§ 6210.104. Content of inspections of care.
(a) The inspection by the Inspection of Care Team shall include:
(1) Personal contact with and observation of each recipient.
(2) Review of each recipients medical record. The record shall include timely certification and recertifications by the physician that the services are needed and a written individual plan of care developed either by an interdisciplinary team or the attending or staff physician, whichever is applicable. The plan of care shall indicate time limits and measurable care objectives and goals to be accomplished and who is to give each element of care.
(b) The team shall determine in its inspection if:
(1) The services are available and adequate to meet the recipients physical, mental and psychosocial needs.
(2) It is necessary for the recipient to remain in the facility.
(3) Each recipient is receiving active treatment.
(4) The recipients medical and social evaluations and the plan of care are complete and current, are followed, and ordered services are provided and recorded.
(5) The recipient receives adequate services based on personal observations of the Inspection of Care Team.
(6) Service needs are met by the facility or by outside arrangements.
(7) The recipient needs continued placement in the facility or there is an appropriate plan to discharge the recipient to an alternative living arrangement.
This section cited in 55 Pa. Code § 6210.101 (relating to scope of claims review procedures).
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