DOH Issues Third Package of Proposed Changes to NF Licensure Regulations

On July 21, 2021, the Pennsylvania Department of Health announced its intent to amend the long-term care regulations.  The Department advised at that time that its proposals would be released in five separate packages.  The first package was released on July 21, 2021, the second was released on October 9, 2021, and the third package was just released on March 19, 2022, Pennsylvania Bulletin (  With the release of the third package, the Department advised that it would combine its planned fourth and fifth packages into one final package and announced its intent to hold meetings with stakeholders to receive comments on the proposed regulations.

In this third package, the Department is proposing significant changes to the application process for new nursing facilities and changes in ownership.  The Department has stated that the purpose of the proposed amendments is to enable it to vet prospective new owners and to address issues related to for-profit ownership of facilities.  It is the Department’s contention that due to the complex ownership structure of many for-profit nursing facilities the Department must obtain additional information from applicants as part of the licensure process.  The following are some of the significant proposed changes to the application process:

  • The Department will require additional contact information for those individuals holding direct or indirect ownership and/or management interests in a facility.  Specifically, the Department will require disclosure of the name, address, email address, and phone number of any individual who holds 5% or more ownership interests in the licensee/operating entity, the real property owner, or the facility management company.  This contact information also would be required for all officers and directors of non-profit organizations who operate nursing care facilities. 
  • The Department will require a list of every licensed facility in any state, District of Columbia, or territory in which the person has or had any percentage of ownership interest.
  • The Department will require any person who is seeking to operate or assume ownership of a nursing facility to provide the licensing and regulatory history in all jurisdictions where they have had direct or indirect ownership interest in a long-term care facility.
  • The Department will require any person seeking to operate or assume ownership of a facility to provide a detailed summary of any current or settled civil or criminal actions filed against them, such as wrongful death actions.
  • The Department will require any person seeking to operate or assume ownership of a facility to provide information regarding any financial failures (e.g. bankruptcy, receivership, mortgage foreclosure, sale or closure of nursing facilities, corporate integrity agreement, debt consolidation or restructuring).
  • The Department will require applicants to provide a proposed staffing and hiring plan, a proposed training plan, a proposed emergency preparedness plan, proposed admissions and discharge agreements, and a detailed budget for 3 years of operations.  The Department plans to create a new unit that will assess the financial information submitted by applicants to determine financial stability.
  • The Department has also included a catch-all provision that will require a person seeking to operate or assume ownership of a facility to provide any additional information the Department may require.

Should there be any issue with an application that is submitted, or should the Department request additional information from an applicant, the Department will allow an applicant to have 30 days to cure defects in their application.  Traditionally the Department has not conducted surveys as part of their CHOW process.  The new proposed regulations state that depending on the circumstances the Department may conduct a survey when there is a change of ownership.  Finally, the Department is proposing to add the name and address of the owner to the license for transparency purposes. 

It should be noted that the application process outlined above will not apply to license renewals.

The remainder of the third package clarifies that all licensees are responsible for adhering to Federal as well as State and local minimum standards.  The Department is also requiring facilities to inform a DOH field office within 24 hours of incidents (outlined in 28 Pa.Code § 51.3) involving residents.  Additionally, the package also proposes to require at least quarterly facility assessments that meet the requirements of 42 C.F.R. § 483.70(e).  The Department proposes to defer to Federal requirements as it relates to Prevention, Control and Surveillance of Tuberculosis, and in the area of Infection Prevention and Control as set forth in 42 C.F.R. §483.80.  Finally, the Department, subject to its review and approval, is proposing to permit a facility to be located in a building that also offers health-related services such as personal care, home health or hospice services, and may share services such as laundry, pharmacy and meal preparations.

There is a 30-day time period (due date April 18, 2022) in which interested persons are invited to submit comments, suggestions, or objections to the proposed regulations.  Comments should be submitted by email to

As always, please do not hesitate to contact us with any questions you may have regarding the Department’s proposed regulations.

Office Number:  717-620-2424

David Marshall –

Jennifer Russell –