HHS Logo: bird/facesU.S. Department of Health and Human Services

State Residential Care and Assisted Living Policy: 2004

Robert Mollica and Heather Johnson-Lamarche
National Academy for State Health Policy

Janet O'Keeffe
RTI International

March 31, 2005

This report was prepared under contract #HHS-100-01-0025 between the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy and Research Triangle Institute. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Gavin Kennedy, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. His e-mail address is: Gavin.Kennedy@hhs.gov.


Below are the sections and tables associated with State Residential Care and Assisted Living Policy: 2004. Each section is a separate file (available in both PDF and HTML), as well as each state's summary from Section 3 being available as a separate PDF file. To view the material, simply clink on the PDF or HTML link beside it.

NOTE: A Portable Document Format (PDF) file requires Acrobat Reader in order to view it.


TABLE OF CONTENTS

ACKNOWLEDGMENTS [PDF (8 pages)of cover, Table of Contents and Acknowledgments]
SECTION 1: OVERVIEW OF RESIDENTIAL CARE AND ASSISTED LIVING POLICY [PDF (70 pages) ] [HTML]
Introduction [HTML]
Overview of Policy Developments Since 2002 [HTML]
Defining Assisted Living [HTML]
Assisted Living Philosophy [HTML]
Occupancy Requirements and Privacy [HTML]
Disclosure Requirements and Residency Agreements [HTML]
Admission and Retention Criteria [HTML]
Nursing Home Level of Care Issues [HTML]
Services [HTML]
Quality Assurance and Monitoring [HTML]
Medication Administration [HTML]
Training Requirements [HTML]
National Activities [HTML]
Lack of Information About Residential Care Facilities for Consumers [HTML]
Provisions for Residents with Alzheimer's Disease and Dementia [HTML]
Public Financing [HTML]
Medicaid Coverage Options [HTML]
Limitations of Using Waiver Programs to Cover Services in Residential Care and How States Have Addressed Them [HTML]
Enabling Medicaid Beneficiaries to Pay for Room and Board [HTML]
Food Stamps [HTML]
Effect of Medically Needy Rules on the Ability to Pay for Room and Board [HTML]
Medicaid Policy Issues for Housing Investors, Developers, and Operators [HTML]
State Approaches to Reimbursing Services [HTML]
Expanding the Supply of Assisted Living for Low-Income Individuals [HTML]
SECTION 1 Boxes, Figures and Tables
BOX 1-1. State Licensing and Regulatory Approaches [HTML]
BOX 1-2. Examples of Definitions of Assisted Living [HTML]

FIGURE 1-1. Supply Changes [HTML]

TABLE 1-1. Number of Medicaid Waiver Clients in Residential Settings [HTML]
TABLE 1-2. Summary of Activities in Residential Care Policy Since 2002 [HTML]
TABLE 1-3. States with Regulations that Include Assisted Living Philosophy [HTML]
TABLE 1-4. Residency Agreement Provisions [HTML]
TABLE 1-5. Comparison of Disclosure Requirements [HTML]
TABLE 1-6. Medicaid Long-Term Care Spending [HTML]
TABLE 1-7. Nursing Home and Residential Care Supply Data, 2003 [HTML]
TABLE 1-8. States Using Medicaid to Cover Services in Residential Care Facilities [HTML]
TABLE 1-9. Sources of Public Funding for Services in Residential Care Settings [HTML]
TABLE 1-10. Differences Between State Plan and Waiver Services [HTML]
TABLE 1-11. States That Limit Charges for Room and Board [HTML]
TABLE 1-12. Family Supplementation Policy [HTML]
TABLE 1-13. State Rate Setting Approaches [HTML]
TABLE 1-14. New Jersey Rate Schedule [HTML]
TABLE 1-15. Oregon Service Priority Categories and Payment Rates: Assisted Living [HTML]
TABLE 1-16. Texas Reimbursement Rates Effective January 1, 2004 [HTML]
SECTION 2: COMPARISON OF STATE POLICIES [PDF (27 pages)] [HTML]
SECTION 2 Tables
TABLE 2-1. Comparison of State Residential and Assisted Living Regulations: Supply [HTML]
TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics [HTML]
TABLE 2-3. Requirements for Facilities Serving Residents with Dementia [HTML]
TABLE 2-4. Requirements for Resident Agreements [HTML]
TABLE 2-5. Staff Training Requirements [HTML]
TABLE 2-6. Comparison of State Reimbursement Policy [HTML]
SECTION 3: STATE SUMMARIES [PDF,(198 pages) complete section] [HTML]
Alabama [PDF, this state only]( 7 pages) [HTML]
Alaska [PDF, this state only] (8 pages) [HTML]
Arizona [PDF, this state only] (9 pages) [HTML]
Arkansas [PDF, this state only] (12 pages) [HTML]

California [PDF, this state only] (8 pages) [HTML]
Colorado [PDF, this state only] (9 pages) [HTML]
Connecticut [PDF, this state only] (9 pages) [HTML]

Delaware [PDF, this state only](7 pages) [HTML]
District of Columbia [PDF, this state only](7 pages) [HTML]

Florida [PDF, this state only](13 pages) [HTML]

Georgia [PDF, this state only] (7 pages) [HTML]

Hawaii [PDF, this state only](6 pages) [HTML]

Idaho [PDF, this state only](9 pages) [HTML]
Illinois [PDF, this state only](13 pages) [HTML]
Indiana [PDF, this state only] (9 pages) [HTML]
Iowa [PDF, this state only](7 pages) [HTML]

Kansas [PDF, this state only](7 pages) [HTML]
Kentucky [PDF, this state only] (7 pages) [HTML]

Louisiana [PDF, this state only](7 pages) [HTML]

Maine [PDF, this state only](10 pages) [HTML]
Maryland [PDF, this state only](9 pages) [HTML]
Massachusetts [PDF, this state only](9 pages) [HTML]
Michigan [PDF, this state only](9 pages) [HTML]
Minnesota [PDF, this state only] (9 pages) [HTML]
Mississippi [PDF, this state only] (7 pages) [HTML]
Missouri [PDF, this state only](7 pages) [HTML]
Montana [PDF, this state only](9 pages) [HTML]
Nevada [PDF, this state only](9 pages) [HTML]
New Hampshire [PDF, this state only](7 pages) [HTML]
New Jersey [PDF, this state only](8 pages) [HTML]
New Mexico [PDF, this state only](8 pages) [HTML]
New York [PDF, this state only] (11 pages) [HTML]
North Carolina [PDF, this state only](11 pages) [HTML]
North Dakota [PDF, this state only](8 pages) [HTML]

Ohio [PDF, this state only](8 pages) [HTML]
Oklahoma [PDF, this state only](9 pages) [HTML]
Oregon [PDF, this state only](11 pages) [HTML]

Pennsylvania [PDF, this state only](7 pages) [HTML]

Rhode Island [PDF, this state only](8 pages) [HTML]

South Carolina [PDF, this state only](7 pages) [HTML]
South Dakota [PDF, this state only](7 pages) [HTML]

Tennessee [PDF, this state only](8 pages) [HTML]
Texas [PDF, this state only](9 pages) [HTML]

Utah [PDF, this state only](7 pages) [HTML]

Vermont [PDF, this state only](11 pages) [HTML]
Virginia [PDF, this state only](9 pages) [HTML]

Washington [PDF, this state only](12 pages) [HTML]
West Virginia [PDF, this state only](9 pages) [HTML]
Wisconsin [PDF, this state only](11 pages) [HTML]
Wyoming [PDF, this state only](7 pages) [HTML]
SECTION 3 Tables
Alabama. Supply [HTML]

Alaska. Supply [HTML]
Alaska. Medicaid Participation [HTML]
Alaska. Assisted Living Reimbursement Rates, July 1, 2004 [HTML]

Arizona. Supply [HTML]
Arizona. Medicaid Participation [HTML]
Arizona. Arizona Rates by Program Contractor [HTML]

Arkansas. Supply [HTML]
Arkansas. Medicaid Participation [HTML]
Arkansas. Assisted Living Waiver Program Tiers and Daily Rates [HTML]
Arkansas. Tier Calculation Point Scale [HTML]

California. Supply [HTML]

Colorado. Supply [HTML]
Colorado. Monthly Rates 2004 [HTML]
Colorado. Medicaid Participation [HTML]

Connecticut. Supply [HTML]
Connecticut. Medicaid Participation [HTML]

Delaware. Supply [HTML]
Delaware. Medicaid Participation [HTML]
Delaware. Reimbursement Levels [HTML]

District of Columbia. Supply [HTML]

Florida. Supply [HTML]
Florida. Medicaid Participation [HTML]
Florida. Admission Requirements [HTML]

Georgia. Supply [HTML]
Georgia. Intermediate Level of Care [HTML]
Georgia. Medicaid Participation [HTML]

Hawaii. Supply [HTML]

Idaho. Supply [HTML]
Idaho. Levels of Care [HTML]
Idaho. Criteria for Determining Nursing Home Need [HTML]
Idaho. Medicaid Participation [HTML]

Illinois. Supply [HTML]
Illinois. Medicaid Participation [HTML]
Illinois. Rates by Geographic Area [HTML]

Indiana. Supply [HTML]
Indiana. Medicaid Participation [HTML]
Indiana. Indiana Service Payment System [HTML]

Iowa. Supply [HTML]
Iowa. Medicaid Participation [HTML]

Kansas. Supply [HTML]
Kansas. Medicaid Participation [HTML]

Kentucky. Supply [HTML]

Louisiana. Supply [HTML]

Maine. Supply [HTML]
Maine. Medicaid Participation [HTML]

Maryland. Supply [HTML]
Maryland. Medicaid Participation [HTML]
Maryland. Maryland Medicaid Payment System [HTML]
Maryland. Maryland Level of Care Differences--Staff Capacities [HTML]

Massachusetts. Supply [HTML]
Massachusetts. Medicaid Participation [HTML]

Michigan. Supply [HTML]
Michigan. Michigan Level of Care Criteria [HTML]
Michigan. Medicaid Participation [HTML]
Michigan. Licensing Fees [HTML]

Minnesota. Supply [HTML]
Minnesota. Participation [HTML]
Minnesota. Minnesota Case-Mix Categories and Maximum Statewide Rate Limits for Assisted Living and All Other Waiver Services-- Effective 7/01/03-6/30/05 [HTML]

Mississippi. Supply [HTML]
Mississippi. Medicaid Participation [HTML]

Missouri. Supply [HTML]
Missouri. Medicaid Participation [HTML]

Montana. Supply [HTML]
Montana. Medicaid Participation [HTML]

Nebraska. Supply [HTML]
Nebraska. Medicaid Participation [HTML]
Nebraska. Nebraska Payment Rates for Assisted Living Facilities [HTML]
Nebraska. Nebraska Payment Rates for Nursing Facility Conversion Program Facilities [HTML]

Nevada. Supply [HTML]
Nevada. Medicaid Participation [HTML]
Nevada. Adult Residential Care Levels of Service [HTML]

New Hampshire. Supply [HTML]
New Hampshire. Medicaid Participation [HTML]

New Jersey. Supply [HTML]
New Jersey. Medicaid Participation [HTML]
New Jersey. New Jersey Rate Schedule [HTML]

New Mexico. Supply [HTML]
New Mexico. Medicaid Participation [HTML]

New York. Supply [HTML]
New York. Medicaid Participation [HTML]
New York. Medicaid Regional RUG Rates for Assisted Living Programs in New York [HTML]

North Carolina. Supply [HTML]
North Carolina. Medicaid Participation [HTML]
North Carolina. North Carolina Medicaid Rates [HTML]

North Dakota. Supply [HTML]
North Dakota. Medicaid Participation [HTML]
North Dakota. North Dakota Point System [HTML]

Ohio. Supply [HTML]

Oklahoma. Supply [HTML]

Oregon. Supply [HTML]
Oregon. Oregon Service Priority Categories & Payment Rates: Assisted Living [HTML]
Oregon. Medicaid Participation [HTML]

Pennsylvania. Supply [HTML]

Rhode Island. Supply [HTML]
Rhode Island. Medicaid Participation [HTML]

South Carolina. Supply [HTML]
South Carolina. Medicaid Participation [HTML]

South Dakota. Supply [HTML]
South Dakota. Participation (State and Medicaid Programs) [HTML]

Tennessee. Supply [HTML]

Texas. Supply [HTML]
Texas. Medicaid Participation [HTML]
Texas. Texas Enhanced Reimbursement Rates [HTML]

Utah. Supply [HTML]
Utah. Medicaid Participation [HTML]

Vermont. Supply [HTML]
Vermont. Living Arrangement [HTML]
Vermont. Medicaid Participation [HTML]
Vermont. Public Payments and Regulatory Service Levels [HTML]
Vermont. Payment Areas and Scoring System [HTML]
Vermont. Vermont Rating System [HTML]

Virginia. Supply [HTML]

Washington. Supply [HTML]
Washington. Medicaid Participation [HTML]
Washington. January 1, 2004 ADSA Community Residential Daily Rates [HTML]

West Virginia. Supply [HTML]

Wisconsin. Supply [HTML]
Wisconsin. Medicaid and State-funded Programs Participation [HTML]
Wisconsin. Requirements and Funding Sources [HTML]

Wyoming. Supply [HTML]
Wyoming. Medicaid Participation [HTML]
Wyoming. Payment Rates [HTML]


ACKNOWLEDGMENTS

We would like to acknowledge the following for their contributions to this project: the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services for its financial support; Christine O'Keeffe for her extensive research assistance; and the many people in state agencies through the country who answered questions and provided copies of the statutes, regulations, and reports needed to update this compendium. We greatly appreciate the willingness of these dedicated professionals to share their knowledge and expertise.