Pennsylvania Code
Title 55 - HUMAN SERVICES
Part VIII - Intellectual Disability and Autism Manual
Subpart A - Statements of Policy
Chapter 6000 - STATEMENTS OF POLICY
Subchapter R - PROCEDURES FOR SURROGATE HEALTH CARE DECISION MAKING
STATUTES
Appendix F - RELATED LAWS, REGULATIONS AND POLICIES
The incident management and reporting detailed in this subchapter are related to a variety of laws, regulations and policies. The applicable licensing regulations (and facilities licensed under those regulations) include:
Related Laws:
* The Mental Health and Mental Retardation Act of 1966 (50 P. S. §§ 4101-4704)
* Title XIX Social Security Act (42 U.S.C.A. §§ 1396 - 1396v)
* 18 Pa.C.S. § 2713 (relating to the neglect of care-dependent person)
* The Child Protective Services Law (23 Pa.C.S. §§ 6301-6385)
* The Older Adults Protective Services Act (35 P. S. §§ 10225.101-10225.5102)
* Elder Care Payment Restitution Act (35 P. S. §§ 10226.101-10226.107)
* Early Intervention Services System Act (11 P. S. §§ 875.101-875.503)
* The Whistleblower Law (43 P. S. §§ 1422-1428)
Title 55 of the Pennsylvania Code.
* Chapter 20-Relating to Licensure or Approval of Facilities and Agencies
* Chapter 2380-Relating to Adult Training Facilities
* Chapter 2390-Relating to Vocational Facilities
* Chapter 3490-Relating to Child Protective Services
* Chapter 3800-Relating to Child Residential and Day Treatment Facilities
* Chapter 5310-Relating to Community Residential Rehabilitation Services for the Mentally Ill
* Chapter 6400-Relating to Community Homes for Individuals with Mental Retardation
* Chapter 6500-Relating to Family Living Homes
* Chapter 6600-Relating to Intermediate Care Facilities for the Mentally Retarded
Title 6 of the Pennsylvania Code (Aging).
* Chapter 11-Relating to Older Adult Daily Living Centers
Related Policy Guidelines:
* Medical Assistance Bulletin-Revised Medical and Treatment Self-Directive Statement: Your Rights As a Patient In Pennsylvania: Making Decisions About Your Care and Treatment (effective June 19, 1998)
* Mental Retardation Bulletin 00-98-08-Procedures for Substitute Health Care Decision Making (effective November 30, 1998)
* Mental Retardation Bulletin 00-94-32-Assessments: Lifetime Medical History (effective December 6, 1994)
* Mental Retardation Bulletin 00-03-01-Passage of Act 171 relating to the Older Adults Protective Services Act (OAPSA)
ADDITIONAL REPORTING:
In addition to the reporting methodologies described in this statement of policy, the following is provided as a guide to assist in identifying additional reporting. This does not fully define, nor is it intended to substitute for, the applicable statutes and regulations.
Reportable incidents involving individuals who reside in facilities licensed as ICF/MRs (both state and privately-operated), are to be reported to the appropriate Regional Field Office of the Pennsylvania Department of Health, Division of Intermediate Care Facilities.
Reportable incidents that occur in facilities licensed by OMR, involving individuals whose support needs are not funded through the Commonwealth or county mental retardation systems, are to be reported to whomever funds the individual's support and to the Commonwealth/Regional Office of Mental Retardation. This includes individuals from other states, individuals who are funded by agencies not part of the mental retardation system and individuals whose support needs are privately funded.
Neglect of care-dependent person (18 Pa.C.S. § 2713)
The neglect of care-dependent person 18 Pa.C.S. § 2713 covers any adult who, due to physical or cognitive disability or impairment, requires assistance to meet his needs for food, shelter, clothing, personal care or health care. 18 Pa.C.S. § 2713 extends to certain listed facilities and to home health services provided to care-dependent persons in their residence. The statute criminalizes intentional, knowing or reckless conduct by a caregiver which results in bodily injury or serious bodily injury to a care-dependent person by the failure to provide treatment, care, goods or services necessary to preserve the health, safety or welfare of a care-dependent person for whom the caregiver is responsible to provide care. A caregiver may also be prosecuted if he intentionally or knowingly uses a physical restraint, a chemical restraint or medication on a care-dependent person, or isolates that person, contrary to law or regulation, such that bodily or serious bodily injury results.
Anyone aware of possible violations of this may make a report to the appropriate law enforcement authorities. The reporting requirements of this bulletin are to be followed even if a report of a possible violation of this statute is made to law enforcement authorities. Copies of the statute were distributed via Mental Retardation Bulletin 00-95-25, issued December 26, 1995 and Mental Retardation Bulletin 00-97-06, issued August 29, 1997.
The Child Protective Services Law (23 Pa.C.S. §§ 6301-6385)
The Child Protective Services Law (CPSL) establishes procedures for the reporting and investigation of suspected child abuse. Certain types of suspected child abuse must be reported to law enforcement officials for investigation of criminal offenses. Children under the age of 18 are covered by the act including those who receive supports and services from the mental retardation system. Providers covered within the scope of this bulletin are required to report suspected child abuse in accordance with the procedures established in the CPSL and the Protective services Regulations. The CPSL defines child abuse as any of the following when committed upon a child under 18 years of age by a parent, person responsible for a child's welfare, an individual residing in the same home as a child or a paramour of a child's parent.
* Any recent act or failure to act that causes non-accidental serious physical injury.
* Any act or failure to act that causes nonaccidental serious mental injury or sexual abuse or sexual exploitation.
* Any recent act or series of such acts or failures to act that creates an imminent risk of serious physical injury or sexual abuse or sexual exploitation.
* Serious physical neglect constituting prolonged or repeated lack of supervision or the failure to provide essentials of life including adequate medical care which endangers a child's life or development or impairs the child's functioning.
Reports of suspected abuse are received by the Department of Public Welfare's (DPW) ChildLine and Abuse Registry (800) 932-0313, which is the central register for all investigated reports of abuse. Individuals who come into contact with children in the course of practicing theirprofession are required to report when they have reasonable cause to suspect on the basis of their medical, professional or other training or experience, that a child is an abused child. Every facility or agency is required by the CPSL to funnel reports to the director or a designee to be promptly reported to ChildLine. The reporting, investigation and documentation requirements of this statement of policy must also be followed when a report of suspected child abuse is made. It must be noted that the definition of abuse found in the CPSL differs greatly from the definition promulgated in this statement. Because of this difference it is possible that an allegation may be "unconfirmed" in terms of the CPSL but still substantiated with reference to these guidelines. Likewise, the scope of reports subject to investigation differs so it is important to be familiar with the requirements of the CPSL.
The Older Adults Protective Services Act (35 P. S. §§ 10225.101- 10225.5102)
The Older Adults Protective Services Act (OAPSA) of 1987 was enacted to protect all Pennsylvanians age 60 and older. The OAPSA established a detailed system for reporting and investigating suspected abuse, neglect, exploitation, and abandonment for care-dependent individuals. Act 13 was signed into law in 1997 as an amendment to the OAPSA. Unlike the other provisions of OAPSA that applied only to adults age 60 and above, Act 13 applied to adults age 18 and above who were considered "care-dependent" individuals and to "care-dependent" individuals under age 18 if they resided in a facility serving individuals over 18. Employees or administrators of a covered entity reported suspected abuse incidents to the local Area Agency on Aging, where indicated, to the Pennsylvania Department of Aging and to local law enforcement pursuant to Chapter 7 of the OAPSA. These requirements existed in addition to the reporting procedures contained in this Bulletin. In 2002, the OAPSA was further amended by the Elder Care Payment Restitution Act.
The Elder Care Payment Restitution Act (35 P. S. §§ 10226.101-10226.107)
The Elder Care Payment Restitution Act eliminated the requirements of Act 13 for which suspected abuse of individuals with mental retardation under the age of 60 was reported to the Area Agency on Aging and in some cases, to the Department of Aging. This act became effective February 9, 2003.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) (Pub lic Law 104-191)
HIPAA and the applicable regulations at 45 CFR Parts 160 and 164 (Privacy Rule) established a set of National standards for the protection of personal health information. The Privacy Rule addresses the use and disclosure of individuals' health information or "protected health information" by organizations subject to the Privacy Rule or "covered entities." The Privacy Rule establishes standards for individuals' rights to understand and control how their personal health information is used. The U. S. Department of Health and Human Services, Office of Civil Rights is responsible to implement and enforce the Privacy Rule.
REPORTING MATRIX
The following is provided as a guide to assist in identifying additional reporting. This does not fully define, nor is it intended to substitute for, the applicable statutes and regulations.
| Reportable Incident | Report to OMR | Report to County1 | Report to AAA2 If 60 or older | Report to ChildLine if under 18 | PA Department of Aging3 If 60 or older | DOH | Local Law Enforcement | Acts 28/264 |
| Death | X | X | If suspicious | If suspicious | If suspicious | If ICF/MR | If suspicious | If the result of neglect |
| Disease Reportable to the Department of Health | X | X | X | |||||
| Emergency Closure | X | X | If ICF/MR | |||||
| Emergency Room Visit | X | X | If ICF/MR | |||||
| Fire | X | X | If ICF/MR | |||||
| Hospitalization | X | X | If ICF/MR | |||||
| Individual to Individual Abuse | X | X | If ICF/MR | |||||
| Injury requiring treatment beyond first aid | X | X | If ICF/MR | |||||
| Law Enforcement Activity | X | X | If ICF/MR | |||||
| Medication Error | X | X | If ICF/MR | |||||
| Missing Person | X | X | If ICF/MR | If person is at risk | ||||
| Misuse of Funds | X | X | If exploitation | If ICF/MR | If it appears that a crime has occurred | |||
| Neglect | X | X | X | X | If serious bodily injury or serious physical injury | If ICF/MR | If serious bodily injury or serious physical injury | If serious bodily injury |
| Physical Abuse | X | X | X | X | If serious bodily injury | If ICF/MR | If serious bodily injury or serious physical injury | |
| Psychiatric Hospitalization | X | X | If ICF/MR | |||||
| Psychological Abuse | X | X | X | X | If ICF/MR | |||
| Restraint | X | X | If ICF/MR | If serious bodily injury | ||||
| Rights Violation | X | X | If ICF/MR | |||||
| Sexual Abuse | X | X | X | X | X | If ICF/MR | X | |
| Suicide Attempt | X | X | If ICF/MR | |||||
| Verbal Abuse | X | X | X | If ICF/MR |
1 If an individual is not funded by OMR or by County MR services a report should be made to the funding agent.
2 Allegations of abuse or neglect involving children under 18 who reside in a facility that primarily serves adults must be reported to Child Line.
3 Allegations of abuse or neglect involving children under 18 who reside in a facility that primarily serves adults must be reported to Child Line.
4 Reporting under Acts 28/26 is only mandated for Commonwealth employees.
This appendix cited in; and 55 Pa. Code § 6000.951 (relating to initial reporter).
