Nursing Facility

Regulations and Related Policies/Procedures for Nursing Facilities

The information contained on this page includes the regulations, policies and procedures related to nursing facility licensing in Pennsylvania, nursing facility surveys, regulatory compliance and Medicaid and Medicare participation requirements.

The Department of Health is responsible for the licensing and oversight of all Pennsylvania nursing facilities.

The Department of Human Services (DHS), Office of Medical Assistance Programs (OMAP) is the single state agency that administers the joint state/federal Medical Assistance Program. The Office of Long-Term Living (OLTL) within the Department of Human Services (DHS) is responsible for managing and overseeing the long term services and supports continuum within the Medical Assistance program, which includes nursing facility services and home and community-based services.

The Center for Medicare and Medicaid Services (CMS) is an agency within the US Department of Health and Human Services responsible for administration of Medicare which is the federal health insurance program for seniors and Medicaid.

DOH Releases Civil Penalty Assessment Guidelines

NewOn December 19, 2016 the Pennsylvania Department of Health (DOH) released a document entitled Description of the Civil Penalty Assessment Guidelines.

Impact on Nursing Care Facilities:

According to the document any nursing facility with a Division of Nursing Care Facilities (Division) survey exit date on or after January 1, 2017, may be subjected – “when warranted” – to civil penalties (CP) calculated on a per violation, per day basis pursuant to 35 P.S. § 448.817.The regulations allows that a facility “may be assessed a civil penalty by an order of the Department of up to $500 for each deficiency for each day that each deficiency continues.”

The document notes that the Secretary of Health has provided to the Division guidance on how to assess CPs. This specific guidance has not been made available to the public or to Nursing Care Facilities. PHCA IS TAKING STEPS TO SECURE A COPY OF THIS GUIDANCE.

The document also notes that the Secretary has created a special committee to review any mitigating or aggravating circumstances that may warrant deviating from the Secretary’s guidance, which would allow the Division of Nursing Care Facilities to propose an alternative CP. Information on this committee has not been provided to the public or to Nursing Care Facilities. PHCA IS TAKING STEPS TO SECURE INFORMATION ON THE SPECIAL COMMITTEE.

Click here to learn more.

DOH Posts Guidance for Calculating Direct Nursing Care Hours

The Department of Health (DOH) posted guidance on the DOH Message Board regarding the calculation of hours of direct nursing care provided for during each 24 hour period. The guidance includes a table that nursing facilities will be requested to complete by DOH surveyors. The table is designed to document the actual number of hours each nursing staff worked for the identified period.

The guidance also provides examples of staff that should NOT be included in the calculation and hours that MAY be included. The guidance reiterates that a nursing facility’s daily number of hours of care per resident/day (PPD) must be at least 2.7 to meet §211.12(i) (relating to nursing services), if this PPD is not met a citation will be issued. Additionally, nursing facilities are reminded that the direct care hours must be adequate to meet the needs of the residents being served in the facility, this may necessitate staffing that exceeds the minimum requirement of 2.7 PPD.

A copy of the guidance can be found here.

If you have questions regarding the guidance, please contact Dawn Murr-Davidson at dmurrdavidson@phca.org or Gail Weidman at gweidman@phca.org.

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