States Set Tougher Assisted Living Penalties, Oversight

Beefed-up monetary penalties and oversight requirements were among the most common regulatory changes to hit assisted living in 2017.

That’s according to the 2017 edition of the Assisted Living State Regulatory Review, an annual report issued by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), a Washington, D.C.-based organization that represents senior living and care services such as skilled nursing, assisted living and sub-acute care.

California, Oregon, Rhode Island, and Virginia all passed new laws to related to raising civil monetary penalties and bolstering oversight requirements between June 2016 and June 2017, according to Lilly Hummel, author of the report and senior policy director at NCAL.


“In some way, they were bulking up their ability to ensure there’s good program integrity and that assisted living providers are all complying with the requirements,” Hummel told Senior Housing News. “I think that will be important for ensuring that residents are receiving the best care possible.”

Specifically, legislators in California and Virginia enhanced civil penalties for licensing violations, according to the report.

Oregon, meanwhile, enacted a bill with enhanced oversight and supervision and overhauled fee and fine structures for assisted living providers. In Rhode Island, lawmakers passed legislation requiring licensing agencies to conduct unannounced on-site inspections of all licensed assisted living residences on a biennial basis.


Regulation updates in other states ran the gamut from training requirements and administrator licensing to background checks and medication administration. In total, 17 states reported updates to assisted living requirements this year, according to the report.

“Of the states that did make changes, they made a large variety of changes,” Hummel said. “They really touched all different aspects of assisted living.”

More action on the way

Over the next year, more than half of all U.S. states are expected to propose, formally review or consider changes that would affect assisted living communities. The scope, timeline and likelihood of finalization of those changes widely varies, however.

Many states are also expected to continue reviewing and possibly revising requirements related to the 2014 home- and community-based services (HCBS) waiver rule, which has caused some consternation among some senior living providers. The rule defines what constitutes a “home- and community-based setting,” and there have been ongoing questions about whether certain assisted living communities qualify.

One route that the states could take is to examine their requirements for Medicaid-certified providers and go through a notice and rule-making process for Medicaid requirements.

Alternatively, states could modify their assisted living licensure requirements to comply with the Medicaid HCBS rule.

“All assisted living would then have to be in compliance with the Medicaid HCBS rule, even though some or maybe many of those providers are not Medicaid providers,”  Hummel explained. “What I’m curious to see is, what states do, and how they handle that. I think in the next year or two we should get some clarity on that.”

Written by Tim Regan

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