Thursday, December 14, 2006

PA Licensure of Home Care Agencies

On July 7, 2006, Governor Rendell signed Act 69 of 2006 requiring licensure of Home Care Agencies (HCA) and Home Care Registries (HCR). The PA Department of Health was required to publish licensure regulations before July 7, 2007. Proposed regulations were recently published.

Act 69 (P. L. 334, No. 69) amended the
Health Care Facilities Act (35 P. S. §§ 448.101--448.904b) to require licensure of HCAs and HCRs. The Act will take effect upon publication of final regulations.

The following references are provided
here on the Department's website:

  • To view the amended Health Care Facilities Act, click here. [PDF format, 40 pages] Requirements applicable to HCAs and HCRs are now part of the Act.
  • To view general regulatory requirements applicable to HCAs, HCRs, and all other Health Care Facilities under Title 28 Pa. Code Chapter 51, click here. [PDF format, 10 pages]
  • To view the draft Home Care Agency/Registry regulations, click here. [PDF format, 20 pages]
HCAs and HCRs provide non-medical services to individuals in their home or in another independent living environment. Services provided include:
  • Assistance with self-administered medications.
  • Personal care such as assistance with personal hygiene, dressing and feeding.
  • Homemaking such as assistance with household tasks, housekeeping, shopping, meal planning and preparation and transportation.
  • Companionship.
  • Respite care such as assistance and support provided to the family.
  • Other nonmedical services.
The proposed regulations were published for public comment in the Pennsylvania Bulletin on Saturday, December 9, 2006, in its Volume 36, Number 49. The publication notice, entitled "Home Care Agency/Home Care Registry Stakeholder Meetings; Draft Licensure Regulations Available for Review", is found here at 36 Pa.B. 7465.

The Notice announced that "Stakeholder meetings" on the draft regulations had been scheduled. These were scheduled for: December 7th at the Harrisburg State Hospital in Harrisburg, PA; December 12th at the Muhlenberg Hospital Center in Bethlehem, PA; and December 15th at the Mayview State Hospital in Bridgeville, PA (near Pittsburgh). Pre-registration was required for an oral presentation at a public meeting.

The Department provided the following summary of Act 69 & the requirements of HCAs/HCRs

Under Act 69, a HCA or HCR is required to:
  • Conduct criminal background checks on all staff.
  • Conduct TB screens for all staff and contractors with direct consumer contact.
  • Ensure the competency of individuals that provide care by making sure they:
    • Possess a valid nurses license; or
    • Have successfully completed at least one of the following:
      • Nurse aide training program approved by the state, or
      • Personal care training program approved by the state, or
      • Competency examination for persons only providing IADL (Instrumental Activities of Daily Living).
    • For current employees, the HCA or HCR has two (2) years to ensure that those employees are in compliance with one of these competency requirements.
  • Maintain documentation to show direct care workers have required skills, criminal background checks, and required TB screening.
  • Supervise employees to ensure they have the proper skills to provide the care required by consumers.
  • Provide information to consumers regarding:
    • The consumer's right to be involved in the service planning process.
    • The consumer's right to receive services with reasonable accommodations.
    • The consumer's right to receive ten (10) days advance notice of termination of service(s).
    • The consumer's right to access the Department of Health's 24-hour hotline and local ombudsman program.
  • Provide information to the consumer concerning the services that will be provided, the hours when services will be provided, fees, and total costs.
  • Inform the consumer whether the direct care worker is an employee or independent contractor.
  • Inform the consumer of the tax obligations and employment responsibilities of HCA/HCR and consumer with regard to the direct care workers.
  • Provide documentation to consumers that demonstrates personal face-to-face interviews with all employees or independent contractors.
Under Act 69, HCAs or HCRs may not:
  • Assume Power of Attorney or guardianship over a consumer utilizing the services of the HCA or HCR.
  • Require a consumer to endorse checks over to the HCA or HCR.
Under Act 69, the Department is required to:
  • Work with and consult the Pennsylvania Departments of Aging and Public Welfare to develop regulations to implement the licensing program for HCAs and HCRs.
  • Collect an annual licensing fee.
  • Determine HCA/HCR compliance with licensure requirements through on-site surveys, interviews with office staff and individuals providing care, and reviews of documents.
  • Identify deficiencies.
  • Require plans of correction for deficiencies.
  • Investigate complaints.
A private website, CarePathways, lists 379 private-pay or Medicare/Medicaid providers in Pennsylvania that offer either skilled (custodial) or unskilled (supportive) home care services. It describes such care provider services generally here. Its list of providers in Pennsylvania can be reviewed and searched here.