited in 6 Pa. Code § 15.102 (relating to maintenance of case files); 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.155 (relating to investigation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.44 Resolution of substantiated reports.

(a) When an investigation confirms the details of a report made under § 15.23 (relating to receiving reports; general agency responsibility) or determines that the subject of the report is an older adult in need of protective services, the report shall be classified as substantiated.

(b) The agency shall provide for a timely assessment of the need for protective services by the older adult who is the subject of a substantiated report if the older adult gives informed consent to an assessment. If an older adult found to need protective services does not consent to an assessment, the agency may seek, when appropriate, a court order under § 15.61 (relating to access to persons).

(c) On the basis of the assessment, the agency shall provide for the development of a service plan of recommended actions which reflect the least restrictive alternatives for removing or reducing imminent risk to person or property and promote self-determination and continuity of care being provided at the time of the agency’s intervention. The service plan may include, when appropriate, the pursuit of civil or criminal remedies.

(d) Developed service plans shall be put into effect under § 15.94 (relating to service delivery).

The provisions of this § 15.44 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228906).

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.155 (relating to investigation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.45 Situations involving State-licensed facilities.

(a) General. The following apply to investigations of reports concerning older adults who reside in State-licensed facilities:

(1) The agency continues to maintain its general responsibility for protective services when a licensing agency assumes the role of investigating a report received by the agency.

(2) The response times provided in § 15.42(a) (relating to standards for initiating and conducting investigations) for initiating investigations of reports apply to initiating investigations of reports under this section. The initiation of the investigation under subsection (c) is accomplished by the referral of the report to the appropriate administrative office.

(3) The supervisor of a protective services caseworker who initiates an investigation under this section shall be informed during the current day or next day of normal agency operating hours concerning the report and shall consult frequently with the caseworker about the progress and findings of the investigation.

(4) The agency shall notify the area agency on aging ombudsman of reports and investigations concerning older adults residing in State licensed facilities for which the area agency on aging provides ombudsman services. In situations that ombudsman services, as established by section 712(g) of the Older Americans Act of 1965 (42 U.S.C.A. § 3058g) and section 2207-A of The Administrative Code of 1929 (71 P. S. § 581-7(d)), are determined to be appropriate, the agency shall request those services from the ombudsman.

(b) Agency coordination with the licensing agency.

(1) Except as provided under subsection (c), the agency shall notify the appropriate licensing agency under procedures developed by the Department, in consultation with the licensing agency

(i) Notification shall identify the facility, the older adult and the nature of the report.

(ii) Notification shall be made immediately by telephone or facsimile to the appropriate field office of the Department of Health that an investigation has been initiated in a facility licensed by the Department of Health.

(iii) Notification shall be made immediately by telephone or facsimile to the appropriate field office or central office of the Department of Public Welfare that an investigation has been initiated in a facility licensed by the Department of Public Welfare.

(2) During the course of the investigation, the agency shall coordinate its investigative activities and findings with the licensing agency to avoid duplication of effort and to foster jointly developed remedies to situations requiring protective services intervention.

(c) State-operated mental health and mental retardation facilities. If the agency receives a report concerning an older adult who resides in a facility operated by the Department of Public Welfare under its Office of Mental Health or its Office of Mental Retardation, the agency shall provide for an investigation of that report as follows:

(1) The protective services caseworker or investigator to whom the report is referred shall initiate the investigation by referring the report to the appropriate administrative office under procedures jointly developed by the Department and the Department of Public Welfare for investigation under their patient rights program. The jointly developed procedures provide for specific points of contact between the agency and the Department of Public Welfare and establish a system which assures that the agency will be kept fully informed of the activities, findings and results of investigations through written records of the investigative activities and remedial actions as they develop.

(2) The agency shall closely monitor an investigation referred under paragraph (1) to determine that the investigation is effectively implemented and that appropriate remedies have been effected to correct the situation which led to the making of the report. The referral of an investigation to the Office of Mental Health or Office of Mental Retardation does not relieve the agency of its mandated authority and responsibility to provide protective services. If the agency determines that an older adult’s need for protective services is not adequately being met under paragraph (1), the agency shall intervene and conduct its own investigation.

The provisions of this § 15.45 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228906) to (228908).

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.155 (relating to investigation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.46 Law enforcement agencies as available resources.

(a) General. This chapter may not be interpreted to deny an older adult who needs protective services access to the normal protections available from the police and other law enforcement agencies as appropriate.

(b) Interagency coordination. To facilitate the cooperation of law enforcement officials with the provision of protective services when necessary, the agency shall fulfill the following minimum coordinating activities:

(1) Achieve specific coordination objectives with:

(i) Police departments in the planning and service area.

(ii) The district attorney’s office.

(iii) State Police field installations for the planning and service area.

(iv) Officials of the court system.

(v) Legal assistance agencies.

(2) Establish designated points of contact with law enforcement agencies to facilitate access when necessary.

(3) Establish basic procedures to be followed when the agency makes reports of criminal conduct or requests for special assistance to law enforcement agencies and when the law enforcement agencies report the need for protective services to the agency.

(4) Provide for the necessary exchange of information about protective services for older adults and the role of law enforcement in the provision of those services.

(c) The role of law enforcement in protective services. The agency’s protective services workers shall receive training as required under § § 15.121—15.127 (relating to staff training and experience standards) in applicable sections of the criminal code and the role of law enforcement officials when criminal conduct is encountered or suspected.

(d) Legal options information. The agency shall take steps to inform older adults who need protective services of the various legal options, civil or criminal, available through appropriate agencies as possible remedies to situations of risk to person or property. If an older adult reported to need protective services requests the agency to contact a law enforcement agency, the agency shall respond to that request in an appropriate and timely manner.

(e) Police assistance to protective services worker. A protective services worker may, as appropriate, request the assistance of a police officer when investigating a report which indicates a possible danger to the worker. As provided under § 15.74 (relating to forcible entry), forcible entry may be made only by a police officer or State Trooper accompanied by a representative of the agency after obtaining a court order.

(f) Simultaneous investigation. When both a report of need for protective services and a police report have been filed, the protective services investigation shall continue simultaneously with the police investigation. The agency may take steps to coordinate its investigation with the police investigation and the investigation of the State licensing agency and shall make available as provided under § 15.105 (relating to limited access to records and disclosure of information) relevant information from the case record.

(g) Report of death. If the death of an older adult reported to need protective services occurs prior to the agency’s investigation of the report, during the investigation or at any time prior to the closure of the protective services case, when there is some nexus between the death and the need for protective services, the agency shall immediately report that death to the police and the county coroner.

The provisions of this § 15.46 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228908) to (208909).

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.155 (relating to investigation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.47 Emergency medical services as available resources.

This chapter may not be interpreted to deny an older adult who needs protective services access to the normal protections of the emergency medical services that would be available to anyone, regardless of age, in similar circumstances.

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.155 (relating to investigation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.61 Access to older adults.

(a) Access assured by law. The agency shall have access to older adults who have been reported to need protective services to:

(1) Investigate reports received under this chapter.

(2) Assess the older adult’s need and develop a service plan for addressing determined needs.

(3) Provide for the delivery of services by the agency or other service provider arranged for under the service plan developed by the agency.

(b) Access to older adults. Except in emergency or priority protective services cases, access to older adults shall be between the hours of 7 a.m. and 9 p.m.

(c) When access is denied. If the agency is denied access to an older adult reported to need protective services and access is necessary to complete the investigation or the assessment and service plan, or the delivery of needed services to prevent further abuse, neglect, exploitation or abandonment of the older adult reported to need protective services, the protective services caseworker shall make reasonable efforts to clearly inform the party denying access of the legal authority for access in section 304 of the act (35 P. S. § 10225.304) and the available recourse through a court order. If the party continues to deny the agency access to the older adult, the agency may petition the court for an order to require the appropriate access when one of the following conditions applies:

(1) The caretaker or a third party has interfered with the completion of the investigation, the assessment and service plan or the delivery of services.

(2) The agency can demonstrate that the older adult reported to need protective services is denying access because of coercion, extortion or justifiable fear of future abuse, neglect, or exploitation or abandonment.

The provisions of this § 15.61 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228909) to (228910).

This section cited in 6 Pa. Code § 15.42 (relating to standards for initiating and conducting investigations); 6 Pa. Code § 15.44 (relating to resolution of substantiated reports); 6 Pa. Code § 15.63 (relating to access by consent); 6 Pa. Code § 15.92 (relating to assessment); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.62 Access to records.

(a) Access assured by law. The agency shall have access to records relevant to:

(1) Investigations of reports received under this chapter.

(2) The assessment of need and the development of a service plan when an older adult’s need for protective services has been or is being established.

(3) The delivery of services arranged for under the service plan developed by the agency to respond to an older adult’s assessed need for specific services.

(b) Access to records. Except in emergency or priority protective services cases, access to records shall be between the hours of 7 a.m. and 9 p.m.

(c) When access to records is denied. If the agency is denied access to records necessary for the completion of a proper investigation of a report or an assessment and service plan, or the delivery of needed services to prevent further abuse, neglect, exploitation or abandonment of the older adult reported to need protective services, the protective services caseworker shall clearly inform the party denying access to the records of the legal authority for access as set forth in section 304 of the act (35 P. S. § 10225.304) by the agency and the available recourse through a court order. If the party continues to deny access to relevant records, the agency may petition the court of common pleas for an order requiring the appropriate access when one of the following conditions applies:

(1) The older adult has provided written consent for confidential records to be disclosed and the keeper of the records denies access.

(2) The agency is able to demonstrate that the older adult is denying access to records because of incompetence, coercion, extortion or justifiable fear of future abuse, neglect, exploitation or abandonment.

The provisions of this § 15.62 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228910) to (228911).

In General

The requirements of this regulation are inherently inconsistent with the ex parte procedure used to obtain search warrants, where the element of surprise is deemed necessary to prevent the destruction of evidence. In the Interest of M. B., 686 A.2d 877 (Pa. Cmwlth. 1996).

This section cited in 6 Pa. Code § 15.63 (relating to access by consent); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.63 Access by consent.

The agency’s access to confidential records held by other agencies or individuals and the agency’s access to an older adult reported to need protective services shall require the consent of the older adult or a court-appointed guardian except as provided under § 15.61, § 15.62 or § 15.71 (relating to access to older adults; access to records; and involuntary intervention by emergency court order).

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.71 Involuntary intervention by emergency court order.

(a) General. When there is clear and convincing evidence that, if protective services are not provided, the older adult to be protected is at imminent risk of death or serious physical harm, the agency may petition the court for an emergency order to provide the necessary services. The person to be protected shall be an older adult in need of protective services as defined in this chapter. The courts of common pleas of each judicial district shall ensure that a judge or district magistrate is available on a 24-hour-a-day, 365-day-a-year basis to accept and decide on petitions for an emergency court order under this section whenever the agency determines that delay until normal court hours would significantly increase the danger the older adult faces. Only the agency, through its official representative, may bring a petition for involuntary intervention by emergency court order.

(b) Legal representation. When the agency petitions the court for emergency involuntary intervention, the agency shall make sure the older adult has the opportunity to be represented by counsel at all stages of the proceedings. If the older adult has an attorney known to the agency, the agency shall attempt to notify that attorney before it files a petition for emergency involuntary intervention. If the agency has no knowledge of an attorney who represents the older adult, the agency shall attempt to notify the legal services provider identified by the area agency on aging in its protective services plan to provide legal assistance under this chapter. The notification shall contain enough information about the risk to the older adult and the proposed remedy to enable counsel to determine if representation is necessary at the emergency hearing. Notification to counsel shall include a copy of the petition with the affidavits attached as well as the time, date and place of presentation of the petition except when § 15.72(b) (relating to petition) applies.

The provisions of this § 15.71 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228911) to (228912).

This section cited in 6 Pa. Code § 15.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 15.42 (relating to standards for initiating and conducting investigations); 6 Pa. Code § 15.63 (relating to access by consent); 6 Pa. Code § 15.73 (relating to court appointed counsel); 6 Pa. Code § 15.81 (relating to rights of protective services clients); 6 Pa. Code § 15.91 (relating to general); 6 Pa. Code § 15.92 (relating to assessment); 6 Pa. Code § 15.93 (relating to service plan); 6 Pa. Code § 15.94 (relating to service delivery); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.72 Petition.

(a) Contents. The petition which the agency files for an emergency court order of involuntary intervention shall state the following information:

(1) The name, age and physical description of the older adult insofar as these facts have been ascertained.

(2) The address or other location where the older adult can be found.

(3) The name and relationship of a guardian, caregiver or other responsible party residing with the older adult, when applicable.

(4) A description of how the older adult is at imminent risk of death or serious physical harm.

(5) The physical and mental status of the older adult, to the extent known.

(6) The attempts made by the agency to obtain the informed consent of the older adult, or the older adult’s court appointed guardian, when applicable, to the provision of protective services by the agency.

(7) The specific short-term, least restrictive, involuntary protective services which the agency is petitioning the court for an order to provide.

(8) A description of how the proposed services would remedy the situation or condition which presents an imminent risk of death or serious physical harm.

(9) A statement showing why the proposed services are not overbroad in extent or duration and why less restrictive alternatives as to their extent or duration are not adequate.

(10) A statement that other voluntary protective services have been offered, attempted or have failed to remedy the situation.

(11) A statement that reasonable efforts have been made to communicate with the older adult in a language the older adult understands in the case of an older adult who is hearing impaired or who does not understand the English language.

(12) Other relevant information deemed appropriate by the agency.

(b) Oral petitions. Nothing in this chapter precludes or prohibits the oral presentation of a petition for emergency involuntary intervention. When oral presentation is warranted, the written petition shall be prepared, filed and served on the older adult and counsel within 24 hours of the entry of the emergency order or on the next business day, when the 24-hour period would fall on a weekend or legal holiday.

(c) Affidavits. Allegations which are not based upon personal knowledge shall be supported by affidavits provided by persons having that knowledge. The affidavits shall be attached to the petition.

(d) Emergency order duration. In the petition, the agency shall request an emergency order of a specific duration which may not exceed 72 hours from the time the order is granted. The agency shall request the court of common pleas to hold a hearing when the initial emergency order expires to review the need for an additional emergency court order or other continued court and protective services involvement, or both. The issuance of an emergency order is not evidence of the competency or incompetency of the older adult.

This section cited in 6 Pa. Code § 15.71 (relating to involuntary intervention by emergency court order); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.73 Court appointed counsel.

The act requires that an emergency order under this section provides that the older adult has the right to legal counsel. If no representation for the older adult is present at the time the emergency order is requested, the agency shall inform the court of its efforts to notify counsel under § 15.71(b) (relating to involuntary intervention by emergency court order). If the older adult is unable to provide for counsel, the court will appoint counsel as authorized by the act at the time the emergency order is entered to ensure that legal representation will be provided at the time of the emergency protective services review hearing.

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.74 Forcible entry.

When the agency requests a court order for forcible entry to the premises where an older adult at imminent risk of death or serious physical harm is located, the agency shall request the court to direct that a local or State police officer carry out the forcible entry accompanied by a representative of the agency.

This section cited in 6 Pa. Code § 15.46 (relating to law enforcement agencies as available resources); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.75 Health and safety requirements.

The agency shall take reasonable steps to assure protection of the older adult’s dependents and property while the older adult is receiving services under an emergency court order. The agency is not responsible for the actual provision of all needed services but shall coordinate professional linkage referrals and follow-up to assure that the needed services and protections are being provided and maintained.

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.76 Documentation.

The agency shall document in the case record emergency intervention actions it takes.

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.81 Rights of protective services clients.

The agency shall observe the following minimum requirements to safeguard the rights of an older adult who is reported to need protective services:

(1) The agency shall discreetly notify the older adult during the investigation that a report of need for protective services has been made and shall provide the older adult with a brief summary of the nature of the report. The protective services caseworker performing the investigation shall determine when and how this notification is accomplished.

(2) If the older adult requests additional information contained in the record, the agency shall provide the information subject to the requirements in § 15.105 (relating to limited access to records and disclosure of information).

(3) A denial of services by the Department or an authorized agency under this chapter may be appealed under Chapter 3 (relating to fair hearings and appeals).

(4) Nothing in this chapter limits the rights of an older adult to file a petition under 23 Pa.C.S. Chapter 61 (relating to the Protection from Abuse Act).

(5) An older adult determined to need protective services has the right to refuse protective services except as provided under a court order. The agency shall obtain, when possible, the older adult’s signed statement refusing protective services or document unsuccessful efforts to obtain a signed statement.

(6) An older adult has the right to legal counsel when the agency petitions the court for emergency or other orders to provide protective services without the older adult’s consent. The act provides that if an older adult is unable to provide for counsel, counsel shall be appointed by the court. Under § 15.71 (relating to involuntary intervention by emergency court order), the agency is required to take steps to involve counsel when emergency petitions are filed.

(7) As provided under § § 15.101—15.105 (relating to confidentiality), an older adult has the right to the confidentiality of information received and maintained by the agency in reports, investigations, service plans and other elements of a case record.

The provisions of this § 15.81 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228914) to (228915).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.82 Rights of alleged abusers.

An individual who, as a result of a protective services investigation, is determined to be a perpetrator of the abuse, neglect, exploitation or abandonment of an older adult is entitled to the following if the report is substantiated by the agency:

(1) The agency shall notify the alleged perpetrator at the conclusion of the investigation of the report that allegations have been made and shall provide the alleged perpetrator with a brief summary of the allegations.

(2) As provided under § 15.105 (relating to limited access to records and disclosure of information), the alleged perpetrator may request, and the agency shall provide, additional information contained in the report.

(3) An alleged perpetrator is entitled to file an appeal with the Department under 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure) to challenge the agency’s finding resulting from the investigation of a report made under this chapter. The agency’s finding is that information, after an investigation is concluded, which substantiated the need for protective services. The appeal process applicable to older adults under Chapter 3 (relating to fair hearings and appeals) also applies to alleged perpetrators of abuse, neglect, exploitation or abandonment. This appeal shall be in writing to the Secretary and be postmarked within 30 days from the date of notification by the agency required under this section.

The provisions of this § 15.82 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228915).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.91 General.

(a) Protective services. Protective services are activities, resources and supports provided to older adults under the act after the initiation of an investigation to prevent, reduce or eliminate abuse, neglect, exploitation and abandonment. Protective services activities include the following:

(1) Administering protective services plans.

(2) Receiving and maintaining records of reports of abuse.

(3) Conducting investigations of reported abuse.

(4) Conducting assessments and developing service plans.

(5) Petitioning the court.

(6) Providing emergency involuntary intervention.

(7) Arranging for available services needed to fulfill service plans, which may include, as appropriate, arranging for services for other household members to reduce, correct or eliminate abuse, neglect, exploitation or abandonment of an older adult. A partial listing of the services which may be made available to reduce, correct or eliminate abuse, neglect, exploitation or abandonment of an older adult is found in § 15.93(c) (relating to service plan).

(8) Purchasing, on a temporary basis, as provided under § 15.112 (relating to uses of funding authorized by the act), services determined by a service plan to be necessary to reduce, correct or eliminate abuse, neglect, exploitation or abandonment of an older adult when the services are not available within the existing resources of the agency or other appropriate provider.

(b) Availability of protective services. The agency shall offer protective services under one or more of the following conditions:

(1) An older adult requests the services.

(2) Another interested person requests the services on behalf of an older adult.

(3) If, after initiation of an investigation of a report, the agency determines the older adult needs the services.

(c) Informed consent required. The agency shall provide protective services only to older adults who give informed consent to the services. The consent shall be in writing when possible. If the older adult does not consent or, if after consenting, withdraws the consent, protective services may not be provided unless the provision of the services is allowable as a consent exemption.

(d) Consent exemptions. Protective services may be provided to older adults in need of protective services without consent only in the following situations:

(1) When ordered by a court under section 304 of the act (35 P. S. § 10225.304).

(2) When requested by an older adult’s court-appointed guardian.

(3) When provided under § 15.71 (relating to involuntary intervention by emergency court order).

(e) Interference with services. If a person interferes with the provision of services or interferes with the right of an older adult to consent to the provision of services, the agency may petition the court for an order enjoining the interference.

The provisions of this § 15.91 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228915) to (228916).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.92 Assessment.

(a) When a report is substantiated by the agency, or if an assessment is necessary to determine whether or not the report is substantiated, the agency shall, with the consent of the older adult, provide for a timely assessment. If the older adult does not consent, the agency may apply § 15.61 or § 15.71 (relating to access to persons; and involuntary intervention by emergency court order).

(b) The protective services caseworker shall make face-to-face contact with the older adult to evaluate and document information including the following:

(1) Personal appearance.

(2) Physical environment.

(3) Physical health.

(4) Mental functioning.

(5) Activities of daily living.

(6) Social environment.

(7) Economic status—including eligibility for public and private entitlements or resources as defined under § 15.2 (relating to definitions).

(8) Nutrition.

(9) Recent experiences—losses, separations, major changes in relationships or environments.

(10) The need for a formal medical or psychiatric evaluation.

(c) The assessment shall be written and include, whenever possible, older adult-given information for each area of functioning.

(d) The assessment shall be written so that the reader can determine which information came from the older adult and which constitutes the worker’s judgment.

(e) The assessment shall be written in a standard format as required by the Department. Data entries shall be based on commonly accepted and defined nomenclature to make the data more usable across and within agencies and to ensure that older adults are evaluated uniformly according to the standardized definitions.

The provisions of this § 15.92 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228916) to (228917).

This section cited in 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.93 Service plan.

(a) Upon completion of the assessment and with the consent of the older adult, a service plan shall be prepared. The service plan shall be cooperatively developed by the agency staff, the older adult or his appointed guardian, and other family members, if appropriate. Protective services may not be provided under the act to an older adult who does not consent to the services or who, having consented, withdraws consent, unless the services are ordered by a court, requested by a court-appointed guardian of the older adult or provided under § 15.71 (relating to involuntary intervention by emergency court order).

(b) The service plan shall be in writing and shall include a recommended course of action which utilizes the least restrictive alternative, encourages self-determination and continuity of care. The recommended course of action may also include pursuit of civil or criminal remedies.

(c) The service plan shall describe the older adult’s identified needs, the goals to be achieved, the specific services which will be used to support attainment of the goals and the procedures to be followed with regard to regular follow-up and assessment of progress. Specific services which may be used to implement the service plan include:

(1) Medical evaluations.

(2) Psychiatric or psychological evaluations.

(3) Legal services.

(4) Public or private entitlements or resources.

(5) Financial management.

(6) Personal or environmental safety.

(7) Emergency shelter.

(8) Transportation.

(9) Home delivered meals.

(10) Attendant care.

(11) Homemaker services.

(d) The service plan shall also address, if applicable, special needs of other members of the household unit as they may affect the older adult’s need for protective services. The identification in a service plan of service needs of other members of the older adult’s household does not obligate the agency to pay the costs of the services.

The provisions of this § 15.93 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228917) to (228918).

This section cited in 6 Pa. Code § 15.91 (relating to general); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.94 Service delivery.

(a) The agency shall, with the consent of the older adult, provide for implementation of the course of action recommended in the service plan. The implementation may be provided by direct provision of services by the agency, purchase of services from another agency, referral to another agency, provision of services by family and friends or a combination of these or other methods.

(b) Protective services may not be provided under the act to an older adult who does not consent to services or who, having consented, withdraws consent, unless the services are ordered by a court, requested by a guardian of the older adult or provided under § 15.71 (relating to involuntary intervention by emergency court order).

The provisions of this § 15.94 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228918).

This section cited in 6 Pa. Code § 15.44 (relating to resolution of substantiated reports).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.95 Case management.

(a) Coordination of services. The protective services caseworker is responsible for coordination of sources of services being provided to the older adult who needs protective services. The caseworker shall also take reasonable steps to assure that services necessary to achieve the goals in the service plan are being provided.

(b) Case records. A separate record shall be established to contain information on protective services cases. The protective service case record on an older adult shall be separated from other records maintained by the agency on that older adult. Confidentiality of the protective services case record shall be maintained by the agency as set forth in § § 15.101—15.105 (relating to confidentiality). The protective services case record includes the following:

(1) The report of a need for protective services.

(2) The record of investigation.

(3) The written findings of the assessment.

(4) The service plan.

(5) Notes of contact with the older adult and others involved with the case.

(6) Court documents—for example, petitions, orders and the like.

(7) Letters of notification—abused and abuser.

(1) Reassessment shall be written in the standardized format established by the Department.

(2) Reassessment shall be done before a protective services case is terminated, transferred, it is the agency’s judgment that a reassessment is appropriate or the older adult’s condition has changed.

The provisions of this § 15.95 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228919).

This section cited in 6 Pa. Code § 15.113 (relating to time limitation on service purchases).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.96 Termination of protective services.

(a) The agency shall terminate protective services when the older adult is no longer ‘‘an older adult in need of protective services’’ under § 15.2 (relating to definitions).

(b) Except when the older adult withdraws consent to the delivery of protective services, the agency may terminate protective services in one of the following ways:

(1) By closing the case when no further service intervention is required by the older adult.

(2) By closing the case when a court order for services has terminated and the older adult does not consent to further service intervention.

(3) By transferring the older adult to the service management system of the area agency.

(4) By transferring the older adult to another appropriate agency.

(c) When the agency terminates protective services, the agency shall inform the older adult and, if applicable, responsible caretakers of this action and its rationale and shall attempt to secure a signed statement of understanding concerning the action. When the agency transfers a protective services case, the case record shall reflect the transfer of an older adult to another agency, the specific agency of referral and the acceptance of the referral by the other agency.

The provisions of this § 15.96 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228920).

This section cited in 6 Pa. Code § 15.13 (relating to organization and structure of protective services functions).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.101 General.

Information contained in the agency’s protective services case files, as defined under § 15.2 (relating to definitions), shall be considered confidential and shall be maintained under this chapter.

This section cited in 6 Pa. Code § 15.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 15.81 (relating to rights of protective services clients); 6 Pa. Code § 15.95 (relating to case management); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.102 Maintenance of case records.

(a) Protective services case records shall be kept, when not in use by authorized persons, in a locked container and separate from other agency files. The report, the record of investigation, notes of contact with the older adult and others involved with the case, court documents and letters of notification may not be transferred to, or reprinted for, other agency files. The assessment and service plan may be transferred to other agency case files with assurance by the agency that an older adult’s complete protective services case record can be immediately produced.

(b) When an individual case record is removed from its storage location for use by an authorized person, the person shall sign for the record according to sign-out procedures developed by the agency.

(c) Except as provided under § 15.105 (relating to limited access to records and disclosure of information), only staff with direct responsibility for protective services functions may be authorized by the agency to have access to the protective services case records. General access is restricted to protective services supervisors, protective services caseworkers and clerical staff assigned to type and maintain case records.

(d) As provided under § 15.43 (relating to resolution of unsubstantiated reports), when the agency cannot substantiate a report of a need for protective services, the case opened by the unsubstantiated report shall be closed and information identifying the person who made the report and the alleged perpetrator of abuse, if applicable, shall be immediately deleted from the case record.

(e) For the purposes of substantiating a pattern of abuse, neglect, exploitation or abandonment, the name of the older adult reported to be in need of protective services and other information relevant to the circumstances which led to the report may be maintained for 6 months in a separate locked file accessible only to authorized staff for review when necessary to establish that a previous report was made. At the end of 6 months, case records maintained under this subsection shall be destroyed unless additional reports lead to their being reopened.

(f) The agency shall develop written procedures for the deletion or expungement of information in case records and for the destruction of case records so that unauthorized persons are not able to gain access to information from case records. The procedures shall be submitted to the Department in the protective services plan required under § 15.12(b) (relating to administrative functions and responsibilities of area agencies on aging).

The provisions of this § 15.102 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228920) to (228921).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.103 Responsibilities of staff with access to confidential information.

(a) The agency shall assure that staff with access to information contained, or to be contained, in a case record are fully aware of the confidentiality provisions of this chapter and of the local agency.

(b) A staff person who is authorized to have access to information contained, or to be contained, in a case record is required to take every possible step to safeguard the confidentiality of that information. This requirement extends to known information related to a case but not recorded in writing.

(c) A staff person who is to be authorized to have access to confidential information related to protective services cases shall sign a statement provided by the Department, assuring knowledge of applicable confidentiality requirements and the penalties for violating them.

The provisions of this § 15.103 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228921) to (228922).

This section cited in 6 Pa. Code § 15.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 15.27 (relating to handling of completed reports); 6 Pa. Code § 15.81 (relating to rights of protective services clients); 6 Pa. Code § 15.95 (relating to case management); 6 Pa. Code § 15.104 (relating to penalties for violation of confidentiality requirements); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.104 Penalties for violation of confidentiality requirements.

(a) If a staff person who is authorized to have access to confidential information under this chapter is strongly suspected of violating the requirements in the signed confidentiality statement under § 15.103(c) (relating to responsibilities of staff with access to confidential information), that person shall be immediately suspended from protective services duties pending an investigation and determination of culpability.

(b) If a staff person who is authorized to have access to confidential information under this chapter is determined upon investigation to have violated the requirements in the signed confidentiality statement under § 15.103(c), that person shall be subject to the appropriate disciplinary action in the confidentiality statement.

This section cited in 6 Pa. Code § 15.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 15.27 (relating to handling of completed reports); 6 Pa. Code § 15.81 (relating to rights of protective services clients); 6 Pa. Code § 15.95 (relating to case management); and 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.105 Limited access to records and disclosure of information.

Information in a protective services case record may not be disclosed, except as provided in this section.

(1) Information may be disclosed to a court of competent jurisdiction or under a court order. The protective service agency shall disclose case record information for the purpose of in camera review by the court.

(2) If an investigation by the agency results in a report of criminal conduct, law enforcement officials shall have access to relevant records maintained by the agency or the Department.

(3) In arranging specific services to effect service plans, the agency may disclose to appropriate service providers information necessary to initiate the delivery of services.

(4) A subject of a report, a court-appointed guardian or an attorney providing legal services to the subject of the report made under § 15.23 (relating to receiving reports; general agency responsibility) may receive, upon written request, information contained in the report except that prohibited from being disclosed by paragraph (5).

(5) The release of information that would identify the person who made a report of suspected abuse, neglect, exploitation or abandonment or a person who cooperated in a subsequent investigation, is prohibited unless the Secretary can determine that the release will not be detrimental to the safety of the person. Prior to releasing information under this paragraph, the Secretary will notify the person whose identity would be released that the person has 45 days to advise the Secretary why this anticipated release would be detrimental to the safety of that person.

(6) When the Department is involved in the hearing of an appeal by a subject of a report made under § 15.23, the appropriate Department staff shall have access to information in the case record relevant to the appeal.

(7) For the purposes of monitoring agency performance, appropriate staff of the Department may have access to agency protective services records.

(8) For the purposes of monitoring agency performance and carrying out other administrative responsibilities, individuals with local administrative authority over the protective services program may have access to agency protective services records.

The provisions of this § 15.105 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228922) to (228923).

This section cited in 6 Pa. Code § 15.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 15.46 (relating to law enforcement agencies as available resources); 6 Pa. Code § 15.81 (relating to rights of protective services clients); 6 Pa. Code § 15.82 (relating to rights of alleged abusers); 6 Pa. Code § 15.95 (relating to case management); 6 Pa. Code § 15.102 (relating to maintenance of case files); 6 Pa. Code § 15.112 (relating to uses of funding authorized by the act); and 6 Pa. Code § 15.157 (relating to confidentiality of and access to confidential reports).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.111 Coordination of available resources.

(a) The agency shall insure that funding authorized under the act is not used to supplant public and private entitlements or resources as defined in § 15.2 (relating to definitions) for which older adults are, or may be, eligible.

(b) The agency shall attempt to establish the older adult’s eligibility for appropriate public and private entitlements and resources and shall exhaust the eligibility for benefits prior to the utilization of funds authorized by the act for the provision of services.

(c) The agency is required to coordinate the utilization of public and private entitlements and resources. This chapter does not establish a means test for the provision of protective services. A protective service client who receives a service may not be required to pay a fee not required of other older adults receiving the same service.

The provisions of this § 15.111 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228923) to (228924).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.112 Uses of funding authorized by the act.

The agency may utilize funding authorized by the act to pay for activities, including the following:

(1) Administering protective services plans as described in § 15.12(b) (relating to administrative functions and responsibilities of area agencies on aging).

(2) Receiving reports and maintaining records of reports as provided under § § 15.23 and 15.101—15.105 (relating to receiving reports; general agency responsibility; and confidentiality).

(3) Conducting investigations under § § 15.41—15.47 (relating to investigating reports of need for protective services).

(4) Conducting assessments and developing service plans under § § 15.92 and 15.93 (relating to assessment; and service plan).

(5) Petitioning the court under § § 15.61—15.63 and 15.71—15.75 (relating to agency access to older persons and records; and emergency intervention).

(6) Providing emergency involuntary intervention under § § 15.71—15.75.

(7) Arranging for available services needed to carry out service plans, which may include, as appropriate, arranging for services for other household members to reduce, correct or eliminate abuse, neglect, exploitation or abandonment of an older adult. The inclusion of services needed by other household members in the service plan will allow the agency to arrange for the provision of those services through public and private entitlements or resources for which the individuals are or may be eligible. The inclusion does not obligate the agency to pay for the services or to provide services which are not available from another appropriate provider.

(8) Purchasing, on a temporary basis, services determined by the service plan to be necessary to reduce, correct or eliminate abuse, neglect, exploitation or abandonment of an older adult when the services are not available within the existing resources of the agency or another appropriate provider. Funding authorized by the act and expended under an area agency on aging protective services plan may not be used for the purchase of services which are already financed through other State-administered plans for local service delivery or through local public and private resources under those plans except with the specific prior approval of the Department. The protective services plan shall identify the agency’s proposed expenditures for activities under this paragraph. The agency shall insure that every attempt has been made to provide the service through existing agency resources, appropriate utilization of other providers and the coordination of public and private entitlements and resources prior to entering into the purchase of services for a protective services client.

The provisions of this § 15.112 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228924) to (228925).

This section cited in 6 Pa. Code § 15.91 (relating to general).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.113 Time limitation on service purchases.

(a) After exhausting available steps to provide necessary services through existing agency resources, utilization of other providers and the coordination of public and private entitlements and resources, the agency may purchase those services on a time-limited basis.

(b) The purchase of services under this section is limited to a 30-day period which may be renewed only with adequate justification. The agency shall consider the 30-day period to be a maximum time limit for the purchase of services and not a standard time allotment. After the decision to purchase services has been made, the agency shall continue the pursuit of alternate ways to provide the services and terminate the purchase of services as soon as possible.

(c) If at the end of 30 days of continuous service purchase on behalf of an individual protective services client, the services are still necessary and still available only through purchase, complete justification of the need for services and documentation of the unavailability of the services shall be made a part of the record as required by § 15.95(b) (relating to case management).

The provisions of this § 15.113 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228925).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.114 Obligation of the Commonwealth and the counties.

The obligation of the Commonwealth and the counties to provide funds to the Department or an agency for services provided under this chapter shall be entirely discharged by the appropriations made to the Department or an agency. If the agency has met its responsibility under the law, no action at law or equity may be instituted in a court to require the Department, an agency, county or the Commonwealth to provide benefits or services under the act for which appropriations from the Commonwealth or counties are not available. The responsibility of the area agency on aging, the county and the Commonwealth to provide funding is met when resources authorized by the act and provided under approved area agency on aging plans have been expended.

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.121 Protective services staff qualifications.

(a) General. The area agency on aging shall assure that staff directly involved with the protective services caseload meet the minimum standards of training and experience in this chapter. The minimum standards apply to staff assigned to protective services on a full-time basis, a part-time basis or as standby staff. The minimum standards apply to incumbent staff as well as those hired after November 26, 1988.

(b) Criminal record. The protective services agency shall require persons to be hired or to be assigned to carry out responsibilities for protective services investigations, assessments and service planning and arrangement to submit the following information:

(1) Under 18 Pa.C.S. § § 9101—9183 (relating to the criminal history record information act), a report of criminal history record information from the State Police or a statement from the State Police that the State Police Central Repository contains no information relating to that person. The criminal history record information shall be limited to that which is disseminated under 18 Pa.C.S. § 9121(b)(2) (relating to general regulations).

(2) If the applicant or assignee is not a resident of this Commonwealth, a report of Federal criminal history record information under the Federal Bureau of Investigation appropriation of Title II of the Act of October 25, 1972 (Pub. L. No. 92-544, 86 Stat. 1109).

(c) Staff training and experience requirements. The minimum standards for protective services job functions are as follows:

(1) Protective services supervisor. A protective services supervisor shall:

(i) Have 3 years direct aging casework experience or an equivalent combination of education and experience.

(ii) Complete the curriculum described in § 15.122 (relating to protective services casework training curriculum).

(iii) Complete the curriculum described in § 15.123 (relating to protective services investigation training curriculum) if the protective services supervisor will be performing protective services investigations.

(iv) Complete written evaluations that assess competencies achieved by the learner.

(v) Undergo in-service training in protective services annually as required by the Department.

(2) Protective services caseworker. A protective services caseworker shall:

(i) Have 1 year direct aging casework experience.

(ii) Complete the curriculum described in § 15.122.

(iii) Complete the curriculum described in § 15.123.

(iv) Complete written evaluations that assess competencies achieved by the learner.

(v) Undergo in-service training in protective services annually as required by the Department.

(3) Protective services intake workers. Staff persons designated to receive reports of older adults who need protective services shall complete the curriculum under § 15.124 (relating to protective services intake training curriculum).

The provisions of this § 15.121 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228925) to (228927).

This section cited in 6 Pa. Code § 15.2 (relating to definitions); 6 Pa. Code § 15.11 (relating to administrative functions and responsibilities of the Department); 6 Pa. Code § 15.13 (relating to organization and structure of protective services functions); 6 Pa. Code § 15.26 (relating to screening and referral of reports received); 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.46 (relating to law enforcement agencies as available resources); 6 Pa. Code § 15.125 (relating to availability of training); and 6 Pa. Code § 15.126 (relating to training evaluation).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.122 Protective services casework training curriculum.

The protective services casework training curriculum shall consist of comprehensive training including the following topics:

(1) An overview of abuse, neglect, exploitation and abandonment.

(2) Laws and regulations of the Commonwealth relating to abuse, neglect, exploitation and abandonment of older adults.

(3) Detection of abuse, neglect, exploitation and abandonment.

(4) Protective services case assessments.

(5) Provision of protective services.

(6) Interviewing skills.

(7) The resistant older adult.

(8) Utilization of local resources.

(9) Incompetence or incapacity.

(10) Relationships with other agencies.

(11) Confidentiality.

(12) Institutional investigations.

(13) Service options for victims of abuse, neglect, exploitation and abandonment.

(14) Informed consent.

(15) Self-neglect.

(16) Retaliation.

The provisions of this § 15.122 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228927).

This section cited in 6 Pa. Code § 15.2 (relating to definitions); 6 Pa. Code § 15.11 (relating to administrative functions and responsibilities of the Department); 6 Pa. Code § 15.13 (relating to organization and structure of protective services functions); 6 Pa. Code § 15.26 (relating to screening and referral of reports received); 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.46 (relating to law enforcement agencies as available resources); 6 Pa. Code § 15.121 (relating to protective services staff qualifications); and 6 Pa. Code § 15.127 (relating to in-service training).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.123 Protective services investigation training curriculum.

The protective services investigation training curriculum shall consist of comprehensive training including the following topics:

(1) Laws and regulations of the Commonwealth related to investigations and criminal procedures.

(2) The criminal justice system.

(3) Developing the investigative plan.

(4) Investigative techniques.

(5) Maintaining control of the interview.

(6) Interviewing reporters.

(7) Interviewing collateral sources.

(8) Interviewing victims.

(9) Observation techniques.

(10) Techniques to obtain documentary evidence.

(11) Techniques to gather and preserve physical evidence.

(12) Closing the investigation.

(13) Presenting testimony in court.

(14) Coordination with other State agencies.

The provisions of this § 15.123 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial pages (228927) to (228928).

This section cited in 6 Pa. Code § 15.2 (relating to definitions); 6 Pa. Code § 15.11 (relating to administrative functions and responsibilities of the Department); 6 Pa. Code § 15.13 (relating to organization and structure of protective services functions); 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.46 (relating to law enforcement agencies as available resources); 6 Pa. Code § 15.121 (relating to protective services staff qualifications); and 6 Pa. Code § 15.127 (relating to in-service training).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.124 Protective services intake training curriculum.

The protective services intake training curriculum shall consist of training including the following topics:

(1) Interviewing the reporter.

(2) Completion of the report form.

(3) Preliminary case status assessment to determine report categories.

(4) Requirements for referral of the report to the protective services staff.

(5) Emergency procedures.

(6) Confidentiality.

This section cited in 6 Pa. Code § 15.2 (relating to definitions); 6 Pa. Code § 15.11 (relating to administrative functions and responsibilities of the Department); 6 Pa. Code § 15.13 (relating to organization and structure of protective services functions); 6 Pa. Code § 15.24 (relating to receiving reports; agency intake process); 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.46 (relating to law enforcement agencies as available resources); and 6 Pa. Code § 15.121 (relating to protective services staff qualifications).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.125 Availability of training.

(a) The Department will provide for the development of training curricula described in this section and will require the training to be conducted on a timely and recurring basis. The Department will also provide for annual in-service training.

(b) The agency shall utilize staff meeting the requirements in § 15.121(c)(1) and (2) (relating to protective services staff qualifications) to conduct training for protective services intake workers. The training shall be in conformity with the curriculum for protective services intake workers established by the Department.

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.126 Training evaluation.

A person who completes the training set forth for each job function in § 15.121 (relating to protective services staff qualifications) shall complete written evaluations that assess competencies achieved by the learner.

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.127 In-service training.

(a) In addition to the required training set forth in § § 15.122 and 15.123 (relating to protective services casework training curriculum; and protective services investigation training curriculum), protective services supervisors and protective services caseworkers shall participate in in-service training in protective services as required by the Department each year beginning with the calendar year following completion of the required basic protective services training set forth in § 15.122 (relating to protective services casework training curriculum).

(b) Annual in-service training shall consist of a minimum of 1 day of training and may include the following topics:

(1) Update on laws and regulations relating to protective services.

(2) Technical assistance for common problems.

(3) Best practice presentations.

The provisions of this § 15.127 amended May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412. Immediately preceding text appears at serial page (228929).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.141 Prospective facility personnel.

(a) General rule. A facility shall require applicants for employment to submit applications with a criminal history report, obtained within 1 year immediately preceding the date of application, or as in § 15.144 (relating to procedure), as follows:

(1) State Police criminal history record. Facilities shall require all applicants to submit a State Police criminal history record.

(2) Federal criminal history record. If the applicant is not and for the 2 years immediately preceding the date of application has not been a resident of this Commonwealth, the facility shall require the applicant to submit a Federal criminal history record and a full set of fingerprints to the Department which will be forwarded to the Federal Bureau of Investigation.

(b) Proof of residency. Facilities may require an applicant to furnish proof of residency, including, but not limited to, any one of the following documents:

(1) Motor vehicle records, such as a valid driver’s license.

(2) Housing records, such as mortgage records, rent receipts or certification of residency in a nursing home.

(3) Public utility records and receipts, such as electric bills.

(4) Local tax records.

(5) A completed and signed, Federal, State or local income tax return with the applicant’s name and address preprinted on it.

(6) Employment records, including records of unemployment compensation.

The provisions of this § 15.141 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated); and 6 Pa. Code § 15.147 (relating to violations).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.142 Employee requirements.

(a) The following employees are required to submit a criminal history report:

(1) Administrators and operators who have direct contact with clients and who began serving as administrators and operators after July 1, 1998. Residents of this Commonwealth shall comply within 30 days of employment and nonresidents shall comply within 90 days.

(2) Employees of a facility who were employed after July 1, 1998. Residents of this Commonwealth shall comply within 30 days of employment and nonresidents shall comply within 90 days.

(3) Exceptions are as follows:

(i) Employees of the facility on July 1, 1998, who were employed by the facility for a continuous period of at least 1 year prior to July 1, 1998.

(ii) Employees who have complied with this section who transfer to another facility established or supervised, or both, by the same operator.

(iii) Employees who are employed by a new facility solely through a transfer of ownership of that facility.

(iv) A consumer attendant.

(v) An individual providing care to a care-dependent person, and employed by the care-dependent person, or by another person designated by the care-dependent person, and not by or through a home health care agency.

(vi) An individual, employed by an enterprise that operates facilities and nonfacilities in the same physical location, who has no employment responsibilities in the facility (Example: An individual employed by a hospital which also has within it a long-term care nursing unit. The individual is employed to work in the hospital).

(vii) A contract employee who has neither direct contact with residents in a facility nor unsupervised access.

(viii) An individual, employed by a home health agency or other entity that supplies, arranges for, or refers personnel to provide care to care-dependent persons, who is employed for purposes other than providing care in a facility or in a recipient’s place of residence (example: an individual employed as a bookkeeper by an agency which supplies homemaker/home health aides).

(ix) An individual functioning in a facility as a volunteer.

(b) Employees at facilities that supply, arrange for, or refer their employees to provide care in other facilities shall provide a criminal history report to the facility that supplies, arranges for, or refers them and to the facility at which they provide care. The exemptions of this section are applicable to these employees. (Example: Employees of a home health care staffing agency assigned by the agency to provide care in a long-term care nursing facility must provide a criminal history report to the staffing agency and to the long-term care nursing facility.) The staffing agency shall be responsible for notifying the employee of criminal history report requirements.

(c) Criminal history reports provided by the Department of Education, under the Nurse Aide Resident Abuse Prevention Training Act (63 P. S. § § 671—680), which meet the criteria established in this chapter may be accepted to satisfy the requirements of this chapter.

The provisions of this § 15.142 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated); and 6 Pa. Code § 15.147 (relating to violations).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.143 Facility responsibilities.

(a) A facility may not hire an applicant nor retain an employee required to submit a criminal history report if the criminal history report reveals a felony conviction under The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. § § 780-101—780-144).

(b) A facility may not hire an applicant nor retain any employee required to submit a criminal history report if the criminal history report reveals a conviction under one or more of the following provisions of 18 Pa.C.S. (relating to the Crimes Code):

(1) Chapter 25 (relating to criminal homicide).

(2) Section 2702 (relating to aggravated assault).

(3) Section 2901 (relating to kidnapping).

(4) Section 2902 (relating to unlawful restraint).

(5) Section 3121 (relating to rape).

(6) Section 3122.1 (relating to statutory sexual assault).

(7) Section 3123 (relating to involuntary deviate sexual intercourse).

(8) Section 3124.1 (relating to sexual assault).

(9) Section 3125 (relating to aggravated indecent assault).

(10) Section 3126 (relating to indecent assault).

(11) Section 3127 (relating to indecent exposure).

(12) Section 3301 (relating to arson and related offenses).

(13) Section 3502 (relating to burglary).

(14) Section 3701 (relating to robbery).

(15) A felony offense under Chapter 39 (relating to theft and related offenses), or two or more misdemeanors under Chapter 39.

(16) Section 4104 (relating to tampering with records or identification).

(17) Section 4114 (relating to securing execution of documents by deception).

(18) Section 4302 (relating to incest).

(19) Section 4303 (relating to concealing death of child).

(20) Section 4304 (relating to endangering welfare of children).

(21) Section 4305 (relating to dealing in infant children).

(22) Section 4952 (relating to intimidation of witnesses or victims).

(23) Section 4953 (relating to retaliation against witness, victim or party).

(24) A felony offense under section 5902(b) (relating to prostitution and related offenses).

(25) Section 5903(c) or (d) (relating to obscene and other sexual materials and performances).

(26) Section 6301 (relating to corruption of minors).

(27) Section 6312 (relating to sexual abuse of children).

(c) A facility may not hire an applicant nor retain an employee required to submit a criminal history report if the criminal history report reveals conviction of a Federal or out-of-State offense similar in nature, as determined by the Department, to those listed in subsections (a) and (b).

(d) A facility shall ensure that applicant or employee responsibility to obtain criminal history reports is explained to each applicant or employee orally and in writing in a language understood by the applicant or employee.

(e) Facilities shall maintain employment records which include copies of completed request forms for criminal history reports, State Police criminal history records and Department letters of determination regarding Federal criminal history records.

(f) An administrator shall assure that information obtained from State Police criminal history records and Department letters of determination regarding Federal criminal history records remain confidential and are used solely to determine an applicant’s eligibility for employment or an employee’s eligibility for retention.

(g) If the decision not to hire or to terminate employment is based in whole or in part on State Police criminal history records, Department letters of determination regarding Federal criminal history records, or both, facilities shall provide applicants and employees with information on how to appeal to the sources of criminal history records if they believe the records are in error.

The provisions of this § 15.143 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.146 (relating to provisional hiring); 6 Pa. Code § 15.147 (relating to violations); and 28 Pa. Code § 611.52 (relating to criminal background checks).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.144 Procedure.

(a) Applicants and employees required to obtain a criminal history report from the State Police may obtain forms from a State Police facility.

(1) The State Police may charge a fee of not more than $10. A facility’s check, cashier’s check, certified check or money order shall accompany the request unless other payment arrangements are made with the State Police.

(2) Facilities may at their option require applicants and employees to return the form to a designated individual for submission by the facility.

(b) Applicants and employees required to obtain a Federal criminal history report shall obtain the information packet from the facility or the Department.

(1) Applicants and employees shall return the Federal Bureau of Investigation fingerprint card and forms, and a cashier’s check, certified check or money order payable to the Federal Bureau of Investigation in the exact amount established by the Federal Bureau of Investigation. Upon receipt, the Department will submit the request to the State Police for transfer to the Federal Bureau of Investigation.

(2) Upon receipt of the criminal history report from the Federal Bureau of Investigation, the Department will determine if the applicant is eligible for employment or if the employee may be retained. The Department will contact the applicant or employee with a written letter of determination.

(c) Applicants and employees shall complete all necessary forms. Facilities shall assist an applicant or employee to comply with this requirement if requested.

(d) Facility administrators may assume financial responsibility for the fees through a quarterly payment system.

(e) Applicants and employees are responsible for reviewing their own criminal history reports for accuracy.

The provisions of this § 15.144 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated); 6 Pa. Code § 15.141 (relating to prospective facility personnel); 6 Pa. Code § 15.147 (relating to violations); and 28 Pa. Code § 611.52 (relating to criminal background checks).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.145 Applicant or employee rights of review.

(a) An applicant or employee may review, challenge and appeal the completeness or accuracy of the applicant’s or employee’s criminal history report under 18 Pa.C.S. § § 9125 and 9152—9183 or 28 CFR 16.34 (relating to procedure to obtain change, correction or updating of identification records), or both.

(b) An applicant or employee may challenge the conviction comparison interpretation of the Department involving the Federal criminal history record by filing an appeal with the Department under 1 Pa. Code Chapter 35 (relating to formal proceedings) and Chapter 3 (relating to fair hearings and appeals). Appeals must be postmarked within 30 days from receipt of the Department’s letter and be in writing to the attention of the Secretary of the Department.

The provisions of this § 15.145 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated); and 6 Pa. Code § 15.147 (relating to violations).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.146 Provisional hiring.

(a) Facilities may employ applicants on a provisional basis for a single period not to exceed 30 days for applicants requesting a State Police criminal history record, and a single period not to exceed 90 days for applicants requesting a Federal criminal history record, if all of the following conditions are met:

(1) Applicants shall have applied for a criminal history report and provided the facility with a copy of the completed request forms.

(2) The facility shall have no knowledge about the applicant that would disqualify the applicant from employment under 18 Pa.C.S. § 4911 (relating to tampering with public record information).

(3) The applicant shall swear or affirm in writing that the applicant is not disqualified from employment under the act.

(4) The provisionally employed applicant shall receive an orientation which provides information on policies, procedures and laws which address standards of proper care and recognition and reporting of abuse or neglect, or both, of recipients.

(5) The facility shall regularly supervise the applicant carrying out assigned duties. The results of the observations shall be documented in the employee personnel file.

(6) A home health care agency shall supervise the applicant through random, direct observation and evaluation of the applicant and care recipient by an employee who has been employed by the home health agency for at least 1 year. The results of the observations shall be documented in the employee personnel file.

(7) A home health agency which has been in business for less than 1 year shall supervise the applicant through random, direct observation and evaluation of the applicant and care recipient by an employee with prior employment experience of at least 1 year with one or more other home health care agencies. The results of the observations shall be documented in the employee personnel file.

(b) If the information obtained from the criminal history report reveals that the applicant is disqualified from employment in accordance with § 15.143 (relating to facility responsibilities), the applicant shall be dismissed immediately.

(c) The administrator or designee shall review the contents of the applicant’s personnel file on the 30th day of provisional employment of a Pennsylvania resident applicant or the 90th day of provisional employment of a nonresident applicant to insure that the copy of the State Police criminal history record, the letter of determination issued by the Department, or both is physically present in the folder along with correspondence from the State Police advising that the applicant’s employment may be continued or must be terminated.

(d) Except as provided in subsection (e), if inspection of the file reveals that the State Police criminal history record, the letter of determination issued by the Department, or both has not been provided to the employer, the applicant’s employment shall be immediately suspended or terminated.

(e) If the criminal history record report, the letter of determination issued by the Department, or both, has not been provided due to the inability of the State Police or the Federal Bureau of Investigation to provide them timely, the period of provisional employment shall be extended until the facility receives the required reports. During the extended provisional employment period, the supervision and documentation requirements of this section shall be continued.

The provisions of this § 15.146 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated); and 6 Pa. Code § 15.147 (relating to violations).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.147 Violations.

(a) Administrative.

(1) An administrator or designee or facility owner-operator who intentionally or willfully fails to comply or obstructs compliance with § § 15.141—15.146 commits a violation of this chapter and shall be subject to an administrative penalty.

(2) Violations and penalties shall be determined by the Commonwealth agency that licenses the facility. The Commonwealth agency may issue an order assessing a civil penalty of not more than $2,500. An order issued under this paragraph is subject to due process as set forth in 2 Pa.C.S. § § 501—508 and 551—555 (relating to practice and procedure of Commonwealth agencies; and practice and procedure of local agencies) and judicial review in 2 Pa.C.S. § § 701—704 and 751—754 (relating to judicial review of Commonwealth agency action; and judicial review of local agency action).

(3) Representatives of the Departments of Aging, Health and Public Welfare who suspect violations of this section shall report them to the appropriate Commonwealth licensing agency under procedures developed by the Department in consultation with the licensing agency. The report shall be made in writing and include, at a minimum, the facility, the administrator, owner, operator or designee suspected of committing the violation and a description of the suspected violation.

(b) Criminal. An administrator or designee or facility owner who intentionally or willfully fails to comply or obstructs compliance with § § 15.141—15.146 commits a misdemeanor of the third degree and shall, upon conviction, be sentenced to pay a fine of $2,500 or to imprisonment for not more than 1 year, or both.

The provisions of this § 15.147 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.41 (relating to reports required to be investigated).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.151 General requirements.

(a) Administrators or employees who have reasonable cause to suspect that a recipient is a victim of abuse shall:

(1) Immediately make an oral report to the agency.

(2) Make a written report to the agency within 48 hours.

(b) Employees making oral or written reports shall immediately notify the administrator or designee of these reports.

(c) Agencies shall notify administrators, or their designees, and State agencies with facility licensing responsibilities immediately when written reports of abuse are received.

(d) Employees required to report abuse may request administrators or their designees to make, or assist the employees to make, oral or written reports.

The provisions of this § 15.151 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.21 (relating to general reporting provisions); 6 Pa. Code § 15.152 (relating to additional reporting requirements); 6 Pa. Code § 15.153 (relating to contents of reports); 6 Pa. Code § 15.155 (relating to investigation); and 6 Pa. Code § 15.158 (relating to penalties).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.152 Additional reporting requirements.

(a) Administrators or employees who have reasonable cause to suspect that a recipient is the victim of sexual abuse, serious physical injury or serious bodily injury, or that a recipient’s death is suspicious, shall, in addition to the reporting requirements in § 15.151(a) (relating to general requirements):

(1) Immediately make an oral report to law enforcement officials. An employee shall immediately notify the facility administrator or a designee following a report to law enforcement officials.

(2) Make an oral report to the Department during the current business day or, if the incident occurs after normal business hours, at the opening of the next business day.

(3) Make a written report within 48 hours of making the oral report, to law enforcement officials and the agency.

(b) Law enforcement officials shall promptly notify facility administrators or their designees that reports have been made with them.

(c) Administrators or employees shall, in addition to complying with these requirements, comply with reporting requirements of the Commonwealth licensing agency that licenses or funds the facility.

The provisions of this § 15.152 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.21 (relating to general reporting provisions); 6 Pa. Code § 15.153 (relating to contents of reports); 6 Pa. Code § 15.154 (relating to reports to Department and coroner by agencies); 6 Pa. Code § 15.155 (relating to investigation); 6 Pa. Code § 15.156 (relating to restrictions on employees); and 6 Pa. Code § 15.158 (relating to penalties).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.153 Contents of reports.

(a) Written reports under § § 15.151 and 15.152 (relating to general requirements; and additional reporting requirements) shall be made on forms supplied or approved by the Department.

(b) The report shall include, at a minimum, the following information:

(1) Name, age and address of recipient.

(2) Name, address of recipient’s guardian or next-of-kin.

(3) Facility name and address.

(4) Description of the incident.

(5) Specific comments or observations.

The provisions of this § 15.153 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.21 (relating to general reporting provisions); and 6 Pa. Code § 15.158 (relating to penalties).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.154 Reports to Department and coroner by agencies.

(a) Department.

(1) Within 48 hours of receipt of a written report under § 15.152 (relating to additional reporting requirements) involving sexual abuse, serious physical injury, serious bodily injury or suspicious death, the agency shall transmit a written report to the Department.

(2) A report under this subsection shall be made in a manner and on forms prescribed by the Department. The report shall include, at a minimum, the following information.

(i) The name and address of the alleged victim.

(ii) Where the suspected abuse occurred.

(iii) The age and sex of the alleged perpetrator and victim.

(iv) The nature and extent of the suspected abuse, including evidence of prior abuse.

(v) The name and relationship of the individual responsible for causing the alleged abuse to the victim, if known, and evidence of prior abuse by that individual.

(vi) The source of the report.

(vii) The individual making the report and where that individual can be reached.

(viii) The actions taken by the reporting source, including taking of photographs and X-rays, removal of recipient and notification under subsection (b).

(b) Coroner. For a report under § 15.152 which concerns the death of a recipient, if there is reasonable cause to suspect that the recipient died as a result of abuse, the agency shall give the oral report and forward a copy of the written report to the county coroner of the county wherein the death occurred.

The provisions of this § 15.154 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.21 (relating to general reporting provisions); and 6 Pa. Code § 15.158 (relating to penalties).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.155 Investigation.

(a) Agency response. Upon receipt of a report under § § 15.151 and 15.152 (relating to general requirements; and additional reporting requirements), the agency shall respond as follows:

(1) If the victim or recipient is 60 years of age or older, the agency shall conduct an investigation to determine if the subject of the report is in need of protective services. The investigation by the agency shall be conducted as set forth at § § 15.41—15.47 (relating to investigating reports of need for protective services).

(2) If the victim or recipient is under 60 years of age, the agency may not conduct an investigation. The investigation of the reports shall be conducted by the State agency, if any, that licensed the facility.

(3) If the victim or recipient is under 18 years of age, the agency shall notify and forward reports to the regional office of the Department of Public Welfare, Office of Children, Youth and Families or the State ‘‘ChildLine’’ and the county office of child protective services.

(4) If the victim or recipient resides in a nursing home or is receiving home health services, the agency shall notify and forward reports to the Department of Health office with facility licensing responsibilities and the regional office of the Department of Health.

(5) If the victim or recipient resides in a personal care home, the agency shall notify and forward reports to the Department of Public Welfare regional office with facility licensing responsibilities.

(6) If the victim or recipient resides in a domiciliary care home or receives services from an adult daily living center, the agency shall notify and forward reports to the Department.

(7) If the agency has knowledge or believes that the victim or recipient has mental retardation or a mental health condition, the agency shall notify the Department of Public Welfare office with facility licensing responsibilities and the county MH/MR office in addition to making other reports required by this subsection.

(b) Cooperation. To the fullest extent possible, law enforcement officials, the facility, the Commonwealth agency that licensed the facility and the agency shall coordinate their respective investigations, and shall advise each other and provide applicable additional information on an ongoing basis.

The provisions of this § 15.155 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.21 (relating to general reporting provisions); and 6 Pa. Code § 15.158 (relating to penalties).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.156 Restrictions on employees.

(a) Upon notification that an employee is alleged to have committed abuse, the facility shall immediately develop and implement an individual plan of supervision or, when appropriate, suspension of the employee. The facility shall submit to the agency and the Commonwealth agency with regulatory authority over the facility a copy of the employee’s individual plan of supervision for approval within the agencies’ accepted time frames.

(b) Following approval of an individual plan of supervision by the agency and Commonwealth agency, the facility shall follow the plan. Changes to the plan must be approved by the agency and the Commonwealth agency with regulatory authority over the facility prior to their implementation.

(c) The individual plan of supervision established by a home health care agency shall, in addition to the requirements of this section, include periodic, random direct observation and evaluation of the employee and care recipient by an individual continuously employed by the home health care agency for at least 1 year. For a home health agency in business for less than 1 year, supervision shall include random, direct observation and evaluation by an employee with prior employment experience of at least 1 year with one or more other home health care agencies.

(d) Upon being notified by law enforcement officials of a decision to file criminal charges against an employee, as a result of a report made in compliance with § 15.152 (relating to additional reporting requirements), the facility shall inform the Commonwealth agency that licenses the facility. The Commonwealth licensing agency shall order the facility to immediately deny the employee access to recipients at the facility. If the employee is a director, operator, administrator or supervisor, the employee shall be subject to restrictions by the Commonwealth licensing agency to assure the safety of recipients at the facility.

The provisions of this § 15.156 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.21 (relating to general reporting provisions); and 6 Pa. Code § 15.158 (relating to penalties).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.157 Confidentiality of and access to confidential reports.

(a) General rule. Except as provided in subsection (b) and § 15.105 (relating to limited access to records and disclosure of information), all information concerning a report under this chapter shall be confidential.

(b) Exceptions. Relevant information concerning a report under this chapter shall be made available to the following:

(1) An employee of the Department or of an agency in the course of official duties in connection with responsibilities under this chapter, including the long term care ombudsman.

(2) An employee of the Department of Health or the Department of Public Welfare in the course of official duties.

(3) An employee of an agency of another state that performs protective services similar to those under this chapter.

(4) A practitioner of the healing arts who is examining or treating a recipient and who suspects that the recipient is in need of protection under this chapter.

(5) The director, or an individual specifically designated in writing by the director, of a hospital or other medical institution where the victim is being treated if the director or designee suspects the recipient is in need of protection under this chapter.

(6) The recipient or the guardian of the recipient.

(7) A court of competent jurisdiction under a court order.

(8) The Attorney General.

(9) Law enforcement officials of any jurisdiction as long as the information is relevant in the course of investigating cases of abuse.

(10) A mandated reporter who made a report of suspected abuse. Information released under this paragraph shall be limited to the following:

(i) The final status of the report following the investigation.

(ii) Services provided or to be provided by the agency.

(c) Excision of certain names. The name of the person suspected of committing the abuse shall be excised from a report made available under subsection (b)(4), (5) and (10).

(d) Release of information to alleged perpetrator and victim. Upon written request, the alleged perpetrator and victim may receive a copy of all information, except that prohibited from being disclosed by subsection (e).

(e) Protecting identity of person making report. Except for reports to law enforcement officials, the release of data that would identify the individual who made a report under this chapter or an individual who cooperated in a subsequent investigation is prohibited. Law enforcement officials shall treat all reporting sources as confidential information.

The provisions of this § 15.157 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

This section cited in 6 Pa. Code § 15.21 (relating to general reporting provisions); and 6 Pa. Code § 15.158 (relating to penalties).

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.158 Penalties.

(a) Administrative.

(1) An administrator or a designee or facility owner who intentionally or willfully fails to comply or obstructs compliance with § § 15.151—15.157 or who intimidates or commits a retaliatory act against an employee who complies in good faith with this chapter commits a violation of this chapter and shall be subject to an administrative penalty.

(2) Violations and penalties shall be determined by the Commonwealth agency that regulates the facility. The Commonwealth agency may issue an order assessing a civil penalty of not more than $2,500. An order issued under this paragraph is subject to due process as set forth in 2 Pa.C.S. § § 501—508 and 551—555 (relating to practice and procedure of Commonwealth agencies; and practice and procedure of local agencies) and judicial review in 2 Pa.C.S. § § 701—704 and 751—754 (relating to judicial review of Commonwealth agency action; and judicial review of local agency action).

(3) Representatives of the Departments of Aging, Health and Welfare who suspect violations of this section will report them to the appropriate Commonwealth licensing agency under procedures developed by the Department in consultation with the licensing agency. The report shall be made in writing and include, at a minimum, the facility, the administrator, owner, operator or designee suspected of committing the violation and a description of the suspected violation.

(b) Criminal. An administrator or a designee or facility owner who intentionally or willfully fails to comply, or obstructs compliance, with § § 15.151—15.157 commits a misdemeanor of the third degree and shall, upon conviction, be sentenced to pay a fine of $2,500 or to imprisonment for not more than 1 year, or both.

(c) Penalties for failure to report. A person required to report a case of suspected abuse under § § 15.151—15.157 and who willfully fails to do so commits a summary offense for the first violation and a misdemeanor of the third degree for a second or subsequent violation. If the agency learns of a refusal to complete all reporting requirements, the agency shall notify the police within 72 hours.

The provisions of this § 15.158 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.159 Immunity.

An administrator or a facility will not be held civilly liable for any action directly related to good faith compliance with this chapter.

The provisions of this § 15.159 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

6 Pa. Code § 15.161 Waivers.

(a) The Department may, at its discretion and for justifiable reason, grant exceptions to and departures from this chapter to an area agency on aging when the area agency on aging can, by clear and convincing evidence, demonstrate that compliance would cause an unreasonable and undue hardship upon the area agency on aging and that an exception would not impair the health, safety or welfare of older adults or otherwise compromise the intent of this chapter. The Department cannot, however, waive statutory requirements in the act.

(b) A waiver request shall be made in writing to the Secretary. A request shall specifically identify and explain the burden created by the requirement for which the exception is being sought, the alternative method for fulfilling the basic intent of the requirement and evidence of the steps to be taken to assure that the health, safety and welfare of older adults will not be compromised.

(c) An exception granted under this chapter may be revoked by the Department at its discretion for a justifiable reason. Notice of revocation will be in writing and will include the reason for the action of the Department and a specific date upon which the exception will be terminated.

(d) In revoking an exception, the Department will provide for a reasonable time between the date of written notice of revocation and the date of termination of an exception for the agency to come into compliance with the applicable regulations.

(e) If an agency wishes to request a reconsideration of a denial or revocation of an exception, it shall do so in writing to the Secretary within 15 days of receipt of the adverse notification.

The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

History

Authority: The provisions of this Chapter 15 issued and amended under the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102), unless otherwise noted.
Source: The provisions of this § 15.161 adopted May 17, 2002, effective May 18, 2002, 32 Pa.B. 2412.

Chapter 20 Family Caregiver Support Program

6 Pa. Code § 20.1 Scope and authority.

(a) The purpose of this chapter is to set forth regulations governing the administration and operation of the Program under the act.

(b) This chapter applies to the Department, area agencies on aging, service providers under contract with an area agency on aging to provide services under this chapter and caregivers and carereceivers who receive benefits of the Program.

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.2 Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise: Act—The Family Caregiver Support Act (62 P. S. § § 3061—3068). Area agency on aging—The local agency designated by the Department within each planning and service area to administer the delivery of a comprehensive and coordinated plan of social and other services and activities in the planning and service area. Assistive devices—Nondisposable personal devices, as distinguished from modifications to a home, that are usable to assist the carereceiver, or the caregiver on the carereceiver’s behalf, to carry out an activity of daily living and, thereby, reduce the caregiver’s burden. Benefits counseling—A service that provides family caregivers with an individual, comprehensive review of their caregiving situations to identify appropriate resources available and to assist caregivers to access these resources. Caregiver education or caregiver training—Services that provide instruction or training to family caregivers, in groups or individually, in general and specific information or skills required in the care of functionally impaired older persons. Carereceiver—A functionally dependent older adult or other adult with chronic dementia such as Alzheimer’s Disease who is being cared for by a relative who lives in the same residence. Chronic dementia—An irreversible global loss of cognitive function causing evident intellectual impairment which always includes memory loss, without alteration of state of consciousness as diagnosed by a physician and which is severe enough to interfere with work or social activities, or both, and to require continuous care or supervision. Consumable supplies—Expendable items needed on an ongoing basis to provide care to a carereceiver. Consumable supplies do not include prescription drugs. Continuous supervision—Uninterrupted care which does not preclude brief periods when the carereceiver may be left alone, if appropriate and consistent with the care plan. Department—The Department of Aging of the Commonwealth. Functionally dependent—Requiring enough assistance with one or more activities of daily living to be deemed by the area agency on aging, under this chapter, to require continuous care or supervision. Limitations contributing to the functional dependency may include physical or cognitive impairments. Home modifications—Reasonable modifications, approved under this chapter, to the structure of a home for the purpose of reducing caregiver burden. The term does not include repairs. Household—Persons who occupy the same residence. Household income—The income of all members of a household with the exception of a minor or dependent student. Income—Income, from whatever source derived, as specified in § 20.23 (relating to income). OPTIONS—A program operated by the Department for persons who need long term care because they are functionally disabled. The program provides a continuum of assessment, care management and services which may make it possible for a functionally disabled person to be maintained in the community as an alternative to institutional placement. Each of these three functions under OPTIONS—assessment, care management and services—is divided into Level I or Level II based on the intensity and complexity of need. Older adult or older person or older relative—A person who is 60 years of age or older, and who is a relative of the caregiver. Ongoing caregiving expenses—The costs of respite care and other supportive services or consumable supplies which are directly related to the provision of care to the older relative. Other adult—A person 18 years of age or older residing within this Commonwealth who is suffering from a chronic dementia such as Alzheimer’s Disease. Other supportive services—Services other than respite care services that are directly related and necessary to the care being provided to the carereceiver and which are noted in the client’s care plan. These services may include the following:

(i) Personal care skills training and other caregiver education services not available directly from the Program.

(ii) Counseling under a certified counseling or mental health agency.

(iii) Legal and financial counseling necessary to manage the affairs of the carereceiver.

(iv) Specialized transportation services. Planning and service area—The geographic unit within this Commonwealth, as designated by the Secretary, for the allocation of funds for the delivery of social services to older persons residing in that unit. Poverty level—The income level indicated in the Federal Poverty Income Guidelines developed, annually updated and published in the Federal Register by the United States Department of Health and Human Services. Primary caregiver—The one identified relative who has assumed the primary responsibility for the provision of care needed to maintain the physical or mental health of a functionally dependent older adult or other adult suffering from chronic dementia such as Alzheimer’s Disease, who lives in the same residence with the individual on a continuous basis and does not receive financial compensation for the care provided. Program—The Family Caregiver Support Program. Relative—A spouse or parent; child; stepparent; stepchild; grandparent; grandchild; brother; sister; half-brother; half-sister; aunt; great aunt; uncle; great uncle; niece; or nephew, by blood, marriage or adoption. Respite care service—A regular, intermittent or emergency service which provides the primary caregiver of a functionally dependent older adult or other adult suffering from a chronic dementia such as Alzheimer’s Disease with relief from normal caregiving duties and responsibilities. Same residence—A house, apartment, mobile home, group of rooms, or single room, occupied as separate living quarters. Secretary—The Secretary of the Department.

This section cited in 6 Pa. Code § 20.21 (relating to eligibility for Program benefits).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.11 Administrative functions and responsibilities of the Department.

(a) The Department will administer the Program under contract with area agencies on aging.

(b) In the administration of the Program, the Department’s functions and responsibilities include the following:

(1) The review and approval of annual Program plans submitted by area agencies on aging under § 20.12 (relating to administrative functions and responsibilities of area agencies on aging).

(2) The allocation to area agencies on aging of funds appropriated for the provision of services and benefits under this chapter.

(3) The establishment and maintenance of minimum standards for the operation of the Program and the provision of services and benefits under this chapter.

(4) The development and maintenance of fiscal and service data collection forms and procedures for collecting information on families served and services and benefits provided.

(5) The monitoring of local Programs for compliance with this chapter and approved area agency on aging Program plans.

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.12 Administrative functions and responsibilities of area agencies on aging.

(a) General.

(1) Each area agency on aging shall administer a Program under this chapter in its planning and service area.

(2) In the administration of the Program, the functions and responsibilities of the area agency on aging shall include the following:

(i) The development and submission of a Program plan under subsection (b).

(ii) The coordination of service development and delivery under this chapter with other appropriate agencies and organizations in the community, with special efforts to develop and maintain an effective network of local support for family caregivers.

(iii) The collection and submission to the Department of Program and fiscal information on families served, and services and benefits provided, on forms provided by the Department.

(b) Program plans. Each area agency on aging shall submit annually a plan which includes the following information:

(1) An organizational chart which illustrates the staffing and flow of decisionmaking for the Program.

(2) A discussion of how the agency will assign casework staff to the Program to achieve and maintain the consistency required under § 20.32 (relating to assessment and care management).

(3) A training plan which describes special training for staff persons to be assigned to the project.

(4) A description of the procedures to be used for reimbursing caregivers.

(5) A description of area agency on aging strategies for the strengthening or developing of a local network of family caregiver resources. At a minimum, an area agency on aging shall form and utilize an inter-organizational advisory or oversight committee to establish or enhance a local network of caregiver resources. This committee may be an adjunct of the area agency on aging advisory council. The use of network models that involve local voluntary groups, churches, health care organizations active in the areas of Alzheimer’s Disease, support groups for family caregivers and other similar organizations is strongly encouraged.

(6) An explanation of how the area agency on aging will assure that all ethnic groups and economic levels of the community are effectively reached by the Program.

(7) A description of strategies for carrying out caregiver education so that different kinds of caregiver education needs are effectively met. Caregiver education shall involve, to the extent possible, the participation of existing community resources. These efforts may include support groups if appropriate.

(8) A 12-month operating budget on a form provided by the Department.

(c) Program compliance. Failure of an area agency on aging to comply with corrective action requirements resulting from the Department’s compliance monitoring shall lead to sanctions imposed by the Department when, after discussion, the area agency on aging and the Department are unable to reach a mutually satisfactory resolution of the noncompliance issue.

This section cited in 6 Pa. Code § 20.11 (relating to administrative functions and responsibilities of the Department); 6 Pa. Code § 20.32 (relating to assessment and care management); 6 Pa. Code § 20.41 (relating to general reimbursement); and 6 Pa. Code § 20.42 (relating to ongoing caregiving expenses).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.21 Eligibility for Program benefits.

(a) General. The services and benefits of the Program are available to the primary caregiver of a functionally dependent older adult relative, or other adult relative suffering from a chronic dementia such as Alzheimer’s Disease, who lives in the same residence and whose household income does not exceed 380% of the poverty level. In addition to a thorough family assessment, these services include benefits counseling, caregiver education and financial benefits. The financial benefits are available, as provided under § § 20.41—20.45 (relating to reimbursement benefits), to reimburse caregivers for expenses directly related to the provision of care. Subject to the availability of appropriated funds allocated to a planning and service area, these benefits are available on a cost-sharing basis up to specified maximum amount according to the caregiver family’s household income and documented expenditures.

(b) Criteria for the determination of eligibility. For a caregiver to be determined eligible for the services and benefits available under this chapter, the following criteria shall be met:

(1) The caregiver shall be the primary caregiver as defined under § 20.2 (relating to definitions).

(2) The primary caregiver and the carereceiver shall be relatives and live together in the same residence as defined under § 20.2.

(3) The caregiver family (carereceiver included) shall cooperate with the area agency on aging in the completion of a comprehensive assessment of the caregiver, the carereceiver and the caregiving environment as required under § 20.32 (relating to assessment and care management).

(4) The carereceiver shall be a functionally dependent older adult or other adult with a chronic dementia such as Alzheimer’s Disease as diagnosed under § 20.32.

(5) The household income of the caregiver family, as provided under § 20.23 (relating to income), may not exceed 380% of the poverty level.

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.22 Conditions of participation.

(a) Certification of accountability. As a condition of participation in the Program, an eligible primary caregiver shall sign a certification of accountability as provided under § 20.32 (relating to assessment and care management). The primary caregiver’s signature on the certification will attest to the truth of information provided during the assessment and will indicate the caregiver’s understanding of responsibility for compliance with Program requirements, especially those under § § 20.41—20.45 (relating to reimbursement benefits) which relate to the reimbursement of caregiver expenses and the penalties for violation of this chapter.

(b) Change of status. It is the responsibility of the primary caregiver to report to the area agency on aging any change of status in the caregiving situation which might affect eligibility for the Program or the service plan developed under § 20.32. Reportable changes include significant changes in the health status of the carereceiver, living arrangements or household income, the ability of the caregiver to provide the necessary care and the availability of informal supports to the care being provided.

(c) Documentation of information. The area agency on aging shall require a primary caregiver to document household income with a copy of Federal income tax returns from the previous calendar year. If the required tax return is unavailable, examples of other documentation which may be provided are listed under § 20.23 (relating to income). The area agency on aging may require a primary caregiver to document other eligibility-related information provided during assessment.

(d) Choice of available services.

(1) Individual carereceivers and their caregiver families may not receive the services of the Program and Level II Services of the OPTIONS Program simultaneously. The caregivers of carereceivers who are on a waiting list for OPTIONS Level II Services may be accepted into the Program until the carereceiver is admitted to Level II Services. When a place becomes available in Level II Services, the area agency on aging, in full consultation with a family which has been in the Program while on the waiting list for Level II Services, shall review the relative benefits and the appropriateness of the two programs and choose the one which is most appropriate. This provision does not preclude the possibility of an OPTIONS Level II care recipient living in the same residence as a separate carereceiver and caregiver who are eligible to receive benefits and services under this chapter.

(2) Carereceivers who are assessed under the OPTIONS Program and referred to Level I Services may receive these services, when appropriate, in addition to their primary caregiver receiving benefits and services from the Program.

(e) Protection from abuse. A substantiated case of abuse, neglect, exploitation, abandonment as defined in The Older Adults Protective Services Act (35 P. S. § § 10211—10224) or under another civil or criminal statute regarding an older adult, shall prohibit a caregiver from receiving benefits and services under this chapter unless authorized by the Department to prevent further abuse. The caregiver is required to certify on the certification of accountability under § 20.32 whether one or more of the following apply:

(1) The caregiver has been convicted of a crime relating to abuse, neglect, exploitation or abandonment of an older adult.

(2) The caregiver has been found civilly liable for abuse, neglect, exploitation or abandonment of an older adult.

(3) The caregiver has been notified that the caregiver is an alleged perpetrator in a substantiated report of need for protective services under The Older Adults Protective Services Act.

This section cited in 6 Pa. Code § 20.32 (relating to assessment and case management); 6 Pa. Code § 20.41 (relating to general reimbursement); and 6 Pa. Code § 20.45 (relating to Program violations and penalties).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.23 Income.

(a) Income limits.

(1) Caregivers whose household income exceeds 380% of poverty level are not eligible for the benefits and services under this chapter.

(2) Caregivers whose income exceeds 200% of poverty level and does not exceed 380% of poverty level are required to share in the costs of reimbursable items and services under this chapter as provided under § 20.41 (relating to general reimbursement).

(b) Income inclusions. Income includes the following:

(1) Salaries.

(2) Wages.

(3) Bonuses.

(4) Commissions.

(5) Net income from self-employment or partnership income.

(6) Alimony.

(7) Support money.

(8) Cash Public Assistance and relief.

(9) The gross amount of pensions or annuities, including Railroad Retirement benefits.

(10) The gross amount of cash benefits received under the Social Security Act (42 U.S.C.A. § § 301—1397e), except Medicare benefits.

(11) Benefits received under State unemployment insurance laws.

(12) Veteran’s disability payments.

(13) Interest, including interest received from the Federal government, State government or an instrumentality or political subdivision thereof.

(14) Realized capital gains except as provided in subsection (c).

(15) Rental income.

(16) Workmen’s compensation benefits and the gross amount of loss of time insurance benefits, except those benefits granted under section 306(c) of the Workmen’s Compensation Act (77 P. S. § 513).

(17) Life insurance benefits and proceeds, except as provided in subsection (c).

(18) Gifts or bequests of cash or property converted to cash, other than transfers by gift between members of a household, in excess of $300.

(19) Any amount of money or the net cash realized from the sale of a prize, such as an automobile or a trip won in a lottery, contest or by a form of gambling.

(20) Royalties.

(21) Dividends.

(1) Surplus food or other noncash relief, including food stamps, supplied by a government agency.

(2) Property tax rebate payments and rent rebate payments, received under the Senior Citizens Rebate and Assistance Act (72 P. S. § § 4751-1—4751-12).

(3) Medicare benefits.

(4) The first $5,000 of the total of death benefit payments received upon the death of each person from whom the benefits may be due.

(5) The difference between the purchase price of a person’s residence and its selling price, to the extent that the person uses the proceeds from the sale of the residence to purchase a different residence within 2 years of the sale of the former residence.

(6) The amount of damages received, whether by civil suit or settlement agreement, due to personal injuries. Damages received means an amount received through prosecution of a legal suit, action or other claim based on tort or tort type rights, or through a settlement agreement entered into in lieu of litigation, except to the extent that the amount duplicates reimbursements previously received. Damages include black lung benefits and benefits granted under section 306(c) of the Workmen’s Compensation Act.

(7) Payments provided to eligible low income households under the Low Income Home Energy Assistance Program.

(8) That portion of client payments received by home providers in the Domiciliary Care Program administered by the Department under Chapter 21 (relating to domiciliary care services for adults), which, for any specific income year, does not exceed the actual expenses of providing domiciliary care services.

(d) Documentation of income.

(1) Except as provided in paragraph (2), a primary caregiver seeking benefits under this chapter shall document through copies of the applicable Federal income tax returns, or other acceptable documentation, the total annual household income for the calendar year immediately preceding the year in which the caregiver is assessed or reassessed for participation in the Program.

Example—A primary caregiver applies to participate in the Program on August 16, 1992. The caregiver shall provide copies of the tax returns which reflect the total annual household income for the previous year, which is calendar year 1991. Accordingly, the caregiver shall provide tax returns which document household income received from January 1, 1991, up to and including December 31, 1991.

(2) If the caregiver believes that recent changes in income have resulted in a lower household income which would affect the caregiver’s eligibility or the level of cost sharing required, the caregiver may provide the area agency on aging with documentation of current annual income. The area agency on aging will determine what documentation is necessary and the period of time for which the documentation is needed in order for the agency to determine an accurate calculation of current annual household income.

(3) The failure to provide truthful information with respect to this section will subject the caregiver to the penalties provided under § 20.45 (relating to Program violations and penalties).

(e) Acceptable documentation of income. The following are examples of documents, photocopies of which may be provided as acceptable documentation of income under subsection (d):

(1) Federal, State or local income tax returns.

(2) Pension checks, annuity checks or checks from other sources of income. When the checks are issued monthly, or on some other less-than-annual basis, a photocopy of the check for a single month, or other applicable period, will suffice. United States Treasury checks may not be photocopied.

(3) Statements from a financial institution where direct deposit is made for the applicant or claimant or statements from a government agency, such as the Social Security Administration or the Railroad Retirement Board.

(4) Documents that clearly verify the type and amount of income or a recent change in previous annual income.

This section cited in 6 Pa. Code § 20.2 (relating to definitions); 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); and 6 Pa. Code § 20.22 (relating to conditions of participation).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.24 Appeals.

Primary caregivers have the right to appeal an adverse decision by an area agency on aging regarding eligibility or the level of cost sharing determined by the agency. Appeals shall be filed under Chapter 3 (relating to fair hearings and appeals).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.31 General.

The core services of the Program include the assessment of the caregiver, carereceiver and caregiving environment; the development of a care plan responsive to the caregiver’s needs and burdens; ongoing casework services as needs may arise; benefits counseling; and caregiver education and training.

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.32 Assessment and care management.

(a) Activities. Assessment and care management services include the following activities:

(1) The assessment of the status and needs of the caregiver, the carereceiver and the caregiving environment.

(2) The development and management of a care plan.

(3) The reassessment of status and needs every 6 months. Reassessment includes ongoing casework as problems arise.

(b) Certification. In addition to the activities provided for under subsection (a), the area agency on aging staff person who carries out the assessment shall secure, at the time of assessment, the signature of the primary caregiver on the certification of accountability required under § 20.22 (relating to conditions of participation). This certification shall make reference to the caregiver’s responsibilities, including compliance with restrictions on the reimbursement of expenses, under the Program and attest to the truth of the information provided by the caregiver. As a witness, the area agency on aging staff person completing the assessment shall also sign it. This certification will serve as the contractual basis for the area agency on aging’s reimbursements for the caregiver’s expenses. It may also be used as a basis for the recovery of reimbursements subsequently determined to be inappropriate under § 20.45 (relating to program violations and penalties).

(c) Standards and procedures. Assessment and care management activities shall be carried out under the following standards and procedures:

(1) In addition to the requirements of this chapter, the activities of assessment and care management under the Program shall be carried out in conformity with the general care management procedures currently in practice with services under Department contracts with area agencies on aging. This includes efforts by area agencies on aging to conserve resources by developing and utilizing screening instruments to target appropriate families for assessment and subsequent services or placement on a waiting list. Waiting list procedures for the Program will establish the priority of service and position on the waiting list by rating factors relating to the status of the carereceiver, the family and the total caregiving situation to determine the situations of greatest need for agency intervention.

(2) An assessment shall be completed on each caregiver family using the current form established by the Department. The assessment provides for the collection of information concerning the caregiver, the caregiver’s burden, the carereceiver and the caregiving environment.

(3) When the carereceiver is an older adult, a clinical determination of the functional dependency of the carereceiver shall be made by the caseworker on the basis of information obtained on the assessment instrument. Special reference shall be made to the carereceiver’s limitations in carrying out the activities of daily living, including mobility; the cognitive limitations of the carereceiver; and the conditions of the caregiving environment that may contribute to the need for the continuous care or supervision of the carereceiver or increase the caregiver’s burden, or both. If the functional dependency of the carereceiver cannot be established, the area agency on aging may not serve the caregiver under the Program.

(4) When the carereceiver is an adult 59 years of age or younger, the area agency on aging shall establish the categorical need for the Program by applying the following provisions:

(i) Through the assessment process, the area agency on aging shall determine that the history of the onset of the carereceiver’s condition indicates an identifiable decline in intellectual function resulting in a cognitive impairment that is severe enough to interfere with work or social activities, or both, and requires the continuous care or supervision of the caregiver.

(ii) The area agency on aging shall require the presentation of written documentation from a physician, or team of physicians, that a medical diagnosis which meets the following minimum criteria indicates that the carereceiver has a chronic dementia such as Alzheimer’s Disease:

(A) It shall document, to the extent possible, that the carereceiver has suffered a decline in intellectual function.

(B) It shall document through the use of a mental status examination or a neuropsychological examination that there is a global loss of cognitive function. Global loss of cognitive function includes memory impairment, the impairment of visio-constructive abilities and at least one of the following:

(I) Impairment of abstract thinking.

(II) Impairment of judgment.

(III) Impairment of other complex capabilities, such as language use, the ability to perform complex physical tasks, the ability to recognize objects or people or the ability to construct objects.

(IV) A personality change.

(C) It shall document testing to establish that the carereceiver was, at the time of diagnosis, in a state of clear consciousness and that other mental states such as acute or subacute delirium, sleep, coma, stupor and intoxication were considered and ruled out. It shall document clinical tests that were administered to insure that the patient’s cognitive impairment is not due to delirium alone and is not due to a reversible loss of cognitive function.

(d) Staff resources.

(1) Assessments and care management shall be carried out by staff persons who meet or exceed the minimum experience and training qualifications for the caseworker classification of the Pennsylvania State Civil Service System.

(2) Consistency in the assignment of casework staff to the Program is required. While this consistency may be achieved with different combinations of shared or dedicated staff, at a minimum, assignments shall provide for the development over time of special staff expertise in the unique aspects of the Program. How the area agency on aging intends to achieve and maintain this staff expertise shall be discussed in the plan required under § 20.12 (relating to administrative functions and responsibilities of area agencies on aging).

(3) Each area agency on aging is required to secure the consultation services of a person experienced in rehabilitation technology to provide consultation, as appropriate, on the agency’s home environment assessments, to help determine if special expertise is needed to assess specific situations (for example, from a rehabilitation engineer), to identify all available resources for responding to the carereceiver’s need for home modifications and assistive devices and how project resources should be utilized for this purpose; and to provide technical assistance to case managers for assessing home environments.

(4) Area agencies on aging shall take special precaution and require disclosure of potential conflicts of interest when using the services of consultants; for example, a consultant who owns, or is employed by, a medical supply company. If a consultant who has a potential conflict of interest is used as a consultant for a specific caregiver case, the area agency on aging shall insure that the arrangement for the consultation precludes the purchase of a recommended item from the consultant.

This section cited in 6 Pa. Code § 20.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); 6 Pa. Code § 20.22 (relating to conditions of participation); and 6 Pa. Code § 20.33 (relating to benefits counseling).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.33 Benefits counseling.

(a) General.

(1) The family-centered assessment of caregiving needs and stresses required under § 20.32 (relating to assessments and care management) forms the basis for the provision of comprehensive counseling about resources and benefits appropriate to meet the specific needs of each caregiving family. This includes Federal, State and local, formal and informal resources and assistance in gaining access to these resources.

(2) Caregivers may be people from a wide range of family circumstances. The benefit and resource information relevant to a caregiver’s needs may be different from that which is relevant to traditional area agency on aging clients. Benefits counseling may need to assist caregivers in securing resources to address a wide variety of problems in areas ranging from day care for young children to mental health, drug and alcohol abuse or vocational rehabilitation.

(b) Service activities. Benefits counseling services include the following activities:

(1) Review of existing assessment documentation, and intensive exploration of additional resources or entitlements, or both.

(2) Providing comprehensive relevant information regarding resources or making referrals to resources, or both. This may be through caseworker/client discussion, the provision of telephone contacts, pamphlets or direct referral.

(3) Exploring resources and benefits, including the following:

(i) MH/MR Programs.

(ii) Drug and alcohol programs.

(iii) Insurance programs/policies.

(iv) Specific disease related organizations—cancer, Alzheimer’s Disease, and the like.

(v) Support groups.

(vi) Veterans Administration programs.

(vii) Healthy Horizons.

(viii) Social Security.

(ix) SSI.

(x) Food Stamps.

(xi) PACE.

(xii) Property Tax/Rent Rebate.

(xiii) LIHEAP (energy assistance).

(xiv) Medical Assistance.

(xv) Housing programs.

(xvi) Weatherization programs.

(xvii) Community based soc/rec programs.

(xviii) Local city mission services.

(xix) Red Cross.

(xx) Lions Club.

(xxi) Blind Association.

(xxii) Transportation programs.

(xxiii) Food banks.

(xxiv) Community action programs.

(xxv) VISTA.

(4) Reviewing of medical supply needs and, in the absence of alternative sources, attempting to obtain supplies and equipment on behalf of the caregiver.

(5) Assisting with the completion of applications for public benefits programs, such as PACE, Property Tax and Rent Rebate, Veterans Administration benefits, housing programs, and the like.

(6) Following-up as appropriate.

(c) Exclusions. While benefits counseling may include the exploration of options, resources and services, as well as the potential consequences of either the use or lack of use of them, it may not include recommendations or advice to caregivers on specific providers of purchased services and supplies when there are specific choices available to them.

(d) In-service training. Staff assigned to the benefits counseling functions shall receive special in-service training in caregiving needs and available resources.

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.34 Caregiver education and training.

(a) General. The purpose of caregiver education and training is to strengthen caregiving skills and ease the burden of caregiving, with special attention to health problems of carereceivers, coping skills for caregivers and the performance of appropriate personal care tasks. For the purpose of this Program, caregiver education shall be carried out on a face-to-face basis or, at a minimum, through videotape instruction. Printed educational materials may be used to supplement these activities.

(b) Service activities. The service activities of caregiver education may consist of a variety of approaches designed to reach the general caregiver population in the community. Area agencies on aging shall take steps to ensure that opportunities for caregiver education are readily accessible to caregivers under the Program. Activities include the following:

(1) The review of existing assessment documentation, and intensive exploration of the educational needs of individual caregivers.

(2) The development of programming to meet the educational needs of individual Program caregivers and groups of Program caregivers.

(3) Hands-on training to develop a caregiver’s skill in performing an essential task of caregiving such as bathing.

(4) The development of an educational library. An educational library may contain either written or videotaped material, and shall promote both individual or group Program caregiver utilization of this material.

(5) Special ‘‘caregiver days,’’ such as events held in recognition of National Caregivers Week or Older Americans Month. These ‘‘Caregiver Days’’ may consist of educational programs, group interaction or group review of educational videotapes.

(6) Support group activities, including educational programming.

(7) The review of educational videotapes by individual caregivers in their homes.

(8) The facilitation of caregiver access to educational services not available directly from the Program.

(c) Funding caregiver education. The area agency on aging is not required to fund as a core service all caregiver education services available. In developing caregiver education services, area agencies on aging shall rely heavily upon other resources of the area agency on aging and local resources available elsewhere in the community. Program plans shall contain minimal reliance upon funding appropriated under this chapter to fund caregiver education activities.

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.41 General reimbursement.

(a) Expenditure parameters. When an area agency on aging has annualized its Program and the ongoing caseload level has stabilized at, or around, the level projected in the approved Program plan, the following parameters on expenditures shall be observed:

(1) At least 55% of the allocated funding shall be budgeted and expended for the reimbursement of care-givers.

(2) No more than 20% of the amount budgeted and expended for the reimbursement of caregivers may be budgeted and expended for home modifications and assistive devices.

(b) Cost-shared benefits. Funding to reimburse primary caregivers for caregiving expenses as provided in this chapter is available on a cost-sharing basis as follows:

(1) Up to 100% of the maximum amounts provided in subsection (c), depending on expenditures and availability of funds, may be used to reimburse primary caregivers whose household income does not exceed 200% of the current poverty level.

(2) As household income increases in 20% brackets, the available reimbursement benefit decreases by 10%. Thus, a primary caregiver whose household income is between 280% and 300% of the poverty level may be reimbursed for up to 50% of the maximum benefit available, or up to $100 per month for ongoing expenses or $1,000 for home modifications or assistive devices as provided under subsection (c).

(3) The Department will maintain a cost-sharing table indicating the current dollar amounts of household income ranges at the different cost-sharing levels and household sizes. This table will be updated annually on the basis of revised Federal poverty guidelines published in the Federal Register. Interested parties may obtain a copy of the current cost-sharing table from the local area agency on aging or from the Division of Policy, Department of Aging, 231 State Street, Harrisburg, Pennsylvania 17101-1195.

(4) To determine the amount which may be reimbursable by the area agency on aging, the appropriate percentage of the maximum benefit available is applied to the amount the caregiver expended up to that maximum. When caregiver expenditures exceed the maximum amounts available, the percentage is applied only to the maximum amount. Thus, if a primary caregiver is eligible for 50% of the maximum benefit and incurs monthly caregiving expenditures of $400, the most the caregiver may be reimbursed is $100; that is, 50% of the $200 maximum benefit available.

(1) To reimburse for ongoing expenses of respite care services, other related services and consumable supplies needed to provide the necessary care, up to $200 per month may be made available depending upon actual expenditures, household income and the availability of funds.

(2) To reimburse for expenses incurred for home modifications and assistive devices purchased under this chapter, up to $2,000, depending upon actual expenditures, household income and the availability of funds, may be made available during the full time that a case is active.

(3) Caregivers are not entitled to the maximum amounts under paragraphs (1) and (2). Reimbursements are made on the basis of need, income, actual expenditures and the availability of funds. Although area agencies on aging retain the discretion to control caregiver reimbursements to prevent the depletion of available funds by projected utilization patterns, an area agency on aging does not have authority to set different maximum amounts in its planning and service area.

(d) Other general controls.

(1) An area agency on aging may control the utilization of reimbursement funding through the use of waiting lists for new families, delay in accepting families from waiting lists to permit attrition to decrease funding demands, delay in preapprovals of home modifications and assistive devices until additional funds are available. Primary caregivers shall be made aware at intake that reimbursements are not entitlements and are contingent upon the availability of funds under the Program appropriation.

(2) An area agency on aging may require a primary caregiver to provide additional documentation of the income information provided during assessment when there is clear justification to question the validity of the documentation provided previously.

(3) Some form of direct reimbursement of documented caregiving expenses shall be instituted. If explained in an approved Program plan, as provided under § 20.12 (relating to administrative functions and responsibilities of area agencies on aging), an area agency on aging may also use one or more other methods, such as a voucher system, to get the reimbursement benefits to primary caregivers.

(4) Funding available for the reimbursement of care-givers is not intended to displace other resources available to the caregiver family. Area agencies on aging may not knowingly use the resources of the Program to provide benefits available under other resources and shall take steps through benefits counseling to promote the utilization of other available resources to assure that displacement of other resources does not occur.

(5) To provide an adequate audit trail for reimbursements, the area agency on aging shall obtain from primary caregivers and retain in agency files documentation of caregiver expenditures for which reimbursements are made.

(6) Funding available for the reimbursement of caregiving expenses may not be used to cover caregiver payments for the services of relatives. Area agencies on aging shall make primary caregivers aware of this restriction at the time they are admitted into the Program by including it in the certification of accountability required under § 20.22 (relating to conditions of participation).

(7) Categories for reimbursed purchases shall remain distinct when maximum amounts are applied. Costs of ongoing expenses and consumable supplies are subject to the $200 per month maximum. Costs of home modifications and assistive device purchases are subject to the $2,000 maximum during the full time the case is active. Since the costs of leasing an assistive device are also an ongoing ‘‘out-of-pocket’’ expense, an area agency may have some discretion in determining which category is to be charged if the caregiver’s needs for other respite care are not jeopardized.

(8) Area agencies on aging are expected to promote the concept that the reimbursement for ongoing expenses is available to empower caregivers to make their own decisions and choices. While it is important to work with caregivers in planning appropriate responses to their needs, the emphasis should be on expanding the awareness of caregivers of the various options which may be open to them.

This section cited in 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); 6 Pa. Code § 20.22 (relating to conditions of participation); and 6 Pa. Code § 20.23 (relating to income).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.42 Ongoing caregiving expenses.

(a) Reimbursable expenses. To qualify for reimbursement under this chapter, ongoing expenses shall be for services or consumable supplies directly related and necessary to the care being provided to the carereceiver. To the extent that they are consistent with the developed care plan, the services may include all forms of respite care, other supportive services and consumable supplies as defined in this chapter.

(b) Accumulated benefits. To facilitate the purchase of more expensive respite care and other supportive services for a period of time that would afford a primary caregiver the opportunity to be away for several days of vacation, hospitalization or special emergency absences, an area agency on aging may permit caregivers to accumulate unused financial benefits under the following provisions:

(1) Unused reimbursement benefits may only be accumulated for the purposes described under this subsection when an area agency on aging has included its intent and procedures for allowing accumulated benefits in its approved Program plan as provided under § 20.12 (relating to administrative functions and responsibilities of area agencies on aging).

(2) Reimbursement benefits available for home modifications and assistive devices may not be used for the special circumstances provided under this subsection.

(3) Accumulated reimbursement benefits may not be anticipated. They shall have been earned on a monthly basis prior to use.

(4) Unused reimbursement benefits may be accumulated over a period of time not to exceed 6 months.

(5) Accumulated reimbursement benefits may not be carried over from 1 contract year to another unless the Department has waived this requirement. The Department will consider waiving this requirement only if an area agency submits a written request for a waiver which adequately explains how the area agency on aging proposes to provide accumulated benefits across contract years without charging expenditures in 1 contract year to the budget for a different contract year. This paragraph is not subject to § 20.62 (relating to waivers).

This section cited in 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); and 6 Pa. Code § 20.22 (relating to conditions of participation).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.43 Home modifications.

(a) Preapproval. Area agencies on aging shall develop a system for the preapproval of home modifications to be authorized for reimbursement benefits. The system shall require all approved home modifications to be in response to specific details noted in the caregiver’s assessment and care plan. The system may include standards for controlling the expenditure of available funding for this purpose in a way that optimizes the distribution of these funds to the most caregivers with the greatest need for home modifications.

(b) Property ownership.

(1) The area agency on aging may approve reimbursement for a home modification of a property owned by the caregiver family without regard for whether the caregiver or the carereceiver is the owner of the property.

(2) An area agency may approve reimbursement of a home modification of rented property at the agency’s discretion if the following minimum standards are observed:

(i) The area agency shall determine that there is a reasonable expectation that the family, including the caregiver, will continue to live in the home in the foreseeable future.

(ii) The caregiver shall secure the permission of the owner before the area agency on aging grants preapproval for the home modification.

(iii) The permission obtained from the owner shall indicate whether the owner will or will not require the home to be returned to its original state when the caregiver family moves out. In some cases, this indication may be a major factor related to area agency on aging approval of the requested home modification. Program funds may not be used for restoring the home to its original state if the owner requires it. In some cases, restoration by the caregiver may be possible without additional funding.

(iv) Major modifications shall only be approved with the highest discretion with regard to caregiver need and the availability of funding.

(v) The documentation maintained by the area agency on aging of an approval of a modification of rented property shall indicate that the minimum standards of this paragraph have been observed and shall state the area agency’s rationale for approving the reimbursement.

This section cited in 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); and 6 Pa. Code § 20.22 (relating to conditions of participation).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.44 Assistive devices.

(a) Preapprovals. Area agencies on aging shall develop a system of preapproval of reimbursable purchases of assistive devices. An area agency on aging shall take appropriate steps to determine the availability of other funding—such as Medicare or Medical Assistance, or local charitable organizations—before authorizing the purchase of assistive devices.

(b) Leased equipment. If the area agency on aging determines that a caregiver-requested assistive device may be leased at a potential saving to the Program, the area agency on aging shall limit reimbursement to the costs of leasing rather than the purchase of the equipment.

(c) Return of assistive devices. When an assistive device purchased under the Program is no longer needed in the caregiving situation, the area agency on aging shall encourage the family to return it to the area agency on aging for use with future clients of the Program.

This section cited in 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); and 6 Pa. Code § 20.22 (relating to conditions of participation).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.45 Program violations and penalties.

(a) Violations. Caregivers who receive services under the Program are subject to the administrative actions and penalties under this section if they commit one or more of the following acts:

(1) Making or causing to be made a false statement or representation of a material fact relating to information affecting eligibility for the benefits of the Program.

(2) Submitting false or fraudulent documentation of caregiving expenses for which reimbursement is sought or received.

(3) Violating this chapter, including a provision which affects the eligibility status of the primary caregiver, the payment of reimbursement benefits under this chapter or the refusal to provide requested documentation of eligibility-related information as provided under § 20.22 (relating to conditions of participation).

(b) Administrative actions and penalties.

(1) If the area agency on aging determines that a primary caregiver has violated the act or this chapter, the area agency on aging has the authority to suspend or terminate services to the caregiver under this chapter.

(2) If the area agency on aging determines that a primary caregiver has knowingly received financial reimbursement for which the caregiver is not eligible as a result of violations under this section, the area agency on aging may recover twice the amount of the reimbursements determined to be inappropriate plus interest.

(3) If the area agency on aging determines that a primary caregiver has knowingly received reimbursement monies from the Program by false or fraudulent documentation of eligibility for that reimbursement, the area agency on aging shall request the appropriate district attorney to initiate proceedings against the caregiver.

(c) Caregiver right to appeal. Actions by an area agency on aging against a primary caregiver for violations under subsection (b)(1) and (2) are subject to the right of appeal under Chapter 3 (relating to hearings and appeals).

This section cited in 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); 6 Pa. Code § 20.22 (relating to conditions of participation); 6 Pa. Code § 20.23 (relating to income); and 6 Pa. Code § 20.32 (relating to assessment and case management).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.61 Entitlement.

The act does not create or provide an individual with an entitlement to services or benefits under this chapter. As provided in section 6 of the act (62 P. S. § 3066), it is the intent of the General Assembly that services under the act shall be made available only to the extent of the availability and level of appropriations made by the General Assembly.

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

6 Pa. Code § 20.62 Waivers.

(a) The Department may for justifiable reasons, grant exceptions to and departures from this chapter to an area agency on aging when the area agency on aging can, by clear and convincing evidence, demonstrate that compliance would cause an unreasonable and undue hardship upon the area agency on aging and that an exception would not create a negative impact upon the participation of a caregiver family in the Program or otherwise compromise the intent of this chapter. The Department will not waive requirements in the act.

(b) A waiver request shall be made in writing to the Secretary. A request shall specifically identify and explain the burden created by the requirement for which the exception is being sought, the alternative method for fulfilling the basic intent of the requirement and evidence of the steps to be taken to prevent a negative impact upon the participation of caregiver families in the Program.

(c) An exception granted under this chapter may be revoked by the Department for a justifiable reason. Notice of revocation will be in writing and will include the reason for the action of the Department and a specific date upon which the exception will be terminated.

(d) In revoking an exception, the Department will provide for a reasonable time between the date of the written notice of revocation and the date of termination of an exception for the agency to come into compliance with the applicable provision of this chapter.

(e) If an agency wishes to request a reconsideration of a denial or revocation of an exception, it shall do so in writing to the Secretary within 15 days of receipt of the notification of adverse action.

This section cited in 6 Pa. Code § 20.42 (relating to ongoing caregiving expenses).

History

Authority: The provisions of this Chapter 20 issued under the Family Caregiver Support Act (62 P. S. § § 3061—3068), unless otherwise noted.
Source: The provisions of this Chapter 20 adopted July 10, 1992, effective July 11, 1992, 22 Pa.B. 3697, unless otherwise noted.

Chapter 21 Domiciliary Care Services for Adults

6 Pa. Code § 21.1 Scope.

This chapter establishes standards for domiciliary care service administered by AAAs.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.2 Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise: AAA (Area Agency on Aging)—The governing authority designated by the Department within each planning and service area to develop and administer an area plan, or the person, agency or organization which is the subcontractor of the AAA. Applicant—A person who applies for domiciliary care service or the domiciliary care supplement, either personally or through a responsible adult. Assessment—A determination based upon a comprehensive review of an applicant’s social, physical and psychological status along with a description of the applicant’s current resources and needs. CAO (County Assistance Office)—An office located in each county of this Commonwealth which is responsible for local administration of the programs under the Department of Public Welfare. Case record—The file maintained on each applicant and client to include pertinent information gathered in assessing need and developing a care plan. The term includes information regarding social supports, activities of daily living, nutrition, physical health and environment, mental and economic status and recent experiences. The term also includes tangential action taken for, or on behalf of, an applicant or client, including, but not limited to, activities done with, for or on behalf of a client, such as contacts with formal and informal service providers, and the like. Client—A resident of this Commonwealth who is 18 years of age or older who has applied for, and has been determined to be eligible for, domiciliary care service or the domiciliary care supplement. Communicable disease—An illness due to a specific infectious agent or its toxic products which arises through transmission of that agent or its products from an infected person to a susceptible host, either directly or indirectly through an intermediate plant or animal host, or the inanimate environment. Department—The Department of Aging of the Commonwealth. Designate—A person chosen by the applicant or client in writing to be notified in case of emergency, termination of services, home closure or other situations indicated by the applicant or client. Domiciliary care home or dom care home—A premises certified by an AAA for the purpose of providing a supervised living arrangement in a homelike setting for a period exceeding 24 consecutive hours to clients placed there by the AAA. Domiciliary care provider service—Services, activities and basic items furnished by the provider to the client. Domiciliary care service or domiciliary care—Services and activities performed by the AAA which are necessary to seek out, assess and determine the eligibility of applicants and prospective providers, to certify domiciliary care homes, and to arrange for, oversee and follow-up on the following:

(i) The placement of clients into domiciliary care homes.

(ii) The receipt of the domiciliary care supplement by clients. Domiciliary care supplement—The monthly monetary supplement to the income of a client who has been placed into a domiciliary care home. The supplement is provided by the Commonwealth under 55 Pa. Code Chapter 299 (relating to supplemental security income program and State supplementary payment program). Exit—A door on the exit path which opens directly to the outside of the building or structure. Exit path—A continuous, unobstructed, unrestricted and safe way of travel from any point in the home to a safe area of refuge outside the building or structure. Full assistance—A client who needs to be led or carried from the building or needs help to get into a wheelchair and needs to be wheeled out of the building or needs help getting into another device and needs helps evacuating the building and is unable to follow verbal or signed prompts. Independently mobile—An individual who is physically and mentally capable of vacating the home without the assistance of another person in the case of an emergency. The term includes a person capable of ascending or descending stairs unassisted, if necessary, to vacate the home in which the person is residing. Joint certification—Certification of a domiciliary care home by an AAA in conjunction with another certifying or licensing agency of the Commonwealth to provide residential care services to domiciliary care clients and clients of other agencies in the same home or facility. Minimal physical assistance—Assistance in getting to one’s feet, into a wheelchair, walker or prosthetic device. Nonmobile—A client who is physically or mentally unable to vacate the building without the continued full assistance of another person. PSA (Planning and Service Area)—A geographic area within this Commonwealth, authorized by the Older Americans Act of 1965 (42 U.S.C.A. § § 3001—3057g) and designated by the Department for the purposes of planning, development, delivery and administration of aging and social services by an AAA. Prospective domiciliary care home or prospective home—A residence in the process of being certified by an AAA as a domiciliary care home. Prospective provider—A person who applies to the AAA to be a provider and is in the process of being determined eligible as a provider. Provider—A person 21 years of age and older determined eligible by an AAA to have responsibility for the day-to-day operation of a domiciliary care home. Relative—A person related to the client by consanguinity, affinity or adoption. SSI (Supplemental Security Income)—Monthly income maintenance provided to aged, blind or disabled individuals through Title XVI of the Social Security Act (42 U.S.C.A. § § 1381—1382j). Semimobile—A client who is able to vacate the home with no more than verbal or minimal physical assistance. To be considered semimobile, a person shall be able to effectively operate a device required for moving from one place to another, be able to understand and carry out instructions for vacating the home and be able to ascend or descend stairs if present on the exit path. The term does not include a person who by reason of physical or mental disability or condition is unable to vacate the home in case of emergency without the continual physical assistance of another. Service management—The process through which AAAs meet their mandate to secure needed services for older people. This process includes the following activities: comprehensive needs assessment to include nutrition assessment; development of a written service plan; arrangement, coordination and follow-up of service delivery; reassessment; and ongoing case recording. Social Security district office—An office in this Commonwealth which has been designated to administer various programs under the Social Security Act, including SSI, in an assigned geographic area. Staff person—An adult who is employed by a provider or who volunteers to furnish services to the clients in a domiciliary care home. State supplement—The monthly monetary supplement to persons receiving SSI in this Commonwealth. The State supplement is provided by the Commonwealth under 55 Pa. Code Chapter 299 (relating to supplemental security income program and State supplementary payment program). Subcontractor—A person, agency or organization which has a written, legally-binding agreement or contract with the AAA to perform services and activities necessary to seek out, assess and determine the eligibility of applicants and prospective providers, to certify domiciliary care homes, and to arrange for, oversee and follow-up on, the placement of clients in domiciliary care homes and the receipt of the domiciliary care supplement by clients. The agreement or contract shall meet the contracting standards of the Department as promulgated in the applicable program directive. Unusual incident—An occurrence which threatens the health and safety of a client. The term includes fires, structural damage to the home, crimes, serious injuries, missing persons, highly contagious diseases, food poisoning, interruptions in utility services which may affect the health and safety of a client, neglect, mistreatment, physical or mental abuse, behavior by a client which constitutes a danger to that client or others, the death of the client, a request by the client for immediate removal or relocation from the domiciliary care home, or the relocation of the domiciliary care home. Verbal assistance—Giving instructions to assist the client in vacating the home.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.3 Waivers.

The Department may grant waivers on provisions in this chapter which are not required by Federal, State or local laws. A request for a waiver shall be submitted in accordance with, and meet the standards provided in, the generic policies and procedures for requesting waivers as provided by the Department in the applicable Aging Program directive. In making decisions regarding waiver requests, the Department will consider: whether the objective of the policy in question will be achieved through granting the waiver, how older people will benefit from approval of the waiver, public input—such as public hearings—regarding the issue in question, and other information which would support a waiver request.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.4 Nondiscrimination.

Domiciliary care service shall be provided in accordance with Title VI, Section 601, of the Civil Rights Act of 1964 (42 U.S.C.A. § 2000d), section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A. § 706), the Age Discrimination Act of 1975 (42 U.S.C.A. § § 6101—6107) and the Pennsylvania Human Relations Act (43 P. S. § § 951—963).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.5 Service goals.

The following are the goals of domiciliary care service:

(1) To provide supportive, homelike, community-based living arrangements for adults who cannot live independently in the community.

(2) To encourage and assist clients in developing and maintaining maximum initiative and self-determination in a homelike setting.

(3) To provide an alternative to institutionalization, and to help adults remain in the community or to return to the community and, if possible, to their own homes.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.21 Eligibility for domiciliary care service.

(a) To receive domiciliary care service, an applicant shall meet the following criteria as determined by the appropriate AAA:

(1) Be a resident of this Commonwealth and 18 years of age or older.

(2) Be independently mobile or semimobile.

(3) Not require skilled or intermediate nursing care, or general or special hospital care on a 24-hour residential basis.

(4) Have no relative, or other person whose relationship with the applicant is important to the applicant’s continued well-being, willing or able to provide the necessary support for independent living.

(5) Be incapable of living alone regardless of available services, or require services to live alone and the services are not available.

(b) An applicant shall meet one or more of the following criteria:

(1) Have demonstrated difficulties in accomplishing activities of daily living, such as purchasing and preparing meals, bathing and grooming, housekeeping and laundry, financial management and taking medication in proper doses at proper times, to an extent which prevents independent living in the community.

(2) Have demonstrated difficulties in social or personal adjustment, usually associated with mental disability, as demonstrated by reduced, lost or nondeveloped capabilities for developing and maintaining appropriate personal relationships, dealing constructively with others, and maintaining or attaining a maximum level of functioning.

(3) Have demonstrated difficulties resulting from disabilities, such as blindness, deafness, amputation, paralysis or birth defects, if the individual is independently mobile or semimobile.

This section cited in 6 Pa. Code § 21.23 (relating to application process for domiciliary care service and the domiciliary care supplement); and 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.22 Eligibility for the domiciliary care supplement.

To receive the domiciliary care supplement, an applicant shall meet the following criteria:

(1) Be eligible for SSI, as determined by the appropriate Social Security District Office and verified by the CAO, or be receiving SSI, as verified by the appropriate CAO, or have personal income less than the combined Federal-State payment level for domiciliary care, as determined by the appropriate CAO under 55 Pa. Code Chapter 299 (relating to suplemental security income program and State supplementary payment program).

(2) Be eligible for domiciliary care service, as determined by the appropriate AAA.

(3) Be residing in or awaiting immediate placement into a domiciliary care home in which the provider is not a relative of the client.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.23 Application process for domiciliary care service and the domiciliary care supplement.

The following procedure shall be used for determining the eligibility of an applicant for domiciliary care service and making payment for the domiciliary care supplement:

(1) The application process includes activity relating to a request by an applicant for an eligibility determination. It begins with the receipt of an application by an AAA and continues until there is a determination of eligibility or ineligibility.

(2) The applicant is responsible for:

(i) Initiating, completing and signing necessary application forms as promulgated by the Department and the Department of Public Welfare.

(ii) Participating in an assessment interview with the AAA.

(iii) Sending required application forms to the appropriate AAA.

(iv) Promptly notifying the appropriate AAA of changes in circumstances that may affect continued eligibility for domiciliary care service or the domiciliary care supplement.

(v) Contacting the appropriate Social Security District Office to place an application for SSI if the applicant is applying for SSI at the same time the applicant is applying for domiciliary care service.

(3) The AAA is responsible for:

(i) Providing the applicant with the necessary application forms and, if appropriate, assisting the applicant with completing the forms.

(ii) Receiving the application and reviewing it to assure that forms are complete and the necessary documentation is attached.

(iii) Accepting an application from a designate when the applicant is incapable of filing an application on the applicant’s own behalf.

(iv) Notifying the applicant of the nature of the error and that an application date cannot be established, and assisting the applicant in correcting errors on the application, if the application is incomplete or incorrect.

(v) Assisting the applicant in contacting the appropriate Social Security District Office, if the applicant is applying for SSI at the same time the applicant is applying for domiciliary care service.

(vi) Arranging for a face-to-face assessment interview within 15 days of the applicant’s request for service.

(vii) Performing, with the applicant’s informed consent, a thorough, indepth, face-to-face assessment of the applicant’s level of functioning and the need for domiciliary care service, as stated in § 21.21 (relating to eligibility for domiciliary care service), using the forms as prescribed by the Department.

(viii) Arranging for a medical examination of the applicant and ensuring that appropriate documentation of the examination is recorded on forms prescribed by the Department of Public Welfare.

(ix) Requesting the domiciliary care review team, within 30 days of the assessment, to review and recommend appropriate action for applicants for whom the AAA is unable to reach a decision concerning the need for domiciliary care service.

(x) Providing notice, in writing, to the applicant or the designate of the applicant’s ineligibility for domiciliary care service, if determined ineligible by the AAA, within 10 days after the decision has been made, and providing the reasons for the determination of ineligibility, along with information on the applicant’s right to appeal the decision under § 21.101 (relating to fair hearings and appeals).

(xi) Forwarding the original application, along with necessary documentation and forms, to the appropriate CAO and retaining a copy for the AAA’s files when the AAA has determined that the applicant is eligible for domiciliary care services and an appropriate domiciliary care home is available in which to place the client.

(xii) Assigning the client to a waiting list until an appropriate domiciliary care home becomes available, when the AAA has determined that the applicant is eligible for domiciliary care service and has made an initial verification that the applicant’s income is low enough to meet the eligibility requirements for the supplement, but there is no appropriate domiciliary care home available in which to place the client and informing, in writing, the client or the designate of the determination and the action which has been taken.

(xiii) Initiating domiciliary care services to the client on a private payment basis when the AAA has determined that the applicant is eligible for domiciliary care service, but the CAO has determined that the applicant is not eligible for the domiciliary care supplement because the applicant’s income is too high. If there is no appropriate domiciliary care home available in which to place the client, the client shall be assigned by the AAA to a waiting list until an appropriate domiciliary care home becomes available, and the client or the designate shall be informed in writing of the determination and the action which has been taken.

(xiv) Beginning the actual process of placing the client into a domiciliary care home as soon as necessary forms and eligibility determinations have been completed by the AAA and the CAO under this section, and the AAA has available an appropriate domiciliary care home in which to place the client, and informing the client and the designate, if one exists, in writing of the determination of eligibility and the action which is being taken. The written notification shall take place within 30 days of the date the eligibility determination was made.

(4) The CAO is responsible for determining eligibility for the domiciliary care supplement under 55 Pa. Code Chapter 299 (relating to supplemental sucurity income program and State supplementary payment program) and, in cases where applicants appeal that determination, conducting hearings and appeals under 55 Pa. Code Chapter 275 (relating to appeal and fair hearing).

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); and 55 Pa. Code § 299.2 (relating to eligibility requirements for SSA-administered optional SSP for DCS and PCS).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.24 Redetermination of eligibility.

The following procedure will be used to redetermine the eligibility of clients for domiciliary care service and the domiciliary care supplement.

(1) Clients are responsible for:

(i) Requesting a redetermination appointment with the AAA and arranging for the completion of necessary redetermination forms upon notification from the CAO, through the AAA, of an annual redetermination of eligibility for the domiciliary care supplement.

(ii) Promptly notifying the AAA regarding a change in circumstances which may affect one’s eligibility for domiciliary care service or the domiciliary care supplement.

(2) The AAA is responsible for:

(i) Arranging for a place and time for a redetermination of eligibility for domiciliary care service through a reassessment.

(ii) Completing annually the appropriate forms for redetermination of eligibility for the domiciliary care supplement.

(iii) Forwarding appropriate documentation to the CAO.

(3) The CAO is responsible for redetermination of eligibility for the domiciliary care supplement under 55 Pa. Code Chapter 299 (relating to supplemental security income program and State supplementary payment program).

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.25 Termination of eligibility for domiciliary care service or the domiciliary care supplement.

The following procedures shall be used to terminate a client’s eligibility for domiciliary care service or the domiciliary care supplement, or both:

(1) The AAA is responsible for:

(i) Notifying the CAO of a change in the client’s status which requires termination of eligibility for domiciliary care service.

(ii) Upon notifying the client or the designate that the client is no longer eligible for domiciliary care service, notifying the client in writing of the client’s right to appeal and receive a fair hearing under § 21.101 (relating to fair hearings and appeals). Notification shall take place within 20 days of the date the decision was made.

(2) The CAO is responsible for termination of eligibility for the domiciliary care supplement, through notification of the Social Security District Office and other appropriate actions, under 55 Pa. Code Chapter 297 (relating to Supplemental Security Income Program).

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.26 Domiciliary care home provider eligibility.

To be eligible to act as a domiciliary care home provider, a prospective provider shall meet the following criteria, as determined by the AAA:

(1) Be a resident of this Commonwealth and 21 years of age or older.

(2) Reside in the domiciliary care home, or reside in the prospective home.

(3) Demonstrate to the AAA, through the application and interview process, that the provider has never been convicted of a crime involving assaultive behavior or moral turpitude and has the experience and capacity to accept persons with physical, mental or age related difficulties, has the willingness and ability to work with the AAA and clients, and has the physical health and stamina to be a provider.

This section cited in 6 Pa. Code § 21.29 (relating to redetermination of provider eligibility and recertification of domiciliary care homes); 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.54 (relating to AAA care plan responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); and 6 Pa. Code § 21.82 (relating to other provider responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.27 Domiciliary care home certification and recertification standards.

To become certified and to retain certification as a domiciliary care home, a domiciliary care home shall meet the basic standards in this section, as determined by the AAA from a site inspection and review of relevant documentation, in conjunction with other appropriate agencies or organizations. Domiciliary care homes with four or more clients shall meet the special recertification standards in § 21.30 (relating to special program and recertification standards for domiciliary care homes with four or more clients).

(1) The home shall be a fixed, individual, private, noncommercial household or family dwelling.

(2) The home shall be the residence of the provider, the residence of the prospective provider or the intended residence of the prospective provider, and may not have residing within it a person who is an employe of an AAA.

(3) The building in which the home is to be located shall meet applicable Federal, State and local statutes and regulations pertaining to zoning, health and safety.

(4) The building in which the home is to be located shall be in good general repair and free of hazards, such as loose or broken window glass, loose or cracked floor coverings, and have no infestation of insects, rodents or other vermin.

(5) If the home uses water which is obtained from a private source, such as a well, spring or cistern, the source may not be polluted or contaminated nor may it be situated, constructed or maintained so that it may become polluted or contaminated or rendered injurious to health, and the water shall be approved as meeting Commonwealth water quality standards.

(6) The home shall have an adequate supply of piped hot and cold water to bathroom, kitchen and laundry equipment, and may not have hot water exceeding 130°F which would be accessible to clients.

(7) The home shall utilize a public sewerage system where one is available, or if a public system is not available, sewage shall be disposed under 25 Pa. Code Chapter 73 (relating to standards for onlot sewage treatment facilities).

(8) The home may not have exposed heating pipes, hot water pipes or radiators which have a temperature exceeding 110°F, in rooms and areas to be used by clients. If these items are located in areas accessible to clients and have temperatures exceeding 110°F, the radiators shall be covered with protective covers and the heating pipes with insulation.

(9) If the home uses woodburning or coal burning stoves, the stoves shall meet applicable local enforcement codes and be installed using permanent connections.

(10) Stairways shall have securely fastened handrails and nonskid surfaces, such as stairtreads, carpeting and the like. Stair coverings shall be securely fastened.

(11) The home shall have a heating system which has the capacity to maintain a temperature of at least 70°F without the use of portable space heaters.

(12) The home shall have been inspected and approved by the local fire department or other qualified agency or individual for fire safety, and it shall meet the requirements in § 21.79 (relating to fire and safety activities).

(13) The home shall have available adequate artificial lighting which is restricted to electrical lighting.

(14) The home shall have a minimum of one operational smoke detector on each occupied floor, plus one in the basement area.

(15) The home shall have space which would be available for storage of the clients’ personal property, such as trunks, suitcases and seasonal clothing.

(16) Each room to be used by clients in the home shall have at least one unobstructed exit path.

(17) The home shall have a living room or recreational area with adequate space which would be available to clients. These areas shall, at least in combination, be large enough to comfortably accommodate all residents at the same time.

(18) The home shall have a dining room or dining area which is properly equipped with items necessary for proper food service. Items of equipment include tables, chairs and utensils for drinking, eating, preparing and serving food and drink. These items shall be furnished in quantities sufficient to serve all residents at the same time.

(19) The home shall have a clean kitchen with working appliances necessary for the preparation of nutritious meals.

(20) The home shall have at least one fully-equipped and operational indoor bathroom which is readily accessible to, and available for use by, clients.

(21) The home shall have bedrooms which meet the following standards:

(i) Bedrooms to be used by clients shall be located on floor levels not more than one story above an exit.

(ii) Bedrooms to be used by clients shall be limited to either single or double occupancy and shall have space which is adequate for a safe and comfortable living environment.

(iii) Bedrooms to be used by clients shall have adequate ventilation and at least one window with direct outside exposure to provide unobstructed natural light.

(iv) Windows in bedrooms to be used by clients shall have adequate covering to ensure the privacy of clients.

This section cited in 6 Pa. Code § 21.28 (relating to provider application and home certification process); 6 Pa. Code § 21.29 (relating to redetermination of provider eligibility and recertification of domiciliary care homes); 6 Pa. Code § 21.30 (relating to special program and recertification standards for domiciliary care homes with four or more clients); 6 Pa. Code § 21.31 (relating to provisional certifications); 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.54 (relating to AAA care plan responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); 6 Pa. Code § 21.74 (relating to basic furnishings); and 6 Pa. Code § 21.79 (relating to fire and safety activities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.28 Provider application and home certification process.

The following process shall be used to determine the eligibility of a prospective domiciliary care home provider and to certify a prospective domiciliary care home.

(1) The prospective provider application process should be conducted by the AAA in conjunction with the domiciliary care home certification process. The interview shall take place in the prospective provider’s home and should be conducted at the same time as the home inspection by the AAA.

(2) The prospective provider is responsible for:

(i) Submitting a completed application to the appropriate AAA on forms required by the Department.

(ii) Reviewing the rules and regulations of the AAA and the Department regarding domiciliary care service.

(iii) Providing information requested by the AAA at an interview conducted in the prospective provider’s home by the AAA.

(iv) Providing the AAA with two written character references, other than relatives, which address the suitability of the prospective provider to offer a homelike setting and care for functionally-impaired persons, and the prospective provider’s sensitivity and capability in addressing the needs of potential clients.

(v) Providing the AAA with two written financial references which address the prospective provider’s current financial situation and ability to function financially independently of client monthly payments. If the prospective provider’s home is mortgaged, one of the references shall be from the mortgage-holding institution or person.

(vi) Providing the AAA with a report from a physical examination which occurred no more than 6 months before the date the AAA conducts the application process. The examination shall be performed by a licensed physician and shall state that the prospective provider is physically able to care for adults with difficulties in independent living and that the provider is free from communicable disease or a medical condition that would endanger clients. This physical examination shall include a test for tuberculosis which may be either a chest x-ray or a tuberculin test. A physical examination is required every 2 years thereafter, or at the request of the AAA. At the determination of the AAA, other persons working or residing in the home may be required to furnish verification of a physical examination by a licensed physician which states that the person is physically able to care for adults with difficulties in independent living and is free from communicable disease.

(vii) Providing the AAA with a signed statement verifying that the prospective provider has never been convicted of a crime involving assaultive behavior or moral turpitude.

(viii) Providing the AAA with proof that the prospective home has a current, valid insurance policy which would be adequate for the protection of providers in the event of a client’s accident, injury or property damage.

(ix) Furnishing the AAA with a statement from the owner that the owner approves of the use of the home for providing domiciliary care services, when the prospective home is rented, and that the use of the home for domiciliary care services would not be in violation of factors—that is, zoning, health and safety—set forth in § 21.27(3) (relating to domiciliary care home certification and recertification standards).

(3) The AAA is responsible for:

(i) Providing information to prospective providers on the nature of the service, home certification and provider eligibility process and a description of the service requirements.

(ii) Providing necessary application forms and assistance to the prospective provider in completing the forms.

(iii) Requesting from the prospective provider the information required in paragraph (2)(iv)—(ix) and obtaining verification from a State Police records search that the statement received from the prospective provider regarding paragraph (2)(vii) is correct. The AAA may request an FBI records search on a prospective provider.

(iv) Presenting the prospective provider with a copy of this chapter so that the prospective provider can review it.

(v) Arranging for an interview and home inspection with a prospective provider within 30 days of the date on which the application was received and conducting the interview with the prospective provider to obtain the requisite information regarding the prospective provider and other persons who will live in the prospective home—other than clients—to demonstrate that the prospective provider has the capacity to perform as an acceptable provider.

(vi) Conducting and documenting an inspection of the prospective home to assure that it meets the standards in § 21.27.

(vii) Requesting the domiciliary care review team to review the application and recommend appropriate action regarding prospective providers and homes for which the AAA is unable to reach a determination of eligibility or decision on certification.

(viii) Determining the eligibility or ineligibility of the prospective provider, based on the application, interview and, if applicable, the recommendation of the domiciliary care review team.

(ix) Certifying or not certifying the prospective domiciliary care home, based on the standards in § 21.27.

(x) Notifying the prospective provider, if the prospective provider is determined ineligible to be a provider, or if the prospective home is determined to be not certifiable, of the determination in written form which lists the reasons for the decision and gives information on the prospective provider’s right to appeal and receive a fair hearing under Chapter 3 (relating to fair hearings and appeals). The notification shall be provided within 30 days of the date on which the determination of ineligibility was made by the AAA.

(xi) Notifying the provider, if the prospective provider is found to be eligible and the home is certified, of the determination of eligibility and certification, and placing the home on the central registry of domiciliary care homes required in § 21.56 (relating to the central registry of certified homes).

(xii) Entering into a written agreement with the provider, on forms provided by the Department, which sets forth the responsibilities of the AAA and the provider.

(xiii) Issuing a certificate of compliance to a certified domiciliary care home.

This section cited in 6 Pa. Code § 21.29 (relating to redetermination of provider eligibility and recertification of domiciliary care homes); 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); 6 Pa. Code § 21.56 (relating to central registry of certified homes); 6 Pa. Code § 21.60 (relating to recordkeeping); and 6 Pa. Code § 21.82 (relating to other provider responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.29 Redetermination of provider eligibility and recertification of domiciliary care homes.

The following process shall be used to redetermine the eligibility of providers and recertify domiciliary care homes:

(1) The provider is responsible for:

(i) Permitting access to the home for the AAA to conduct follow-up interviews and inspections. The AAA may inspect the home to ensure that it complies with this chapter. This inspection shall occur during normal business hours.

(ii) Permitting access to the home for the AAA for emergency visits. These visits may occur anytime and may be based upon a report of a client in need of protective services, investigation of a death or injury to a client or occurrence of an unusual incident.

(iii) Notifying the AAA of a change in the provider’s situation or home standards which may affect the eligibility of the provider or certification of the home. The eligibility requirements in § § 21.26 and 21.28 (relating to domiciliary care home provider eligibility; and provider application and home certification process) are of a continuing nature and it is the obligation of the provider to meet these standards on a continuing basis. Failure to comply with this subparagraph renders the provider ineligible.

(2) The AAA is responsible for:

(i) Annual redetermination of provider eligibility using the criteria in § 21.26 during a face-to-face interview with the provider.

(ii) Annual recertification of the home using the standards in either § 21.27 or § 21.30 (relating to domiciliary care home certification and recertification standards; and special program and recertification standards for domiciliary care homes with four or more clients), depending upon how many clients reside in the home, during a site inspection conducted by the AAA.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); and 6 Pa. Code § 21.82 (relating to other provider responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.30 Special program and recertification standards for domiciliary care homes with four or more clients.

(a) For domiciliary care homes with four or more clients, the following special building recertification standards apply. Domiciliary care homes with four or more clients shall meet the home recertification standards in this section in lieu of the standards in § 21.27 (relating to domiciliary care home certification and recertification standards).

(1) Domiciliary care homes with four to eight clients shall meet the standards for small group homes in 34 Pa. Code Chapter 56 (relating to division C-3 small group habitation) and shall provide verification of inspection and approval by the Department of Labor and Industry under 34 Pa. Code Chapter 49 (relating to administration—buildings) before recertification is granted by the AAA.

(2) Domiciliary care homes with nine or more clients shall meet the standards for large facilities in 34 Pa. Code Chapter 55 (relating to division C-2 hotels, motels, apartment buildings, etc.) and shall provide verification of inspection and approval by the Department of Labor and Industry under 34 Pa. Code Chapter 49 before recertification is granted by the AAA.

(3) Homes located in Philadelphia, Pittsburgh or Scranton shall provide verification of inspection and approval in accordance with the Occupancy and Fire Safety Codes of the appropriate city.

(4) Prior to recertification by the AAA, the home shall provide verification that remodeling, reconstruction or substantial alteration to the domiciliary care home has been done in accordance with plans approved by the Department of Labor and Industry under 34 Pa. Code Chapter 49.

(5) There shall be at least one operational bathroom, having a toilet, sink and tub or shower, for every eight clients.

(6) When the home consists of a cluster of living units rather than a single living unit, the clustered living units shall be in physical proximity, and each unit shall conform to the applicable sections of this chapter.

(7) No domiciliary care home may have more than 13 clients residing within it.

(b) In addition to other program requirements provided in this chapter, the following special program requirements apply to domiciliary care homes with four or more clients:

(1) Mobility. Clients residing in domiciliary care homes having four or more clients shall be independently mobile or semimobile. The semimobile clients shall be able to get out of bed without assistance from another person.

(2) Staffing.

(i) During the waking hours established by the home, at least one provider or staff person shall be present and available on the premises when one or more clients are present in the home. If one or more of the clients are not independently mobile, at least one provider or staff person shall be present and available in each building or cluster unit where clients are present.

(ii) During hours when clients are sleeping, one provider or staff person shall be present and available in each building or cluster unit housing clients who are not independently mobile. For buildings or cluster units with only independently mobile clients, one provider or staff person who is awake and circulates to each building or unit hourly or who is on the premises and available to clients through an intercom system may be substituted for a provider or staff person in each building or cluster unit.

(iii) The AAA may require an increase in the number of staff persons as it deems necessary.

This section cited in 6 Pa. Code § 21.27 (relating to domiciliary care home certification and recertification standards); 6 Pa. Code § 21.29 (relating to redetermination of provider eligibility and recertification of domiciliary care homes); and 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.31 Provisional certifications.

The AAA may grant provisional certification of a domiciliary care home if the home is in substantial compliance with this chapter so that the health and safety of clients are not endangered. Provisional certification may not exceed 90 days and can only be granted subject to an agreement with the provider that the domiciliary care home shall meet the standards prescribed in § 21.27 (relating to domiciliary care home certification and recertification standards) by the end of the 90-day period. The AAA may place a provisionally certified home on the central registry of certified homes so that placements may begin in that home.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.32 Joint certifications.

(a) For homes which are jointly certified on or after January 6, 1990 or had been jointly certified prior to January 6, 1990 and had a certified capacity of three or fewer total clients, the following applies: The AAA may not conduct placement activities which result in more than three clients or residents unrelated to the provider, including clients of other certifying or licensing agencies, residing in one home at one time.

(b) A jointly-certified home which has a certified capacity of four or more total clients prior to January 6, 1990 may continue to operate with more than three clients, if applicable State and local laws are observed in conjunction with this chapter.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.33 Decertification of domiciliary care homes and removal of provider eligibility.

The AAA shall notify the provider in writing of the provider’s right to appeal and receive a fair hearing under Chapter 3 (relating to fair hearings and appeals), if the home has been decertified or if the provider has been determined to be ineligible. Grounds for decertification of a domiciliary care home or removal of provider eligibility are specified in § 21.55(q) (relating to AAA placement activities).

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.41 Departmental responsibilities.

The Department is responsible for the following activities under this chapter:

(1) To develop regulations and to supervise and administer domiciliary care service on the State level under section 2203-A(16) and (19) of The Administrative Code of 1929 (71 P. S. § 581-3(16) and (19)).

(2) To provide technical assistance to AAAs and other community organizations and persons regarding domiciliary care service.

(3) To issue program directives, forms and assessment instruments under this chapter.

(4) To monitor and evaluate AAAs with regard to the provision of domiciliary care service.

(5) To conduct hearings and appeals regarding domiciliary care service under Chapter 3 (relating to fair hearings and appeals).

(6) To determine the monthly dollar amount which clients shall pay to providers for domiciliary care provider services. The determination shall be issued at least annually by the Department through the Department’s program directive process, based on the annual cost of living increase to clients who receive SSI. Increases will normally be apportioned so that 82% of the client’s total monthly domiciliary care payment—that is, the Federal SSI payment plus the State supplement plus the domiciliary care supplement—is given as a monthly fee to the provider, and 18% retained by the client, although the Department may revise this distribution if warranted by economic circumstances. Private-pay clients in the domiciliary care program shall pay the same monthly dollar amount to the provider as do the clients who are SSI recipients.

(7) To act as the standard-setting authority for domiciliary care service under 45 CFR Part 1397 (relating to standard setting requirements for medical and nonmedical facilities where SSI recipients reside) and to work with the Department of Public Welfare for enforcement of the standards set for domiciliary care homes in accordance with established procedures.

This section cited in 6 Pa.B. § 21.54 (relating to AAA care plan responsibilities); and 6 Pa. Code § 21.92 (relating to client responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.51 General provisions.

The AAA is responsible for the overall local administration and operation of domiciliary care service in the PSA.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.52 AAA service responsibilities.

Specific service activities to be performed by AAAs providing domiciliary care service include, but are not limited to, the following:

(1) Determining client eligibility under § 21.21 (relating to eligibility for domiciliary care service).

(2) Placing clients, with their informed consent or the consent of their legal guardian, in domiciliary care homes suited to their individual needs.

(3) Performing the eligibility and home certification activities as prescribed in § § 21.23—21.33.

(4) Maintaining ongoing contact—as set forth in § 21.54 (relating to AAA care plan responsibilities)—with clients placed in domiciliary care homes to assure adequacy of care and appropriateness of placement.

(5) Identifying prospective domiciliary care home providers who are qualified under § 21.26 (relating to domiciliary care home provider eligibility) and arranging for their training. The training shall be based on course materials as required by the Department and shall ensure that providers achieve competencies through educational programs which include the following:

(i) Major health problems of older persons.

(ii) Accident prevention.

(iii) Nutrition.

(iv) The psychology of aging.

(v) Interpersonal communication.

(vi) General principles of cleanliness and hygiene.

(vii) Recognition and response to crises and emergency situations.

(6) Maintaining a registry of certified domiciliary care homes under § 21.56 (relating to a central registry of certified homes).

(7) Assuring provision of services by domiciliary care providers in accordance with § § 21.71—21.82.

This section cited in 6 Pa. Code § 21.82 (relating to other provider responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.53 AAA client and applicant related activities.

Specific client and applicant related activities to be performed by AAAs providing domiciliary care service include, but are not limited to, the following:

(1) The AAA shall actively engage in information and referral efforts to identify adults in need of domiciliary care service and shall maintain contact with community resources which will facilitate the identification of adults in need—for example, clergy, physicians and civic organizations.

(2) The AAA shall make available information on domiciliary care service to community agencies and shall encourage and assist these agencies in the identification of adults in need of domiciliary care.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.54 AAA care plan responsibilities.

(a) The AAA shall be responsible for the development and implementation of a plan of care for each domiciliary care client.

(b) The care plan shall be developed in consultation with the client and shall be signed by the client or the designate, if appropriate, and the provider indicating their agreement with the plan.

(c) The care plan shall indicate problems or needs identified, desired outcomes (long and short term goals), services or providers (informal or formal), pattern of service delivery and follow-up monitoring and reassessment updates.

(d) Arrangements for service to supplement service given by the provider shall be prescribed in the care plan and may be made by the AAA directly or by referral to another agency. The purpose of the supplemental service shall be to address special client needs which provide the support necessary for the client to be maintained in the domiciliary care home.

(e) The AAA shall orient the provider to the client’s care plan, secure the provider’s approval and furnish the provider with a copy of the plan.

(f) When the care plan is carried out by an agency other than the AAA, that agency shall, with the concurrence of the AAA, modify the care plan as required. This modification may include specification of the client’s role in providing for or assisting with laundry or meal service as specified in § 21.74 (relating to basic furnishings).

(g) When the care plan is carried out by an agency other than the AAA, the AAA shall monitor as necessary to insure that the care plan is being implemented.

(h) When an agency other than an AAA has the primary care plan responsibility for a client, and the home in which that client resides or is to be placed is operating under a joint certification between the AAA and the agency with primary care plan responsibility, the provider residency requirements in § § 21.26(2) and 21.27(b)(relating to domiciliary care home provider eligibility; and domiciliary care home certification and recertification standards) and determinations regarding the apportionment of payments by clients to providers made in accordance with § 21.41(6) (relating to Departmental responsibilities) are not applicable.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.60 (relating to recordkeeping); 6 Pa. Code § 21.74 (relating to basic furnishings); and 6 Pa. Code § 21.76 (relating to personal care responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.55 AAA placement activities.

(a) Limitation.

(1) In a home which is certified on or after January 6, 1990 or which had a certified capacity of three or fewer clients under a certification or recertification made prior to January 6, 1990, the AAA shall conduct its placement activities so that no more than three clients reside in the home at one time.

(2) A domiciliary care home which had a certified capacity of four or more clients prior to January 6, 1990 may continue to operate with more than three clients, if applicable State and local laws are observed in conjunction with the applicable sections of this chapter.

(b) Selection of home. The AAA shall, in consultation with the specialized service agency having primary care management responsibilities, if one has been assigned, select a home for the client from the central registry of certified domiciliary care homes located in the PSA.

(c) Approval required. The domiciliary care home selected shall have the approval of the client prior to placement. Recipients of SSI shall be given the opportunity to accept placement in a domiciliary care home, subject to provider approval, prior to the offering of placement to private pay clients.

(d) Provider approval. The client selected for the domiciliary care home shall have the approval of the provider prior to placement.

(e) Department certification. The domiciliary care home shall have been certified by the Department under § 21.28 (relating to provider application and home certification process).

(f) Follow-up by other agency. In selecting a domiciliary care home for a client, the AAA shall insure, if the follow-up is to be assigned to another agency, that every effort is made to minimize the number of agencies and staff which will be relating to a single domiciliary care home.

(g) Visit prior to placement. A visit shall be made to the domiciliary care home by the client and the designated agency staff person responsible for the placement prior to placement for the purpose of acquainting the client with the home, the provider and the surrounding community. During this visit, the rights and responsibilities of both the client and the provider shall be reviewed by the designated staff person in the presence of the client and provider. Other elements necessary for a successful placement shall also be reviewed prior to placement, including the following:

(1) Client and provider preferences.

(2) Acceptable behaviors.

(3) Smoking and consumption of alcohol.

(4) Pets.

(h) Decision by client. The decision of the client to accept or reject the placement shall be made following the visit and out of the presence of the provider. The AAA is required to show only a reasonable number of homes to a client before placement activity with that client is suspended.

(i) Notification of impending move. If appropriate, the AAA shall encourage and assist the client in notifying all concerned; for example, the client’s family or designate and the post office, of the impending move to a domiciliary care home.

(j) Information to provider. The AAA shall provide the domiciliary care home provider with the following written information about a client:

(1) Name.

(2) Sex.

(3) Date of birth.

(4) Social security number.

(5) Religious affiliation, if the client chooses to disclose.

(6) Date of entry into the home.

(7) The name of the referring agency.

(8) The names, addresses and telephone numbers of the client’s family.

(9) The name and telephone number of the person to be called in case of emergency.

(10) A copy of the provider/client agreement.

(11) An inventory of personal property which the client brings to the facility, on an inventory form developed by the AAA.

(12) Dietary restrictions.

(13) A full disclosure of medical problems or history of medical problems.

(14) Medication regimen.

(15) The name and telephone number of the client’s personal physician and dentist. In the absence of a personal physician or dentist, the client shall participate in the selection of a physician or dentist.

(16) The guardian’s name, address and telephone number, if applicable.

(k) Follow-up agency and information. The AAA shall inform the provider, in writing, of the agency and person responsible for follow-up and the telephone number of the person or agency responsible for follow-up.

(l) Placement. A mutually agreeable time and date for the placement shall be determined by the provider, the client and the agency responsible for placement. The agreement between the client and the provider shall be developed and completed at the time of placement on a form provided by the Department.

(m) Domiciliary care house rule approval. The AAA shall, before placement, approve the house rules of the domiciliary care home and assure that the client has a written copy of the rules and that the rules are explained to the client. The house rules shall be incorporated into the agreement between the client and provider specified in § 21.75 (relating to the client and provider agreement). The house rules shall, at a minimum, contain an agreement outlining when the client is expected to be present in the home and when the client is expected to be away from the home. The purpose of this agreement is to allow the client and provider the necessary freedom to participate in activities not related to the domiciliary care home. A dispute regarding the interpretation of house rules shall be decided by the AAA.

(n) Follow-up assessment. Follow-up, ongoing assessment and monitoring of the care plan and placement shall be conducted as follows:

(1) The AAA shall evaluate or designate another agency to evaluate the client’s adjustment to the domiciliary care home within 15 days of the placement and shall insure that indicated modifications to the care plan are made. Follow-up of a client placed in a domiciliary care home shall be performed by a home visit at least once every 6 months thereafter, the results of which shall be recorded in writing.

(2) An evaluation shall include a visit to the home and shall be based on discussion with the client outside the provider’s presence, and then with the client and provider together.

(3) The AAA shall reassess the continuing adequacy of the placement and care plan at least every 6 months using the reassessment form provided by the Department and shall insure that indicated modifications are made to the care plan. Additionally, when the care plan calls for the provider to manage a client’s financial affairs under § 21.81(c) (relating to provider financial accountability), the AAA shall review the financial records of the provider at 6-month intervals.

(4) A complete and comprehensive reassessment of need, utilizing forms prescribed by the Department, shall be performed annually, at minimum, or more frequently, as may be indicated by a significant change in the client’s health or a demonstrated change in the client’s level of functioning.

(5) If the follow-up, ongoing assessment and monitoring of the placement is performed by an agency other than the AAA, the AAA shall obtain periodic reports and otherwise monitor these activities to insure that they are being performed.

(o) Notification upon unusual incident. The AAA shall notify promptly the client’s family or designate, if these persons are available, in the event of an unusual incident involving the client.

(p) Investigation of reports. A report of an unusual incident in the domiciliary care home shall be thoroughly investigated by representatives of the AAA as follows:

(1) The investigation shall include a home visit which shall take place within 72 hours of the date the report was received by the AAA. One copy of the investigation report shall be kept by the AAA as part of the case record and one copy sent to the agency with primary care plan responsibilities, if this agency is not the AAA.

(2) Investigations performed by the AAA as part of a protective services intervention under the Older Adults Protective Services Act (35 P. S. § § 10211—10224) and Chapter 15 (relating to protective services for older adults) satisfy the requirements in paragraph (1).

(q) Grounds for removal and decertification. One or more of the following reported and documented occurrences shall be grounds for removal and relocation of the client from a domiciliary care home and, if appropriate, decertification of the home or removal of provider eligibility by the AAA:

(1) Neglect, mistreatment or physical or mental abuse of a client.

(2) Violation of a client’s rights as cited in § 21.91 (relating to client rights).

(3) Failure of the provider to comply with § 21.26 or § § 21.71—21.83 (relating to provider rights and responsibilities), or the domiciliary care home’s failure to meet the standards in § 21.27 or § 21.28 (relating to domiciliary care home certification and recertification standards; and provider application and home certification process).

(4) Relocation for the client’s physical or mental health and welfare when it is determined, in consultation with the client, to be necessary.

(5) A client becomes nonmobile. In this case, the provider shall immediately inform the AAA and make arrangements for the client to be examined by a physician. If the physician finds that the medical and health needs of the client cannot be met in the domiciliary care home, the AAA and provider shall cooperate to transfer the client to the appropriate level of care. The AAA shall ensure the safety of the client pending transfer to the appropriate level of care by providing or making available other services and supports considered necessary or appropriate by the AAA.

(r) Neglect, mistreatment or abuse of client. Reports of neglect, mistreatment or abuse shall be made as follows:

(1) The AAA shall report to the Department, within 72 hours, a documented instance of client neglect, mistreatment or abuse, or a major fire or structural damage in a domiciliary care home and an associated client injury or death.

(2) Reports which are related to protective services cases and are made by the AAA under the Older Adults Protective Services Act and Chapter 15 satisfy the requirements in paragraph (1).

(s) Relocation of client. The AAA is responsible for the relocation of a client in the event of home closure. However, with regard to joint certifications, the agency which has primary care plan responsibility for a client is responsible for relocation of that client.

(t) Relatives excluded. The AAA may not place a client into the home of a provider who is a relative of that client.

This section cited in 6 Pa. Code § 21.33 (relating to decertification of domiciliary care homes and removal of provider eligibility); 6 Pa. Code § 21.60 (relating to recordkeeping); 6 Pa. Code § 21.75 (relating to client and provider agreement); 6 Pa. Code § 21.77 (relating to provider and AAA related activities); and 6 Pa. Code § 21.91 (relating to client rights).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.56 Central registry of certified homes.

(a) The AAA shall develop and maintain a registry of certified domiciliary care homes within the PSA.

(b) The registry shall contain the following information for each home:

(1) The name, address and telephone number of each provider.

(2) The dates of inspection, certification or recertification and follow-up visits.

(3) The written record of the information obtained from the interview with the provider conducted under § 21.28(3)(vi) (relating to provider application and home certification process) and inspection of the home.

(4) The total resident capacity.

(5) The number of clients presently placed in home and dates of placement.

(6) The name of the agency and person responsible for follow-up.

(7) Other information determined necessary and useful, such as a record of unusual incident reports.

(d) It is the responsibility of the AAA to continually update the occupancy data contained in the registry.

This section cited in 6 Pa. Code § 21.28 (relating to provider application and home certification process); and 6 Pa. Code § 21.52 (relating to AAA service responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.57 Domiciliary care review team.

(a) A domiciliary care review team shall be established by the AAA which shall consist of at least one person from the AAA, one person from the CAO and one person from the county mental health/mental retardation program. A representative from another agency, such as Office for the Visually Handicapped, may be included at the determination of the AAA.

(b) The AAA may utilize its existing advisory council as the domiciliary care review team if the membership of the advisory council meets the standards in subsection (a).

(c) The domiciliary care review team shall meet as often as the AAA deems necessary. Minutes of domiciliary care review team meetings shall be maintained on file by the AAA.

(d) The domiciliary care review team shall be used to handle complaints or appeals from providers, prospective providers, applicants and clients.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.58 Staffing responsibilities for AAAs providing domiciliary care.

(a) The AAA shall have paid staff sufficient in number and qualifications to carry out the responsibilities required by this chapter. These responsibilities shall include, but not be limited to, the following:

(1) Prompt assessment of applicants.

(2) Prompt inspection of homes and ongoing assessment of providers.

(3) Necessary contact with referral agencies and community resources.

(4) Monitoring of agencies assigned responsibility for service plan development including the placement of adults in domiciliary care homes, implementation and follow-up.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.59 Training requirements.

The AAA shall assure that its staff receives periodic training in job-related areas.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.60 Recordkeeping.

(a) Confidentiality.

(1) Client record information is confidential and may not be disclosed or made use of, directly or indirectly, except in the legitimate performance of domiciliary care services, and in monitoring and evaluation of the service by State and local officials.

(2) If names and other identifying information are disguised, material from client records may be used for other legitimate functions such as:

(i) Teaching and research purposes.

(ii) Development of understanding and knowledge of agency services by the placement agency.

(iii) Other similar educational purposes.

(b) Client records.

(1) A case record for each applicant and client reflecting an assessment of the applicant or client, and a clearly defined and periodically updated service plan for each client as specified under § § 21.54 and 21.55 (relating to AAA care plan responsibilities; and AAA placement activities) shall be maintained. A record shall include, from intake until the termination of service, a description of the responsibilities assumed by the AAA and the manner in which these responsibilities are carried out, either directly or through assignment to another agency, as well as periodic evaluations of the service delivered to the client. The evaluations shall include the appropriateness of the service from the perspective of the client and the agency.

(2) Documentation pertaining to the applicant or client, including medical and psychiatric reports; forms required by the Department to implement the domiciliary care program; and other relevant information, including relevant information regarding client and provider contract, shall be filed in the case record.

(1) A record shall be maintained for each of the homes for which an application for certification as a domiciliary care home is filed. A record shall contain information obtained from the interviews with the provider, the home inspection and the written references described in § 21.28 (relating to provider application and home certification process).

(2) Documentation pertaining to the certification of the home and application of the provider, including forms required by the Department, shall be filed with the home records.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.61 Domiciliary care service’s relationship to service management.

The AAA shall determine how domiciliary care service interrelates with service management and specify that interrelationship in a written statement to be kept on file for review by the Department.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.62 Facility ownership.

The AAA may not own or directly operate a domiciliary care facility.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.71 General provisions.

A domiciliary care home provider shall operate in accordance with applicable provisions of this chapter to assure a safe, supportive, homelike setting for clients.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); and 6 Pa. Code § 21.81 (relating to provider financial accountability).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.72 Staff qualifications.

The provider shall ensure that the following basic qualifications are met for the staff persons involved in home provider services. A staff person:

(1) Shall be 18 years of age or older.

(2) Shall be capable of performing home provider services in accordance with this chapter.

(3) May never have been convicted of a crime involving assaultive behavior or moral turpitude.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.73 Staffing.

(a) At least one provider or staff person shall be present and available on the premises when one or more clients are present in the home.

(b) The AAA may waive the requirements in subsection (a), if the clients are independently mobile and the provider or staff absences would be of limited duration and not during hours when the clients are sleeping. This waiver, if granted by the AAA, shall be made in writing and recorded in the case record.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.74 Basic furnishings.

A provider is responsible for furnishing to a client or, if appropriate, paying for the full cost of, the following basic items:

(1) Adequate housing in accordance with the standards in § § 21.27 and 21.80 (relating to domiciliary care home certification and recertification standards; and domiciliary care home maintenance activities).

(2) Basic utilities, including heat, electricity, hot and cold water, sewage and nontoll telephone service.

(3) Laundry service for bed linens, towels and personal clothing. A provider shall allow access to laundry equipment such as a washer, dryer, iron and ironing board for a client if the service is specified in the care plan. The home shall have sufficient bed linens to allow for a complete change of linens for a client once a week, or more often if necessary, and bed linens shall be changed at least once every week.

(4) Three nutritious meals per day, provided in accordance with § 21.78 (relating to nutrition responsibilities of providers). If some meals are provided through a Department-funded senior center, the provider shall pay the center for the full cost of meals received by the client at the center, or pay the center for meals as otherwise specified in the care plan developed under § 21.54(d) (relating to AAA care plan responsibilities).

(5) Other meals received outside the domiciliary care home which are initiated by the provider or which otherwise can be identified as the responsibility of the provider.

(6) Basic furnishings to include the following:

(i) A twin (or larger) bed without casters, or with locked casters, which does not require a client to climb steps or a ladder to get into or out of the bed.

(ii) A mattress and box spring.

(iii) A bed pillow.

(iv) A bedside table or shelf and bedside light.

(v) A dresser and mirror.

(vi) A clothes closet or wardrobe.

(vii) Bed linens and blankets.

(viii) Towels and washcloths and a towel bar.

(7) Transportation to enable a client to receive necessary, nonemergency medical services.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.54 (relating to AAA care plan responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); 6 Pa. Code § 21.75 (relating to client and provider agreement); 6 Pa. Code § 21.81 (relating to provider financial accountability); and 6 Pa. Code § 21.92 (relating to client responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.75 Client and provider agreement.

(a) There shall be a written agreement between the provider and the client, specifying the monthly charge for domiciliary care provider services in accordance with the amounts established by the Department. The agreement, to be completed on a form provided by the Department, shall be fully explained to the client prior to placement.

(b) The agreement is subject to prior approval by the AAA and shall, at a minimum, specify the house rules of the provider established under § 21.55(m) (relating to AAA placement activities) and set forth the responsibilities of the provider to furnish items specified in § 21.74 (relating to basic furnishings).

(c) The agreement shall be amended at least annually to reflect changes in client payments to providers as established by the Department. The agreement may be amended at other times, on terms mutually agreeable to the provider and the client, subject to review and approval by the AAA.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); 6 Pa. Code § 21.81 (relating to provider financial accountability); and 6 Pa. Code § 21.92 (relating to client responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.76 Personal care responsibilities.

(a) The provider shall help the client in developing or maintaining self-help skills, personal hygiene skills and other skills relating to activities of daily living in accordance with the care plan established under § 21.54 (relating to AAA care plan responsibilities).

(b) If necessary, the provider shall assist with the administration of medication prescribed for self-administration, and will do so in accordance with the care plan established under § 21.54.

(1) The provider shall take reasonable precaution to assure that drugs are stored and maintained in a safe and secure manner to protect against contamination, spillage, misidentification and pilferage. In establishing a means for safe storage with the client, the provider shall consider the status of the client and others living in the home, the degree to which the client needs immediate access to the drug and the potential harm if the drug should be misused.

(2) The provider may assist with medications by helping the client to remember the client’s schedule in accordance with the prescription, storing the medication in a secure place and offering the client the medication at the prescribed times.

(3) Only currently prescribed medication of a client living in the home may be stored in the home.

(4) Medication, prescription and nonprescription and topical preparations, except as specified in paragraph (5), shall be stored in locked areas.

(5) Medication may be stored in a client’s room for self-administration upon written instructions of a licensed physician.

(6) Medication prescribed for one client may not be provided to another client.

(7) Medication assistance errors and drug reactions shall be reported immediately to the physician who ordered the medication.

(8) Medication shall be kept in its original prescription container.

(9) When the client permanently leaves the home, the client’s medications are to be given to the client, the family or the client’s designate.

(10) When medication is discontinued, becomes outdated or was prescribed for a client who died before taking all of the prescribed medications, the remaining medications shall be destroyed.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.77 Provider and AAA related activities.

(a) The provider, in cooperation with the AAA, shall:

(1) Assure that each client visits or is seen by his physician at least annually or more frequently if indicated by the client’s health needs.

(2) Obtain emergency medical care when the client’s personal physician is not available.

(3) Assure that dental, eye and other medical services are made available to clients as necessary.

(b) If a client becomes nonmobile or if the client’s medical situation, as determined by a physician, indicates the need for a transfer to a health care facility, the provider shall immediately notify the AAA so that the AAA can assist with the client’s transfer to the appropriate facility and take appropriate action under § 21.55(q)(5) (relating to AAA placement activities).

(c) If a provider intends to close a home, at least 30 days prior to the intended date of closure, the provider shall submit a written statement to each client, the designate—if one exists—and the AAA. The statement shall include:

(1) The provider’s intent to cease operations.

(2) The closing date.

(3) A guarantee that the domiciliary care home will continue operation at least 30 days beyond the closing date for the relocation of clients except in cases in which the AAA determines that removal of the client at an earlier time is necessary for the client’s health and welfare.

(d) The provider shall maintain information on each client containing the information listed in § 21.55(j).

(e) The provider shall notify immediately the AAA regarding unusual incidents which occur. The AAA shall then take action, deemed appropriate, in accordance with § 21.55.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.78 Nutrition responsibilities of providers.

The provider shall assure that:

(1) A client is served daily at least three well-balanced meals which are designed to meet the daily nutritional requirements of the client and which are prepared either by the provider, or as indicated in the care plan, by the client with the supervision of the provider.

(2) A substitute meal is available to the client, if a client misses a meal.

(3) Dietary restrictions prescribed by the client’s personal physician are followed.

(4) Meals are served to clients in a dining area, except that:

(i) Meal service to a client’s bedroom shall be made available only if the client is temporarily ill or indisposed.

(ii) Meal service to other rooms in the home may be made available if the client requests that service and the provider agrees to deliver that service.

(5) Food returned from individual plates is discarded and is not used in the preparation of other food dishes or served again.

(6) Milk served to clients or used in food preparation is pasteurized, canned or powdered.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); 6 Pa. Code § 21.74 (relating to basic furnishings); and 6 Pa. Code § 21.81 (relating to provider financial accountability).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.79 Fire and safety activities.

The provider shall assure that:

(1) First aid supplies such as bandages, adhesive tape, bandaids, slings, cotton, sterile dressings, antiseptics, safety pins and scissors, are available in the home.

(2) The telephone number of the local fire department, police, poison control and ambulance serving the home is posted by the telephones.

(3) A minimum of one operational fire extinguisher is located on each occupied floor, with at least one fire extinguisher located in the kitchen or cooking area, unless otherwise prescribed by the local fire inspecting authority under § 21.27(12) (relating to domiciliary care home certification and recertification standards). The provider and each staff person shall be trained to use the fire extinguishers.

(4) A written plan is available for evacuation of the building in case of a fire or other emergency, and the clients and residents of the home are made aware of the plan.

(5) Fire drills are conducted at least quarterly in accordance with the plan established under paragraph (4). A written record listing the time and date of the drills shall be kept by the provider. Annually, at least one fire drill shall be conducted without prior notice to clients.

(6) Proper safeguards are taken against the fire hazards involved in smoking. For example, ashtrays and special smoking areas and nonsmoking areas shall be provided.

(7) Firearms kept on the premises are stored in a locked area which is inaccessible to clients.

(8) Containers of poisonous, caustic, toxic, flammable or other dangerous materials kept in the home are prominently and distinctly marked or labeled as hazardous and stored in an area that is inaccessible to clients. The use and storage of these materials may not constitute a hazard to the clients.

(9) Combustible trash is stored in fire resistant containers.

(10) Fireplaces are securely screened when in use.

(11) Portable space heaters are not used. If nonportable electric baseboard space heaters are used, they shall be installed with permanent connectors and protectors.

This section cited in 6 Pa. Code § 21.27 (relating to domiciliary care home certification and recertification standards); 6 Pa. Code § 21.52 (relating to AAA service responsibilities); 6 Pa. Code § 21.55 (relating to AAA placement activities); and 6 Pa. Code § 21.81 (relating to provider financial accountability).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.80 Domiciliary care home maintenance activities.

The provider shall assure that:

(1) The atmosphere and routine of the domiciliary care home enables clients to spend the majority of their hours outside of their bedrooms.

(2) Furnishings and housekeeping standards are of a standard that the domiciliary care home is comfortable and clean. Closets, attics, basements, cellars and furnace rooms shall be kept free from accumulation of extraneous material, such as discarded furniture, clothing, newspapers or magazines. Garbage and rubbish shall be removed from the premises at least once per week, and shall be stored in containers that have tight fitting covers.

(3) A minimum temperature of 68°F during waking hours and 65°F during sleeping hours is maintained in rooms used by clients. If the clients are 65 years of age or older, a minimum temperature of 70°F is maintained during waking hours and 65°F during sleeping hours in rooms used by those clients. If the temperature in rooms used by clients exceeds 85°F, a fan or air conditioner shall be provided.

(4) A client’s bedroom is not used for other purposes by the provider.

(5) Doors into rooms used by clients are not locked from the outside when a client is in the room.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.81 Provider financial accountability.

(a) The provider shall maintain accurate financial records regarding the operation of the domiciliary care home. The records shall include, but not be limited to, records of payments made to utilities and mortgage-holders, and records of purchases made and costs incurred to meet the provider responsibilities as outlined in this section and § § 21.71—21.80 and 21.82.

(b) The provider may not manage the client’s finances unless prior approval is received from the client and the AAA and the activity is specified in the care plan developed by the AAA.

(1) Maintain detailed and accurate financial records of each individual client’s assets, expenditures and payments received. These records shall include the client’s banking statements, receipts for client deposits to accounts and expenditures exceeding $25, records of payments from the client to the provider for home provider services and the client’s current fund balance. The provider may not commingle his money with that of the client’s.

(2) Notify the client and offer assistance with establishing an interest-bearing account in the client’s name at a local financial institution protected by the Federal Deposit Insurance Corporation or the Federal Savings and Loan Insurance Corporation, if the client’s excess funds exceed $200 at the end of 2 consecutive months.

(3) Surrender to the administrator or executor of the client’s estate the assets of that client which have been entrusted to the provider, upon the death of the client. If there is no administrator or executor appointed within 1 week, the provider shall surrender the assets to the AAA pending probate. An itemized written account of the client’s fund balance and an inventory of the assets shall be furnished by the provider.

(4) Immediately provide the client with an itemized written account of the funds and pay to the client the remaining balance in funds, upon termination of domiciliary care home provider service.

This section cited in 6 Pa. Code § 21.52 (relating to AAA service responsibilities); and 6 Pa. Code § 21.55 (relating to AAA placement activities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.82 Other provider responsibilities.

(a) The provider shall pay a client for work performed which is of a consequential economic benefit to the provider. This work shall be paid for under 29 CFR Part 529 (relating to employment of patient workers in hospitals and institutions at subminimum wages) and the Fair Labor Standards Act of 1938 (29 U.S.C.A. § § 201—219).

(b) The provider may not enter into a contract to keep or care for a client for the remainder of the client’s life.

(c) The provider shall assure that clients in the home are informed of, and afforded, the rights delineated in § 21.91 (relating to client rights).

(d) The provider may not accept a power of attorney, a designation as representative to receive Social Security payments or the legal guardianship from a client, unless prior written approval is received from the AAA.

(e) The provider shall permit members of a client’s family, community service organizations and representatives of community legal service programs and the Department to have access to the domiciliary care home during the home’s visitation hours or by appointment for the purpose of visiting or rendering assistance to a client or informing clients of the availability of services and assistance. The visitation hours shall be at a reasonable time of day and a reasonable amount of time shall be allowed for visitation.

(f) The provider shall permit access to the home for the AAA to conduct follow-up interviews, inspections and emergency visits under § § 21.29(1)(i) and (ii) (relating to redetermination of provider eligibility and recertification of domiciliary care homes).

(g) The provider shall have a physical examination at least every 2 years to demonstrate that the provider continues to meet the criteria and responsibilities in § § 21.26(3) and 21.28(2)(vi) (relating to domiciliary care home provider eligibility; and provider application and home certification process).

(h) The provider shall maintain in force an insurance policy in accordance with the specifications in § 21.28(2)(viii) (relating to provider application and home certification process).

(i) By July 6, 1990, a current provider shall successfully complete a training program offered under § 21.52(5) (relating to AAA service responsibilities) and a basic life support course in Cardiopulmonary Resuscitation (CPR) and Basic First Aid offered through a local Red Cross Chapter or other similar resource. Failure to complete these training programs may lead to the removal of provider certification by the AAA.

(j) A provider determined to be eligible after January 6, 1990 shall meet the requirements of subsection (i) within 6 months of the date their eligibility determination was made by the AAA.

(k) After-receiving initial training, a provider shall maintain certification in CPR and Basic First Aid by completing requisite course updates at intervals prescribed by the training resources—for example, the Red Cross.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.83 Provider rights.

A domiciliary care provider shall be afforded the following rights:

(1) The right to appeal an adverse action by the Department or the AAA and receive a fair hearing under Chapter 3 (relating to fair hearings and appeals).

(2) The right to prompt action on reasonable requests made to the AAA with regard to problems encountered with the provision of domiciliary care provider services.

(3) The right to timely payments from clients for domiciliary care provider services.

(4) The right to receive training and technical assistance from the AAA regarding domiciliary care provider services.

(5) The right to assistance and support from the AAA when serving special needs or during emergency situations.

This section cited in 6 Pa. Code § 21.55 (relating to AAA placement activities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.91 Client rights.

A client residing in a domiciliary care home shall be afforded the following basic rights:

(1) The client may not be restricted in the right to leave and return to the domiciliary care home at reasonable times consistent with the house rules developed under § 21.55(m) (relating to AAA placement activities).

(2) The client shall have the right to attend and participate in the religious activities of the client’s choice or to abstain from religious practice, and shall have the right to be free from the imposition of the religious practices of others.

(3) The client shall be free to receive visitors at times mutually-agreed upon by the client and provider.

(4) The client shall have access to a telephone in the domiciliary care home and may make local calls, in reasonable privacy, without charge. The client shall be allowed to make arrangements for payment of toll calls.

(5) The client shall have access to the United States mails, may write and send uncensored mail at the client’s own expense, and receive, unopened, mail addressed to the client.

(6) The client shall be free to voice grievances and recommend changes in the policies and services of the domiciliary care provider during periodic updates of the house rules.

(7) The client shall be allowed to keep in the client’s room personal possessions including, but not limited to, radios, pictures, plants, cards, photographs, rockers, footstools and chairs.

(8) The client shall have the right to privacy in all aspects of daily living, including visual privacy in the bathroom and in intimate personal hygiene.

(9) The client shall have the right to a diet consistent with religious or health restrictions.

(10) The client shall have the right to be treated in a courteous manner by the provider and staff of the domiciliary care home.

This section cited in 6 Pa. Code § 21.55 (relating to AAA placement activities); 6 Pa. Code § 21.82 (relating to other provider responsibilities); and 6 Pa. Code § 21.92 (relating to client responsibilities).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.92 Client responsibilities.

A client residing in a domiciliary care home is responsible for the following:

(1) Paying the monthly domiciliary care provider fee as established by the Department under § 21.41(6) (relating to Departmental responsibilities) to the provider in a timely manner.

(2) Paying for personal expenses not specified in § 21.74 (relating to basic furnishings).

(3) Treating the provider, the staff and other residents of the home in a courteous manner.

(4) Respecting the rights of the other clients in the home as specified in § 21.91 (relating to client rights).

(5) Complying with the house rules of the agreement entered into with the domiciliary care home provider established under § 21.75 (relating to client and provider agreement), as long as the provisions of that agreement do not conflict with § 21.91.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.101 Fair hearings and appeals.

(a) All parties have the right to express grievances and complaints and to appeal and receive a fair hearing on adverse actions regarding services or activities funded by the Department under Chapter 3 (relating to fair hearings and appeals).

(b) The AAA shall utilize the domiciliary care review team to handle complaints or appeals from domiciliary care providers and applicants for or recipients of domiciliary care services.

This section cited in 6 Pa. Code § 21.23 (relating to application process for domiciliary care service and domiciliary care supplement); and 6 Pa. Code § 21.25 (relating to termination of eligibility for domiciliary care service or the domiciliary care supplement).

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

6 Pa. Code § 21.111 Forms, documents and other written materials.

The Department may supplement or interpret this chapter by developing and issuing forms, documents or other written materials necessary for the effective administration of the program.

History

Authority: The provisions of this Chapter 21 issued under section 2203-A of The Administrative Code of 1929 (71 P. S. § 581-3), unless otherwise noted.
Source: The provisions of this Chapter 21 adopted January 5, 1990, effective January 6, 1990, 20 Pa.B. 13, unless otherwise noted.

Chapter 22 Pharmaceutical Assistance Contract for the Elderly

6 Pa. Code § 22.1 Scope and authority.

(a) This chapter sets forth regulations governing the administration, provision and receipt of prescription drug benefits available to older Pennsylvanians under the Pharmaceutical Assistance Contract for the Elderly (PACE) Program.

(b) This chapter applies to the Department, providers who wish to participate in the PACE Program, applicants for program benefits and claimants.

(c) This chapter is issued under Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.

(d) The Department will develop PACE Program policies and regulations, and reserves the right to delegate administrative responsibilities as may be necessary to implement the PACE Program.

The provisions of this § 22.1 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.2 Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise: Act—Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly. Acute condition—A short-term medical condition or ailment for which the normal and typically recommended drug therapy does not exceed 15 days. Applicant—A person who applies to participate in the PACE Program, either personally or through an authorized agent. Application—The form completed and submitted to the Department by an applicant which is used by the Department to determine that applicant’s eligibility to participate in the PACE Program. Also, the form completed and submitted to the Department by a claimant which is used by the Department to redetermine that claimant’s eligibility to participate in the PACE Program. Average wholesale cost—The cost of a dispensed drug based upon the price published in a national drug pricing system in current use by the Department as the average wholesale price of a prescription drug in the most common package size. The terms ‘‘average wholesale cost’’ and ‘‘average wholesale price’’ are synonymous. Claim—In the case of a claimant, presentation to an enrolled provider of a valid PACE identification card in order to receive prescription drugs. In the case of an enrolled provider, a request to the Department for payment for providing prescription drugs under the PACE Program. Claimant—A resident of this Commonwealth who meets the conditions specified in § § 22.21—22.26 (relating to claimant eligibility) and whose application for enrollment in the PACE Program has been approved by the Department. Contractor—The person, partnership or corporate entity which has an approved contract with the Department to administer the pharmaceutical assistance program as established under the act and this chapter. Copayment—The dollar amount which is required under the program to be paid to enrolled providers by claimants for each prescription. DESI (Drug Efficacy Study Implementation) drug—Drug products introduced into the market as new drugs from 1938-1962 which were submitted for review by the National Academy of Sciences—National Research Council Drug Efficacy Study Group and are still considered by the Food and Drug Administration as less than effective in meeting their manufacturers’ claims. The term includes identical, related or similar products as covered under 21 CFR 310.6 (relating to applicability of ‘‘new drug’’ or safety or effectiveness findings in drug efficacy study implementation notices and notices of opportunity for hearing to identical, related, and similar drug products). The term includes the same drug products considered not reimbursable by the Medical Assistance Program under 42 CFR 441.25 (relating to prohibition on FFP for certain prescribed drugs). Department—The Department of Aging of the Commonwealth, its authorized agent or the contractor. Dispensing—Under the PACE Program, the preparation of a prescription drug by a PACE provider, the delivery of the prepared prescription drug to a PACE claimant and the collection from the PACE claimant of the required copayment. Dispensing fee—The dollar amount paid to the participating pharmacy by the program for filling prescriptions approved under the PACE Program. Dispensing physician—A medical doctor or osteopathic doctor currently licensed by the Commonwealth who dispenses prescription drugs. Enrolled provider—A pharmacy or dispensing physician that meets the conditions of eligibility and participation in § § 22.61 and 22.62 (relating to conditions of provider eligibility; and conditions of provider participation). Experimental drug—A drug currently being administered under an investigational new drug application as required by the United States Food and Drug Administration (FDA) under 21 CFR Part 312 (relating to new drugs for investigational use) to determine its safety and effectiveness. Generically equivalent drugs—Prescription drug products, including those sold under brand names, having the same generic name, dosage form and labeled potency, listed in the Formulary of Generically Equivalent Drug Products at 28 Pa. Code § 25.58 (relating to generically equivalent drug products). Generic differential—A percentage of the average wholesale cost of a brand name prescription drug as provided under § 22.11(g) (relating to general payment principles). The percentage is the same for all applicable transactions. This percentage is established by the Department as specified under § 22.11(g)(3). Income—All income from whatever source derived, as specified in § 22.24 (relating to income provisions). Mail—First class mail under the regulations of the United States Postal Service or common carrier, able to assure delivery within 5 calendar days. Medical Assistance Program—The Federal Medicaid program as administered under 55 Pa. Code Part III (relating to Medical Assistance Manual). Medicare—The Federal program which provides medical care under Title XVIII of the Social Security Act (42 U.S.C.A. § § 1395—1395xx). Medication history—A pharmacy medication record established and maintained on each PACE claimant served by the pharmacy. This record shall include, as a minimum, the following claimant information as obtained from the claimant or equivalent information as approved by the Department:

(i) Name.

(ii) PACE identification card number.

(iii) Medication allergies and other allergies.

(iv) Current medication utilization.

(v) Indication of all medical disorders known to the claimant.

(vi) Separate entries for each prescription medication dispensed by the provider. Most common package size—A prescription drug package size identified in one of the following descriptions as the size most commonly purchased by enrolled providers:

(i) The package size listed in the February 1984 ‘‘Yellow Book’’ distributed by the United States Health Care Financing Administration (HCFA) for drugs contained on that list.

(ii) Changes or additions to the package sizes listed in the February 1984 ‘‘Yellow Book’’ established by the Department with the approval of the Pharmaceutical Assistance Review Board and published in the Pennsylvania Bulletin. National drug pricing system—A published data information system which includes listings of average wholesale prices and direct prices of prescription drugs such as ‘‘The Drug Topics Red Book,’’ Medi-Span, Inc. or ‘‘Prescription Pricing Guide.’’ PACE—The Pennsylvania Pharmaceutical Assistance Contract for the Elderly Program. Pharmaceutical Assistance Review Board—The Board established by the act in order to help ensure the continuing efficiency and effectiveness of the PACE Program. Pharmacy—A pharmacy currently licensed by the Commonwealth. Prescriber—A physician or other health practitioner licensed by the Commonwealth to prescribe drugs or a physician authorized by the Department under § 22.11(f)(9). Prescription drugs or drugs—Drugs requiring a prescription in this Commonwealth, and insulin, insulin syringes and insulin needles. The term does not include experimental drugs, DESI drugs and drugs not approved by the Department of Health for use in this Commonwealth. Principal place of business—A location in this Commonwealth where an enrolled provider can and will conduct all business directly related to the dispensing of prescription drugs under the PACE Program. Resident—A person who has lived within this Commonwealth for a period of at least 90 consecutive days and who meets the conditions as set forth in § 22.22 (relating to residence provisions). Secretary—The Secretary of the Department. Unit—The measured quantity of a prescription drug to be used such as a single tablet or capsule. The term only includes drugs dispensed in tablet or capsule form. Universal Claim Form—The standard form, copyrighted by the National Council of Prescription Drug Programs, and in current usage by pharmacies to document for third-party payors prescription services provided by claimants eligible for prescription benefits under a plan administered by a third-party payor. Current usage connotes the most current official version of this form in use at this time and at any given time in the future. Usual charge—An enrolled provider’s charge to the cash-paying public for a prescription drug, in a specific strength and quantity within a specific calendar month. Discounts or coupons offered to the cash-paying public shall be considered to be offered to the Commonwealth as well. Discounts applicable to claimants or coupons presented by claimants shall be accepted by the provider and credited to the PACE Program payment and not the copayment or, if applicable, the generic differential.

The provisions of this § 22.2 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; corrected July 6, 1984, effective June 16, 1984, 14 Pa.B. 2331; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; corrected April 12, 1985, effective March 30, 1985, 15 Pa.B. 1353; amended December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (91333) to (91334) and (103119) to (103120).

This section cited in 6 Pa. Code § 22.11 (relating to general payment principles); 6 Pa. Code § 22.24 (relating to income provisions); 6 Pa. Code § 22.33 (relating to responsibilities of the applicant in the application process); and 6 Pa. Code § 22.42 (relating to responsibilities of the claimant in the eligibility redetermination process).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.11 General payment principles.

(a) Provider billing. A provider is required to bill the Department at the usual charge for the drug dispensed.

(b) Payment elements. A payment to an enrolled provider under the PACE Program shall consist of the following:

(1) The copayment required of claimants on each prescription billed under the PACE Program.

(2) The payment of the generic differential required of claimants under subsection (g).

(3) The approved PACE Program payment.

(c) Program payment calculations. When the Department calculates the approved PACE Program payment, the following requirements apply:

(1) A pharmacy will be paid the lower of the following two amounts:

(i) The average wholesale cost of the prescription drug dispensed, plus the dispensing fee, minus the copayment and, if required under subsection (g), minus the generic differential.

(ii) The pharmacy’s usual charge for the dispensed drug, minus the copayment and, if required under subsection (g), minus the generic differential.

(2) In addition to the approved program payment under paragraph (1), a pharmacy may qualify for a supplemental dispensing fee as provided under subsection (e)(2).

(3) A dispensing physician will be paid the lower of the following two amounts:

(i) The average wholesale cost of the prescription drug dispensed, minus the copayment and, if required under subsection (g), minus the generic differential.

(ii) The dispensing physician’s usual charge minus the copayment and, if required under subsection (g), minus the generic differential.

(d) Copayments.

(1) A claimant of PACE Program benefits is required to pay to the provider the established copayment for each prescription filled under the PACE Program.

(2) The copayment amount for each prescription is $6. The copayment amount will increase or decrease on an annual basis by the average percent change, as determined by the Department, of ingredient costs for prescription drugs dispensed under the program plus a differential to raise the copayment to the next highest 25¢ increment. The Department will publish a notice in the Pennsylvania Bulletin of changes in the copayment amount.

(3) The Department may increase or decrease the amount of the copayment based upon the financial experience and projections of PACE and after consultation with the Pharmaceutical Assistance Review Board. The Department will not approve adjustments to the copayment more frequently than semiannually.

(e) Dispensing fee.

(1) The minimum dispensing fee under the PACE Program will be the dollar amount of the dispensing fee in use under the Medical Assistance Program as specified in 55 Pa. Code § 1121.55(a) (relating to method of payment). A dispensing fee of $2.75 was adopted by the Department as the dispensing fee under the PACE Program effective July 1, 1985. Only pharmacies enrolled in the PACE Program are eligible to receive dispensing fees. A dispensing fee will not be paid to dispensing physicians enrolled in the PACE Program.

(2) When a pharmacy enrolled in the PACE Program can document that, as a result of one of its pharmacist’s consultation with a prescriber, a claimant’s prescription for a higher priced brand name drug, with no substitutions permitted, was changed to permit substitutions and a lower priced generically equivalent drug was dispensed, the Department will pay that pharmacy a supplemental dispensing fee of $1. This fee shall apply only to an original prescription and not to subsequent refills for the same drug. Documentation of the prescription change shall consist of a notation on the back of the original prescription which includes the initials of the pharmacist who consulted with the prescriber, and the date of the consultation.

(f) Special conditions for payment.

(1) A provider shall collect the full copayment required on each prescription filled before the provider submits an allowable claim to the Department for payment. A claim which relates to services for which the full copayment has not been collected will not be considered an allowable claim.

(2) Payments will be made for prescription drugs dispensed by mail when prescription drugs have been ordered and dispensed under this chapter.

(3) A provider who dispenses prescription drugs to PACE claimants by both mail and walk-in procedures will be assigned one number for mail transactions and a second number for walk-in transactions. To be considered a valid claim, a claim submitted to the Department for payment shall be identified as a claim for service by mail or for walk-in service by use of the appropriate provider number. The use of the incorrect provider number shall invalidate a claim and result in a disallowance of the related costs.

(4) A provider of PACE benefits may not charge PACE claimants additional fees above the required copayment and, if applicable, charges due for generic differential costs.

(5) Payment will not be made for prescription drugs dispensed in response to a prescription issued by a prescriber who has been precluded or excluded from the Medicare Program or the Medical Assistance Program for cause or who has committed offenses related to the standards of practice of the medical professions as regulated by the Department of State. This preclusion or exclusion for cause includes voluntary or involuntary termination for cause or voluntary or involuntary suspension for cause. The prescriptions of a prescriber whose name appears on a list issued by the Department of Public Welfare which indicates that the prescriber’s participation in Medicare or Medical Assistance has been precluded or excluded will not be paid for by the PACE Program. The Department will notify providers of prescribers which it learns have been precluded or excluded from the Medical Program or Medical Assistance Program within 30 days of the date when the Department learned of these actions. The Department will reimburse providers for prescriptions written by precluded or excluded prescribers when the prescriptions were filled before the Department’s notification of providers. Prescriptions written by precluded or excluded prescribers which are filled after the Department’s notification are not reimbursable under the PACE Program.

(6) A payment for prescription drugs dispensed under the PACE Program is limited to a prescription filled in a quantity which:

(i) Is consistent with the medical needs of the claimant.

(ii) Does not exceed a 30-day supply or 100 units, whichever is less. The 100 unit limitation applies only to drugs dispensed in tablet or capsule form. Liquids, ointments, powders and other drug forms are subject only to the 30-day supply restriction.

(iii) Does not exceed a 15-day supply and may not be renewed beyond that 15-day period in the case of a prescription for an acute condition.

(iv) Is the maximum supply covered under the act in other cases; that is, a 30-day supply or 100 units, whichever is less, except in cases where the prescriber is utilizing a test dosage to determine the appropriateness of a specific drug for use in maintenance therapy for a chronic condition.

(7) Except for drugs prescribed for acute conditions, payment shall be made for prescriptions refilled up to and including five refills or to provide a 6-month supply, whichever occurs first, from the date of the original filling of the prescription.

(8) Payments will not be made to a claimant or to a party other than an enrolled provider.

(9) PACE Program benefits are not available to cover the costs of filling prescriptions written by prescribers who are not licensed by the Commonwealth unless the pharmacist complies with the following:

(i) At the time of dispensing, the pharmacist shall determine that a physician not licensed by the Commonwealth to practice medicine has a valid license to practice in the District of Columbia or one of the following states: Delaware, Maryland, New Jersey, New York, Ohio, Virigina or West Virginia.

(ii) Under procedures set forth by the Department, the pharmacist shall submit to the Department the name, address, telephone number and appropriate out-of-State physician license number.

(10) Failure by the provider to comply with paragraph (9)(i) and (ii) constitutes grounds for denial of reimbursement under the PACE Program and termination of the provider agreement.

(11) The Department will not pay providers for prescription drugs dispensed when the claimant is outside this Commonwealth.

(12) The Department will not pay providers for dispensing DESI drugs unless the prescription indicates that the prescribed DESI drug is medically necessary.

(13) The Department will not pay a provider for claims for which documentation, as required under § 22.62(c)—(e) (relating to conditions of provider participation), cannot be presented by the provider.

(g) Generic differential.

(1) When a claimant’s prescription permits the substitution of generically equivalent drugs and the claimant requests and purchases a more expensive brand name drug, the claimant is required to pay the provider the generic differential, as defined under § 22.2 (relating to definitions), in addition to the required copayment.

(2) When a claimant’s prescription permits the substitution of a generically equivalent drug, and the provider dispenses a more expensive brand name drug not requested by the claimant, the provider will be charged for the generic differential.

(3) When applicable under paragraphs (1) and (2), the generic differential is 50% of the average wholesale cost, as defined under § 22.2, of the brand name drug dispensed. The Department may increase or decrease the amount of the generic differential based upon the financial experience projections of PACE. Changes will be effective when announced in the Pennsylvania Bulletin.

Example: Usual and custom- ary charge of drug demanded by card- holder … $20 Average wholesale cost (AWC/AWP) of drug … $18 Generic differential (50% OF AWC/AWP) … $9 Copayment … $6 Amount collected by provider … $15 Amount billed to PACE … $5 (Usual and custom- ary charge minus amount collected)

(h) Payment procedures of the Department.

(1) The national drug pricing system currently in use by the Department is ‘‘The Drug Topics Red Book.’’ The Department may change that system after consultation with the Pharmaceutical Assistance Review Board to be effective upon announcement in the Pennsylvania Bulletin.

(2) The Department’s payments to enrolled providers will be remitted within 21 calendar days of the Department’s receipt of a complete and approvable claim.

(3) Claims containing errors or omissions which are the fault of the enrolled provider will be rejected by the Department and returned to the enrolled provider within 21 days of the date of receipt.

(4) Enrolled providers are entitled to interest for payments not remitted by the Department within the 21-day period on complete and approvable claims at a rate to be determined by the Department of Revenue, under section 1507 of The Fiscal Code (72 P. S. § 1507) and approved by the Pharmaceutical Assistance Review Board. Interest payments by the Department will be limited to that time period beginning with the 22nd day and ending with the issuance of payment.

(5) The Department reserves the right to refuse payment of claims submitted more than 90 days after the date the provider dispensed the prescription drugs covered by the claim.

(6) The PACE Program is the payor of last resort. Claimants are required under § § 22.33(1)(ii)(D) and 22.51(1) (relating to responsibilities of the applicant in the application process; and responsibilities regarding eligibility) to inform the Department of coverage they may have under other prescription drug benefit programs. The PACE Program will accept responsibility only for costs not covered by the claimant’s other prescription drug benefit program.

Example—If a claimant purchases a prescription drug costing $15 and has other coverage which provides $7 toward the cost of the prescription, then $6 would be payable by the claimant in the form of a copayment, $7 by the other resource and $2 by PACE.

(i) Other benefits. The Department will be responsible for the coordination and collection of other benefits due in cases where enrolled providers were unable to determine the availability of the other benefits or to secure payment for costs due under the other benefit programs. When PACE benefits have inadvertently been paid to cover costs payable under other prescription benefit programs, the Department will take the necesssary steps to recover those costs plus interest.

The provisions of this § 22.11 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; corrected July 6, 1984, effective June 16, 1984, 14 Pa.B. 2331; amended December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143; amended June 14, 1991, effective July 1, 1991, 21 Pa.B. 2722. Immediately preceding text appears at serial pages (153445) to (153451).

This section cited in 6 Pa. Code § 22.2 (relating to definitions); 6 Pa. Code § 22.62 (relating to conditions of provider participation); and 6 Pa. Code § 22.84 (relating to administrative actions and penalties).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.21 General claimant eligibility policy.

To be eligible to participate in PACE, an applicant shall be a resident of this Commonwealth, be 65 years of age or older, have annual income less than the maximum annual income and not be qualified for payment for prescription drug benefits under a public assistance program or qualified for full coverage of prescription drugs under another plan of insurance or assistance. These eligibility conditions are detailed in § § 22.22—22.26.

The provisions of this § 22.21 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (103124).

This section cited in 6 Pa. Code § 22.2 (relating to definitions).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.22 Residence provisions.

(a) Residence criteria. Except as set forth in subsection (d), a resident is a person who has lived within this Commonwealth, under color of law, for a period of at least 90 consecutive days immediately preceding the date the applicant’s application to participate in PACE is received by the Department. The applicant shall have or intend to have a fixed place of abode in this Commonwealth, with the present intent of maintaining a permanent home in this Commonwealth for the indefinite future. The burden of establishing proof of residence within this Commonwealth is on the applicant. Included in this section are persons residing in long-term care institutions located within this Commonwealth.

(b) Documentation of residence. The following are categories of documents which may be submitted as proof of residence in this Commonwealth. Documents submitted shall show the applicant’s name and address. If the application submitted has the applicant’s current name and address preprinted upon it, no other piece of documentation of residence is required to be submitted. Otherwise, one document from one of the following categories shall be photocopied and be provided as reasonable proof of residence:

(1) Motor vehicle records, such as a valid driver’s license.

(2) Housing records, such as mortgage records, rent receipts or certification of residency in a nursing home.

(3) Public utility records and receipts, such as electric bills.

(4) Local tax records.

(5) A completed and signed, Federal, State or local income tax return with the applicant’s name and address preprinted on it.

(6) Records of contacts with public or private social agencies.

(7) Employment records, including records of unemployment compensation.

(8) Additional documents or records determined acceptable by the Department and indicated in the instructions which accompany the PACE application form.

(c) Other documentation. If an individual does not have one or more documents listed in subsection (b), the individual may submit other documentation showing the applicant’s name and address for consideration by the Department. Documentation evidencing financial transactions, such as bank statements or credit card statements, are preferable. If it can be determined that no documentation of residency is available to the applicant, PACE may accept a notarized statement from a family member or other responsible person. The statement shall include the relationship to the applicant of the person making the statement, the address and length of residence of the applicant, and shall be dated within the current or preceding year. The statement shall include the address and telephone number of the person making the statement. These statements shall be approved by the Department before they will be accepted.

(d) Exception to the 90-day residency provision. An applicant who has not lived within this Commonwealth for 90 consecutive days will be considered a resident under the PACE Program if the applicant can establish intent to maintain a permanent home in this Commonwealth for the indefinite future by submitting a photocopy of a document from one of the following categories:

(1) Motor vehicle records, such as a valid driver’s license.

(2) Public utility records and receipts, such as electric bills.

(3) Local tax records.

(4) A completed and signed Federal, State or local income tax return with the applicant’s name and address preprinted on it.

(e) Continued residence. Residence in this Commonwealth of a claimant absent from this Commonwealth shall be based upon whether or not the claimant intends to return to this Commonwealth or remain indefinitely in another jurisdiction. If a claimant leaves this Commonwealth with the intent to establish a place of abode elsewhere, the claimant becomes ineligible to participate in PACE effective as of the date of exit from this Commonwealth.

The provisions of this § 22.22 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (103124) to (103125).

This section cited in 6 Pa. Code § 22.2 (relating to definitions); 6 Pa. Code § 22.21 (relating to general claimant eligibility policy); 6 Pa. Code § 22.33 (relating to responsibilities of the applicant in the application process); and 6 Pa. Code § 22.42 (relating to responsibilities of the claimant in the eligibility redetermination process).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.23 Age provisions.

(a) Age limit. An applicant shall be 65 years of age or older to participate in the PACE Program.

(b) Early application. An applicant may, in order to assist in the timely determination of eligibility, submit a completed application to participate in PACE up to 30 calendar days prior to the actual date that the applicant will become 65 years of age.

(c) Documentation of age. The following are examples of documents, one of which shall be photocopied and provided as reasonable proof of age:

(1) Birth certificate or delayed birth certificate.

(2) Church baptismal record showing date of birth.

(3) Hospital birth record established during the first few years of life and certified by the custodian of the record.

(4) Additional documents or records determined acceptable by the Department and indicated on the instructions which accompany the PACE application form.

(d) Other documentation of age. If none of the documents listed in subsection (c) establishing age or date of birth is available, the applicant shall furnish for consideration photocopies of at least two other types of documents showing age or date of birth. Examples of these documents include a Bible or other family record, employment record, voting or registration record and immunization record.

The provisions of this § 22.23 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (103125) and (96825).

This section cited in 6 Pa. Code § 22.2 (relating to definitions); 6 Pa. Code § 22.21 (relating to general claimant eligibility policy); and 6 Pa. Code § 22.33 (relating to responsibilities of the applicant in the application process).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.24 Income provisions.

(a) Income limits. Applicants shall have an annual income of $11,999.99 or less in the case of a single individual, or $14,999.99 or less combined income in the case of married couples, with the following exceptions:

(1) Married applicants will be subject to the income provisions for single individuals if each spouse maintains a separate residence and neither spouse has access to, or receives support from, the other’s income during the year for which income is declared as provided for in subsections (d) and (f).

(2) Married applicants will be subject to the income provisions for single individuals if either spouse is a resident of a long-term care facility during the year for which income is declared as provided for in subsections (d) and (f).

(3) Recently widowed or divorced applicants, will be subject to the income provisions for married couples if they had access to, or received support from, the former spouse’s income during the year for which income is declared as provided for in subsections (d) and (f).

(b) Income inclusions. Income includes income from whatever source derived, including but not limited to the following:

(1) Salaries.

(2) Wages.

(3) Bonuses.

(4) Commissions.

(5) Income from self-employment or partnership income.

(6) Alimony.

(7) Support money.

(8) Cash public assistance and relief.

(9) The gross amount of pensions or annuities including Railroad Retirement benefits.

(10) The gross amount of cash benefits received under the Federal Social Security Act, except Medicare benefits.

(11) Benefits received under State unemployment insurance laws.

(12) Veteran’s disability payments.

(13) Interest, including interest received from the Federal government, State government or an instrumentality or political subdivision thereof.

(14) Realized capital gains except as provided in subsection (c).

(15) Rental income.

(17) Life insurance benefits and proceeds, except as provided in subsection (c).

(18) Gifts or bequests of cash or property, other than transfers by gift between members of a household, in excess of a total value of $300.

(19) Any amount of money or the fair market value of a prize, such as an automobile or a trip won in a lottery, a contest or by a form of gambling.

(20) Royalties.

(21) Dividends.

(1) Surplus food or other noncash relief, including food stamps, supplied by a government agency.

(2) Property tax rebate payments, rent rebate payments, and inflation dividends received under the Senior Citizens Rebate and Assistance Act (72 P. S. § § 4751-1—4751-12).

(3) Medicare benefits.

(4) The first $5,000 of the total of death benefit payments received upon the death of each person from whom the benefits may be due.

(6) The amount of damages received, whether by civil suit or settlement agreement, on account of personal injuries. Damages received means an amount received through prosecution of a legal suit, action or other claim based on tort or tort type rights, or through a settlement agreement entered into in lieu of litigation, except to the extent that the amount duplicates reimbursements previously received. Damages include black lung benefits and benefits granted under section 306(c) of the Workmen’s Compensation Act (77 P. S. § 513).

(7) Payments provided to eligible low income households under the Commonwealth’s Low Income Home Energy Assistance Program.

(8) With reference to client payments received by home providers of the domiciliary care program administered by the Department under the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12), that portion of the payments which, for any specific income year, does not exceed the actual expenses of providing domiciliary care services.

(d) Declaration of income. An applicant shall declare the total annual income for the calendar year immediately preceding the year in which the applicant applies to participate in PACE.

Example—An applicant applies to participate in the PACE Program on August 16, 1990. The applicant shall declare his total annual income for the previous year, which is calendar year 1989. Accordingly, the applicant shall declare all of the income which he received from January 1, 1989 up to and including December 31, 1989.

(1) The applicant shall indicate, in spaces provided on the PACE Application Form, the source and amount of each type of annual income.

(2) The applicant shall declare all income, as defined in this section, identifying each source separately.

(3) A married applicant, unless covered under subsection (a), shall declare all applicable income of the spouse, identifying each source separately. If only one spouse is applying for PACE benefits, that spouse shall declare all applicable income of both spouses.

(4) The failure to provide truthful information with respect to this section will subject the applicant to the criminal penalties provided in § 22.72 (relating to prohibited acts and criminal penalties).

(e) Documentation of income. An applicant or a claimant may be required to document the annual receipt of income, derived from all sources, when requested to do so by the Department. Whenever this is the case, the following are examples of documents, photocopies of which shall be provided as reasonable proof of income:

(1) Federal, State or local income tax returns.

(4) Another type of document which is likely to verify the type and amount of income.

(f) Period used to determine income. For purposes of PACE eligibility, the income, as defined in § 22.2 (relating to definitions) and this section, used to determine eligibility will be that income received by an applicant during the calendar year immediately preceding the year in which the applicant applies to participate in PACE.

The provisions of this § 22.24 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, except subsection (a) which shall take effect April 1, 1985, 15 Pa.B. 1163; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96825) to (96828).

Declaration of Income

The Department of Aging did not err in denying the claimant benefits based upon the receipt of past due Social Security benefits in 1999 when, in fact, those benefits were attributable to years prior to 1997, since this regulation illustrates that all income acquired between January and December of a given year is to be considered as income. Scanlon v. Department of Public Welfare, 739 A.2d 635 (Pa. Cmwlth. 1999).

Participation in PACE Based on Preceding Year’s Income

Department of Aging Pharmaceutical Assistance Contract for the Elderly (PACE) regulation that eligibility is based on income received by applicant during calendar year immediately preceding year in which applicant applies to participate is not an unreasonable interpretation of the statute. Peek v. Department of Aging, 873 A.2d 43, 47 (Pa. Cmwlth. 2005).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.25 Other third-party benefits.

(a) Applicants who are qualified for coverage of payments for prescription drugs under a public assistance program are ineligible for PACE as long as they are so qualified.

(b) Applicants who are qualified for full coverage of payments for prescription drugs under another plan of assistance or insurance are ineligible for PACE as long as they are so qualified.

(c) Applicants or claimants who are qualified for partial payments for prescription drugs under another insurance plan are eligible for PACE, but may receive reduced assistance from PACE.

The provisions of this § 22.25 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; corrected July 6, 1984, effective June 16, 1984, 14 Pa.B. 2331; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96828) to (96829).

This section cited in 6 Pa. Code § 22.2 (relating to definitions); 6 Pa. Code § 22.21 (relating to general claimant eligibility policy); 6 Pa. Code § 22.33 (relating to responsibilities of the applicant in the application process); 6 Pa. Code § 22.42 (relating to responsibilities of the claimant in the eligibility redetermination process); and 6 Pa. Code § 22.51 (relating to responsibilities regarding eligibility).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.26 PACE eligibility.

(a) Eligibility for PACE is established during a calendar year when a valid PACE application is approved, and remains in effect until the expiration date stated on the PACE identification card, unless there is cause for earlier termination.

(b) The PACE eligibility effective date and expiration date shall appear on the face of the PACE identification card issued by the Department to claimants.

The provisions of this § 22.26 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

This section cited in 6 Pa. Code § 22.2 (relating to definitions); and 6 Pa. Code § 22.21 (relating to general claimant eligibility policy).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.31 General provisions.

The application process includes all activity relating to a request for eligibility determination. It begins with the receipt by the Department of an eligibility application and continues until there is an official disposition of the request by the Department.

The provisions of this § 22.31 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.32 Initiating the application process.

An applicant requests a determination of eligibility to participate in the PACE Program by completing a PACE application form and submitting it to the Department.

The provisions of this § 22.32 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.33 Responsibilities of the applicant in the application process.

The applicant has the responsibility to conform to the following:

(1) Complete the PACE application form legibly and accurately.

(i) Answer questions fully.

(ii) Present necessary evidentiary documents under the following requirements:

(A) Regarding residence, one of the documents listed in § 22.22(b) (relating to residence provisions) or other documentation of residence acceptable to the Department, except when the application has the applicant’s name and current address preprinted on it.

(B) Regarding age, one of the documents listed in § 22.23(c) (relating to age provisions), or two of the other types of documentation of age listed in § 22.23(d).

(C) Regarding income, documents required to substantiate each source of income, as defined in § 22.2 (relating to definitions) and as set forth in § 22.24(e) (relating to income provisions), whenever required to do so by the Department.

(D) Regarding qualification for other benefits, information identifying participation in any of the other programs referred to in § 22.25 (relating to other third-party benefits).

(iii) Read the certification and authorization statement.

(iv) Sign or mark the application form.

(v) Obtain signatures required by the Department on the instructions which accompany the application form.

(2) Submit the completed PACE application form to the Department.

(3) Assist the Department in securing evidence which corroborates the applicant’s statements when necessary.

(4) Consent to a review by the Department of information submitted on the application form, with reasonable prior notice to the applicant, if selected for review. PACE eligibility may be denied if the applicant refuses to cooperate with the request.

The provisions of this § 22.33 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; corrected July 6, 1984, effective June 16, 1984, 14 Pa.B. 2331; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96829) to (96830).

This section cited in 6 Pa. Code § 22.11 (relating to general payment principles).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.34 Authorized agent.

(a) Adjudicated incompetency. When the applicant is adjudicated incompetent, the Department will accept the court-appointed guardian as an authorized agent for the purpose of initiating an application on behalf of the applicant.

(b) Incapacity. If the applicant is incapable of filing an application on his own behalf, the Department will accept one of the following persons designated by the applicant, listed in the order of priority, as an authorized agent for the purpose of initiating the application if a power of attorney or agent’s affidavit of authority accompanies the application:

(1) A close relative by blood or marriage, such as a parent, spouse, son, daughter, brother or sister.

(2) A representative payee designated by the Social Security Administraton.

(3) A representative of a public/private social service agency, of which the applicant is a client, who has been designated by the agency to so act.

The provisions of this § 22.34 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96830) to (96831).

This section cited in 6 Pa. Code § 22.43 (relating to authorized agent).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.35 Certification.

The applicant shall certify that the answers to the questions and items on the application form are true and accurate to the best of the applicant’s knowledge. Before the application can be processed, the certificate shall be dated and signed by the applicant and any other party whose signature is required by the Department in the instructions which accompany the application form.

The provisions of this § 22.35 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163. Immediately preceding text appears at serial page (89803).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.36 Authorization.

By signing/marking the certification and authorization statement on the application form, the applicant authorizes:

(1) The Department to verify any information on the form by contacting the Social Security Administration, the Internal Revenue Service, the Department of Revenue, employers or others, as the need arises.

(2) The Department to visit, with reasonable prior notice to the applicant, for the purpose of determining the validity of claims made under the PACE Program.

The provisions of this § 22.36 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.37 Right of appeal.

Departmental actions against an applicant which relate to the application process are subject to the right of appeal under § § 22.91—22.95 (relating to claimant hearings and appeals).

The provisions of this § 22.37 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.41 General provisions.

A claimant requests a redetermination of eligibility to participate in the PACE Program each year by completing a PACE application form and submitting it to the Department. Eligibility will continue without interruption each year if the claimant completes and submits the application form on or before the date specified by the Department. If the application form is not submitted at that time, eligibility will begin after the date when a completed application form is received and approved by the Department.

The provisions of this § 22.41 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.42 Responsibilities of the claimant in the eligibility redetermination process.

The claimant has the responsibility to conform to the following:

(1) Complete the PACE application form legibly and accurately.

(i) Answer questions fully.

(ii) Present necessary evidentiary documents under the following requirements:

(A) Regarding residence, a photocopy of one of the documents listed in § 22.22(b) (relating to residence provisions) or other documentation acceptable to the Department, except when the application has the claimant’s current name and address preprinted on it. A claimant applying for redetermination of eligibility is not required to submit documentation of residence if the claimant’s name and current address is preprinted on the application form.

(B) Regarding income, documents required to substantiate each source of income, as defined in § 22.2 (relating to definitions) and as set forth in § 22.24(e) (relating to income provisions), whenever required to do so by the Department.

(C) Regarding qualification for other benefits, information identifying participation in the other programs referred to in § 22.25 (relating to other third-party benefits).

(iii) Read the certification and authorization statement.

(iv) Sign or mark the application form.

(v) Obtain signatures required by the Department on the instructions which accompany the application form.

(2) Submit the completed application form to the Department.

(3) Assist the Department in securing evidence which corroborates the claimant’s statements when necessary.

(4) Consent to a review by the Department of information submitted on the application form, with reasonable prior notice to the claimant, if selected for review. PACE eligibility may be terminated if the claimant refuses to cooperate with the request.

The provisions of this § 22.42 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; amended December 15, 1990, effective December 16, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96832) and (103127).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.43 Authorized agent.

In those instances when the claimant is either adjudicated incompetent or is incapable of filing an application form on the claimant’s own behalf, the Department will accept as authorized agents the persons designated in § 22.34(a) and (b) (relating to authorized agent) for the purpose of submitting the application form on behalf of the claimant.

The provisions of this § 22.43 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.44 Certification.

The claimant shall certify that all the answers to the questions and items on the application form are true and accurate to the best of the claimant’s knowledge. Before the application form can be processed, the certification shall be dated and signed by the claimant and by any other party whose signature is required by the Department in the instructions which accompany the application form.

The provisions of this § 22.44 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163. Immediately preceding text appears at serial page (89805).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.45 Authorization.

By signing or marking the certification and authorization statement on the application form, the claimant authorizes:

(1) The Department to verify information on the form by contacting the Social Security Administration, the Internal Revenue Service, the Department of Revenue, employers or others, as the need arises.

(2) The Department to visit, with reasonable prior notice to the claimant, for the purpose of determining the validity of claims made under the PACE Program.

The provisions of this § 22.45 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.46 Right of appeal.

Departmental actions against a claimant which relate to the eligibility redetermination process are subject to the right of appeal under § § 22.91—22.95 (relating to claimant hearings and appeals).

The provisions of this § 22.46 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.51 Responsibilities regarding eligibility.

The claimant has the responsibility to:

(1) Notify the Department whenever the claimant becomes eligible for another plan of assistance or insurance, as set forth in § 22.25 (relating to other third-party benefits).

(2) Return the PACE identification card to the Department whenever becoming ineligible due to one of the following:

(i) Establishing residence outside of this Commonwealth.

(ii) Becoming eligible for full coverage of payment for prescription drugs under another plan of assistance or insurance under § 22.25(a) and (b).

(3) Repay the Commonwealth, upon request, for the cost of benefits inappropriately paid on the claimant’s behalf, if the payment was caused by an act or omission on the part of the claimant.

The provisions of this § 22.51 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (103128).

This section cited in 6 Pa. Code § 22.11 (relating to general payment principles).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.52 Use of the PACE identification card.

(a) The PACE identification card shall be retained in the possession of claimant or the claimant’s authorized representative and not be given to providers except for inspection and immediate return. The claimant remains responsible for its appropriate use to claim benefits. In no case may a claimant send the PACE identification card through the mail to a provider.

(b) A claimant may claim PACE benefits only if the claimant, or the claimant’s designated representative, presents the enrolled provider with a validated PACE identification card except when the claimant orders prescriptions services by mail.

(c) An incapacitated claimant who is, because of the incapacity, unable to personally claim PACE benefits may designate another person to do so. Persons so designated shall, whenever they claim PACE benefits on behalf of an incapacitated claimant, present the enrolled provider with the claimant’s validated PACE identification card except when they request prescription services by mail; inform the enrolled provider of their designation; and sign their own name and indicate their relationship to the incapacitated claimant on the PACE claim form. To claim PACE Program benefits through prescription services by mail, designated representatives of an incapacitated claimant shall have legal authority to represent the claimant as evidenced by power of attorney or other legal document and shall sign all forms requiring the claimant’s signature.

(d) Eligibility for PACE benefits terminates upon the death of a claimant. A deceased claimant’s PACE identification card should be promptly returned to the Department by the claimant’s relative, representative or by another responsible person.

The provisions of this § 22.52 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427. Immediately preceding text appears at serial page (96834).

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.61 Conditions of provider eligibility.

(a) Only pharmacies and dispensing physicians that are currently licensed by the Commonwealth and which have their principal place of business in this Commonwealth are eligible to participate as providers in the PACE Program.

(b) Only services of enrolled providers which are performed and delivered within this Commonwealth are eligible for coverage under the PACE Program.

(c) Pharmacies or dispensing physicians whose PACE provider agreements have been terminated for cause, or who have been precluded or excluded for cause from participation in the Medicare Program or the Commonwealth’s Medical Assistance Program are not eligible to participate as providers in the PACE Program unless they meet the requirements for re-enrollment in § 22.85 (relating to re-enrollment of providers whose agreements have been terminated).

The provisions of this § 22.61 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; corrected April 12, 1985, effective March 30, 1985, 15 Pa.B. 1353; amended December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (103129).

Failure to Keep Pharmacy License Current

The failure of a PACE provider to have a current license constitutes a material breach of the provider agreement and the recoupment of all claims made by an unlicensed provider is not excessive and constitutes liquidated damages, not a ‘‘penalty.’’ Calabro v. Department of Aging, 689 A.2d 347 (Pa. Cmwlth. 1997); appeal denied 698 A.2d 596 (Pa. 1997).

This section cited in 6 Pa. Code § 22.2 (relating to definitions); and 6 Pa. Code § 22.62 (relating to conditions of provider participation).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.62 Conditions of provider participation.

(a) Enrollment.

(1) Only providers who have been enrolled in the PACE Program are qualified to receive payments made under the program.

(2) A provider seeking enrollment as a PACE provider may seek to be enrolled as a provider of walk-in prescription services, as a provider of prescription services by mail or as a provider of both kinds of services. The Department will assign separate and distinct provider numbers to be used in identifying claims submitted for reimbursement as claims for walk-in services or mail-order services and delivery as required under § 22.11(f)(3) (relating to general payment principles).

(3) In order to become enrolled in the PACE Program as a provider of walk-in prescription services, a provider shall:

(i) Meet the conditions of eligibility set forth in § 22.61 (relating to conditions of provider eligibility), both at the time of initial application for enrollment and on an ongoing basis.

(ii) Satisfactorily complete and submit to the Department the appropriate enrollment forms.

(iii) Submit a signed provider agreement with the enrollment forms which sets forth the provisions and assurances required of all participating providers and makes specific reference to the instructions in the standard provider manual relating to the dispensing of walk-in prescription services.

(4) In order to become enrolled as a provider of PACE prescription services by mail, a provider shall:

(i) Meet the conditions of eligibility set forth in § 22.61, both at the time of initial application for enrollment and on an ongoing basis.

(ii) Satisfactorily complete and submit to the Department the appropriate enrollment forms which shall include information which establishes the provider’s methods and procedures for carrying out the requirements of subsection (e)(3) and § 22.63 (relating to other provisions for providing services by mail).

(iii) Submit with the enrollment forms a signed provider agreement which sets forth the standard provisions and assurance required of participating providers and makes specific reference to § 22.63 and instructions in the standard provider manual relating to the dispensing of prescription services by mail.

(5) Providers who meet all of the following conditions will not be considered to be providers of PACE benefits by mail:

(i) Those who do not have or do not take steps to develop a systematic mail order operation.

(ii) Those who limit their use of mail delivery of PACE Program benefits to claimants with whom they have already established a face-to-face customer relationship and comply with § 22.63(c)(1).

(iii) Those who do not dispense to PACE Program claimants more than ten PACE claims by mail in a given month.

(6) A provider’s enrollment in the PACE Program shall be effective on the date when the signatures of the Department’s authorized representatives have been affixed to the provider agreement. Except as provided for in subsection (b), no services rendered prior to that date shall be eligible for reimbursement.

(7) A provider’s enrollment shall cease to be effective on the date when the Department suspends or terminates the provider agreement under § 22.84 (relating to administrative actions and penalties). Payments or reimbursements will not be made for prescription drugs dispensed on dates when a provider’s enrollment is not effective.

(b) Change of ownership. For the purposes of this subsection, a change of ownership includes a sale, a change in corporate structure or controlling interest in the pharmacy business, the addition of a partner or other corporate reorganization. When a change of ownership is to take place in a pharmacy which has, until that time, been an enrolled provider of the PACE Program, the following applies to avoid unnecessary interruption in the participation of the pharmacy and the PACE claimants who use the pharmacy:

(1) As early as possible before the change of ownership occurs, the prospective provider shall file a PACE enrollment application and agreement with the Department.

(2) Immediately upon receipt of its pharmacy permit number, issued by the State Board of Pharmacy, the prospective provider shall notify the Department of the permit number.

(3) Upon notification of the new owner’s pharmacy permit number, the Department will execute the provider agreement and enroll the new owner’s pharmacy in the PACE Program.

(4) The effective date of the new owner’s provider agreement shall be the date of issuance of the permit number by the State Board of Pharmacy, unless the Department is reviewing the change of ownership. If the Department is reviewing the change of ownership, the Department will determine the effective date of the new owner’s provider agreement. The Department will notify the new owner that a review of the change in ownership is occurring and that the Department will not pay the provider for prescriptions filled prior to the date of a valid and fully executed provider agreement. During the period of review, the provider may service claimants with the understanding that reimbursement under the PACE Program may subsequently be disallowed if the Department determines that the provider will not be enrolled or that disenrollment of the provider is warranted.

(c) Maintenance of prescriptions. As required under § 22.11(f)(12), the Department will not pay for claims for which the following documentation cannot be presented, and the lack of this documentation may constitute grounds for terminating a provider agreement:

(1) An enrolled provider shall retain original hardcopy prescriptions for 4 years at the principal place of business. An original hardcopy prescription is one of the following:

(i) The original order as it was reduced to writing by the prescriber by hand, typewriter, computer or other mechanical or electronic means.

(ii) The oral order, such as one issued over the telephone, as it was originally reduced to writing by the pharmacist by hand, typewriter, computer or other mechanical or electronic means.

(2) As defined in paragraph (1), original hardcopy prescriptions which are not handwritten by the prescriber shall bear the date and the handwritten signature or the handwritten initials of the dispensing pharmacist.

(3) In addition to the original hardcopy prescription, the provider shall maintain a daily hardcopy record of filled and refilled prescriptions. The daily hardcopy record shall identify the prescriber who ordered the prescription, the patient for whom the prescription is intended, the strength and dosage of the medication, the number assigned to the prescription and the date of dispensing. The daily hardcopy record shall bear the handwritten signature or the handwritten initials of the pharmacist who filled or refilled the prescription. The data which supports the daily hardcopy record may be maintained by a manual system or by an electronic data processing system which meets the requirements in this paragraph.

(i) The provider shall assure that the system prevents improper access to, and manipulation or alteration of, stored records. The Department may develop provider instructions for the safeguarding of stored records. If the Department does develop provider instructions, they will be distributed to providers as technical assistance to facilitate the provider’s compliance with this subparagraph.

(ii) Arrangements shall be made which assure completeness and continuity of prescription records if the relationship between a pharmacy and a supplier of data processing services terminates.

(iii) The system shall provide retrieval of information regarding the original dispensing and the refilling of prescriptions.

(iv) A pharmacist, and a pharmacy intern, if applicable, using a computerized system shall sign or initial the original hardcopy prescription at the time of the first dispensing and the initials of the pharmacist shall be entered into the computer record of the dispensing.

(v) The introduction of prescription refill records into the system shall meet the following criteria:

(A) The initials of the pharmacist who dispensed the refill shall be entered at the time of dispensing.

(B) One of the following:

(I) The system shall be capable of displaying a record of prescriptions refilled each day on a daily hardcopy printout of prescriptions refilled that day and the dated signature of each pharmacist whose initials appear on the printout shall be affixed, on a daily basis, to the daily hardcopy printout to certify that it is a complete and accurate record.

(II) Documentation of the required refill information at the time of dispensing shall be reduced to a hardcopy record of the prescription which contains the information required by this paragraph. The handwritten signature or the handwritten initials of the dispensing pharmacist shall be affixed on a daily basis to the hardcopy record to certify that it is a true, complete and accurate record.

(III) Documentation of the required refill information at the time of dispensing shall be reduced to a pharmacy dispensing log which contains the prescription number which leads directly to the hardcopy record of information under this paragraph in the provider’s principal place of business; the signature of the PACE claimant; and the date the prescription was refilled. The handwritten signature or the handwritten initials of the dispensing pharmacist shall be affixed on a daily basis to the pharmacy dispensing log to certify that it is a true, complete and accurate record.

(vi) A pharmacy that employs a computerized system shall have an auxiliary procedure which shall be used for documentation of all new and refilled pescriptions dispensed during system downtime. The auxiliary procedure shall provide for the entry into the computer of data collected during the downtime, and the pharmacist shall insure that the maximum number of refills authorized on the original prescription has not been exceeded.

(vii) Only pharmacists, pharmacy interns or personnel authorized by, and under the direct supervision of, the dispensing pharmacist may enter prescription data into the computerized system. A person authorized to enter data into the computerized system shall be readily identifiable as being accountable for the entering of the specific data which that person entered.

(4) A change of a prescription order shall be documented on the original hardcopy prescription. Changes in the nature of a medication, the brand or manufacturer of a medication, the strength of a medication, or directions for its use are acceptable only if the consent of the prescriber was obtained before dispensing. The written explanation of the pharmacy on the prescription shall state that this was done and give the reasons for the change.

(5) Prescription records of PACE claimants shall be readily available for review, copying or photographing by authorized Commonwealth officials or their authorized agents. ‘‘Readily available’’ means that the records shall be maintained in a reasonable and retrievable manner at the provider’s principal place of business.

(d) Maintenance of other records. Other records necessary to disclose the full nature and extent of prescription drugs, both covered and not covered by the PACE Program, which were dispensed by a provider shall be retained for 4 years and shall be available for review and copying by authorized Commonwealth officials or their authorized agents within 7 business days of a request for the records. These records include purchase orders and invoices, billing records, computer user manuals and computer security information.

(e) Access to records. Enrolled providers shall agree to provide reasonable access to records necessary to comply with the provisions for program review set forth in the provider agrement.

(f) Standards of practice.

(1) When dispensing prescription drugs to claimants enrolled in the PACE Program, enrolled providers shall conform to the standards of the State Board of Pharmacy, 49 Pa. Code § § 27.1—27.4 and 27.11—27.18 (relating to general provisions; and standards), and the State Board of Medicine, 49 Pa. Code Chapters 16—18 (relating to State Board of Medicine—general provisions; State Board of Medicine—medical doctors; and State Board of Medicine—practitioners other than medical doctors), the Controlled Substance, Drug, Device, and Cosmetic Act (35 P. S. § § 780-101—780-144), and other Federal and Commonwealth statutes and regulations applicable to the writing of medical prescriptions and the dispensing of prescription drugs to the general public.

(2) It is contrary to accepted standards of practice for an enrolled provider to differentiate between PACE Program claimants and the general public in levels or quality of service.

(3) Enrolled providers are prohibited from denying services to, or otherwise discriminating against, a claimant on the basis of race, color, sex, age, religious preference, national origin or handicap.

(g) Verification of claimant identity.

(1) Responsibility. It is the responsibility of enrolled providers of PACE benefits to establish the identity and current eligibility status of claimants which they serve under the PACE Program. Claims for PACE benefits received by persons who are not bona fide PACE claimants will not be considered valid claims.

(2) Walk-in services. When providing walk-in prescription services to PACE claimants, enrolled providers shall observe a claimant’s signed PACE identification card on each occasion when a prescription drug is dispensed to a claimant under the PACE Program. Providers are prohibited from retaining the claimant’s PACE identification card after dispensing a prescription drug and shall return the card with the prescription drug to the claimant or the claimant’s designated representative. Providers may not request PACE claimants to send a PACE identification card through the mail.

(3) Services by mail. As a basis for establishing the identity of PACE claimants as program benefits are provided, an enrolled provider of PACE Program benefits by mail, shall have, or secure, and maintain on file a signature reference for each PACE claimant requesting services by mail from that provider. The signature reference shall bear the original signature of the claimant or the claimant’s authorized representative and shall form a basis for signature comparisons carried out under § 22.63(d). The Department reserves the right to waive this requirement, and the related requirement of § 22.63(d)(1), for a provider who can present an alternative system of control which offers assurance to the Department that verification of claimant identity and claimant receipt of ordered prescription drugs can and will be effectively accomplished without signature references.

(h) Designated representatives.

(1) Walk-in services. As required under § 22.52(c) (relating to use of the PACE identification card), walk-in prescription services to PACE claimants may be provided to a designated representative of an incapacitated PACE claimant. Providers shall see the claimant’s PACE identification card and obtain the signature and relationship to the claimant of the designated representative. If a provider has reason to believe that a person presenting a PACE claimant’s identification card has not been designated by the claimant as the claimant’s representative, the provider shall refuse to provide the requested prescription services as a PACE claim.

(2) Services by mail. As required under § 22.52(c), a designated representative requesting PACE benefits by mail shall have legal authority to represent an incapacitated claimant as evidenced by power of attorney or other legal document, and shall sign forms requiring the claimant’s signature. Providers of prescription services by mail shall require designated representatives to provide documentation of their legal authority to represent the claimant.

(i) Authenticity of prescriptions. Prior to the dispensing of prescription drugs, the provider shall take necessary steps to identify prescriptions which may not be authentic. These steps shall include the following:

(1) Prescriptions shall be reviewed by a pharmacist for obvious irregularities, including noncompliance with prescription writing standards, dosage errors, technical errors of drug references and conflicts with claimant medication history.

(2) When an irregularity, as discussed under paragraph (1), is noted, a provider shall contact the prescriber to determine the authenticity of the prescription or, as appropriate, establish errors and make corrections.

(3) Providers shall refuse to fill prescriptions which they suspect are not authentic. If, in the professional judgment of the provider, a prescription does not appear to be authentic, the provider shall contact the indicated prescriber by telephone to check on its authenticity. Whenever, as a result of a check, the provider is professionally convinced that the prescription is fraudulent, the provider may not return the prescription to the claimant, but shall forward it to the Department accompanied by the name, address and PACE identification card number of the claimant.

(j) Payments.

(1) Enrolled providers shall collect the required copayment and, if applicable, the generic differential, from each claimant for each prescription filled under the PACE Program. For the purpose of reimbursement under the program, no provider claim which relates to services for which the full copayment and an applicable generic differential have not been collected may be considered an allowable claim. Failure to comply with this subsection constitutes a false or fraudulent claim under § 22.82 (relating to false or fraudulent claims by providers).

(2) Providers shall consider as full payment for PACE-covered services the claimant copayment, the generic differential whenever applicable and the Department’s payment for prescription drugs dispensed. Nothing in this section prevents a provider from appealing an inappropriate reimbursement under § § 22.101—22.104 (relating to provider hearings and appeals).

(k) Claimant health and safety.

(1) Walk-in services. Consistent with 49 Pa. Code § 27.18(c) (relating to standards of practice), enrolled providers of walk-in services are authorized to take appropriate steps to prevent the inadvertent misutilization of prescription drugs, with special concern for the potentially dangerous interaction of two or more prescription drugs from different prescribers. Steps may include telephone consultation with prescribing physicians and the maintenance of a medication history on each claimant to whom prescription drugs are dispensed.

(2) Services by mail. Enrolled providers offering mail-ordered or mail-dispensed prescription service shall have or establish and maintain a medication history on PACE claimants provided with these services.

(3) General. When the Department determines that, in the interest of a claimant’s health and safety, a prescription should not be filled, the Department may take steps in accordance with the act and this chapter to prevent the dispensing of the prescribed drug.

The provisions of this § 22.62 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; amended December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (103129) to (103130), (115961) to (115962) and (103133) to (103134).

This section cited in 6 Pa. Code § 22.2 (relating to definitions); 6 Pa. Code § 22.11 (relating to general payment principles); and 6 Pa. Code § 22.63 (relating to other provisions for providing services by mail).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.63 Other provisions for providing services by mail.

(a) Mail orders for prescription drugs. Providers shall provide PACE claimants who wish to request PACE Program benefits by mail with order forms and clear instructions for submitting mail orders. As a minimum, order forms submitted shall include the claimant’s signature, address, telephone number, where applicable and PACE identification card number. For each initial mail-ordered prescription to be filled, a valid prescription as written by the licensed prescriber shall accompany the order form. When mail-ordered prescription drugs can not be delivered by mail as restricted by the standards of the State Board of Pharmacy, 49 Pa. Code § 27.18 (relating to standards of practice) and other applicable State and Federal statutes, or can not be dispensed for another reason, the provider shall, within 2 working days of the provider’s receipt of the mail order, notify the claimant and the prescriber by telephone or mail and return the written prescription to the claimant, except as provided for under § 22.62(g)(3) (relating to conditions of provider participation).

(b) Telephone prescription orders. Refill prescription orders may be accepted by telephone. Providers of prescription services by mail may not accept initial prescription orders for PACE Program benefits by telephone except when all of the following control steps have been taken:

(1) The provider has secured the name, address and telephone number of the licensed prescriber making the telephone order.

(2) The provider has secured the license number assigned by the appropriate State licensing board to the licensed prescriber making the telephone order.

(3) The provider has secured the United States Drug Enforcement Administration registration number of the licensed prescriber making the telephone order unless that prescriber has no registration number.

(4) The provider has verified that the information secured is correct and that the telephone order originated from the licensed prescriber.

(1) Prescription drugs dispensed by mail may not be mailed to an address outside this Commonwealth. Packages used for the dispensing of prescription drugs by mail shall bear the words ‘‘DO NOT FORWARD’’ on the face which bears the claimant’s address.

(2) A prescription drug delivered by mail shall be accompanied, as a minimum by the following:

(i) A Universal Claim Form.

(ii) Clear instructions to the claimant about the completion, signing and return of the Universal Claim Form accompanied by payments due from the claimant if full payment has not been received in advance of delivery. These instructions shall advise the claimant that the Universal Claim Form and payments due shall be returned to the provider within 5 days of the claimant’s receipt of the prescription drug.

(iii) Information regarding the use and storage of the prescription drug, as appropriate.

(iv) A postage paid, provider self-addressed envelope to facilitate the claimant’s response to receipt of the prescription drug.

(d) Other provisions for control of PACE benefit utilization.

(1) When a provider authorized to provide prescription services by mail to PACE claimants observes irregularities in prescriptions, dosages, medication history, prescriber utilization, mailing address, claimant name or PACE identification card number or other similar kinds of irregularities, the provider shall make an immediate comparison of signatures in the claimant’s file.

(2) The provider shall discontinue prescription services by mail to a claimant who fails to return the Universal Claim Form appropriately completed, fails to submit all due claimant payments, or is suspected of submitting false or fraudulent prescription order or false or fraudulent information on a Universal Claim Form.

(3) Whenever a provider of prescription services by mail discontinues services under paragraph (2), the provider shall notify the Department of the claimant’s name and PACE identification card number and the name of the prescriber of prescriptions related to the reasons for the provider’s decision to discontinue services.

(e) Mail order service provider accessibility to claimants.

(1) Enrolled providers authorized to provide prescription services by mail shall, as required in the provider agreement, arrange for access by claimants and appropriate medical personnel treating a claimant to a registered pharmacist in the event of drug concerns and emergency situations including, but not limited to, the following:

(i) Disturbing drug side effects and reactions.

(ii) Drug interactions.

(iii) Dosage.

(iv) Drug ingestion or administration and proper storage.

(v) Drug identification—for example—in the event of lost labels.

(vi) Emergency medical treatment of a claimant.

(2) Access shall include the acceptance of collect calls from claimants and appropriate medical personnel or a toll-free telephone number, accessible by claimants and appropriate medical personnel on a 9 a.m. to 5 p.m. basis during the days when the pharmacy is normally open for business. The provider shall issue clear instructions to the claimant regarding the access number and its appropriate use.

The provisions of this § 22.63 adopted December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; corrected December 27, 1985, effective December 14, 1985, 15 Pa.B. 4581.

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.71 False or fraudulent claims by applicants and claimants.

Applicants, claimants or other persons submit a false or fraudulent claim subject to administrative action and penalties of § 22.73 (relating to administrative actions and penalties) if they commit one or more of the following acts:

(1) Make or cause to be made a false statement or representation of a material fact in any application for any benefit.

(2) Attempt to secure for personal use or the use of another individual an unauthorized benefit by concealing or failing to disclose known information which would result in the rejection of an application for initial or continued eligibility for the benefit.

(3) Having made application to receive a benefit for personal use or the use of another and having received it, convert the benefit or a part thereof to a use other than that for which it was intended.

(4) Seek to obtain from providers excessive services or benefits beyond what is reasonably needed, as determined by the Department, for the treatment of a diagnosed condition of the claimant.

(5) Borrow or use a PACE identification card to which the person is not entitled or otherwise gain or attempt to gain benefits under the PACE Program if the person has not been determined eligibile for the program and enrolled in it.

The provisions of this § 22.71 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (103137).

This section cited in 6 Pa. Code § 22.73 (relating to administrative actions and penalties).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.72 Prohibited acts and criminal penalties.

(a) It is unlawful for a person to submit a false or fraudulent claim or application under the act; to aid or abet another in the submission of a false or fraudulent claim or application; to receive benefits or reimbursement under a private, State or Federal program for prescription assistance and claim or receive duplicative benefits under this chapter; to solicit, receive, offer or pay a kickback, bribe or rebate, in cash or in-kind, from or to a person in connection with the furnishing of services under the act; or to otherwise violate the act. A person who commits a prohibited act shall be charged with a criminal offense under 18 Pa.C.S. (relating to the Crimes Code).

(b) A person who is found guilty of a criminal offense under the act is subject to repay three times the value of any material gain received as a result of the offense.

The provisions of this § 22.72 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (103138) and (115963).

This section cited in 6 Pa. Code § 22.24 (relating to income provisions).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.73 Administrative actions and penalties.

(a) A person who is convicted of a violation of § 22.71 (relating to false or fraudulent claims by applicants and claimants) shall, upon notification by the Department, be terminated from the program.

(b) If the Department determines that a claimant misuses or abuses PACE benefits, the Department is authorized to restrict that claimant to a provider of the Department’s choice.

(c) If the Department determines that a claimant has violated § 22.71, the Department will have the authority to suspend or terminate the claimant’s enrollment in the PACE Program.

(d) If the Department determines that a claimant has violated § 22.71, the Department may request the Attorney General to initiate appropriate proceedings against the claimant.

The provisions of this § 22.73 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (115963)

This section cited in 6 Pa. Code § 22.71 (relating to prohibited acts by applicants and claimants).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.74 Claimant right of appeal.

Departmental actions against an applicant or claimant for misutilization and abuse of program benefits are subject to the right of appeal under § § 22.91—22.95 (relating to claimant hearings and appeals).

The provisions of this § 22.74 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2709.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.81 Utilization control.

(a) Enrolled providers are required, upon request, to furnish the Department with medical and fiscal records relating to participation in PACE. Providers shall fully cooperate with audits and reviews made by the Department for the purpose of determining the validity of claims and the reasonableness and necessity of benefits provided or for another purpose.

(b) Providers shall furnish to the Department, within 15-calendar days of request, complete information related to PACE-related business transactions.

(c) Under § 22.84 (relating to administrative actions and penalties), failure of a provider to comply with the Department’s request for information referred to in this section may result in the termination of a provider’s enrollment in the PACE Program.

(d) Enrolled providers shall respond in a complete manner to inquiries by utilization review committees within 7 business days of a committee’s request.

The provisions of this § 22.81 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (115963) to (115964).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.82 False or fraudulent claims by providers.

An enrolled provider submits a false or fraudulent claim if the provider directly or indirectly commits one or more of the following acts:

(1) Submits false information for the purpose of obtaining greater compensation than that to which the provider is legally entitled for dispensing prescription drugs under PACE.

(2) Submits a claim for dispensing only part of a prescription amount which is less than the maximum limit of the program except when the provider can document that insufficient inventory prevented the dispensing of the program limit and that no additional dispensing fee or copayments were charged for dispensing the remainder of the prescription at a later time.

(3) Submits false information to obtain authorization to dispense prescription drugs under PACE.

(4) Solicits, receives, offers or pays remuneration, including a kickback, bribe or rebate, directly or indirectly in cash or in kind, from or to a person in connection with the dispensing of prescription drugs or referral of claimants for prescription drugs.

(5) Submits a duplicate claim for prescription drugs for which the provider has already received or claimed reimbursement from any source.

(6) Submits a claim for prescription drugs which were not dispensed by the provider at the provider’s principal place of business or were not dispensed to a claimant.

(7) Submits a claim for prescription drugs dispensed which are not documented in the prescribed manner. See 49 Pa. Code Chapters 16—18 (relating to State Board of Medicine—general provisions; State Board of Medicine—medical doctors; and State Board of Medicine—practitioners other than doctors) and 49 Pa. Code § 27.78 (relating to standards of practice).

(8) Submits a claim, order or prescription, for prescription drugs which are of little or no benefit to the claimant, are below accepted treatment standards or are not medically necessary, in the case of a dispensing physician who is a provider.

(9) Submits a claim which misrepresents the description of the prescription drugs dispensed, the date of service, the identity of the claimant, the identity of the prescriber or the identity of the actual provider.

(10) Submits a claim for a prescription drug dispensed under PACE at a cost that is greater than the provider’s usual charge to the general public.

(11) Submits a claim for a prescription drug dispensed for which the provider has not collected from the claimant all due payments, including the required copayment and any applicable generic differential.

(12) Enters into an agreement, combination or conspiracy to obtain or aid another in obtaining from the Department payment to which the provider or other person is not entitled.

(13) Submits a claim for prescription drugs dispensed to a claimant outside this Commonwealth.

The provisions of this § 22.82 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (115964) and (96841).

Violation of Agreement

Pharmacy that participated in the Pharmaceutical Assistance Contract for the Elderly program sought return of moneys Department of Aging recouped from claims it submitted to the Department; pharmacy violated its provider agreement by failing to use the correct National drug code on its claims for reimbursement, which authorized the Department to seek restitution of moneys for which it had reimbursed pharmacy. Christian St. Pharm. v. Pa. Dept. of Aging, 946 A.2d 798, 802 (Pa. Cmwlth. 2008).

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation); and 6 Pa. Code § 22.84 (relating to administrative actions and penalties).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.83 Prohibited acts and criminal penalties.

(a) It is unlawful for a person to submit a false or fraudulent claim or application under the act; to aid or abet another in the submission of a false or fraudulent claim or application; to receive benefits or reimbursement under a private, State or Federal program for prescription assistance and claim or receive duplicative benefits under this chapter; to solicit, receive, offer or pay a kickback, bribe or rebate, in case or in-kind, from or to a person in connection with the furnishing of services under the act; or to otherwise violate a provision of the act. A person who commits a prohibited act shall be charged with a criminal offense under 18 Pa.C.S. (relating to the Crimes Code).

(b) A person who is found guilty of a criminal offense under the act is subject to repay three times the value of any material gain received as a result of the offense.

The provisions of this § 22.83 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (96841).

This section cited in 6 Pa. Code § 22.101 (relating to provider appeals).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.84 Administrative actions and penalties.

(a) Grounds for action. The Department may terminate an enrolled provider’s agreement and seek restitution from that provider if it determines that the provider, owner of the provider, an employe of the provider or an agent of the provider has done one of the following:

(1) Failed to comply with § 22.82 (relating to false or fraudulent claims by providers) or other provisions of the PACE Program.

(2) Failed to comply with the conditions of participation in the PACE Program.

(3) Failed to comply with the terms of the provider agreement.

(4) Been precluded or excluded for cause, either voluntarily or involuntarily, from Medicare or Medical Assistance.

(5) Been convicted of a Medicare or Medical Assistance related criminal offense as certified by a Federal, State or local court.

(6) Been convicted of a criminal offense under State or Federal laws relating to the practice of the provider’s profession as certified by a court.

(7) Been subject to license suspension or revocation following disciplinary action entered against the provider by the State licensing or certifying agency.

(8) Had a controlled drug license withdrawn or failed to report to the Department changes in the provider’s Drug Enforcement Agency Number.

(9) In the case of dispensing physicians who are providers, dispensed prescriptions which the Department has determined to be harmful to the claimant, of inferior quality or medically unnecessary.

(10) Refused to permit authorized State or Federal officials or their agents to examine the provider’s medical, fiscal or other records as necessary to verify claims under the PACE Program.

(b) Procedures for terminating provider agreements.

(1) The Department, upon notice, may terminate the agreement of, and suspend payments to, an enrolled provider.

(2) Termination for criminal conviction or administrative action will be as follows:

(i) The Department will terminate an enrolled provider’s agreement for a period of up to 5 years if the provider is convicted of a Medicare/Medical Assistance related crime or a criminal offense under State or Federal law relating to the practice of the provider’s profession. If the Department has an additional basis for termination which is unrelated to the criminal conviction, it may terminate the provider agreement for a period in excess of 5 years.

(ii) If the additional basis for the termination is a license suspension or revocation following disciplinary action entered against the provider by the State licensing or certifying agency, the period of termination will be the duration of the disciplinary action plus 5 years for the criminal conviction.

(iii) If the Department has a basis for termination which is related to the criminal conviction, with the exception of exclusions from Medicare or Medical Assistance, the minimum period of the termination will be the longer of 5 years or the period related to the other action.

(1) The Department will not pay providers for prescription drugs dispensed on or after the effective date of the termination of a provider agreement.

(2) An enrolled provider whose agreement has been terminated may not receive payments from the PACE Program during the period of termination.

(3) If a provider appeals the Department’s action of terminating the provider agreement, the Department will not pay the provider for prescription drugs dispensed on or after the effective date specified in the notice of termination.

(d) Notification of termination of a provider agreement.

(1) The Department will issue a notice of termination to an enrolled provider whose agreement is being terminated for cause or as a result of a criminal conviction.

(2) The notice will state the basis for the action, the effective date, whether the Department will consider re-enrollment and, if so, the date when re-enrollment will be considered.

(e) Dissemination of information.

(1) When the Department takes action against a provider, including termination and initiation of a civil suit, it may also notify and give the reason for the termination to the following:

(i) The Medicaid Fraud Control Unit, Office of the Attorney General.

(ii) The Health Care Financing Administration.

(iii) Other State and local agencies involved in providing or paying for the provision of health care.

(iv) The applicable Commonwealth professional licensing board.

(v) The United States Postal Service.

(2) After final adjudication, a copy of the notice of termination and the reasons for termination may be made available to Medicaid agencies of other states, the appropriate professional associations and the news media. Detailed case material and findings will be made available to the agencies specified in paragraph (1) if the agencies are notified.

(f) Referral of criminal offenders. In the case of a provider which the Department determines has criminally violated any of the provisions of the PACE Program, the Department may refer the provider to the proper authorities for prosecution under the act or other applicable laws.

(g) Restitution and repayment.

(1) If the Department determines that a provider has billed and received payment for prescription drugs for which payment should not have been made, it will review the provider’s paid and unpaid invoices and compute the amount of the overpayment or improper payment. The Department may conduct a test audit and base the restitution amount on the findings of that audit or any extrapolations from those findings.

(2) The amount of restitution or repayment shall be equal to the amount of all unauthorized payments which the Department has made to a provider plus interest.

(3) In the case of unauthorized payments made as a result of criminal action on the part of a provider, the provider shall, if found guilty under the act, be subject to repay three times the value of the material gain received.

(4) The provider shall pay the amount of restitution owed to the Department either directly or by offset of valid invoices that have not yet been paid. The method of repayment is determined by the Department.

(5) If the Department determines that a provider has committed a prohibited act or has failed to satisfy any requirement under § 22.82, it may institute a civil action against the provider in addition to terminating the provider’s enrollment.

(6) The provider is prohibited from billing a claimant for any amount for which the provider is required to make restitution to the Department.

(h) Suspension of payments. If the Department determines that a provider has submitted a claim for payment which violates the PACE Program, the provider may be notified in writing that payment on outstanding invoices will be delayed or suspended for a period not to exceed 120 days pending a review of his billing and service patterns. In this situation, the Department reserves the right to waive the 21 day payment provision of § 22.11 (relating to general payment principles).

The provisions of this § 22.84 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109; amended December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96841) to (96842) and (103139) to (103140).

Failure to Keep Pharmacy License Current

The failure of a PACE provider to have a current license constitutes a material breach of the provider agreement and the recoupment of all claims made by an unlicensed provider is not excessive and constitutes liquidated damages, not a ‘‘penalty.’’ Calabro v. Department of Aging, 689 A.2d (Pa. Cmwlth. 1997); appeal denied 698 A.2d 596 (Pa. 1997).

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation); 6 Pa. Code § 22.81 (relating to utilization control); and 6 Pa. Code § 22.101 (relating to provider appeals).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.85 Re-enrollment of providers whose agreements have been terminated.

(a) Request for re-enrollment. To request re-enrollment the provider shall send a written request to the Department. For the request to be considered, it should include statements from peer review bodies, probation officers where appropriate or professional associates, giving factual evidence to support their belief that the violation leading to the termination will not be repeated. A statement from the provider setting forth the reasons why he should be re-enrolled should also be included.

(b) Criteria for provider re-enrollment. In considering the provider’s request for re-enrollment, the Department will take into account such factors as the severity of the offense, whether there has been licensure action against the provider, whether the provider has been convicted in a State, Federal or local court of Medicaid offenses or similar offenses and whether there are claims or penalties outstanding against the provider. If the Department’s notice of termination or exclusion specifies a date after which the Department will consider re-enrolling the provider, the Department will under no circumstances consider re-enrolling the provider before the specified date. Under § 22.101(b)(3) (relating to provider appeals), the Department rejection of a request for re-enrollment prior to the specified date is not subject to appeal.

(c) Notification of action on re-enrollment request. The provider will be notified in writing of the Department’s decision on a request for re-enrollment within 60 days of the date of receipt of the application. The Department’s notification of approval of a re-enrollment request shall contain an effective date of re-enrollment.

The provisions of this § 22.85 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163. Immediately preceding text appears at serial pages (89814) to (89815).

This section cited in 6 Pa. Code § 22.61 (relating to conditions of provider eligibility).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.86 Provider right of appeal.

Departmental actions against a provider for misutilization or abuse of PACE Program provisions are subject to the provider’s right of appeal under § § 22.101—22.104 (relating to provider hearings and appeals).

The provisions of this § 22.86 adopted December 15, 1984, effective December 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.91 Applicant or claimant appeals.

(a) Appealable actions. Applicants for, or claimants of, benefits provided under the PACE Program shall have the right to appeal the following adverse actions taken by the Department:

(1) The rejection of an application for enrollment in the PACE Program except as provided for in subsection (b)(1).

(2) The suspension or termination of a claimant’s enrollment and the benefits of enrollment in the program because of abuse or misuse of the program.

(3) The disallowance of, and actions to recover, costs related to claimant abuse or misuse of the program benefits.

(4) Other adverse actions of the Department except those which are indicated in subsection (b).

(b) Nonappealable actions. Applicants or claimants do not have the right to appeal the following actions:

(1) Rejection of an application for enrollment or termination of benefits because the applicant has refused to submit requested documents or other information necessary to establish eligibility for enrollment.

(2) Rejection of an application for re-enrollment from a claimant whose enrollment has been suspended or terminated prior to the date on which the Department specified that re-enrollment would be considered.

(3) Disallowances for prescription drugs dispensed during a period of nonenrollment, supsension or termination of claimant benefits, except on the issue of identity.

The provisions of this § 22.91 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (103141) to (103142).

This section cited in 6 Pa. Code § 22.37 (relating to right of appeal); 6 Pa. Code § 22.46 (relating to right of appeal); and 6 Pa. Code § 22.74 (relating to claimant right of appeal).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.92 Notification of adverse action and right to appeal.

(a) The Department will provide written notice of an adverse action it has decided to take against a claimant or applicant directly to the party affected by the decision or to the party’s representative.

(b) The notice of adverse action will be given in a timely manner and the notice will not be given more than 30 days after the decision has been made.

(d) The notice will advise the person affected by the decision that:

(1) In the case of a proposed action to terminate the benefits of a claimant, the adverse action will be effective no sooner than 30 days after the date of the notice.

(2) The decision may be appealed under this chapter.

(3) If an appeal is to be made, it shall be filed with the Department within 30 days following the date of the notice of adverse action.

The provisions of this § 22.92 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (103142).

This section cited in 6 Pa. Code § 22.37 (relating to right of appeal); 6 Pa. Code § 22.46 (relating to right of appeal); and 6 Pa. Code § 22.74 (relating to claimant right of appeal).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.93 Filing of appeals.

(a) Appeals shall be filed within 30 days of the date of a notice of adverse action and shall be submitted to the Department.

(b) In the case of appeals of proposed adverse actions to terminate a claimant’s benefits under the PACE Program, filing of the appeal within the 30 days allowed will prevent termination of benefits until the end of the appeal process.

(c) The content of applicant or claimant appeals shall include the appellant’s name, address, telephone number, PACE enrollment number and the reasons for the appeal. If the appellant has no PACE enrollment number, the appeal shall include the appellant’s Social Security Number, when available.

The provisions of this § 22.93 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; corrected April 12, 1985, effective March 30, 1985, 15 Pa.B. 1353; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (103142) to (103143).

This section cited in 6 Pa. Code § 22.37 (relating to right of appeal); 6 Pa. Code § 22.46 (relating to right of appeal); and 6 Pa. Code § 22.74 (relating to claimant right of appeal); and 6 Pa. Code § 22.95 (relating to formal appeals and hearings).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.94 Informal handling of appeals.

(a) The Department will initially seek to resolve all applicant/claimant appeals through a letter-ruling process which shall consist of the following steps:

(1) The Department will review the adverse action taken, including a review of applicable documentation, to determine any possibility of error.

(2) Within 15 days of the receipt of the appeal, a letter will be sent to the applicant/claimant which sets forth the results of the review. The letter will cite the statutory/regulatory basis for the results, indicate the appropriate action being taken and inform the applicant/claimant of the right to a formal hearing if the applicant/claimant does not accept the results set forth in the letter.

(b) Results and opinions set forth in letter-rulings will have no precedential authority and are subject to withdrawal or change at any time to conform with new or different interpretations of the law.

(c) Appeals or complaints which cannot be resolved informally through the letter-ruling process shall be considered to be formal complaints and will be handled under § 22.95 (relating to formal appeals and hearings).

The provisions of this § 22.94 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163. Immediately preceding text appears at serial page (89817).

This section cited in 6 Pa. Code § 22.37 (relating to right of appeal); 6 Pa. Code § 22.46 (relating to right of appeal); and 6 Pa. Code § 22.74 (relating to claimant right of appeal).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.95 Formal appeals and hearings.

(a) Right to a formal hearing. If an applicant/claimant who has filed an appeal under § 22.93 (relating to filing an appeal) disagrees with the Department’s letter ruling, the applicant/claimant is entitled to a formal hearing on the complaint.

(b) Notification of the Department. If the appellant wishes to pursue an appeal to a formal hearing, the appellant shall notify the Department in writing within 15 calendar days of the date of the letter ruling that the letter ruling is not accepted and a formal hearing is requested.

(1) When the Department receives a request for a formal hearing as provided for under subsections (a) and (b) the Secretary or the Secretary’s designee will appoint a hearing examiner to preside over the formal hearing.

(2) It shall be the responsibility of the appointed hearing examiner to schedule the hearing and conduct it in accordance with this chapter and 1 Pa. Code Part II (relating to general rules of administrative practice and procedure).

(3) Subsection (c)(1) supplements 1 Pa. Code § 35.185 (relating to designation of presiding officers). Subsection (c)(2) supplements 1 Pa. Code § 35.187 (relating to authority delegated to presiding officers).

(d) Scheduling formal hearings.

(1) General provisions.

(i) The hearing examiner shall notify the appellant and the Department of the date, time and location of the hearing at least 10 days prior to the selected date. This notification shall include clear instructions relative to the appellant’s opportunity to have the hearing conducted by way of a telephone conference call, or face to face, as provided for in subsection (e). This subparagraph supersedes 1 Pa. Code § 35.105 (relating to notice of nonrulemaking proceedings).

(ii) A prehearing conference may be held at the discretion of the hearing examiner. This subparagraph is identical to 1 Pa. Code § 35.111 (relating to conferences to adjust, settle or expedite proceedings).

(iii) The hearing examiner shall complete the hearing within 45 days of receipt of the assignment at the time the appointment as hearing examiner is made.

(2) Continuances.

(i) Hearings shall commence on the first day scheduled and continuances may not be granted by the hearing examiner except for good cause shown. A hearing examiner may only grant a second continuance in extraordinary circumstances.

(ii) Requests for a continuance shall be made in writing to the hearing examiner and the Department.

(iii) The appellant requesting a continuance shall first consult the Department to seek agreement to the request. The request shall then indicate whether the request is unopposed.

(iv) The Department’s objections, if any, to a request for continuance shall be in writing and delivered to the hearing examiner and the appellant or the appellant’s representative. Objections shall be made immediately upon receipt of notification of a request for a continuance.

(v) The period of a continuance granted to an appellant may not be counted as part of the 45-day period required in subsection (d)(1)(iii) to complete an assigned hearing.

(vi) Paragraph (2) supersedes 1 Pa. Code § 31.15(6) (relating to extension of time).

(3) Failure to appear at hearing.

(i) If the appellant or the appellant’s representative fails to appear at the scheduled hearing without good cause, as determined by the hearing examiner, the complaint shall be deemed abandoned and shall be dismissed with prejudice.

(ii) If the Department fails to appear at the hearings without good cause as determined by the hearing examiner, the hearing shall proceed in absentia.

(iii) If neither the appellant nor the Department or their representatives appear at the hearing, the hearing examiner will reschedule the hearing.

(e) Two hearing procedure options.

(1) The Department will provide appellants desiring formal hearings with the opportunity of having their hearings conducted by way of a telephone conference call. This opportunity will be provided in writing with the hearing examiner’s notification of the date, time and location of a scheduled hearing, and will include clear instructions to the appellant for taking advantage of this opportunity to avoid the time and travel to appear at a special hearing location.

(2) Appellants who do not wish to take advantage of the telephone conference call procedure may elect to have a face-to-face hearing at one of several locations selected by the Department. The hearing examiner’s scheduling notification will include instructions for electing a face-to-face hearing.

(3) This subsection supersedes 1 Pa. Code § 35.123 (relating to conduct of hearings).

(f) Purpose of formal hearings. The purpose of a hearing includes all of the following:

(1) To give both the appellant and the Department an opportunity to present testimony, witnesses and documentary evidence relevant to the issue in question.

(2) To give both the appellant and the Department an opportunity to cross examine the opposing party’s witnesses.

(3) To assure that documents and records presented or referred to during the course of the hearing are made part of the hearing transcript.

(4) To give the appellant an opportunity to review pertinent evidence on which the adverse action was based. This may be done at the prehearing conference, if one is held.

(g) Hearing authority.

(1) The hearing authority is the Secretary.

(2) The Secretary will delegate to the hearing examiner the authority necessary to conduct the hearing proceedings and to perform the following functions:

(i) Determine the facts.

(ii) Determine the appropriate regulations that apply.

(iii) Interpret a regulation when the regulation is ambiguous.

(iv) Interpret a directive of the Department when the directive is ambiguous.

(v) Apply the facts to the law to determine the correct result.

(vi) Recommend that the Secretary adopt the result.

(3) The hearing examiner’s recommendation shall be submitted to the Secretary or the Secretary’s designee within 30 days of the conclusion of the hearing.

(4) Hearing examiners may not invalidate or modify a Departmental regulation.

(5) Subsection (g) supplements 1 Pa. Code § 35.187.

(h) Decision of the Secretary.

(1) The recommendation of the hearing examiner shall be reviewed by the Secretary or the Secretary’s designee.

(2) After a recommendation has been proposed by the hearing examiner, appellants will not be afforded an opportunity to submit oral or written statements of their position to the Secretary or the Secretary’s designee.

(3) Findings of fact made by the hearing examiner are subject to review and reversal by the Secretary. The Secretary or the Secretary’s designee may return the case to the hearing examiner for further findings of fact.

(4) The Secretary or the Secretary’s designee will issue an opinion and order as soon as possible after receiving the final recommendation of the hearing examiner.

(5) Paragraph (1) supersedes 1 Pa. Code § 35.201 (relating to certification of record with proposed report). Paragraph (2) supersedes 1 Pa. Code § 35.211 (relating to procedure to except to proposed report). Paragraph (4) supplements 1 Pa. Code § 35.226 (relating to final orders).

The provisions of this § 22.95 adopted March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; corrected April 12, 1985, effective March 30, 1985, 15 Pa.B. 1363.

This section cited in 6 Pa. Code § 22.37 (relating to right of appeal); 6 Pa. Code § 22.46 (relating to right of appeal); 6 Pa. Code § 22.74 (relating to claimant right of appeal); and 6 Pa. Code § 22.94 (relating to informal handling of appeals).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.101 Provider appeals.

(a) Appealable actions. Providers shall have the right to appeal the following adverse actions taken by the Department:

(1) The rejection of an application for enrollment in the PACE Program when the provider believes the rejection is based upon incorrect or incomplete information.

(2) The termination of an enrolled provider’s agreement under § 22.84 (relating to administrative actions and penalties), except as provided for in subsection (b)(1).

(3) The disallowance of payments to an enrolled provider where the Department has determined the payments are not valid because of provider error, negligence or abuse.

(4) Other adverse actions of the Department except those which are indicated in subsection (b).

(b) Nonappealable actions. Providers do not have the right to appeal the following actions:

(1) The termination of a provider agreement because of the provider’s termination or suspension from Medicare or Medical Assistance, or because of a conviction of a criminal offense under § 22.83 (relating to prohibited acts and criminal penalties), or because of a conviction of another criminal offense or disciplinary action indicated in § 22.84 except on the issues of identity or misinformation.

(2) Disallowances for prescription drugs dispensed during a period of nonenrollment or termination, except on the issues of identity or misinformation.

(3) Rejection of an application to reenroll a terminated or excluded provider prior to the date the Department specified that it would consider reenrollment.

The provisions of this § 22.101 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial pages (96851) to (96852).

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation); 6 Pa. Code § 22.85 (relating to re-enrollment of providers whose agreements have been terminated); and 6 Pa. Code § 22.86 (relating to provider right of appeal).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.102 Notification of adverse action and right to appeal.

(a) The Department will provide written notice of any adverse action it has decided to take against a provider.

(b) The notice of adverse action will be given in a timely manner and in no event will the notice be given more than 30 days after the decision has been made.

(d) The notice will advise the provider affected by the decision that:

(1) The decision may be appealed under this chapter.

(2) If an appeal is to be made, it shall be filed with the Department within 30 days following the date of the notice of adverse action.

The provisions of this § 22.102 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation); and 6 Pa. Code § 22.86 (relating to provider right of appeal).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.103 Filing of appeals.

(a) Appeals shall be filed within 30 days of the date of a notice of adverse action and shall be submitted to the Department.

(b) The form and content of provider appeals shall be under 1 Pa. Code § 35.10 (relating to form and content of formal complaints).

The provisions of this § 22.103 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation); and 6 Pa. Code § 22.86 (relating to provider right of appeal).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.104 The handling of appeals.

Appeals or complaints shall be handled as formal complaints under 1 Pa. Code Part II (relating to general rules of administrative practice and procedure).

The provisions of this § 22.104 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

This section cited in 6 Pa. Code § 22.62 (relating to conditions of provider participation); and 6 Pa. Code § 22.86 (relating to provider right of appeal).

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

6 Pa. Code § 22.111 Forms, handbooks and other materials.

The Department may supplement or interpret this chapter by developing and issuing forms, handbooks or other materials necessary to the effective administration of the program.

The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

History

Authority: The provisions of this Chapter 22 issued under the Pharmaceutical Assistance Contract for the Elderly Act (62 P.S. § § 2901—2908), (Repealed and replaced by Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.), unless otherwise noted.
Source: The provisions of this § 22.111 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109.

Chapter 30 Designation and Redesignation of Area Agencies on Aging

6 Pa. Code § 30.1 Purpose and authority.

(a) The purpose of this chapter is to set forth the procedures to be followed by the Department in designating and redesignating organizations or agencies as Area Agencies on Aging.

(b) This chapter is issued pursuant to the authority contained in the act and in conformity with the Older Americans Act of 1965 and Federal regulations issued pursuant to that Act.

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.2 Definitions.

The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise: Act—Section 6 of the act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 581-1—581-12). Area agency on aging—The single local agency designated within each planning and service area to administer the delivery of a comprehensive and coordinated plan of social and other services and activities; local agencies which have been designated as Area Agencies on Aging are listed in Appendix A to this chapter. Area plan—The plan submitted to the Department by an Area Agency on Aging describing the methods by which it will ensure a coordinated and comprehensive plan of social and other services and activities in the planning and service area. Chief elected officials—County commissioners acting collectively, governing bodies of home rule counties, and mayors of cities with a total population of over 100,000. Department—The Pennsylvania Department of Aging. Planning and service area—The geographic unit within this Commonwealth, as authorized by the Federal Older Americans Act of 1965, for allocation of funds for the delivery of social services; geographic areas which have been designated as planning and service areas in this Commonwealth are displayed in Appendix B of this chapter. Secretary—The Secretary of Aging of the Commonwealth. Units of general purpose local government—Counties, and municipalities with a total population of over 100,000.

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.11 Circumstances requiring designation.

An Area Agency on Aging will be designated for each planning and service area in this Commonwealth. The Department will act to designate an organization or agency as the Area Agency on Aging only when changes in the designation of existing planning and service areas result in the creation and designation of a new planning and service area for which no Area Agency on Aging has been designated.

This section cited in 6 Pa. Code § 30.14 (relating to procedure for designation).

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.12 Organization/agency eligibility.

In order to be eligible for designation by the Department as an Area Agency on Aging, an organization or agency:

(1) shall be:

(i) an established office of aging which is operating within the newly-designated planning and service area designated by the Department;

(ii) any office or agency of a unit of general purpose local government which office or agency is designated for the purpose of serving as an area agency by the chief elected officials of such unit;

(iii) any office or agency designated by the appropriate chief elected officials of any combination of units of general purpose local government to act on behalf of such combination for such purpose; or

(iv) any public or nonprofit private agency in the newly-designated planning and service area which is under the supervision or direction for this purpose of the designated State agency and which can engage in the planning or provision of a broad range of social services or nutrition services within such newly-designated planning and service area; and

(2) shall provide assurances determined adequate by the Department that it will have the ability to develop an area plan and to carry out, directly or through contractual arrangements, a program in accordance with the area plan within the newly-designated planning and service area.

This section cited in 6 Pa. Code § 30.14 (relating to procedure for designation); 6 Pa. Code § 30.21 (relating to circumstances requiring redesignation); and 6 Pa. Code § 30.24 (relating to interim emergency redesignation).

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.13 Preference in designation.

In designating an Area Agency on Aging within a newly-designated planning and service area or within any unit of general purpose local government newly-designated as a planning and service area, the Department will give preference to an established office on aging unless it finds that no such office within the newly-designated planning and service area will have the capacity to carry out the area plan.

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.14 Procedure for designation.

(a) Preliminary departmental action. Under § 30.11 (relating to circumstances requiring designation) and in order to make a determination regarding designation in a way which will be efficient, appropriate, and equitable, the Department will take whatever preliminary actions it deems necessary. Such actions will include but need not be limited to the determination through an on-site assessment of the capacity of an organization or agency to carry out all the functions of an Area Agency on Aging as specified in the act and in the Federal Older Americans Act of 1965.

(b) Issuance of notice of intent to designate. The procedure for issuance of notice of intent to designate shall be as follows:

(1) The Secretary will, pursuant to § 30.11 (relating to circumstances requiring designation), and at least 210 days prior to the beginning of the next Area Agency on Aging contract year, issue a written notice of intent to designate an organization or agency as the Area Agency on Aging within a newly-designated planning and service area. This notice will be processed as follows:

(i) The notice will be transmitted to the proposed Area Agency on Aging.

(ii) The notice will be transmitted to the chief elected officials of units of general purpose local government in the newly-designated planning and service area. The chief elected officials shall present their views to the Secretary in writing within 30 days of being notified. Receipt of such views will be promptly confirmed by the Secretary in writing. In the absence of a response from the chief elected officials in the newly-designated planning and service area, the Secretary will proceed with the process of designation pursuant to this Chapter.

(iii) The notice will be published in the Pennsylvania Bulletin.

(iv) The notice will be published in newspapers of general circulation in the newly-designated planning and service area.

(2) Paragraph (1) supplements 1 Pa. Code § 35.105 (relating to notice of nonrulemaking proceedings).

(1) The notice of intent to designate an organization or agency in a newly-designated planning and service area as the Area Agency on Aging issued pursuant to subsection (b) will comply with all of the following:

(i) Identify the organization or agency to be designated as the Area Agency on Aging in the newly-designated planning and service area.

(ii) State the reason for the issuance of intent to designate.

(iii) Announce that a public hearing will be held in the newly-designated planning and service area so as to afford the public an opportunity to give testimony regarding the intent to designate.

(iv) Contain the time, the place, and a brief description of the conduct of these hearings and the name, telephone number, and address of the person to be contacted regarding the offering of testimony.

(v) Contain any other information the Secretary deems necessary.

(2) Paragraph (1) supersedes 1 Pa. Code § 35.106 (relating to contents of notice of nonrulemaking proceedings).

(d) Public hearings. The procedure for public hearings shall be as follows:

(1) The Department will hold public hearings within 45 days of the transmittal of the notice of intent to designate the Area Agency on Aging in as many locations as needed to assure convenient public access within the newly-designated planning and service area but no sooner than 15 days after publication of the notice of intent to designate in the Pennsylvania Bulletin. The presiding officer at these hearings will be the Secretary or his designee. A stenographer will be employed by the Department at all hearings to provide a verbatim transcription of all testimony, a copy of which will be available for public inspection at the main office of the Department.

(2) Paragraph (1) supplements 1 Pa. Code § 35.185 (relating to designation of presiding officers) and § 35.131 (relating to recording of proceedings) and supersedes 1 Pa. Code § 35.133 (relating to copies of transcripts).

(e) Preliminary decision regarding designation. At least 150 days prior to the beginning of the next Area Agency on Aging contract year, the Secretary will, in writing, notify the organization or agency of his preliminary decision to designate it as the Area Agency on Aging in the newly-designated planning and service area. The organization or agency so notified shall thereupon submit the assurances required by § 30.12(2) (relating to organization/agency eligibility). Such assurances shall be in writing and in a form prescribed by the Secretary and shall be submitted by the organization or agency within 15 days of receipt of the preliminary decision to designate. This form, the statement of assurances, shall be as follows:

I (we) am (are) in receipt of the Preliminary Decision to designate

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.21 Circumstances requiring redesignation.

The Department will act to redesignate an organization or agency as the Area Agency on Aging within a designated planning and service area when it determines that the currently-designated Area Agency on Aging in the affected planning and service area will not be able to comply satisfactorily with the assurances originally given pursuant to § 30.12(2) (relating to organization/agency eligibility) for the coming Area Agency on Aging contract year or in any other circumstances deemed appropriate by the Secretary. Circumstances leading to such an action may include but shall not be limited to the following:

(1) Failure of the Area Agency on Aging to meet the requirements of 45 CFR Part 1321 (1980).

(2) Disapproval of the area plan or its amendments.

(3) A finding by the Department that the Area Agency on Aging’s administration of the provisions of its approved area plan fails to substantially comply with the requirements of 45 CFR Part 1321 (1980).

(4) A finding by the Department that the provisions of an approved Area Plan fail to substantially comply with 45 CFR Part 1321.

(5) Receipt by the Department of written statements by agencies, organizations, or units of general purpose local government in the affected planning and service area including the Area Agency on Aging itself requesting redesignation of the Area Agency on Aging and providing justification therefor. The Department reserves the right to reject any requests received pursuant to this paragraph which are accompanied by justifications deemed inadequate or spurious.

(6) Any other circumstances unforeseen at the time of original designation.

This section cited in 6 Pa. Code § 30.23 (relating to procedure for redesignation).

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.22 Preliminary departmental action.

In order to make a determination regarding redesignation which will be efficient, appropriate, and equitable, the Department will take whatever preliminary actions it deems necessary. Such actions will include meeting with the governing authority of the currently-designated Area Agency on Aging, and may include, but not be limited to on-site visits or other communication with:

(1) staff of the currently-designated Area Agency on Aging;

(2) subcontractors of the currently-designated Area Agency on Aging;

(3) other service providers in the affected planning and service area;

(4) older persons in the affected planning and service area;

(5) the chief elected officials of units of general purpose local government in the affected planning and service area; and

(6) any other persons, organizations, or agencies in the affected planning and service area.

This section cited in 6 Pa. Code § 30.23 (relating to procedure for redesignation); and 6 Pa. Code § 30.24 (relating to interim emergency redesignation).

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.23 Procedure for redesignation.

(a) Issuance of notice of intent to redesignate. The procedure for issuance of notice of intent to redesignate shall be as follows:

(1) Pursuant to § § 30.21 and 30.22 (relating to circumstances requiring redesignation; and preliminary departmental action), the Secretary will, at least 240 days prior to the beginning of the next Area Agency on Aging contract year, issue a written notice of intent to redesignate the Area Agency on Aging. This notice will be:

(i) transmitted to the currently-designated Area Agency on Aging in the affected planning and service area;

(ii) transmitted to the chief elected officials of the units of general purpose local government in the affected planning and service area;

(iii) published in the Pennsylvania Bulletin; and

(iv) published in newspapers of general circulation in the affected planning and service area.

(2) Paragraph (1) supplements 1 Pa. Code § 35.105 (relating to notice of nonrulemaking proceedings).

(b) Contents of notice. Notice shall comply with the following:

(1) The notice of intent to redesignate the Area Agency on Aging issued pursuant to subsection (a) shall comply with all of the following:

(i) State the reason for the issuance of intent to redesignate.

(ii) Announce that a public hearing will be held in the affected planning and service area so as to afford the public an opportunity to give testimony regarding the intent to redesignate.

(iii) Contain the time, the place, and a brief description of the conduct of these hearings, and the name, telephone number, and address of the person to be contacted regarding the offering of testimony.

(iv) Contain any other information the Secretary deems necessary.

(2) Paragraph (1) supersedes 1 Pa. Code § 35.105 (relating to contents of notice of nonrulemaking proceedings).

(1) The Department will hold public hearings within 45 days of the transmittal of the notice of intent to redesignate the Area Agency on Aging in as many locations as are needed to assure convenient public access within the affected planning and service area, but no less than 15 days after publication of the notice of intent to redesignate in the Pennsylvania Bulletin. The presiding officer at these hearings will be the Secretary or his designee. A stenographer will be employed by the Department at all hearings to provide a verbatim transcription of all testimony, a copy of which will be available for public inspection at the main office of the Department.

(d) Preliminary decision regarding redesignation. The Secretary will, within 15 days of the date of the last public hearing held pursuant to subsection (c) of this section, issue his preliminary decision regarding redesignation. This preliminary decision will state the reasons for the decision and will be communicated in writing to:

(1) The currently-designated Area Agency on Aging.

(2) The organization or agency to be designated as the new Area Agency on Aging in the event the Secretary has preliminarily decided to redesignate an organization or agency within the affected planning and service area.

(3) The chief elected officials of units of general purpose local government in the affected planning and service area.

(e) Factors to be considered. Before making his preliminary decision regarding redesignation pursuant to subsection (d) the Secretary will consider the following:

(1) The impact of redesignation on the provision of services in the designated planning and service area.

(2) The comments of the Advisory Council of the currently-designated Area Agency on Aging.

(3) All information and findings obtained pursuant to § § 30.21 and 30.22 (relating to circumstances requiring redesignation and preliminary departmental action).

(4) All testimony given at the public hearings held pursuant to subsection (c).

(5) All other pertinent information in his possession.

(f) Notice to the currently-designated Area Agency on Aging of its right to an adjudicatory hearing. Notice to the currently-designated Area Agency on Aging of its right to an adjudicatory hearing shall comply with the following:

(1) In the event the Secretary’s decision is to redesignate, he will inform the currently-designated Area Agency on Aging in the affected planning and service area of its right to request a hearing before the Department regarding this decision.

(2) The request for a hearing must be in writing and, in order to be considered, must be received by the Department within 30 days of the Area Agency on Aging’s receipt of the Secretary’s preliminary decision. If the currently-designated Area Agency on Aging, after being notified of the preliminary decision pursuant to subsection (d), fails to request a hearing as specified in this subsection, the preliminary decision will become final.

(3) Paragraphs (1) and (2) supersede 1 Pa. Code § § 35.226 and 35.231 (relating to final orders and reopening on application of party).

(g) Adjudicatory hearing. All hearings held pursuant to subsection (f) will be conducted in accordance with the provisions of 2 Pa.C.S. § § 501—508 and 701—704.

(h) Final decision regarding redesignation. The Secretary, after considering all of the information obtained under § § 30.21 and 30.22 (relating to circumstances requiring redesignation and preliminary departmental action); all of the testimony given at the public hearings held pursuant to subsection (c); and all of the testimony given at the adjudicatory hearing, if any, will publish notice of a final decision regarding redesignation in the Pennsylvania Bulletin, along with the reasons therefor, no less than 100 days prior to the beginning of the next Area Agency on Aging contract year.

This section cited in 6 Pa. Code § 30.24 (relating to interim emergency redesignation).

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

6 Pa. Code § 30.24 Interim emergency redesignation.

(a) Whenever circumstances in a designated planning and service area render the designated Area Agency on Aging immediately incapable of complying with the assurances specified in § 30.12(2) (relating to organization/agency eligibility), the Department will—all other provisions of this chapter notwithstanding and in order to guarantee the uninterrupted provision of services—take all appropriate action, including but not limited to acting immediately to redesignate an organization or agency as the Area Agency on Aging on an interim emergency basis. Such redesignation shall remain in effect as long as necessary, but in no case longer than 180 days.

(b) Within the 180-day period specified in subsection (a), the Department will make a final decision regarding redesignation in the affected planning and service area. In so doing, the Department will follow the procedures specified in § § 30.22 and 30.23 (relating to preliminary departmental action and procedure for redesignation); except that it will not be required to act within the time limits specified in these sections.

Editor’s Note: The following document is being codified under 1 Pa. Code § 3.1(9) (relating to contents of Pennsylvania Code) as a document which the Legislative Reference Bureau finds to be general and permanent in nature.

History

Authority: The provisions of this Chapter 30 issued under The Administrative Code of 1929 (71 P. S. § § 581-1—581-12), unless otherwise noted.
Source: The provisions of this Chapter 30 adopted May 23, 1980, effective May 24, 1980, 10 Pa.B. 2040, unless otherwise noted.

Chapter 35 Area Agency on Aging Advisory Councils

6 Pa. Code § 35.1 Purpose and authority.

(a) The purpose of this chapter is to set forth the responsibilities and composition of Area Agency Advisory Councils. In addition, this chapter sets forth the corresponding responsibilities of Area Agencies and of the Department.

(b) This chapter is issued pursuant to the authority contained in § 2208-A of the act (71 P. S. § 581-8), and in conformity with the Older Americans Act of 1965 and Federal regulations issued pursuant to the Federal Act.

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.2 Effective date, exemption of present Advisory Council members, and request for waiver.

(a) The provisions of this chapter shall be effective on January 1, 1982.

(b) All persons serving terms on Advisory Councils as of January 1, 1982, shall be exempt from the provisions of this chapter until their terms expire.

(c) In the event an Area Agency finds that compliance with one or more of the provisions of this chapter will not be feasible or would be counterproductive, it shall apply in writing to the Director of the Bureau requesting a waiver, along with the reasons therefor. The Director of the Bureau shall forward a recommendation on the waiver request, based upon the reasons given by the Area Agency and any other information in its possession, to the Secretary. The Secretary will promptly render a decision as to the granting of a waiver. This decision will be transmitted in writing to the Advisory Council chairpersons, to the appointing authority, and to the Area Agency Director. The decision will state the reasons therefor and it will be considered final.

This section cited in 6 Pa. Code § 35.41 (relating to responsibilities of the Department).

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.3 Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise: Act—The act of June 20, 1978 (P. L. 477, No. 70) (71 P. S. § § 61, 63, 66, 67.1(d)(1), 158(1), first paragraph, 581-1—581-12 and 611.8). Advisory Council—The Area Agency Advisory Board required by both section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8) and by the Older Americans Act of 1965 42 U.S.C.A. § 3026(a)(6)(G), and Federal regulations issued pursuant thereto at 45 CFR 1321.97 (1980). Appointing authority—Chief elected officials of the county for public Area Agencies; the board of directors or its equivalent for nonprofit Area Agencies. Area agency—The single local agency designated within each PSA to develop and administer the Area Plan. Area plan—The plan submitted to the Department by an Area Agency describing the methods by which it will ensure a coordinated and comprehensive system of social and other services and activities for older persons in the planning and service area. Bureau—The Bureau of Program and Field Operations. Department—The Pennsylvania Department of Aging. Greatest economic need—The need resulting from an income level at or below the poverty threshold established by the United States Bureau of the Census. Greatest social need—The need caused by noneconomic factors which include physical and mental disabilities; language barriers; and cultural or social isolation including that caused by racial or ethnic status—for example: Black, Hispanic, American, Indian, and Asian American—which restrict an individual’s ability to perform normal daily tasks or which threaten his capacity to live independently. Local elected officials—All officials holding elective public office within a PSA except those public officials who are also appointing authorities. Older persons—Those persons residing within this Commonwealth who are 60 years of age or older. PSA or Planning and Service Area—The geographic unit within this Commonwealth, as authorized by the Federal Older Americans Act of 1965, that is designated for purposes of planning, development, delivery, and overall administration of services under an area plan. Secretary—The Secretary of Aging of the Commonwealth.

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.11 Advisory Council composition.

(a) The Advisory Council shall consist of a minimum of 15 voting members.

(b) In order to assure that the Advisory Council constitutes a maximally representative citizen body, the Advisory Council shall be composed of the following:

(1) More than 50% older persons and include:

(i) older persons with greatest economic or social need; and

(ii) Area Agency service recipients.

(2) One or more representatives of older persons.

(3) One or more local elected officials.

(4) The general public.

(c) Appointing authorities and their employes may serve as members of the Advisory Council, but only in ex officio, nonvoting capacity, and are not eligible to serve as officers of the Advisory Council.

(d) Subcontractors under the area plan, their employes, and members of their boards of directors and advisory councils may, at the discretion of the Advisory Council, serve either as regular voting members or in an ex officio, nonvoting capacity. The Advisory Council’s decision in this regard shall:

(1) be universally applied—that is, the basic decision, once reached by the Advisory Council, must thereafter apply to all subcontractors under the area plan, their employes, and members of their boards of directors and advisory councils who serve on the Advisory Council;

(2) be included as a statement of policy in the Advisory Council’s bylaws;

(3) require—where the Advisory Council has decided to allow subcontractors under the area plan, their employes, and members of their boards of directors and advisory councils to serve as regular voting members—that such persons comply with those provisions of the Advisory Council’s bylaws explicitly designed to avoid the possibility of conflicts-of-interest, as set forth in § 35.21 (a)(6) (relating to Advisory Council organization responsibilities).

(e) Advisory Councils may, at their discretion, establish further membership requirements in accordance with other demographic features within the PSA. Such additional requirements may be established in order to guarantee equitable geographic distribution of membership, particularly in bicounty or multicounty PSA’s, and shall not conflict with the membership requirements established in this chapter.

(f) The Advisory Council shall not establish any membership requirement based on religion.

This section cited in 6 Pa. Code § 35.12 (relating to filling vacancies on advisory councils).

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.12 Filling vacancies on Advisory Councils.

(a) Advisory Council members shall play an active, coordinating role in the recruitment and selection of new members to serve on the Advisory Council. Whenever a vacancy in the Advisory Council occurs, the Advisory Council shall solicit capable representatives of the population of older persons within the PSA, in accordance with the composition requirements in § 35.11(b)—(f) (relating to advisory council composition), by utilizing procedures which they find to be adequate, appropriate, and feasible. Such procedures may, for example, include the placing of an announcement of the vacancy to be filled in newspapers or in other appropriate media outlets.

(b) The Advisory Council’s procedure for filling vacancies shall:

(1) be adequately documented; documentation may include, for example, copies of letters to prospective nominees or copies of announcements placed in newspapers or in other appropriate media outlets;

(2) be specified in the Advisory Council’s bylaws, as stated in § 35.21(a)(3) (relating to advisory council organization responsibilities);

(3) result in the nomination of a person to serve on the Advisory Council; and

(4) be presented to the appointing authority, who reserves the right to accept or reject any nomination so presented.

(c) The appointing authority shall act either to accept or reject the nomination of a person to serve on the Advisory Council within 60 days of the date the nomination is presented to it under subsection (b)(4).

(d) Where the appointing authority has delegated responsibility for selection of Advisory Council members to the Advisory Council, new members may be selected by the Advisory Council itself, following a procedure which assures that its membership is truly representative of older persons within the PSA. Such procedures may include, for example, selection by older persons themselves in a democratic fashion.

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.21 Advisory Council organization responsibilities.

(a) The Advisory Council shall assist the Area Agency to develop and make public bylaws specifying the following:

(1) The role and function of the Advisory Council.

(2) The number of members.

(3) Procedures for selection of members.

(4) Term of membership.

(5) Frequency of meetings.

(6) Provisions explicitly designed to avoid the possibility of conflicts-of-interest, by including at least the following language: ‘‘An Advisory Council member must absent himself/herself from all deliberations concerning programs or funding for projects with which his/her organization is directly involved. Any voting member of the Advisory Council who is directly involved with the development and/or implementation of a proposal or contract to be funded by the area agency will declare a potential conflict of interest at each Advisory Council meeting on the subject. This declaration will be stated and recorded as part of the minutes and will include refraining from any discussion, comments, or voting on matters pertaining to the program or contract.’’

(b) The Advisory Council may, in addition to the requirements of subsection (a), assist the Area Agency to develop, and make public, bylaws specifying:

(1) standing committees, as well as procedures for the establishment of special committees and task forces; and

(2) other matters, as deemed appropriate.

(c) The Advisory Council shall keep minutes of each meeting. The minutes shall be approved by the membership and shall be available to the general public upon request. A copy of all minutes shall be maintained at the office of the Area Agency.

This section cited in 6 Pa. Code § 35.11 (relating to advisory council composition); 6 Pa. Code § 35.12 (relating to filling vacancies on advisory councils); and 6 Pa. Code § 35.31 (relating to responsibilities of the area agency).

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.22 Advisory Council responsibility to provide informed and regular counsel.

(a) In order to fulfill its responsibility to provide the Area Agency with informed and regular counsel, the Advisory Council will:

(1) Meet at least quarterly.

(2) Conduct all meetings in conformity with the act of July 19, 1974 (P. L. 486, No. 175) (65 P. S. § § 261—269).

(3) Review documents or summaries thereof pertaining to the substance and scope of the area plan and area plan contract, in sufficient detail to enable it to carry out its responsibilities.

(4) Participate in such training and technical assistance as will enable it to carry out its responsibilities.

(5) Utilize appropriate Area Agency staff and assistance in order to carry out its responsibilities.

(6) Review, at least quarterly, documents or summaries thereof detailing the progress achieved to date by the Area Agency toward the accomplishment of the objectives set forth in the area plan. Such documents may include, for example, the Financial Expenditure Report, the Quarterly Progress Report, Annual Self-Evaluation Report, and Monitoring Reports.

(7) Advise the appointing authority concerning selection of a new Area Agency Director whenever there is an actual or impending vacancy.

(8) In cooperation with the Area Agency, plan, publicize, and hold public hearings on the area plan.

(b) The Advisory Council may, in cooperation with the Area Agency:

(1) Plan, publicize, and hold public hearings on specific issues affecting older persons which receive Council attention.

(2) Form task forces or special committees in order to deepen Council understanding of specific issues. Such task forces or special committees must include one Advisory Council member and may include: Area Agency personnel, service provider staff, representatives of local government, and members of the larger community; activities of such task forces or special committees, including any reports they produce, are not official, and their draft reports should not be widely disseminated without approval by the Advisory Council.

(3) Conduct surveys of the needs and attitudes of consumers or potential consumers of services under the area plan.

This section cited in 6 Pa. Code § 35.31 (relating to responsibilities of the area agency).

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.23 Advisory Council responsiblity to advise the Area Agency to develop and administer the area plan.

(a) In order to fulfill its responsibility to advise the Area Agency in the development and administration of the area plan, the Advisory Council will:

(1) confer with the Area Agency Director regarding the area plan and contract and any revision to the area plan or contract prior to their submission by the Director to the appointing authority and to the Department; and

(2) certify that it has participated in the development of the area plan, that it has reviewed the area plan as submitted to the Department, and that it recommends either approval or disapproval, by signature of the Chief Officer of the Advisory Council on the area plan application form submitted to the Department.

(b) The Advisory Council may, in cooperation with the appointing authority:

(1) review and discuss with the Area Agency Director any subcontracts for services entered into by the agency before such contracts are let and at such other times as indicated by the appearance of problems with or questions about such contracts; and

(2) ensure that the Department’s appeal procedures for service providers, as set forth in Chapter 3 (relating to hearing and appeals procedure) proposed at 10 Pa.B. 3922 (October 4, 1980), are available and, when necessary, utilized within the PSA.

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.24 Advisory Council responsibility to act as advocate for older persons.

In order to fulfill its responsibility to act as advocate for all older persons in the PSA, the Advisory Council shall do the following:

(1) Ensure that the public is informed, whether by the Area Agency staff or by the Advisory Council, concerning the needs of the PSA’s elderly.

(2) Ensure that the Department’s appeal procedures for applicants for services funded under the Federal Older Americans Act, as set forth in Chapter 3 (relating to hearing and appeals procedure) proposed at 10 Pa.B. 3922 (October 4, 1980), are available and, when necessary, utilized within the PSA.

(3) Advise the Area Agency regarding its mandated responsibilities to review and comment on all community policies, programs, and actions affecting older persons.

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.31 Responsibilities of the Area Agency.

(a) In order to assist the Advisory Council to fulfill its responsibilities, the Area Agency shall do the following:

(1) Establish an Area Agency Advisory Council in conformity with regulations issued by the Administration on Aging and with the provisions of this chapter.

(2) Afford the Advisory Council ready access to all documents or summaries thereof pertaining to the substance and scope of the area plan and contract.

(3) Facilitate the provision of appropriate training and technical assistance—whether provided by the Area Agency, the Department, or by others—to Advisory Council members.

(4) Provide the Advisory Council with staff support and assistance.

(5) Provide the Advisory Council, at least quarterly, with documents or summaries thereof detailing the progress achieved to date by the Area Agency toward the accomplishment of the objectives set forth in the Area Plan, in sufficient detail to enable the Advisory Council to carry out its responsibilities. Examples of documents or summaries thereof which may be provided are referenced in § 35.22(a)(6) (relating to advisory council responsibility to provide informed and regular counsel).

(6) In cooperation with the Advisory Council, develop and make public Advisory Council bylaws in accordance with the provisions of § 35.21(a) and (b) (relating to advisory council organization responsibilities).

(b) The Area Agency Director or his designee shall attend all meetings of the Advisory Council and shall serve as a resource person.

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.

6 Pa. Code § 35.41 Responsibilities of the Department.

In order to assist Advisory Councils to carry out their mandated responsibilities, the Department will:

(1) Make every effort, consistent with the amount of available funding, to provide Advisory Council members with appropriate training and technical assistance.

(2) Render decisions as to the granting of waivers to one or more of the provisions of this chapter, following the procedures specified in § 35.2(c) (relating to effective date, exemption of present advisory council members, and request for waiver), as promptly as possible.

History

Authority: The provisions of this Chapter 35 issued under section 2208-A of The Administrative Code of 1929 (71 P. S. § 581-8), unless otherwise noted.
Source: The provisions of this Chapter 35 adopted November 13, 1981, effective November 14, 1981, 11 Pa.B. 4035, unless otherwise noted.