reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › GENERAL PROVISIONS › Section 101.1 - Legal base

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This subpart
					 implements the powers and duties of the Department contained in Chapter 8 of
					 the act of July 19, 1979 (P.L. 130, No. 48) added by the act of July 12, 1980
					 (P.L. 655, No. 136) (35 P.S. §§
												448.801-448.821) known as the Health Care
					 Facilities Act and contained in article II of the act (62 P.S.
					 §§
												201-209), as transferred to the
					 Department in Reorganization Plan No. 5 of 1973 (71 P.S. §
												755-5).
(b) This subpart establishes standards which
					 the Department hereby brings to the attention of the officers or other persons
					 having the management of licensed general and special hospitals and which, it
					 is the duty of such officers or such other persons to adopt and to put into
					 practice, pursuant to sections 803 and 806 of the act (35 P.S.
					 §§
												448.803 and
					 448.806).
(c) This subpart establishes the rules and
					 regulations for visitation, examination, and inspection of all licensed general
					 and special hospitals, pursuant to sections 810 and 813 of the act
					 (35
					 P.S. §§
												448.810 and
					 448.813).
(d) This subpart establishes provisions for
					 minimum standards in the construction, maintenance, and operation of hospitals
					 and for the issuance of licenses for general and special hospitals pursuant to
					 sections 803 and 806 of the act.
The provisions of this §
													101.1 issued under section 2102(g)
						  of The Administrative Code of 1929 (71 P.S. §
														532(g)); and under 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
This chapter cited in 55 Pa. Code §
													6100.2 (relating to
						  applicability).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › GENERAL PROVISIONS › Section 101.2 - Construction and amendment

Current through Register Vol. 54, No. 28, July 13, 2024
This subpart establishes minimum standards with which
						licensed hospitals must comply. This subpart is subject to revision and
						reasonable interpretation by the Department in accordance with the changing
						needs for health services in this Commonwealth.
The provisions of this §
													101.2 issued under section 2102(g)
						  of The Administrative Code of 1929 (71 P.S. §
														532(g)); and under 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › GENERAL PROVISIONS › Section 101.3 - Affected institutions

Current through Register Vol. 54, No. 28, July 13, 2024
This subpart shall apply to all general and special
						hospitals within this Commonwealth except those hospitals operated by the
						United States.
The provisions of this §
													101.3 issued under section 2102(g)
						  of The Administrative Code of 1929 (71 P.S. §
														532(g)); and under 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › GENERAL PROVISIONS › Section 101.6 - Contact person

Current through Register Vol. 54, No. 28, July 13, 2024
Any person having questions or comments concerning this
						subpart may address those questions or comments to:
Bureau of Quality Assurance
Pennsylvania Department of Health
Post Office Box 90
Harrisburg, Pennsylvania 17108
The provisions of this §
													101.6 issued under section 2102(g)
						  of The Administrative Code of 1929 (71 P. S. §
														532(g)); and under 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › EXCEPTIONS › Section 101.11 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may, and for justifiable reason, grant
						exceptions to and departures from this subpart when the policy objectives and
						intentions of this subpart are otherwise met or when compliance would create an
						unreasonable hardship but would not impair the health, safety, or welfare of
						any patient.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › EXCEPTIONS › Section 101.12 - Exceptions for innovative programs

Current through Register Vol. 54, No. 28, July 13, 2024
This subpart is not intended to restrict the efforts of
						any hospital to develop innovative and improved programs of management,
						clinical practice, physical renovation, or structural design. Whenever the
						provisions of this subpart appear to preclude any program which may improve the
						capacity of the hospital to deliver higher quality care and services or to
						operate more efficiently, the Department encourages the hospital to request
						appropriate exceptions pursuant to this chapter.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › EXCEPTIONS › Section 101.13 - Requests for exceptions

Current through Register Vol. 54, No. 28, July 13, 2024
Requests for exceptions to this subpart shall be made in
						writing to the Department. Such requests, whether approved or not approved,
						will be documented and retained on file by the Department. Approved requests
						shall be retained on file by the hospital applicant during the period the
						exception remains in effect.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › EXCEPTIONS › Section 101.14 - Revocation of exceptions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Any
					 exception granted under this chapter may be revoked by the Department for any
					 justifiable reason. Notice of revocation will be in writing and will include
					 the reason for the action of the Department and a specific date upon which the
					 exception will be terminated.
(b)
					 In revoking an exception, the Department will provide for a reasonable time
					 between the date of written notice of revocation and the date of termination of
					 an exception for the hospital to come into compliance with the applicable
					 regulations. Failure by the hospital to comply after the specified date may
					 result in enforcement proceedings under this chapter.
(c) If a hospital wishes to request a
					 reconsideration of a denial or revocation of an exception, it must do so in
					 writing to the Director of the Bureau of Quality Assurance of the Department
					 within 30 days of receipt of the adverse notification.
The provisions of this § 101.14 issued under
						  67 Pa.C.S. §§
														6101-6104 (Repealed); and Reorganization Plan
						  No. 2 of 1973 (71 P. S. §
														755-2)
						  (Renumbered).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CLASSIFICATION OF HOSPITALS › Section 101.21 - Classification

Current through Register Vol. 54, No. 28, July 13, 2024
Every hospital licensed under this subpart shall be
						designated as either a general or special hospital, and this classification
						shall be noted on its license.
The provisions of this §
													101.21 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › HOSPITAL REQUIREMENTS › Section 101.31 - Hospital requirements

Current through Register Vol. 54, No. 28, July 13, 2024
A hospital shall have all of the following:
(1) An organized governing body.
(2) A chief executive officer.
(3) An organized medical staff.
(4) An organized nursing staff.
(5) Medical services, continuous.
(6) Nursing services, continuous.
(7) Permanent on-site facilities for the care
					 of patients 24 hours a day.
(8) A
					 hospital-wide infection control program.
(9) Minimum on-site clinical provisions as
					 follows:
(i) Inpatient care areas equipped
					 with hospital furnishings.
(ii)
					 Nursing care units.
(iii)
					 Diagnostic and treatment areas.
(iv) Supplies and equipment to meet the
					 medical and nursing needs of the patients within the scope of the services
					 provided.
(v) Pharmaceutical
					 services in compliance with Chapter 113 (relating to pharmacy
					 services).
(vi) Facilities for the
					 sterilization of equipment and supplies.
(vii) Treatment equipment for drug, blood,
					 and parenteral fluid administration and for performance of medical or surgical
					 nursing procedures.
(viii)
					 Treatment equipment for the management of common medical or surgical, or both,
					 emergencies, including facilities for cardio-pulmonary resuscitation.
(ix) Medical records services.
(x) Provision for medical social work
					 services in compliance with Chapter 121 (relating to social work
					 services).
(xi) Professional
					 library services in compliance with Chapter 145 (relating to professional
					 library services).
(xii) Provision
					 for therapeutic diets.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INITIAL APPLICATION AND AUTHORIZATION TO OPERATE A HOSPITAL › Section 101.41 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will grant the initial license to operate
						a new hospital after a survey conducted by the Department indicates that the
						applicant is in compliance with applicable provisions of this subpart. Such
						survey shall include an on-site inspection and review of written approvals
						submitted to the Department by regulatory agencies responsible for building,
						electric, fire, and environmental safety.
The provisions of this §
													101.41 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
This section cited in 28 Pa. Code §
													101.43 (relating to request for
						  application).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INITIAL APPLICATION AND AUTHORIZATION TO OPERATE A HOSPITAL › Section 101.42 - Building occupancy

Current through Register Vol. 54, No. 28, July 13, 2024
New construction, alterations, or renovations that
						provide space for patient services or patient rooms shall not be used or
						occupied until authorization for such occupancy has been received by the
						hospital from the Department. It is the responsibility of the hospital to
						request a preoccupancy survey at least two weeks prior to the anticipated
						occupancy of a hospital or any addition or remodeled part thereof. The
						Department will conduct an on-site survey of the new or remodeled portion of
						the hospital prior to granting approval for occupancy. The Department, acting
						through the Director of the Division of Hospitals, may give such authorization
						orally, either in person or by telephone. The Department will provide the
						hospital with written confirmation of such oral authorization within 30
						days.
The provisions of this §
													101.42 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803), unless otherwise
						  noted.
This section cited in 28 Pa. Code §
													101.43 (relating to request for
						  application).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INITIAL APPLICATION AND AUTHORIZATION TO OPERATE A HOSPITAL › Section 101.42a - Code compliance

Current through Register Vol. 54, No. 28, July 13, 2024
A hospital shall meet the edition of the National Fire
						Protection Association 101, Life Safety Code and all applicable appendices
						which are currently enforced by the Federal government. Hospitals previously in
						compliance with prior editions of the Life Safety Code will be deemed in
						compliance with any subsequent edition with the exception of any new renovation
						or construction, which shall meet the current standard.
The provisions of this §
													101.42a issued under section 803
						  of the Health Care Facilities Act (35 P. S. §
														448.803); and section 2102(g) of The
						  Administrative Code of 1929 (71 P. S. §
														532(g)).
This section cited in 28 Pa. Code §
													101.43 (relating to request for
						  application).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INITIAL APPLICATION AND AUTHORIZATION TO OPERATE A HOSPITAL › Section 101.43 - Request for application

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will supply the necessary forms for
						application under §§
											101.41,
						101.42 and
						101.42a (relating to principle;
						building occupancy; and code compliance).
The provisions of this §
													101.43 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CONTINUING OPERATIONS › Section 101.51 - Policy

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will issue a license valid for two years
						to any hospital which is in compliance with this subpart.
The provisions of this §
													101.51 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CONTINUING OPERATIONS › Section 101.52 - Nontransfer of license

Current through Register Vol. 54, No. 28, July 13, 2024
A hospital shall advise the Department no later than 90
						days prior to an intended change of ownership or control of the hospital. No
						license shall be transferable to new owners or controlling parties except upon
						a finding by the Department that they are responsible
						persons.
The provisions of this §
													101.52 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CONTINUING OPERATIONS › Section 101.53 - Void license

Current through Register Vol. 54, No. 28, July 13, 2024
The license of a hospital becomes automatically void when
						any or all of the following occur:
(1)
					 The license term expires.
(2) The
					 hospital substantially changes its name or location, in which case a new
					 license will be automatically issued upon application by a hospital if the
					 hospital is otherwise in compliance with the applicable provisions of this
					 subpart.
(3) If the hospital
					 locates or relocates services at a site other than the current, contiguous
					 site, it shall notify the Department 30 days prior to such change in order that
					 the Department may determine if a new license is necessary.
The provisions of this §
													101.53 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CONTINUING OPERATIONS › Section 101.54 - Inpatient bed complement

Current through Register Vol. 54, No. 28, July 13, 2024
A license is issued for approved existing facilities and
						bed complement. A hospital shall notify the Department when increases in bed
						complement are scheduled according to the following guidelines:
(1) If the increased bed complement will
					 increase the total number of beds by more than ten beds or by more than 10% of
					 the total bed capacity, the hospital shall not utilize the increased capacity
					 until approval is obtained from the Department.
(2) If the hospital increases the bed
					 complement by not more than ten beds or 10% of the total bed capacity,
					 whichever is less, during a period of a license, prior approval of the
					 Department is not required, although notification of the change must still be
					 made. A hospital must at all times meet the physical plant, staffing, and all
					 other requirements, as defined by this chapter, if additional beds are
					 added.
The provisions of this §
													101.54 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CONTINUING OPERATIONS › Section 101.55 - Display of license

Current through Register Vol. 54, No. 28, July 13, 2024
The current license shall be displayed in a public and
						conspicuous place in the hospital.
The provisions of this §
													101.55 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CONTINUING OPERATIONS › Section 101.56 - Licensure information/application

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Information regarding licensure must be
					 completed annually on forms supplied by the Department. The Annual Hospital
					 Questionnaire shall be completed each year; the Application for Hospital
					 Licensure shall be completed biennially.
(b) If a hospital operates any number or
					 variety of separate or distinct clinical facilities and has been issued a
					 single license, information requested on the questionnaire and application
					 forms must be separate and distinct according to location of facilities
					 listed.
The provisions of this §
													101.56 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.61 - Policy

Current through Register Vol. 54, No. 28, July 13, 2024
Representatives of the Department will biennially conduct
						a survey of every hospital required to be licensed under this subpart or will
						conduct surveys in conjunction with representatives of accrediting agencies in
						Appendix A and in accordance with §
											101.62 (relating to combined
						survey).
Appendix A appears at the end of Subchapter B, Chapter
						  158.
The provisions of this §
													101.61 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.62 - Combined survey

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A provider
					 may request that the Department consider, during the determination of the
					 Department whether a particular hospital is in compliance with these
					 regulations, the survey report of the Federal government or a nationally
					 recognized accrediting agency if the provider has been issued a regular license
					 covering the particular hospital to be surveyed for the last 3 years.
(b) If a provider requests to be licensed in
					 accordance with subsection (a), it must submit to the Department a copy of the
					 accrediting survey report of the agency within 7 days of receipt.
(c) If a provider requests to be licensed in
					 accordance with subsection (a), it must comply with all requirements of this
					 subpart. The requirements that are not covered by the standard survey of each
					 approved accrediting agency are listed in Appendix B.
(d) The Department will have the sole
					 authority to accept or reject, in whole or in part, the findings of the
					 accrediting agency.
(1) If the accrediting
					 findings of the agency are rejected, a full or partial survey at the discretion
					 of the Department will be conducted by the surveyors of the Department to
					 determine whether a license can be issued.
(2) If the accrediting agency denies
					 accreditation to a provider, a full State survey will be conducted to determine
					 whether a license can be issued.
(3) If a provider chooses not to apply for a
					 license through the accrediting procedure even though qualified to do so under
					 this section, a full State survey will be conducted to determine whether a
					 license can be issued.
(4) For
					 those portions of the accrediting agency survey report which the Department
					 accepts as evidence that the provider is meeting the provisions of this
					 subpart, the provider will be considered to be in full compliance with the
					 corresponding provisions of this subpart.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.63 - Department responsibilities

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will provide the Department of
						Environmental Protection with its schedule for biennial hospital licensure
						inspections at a reasonable time in advance of such inspections. It will also
						be responsible for updating this schedule promptly as required in the event of
						any changes. The Department will exert every effort to coordinate and cooperate
						with DER in the exercise of their duties to enforce all applicable
						environmental, health, sanitation and safety standards under their
						jurisdiction.
The provisions of this §
													101.63 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.64 - Hospital responsibilities

Current through Register Vol. 54, No. 28, July 13, 2024
A hospital shall comply with all applicable
						environmental, health, sanitation, and life-safety standards which are not
						under the direct jurisdiction of the Department. This shall include, but not be
						limited to, radiologic health, sanitation, food service, pharmacy, electric
						wiring and life-safety code compliance. When the hospital has been inspected by
						another regulatory agency, it shall have on the record during the survey by the
						Department written confirmation of compliance as provided by the rules and
						regulations of appropriate agencies.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.65 - Notice of biennial survey

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will give reasonable notice to a hospital
						of its intent to conduct the site visit component of the biennial
						survey.
The provisions of this §
													101.65 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.66 - Presurvey preparation

Current through Register Vol. 54, No. 28, July 13, 2024
Prior to a biennial survey site visit of a hospital by
						the Department, the Department may request from the hospital any documents,
						records, necessary consents to review the records of the hospital held by other
						organizations or agencies, or other information necessary for the Department to
						prepare for the site visit. The hospital shall provide any and all information
						or consents so requested.
The provisions of this §
													101.66 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P.S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P.S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.67 - Access by the Department

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Upon
					 presenting the official Department of Health identification card to the
					 hospital's chief executive officer or his designee, authorized agents of the
					 Department shall have access to the hospital to determine compliance with this
					 subpart. Such access shall include:
(1) Entry
					 to all hospital premises.
(2)
					 Inspection and examination of all of the facilities, records, documents, and
					 phases of operations, as permitted by law, including those relating to
					 compliance with Chapter 103 (relating to governance and management).
(3) Interviewing of any staff, employes,
					 members of the governing body and patients, subject to subsection
					 (b).
(4) Examination of any
					 patient, with his consent.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.68 - Site survey coverage

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may survey onsite only those aspects of
						the hospital as it deems necessary to fully and fairly assess the compliance of
						the hospital with this subpart.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › INSPECTION AND SURVEY ACTIVITIES › Section 101.69 - Documentation

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will document the extent of the compliance
						of a hospital with this subpart in at least one of the following ways:
(1) The statement of a responsible,
					 authorized administrator or staff member.
(2) Documentary evidence provided by the
					 facility.
(3) Answers by the
					 hospital to detailed questions provided by the Department concerning the
					 implementation of any provision of this subpart or examples of such
					 implementation which will enable a judgment about compliance to be
					 made.
(4) On-site observation by
					 surveyors.
(5) Interviews with
					 patients, employes or other persons or sources capable of providing reliable
					 information to the Department.
The provisions of this §
													101.69 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › POSTSURVEY PROCEDURES › Section 101.71 - Policy

Current through Register Vol. 54, No. 28, July 13, 2024
After completion of the site visit, the Department will
						evaluate all relevant information gathered during the survey, formulate its
						compliance findings and determinations, notify the hospital of its findings and
						determinations, and order the hospital to correct, within a specified period of
						time, any deficiencies found.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › POSTSURVEY PROCEDURES › Section 101.72 - Compliance directive

Current through Register Vol. 54, No. 28, July 13, 2024
(a) In
					 the event of noncompliance with any provision of this subpart, the Department
					 will notify the hospital, in writing, of any deficiencies and will direct the
					 officers governing or managing the hospital to take such corrective action as
					 the Department directs or to submit a plan of correction, or to do both, within
					 the time specified by the Department. In its compliance directive and request
					 for plan of correction, the Department will state its findings and the reasons
					 for its determination.
(b) The
					 hospital shall be presumed to be in compliance with any provision of this
					 subpart for which the compliance directive does not cite a
					 deficiency.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › POSTSURVEY PROCEDURES › Section 101.73 - Submission of plan of correction

Current through Register Vol. 54, No. 28, July 13, 2024
Unless Federal regulations require an earlier submission,
						a plan of correction shall be submitted to the Department within the period
						specified by the Department. The plan shall be attested to by the signature of
						the chairman of the governing body or the chief executive officer. The plan of
						correction shall be submitted to the governing body as a whole for its review
						at its next regular meeting.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › POSTSURVEY PROCEDURES › Section 101.74 - Content of plan of correction

Current through Register Vol. 54, No. 28, July 13, 2024
A plan of correction shall address all deficiencies cited
						in the compliance directive of the Department. The plan shall state
						specifically what corrective action is to be taken, by whom, and
						when.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › POSTSURVEY PROCEDURES › Section 101.75 - Public inspection of compliance documents

Current through Register Vol. 54, No. 28, July 13, 2024
Copies of compliance directives and plans of correction
						will be kept readily available by the Department's Division of Hospitals or its
						successor in appropriate regional offices for the purpose of public inspection,
						examination, and duplication at a reasonable cost. Each hospital shall make
						available for inspection and examination by any person a current copy of these
						documents provided to it by the Department.
The provisions of this § 101.75 issued under
						  67 Pa.C.S. §§
														6101-6104 and Reorganization Plan No. 2 of
						  1973 (71 P. S. §
														755-2).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CONTINUING SURVEILLANCE › Section 101.81 - Unannounced surveys

Current through Register Vol. 54, No. 28, July 13, 2024
Whenever the Department has received any complaint or has
						other reasonable grounds to believe that a deficiency exists, the Department
						may without notice to the hospital, investigate, inspect or survey any service,
						facility, or portion of the hospital to which the alleged deficiency
						relates.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › ISSUANCE OF LICENSE › Section 101.91 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will issue hospital licenses to qualified
						facilities. The license will reflect a regular or provisional status of the
						hospital. The license shall apply only to those facilities
						designated.
The provisions of this §
													101.91 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 808 of
						  the Health Care Facilities Act (35 P. S. §
														448.808).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › ISSUANCE OF LICENSE › Section 101.92 - Regular license

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 Department will issue a regular 2-year license to a hospital when that hospital
					 is in full compliance with section 808 of the act (35 P. S. §
												448.808) and is in full or substantial
					 compliance with the provisions of this subpart.
(b) As used in subsection (a), "full
					 compliance" means total compliance; as used in subsection (a), "substantial
					 compliance" means:
(1) That any deficiencies
					 are, individually and in combined effect, of a minor nature such that neither
					 the deficiencies nor efforts toward their correction will:
(i) Interfere with or adversely affect normal
					 hospital operations; or
(ii)
					 Adversely affect any patient's health or safety; and
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › ISSUANCE OF LICENSE › Section 101.93 - Provisional license

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 Department may issue a provisional license, valid for a specified time period
					 of no more than 6 months, when there are numerous deficiencies or a serious
					 specific deficiency in compliance with applicable statutes, ordinances or
					 regulations but when:
(1) The hospital is
					 taking appropriate steps to correct the deficiencies in accordance with a
					 timetable submitted by the hospital and agreed upon by the
					 Department.
(2) There is no pattern
					 of repeat deficiencies over a period of 2 or more years.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › REFUSAL OR REVOCATION › Section 101.101 - Grounds

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Department
					 may revoke or refuse to issue a license for any of the following reasons:
(1) Failure to comply with any compliance
					 directive issued by the Department.
(2) Violation of or noncompliance with this
					 subpart except when the hospital is in full compliance or substantial
					 compliance as defined in §
												101.92(b)
					 (relating to regular license) or otherwise meets the conditions set forth in
					 §
												101.93 (relating to provisional
					 license).
(3) Failure to correct
					 any deficiency pursuant to a plan of correction, unless the Department approves
					 an extension or modification of the plan of correction.
(4) Gross incompetence, negligence or
					 misconduct in operating the hospital.
(5) Fraud, deceit, misrepresentation or
					 bribery in obtaining or attempting to obtain a license.
(6) Lending, borrowing, or using the license
					 of another hospital.
(7) Knowingly
					 aiding or abetting in any way the improper granting of a license.
(8) Mistreating or abusing individuals cared
					 for by the hospital.
(9) A pattern
					 of continued noncompliance, in disregard of regulations, which is corrected
					 only when actively supervised by the Department.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › REFUSAL OR REVOCATION › Section 101.102 - Modification of license

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may modify a license by substituting a
						provisional license for a regular license whenever the Department determines
						that the hospital is not in full compliance or substantial compliance as
						defined in §
											101.92(b)
						(relating to regular license) but the hospital otherwise meets the requirements
						of §
											101.93(b)
						(relating to provisional license).
The provisions of this §
													101.102 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › REFUSAL OR REVOCATION › Section 101.103 - Notice

Current through Register Vol. 54, No. 28, July 13, 2024
Whenever the Department proposes to revoke, modify or
						refuse to issue a license or to issue a provisional license, or to suspend
						admissions or withholds State funds available to the hospital, it will give
						written notice to the hospital by certified mail.
The provisions of this §
													101.103 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
This section cited in 28 Pa. Code §
													101.104 (relating to form of
						  notice); and 28 Pa. Code §
													101.121 (relating to demand for
						  hearing).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › REFUSAL OR REVOCATION › Section 101.104 - Form of notice

Current through Register Vol. 54, No. 28, July 13, 2024
A notice under §
											101.103 (relating to notice) will
						conform to 1 Pa. Code §
											35.14 (relating to orders to show
						cause). The order will specify the reasons for the proposed action of the
						Department and will notify the hospital of its right to a hearing. The order
						will specify the time within which the request of the hospital for a hearing
						must be filed with the Department.
The provisions of this §
													101.104 issued under sections
						  2101-3002 of The Administrative Code of 1929 (71 P. S. §§
														531-732); Articles IX and X of the Public
						  Welfare Code (62 P. S. §§
														901-1059); and Reorganization Plan No. 3 of
						  1975.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CORRECTION OF DEFICIENCY › Section 101.111 - Policy

Current through Register Vol. 54, No. 28, July 13, 2024
Whenever any hospital notifies the Department that it has
						completed a plan of correction and corrected its deficiencies, the Department
						will conduct a survey to ascertain completion of the plan of correction. Upon
						finding full or substantial compliance, as defined in §
											101.92(b) 
						(relating to regular license), the Department may issue a regular
						license.
The provisions of this §
													101.111 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › HEARINGS › Section 101.121 - Demand for hearing

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will convene and conduct a hearing for any
						hospital which requests, in accordance with 1 Pa. Code §
											35.37 (relating to answers to
						orders to show cause) and this chapter, a hearing to contest an order to show
						cause issued pursuant to §
											101.103 (relating to
						notice).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › HEARINGS › Section 101.122 - Conduct of proceedings

Current through Register Vol. 54, No. 28, July 13, 2024
Any administrative hearing held pursuant to this subpart
						shall be conducted in accordance with 1 Pa. Code Part II (relating to general
						rules of administrative practice and procedure).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › ADDITIONAL REMEDIES › Section 101.141 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will enforce this subpart and its
						recommendations and directives through all lawful and appropriate
						means.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › ADDITIONAL REMEDIES › Section 101.142 - Withhold State funds

Current through Register Vol. 54, No. 28, July 13, 2024
After proper notice and the opportunity for a hearing,
						the Department may withhold, in whole or in part, any and all State funds
						available to any hospital which does either:
(1) Fails to comply with a compliance
					 directive without having timely requested a hearing.
(2) Operates without a valid
					 license.
The provisions of this §
													101.142 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › ADDITIONAL REMEDIES › Section 101.143 - Judicial proceedings and injunctions

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may request the Office of Attorney General
						to institute appropriate legal proceedings to enforce compliance with this
						subpart.
The provisions of this §
													101.143 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CHILD ABUSE › Section 101.151 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
All hospitals shall comply with the Child Protective
						Services Law,
						23 Pa.C.S. §§
												6301-6384, and with any regulations
						promulgated thereunder by the Department of Public Welfare.
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CIVIL RIGHTS › Section 101.161 - Principle

Current through Register Vol. 54, No. 28, July 13, 2024
Hospitals shall comply with the Pennsylvania Human
						Relations Act (43 P. S. §§
												951-963) and 16 Pa. Code Part II, Subpart A
						(relating to Human Relations Commission).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CIVIL RIGHTS › Section 101.162 - Civil rights compliance

Current through Register Vol. 54, No. 28, July 13, 2024
Civil rights compliance shall be a condition required for
						the issuance of a license. The Department may make onsite visits at its
						discretion to verify the civil rights compliance status of the
						hospital.
The provisions of this §
													101.162 issued under section
						  2102(g) of The Administrative Code of 1929 (71 P. S. §
														532(g)); and section 803 of
						  the Health Care Facilities Act (35 P. S. §
														448.803).
Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part IV - Health Facilities › Subpart B - General and Special Hospitals › Chapter 101 - GENERAL INFORMATION › CIVIL RIGHTS › Section 101.163 - Compliance requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Inpatient and outpatient care including all clinic locations, emergency room
					 care and any contracted services for patients shall be provided without regard
					 to race, color, national origin, sex or sexual preference or
					 religion.
(b) All patients shall be
					 assigned to rooms, floors and sections in accordance with their medical
					 needs.
(c) Patients shall not be
					 asked whether they are willing or desire to share a room with a person of
					 another race or religion.
(d)
					 Employes shall be assigned to patient services without regard to the race,
					 color, national origin, or religion of either the patient or employe.
(e) Transfer of patients from rooms assigned
					 or selected, or both, shall not be made for other than valid medical
					 reasons.
(f) At discharge, patients
					 shall be referred only to those skilled nursing care facilities, intermediate
					 care facilities, personal care facilities or foster homes which are not known
					 to the hospital to be in noncompliance with the provisions of the Pennsylvania
					 Human Relations Act (43 P. S. §§
												951-963). The hospital shall report
					 immediately to the Compliance Office of the Department all instances of
					 posthospital discriminatory practices experienced by patients referred by the
					 hospital when such practices are brought to the attention of the
					 hospital.
(g) All training programs
					 and opportunities offered by the hospital shall be open to qualified applicants
					 without regard to race, creed, color, national origin, sex, or, in nonsectarian
					 hospitals, religion; and recruitment efforts for these shall include sources
					 having potential racial minority applicants.