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Last Updated: Oct 12, 2021

The Pennsylvania Department of Health (DOH) has proposed updates to its long-term care nursing facility regulations. These updates will be proposed through five sets of proposed regulations that DOH will publish over the coming months. These regulations were last updated in 1999.  

The first set of proposals were published in July 2021. The second and latest set were published in the October 9, 2021 edition of the Pennsylvania Bulletin.

What does this second set of proposals include?

This second set of proposals update requirements related to alterations, renovations, and construction of long-term care nursing facilities. This set of proposals adds a new chapter to the existing regulations that will apply to plans for alterations, renovations or construction of long-term care nursing facilities submitted approved 6 months after these regulations are published as a final-form rulemaking.

Additionally, this second set of proposals also deletes certain current provisions in the existing regulations regarding closure of facilities. DOH is proposing deletion of these existing provisions to eliminate duplication and to avoid unnecessary confusion and potential conflict between DOH’s regulations and the Federal requirements for long-term care nursing facilities. DOH proposes to add language to clarify that it is using the Federal requirements as the baseline standard for the closure of a long-term care nursing facility.

What did the first set of proposals include?

The first set of proposed regulations focuses on adding 1.4 required hours of direct care for residents each day, increasing the minimum standard from 2.7 to 4.1 hours within a 24-hour period.

This initial set also incorporates references to federal regulations and the Centers for Medicare & Medicaid Services’ (CMS) Long-Term Care State Operations Manual. The existing regulations already incorporate many of the Federal requirements. DOH cites that any burden by the expansion in the proposed regulations to incorporate the remaining federal requirements will only impact those long-term care nursing facilities that do not participate in Medicare or Medicaid, of which only three such facilities do not.

The first set of proposed regulations were published in the July 31, 2021 edition of the Pennsylvania Bulletin and can be accessed here.

How can I submit comments?

Interested parties have 30-days from publication in the Pennsylvania Bulletin to submit comments to DOH. Comments regarding the second set of proposed regulations must be submitted by Nov. 8, 2021 and may be submitted as follows:

By email to:


By mail to:

Lori Gutierrez, Deputy Director
Office of Policy
625 Forster Street
Room 814 Health and Welfare Building
Harrisburg, PA 17120

Comments should reference the following:

Rulemaking 10-222 (Long-Term Care Nursing Facilities, Proposed Rulemaking 2).

What will the next three sets of proposals include?

The next three updates will address change of ownership, staff development, staffing ratios and infection control and prevention. DOH plans to submit the final-form regulations once all five packages of updates move through the state’s regulatory review process. Note that the regulations will apply only to the 692 licensed skilled nursing facilities regulated by DOH. These facilities provide health services to more than 72,000 residents. Personal care homes and assisted living homes are regulated by the Department of Human Services under separate regulations. 

Where Can I Find Additional Information?

The Pennsylvania Medical Society (PAMED) will continue to monitor for the publication of the additional four installments of proposed regulations and alert members when these proposals are published and how to provide comments. 

For a comprehensive list of regulatory items that PAMED is tracking, please visit PAMED's Regulatory Update.

For further information on legal topics, visit PAMED’s Legal Resource Center at  www.pamedsoc.org/LegalResourceCenter. PAMED's Legal Resource Center provides quality, timely legal advocacy and resources for member physicians who practice in Pennsylvania.

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