RCPA - Rehabilitation and Community Providers Association


Surrogate Health Care Decision Making
January 19, 2011

The Department of Public Welfare (DPW) has submitted a statement of policy to the Pennsylvania Bulletin which addresses “Procedures for Surrogate Health Care Decision Making” under Title 55 PA Code Chapter 6000. This policy was effective January 15 and applies to administrative entity directors, county mental health and mental retardation administrators, supports coordination organization directors, providers of community mental retardation residential services, state center directors, and directors of non-state intermediate care facilities for the mentally retarded (ICF/MR).

This policy statement is to clarify surrogate health care decision making procedures applicable to persons with mental retardation who are age 18 or older and is relevant to Public Law 1484, Act 169 of 2006 (Advance Health Care Directives and Health Care Decision Making).  However, it is noted that DPW does not have statutory authority to interpret Act 169-2006 and does not assume any liability from the application of these guidelines with respect to private providers. Therefore this policy statement is not binding on these entities and does not offer protection against claims that may impact those private agencies. Agencies are encouraged to consult legal counsel for advice on the implementation of the statues discussed in this policy.


  • Section 417(c) of the MH/MR Act of 1966 survives Act 169 and covers the identification of a surrogate health care decision maker for a resident of a MH/MR facility who has no other surrogate decision maker.
  • Under Section 417 the facility director is made a guardian for the individual and not a Health Care Representative. Act 169 does not affect the rules for the identification of guardians.
  • Under Section 417(c) the facility director’s authority should be construed to include authority to make decisions regarding palliative and life-sustaining care for those in end-state condition and limits the facility director’s authority to decision making after receiving the advice of two physicians not employed by the facility.
This Pennsylvania Bulletin policy replaces the 1998 Office of Developmental Programs (ODP) Bulletin #00-98-08. The contact person is Dr. Jill Morrow-Gorton, ODP medical director (jmorrowgor@state.pa.us).


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