§ 6000.1. Definitions.

 The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:

   Act No. 1985-33—The act of July 1, 1985 (P. L. 124, No. 33), amending the Child Protective Services Law (11 P. S. § §  2201—2224).

   Act No. 1987-80—The act of November 6, 1987 (P. L. 391, No. 80).

   CWEP—The Community Work Experience Program.

   Child—A person 17 years of age or younger.

   Department—The Department of Public Welfare of the Commonwealth.

   Founded report—A report made under the Child Protective Services Law if there has been a judicial adjudication based on a finding that a child who is a subject of the report has been abused.

   Indicated report—A report made under the Child Protective Services Law if an investigation by the child protective service determines that substantial evidence of the alleged abuse exists based on one of the following:

     (i)   Available medical evidence.

     (ii)   The child protective service investigation.

 (a) Act Nos. 1985-33 and 1987-80 apply to facilities that are licensed, approved, certified or registered or provided by the Department and programs that are provided through a contract with the Department or a county social service agency. Act Nos. 1985-53 and 1987-80 apply to facilities which primarily serve children.

 (b)  For mental retardation facilities and services Act Nos. 1985-33 and 1987-80 apply to the following:

   (1)  Licensed community residential mental retardation facilities and agencies serving primarily children.

   (2)  Licensed non-State ICFs/MR serving primarily children.

   (3)  State-operated ICFs/MR serving primarily children.

   (4)  Early intervention facilities—licensed/approved as child day care centers.

   (5)  Nonlicensed mental retardation children’s programs, such as recreation programs, camps, transportation, family aid services, family support services and homebound instruction programs.

   (6)  County mental retardation program staff members who provide direct care, supervision, guidance or control of children.

 (c)  Act Nos. 1985-33 and 1987-80 do not apply to vocational facilities or adult day care centers that are licensed under Chapters 2380 and 2390 (relating to adult training facilities; and vocational facilities).

 The legal entity and administrator of the child care facilities and children’s programs listed under §  6000.2 (relating to applicability) are responsible for compliance with Act Nos. 1985-33 and 1987-80. The penalty for noncompliance with these acts is a civil penalty of up to $2,500.

REQUIREMENTS

§ 6000.21. Individuals requiring clearances.

 (a)  Act No. 1985-33 requires that certain staff members employed in the types of child care facilities and children’s programs listed under §  6000.2 (relating to applicability) have both child abuse and criminal history record clearances prior to employment. Only staff members who will be providing direct care, supervision, guidance or control of children are covered by Act No. 1985-33.

 (b)  The following is a description of which staff members require and do not require clearances:

   (1)  Staff members hired after January 1, 1986 require the clearances.

   (2)  Staff members providing only adult care do not require clearances.

   (3)  Only paid employes of the facility or agency require clearances; volunteers do not require clearances.

   (4)  Paid substitute and temporary staff members require clearances.

   (5)  CWEP workers require clearances.

   (6)  If a person meets the following criteria, clearances are not required:

     (i)   Is 20 years of age or younger.

     (ii)   Is employed for periods of 90 days or less.

     (iii)   Is part of a job development or job training program funded in whole or in part by public or private sources—other than CWEP.

   (7)  A new administrator or chief executive officer hired after January 1, 1986 requires clearance only if that person has direct contact with children. If the administrator or chief executive officer requires a clearance, the legal entity shall complete the clearances and keep documentation of the checks on file at the agency or facility.

 (a)  Two clearances are required: a criminal records check to investigate past criminal convictions and a child abuse check to determine if there have been founded or indicated reports of child abuse naming the applicant as perpetrator.

   (1)  Child Abuse Check.

     (i)   Departmental form CY113, titled ‘‘Application for Child Abuse History’’, shall be used to request child abuse checks. A copy of this form may be obtained by calling ChildLine at (717) 783-6211, or, by writing to ChildLine and Abuse Registry, Post Office Box 8170, Lanco Lodge, Second Floor, Harrisburg, Pennsylvania 17105-8170.

     (ii)   To request the child abuse check, form CY113 shall be submitted to ChildLine at the address in subparagraph (i) with a check or money order for $10 made payable to the ‘‘Pennsylvania Department of Public Welfare’’. If form CY113 is not used or if the $10 fee is not attached, the child abuse record check request will not be processed and ChildLine will return the request to the applicant. A CWEP applicant is exempt from payment of the $10 fee.

     (iii)   The Department is required to comply with certification requests within 14 days from the date of receipt at ChildLine.

   (2)  Criminal history records check.

     (i)   A separate request shall be made to the State Police to obtain a criminal history records check. The facility or agency may contact a State Police facility to request copies of the criminal records check forms.

     (ii)   The State Police charge $10 for the criminal history records check. A personal check, cashier’s check or certified check or money order shall accompany the request.

     (iii)   The estimated processing time from the date of receipt for the criminal history records check is 21 days.

     (iv)   If the prospective employe resides outside of this Commonwealth, a Federal FBI check is required in addition to the Pennsylvania criminal records check. For out-of-State prospective employes, contact ChildLine for a complete packet that will include an FBI check form. The charge for an FBI report is $14.

     (v)   The State Police do not maintain criminal information on persons 17 years of age or younger. However, Act No. 1985-33 requires that criminal history records checks be conducted on all prospective employes, which include prospective employes 17 years of age or younger. Therefore, a criminal records check shall be requested on individuals 17 years of age or younger, and a report of ‘‘no information available’’ will be considered compliance.

 (b)  Both the child abuse check and the criminal history records check shall be obtained by the applicant within 1 year prior to the application for employment of the prospective employe. If the date of a clearance exceeds 1 year prior to the application for employment, a new clearance shall be obtained.

 (c)  There is no requirement that specifies who is required to pay the fees for the criminal history records check and the child abuse records check.

 (d)  A prospective employe may not be hired in a child care position—direct care, supervision, guidance or control of children—if the results of either of the two clearances indicate that one of the following applies:

   (1)  The prospective employe is a perpetrator of a founded report of child abuse within 5 years prior to the report from the Department regarding the child abuse check, see 11 P. S. §  2223.1(d).

 (a)  Under Act No. 1987-80, child care administrators are permitted, but not required, to hire staff members in a child care position—direct care, supervision, guidance or control of children—for a single period not to exceed 30 calendar days for residents of this Commonwealth, or 90 calendar days for out-of-State residents, if the following conditions are met:

   (1)  The applicant has mailed the requests for the required clearances to ChildLine, the State Police and the FBI, if applicable.

   (2)  The applicant provides copies of the completed request forms for clearances to the administrator.

   (3)  The administrator has no knowledge of information which would disqualify the applicant from employment under section 23.1(d) or (e) of the Child Protective Services Law (11 P. S. §  2223.1(d) or (e)).

   (4)  The applicant swears or affirms in writing that he is not disqualified from employment under section 23.1(d) or (3) of the Child Protective Services Law.

 (b)  The applicant shall be immediately dismissed from employment if disqualified from employment under section 23.1(d) or (e) of the Child Protective Services Law.

 (c)  During the 30- or 90-day provisional period, the provisional employe is not permitted to work alone with children and shall work in the immediate vicinity of a permanent employe. As used in this subsection:

   (1)  ‘‘Immediate vicinity’’ means that the provisional employe shall work within eyesight of a permanent employe at all times.

   (2)  ‘‘Permanent employe’’ means one of the following:

     (i)   A child care worker who has been successfully cleared by ChildLine, State Police and FBI, if applicable.

 (a)  In addition to this chapter, Chapter 20 (relating to licensure or approval of facilities and agencies) also governs abuse and other circumstances which are considered as part of the Department’s issuance of certificates of compliance.

 The appropriate regional office of mental retardation may be contacted for a single copy of the following:

   (1)  Act No. 1985-33.

   (2)  Act No. 1987-80.

   (3)  Chapter 3490 (relating to protective services).

   (4)  A sample Criminal History Records Check Form.

   (5)  An application Form for Child Abuse History—Form CY113.

DETERMINATIONS

§ 6000.31. Child care service.

 (a)  To fall within this subchapter, the service shall be primarily for children. A vocational facility which occasionally serves a client 17 years of age or younger would not be covered. Residential programs for the mentally retarded are covered only if they primarily serve children, and not if they have a resident 17 years of age or younger from time to time. The reason for this distinction is that a facility which is primarily for adults has no special attraction for persons disposed toward child abuse, and that children who are present are likely to be in their mid to upper teens, and therefore somewhat less vulnerable than younger children.

 (b)  Regular child care employes are covered as well as employes who rotate into child care positions. An employe who predictably provides child care services as part of employment is covered, whether this is 5 days a week or 1 day a month.

 (c)  Act Nos. 1985-33 and 1987-80 do not apply to employes who provide child care coverage on only an unpredictable emergency basis. Because the attraction to persons disposed toward abuse is slight, the need for emergency care outweighs the small risk of an unscreened person providing it.

 (d)  Staff members employed prior to January 1, 1986, in a nonchild care position who are promoted or transferred to a child care position after January 1, 1986, with the present employer shall obtain clearances. The promoted or transferred individual would be deemed a prospective employe under Act Nos. 1985-33 and 1987-80. If an individual is already employed in a child care service in a position which involves direct contact with children and is promoted to a higher level, which still involves direct contact with children or which does not require direct contact with children, the individual is exempt from the screening requirements.

 (e)  Act No. 1985-33 does not apply to a person hired on or prior to December 31, 1985, but does not begin to work until after January 1, 1986, if a written commitment to hire an individual was made prior to January 1, 1986. The individual is not required to submit verifications prior to actual commencement of employment after January 1, 1986. Once the commitment to employ an individual is made, that individual has been hired for purposes of Act No. 1985-33, which provides that an administrator of a child care service may not hire an individual who possesses an adverse criminal record or child abuse history.

 (f)  An employe who works for an agency prior to January 1, 1986, and who resigns or is furloughed and later reapplies with the same agency after January 1, 1986 shall receive clearances as follows:

   (1)  If the employe is furloughed, clearances depend upon whether the furloughed employe retains a right to reemployment with the agency. Particularly in the case of a union contract, a furloughed employe may have a property interest in continued employment and is considered a current employe during the period of the furlough and is not required to submit the verifications. If the furloughed employe is not a union employe or if there is no contract with the employer regarding reemployment rights, the employe would require screening.

   (2)  The employe who resigns is treated differently. The employe retains no property right in reemployment and would be deemed a prospective employe and require the clearances.

 (g)  An administrator is subject to Act Nos. 1985-33 and 1987-80 if job duties involve direct contact with children.

   (1)  If an administrator’s job duties do not involve direct contact, he is outside the scope of Act No. 1985-33. In emergency situations, an administrator whose job duties do not involve direct contact with children is not required to be screened.

   (2)  An administrator may not be hired provisionally under Act No. 1987-80. Refer to §  6000.32(i) (relating to provisional hiring process).

 (h)  Janitors and food service workers who seek employment in a child care service are generally not required to seek criminal history and ChildLine clearances.

   (1)  Section 23.1(a) of the Child Protective Service Law (11 P. S. §  2223.1(a)) governing applicability, provides: ‘‘This section shall not apply to administrative or other support personnel unless their duties will involve direct contact with children.’’ Section 3490.121 (relating to definitions) defines ‘‘direct contact with children’’ as ‘‘care, control, supervision or guidance of a child.’’ In the ordinary course of employment, a janitor’s or food service worker’s job duties do not involve direct contact with children.

   (2)  If the janitor’s or food service worker’s job duties involve care, control, supervision or guidance of a child, the prospective janitor or food service worker who applies for a job in a child care service is required to submit the necessary verifications required by Act No. 1985-33. If, for example, a prospective food service worker’s job duties involve supervising a child in assisting in the preparation of meals at a juvenile detention facility when no other direct care staff person is present, the food service worker would have to be screened.

 (i)  Drivers of buses and vans who take children to and from child care services are within the scope of Act Nos. 1985-33 and 1987-80 if the drivers are employes of the child care agency or service, and there are no other child care services employes in the bus. The children would, in these circumstances, be under the supervision of the driver.

   (1)  If the driver is alone with the children, provisional hiring is not permitted.

   (2)  If there is another child care employe on the bus or van, and the driver is not in charge of the children, Act No. 1985-33 is not applicable to the driver.

   (3)  Drivers who are employes of general transportation companies which contract with child care services are not covered, because employment in a general transportation company is not especially attractive to persons with dispositions toward child abuse.

 (j)  In a family living community residential facility, only the family members applying to be family living providers are required to have clearances and are covered by Act Nos. 1985-33 and 1987-80. Other persons, including other adults living in the household, are not covered.

 (k)  The medical staff of mental retardation facilities for children who administers medications or other medical or health services to children, but who are not alone with the children, are covered under Act Nos. 1985-33 and 1987-80. They apply since the medical staff has direct contact, care, supervision, guidance or control of the children.

 (l)  Act Nos. 1985-33 and 1987-80 apply to consultants employed through contract by a child care service if the consultant will be providing direct care, supervision, guidance or control of children.

 (m)  Persons seeking employment as a substitute staff member are subject to Act Nos. 1985-33 and 1987-80. A person who seeks employment in a child care service whether on a full-time, part-time or substitute basis is a prospective employe for purposes of Act Nos. 1985-33 and 1987-80. No distinction is drawn among these types of employment.

 (n)  If a substitute is employed for Agency X and Agency Y, the substitute is required to be cleared only one time.

   (1)  A prospective substitute employe shall submit the required clearances with his application for employment to each child care service agency or facility to which he applies. Act No. 1985-33 permits prospective employes to submit copies of the verifications with the applications for employment. The original child abuse history clearance form and State Police criminal history clearance form shall be presented by the employe to the employer prior to employment.

   (2)  The prospective employe need only obtain one set of clearances, and may submit copies to each child care service where employment is sought. Verifications of child abuse and criminal record histories are valid for 1 year.

 (o)  Volunteers of child care services who are paid only expenses are not included within the scope of Act Nos. 1985-33 and 1987-80. They cover employes, not volunteers. An individual who volunteers to participate in a child care service who is paid, from whatever source, for expenses only, is outside the scope of Act Nos. 1985-33 and 1987-80; they remain volunteers. The individual is in no way receiving wages or salary or other compensation for services performed but is merely paid for expenses incurred for participation in the child care service activities. Act No. 1985-33 does permit an individual who is not otherwise subject to the act to seek voluntary certification as a child caretaker.

 (p)  Act Nos. 1985-33 and 1987-80 apply to a prospective employe of a Department licensed residential facility which has an onsite school licensed by the Department of Education depending upon whether the individual’s job duties will be strictly limited to teaching or whether the individual’s job duties include teaching in addition to other functions, such as a houseparent or counselor for children cared for in the facility.

   (1)  If the individual seeking employment in the facility will perform only educational services within the Department of Education-licensed school, the individual is outside the scope of Act Nos. 1985-33 and 1987-80. The individual would, however, be subject to section 111 of the Public School Code of 1949 (24 P. S. §  1-111), which governs prospective school employes and requires prospective employes to submit criminal history record information prior to employment.

   (2)  If the individual will perform functions other than teaching, the person would be subject to Act Nos. 1985-33 and 1987-80 and be required to submit both the criminal history record information and the ChildLine checks.

 (q)  If a facility changes ownership, but operates continuously after January 1, 1986, current employes at the center do not require screening. The fact that the current employes usually remain in spite of the change in ownership makes the employes more akin to current employes, rather than prospective employes seeking initial employment. Current child care service employes are not required to submit the record clearances as a condition of continued employment.

 (r)  An FBI check is required if a person lived in this Commonwealth at one time but now resides in another state. A person who currently resides outside of this Commonwealth is considered an out-of-State resident. Under Act No. 1985-33, a person who is not a resident of this Commonwealth shall submit an FBI report. There is no length of residency requirement. The fact that the prospective employe formerly resided in this Commonwealth is not relevant.

 (s)  If a prospective employe moved to this Commonwealth the week before application for employment, an FBI check is not required for the applicant. The person who moves to this Commonwealth is considered a Pennsylvania resident as soon as he takes residence in this Commonwealth. There is no length of residence requirement. A Pennsylvania resident, regardless of length of residency, is not required to seek FBI clearance.

 (t)  Private practitioners of licensed professions, such as child psychiatrists, are not covered by Act Nos. 1985-33 and 1987-80. Consideration of the statutes as a whole, especially the enforcement provisions, clearly indicate that the private practitioner was not intended to be covered. A psychiatrist who contracts with a psychiatric clinic for children is covered, however, because persons who contract with child care services whose duties involve direct contact with children are covered. The basis for this distinction is that the client of the private practitioner, or the parent, can choose the practitioner. This choice is usually not available in a clinic or other facility setting.

 (u)  Private practitioners are not covered by Act Nos. 1985-33 and 1987-80 if the practitioner is reimbursed by medical assistance.

 (v)  Summer camps are covered by Act Nos. 1985-33 and 1987-80 if the program offered is primarily for one of the groups of children specifically identified in the definition of ‘‘child care services’’: delinquent, dependent, mentally retarded, mentally ill, alcohol or drug dependent.

 (w)  If a county agency contracts with the YWCA for swimming lessons for mentally retarded children, the YWCA is not considered a child care service unless the swimming program is specifically identified as a service for mentally retarded children. The fact that a mentally retarded child is present either in a group of ‘‘regular’’ children who are receiving swimming lessons or a group composed entirely of mentally retarded is considered a child children receiving swimming lessons does not convert the YWCA into a child care service.

 (x)  A county mental retardation casemanager requires clearances depending upon the job duties of the casemanagers. If the case manager’s job duties involve direct contact with children, the individual who applies to be a casemanager is required to submit criminal history and child abuse history information. Section 3490.121 defines ‘‘direct contact’’ as ‘‘care, control, supervision or guidance’’ of a child.

 (y)  A child care service contractor with a pre-existing contract which is renewed on an annual basis is not required to submit clearances each year.

   (1)  Act Nos. 1985-33 and 1987-80 do not provide for annual checks of employes who were either hired before January 1, 1986, or those prospective employes hired after January 1, 1986.

   (2)  There is no rationale to treat current contractors who renew their contracts on an annual basis without interruption of service differently from current employes for purposes of Act Nos. 1985-33 and 1987-80.

 (z)  A new employe of a child care services contractor, who applies for employment after January 1, 1986 is subject to Act Nos. 1985-33 and 1987-80. The employe would be a prospective employe.

 (aa)  The project operator is responsible for the decision that a child care CWEP assignment involves direct contact with children and is in the best position to certify whether or not direct contact with children will be involved when the project position request is made to the employment office in the county assistance office.

 (bb)  Act Nos. 1985-33 and 1987-80 do not apply to all facilities/programs serving children.

   (1)  The acts apply only to facilities/programs primarily serving children. If more than 50% of the population served at a facility or unit within a facility are children, the facility or unit is considered a child care service. ‘‘Facility’’ means a building in which child care services are provided and ‘‘unit’’ means a separate and distinct portion or area of a building, such as an apartment unit, a wing of a building, or a floor of a building in which child care services are provided.

   (2)  The determination of whether a service is a child care service should be based upon the annual population of children cared for by the facility. The census of each facility should be examined on an annual basis to determine if more than 50% of the population is under 17 years of age or younger. If so, the facility is considered a child care service.

 (a)  A person may be hired in a child care position conditionally pending receipt of the clearances if the requirements specified in Act No. 1987-80 and Chapter 3490 (relating to protective services) are met.

 (b)  A person may be hired and placed in a training program prior to receipt of the clearances if the requirements specified in Act No. 1987-80 and Chapters 3480 and 3490 are met.

 (c)  If the applicant states that he has submitted the necessary requests for clearance, but did not make a copy of those requests for clearance, the administrators may not hire the applicant. The administrator shall retain a copy of those requests as a condition of provisional employment.

 (d)  An administrator as a matter of hiring policy may decide not to hire on a provisional basis.

 (e)  The administrator’s most prudent action to attempt to assure that the prospective employe would not be disqualified from employment under section 23.1(d) or (e) of the Child Protective Services Law (11 P. S. §  2223.1(d) or (e)) is to:

   (1)  Ask the applicant whether he will be disqualified under section 23.1(d) or (e) of the Child Protective Services Law and read those sections to the prospective employe.

   (2)  If the prospective employe answers that he would not be disqualified under section 23.1(d) or (e) of the Child Protective Services Law, he is required to affirm or swear to that in writing.

 (f)  Subsection (d) applies to an out-of-State person applying for employment in this Commonwealth. In addition, the applicant shall swear or affirm that he has not been convicted of an equivalent crime as listed in section 23.1(d) or (e) of the Child Protective Services Law in another state within 5 years preceding the application for employment.

 (g)  If the provisional employe does not submit the required clearances to the administrator within 30 calendar days of employment, the administrator has three options:

   (1)  Dismiss the employe until clearances are received.

   (2)  Retain and reassign the employe in a position that does not involve direct contact with children. As used in this subsection, ‘‘direct contact with children’’ means care, supervision, guidance or control of children.

   (3)  Furlough or lay off the employe until the clearances are received. This option is not applicable for Civil Service employes.

 (h)  A prospective operator or administrator of a new facility or agency may not acquire a license pending ChildLine and State Police clearances. Section 23.1(o) of the Child Protective Services Law does not apply to an operator or administrator seeking a license for a new facility or agency.

 (i)  The legal entity of a licensed/operating facility may not provisionally hire an administrator whose job duties involve direct contact with children. Section 23.1(o) of the Child Protective Services Law does not permit a legal entity to hire an administrator for the agency or facility pending clearances. Act No. 1987-80 was intended to allow administrators to hire child care staff to assure adequate supervision of children in care.

 (j)  Employment begins on the first day of work, rather than when the job is offered or accepted.

 (k)  The administrator may call ChildLine to confirm that the request has been received, processed or returned to the prospective employe. It is suggested that the administrator call between the 20th and 25th day after provisional hire. The number is (717) 783-6211. Staff members are on duty Monday through Friday between 8 a.m. and 4:30 p.m.

 (l)  The administrator needs to have the name, address and social security number of the employe and approximate date when the request was mailed when he calls ChildLine.

 (m)  When the administrator calls ChildLine, he shall confirm whether the request has been received and processed, and the date the response was mailed. ChildLine will not release the results of the clearance.

 (n)  If the applicant has not received the clearance within 7 days after the date ChildLine confirmed it was mailed, the applicant should call ChildLine at (717) 783-6211 for assistance in resolving the problems.

   This section cited in 55 Pa. Code §  6000.31 (relating to child care service).

MONITORING

§ 6000.41. Licensed community residential mental retardation facilities and agencies serving children and non-State operated intermediate care facilities for the mentally retarded serving children.

 (a)  The Department through the Office of Mental Retardation, will monitor licensed community residential mental retardation facilities and agencies for compliance with Act Nos. 1985-33 and 1987-80 routinely as part of the licensure process. The Department of Health will monitor licensed non-State operated intermediate care facilities for the mentally retarded for compliance with Act Nos. 1985-33 and 1987-80 routinely as part of their licensure process. The licensing procedures in this section will be followed by both the Office of Mental Retardation’s and the Department of Health’s licensing inspectors.

 (b)  During each annual licensing inspection, the licensing inspector will request access to the records of new child care employes hired or transferred to child care during the past 12 months—not to precede January 1, 1986. The licensing inspector will review a minimum of a 25% random sample of the records of new child care employes for each facility. The inspector will review the records for:

   (1)  A copy of Form CY113 showing no founded reports of child abuse within 5 years preceding clearance, or showing a founded report of child abuse not within 5 years preceding clearance or showing an indicated report of child abuse but giving justification for hiring person in child care position.

   (2)  A copy of State Police Criminal History Records form showing no criminal convictions listed in Act No. 1985-33 within 5 years preceding clearance.

   (3)  The dates of hire in child care position compared to the dates requests for clearances were mailed to ChildLine, the State Police, and the FBI, if applicable, and the dates clearances were received by the facility or program.

 (a)  Nonlicensed mental retardation children’s programs, such as recreation programs, camps, transportation, family aid services, family support services and homebound instruction programs that are specifically designed for children with mental retardation are covered by Act Nos. 1985-33 and 1987-80.

 (b)  The Department does not have responsibility for these programs for compliance with Act Nos. 1985-33 and 1987-80 since the programs do not require licensure/approval. Therefore, the Office of Mental Retardation will not routinely monitor the programs if the programs are not licensed/approved by the Department.

 County mental retardation programs staff members who provide direct care, supervision, guidance or control of children require child abuse and criminal records clearance. The Office of Mental Retardation will monitor county mental retardation programs to determine compliance with Act Nos. 1985-33 and 1987-80.

Subchapter B. RESERVED BED DAY PROCEDURES FOR HOSPITALIZATION AND THERAPEUTIC LEAVE UNDER 2176 WAIVER

Sec.

 (a)  For purposes of the 2176 Waiver program, a reserved hospital day is a vacancy. As a vacancy, a reserved hospital day is not billable or reportable as a day or unit of waiver services to the County Mental Health/Mental Retardation Program or to the Department.

 (b)  The Department will participate in the cost of an unoccupied bed or program space for a waiver beneficiary while he is receiving inpatient hospitalization when the following exist:

   (1)  The estimated cost of the unoccupied bed or program space is established as part of the interim rate with the provider of services.

   (2)  The interim rate which contains the estimated cost of the unoccupied bed or program space is reconciled to the actual allowable cost. Actual provider costs are reported to the County Mental Health/Mental Retardation Program through their annual audit. The County then reports these costs on the appropriate annual income and expenditure report to the Department for waiver eligible services.

 (a)  The Medical Assistance program provides for a maximum of 60 days of therapeutic leave per calendar year, plus an additional 15 days for other special programs. The additional leave of 15 days shall be included in the individual’s plan of care.

 (b)  As a service day, a therapeutic leave day, within Medical Assistance limits, is subject to payment at the interim rate and reported as a day of waiver service to the County Mental Health and Mental Retardation Program and to the Department.

 (c)  The Department will participate in the cost of therapeutic leave days within Medical Assistance limits when the following exist:

   (1)  The billing rate for a therapeutic leave day does not exceed the interim rate for services established by the County Mental Health/Mental Retardation Program.

   (2)  The interim payments for therapeutic leave are reconciled to actual allowable costs in the County’s annual income and expenditure report to the Department for waiver eligible service.

 (d)  A therapeutic leave day exceeding the Medical Assistance limits of 60 plus 15 days a calendar year is a vacancy. As a vacancy, therapeutic leave days exceeding the Medical Assistance limits are not billable or reported as a day of waiver services to the County Mental Health/Mental Retardation Program or to the Department.

 (e)  The Department will participate in the cost of therapeutic leave days exceeding the Medical Assistance limits through the waiver ineligible portion of the County’s waiver allocation. Home visits and other special programs provided outside the direct control of the service provider should not be restricted by the limits established under the Medical Assistance Program. Beneficiaries should be encouraged to participate in therapeutic leave based on their individual plan of care.

 (f)  The County Mental Health and Mental Retardation Program is responsible for ensuring that providers of service do not report or bill therapeutic leave exceeding the Medical Assistance limits under the waiver eligible portion of the County’s waiver allocation.

Subchapter C. LICENSING

TYPE OF CERTIFICATE OF COMPLIANCE

Sec.

§ 6000.301. Certificate of compliance determination.

 The type of certificate of compliance indicated is determined by the type of noncompliance areas, the total weighted score for vocational and community residential mental retardation facilities, the percentage of compliance with the licensing regulations for adult day care centers and the number of repeated areas of noncompliance.

COMMUNITY RESIDENTIAL MENTAL
RETARDATION FACILITIES AND AGENCIES

§ 6000.302. Computation of weighted score.

 (a)  The total weighted score for each facility shall be computed according to the instructions in the licensing inspection instrument. The individual weights for each licensing inspection instrument item are listed in Appendix A.

 (b)  The distribution of the weighted scores used to determine the type of license to be issued is as follows:

   (1)  Score of 100 through 65 = Regular license.

   (2)  Score of 64 through 43 = Provisional license.

 If there is noncompliance with either of the following two sections at the time the license is to be issued, no license will be issued:

   (1)  Section 6400.13 (relating to maximum capacity)—first sentence. This is a no license regulation for new facilities and for facilities with no occupancy permit.

 If there is noncompliance with any one of the following sections at the time the license is issued, a provisional license is indicated:

   (1)  Section 6400.13 (relating to maximum capacity)—first sentence. This is a provisional regulation for existing facilities that have an occupancy permit, but the occupancy classification is not correct.

   (2)  Section 6400.45 (relating to staff).

   (3)  Section 6400.46(a) and (b) (relating to staff training).

   (4)  Section 6400.103 (relating to evacuation procedures).

   (5)  Section 6400.105 (relating to flammable and combustible materials).

   (6)  Section 6400.133 (Reserved).

   (7)  Section 6400.136 (Reserved).

   (8)  Section 6400.156 (Reserved).

VOCATIONAL FACILITIES

§ 6000.311. Computation of weighted score.

 (a)  The total weighted score shall be computed according to the instructions in the licensing inspection instrument. The individual weights for each item are listed in Appendix B:

 (b)  The distribution of weighted scores used to determine the type of license to be issued is as follows:

   (1)  Score of 100 through 70 = Regular license.

   (2)  Score of 69 through 52 = Provisional license.

 (a)  Compliance with certain sections with a weight of 8 or above is so critical that if there is noncompliance with that section or subsection a regular license cannot be issued.

 (b)  If there is noncompliance with either of the following sections at the time the license is to be issued, no license will be issued:

   (1)  Section 2390.14(a) (relating to fire safety occupancy permit)—weight 8.33. This is a no license regulation for new facilities and facilities with no occupancy permit.

 If there is noncompliance with any of the following sections at the time the license is issued, a provisional license is indicated:

   (1)  Section 2390.14(a) (relating to fire safety occupancy permit)—weight 8.33. This is a provisional regulation for existing facilities that have an occupancy permit, but the occupancy classification is not correct.

   (2)  Section 2390.19 (relating to abuse).

     (i)   Subsection (b)—weight 8.64.

     (ii)   Subsection (c)—weight 8.60.

     (iii)   Subsection (d)—weight 8.76.

   (3)  Section 2390.53 (relating to outside walkways)—weight 8.17.

   (4)  Section 2390.54 (relating to combustible materials)—weight 8.59.

   (5)  Section 2390.63 (relating to lighting)—weight 8.06.

   (6)  Section 2390.64 (relating to handrails)—weight 8.06.

   (7)  Section 2390.68 (relating to hazardous equipment)—weight 8.64.

   (8)  Section 2390.69 (relating to personal protective equipment)—weight 8.65.

   (9)  Section 2390.70 (relating to special signals on equipment)—weight 8.13.

   (10)  Section 2390.71(b) (relating to ventilation)—weight 8.49.

   (11)  Section 2390.75 (relating to nutrition).

     (i)   Subsection (a)(1)—weight 8.37.

     (ii)   Subsection (a)(2)—weight 8.17.

   (12)  Section 2390.81 (relating to exits)—weight 8.42.

   (13)  Section 2390.83 (relating to fire alarms)—weight 8.56.

   (14)  Section 2390.84 (relating to fire extinguishers).

     (i)   Subsection (a)—weight 8.14.

     (ii)   Subsection (c)—weight 8.24.

     (iii)   Subsection (f)—weight 8.14.

     (iv)   Subsection (g)—weight 8.04.

   (15)  Section 2390.101 (relating to communicable disease)—weight 8.37.

   (16 )  Section 2390.102 (relating to first aid staff)—weight 8.15.

   (17)  Section 2390.104 (relating to emergency medical information)—weight 8.32.

ADULT DAY CARE CENTERS

§ 6000.321. Computation of percentage of compliance.

 (a)  If there is 95% compliance or above, a regular certificate is indicated.

 (b)  If there is greater than or equal to 85% but less than 95% compliance, a provisional certificate is indicated.

 If there is noncompliance with any of the following sections at the time the license is issued, a provisional license is indicated:

   (1)  Section 2380.25 (Reserved).

   (2)  Section 2380.41 (Reserved).

REQUIREMENTS FOR ALL TYPES
OF FACILITIES AND AGENCIES

§ 6000.331. Repeated noncompliance areas.

   (1)  Repeated noncompliance areas are determined based on the previous annual, provisional or interim—announced and unannounced—inspections.

   (2)  Repeated noncompliance areas are determined based on areas of noncompliance observed during the previous initial licensing inspection, and not at the time the previous license was issued.

   (3)  If there are one, two or three repeated noncompliance areas—regardless of weight—from the previous licensing inspection to the present licensing inspection, a provisional certificate is indicated.

   (4)  If there are four or more repeated noncompliance areas—regardless of weight—from the previous licensing inspection to the present licensing inspection, no certificate is indicated.

   (5)  If there are one or more repeated noncompliance areas—regardless of weight—in three or more consecutive annual, provisional or interim licensing inspections, no certificate is indicated.

   (6)  For community residential agencies, if the same noncompliance area at one facility is repeated at a different facility operated by the same community residential agency during the next inspection, this is considered a repeated noncompliance area.

 (a)  The weighting and percentage of compliance systems are guidelines used to determine the type of licensing to be issued. It is recognized that in special circumstances these standardized scoring systems may not be in the best interests of the clients and that professional discretion must be exercised.

 (b)  The policies and procedures for the type of certificate of compliance should be the basis for the licensure recommendation. If the Regional Mental Retardation Program Manager disagrees with the type of certificate to be issued based on this chapter, the Regional Mental Retardation Program Manager may make a recommendation that differs from these policies and procedures. If the Regional Mental Retardation Program Manager makes a recommendation for licensure that is inconsistent with the manual instructions, detailed written justification for the variance from the Regional Mental Retardation Program Manager will accompany the licensure packet.

LICENSED/APPROVED CAPACITY

§ 6000.341. Capacity.

 (a)  Licensed/approved capacity is defined as the maximum number of clients or residents who may be served at a facility at any one time. The licensed/approved capacity appears on a certificate of compliance. Capacity is based on the amount of available indoor floor space at the facility. Compliance with all other licensing regulations is measured by onsite observation, record review and interviews. Compliance with staffing ratios is measured by actual attendance on any given day.

 (b)  Licensed/approved capacity does not mean that the facility currently meets all the staffing requirements necessary for that number of clients. Licensed/approved capacity means only that the facility may serve up to the specified number of clients as determined by the application of minimum floor space requirements. The actual number of clients served depends on the facility meeting staffing and other regulations.

 (c)  The capacity of a facility will be increased or decreased only in the following instances:

   (1)  There is renovation or construction of the facility which changes the amount of indoor floor space.

   (2)  There is reallocation of the indoor space.

   (3)  There was an error in the previous calculation of the amount of indoor floor space.

 (d)  The licensed/approved capacity of a currently licensed/approved facility will be adjusted, if necessary, according to this statement of policy in either of the following instances:

   (1)  When the facility’s next renewal certificate of compliance is issued.

 The minimum amount of indoor floor space required for facilities is specified in the appropriate chapter of licensing regulations and further clarified in the corresponding licensing inspection instrument.

   (1)  Community Residential Mental Retardation Facilities—§ §  6400.85(b) and 6400.232 (relating to swimming pools; and awake staff persons) and corresponding sections of the Licensing Inspection Instrument. In addition to the amount of indoor floor space, the licensed/approved capacity for community residential facilities shall also be based upon the type of fire safety approval that the facility has. The licensed/approved capacity shall be based upon the amount of indoor floor space not to exceed the occupancy limit of the facility’s current fire safety approval. For example, if a facility has indoor floor space for 12 residents, but the facility has only a C-3 Certificate of Occupancy from the Department of Labor and Industry which limits occupancy to eight residents, the licensed/approved capacity will be eight.

   (2)  Adult Day Care Centers—§  2380.61 (relating to minimum amount of space) and corresponding section of the licensing inspection instrument. For the adult day care centers, indoor floor space is measured wall to wall, including space occupied by furniture. Hallways and offices are not counted when measuring indoor floor space. Dining areas, kitchens, bathrooms and first aid rooms are counted when measuring indoor floor space if it is clearly documented that the area is used for program purposes for at least 50% of each program day or if it is clearly documented in the facility’s training curriculum that the area is used as an integral part of their training program.

   (3)  Vocational Facilities—§  2390.52 (relating to indoor floor space) and corresponding sections of the licensing inspection instrument.

LICENSURE OF COMMUNITY RESIDENTIAL
MENTAL RETARDATION FACILITIES

§ 6000.351. Licensing criteria.

 (a)  The following criteria should be applied to determine if a facility should be licensed under Chapter 6400 (relating to community homes for individuals with mental retardation).

   (1)  If a facility meets either of the following criteria, the facility is considered a community residential facility and shall comply with Chapter 6400:

     (i)   The facility is leased or owned by the provider agency or County MH/MR Program. The resident does not sign his own lease or own his own home.

     (ii)   An average of more than 10 hours of direct staff contact per week is provided to the facility. Staff may or may not live within the same apartment building or complex.

   (2)  Direct staff contact includes person to person contact spent in training, programming and assisting the resident with daily living skills. It does not include telephone contact and time spent providing transportation to residents.

   (3)  Licensing staff should review written leases and staffing schedules to determine if the criteria in this section apply to a specific individual facility. Following is a matrix that may be helpful in determining applicability of the regulations for a specific facility.

LICENSURE OF ADULT DAY CARE CENTERS
LOCATED IN NURSING HOMES

§ 6000.361. Adult day care centers located in a nursing home.

 (a)  If an adult day care center located in a nursing home serves only nursing home clients, the Department should not license the adult day care center.

 (b)  If an adult day care center located in a nursing home serves one or more public clients (nonnursing home clients), with at least a total of four clients, the Department should license the adult day care center using the following procedures:

   (1)  The inspector asks the provider or inspects the facility to determine if the facility has a current License to Operate a Health Care Facility issued by the Department of Health. This license covers both skilled and intermediate nursing homes. This license should be posted in a conspicuous place in the facility.

   (2)  If the facility has a current Department of Health license, the provider shall acquire a letter from the Department of Health stating that specific space within the nursing home building may be utilized for adult day care.

   (3)  If the provider produces a letter from the Department of Health stating that specific space may be used for adult day care, standard procedures should be followed.

   (4)  If the provider cannot produce a letter from the Department of Health stating that space may be used for adult day care, the Department of Public Welfare cannot license the facility for adult day care and the facility may not provide adult day care to nonnursing home clients.

DUAL LICENSURE OF ADULT DAY CARE
CENTERS AND VOCATIONAL
REHABILITATION FACILITIES

§ 6000.371. Dual licensure.

 (a)  A facility should be licensed under both adult day care center and vocational facility regulations if the regulatory definitions of both sets of regulations are met. The main regulatory distinction between an adult day care center and a vocational facility is that an adult day care center, less than 20% of the client’s programming is comprised of remunerative work experience. In a vocational facility, 20% or more of the client’s programming is comprised of remunerative work experience. The average percentage of remunerative work experience provided to each client over a 12-month period will be considered in this determination.

 (b)  If both adult day care center and vocational facility definitions are met, the following dual licensure procedures apply.

   (1)  Adult day care clients and vocational clients must be served in separate and distinct program areas or groups within the facility. Nonprogram areas such as bathrooms and dining areas can be shared.

   (2)  Apply both sets of regulations, completing two separate licensing inspection instrument scoresheets and two licensing inspection instruments.

   (3)  Apply adult day care and vocational regulations separately. For example, apply 1:7 ratio adult day care clients and 1:15 or 1:20 ratio for vocational facility clients.

   (4)  Issue two separate certificates. It is possible that the adult day care center could receive a regular certificate and the vocational facility could receive a provisional certificate.

   (5)  The facility will appear on licensing printouts as both an adult day care center and a vocational facility.

Subchapter D. [Reserved]

Sec.

§ § 6000.401—6000.404. [Reserved].

   The provisions of these § §  6000.461—6000.474 adopted April 26, 2002, effective March 25, 2002, 32 Pa.B. 2117; reserved February 27, 2004, effective February 21, 2004, 34 Pa.B. 1234. Immediately preceeding text appears at serial pages (288022) to (288043).

Subchapter E. ZONING REQUIREMENTS FOR
LICENSURE OF INTERMEDIATE CARE FACILITIES
FOR THE MENTALLY RETARDED

Sec.

 (a)  Prior to October 3, 1988, a provider who intended to operate a four to eight bed ICF/MR was required to obtain written approval from the local zoning authorities to occupy a single family dwelling with more than three unrelated people. Various zoning officials were reluctant to provide this approval, thus delaying the opening of certain ICFs/MR. By removing the zoning requirement, ICF/MR providers may obtain licensure in a more timely manner.

 (b)  Current and future providers who apply for certificates of compliance from the Department of Public Welfare to operate ICFs/MR are no longer required to submit documentation with the Application for a Certificate of Compliance that zoning approval for the ICF/MR sites has been obtained.

 (c)  The Office of Mental Retardation has informed Department of Health staff from the Division of Long Term Care that ICF/MR providers need not produce, during survey site visits, documentation that zoning has been approved in order for survey staff to recommend that the Department of Public Welfare license and certify the facilities.

Subchapter F. ADMINISTRATION AND
MANAGEMENT OF CLIENT FUNDS

Sec.

§ 6000.521. Administration and management of client funds.

 (a)  The County Mental Health/Mental Retardation Administrator (Administrator) is responsible for compliance with the policies and procedures in this statement of policy.

 (b)  An Administrator should ensure that community residential facilities with which they contract establish policies and procedures on the administration and management of client funds consistent with this statement of policy. Administrators should review and approve the policies and procedures on client funds and monitor the implementation of these policies and procedures.

 (c)  Policies and procedures should include provision for a financial plan to be integrated into each client’s Individual Program Plan to insure the satisfaction of current and future needs. The financial plan should include, at a minimum:

   (1)  Documentation that a client has received assistance in applying for funds and benefits to which the client is entitled by establishing residential intake procedures that identify client eligibility for benefits from all resources and annually reviewing each client’s eligibility for programs—for example, rent rebate, food stamps and the like. A decision not to access benefits shall be approved by the Administrator.

   (2)  A forecast of cash flow, a budget plan and a review of proposed cash needs.

   (3)  A review and analysis of the client’s investments, insurance policies, burial accounts and conserved resources identified by family—for example, burial plots and the like.

   (4)  Development of a room and board contract, if applicable, in accordance with Chapter 6200 (relating to room and board charges).

   (5)  An assessment of the client’s need for supervision or training in money management, or both.

   (6)  Documentation of the client’s desire to receive oversight/training in the management of personal funds.

   (7)  An assessment of the individual client’s need for a representative payee based on the client’s ability to manage the client’s own monies.

 (d)  Policies and procedures should include provision for training clients in the management of personal funds. Training should include at a minimum:

   (1)  Assessing the client’s skills in the management of funds and the need for specific skill training.

   (2)  Specifying goals related to training in the management of personal funds. Goals should be included in the client’s Individual Program Plan, if appropriate.

   (3)  Monitoring of the training program via the client’s Individual Program Plan.

 (e)  Policies and procedures should include provision for the creation of irrevocable burial accounts. The policies and procedures should include:

   (1)  Review of individual client balances and spending patterns to determine if the client has adequate funds to meet present and projected financial needs.

   (2)  Consultation, if appropriate, with the client/the client’s family/interdisciplinary team about other available resources and whether a burial fund or other appropriate arrangements are in the client’s best interests.

   (3)  Review of the client’s insurance records to assure that the burial reserve plus cash surrender value of insurance policies would be adequate to meet anticipated client burial costs.

   (4)  Discussion of the nature of irrevocable burial funds—money can be withdrawn only for burial purposes.

   (5)  Establishment of a separate irrevocable burial reserve, interest-bearing account in the client’s name ensuring the following:

     (i)   Burial reserve funds are deposited either on a one-time basis or through periodic deposits.

     (ii)   Bank statements are received at least annually.

     (iii)   The bank is notified of client address changes.

     (iv)   Pertinent information on the existence of the burial reserve account is filed with the Case Management Unit and provider offices.

     (v)   The client’s family is notified about the existence of the burial reserve account, if appropriate.

     (vi)   For SSI beneficiaries:

       (A)   The Social Security field representative is notified of plans to establish an irrevocable burial account.

       (B)   A brief memorandum is sent to the Social Security Administration field representative stating the client’s name, referencing the initial discussion and attaching a copy of the irrevocable burial agreement.

       (C)   A standard agreement which meets the language requirements of the benefit-issuing agency is used.

 (f)  Policies and procedures should include provision for safeguarding client funds. The policies and procedures should include:

   (1)  A monitoring system to assure continuing eligibility of client benefits.

   (2)  The reporting of changes in client income or living situations to the appropriate benefit-issuing agency.

   (3)  The prompt deposit of client-funds in bank accounts. Client funds in excess of immediate financial obligations should be deposited in interest-bearing accounts where interest is allocated to individual client accounts on at least a quarterly basis.

   (4)  A monitoring system of the client’s checking account, savings account and cash on hand.

   (5)  Policies for client expenditures such as personal needs, movie tickets, vacations, newspaper, toll calls, cable TV and shared costs for fixed assets. A written rationale should be developed for client-shared costs.

   (6)  The establishment of procedures, including maintenance of an inventory, to safeguard client personal property.

   (7)  The maintenance of client funds in a secure manner.

   (8)  A procedure to meet client financial obligations and assure that client charges are made accurately and fairly.

   (9)  The documentation of—by receipt, invoice or expense record—client fund use.

   (10)  The maintenance, on an ongoing basis, of client financial records including, at a minimum, account balances, receipts, expenditures and reconciliations of client account balances.

     (i)   A client financial reconciliation should be completed monthly.

     (ii)   A periodic review of client funds should be conducted at least once a year.

   (11)  The establishment of criteria to determine and recommend payeeship responsibility and review individual assignment annually or as needed.

   (12)  The establishment of representative payee responsibility regarding documentation of money spent on client’s behalf.

   (13)  The prohibition of the commingling of client funds with agency operational funds, the borrowing of funds between clients and staff and the use of client’s money for rewards in behavior management programs.

   (14)  The establishment of procedures to be followed in the event of misappropriation or theft of clients funds or property as defined in Subchapter D (relating to unusual incidents and deaths).

 (g)  An Administrator should:

   (1)  Insure that Mental Retardation Bulletin # 99-87-18, issued November 23, 1987, titled ‘‘Case Management Services’’ is being followed in the area of safeguarding the use of client funds.

   (2)  Insure that policies and procedures specified in subsections (b)—(f) are in place and include reporting and auditing requirements.

   (3)  Monitor by random sampling at least 10% of client inventories against actual existence of the items.

   (4)  Ensure that, as part of the annual audit requirement for a provider, the system of internal control over client funds is evaluated and that a representative sample of individual client accounts are tested as part of the process.

Subchapter G. EARLY INTERVENTION

Sec.

§ 6000.601. Services—statement of policy.

 (a)  It is the policy of the Department as the lead agency, to plan, develop and implement a Statewide, comprehensive, coordinated, multidisciplinary, interagency system of early intervention services that incorporates the 14 components as specified under the Education of the Handicapped Act Amendments of 1986 (20 U.S.C.A. § §  1471—1485). It is further the intent of the Department to develop and implement policies pertaining to each of the 14 components. These policies will be in place by the beginning of the fourth year (Fiscal Year 1990-1991) of the Commonwealth’s involvement in the Education of the Handicapped Act Amendments of 1986, except for the delivery of services under the Individualized Family Service Plan (IFSP) which will be in place at the beginning of the fifth year (Fiscal Year 1991-1992).

 (b)  Components of a Statewide early intervention system shall include the following:

   (1)  A definition of developmentally delayed to be used in this Commonwealth to carry out programs.

   (2)  Timetables insuring availability of appropriate early intervention services for handicapped infants and toddlers before the beginning of the fifth year of the Commonwealth’s participation.

   (3)  A timely, comprehensive, multidisciplinary evaluation of the functioning of each handicapped infant and toddler and the needs of the family to assist the development of the infant and toddler.

   (4)  An individualized family service plan including case management services for each handicapped infant and toddler.

   (5)  A comprehensive childfind system that includes a system for making referrals to service providers that includes timelines and provides for participation by primary referral services.

   (6)  A public awareness program focusing on early identification of handicapped infants and toddlers.

   (7)  A central directory that includes early intervention services, resources and experts available in the State to research and demonstrate projects being conducted.

   (8)  A comprehensive system of personnel development.

   (9)  A single line of responsibility in a lead agency established by the Governor for carrying out the following:

     (i)   General administration, supervision and monitoring of programs and activities receiving assistance to ensure compliance.

     (ii)   The identification and coordination of available resources from Federal, State, local and private sources.

     (iii)   Assignment of financial responsibility to the appropriate agency.

     (iv)   The development of procedures to ensure that services are provided to handicapped infants and toddlers and their families in a timely manner pending resolution of disputes among public agencies or service providers.

     (v)   The resolution of intra- and interagency disputes.

     (vi)   The entry into formal interagency agreements that define financial responsibility of each agency for paying for early intervention services and procedures for resolving disputes and that include additional components necessary to ensure meaningful cooperation and coordination.

   (10)  A policy pertaining to contracting or making other arrangements with service providers to provide early intervention services, including contents of the application used and conditions of the contract or other arrangements.

   (11)  A procedure securing timely reimbursement of funds.

   (12)  Procedural safeguards with respect to programs.

   (13)  Policies and procedures relating to establishment and maintenance of standards to ensure that personnel are appropriately and adequately trained, including:

     (i)   Standards that are consistent with any State approved or recognized certification, licensing, registration or other comparable requirements which apply to the area in which the personnel are providing early intervention services.

     (ii)   The steps the Commonwealth is taking to require the retraining or hiring of personnel that meet appropriate professional requirements of the Commonwealth.

   (14)  A system for compiling data on the numbers of handicapped infants and toddlers and their families in need of early intervention services, the numbers of infants and toddlers and their families served, the types of services provided, and other information required by the Secretary of the United States Department of Education.

   The provisions of this §  6000.601 adopted August 25, 1989, effective August 10, 1989, 19 Pa.B. 3686.

Subchapter H. QUALITY ENHANCEMENT POLICY

Sec.

§ 6000.621. County policy.

 A county policy statement should contain the following elements:

   (1)  A statement of philosophy embracing the concept of quality in services for persons with mental retardation.

   (2)  A statement of methodology to be used by the county to conduct self-assessment. This methodology should support the consumer-oriented principles and practices and include involvement by family, friends, advocates and interested citizens.

   (3)  A description of the responsibility of providers, including staff and board, in enhancing quality in programs provided.

   (4)  A statement that the county and each of its providers will work cooperatively and within standards adopted by the county to develop the provider’s policy on assessment of quality.

   (5)  A statement addressing the incorporation of appropriate components of the definition of quality into the contracts drawn between the county and the providers of the service.

   (6)  A provision that orientation to the concept of quality enhancement be incorporated into staff development programs.

   (7)  A provision to update and refine both county and provider policy on quality enhancement and a mechanism as a result of ongoing feedback from the implementation.

 A county should formulate a separate procedures statement that utilizes its quality enhancement policy. Procedures should ensure that the process is consumer-centered. Procedures should address the methods the county will use to determine whether programs are having a positive effect on people’s lives. At a minimum, these methods should address consumer growth and development and consumer satisfaction. These procedures should contain the following:

   (1)  Methods for conducting annual self-assessments that measure individual consumer concern including growth, development and satisfaction.

   (2)  Methods for conducting an annual self-assessment that measures the availability of services in the county system as a whole. This includes addressing not only the availability of existing services but the need for additional services.

   (3)  Methods for contract monitoring to assure that quality enhancement provisions are being met.

 Elements in the county action plan should include:

   (1)  Identification of persons responsible for quality enhancement activities.

   (2)  Establishment of priorities for implementation and the respective roles identified for members of the partnership.

   (3)  A schedule for county and provider self-assessment, how that self-assessment is to be accomplished and the basis for the assessment. This assessment should include the County Mental Health and Mental Retardation Board and the members of the partnership, as well as provider staff and boards.

   (4)  Time frames for implementation which detail all levels of involvement.

   (5)  Strategy for utilizing the results of the self-assessment.

   (6)  Identification of ways to continually improve the quality of service delivery.

   (7)  Identification of the sources and recipients of technical assistance and training activities.

 (a)  Direct and independent review should include:

   (1)  A review of the county quality enhancement policy statement, county procedures to implement the policy and the county’s most recent action plan.

   (2)  A review of the most recent county self-assessment.

   (3)  Application of the county self-assessment methodology with a sample of consumers including record review and program observation.

   (4)  Verification of the contract provisions addressing quality and reports resulting from contract monitoring by the county.

 (b)  The Office of Mental Retardation will issue a written report in a timely manner as a result of the independent and direct review.

   The provisions of this §  6000.624 adopted November 11, 1989, effective July 1, 1990, 19 Pa.B. 4879.

Subchapter I. SUPPORT FOR INDEPENDENT LIVING

Sec.

§ 6000.641. Criteria for provision of support services.

 (a)  Support is provided in a residential setting in which there are 10 hours or less direct staff contact per week per facility, and residents sign their own lease without agency cosignature or own their own home.

 (b)  Support services are for persons who can live independently and who can generally be expected to pay their own room and board costs.

 (a)  Payment for support for people who live independently is made through the community mental retardation residential or nonresidential allocation and does not require a county match. Support services include the following:

   (1)  Reimbursement for up to an average of 10 hours a week of staff salaries.

   (2)  Minor physical adaptations of the resident’s home to accommodate a handicapping condition.

   (3)  Supplementation of room and board costs.

 (b)  Individuals receiving support to live independently are eligible for Federal funding participation through the Department’s approved 2176 Waiver Program based on the individual’s meeting applicable waiver eligibility requirements.

 In cases where room and board costs are supplemented, there should be documentation on file that the person has applied for and exhausted benefit payments under fuel assistance, food stamps and other public benefit programs that are available for payment of room and board costs.

 Support for people to live independently in the community may be provided in settings that were previously licensed as a community residential facility. Residents of prior licensed settings do not have to move from a community residential facility when they need an average of 10 hours or less of direct staff contact a week, although they are free to do so.

 Persons receiving support to live independently should be reported on the community residential services information system through use of the mental retardation community residential data input form MR 5.

 The person’s ability and willingness to live independently with supports should be verified by the county mental health/mental retardation program based on a recommendation of the person’s interdisciplinary team and assessment of the person’s need for staff support and supervision not to exceed an average of 10 hours per week.

   The provisions of this §  6000.646 adopted January 11, 1991, effective July 1, 1990, 21 Pa.B. 167.

Subchapter J. THERAPIES AND SPECIALIZED SERVICES

Sec.

§ 6000.661. Intent.

 (a)  Therapy and other specialized services are intended to:

   (1)  Provide necessary and appropriate services for individuals with mental retardation whose condition requires the services of a health care or human services professional.

   (2)  Focus on supporting the individual, together with the individual’s family and support staff, to address the individual’s needs to the greatest extent possible and to build upon the individual’s strengths and assets.

   (3)  Be time limited based upon measurable outcomes for the service.

 (b)  A distinguishing aspect of therapies and other specialized services is that they are focused on meeting a specific condition of an individual. Training for staff or family members which is not directly related to the condition does not constitute a therapy or specialized service, but is reimbursable as a training cost if it is relevant to the trainee’s general duties or responsibilities.

 (a)  Each therapy and other specialized service should be specified in the individual’s plan of care, individualized family service plan or habilitation plan and authorized by the county mental health/mental retardation administrator.

 (b)  To be included in the plan of care, each therapy and other specialized service should be based on a written assessment by a qualified professional and the recommendation of the individual’s interdisciplinary team.

 (c)  The plan of care should document the frequency, such as length and number of sessions a month, and duration of services—length of time the service is required—services methods to be employed, the name of the health care professional or agency responsible for the service and expected outcomes.

 (d)  The plan should be reviewed at regular intervals consistent with this title, accepted standards of professional practice and changes in the individual’s condition.

 The definitions in paragraphs (4) and (5) apply to all therapies and specialized services that are approved by the county mental health and mental retardation program:

   (1)  Under the 2176 Waiver Program, including visiting nurse services.

   (2)  Under the Family Resource Services Program—Chapter 6350 (relating to family resource services) and subsequent Family Support Services policy bulletins.

   (3)  Under other programs or services administered by the county mental health and mental retardation program, including community residential services, adult day services and early intervention services.

   (4)  Therapy—A therapy consists of one of the following services:

     (i)   Physical therapy provided by a licensed physical therapist based on either documentation or a prescription for a specific therapy program by a physician.

     (ii)   Occupational therapy by a registered occupational therapist based on either documentation or a prescription for a specific therapy program by a physician.

     (iii)   Speech/language therapy provided by a licensed speech therapist or certified audiologist upon examination and recommendation by a certified or certification-eligible audiologist or a licensed speech therapist.

     (iv)   Visual/mobility therapy provided by a trained visual or mobility specialist/instructor based on an evaluation by a trained mobility specialist/instructor who has recommended a specific therapy program.

     (v)   Behavior therapy provided by a licensed psychologist or psychiatrist based on an evaluation by a licensed psychologist or psychiatrist who has recommended a specific therapy program.

     (vi)   Visiting nurse services provided by a registered nurse or licensed practical nurse based on a prescription by a physician for a specific therapy program.

   (5)  Specialized services—Specialized services, some of which have taken on the name of a therapy, are recognized and reimbursable by the Department for individuals requiring the services, but are not considered therapies for the purpose of this subchapter. Specialized services include: nutrition services, disease prevention procedures, medications training, medical supplies and equipment, family planning, behavioral assessment and related program development, training, supervision and evaluation. A specialized service should be needed for the habilitation of the individual. Habilitation means ‘‘health, social, and other services needed to insure optimal functioning of persons with mental retardation in their home and community’’ (42 CFR 440.180 (relating to home or community-based services)). The same administrative controls which are applicable to specialized therapies also apply to specialized services.

 The county mental health and mental retardation administrator should ensure that the following administrative controls are in place for therapy and specialized services:

   (1)  That the need for service is documented by a written assessment and recommendation for the service by the individual’s interdisciplinary team.

   (2)  That the service incorporated in the individual’s plan is focused on supporting the recipient, family and staff to ameliorate the targeted condition to the greatest extent possible.

   (3)  That the service is provided at a duration and frequency which meets the needs of the recipient as indicated in the recipient’s individual plan.

   (4)  That the service is terminated or changed based on regular reviews by the qualified professional and the county case manager at intervals consistent with accepted standards of professional practice.

   (5)  That appropriate safeguards are implemented to protect the recipient’s rights to treatment and choice.

   (6)  That services meet applicable State, Federal and professional standards and requirements.

   (7)  That the provider is qualified to provide the services and documentation of the provider’s qualifications is maintained by the county mental health and mental retardation program, or its designee.

   (8)  That services are coordinated, reviewed and monitored through the county’s case management system.

 (a)  Some therapies and other specialized services may be available through funding streams apart from the county’s community mental retardation allocation. In keeping with the Mental Health and Mental Retardation Act of 1966 (50 P. S. § §  4101—4704) those sources of funding need to be explored and exhausted prior to funding by the county mental health and mental retardation program. An example of a potential funding source is the Medical Assistance Program, particularly home health services under the State’s Medical Assistance Plan, for individuals eligible for these benefits.

 (b)  Funding for therapies and specialized services authorized by the county mental health and mental retardation administrator is eligible for 100% State funding when the recipient receives services in a community residential facility or other service which qualifies as a new service under section 507 of the Mental Health and Mental Retardation Act of 1966 (50 P. S. §  4507). Funding for therapies and specialized services authorized by the county mental health/mental retardation administrator when criteria for 100% State funding participation are not met is eligible for 90% State funding.

 (c)  Therapy and other specialized services are eligible for Federal financial partcipation under the 2176 Waiver program in accordance with the conditions in the Department’s approved waiver proposal.

 (a)  As a general principle, costs for therapies and specialized services shall be applied to the cost center when costs may be readily classified.

 (b)  County mental health and mental retardation programs should report the cost and utilization of therapy and specialized services received by individuals receiving a community residential service under the community residential cost center on the Annual Income and Expenditure Report.

 (c)  County mental health and mental retardation programs should report the cost and utilization of all therapy and specialized services for all other recipients on the Annual Income and Expenditure Report under the family resource services cost center. If the service was included as part of a negotiated service rate it need not be separately identified as a therapy or specialized service and reported separately. For example, if the service was provided as part of an early intervention service, the costs would be reported under the early intervention cost center.

 (d)  County mental health and mental retardation programs should report annual specialized therapy costs as requested by the Health Care Financing Agency for the 2176 Waiver Program in accordance with reporting instructions issued by the Department.

   The provisions of this §  6000.666 adopted January 11, 1991, effective January 12, 1991, applies retroactively to January 2, 1991, 21 Pa.B. 167.

Subchapter K. EMPLOYMENT

Sec.

§ 6000.681. Employment.

 Persons with mental retardation who are of legal working age should have access to employment and the training necessary to sustain employment.

 (a)  Counties are encouraged to redirect existing resources from traditional adult day services, such as adult developmental training and sheltered workshops, to community-integrated employment opportunities for persons with mental retardation.

 (b)  If additional funding becomes available for adult day services in the future, the funding will be targeted specifically and exclusively for employment opportunities for persons with mental retardation.

 (c)  The Office of Mental Retardation will continue to support the projects sponsored by the Competitive Supported Employment of Pennsylvania (CSEPA) Task Force through local funding arrangements with the participating county mental retardation programs.

   The provisions of this §  6000.682 adopted January 11, 1991, effective January 12, 1991, and apply retroactively to January 2, 1991, 21 Pa.B. 169.