§ 2800.229. Excludable conditions; exceptions.

 (a)  Excludable conditions. Except as provided in subsection (b), a residence may not admit, retain or serve an individual with any of the following conditions or health care needs:

   (1)  Ventilator dependency.

   (2)  Stage III and IV decubiti and vascular ulcers that are not in a healing stage.

   (3)  Continuous intravenous fluids.

   (4)  Reportable infectious diseases, such as tuberculosis, in a communicable state that requires isolation of the individual or requires special precautions by a caretaker to prevent transmission of the disease unless the Department of Health directs that isolation be established within the residence.

   (5)  Nasogastric tubes.

   (6)  Physical restraints.

   (7)  Continuous skilled nursing care 24 hours a day.

 (b)  Exception. The residence may submit a written request to the Department on a form provided by the Department for an exception related to any of the conditions or health care needs listed in subsection (a) or (e) to allow the residence to admit, retain or serve an individual with one of those conditions or health care needs, unless a determination is unnecessary as set forth in subsection (e).

 (c)  Submission, review and determination of an exception request.

   (1)  The administrator of the residence shall submit the exception request. The exception request must be signed and affirmed by an individual listed in subsection (d) and accompanied by a support plan which includes the residence accommodations for treating the excludable condition requiring the exception request. Proposed accommodations must conform with the provisions contained within the resident-residence contract.

   (2)  The Department will review the exception request in consultation with a certified registered nurse practitioner or a physician, with experience caring for the elderly and disabled in long-term living settings.

   (3)  The Department will respond to the exception request in writing within 5 business days of receipt.

   (4)  The Department may approve the exception request if the following conditions are met:

     (i)   The exception request is desired by the resident or applicant.

     (ii)   The resident or applicant will benefit from the approval of the exception request.

     (iii)   The residence demonstrates to the Department’s satisfaction that the residence has the staff, skills and expertise necessary to care for the resident’s needs related to the excludable condition.

     (iv)   The residence demonstrates to the Department’s satisfaction that any necessary supplemental health care provider has the staff, skills and expertise necessary to care for the resident’s needs related to the excludable condition.

     (v)   The residence provides a written alternate care plan that ensures the availability of staff with the skills and expertise necessary to care for the resident’s needs related to the excludable condition in the event the supplemental health care provider is unavailable.

   (5)  The Department will render decisions on exception requests on a case-by-case basis and not provide for facility-wide exceptions.

 (d)  Certification providers. The following persons may certify that an individual with an excludable condition may not be admitted or retained in a residence:

   (1)  The administrator acting in consultation with supplemental health care providers.

   (2)  The individual’s physician or certified registered nurse practitioner.

   (3)  The medical director of the residence.

 (e)  Departmental exceptions. A residence may admit, retain or serve an individual for whom a determination is made by the Department, upon the written request of the residence, that the individual’s specific health care needs can be met by a provider of assisted living services or within a residence, including an individual requiring:

   (1)  Gastric tubes, except that a determination will not be required if the individual is capable of self-care of the gastric tube or a licensed health care professional or other qualified individual cares for the gastric tube.

   (2)  Tracheostomy, except that a determination will not be required if the individual is independently capable of self-care of the tracheostomy.

   (3)  Skilled nursing care 24 hours a day, except that a determination will not be required if the skilled nursing care is provided on a temporary or intermittent basis.

   (4)  A sliding scale insulin administration, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the insulin.

   (5)  Intermittent intravenous therapy, except that a determination will not be required if a licensed health care professional manages the therapy.

   (6)  Insertions, sterile irrigation and replacement of a catheter, except that a determination will not be required for routine maintenance of a urinary catheter, if the individual is capable of self-administration or a licensed health care professional administers the catheter.

   (7)  Oxygen, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the oxygen.

   (8)  Inhalation therapy, except that a determination will not be required if the individual is capable of self-administration or a licensed health care professional or other qualified individual administers the therapy.

   (9)  Other types of supplemental health care services that the administrator, acting in consultation with supplemental health care providers, determines can be provided in a safe and effective manner by the residence.

   (10)  For purposes of paragraphs (1), (4), (7) and (8), a ‘‘qualified individual’’ means an individual who has been determined by a certification provider listed under subsection (d) to be capable of care or administration under paragraphs (1), (4), (7) and (8).

 (f)  Request for exception by resident. Nothing herein prevents an individual seeking admission to a residence or a resident from requesting that the residence apply for an exception from the Department for a condition listed in this section for which an exception must be granted by the Department. The residence’s determination on whether or not to seek such an exception shall be documented on a form supplied by the Department.

 (g)  Record. A written record of the exception request, the supporting documentation to justify the exception request and the determination related to the exception request shall be kept in the records of the residence. The information required by this subsection shall also be kept in the resident’s record.

 (h)  Decisions. The residence shall record the following decisions made on the basis of this section.

   (1)  Admission denials.

   (2)  Transfer or discharge decisions that are made on the basis of this section.

Cross References

   This section cited in 55 Pa. Code §  2800.228 (relating to transfer and discharge); and 55 Pa. Code §  2800.252 (relating to content of resident records).



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