State Residential Care and Assisted Living Policy: 2004

SECTION 2. COMPARISON OF STATE POLICIES

March 31, 2005

PDF File


SECTION 2, TABLE OF CONTENTS

LIST OF TABLES
TABLE 2-1. Comparison of State Residential and Assisted Living Regulations: Supply
TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics
TABLE 2-3. Requirements for Facilities Serving Residents with Dementia
TABLE 2-4. Requirements for Resident Agreements
TABLE 2-5. Staff Training Requirements
TABLE 2-6. Comparison of State Reimbursement Policy


TABLE 2-1. Comparison of State Residential and Assisted Living Regulations: Supply
State Category 2004 2002 2000 CoN
Facilities Units/Beds Facilities Units/Beds Facilities Units/Beds
AL Assisted living facilities 335 9,876 327 9,738 304 8,000 N
AK Assisted living homes 162 1,650 143 1,497 123 1,346 N
AR Residential long-term care facilities 111 4,369 122 4,647 152 5,438 Y
Assisted living facilities 6 275 NA NA NA NA Y
AZ Assisted living facilities 1,509 24,500 1,524 24,002 1,242 22,848 N
CA Residential care facilities for elderly 6,543 154,830 6,207 147,580 6,152 136,719 N
CO Assisted living residences 525 13,799 538 14,291 551 13,868 N
CT Assisted living service agencies 65 NA 63 NA 48 NA N
Residential care homes 101 2,753 109 2,949 113 3,015 Y
DC Community residence facilities 200 1,866 NR NR NR NR N
DE Rest residential homes 3 NR 6 160 4 99 N
Assisted living 29 1,738 27 1,300 18 927 N
FL Assisted living facilities standard 2,250 74,762 2,328 78,348 2,361 77,292 N
Limited nursing services
Assisted living extended congregate
GA Personal care homes 1,687 25,434 1,648 25,563 1,606 24,437 Y/M
HI Assisted living facilities 7 1,008 3 354 0 0 N
Adult residential care home 542 2,882 545 2,882 552 2,866
Expanded care adult residential care home 77 157
ID Residential and assisted living facilities 266 6,160 253 5,815 226 5,185 N
IL Assisted living facilities 120 5,830 24 1,667 NA NA N
Shelter care facilities 149 8,484 156 8,240 156 8,302 N
Shared housing 13 92 NR NR NR NR N
IN Residential care facilities 147 11,767 140 11,555 127 10,098 N
IA Assisted living programs 184 5,220 154 4,180 78 3,409 N
KS Assisted living 191 7,971 129 5,658 80 4,521 N
Residential health care facility 98 2,918 43 2,355 N
KY Assisted living communities 83 NA 73 NA 6 NA N
Personal care homes 204 7,389 204 7,792 201 NR N
LA Personal care homes 44 286 29 176 33 216 N
Assisted living 67 4,157 66 3,906 66 3,119 N
ME Assisted living programs 30 1,429 24 1,133 14 799 N
Residential care facilities - 1 (I-IV 2004)
Residential care facilities - II-IV		 711 7,593 473
192		 1,711
5,220		 509
189		 1,799
4,094		 N
N
MD Assisted living programs 1,248 17,148 2,000 14,273 2,500 NR N
MA Assisted living residences 171 10,585 139 9,796 139 8,200 Y
MI Homes for the aged 190 14,588 188 14,500 NR NR N
Adult foster care: small group homes
Adult foster care: large group homes
Adult foster care: congregate homes		 4,265 32,915 4,353 33,317 3,735 26,015 N
N
N
MN Housing with services establishments 931 NA 600 NA 592 NA N
MO Residential care facilities I 280 6,363 285 6,533 313 7,030 Y
Residential care facilities II 363 15,434 363 15,106 364 15,405 Y
MS Personal care homes 194 4,197 207 5,137 197 4,568 Y
MT Personal care facilities 177 3,730 149 3,276 127 2,600 N
NE Assisted living facilities 259 9,187 227 8,369 167 7,077 N
NV Residential care facilities for groups 300 4,021 374 NR 326 4,581 N
NH Supported residential care facilities 137 4,013 148 3,936 75 2,797 N
Residential care home facilities 67 769 N
NJ Assisted living residences 152 13,696 129 11,645 91 8,672 Y
Assisted living programs 13 NA 17 NA 16 NA Y
Comprehensive personal care homes 43 2,388 41 2,642 29 1,752 Y
NM Adult residential care 346 NR 305 NR 255 NR N
NY Adult care homes 431 32,859 449 34,805 453 33,589 N
Enriched housing programs 90 7,227 83 5,308 44 3,147 N
Residences for adults 6 200 8 345 8 464 N
Assisted living programs 57 3,315 53 3,034 45 2,522 N
NC Adult care homes 629 35,247 631 34,776 610 32,995 Y
Family care homes 648 3,642 682 3,816 743 4,134 N
Multi-unit housing with services 23 1,053 20 1,538 NR NR N
ND Basic care facilities 46 1,490 47 1,490 43 1,436 N
Assisted living facilities 42 1,361 NA NA NA NA N
OH Adult care facilities (3-16) 712 5,666 805 5,783 860 6,017 N
Residential care facilities (17+) 510 36,255 462 31,937 439 28,139 N
OK Residential care home 103 3,358 210 8,620 147 8,478 N
Assisted living centers 115 6,308 8 1,253 87 NR N
OR Assisted living facilities 190 12,566 180 11,998 138 8,661 M
Residential care facilities 236 8,504 220 8,227 187 6,805 M
PA Personal care homes 1,718 76,385 1,786 79,929 1,803 73,075 N
RI Assisted living facilities 73 3,676 68 3,270 68 3,196 N
SC Community residential care facilities 504 16,641 545 17,761 553 16,119 N
SD Assisted living centers 162 3,360 153 3,084 127 NR N
TN Assisted care facilities 184 10,699 178 10,495 160 8,691 N
Homes for the aged 155 3,230 166 3,307 198 3,994 N
TX Assisted living facilities 1,378 42,245 1,324 41,424 1,304 39,596 N
UT Assisted living facilities type I 92 1,678 108 1,886 116 1,954 Y
Assisted living facilities type II 49 2,800 43 2,460 26 1,221 Y
VA Assisted living facilities 636 34,598 659 34,200 663 32,768 N
VT Residential care facilities 110 2,302 109 2,213 114 2,351 N
Assisted living residences 3 108 NA NA NA NA N
WA Boarding homes 538 24,498 525 23,830 498 22,140 Y/M
WV Personal care homes NA NA 50 2,310 52 2,342 N
Residential board and care homes NA NA 82 1,498 80 1,197 N
Residential care communities 3 88 3 88 3 88 N
Assisted living residences 113 3,197 NA NA NA NA N
WI Residential care apartment complexes 151 6,001 122 4,452 94 3,211 N
Community-based residential facilities 1,359 21,374 1,350 21,242 1,340 21,064 N
WY Assisted living facilities 15 970 14 1,005 13 960 N
Boarding homes 17 315 NR NR 26 419
Total 36,451 937,601 36,283 909,196 35,066 801,148  
NOTES:
M: Moratorium
NR: Not reported
NA: Not aplicable
AZ: Figures represent combined supply for three categories
GA: CoN applies to facilities serving more than 24 residents


TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics
State Category Size
Definition1		 Apt
Required		 Sharing
by
Choice?2		 Max #
Occupants		 Size-
Single		 Size
2+3		 #/
Toilet		 #/
Bath
AL Assisted living facilities 2 N N 2 80* 130* 6 8
AK Assisted living homes 3 N Y 2 80 140 NS NS
AR Residential long-term care facilities 3 N Y 2 100 160 6 10
Assisted living facilities 3 Y* Y 2 150 230 2 2
AZ Assisted living facilities <10, >10 N Y 2 80/220* 120/320 8 8
CA Residential care facilities for elderly NS N Y* 2 ** ** 6 10
CO Assisted living residences 3 N N 2 100 120 6 6
CT Assisted living service agencies NS* Y Y * * * * *
Residential care homes 2 N Y 2 150 250 4 8
DE Rest residential homes NS N N 4 100 80 4 4
Assisted living NS N Y 2 ** ** NA NA
FL Assisted living faciltiies (standard) 1 N N 2* 80 60* 6 8
Limited nursing services N 2* 6 8
Assisted living extended congregate care Y 2 4 4
GA Personal care homes 2 N N 4 80 60 4 8
Community living arrangements 2 N N 2 NS NS 4 4
HI Assisted living facilities NS Y Y NS 220 NA 1 1
Adult residential care home <6, >6 N N 4 90 70 8 14
ID Residential and assisted living facilities 3 N N 2 100 80 6 8
IL Assisted living facilities 3 N* Y NS NS NS 1 NS
Shelter care facilities NS NS NS 4 70 60 10 15
Shared housing < 12 N NS NS NS NS 4 6
IN Residential care facilities NS N N 4 100 80 8 8
IA Assisted living programs 6 N Y 2 240/70* 340/70 1 1
KS Assisted living 6 Y Y NS 200 NS 1 1
KY Assisted living communities 5 N Y 2 200 200 NA
Personal care homes NS N N 4 NS NS 8 12
LA Personal care homes 2-8 N N 2 100 70 NS NS
Assisted living 2 Y Y 2 250 250* 1 1
ME Assisted living programs NS Y Y NA NA NA NA NA
Assisted living residential care I-IV NS N N 2 100 160 6 10
MD Assisted living programs NS N N 2 80 120 4 8
MA Assisted living residences 3 ** NS 2 NS NS ** **
MI Homes for the aged > 20 N N 4 100 80 8 15
Adult foster care: small group homes < 12 N N 2 80 170 8 8
Adult foster care: large group homes 13-20
MN Housing with services establishments 1 ** ** ** ** ** 10 20
MO Residential care facilities I & II 3 N N 4 70 70 6 20
MS Personal care homes NS N N 4 80 80 6 12
MT Personal care facilities NS N N 4 100 80 4 12
NE Assisted living facilities 4 N N 2 100 80 1* 8*
NV Residential care facilities for groups 3 N N 3 80 60 4 6
NH Supported residential care facilities 2 N N 2 80 140 6 6
Residential care home facilities 2 N N 2 80 140 6 6
NJ Assisted living residences 4 Y Y 2 150 230 1 1
Assisted living programs NS* NA Y NA NA NA NA NA
Comprehensive personal care 4 N Y 2 80 130 NS NS
NM Adult residential care 2 N N 2 100 80 8 8
NY Adult care homes 5 N N 2 100 160 6 10
Enriched housing programs 5 Y Y NS NS NS 3 3
Residence for adults NS N N 2 100 160 6 10
Assisted living programs 5 Y/N Y/N ** ** ** ** **
NC Adult care homes 7 N N 4 100 80 5 10
ND Basic care facility 5 N N NS 100 80* 4 15
Assisted living facilities 5 ** ** ** ** ** ** **
Adult care facilities 3-16 N N 4 80 60 8 8
OH Adult care facilities 3-16 N N 4 80 60 8 8
Residential care facilities 17+ N N 3 100 80 8 8
OK Residential care home NS N N NS 80 60 6 10
Assisted living centers 2 N N 2 ** ** 4 4
OR Assisted living facilities 6 Y Y 1 220 NA 1 1
Residential care facilities 6 N N 2 70 120 6 10
PA Personal care homes 4 N N 4 80 60 6 15
RI Assisted living facilities 2 N N 2 100 80 8 10
SC Community residential care facilities 2 N N 4 80 60 8 10
SD Assisted living centers 2 N N 2 120 220 1 1
TN Assisted living facilities NS N N 2 80 160 6 6
Homes for the aged 1 N N 2 80 80 6 6
TX Assisted living facilities 4 N Y 4 100* 80* 6 6
UT Assisted living facilities type I 2 N N 2 100 160 6 10
Assisted living facilities type II 2 N Y 2 120 200 4 10
VA Assisted living facilities 4 N N 4 100 80 7 10
VT Residential care facilities 3 N N 2 100 80 8 8
Assisted living facilities NS Y Y 2 225 NA 1 1
WA Boarding homes 7 N N 2 80 70 8 12
Assisted living facilities (Medicaid) 7 Y NA 1 220 NA 1 1
WV Assisted living residences 4 -- -- 2 100 180 6 10
Residential care communities 17 Y Y 2 300 * NS NS
WI Residential care apartment complexes NS Y Y* 2 250 NA NS NS
Community-based residential facilities 5 N N 2 100 80 8 8
WY Assisted living facilities NS N N 2 120 80 2 10
Boarding homes
NOTES:
M: Moratorium.  NR: Not reported.  NA: Not applicable.  NS: Not specified.  */** See state notes below.
  1. This column presents the number of units/beds included in the definition of the licensing category, e.g., serving four or more individuals.
  2. Indicates whether residents share units by choice.
  3. Square footage in shared units is total square footage for two residents or square footage per resident in rooms for two or more.
*/** STATE NOTES:
AL: Private room with sitting areas, 160 square feet. Double room with sitting area, 200 square feet.
AR: Rules for assisted living require apartments.
AZ: Unit size figures are for rooms/apartment units. Apartments are required in centers that contract with the ALTCS (Medicaid) Program.
CA: Choice whenever possible. No requirements for size of bedrooms.
CT: Rules only address requirements for assisted living service agencies. Unit requirements are specified by the housing funding source.
DE: Space requirements are not specified.
FL: Facilities licensed after October 1999. Four persons may share a room in standard facilities licensed prior to 1999.
IA: Additional habitable rooms in any unit must be at least 70 square feet.
IL: Nursing homes converting a portion of a facility to supportive living must offer apartments with 160 square feet for single occupancy and 320 square feet for units shared by two persons.
LA: Rules require 250 square feet of living space. Units with two bedrooms must have 190 square feet of living/dining/kitchen space and 120 square feet for each bedroom.
MA: New construction requires private bathroom and kitchenette or access to cooking capacity. Existing construction requires private half bathroom. Full bathrooms may be shared by up to three residents. Bedrooms may be shared.
MN: Licensing rules apply to service providers. Local codes apply to the building based on its use.
NE: New construction facilities must have a toilet and sink adjoining each bedroom. Existing or new facilities may have shared toilet rooms provided the following: one toilet for every six beds in existing facilities; one toilet per four beds in new facilities. Facilities must provide a bathing facility consisting of a tub and/or shower adjacent to each room or provide a central bathing room. In existing facilities, rooms must have 80 square feet and in multiple occupancy rooms 60 square feet per bed with no more than four persons occupying a room. In new construction, apartments must have 150 square feet for one resident and 110 square feet for each additional resident. In existing facilities, apartments must have 120 square feet for one resident and 100 square feet for each additional resident.
NJ: ALPs operate in conventional publicly subsidized senior housing complexes.
NY: Assisted living programs comply with the relevant requirements under which the contracting facility is licensed (i.e., adult home or enriched housing program).
ND: Rooms for three or more, 70 square feet per bed. There are no unit requirements for assisted living facilities. New rules define a living unit as a portion of an assisted living facility occupied as the living quarters of an individual who has entered into a lease agreement with an assisted living facility.
OK: Regulations do not specify requirements for the size of bedrooms.
TX: Type A facilities require 80 square feet for single occupancy and 60 square feet per resident in multiple occupancy rooms.
UT: A single occupant unit without additional living space shall be a minimum of 120 square feet. A double occupant unit without additional living space shall be a minimum of 200 square feet. A single occupant bedroom in a unit with additional living space shall be a minimum of 100 square feet. A double occupant bedroom in a unit with additional living space shall be a minimum of 160 square feet..
WV: Multi-occupancy apartments must have at least 80 square feet of bedroom space per resident and no more than two residents may occupy an apartment.
WI: Allows sharing with a spouse or a roommate chosen by the tenant.


TABLE 2-3. Requirement for Facilities Serving Residents with Dementia
  AL AK AZ AR CA CT CO DE* FL GA HI ID IL* IN IA KS KY*
Training X   X X X   X   X     X   X X X  
Staffing X   X X                 X   X    
Activities X   X   X       X     X X        
Environment     X X X   X   X     X X   X X  
Disclosure       X X     X X X   X X       X
Other X     X       X                 X
  LA ME MD MA MI MN MS MO MT* NE* NV* NH NJ NM NY* NC ND
Training   X X X X X X X X X X       X X X
Staffing     X X     X X X X X       X X  
Activities   X X       X X     X         X  
Environment   X X       X X X X X       X X  
Disclosure   X X   X X   X X     X       X  
Other     X X     X X X X X       X    
  OH OK OR PA RI* SC SD* TN* TX UT VA VT WA WV WI WY*  
Training X   X X X X X   X X X X X X X X  
Staffing   X X X X       X   X     X   X  
Activities X   X X     X   X   X   X X   X  
Environment X   X   X       X   X   X X   X  
Disclosure X X X X X X   X X     X          
Other     X X     X       X         X  
*STATE NOTES:
DE: Facilities must develop policies to prevent wandering and safe storage of medications.
IL: An Alzheimer's facility has been selected for one pilot program, and it must meet all applicable state, federal, and local requirements.
KY: Lease agreements contain a description of special programming, staffing or training for serving clients with special needs.
MT: Requirements for administrators.
NE: Admission and discharge criteria.
NV: Administrators have three years experience serving people with Alzheimer's disease or equivalent education and training.
NY: See state summary. May not operate dementia units without written authorization from the Department of Health.
RI: Philosophy and criteria for placement.
SD: Also have fire safety/evacuation provisions.
TN: An interdisciplinary team must review residents with early stage Alzheimer's disease to examine appropriateness of placement on a quarterly basis.
WY: Facilities must provide cuing with guidance for ADLs for people who are intermittently confused and/or agitated and require occasional reminders to time, place, and person.


TABLE 2-4. Requirements for Resident Agreements
  AL AK AZ AR CA CT CO DE FL GA HI ID IL IN IA KS KY
Services included in the basic rate X X X X X X X X X X X X X X X X X
Cost of the basic service package X X X X X   X X X X X   X X X   X
Accommodations included   X             X                
Terms of occupancy   X X X   X   X         X       X
Period covered X     X             X   X        
Services beyond basic rate X   X X X     X X X X   X X X   X
Cost of additional services X     X X X   X X X     X   X    
Services not available/not covered             X X X                
Temporary absence policy     X       X X X       X        
Payment/billing provisions       X X X   X         X   X    
Statement of resident's rights   X       X X X X       X       X
Admission/discharge criteria           X X   X       X X X   X
Refund policy X X X X X   X   X     X X       X
Provisions for changing rates     X X X X   X X       X X     X
Termination provisions X X X X X             X X       X
Purpose of deposits/advance payments   X         X   X                
Grievance process     X     X X X X       X   X   X
Other X X   X X   X X X X   X X   X X X
  LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND
Services included in the basic rate X X X X X X X X X X X X X X X X  
Cost of the basic service package X X X X X X X X X X X X X X X X X
Accommodations included   X   X           X   X     X X X
Terms of occupancy     X X X         X           X  
Period covered       X     X                 X  
Services beyond basic rate X     X   X X X     X X     X    
Cost of additional services X X   X   X X X     X X X        
Services not available/not covered   X X X         X                
Temporary absence policy     X               X   X X      
Payment/billing provisions X   X X X X     X X X     X X   X
Statement of resident's rights   X X X X       X       X     X  
Admission/discharge criteria X X X X X X X   X       X X   X X
Refund policy   X X X X   X   X   X       X X X
Provisions for changing rates X X X     X X   X         X X   X
Termination provisions       X           X   X     X   X
Purpose of deposits/advance payments   X             X     X          
Grievance process   X X X   X     X           X X  
Other X   X X X     X X     X X X X X  
  OH OK OR PA RI SC SD TN TX UT VA VT WA WV WI WY  
Services included in the basic rate X X X X   X X X X X X X X X X X  
Cost of the basic service package X   X X     X X X X X X X X X X  
Accommodations included             X       X X          
Terms of occupancy X X X   X             X   X      
Period covered X X X                 X          
Services beyond basic rate     X       X     X   X X   X    
Cost of additional services     X X     X     X   X X X X X  
Services not available/not covered     X                 X          
Temporary absence policy       X     X         X X   X X  
Payment/billing provisions X   X X             X X       X  
Statement of resident's rights X   X X X X     X     X   X      
Admission/discharge criteria X X X   X X   X X X   X   X   X  
Refund policy X   X X         X X X X   X   X  
Provisions for changing rates     X X   X       X X     X X    
Termination provisions X X X X           X   X   X   X  
Purpose of deposits/advance payments     X               X            
Grievance process   X X   X X X                 X  
Other   X   X X   X   X X X   X X X    
STATE NOTES:
AL: A statement that the facility is not staffed to provide skilled nursing or care for residents with severe cognitive impairments.
AK: Duties and obligations of the resident.
AR: Health care services available through home health agencies; parameters for pets; policy on acceptance of responsibility for personal funds and valuables; responsibility for medication; a copy of facility rules; and provisions for emergency transfers.
CA: A monthly statement of services and charges; a statement acknowledging the acceptance or refusal to purchase the additional services shall be signed and dated by the resident or the resident's representative and attached to the admission agreement; an explanation of the use of third-party services within the facility that are related to the resident's service plan, including, but not limited to, ancillary, health, and medical services, how they may be arranged, accessed, and monitored, any restrictions on third-party services, and who is financially responsible for the third-party services; the facility's policy concerning family visits and other communication with residents; refund policy; conditions under which the agreement may be terminated; and an explanation of the resident's right to notice prior to an involuntary transfer, discharge, or eviction, the process by which the resident may appeal the decision and a description of the relocation assistance offered by the facility.
CO: Transportation services; therapeutic diets; and whether the facility will be responsible for providing bed and linens, furnishing and supplies. There must also be written evidence that the facility has disclosed the policies and procedures (admissions; discharges; emergency plan and fire escape procedures; illness, injury or death; smoking; management of residents' funds; investigation of abuse and neglect allegations; and restrictive egress devices); method of determining staffing levels and the extent to which certified or licensed health professionals are available on-site; whether the facility has an automatic sprinkler systems; if the facility uses restrictive egress alert devices and the types of individual behaviors exhibited by persons needing such devices.
DE: Transfer procedures, security, staff's right to enter a resident's room, resident rights and obligations, temporary absence policy, interim service arrangement during an emergency, obligations of the facility, and a listing of the resident's personal belongings. The financial areas include the party responsible for handling finances, obtaining equipment and supplies, arranging services not covered by the contract, disposing of belongings.
FL: Statement of any religious affiliation; notice of transfer if the facility is not able to serve the resident.
GA: Copy of house rules; provisions for ongoing resident assessments; provisions for transportation services; authorization to release medical records.
ID: Whether or not the resident is responsible for his or her own medications; statement regarding managing personal funds; conditions for emergency transfers; permission to transfer information.
IL: Statement of the annual licensing on-site review process; statement that Medicaid is not available for payment of services; description of the process for terminating or modifying the contract; the admission, risk management, and termination procedures; and policy concerning notification of relatives of changes in the resident's condition.
IA: Statement regarding the impact of the fee structure on third-party payments and whether they are accepted; emergency response policy; staffing policy and whether staff are available 24 hours a day; whether nurse delegation will be used and staffing will be adapted to meet changing needs.
KS: Negotiated service agreement; provider of services; agreement supports individual dignity, choice, privacy, etc.; addresses services refused by resident and resident's acceptance of risk.
KY: Assisted living residences: 30-day notice of move-out for non-payment, assistance finding appropriate housing, other community rights, practices and procedures, policy concerning the ability to contract directly with outside agents, professionals, providers, or other individuals.
LA: Authority of the licensing agency to review records; responsibilities for overseeing medical care; purchasing supplies and equipment. Must allow review by an attorney.
MD: Includes a clear and complete reflection of commitments and actual practices; level of care for which the facility is licensed; obligations of all parties for arranging for medical care and other provisions (see summary).
MA: Sponsor's covenant to comply with applicable laws; reasonable rules for staff, management, and resident behavior, and limits on what the residence will as well as policy on self-administration of medication.
MI: AFC: Assurance of provision of care, supervision, and protection; agreement to provide necessary intake information and current health appraisal; statement of how funds and valuables are handled; statement that the home is licensed to provide care.
MO: Right to make treatment decisions; provisions in a medical emergency; state laws relating to advance directives.
MT: Availability of skilled nursing and other professional services from third-party payers; specific assistance available with ADLs.
NE: Included in the terms of occupancy requirement.
NH: Notification required for involuntary and emergency transfer.
NJ: Some information is provided during admission interviews.
NY: Includes a list of services, material, equipment required by law; guarantee that supplemental services are made at the resident's option; offer to manage funds received from public sources; statement that the resident will provide a signed medical statement and inform operator of changes in health conditions, status, or medications.
NC: Policy on smoking, alcohol consumption, and visitation.
OH: A statement is included about discharge of residents when skilled nursing needs exceed their capacity.
OK: Conformity with state law.
PA: Amount of personal needs allowance; method of payment for long distance calls; financial management arrangements; explanation of annual screening and medical evaluation requirements.
RI: Also includes shared space and facilities, special care provisions, resident responsibilities and house rules, and evaluation and service plan. A general provision called financial terms would cover cost of services, additional charges, and refunds.
SD: Policies for protection of personal funds; list of names, addresses, and numbers of client advocates; how to contact the resident's physician; how to apply for Medicare/Medicaid.
TN: Information on the cost of services is provided to residents but it is not part of the agreement. The agreement includes the procedure for handling transfers and discharges.
TX: See summary. Some provisions are part of the disclosure requirement or part of the written policies of the facility.
UT: Notice that the state has the authority to examine resident records.
VT: See state summary.
VA: Stipulation about the transfer of ownership of any property, real estate, or money to the facility; description of the type of staff, services available and the hours of service.
WA: Rules of operation.
WV: 1. Personal care homes: house rules; how emergencies are addressed; arrangement for transportation; procurement and payment for medications; storage and administration of medications. 2. Residential board and care homes: how health care will be provided; provide copies of all inspection reports; how to access activities and assurances that the home offers services to meet identified needs. 3. Residential care communities: procurement and payment for medications; storage and administration of medications; assurance that the resident is not liable for undisclosed costs; assurance that the individual's needs will be met.
WI: 1. CBRFs: bed hold fee. 2. RCAC: Some of the requirements are posted and others are included in a service agreement. Activity and social connections the resident will be assisted in maintaining.
WY: Managers are required to establish policies in the specified areas that are available to residents and staff on items that are normally specified in resident agreements.


TABLE 2-5. Staff Training Requirements (see note)
State Initial Annual State Initial Annual State Initial Anaual
AL Topics Topics KY Topics Not specified ND Topics Not specified
AK Topics 12 hours LA Topics Annual plan OH Training course Not specified
AZ Topics/hours* 12 hours ME Complete course 8 hours/2 years OK* 8 hours 8 hours
AR Topics 6 hours MD Topics* Topics OR Topics Not specified
CA Topics Plan MA 7 hours 10 hours PA Topics Not specified
CO Topics Topics MI Topics Not specified RI* Topics Not specified
CT 10 hours/topics* 6 hours MN Competency test Not specified SC Topics General
DE Topics 12 hours MS Topics Quarterly SD Topics Not specified
DC 40 hours 12 hours MO* 1 hour Not specified TN Not specified Not specified
FL 26 hours* Not specified MT Topics/16 hours* Not specified TX 16 hours 6 hours
GA Topics 16 hours NE Topics 12 hours UT Topics Not specified
HI Topics 6 hours NV General 8 hours VT* Topics 20 hours
ID 8 hours 8 hours NH Topics Topics VA Topics 12 hours
IL 20 hours 12 hours NJ Complete course 20 hours/2 years* WA* Topics/competency test Not specified
IN Topics Topics/hours* NM Complete course Topics WV Topics Topics
IA Plan on file Not specified NY Complete course Not specified WI Topics Not specified
KS Topics Topics NC Complete course Not specified WY Topics Not specified
NOTE:
Rules specifying a number of hours also include topics that are covered. Rules listing topics only do not specify how many hours of training are needed.
*STATE NOTES:
AZ: Hours/topics vary by level of licensing.
CT: Aides must pass a competency exam.
FL: Core training for staff is 26 hours. Additional hours are required for specific tasks or settings e.g., medication assistance (4) and extended congregate care (2).
IN: Nursing staff, 8 hours per year; non-nursing staff, 4 hours per year.
MD: For Medicaid waiver programs, 8 hours on medication administration is also required.
MO: Complete course for medication administration.
MT: Topics are listed for category A and 16 hours of training in services provided by category B facilities.
NJ: 20 hours every 2 years; medication aides, 10 hours every 2 years.
OK: For residential care homes.
RI: Medicaid waiver: one hour orientation; 12 hours annual.
VT: For residential care homes.
WA: Additional requirements for Medicaid providers.


TABLE 2-6. Comparison of State Reimbursement Policy
State Coverage Payment
method		 Rates Rates
Include
R&B		 R&B
limits		 Family
supplement		 Personal
needs
allowance		 SSI
payment
standard1
Date Method
AL NA Waiver submitted TBD $30.00 $564.00
AK 1993 Waiver Tiered $70.54-$93.70 N No No policy $100.00 $907.00
AZ 1989 Waiver Tiered $34.67-$87.10* Y $497.10 Y $66.90 $564.00
AR 1993
2003		 State plan
Waiver		 Care plan
Tiered		 $790.40 cap
$39.51-$49.91		 N No No policy $30.00 $564.00
CA Planning Planned TBD $111.00 $853.00
CO 1984
1987		 Waiver
State funds		 Flat $36.03/day N $518 Y $46.00 $564.00
CT 2003
NR		 Waiver
State funds		 Tiered $65/day cap N % of income* N $164.00 $1692 cap*
DE 1999 Waiver Tiered $940-$1460 N $598 N $106.00 $704.00
DC Approved Waiver TBD No policy $70.00 $564.00
FL 1997
2001		 Waiver
State funds		 Flat
Flat		 $28/day
$9.28/day		 N No Y $54.00 $642.40
GA 1981 Waiver Flat $31.04/day N $475 Y $89.00 $564.00
HI 2000 Waiver Flat $58.46/day* N $418 No policy $150.90 $568.90
ID 1999
2000		 Waiver
State plan
State funds		 Care plan
Care plan		 Capped/NF cost
$921.92*		 N
N		 $497*
$497*		 Y $67.00 $564.00
IL 1999 Waiver Regional variations $45.54-$61.94 N $474* N $90.00 $564.00
IN 2001 Waiver Tiered $45.86-$61.68 N $512 No policy $52.00 $564.00
IA 1990 Waiver Care plan Cap of $1,025 N No Y $30.00 $564.00
KS 1997 Waiver Care plan Varies N No Y $30.00 $564.00
KY NA   NS $906.00
LA NA Planned   NS $564.00
ME 1970s
1990		 State funds
State plan
Waiver		 Care plan
Cost based/ case-mix		 Varies & % of income Y $50.00 $574.00
MD 1993
1986		 Waiver
State funds		 Tiered $1611-$2031* Y $420 N $60.00 $564.00
MA 1992 State plan Flat $37.75 per day N N No policy NS $1018.00
MI 1983 State plan Flat $174.38 N N Y $44.00 $724.30*
$721.50
MN 1988
1991		 Waiver
State funds		 Case-mix $1029-$2392* N $674 Y $72.00 $752.00
MS 2001 Waiver Flat $33.18/day N $520 No policy $44.00 $564.00
MO 1993
1973		 State plan
State funds		 Care plan Varies/capped at NF cost N N Y $25.00 $720.00
$856.00
MT 1994 Waiver Care plan $520-$1800* N $525   $100.00 $625.00
NE 1998 Waiver Flat (rural/urban variations) $1520-2150* Y $504 N $60.00 $564.00
NV 1993 Waiver Flat $20, $45, $60/day N N No policy $88.00 $914.00
NH 1999 Waiver Flat $50/day
$1250/month*		 N
Y		 N
Y		 Y $50.00 $758.00
NJ 1997 Waiver Setting* $2130.55-$2430.55 Y $631.50 Y $80.50 $714.05
NM 1996 Waiver Flat $50.50/day N $1024 No policy $30.00 $664.00
NY   State plan Case-mix Varies by county and case-mix N N Y $70.00*
$115.00		 $969.00-
$999.00*
NC 1995 State plan Case-mix Varies/$49.62 max* N $1066 Y $46.00 $1132.00
ND   Waiver
State funds		 Care plan
Care plan		 $80/day cap
$40/day cap		 N
N		 $375
NR		 Y
Y		 $60
NS		 $564.00
OH NA   $50.00 $850.00
OK NA   $50.00 $564.00
OR 1990 Waiver Tiered $1144-$2399 Y $455.70 N $110.00 $565.70
PA 2000 Waiver demo Care plan Cap 80% of NF N $898.30 N $60.00 $958.30
RI  
1999		 Waiver Flat
Flat		 $37/day*
$1400		 N
Y		 N
N		 N $100.00 $1159.00
SC 2002 State plan Flat $12.80/day N $865.00 N $47.00 $912.00
SD 1988 State funds
Waiver		 Flat
Flat		 $1094
$43.92/day		 Y $534.00 N $30.00 $1094.00
$564.00
TN NA   NS $564.00
TX 1994
1985		 Waiver
State funds		 Tiered $23.21-
$59.88/day		 N $479 N $85.00 $564.00
UT 2000 1915 (a) Negotiated Negotiated Y NA Y $45.00 $560.00
VA* NA   $62.00 $833.00-
$958.00
VT 1996
1999		 Waiver
State plan		 Tiered
Flat		 $42-$55
$30.25*		 N $564 N $47.76 $592.66III
$735.94 IV
WA 1991 Waiver Tiered See summary Y $453.16 N $58.84 $564.00
WV 2004 Waiver approved $69.00 $627.00
WI 1997 Waiver
State funds		 Care plan
Care plan		 Cap $77.81*
No cap		 N $626.77 Y $65.00-
$240.00		 $647.78*
WY 2001 Waiver Tiered $32-$40/day N N No policy NS $564.00
GENERAL NOTES:
TBD: To be determined
NR: Not reported
NA: Not applicable
NS: Not specified
  1. SSI Payment standard includes a state supplement, if available. The standards include an amount retained by the beneficiary as a personal needs allowance (PNA). The PNA varies by state.
AZ: Payments vary by three levels of care and by setting: adult family care, assisted living homes, assisted living centers.
CT: Pilot program with the Housing Finance Agency to create affordable assisted living. The SSI rate in residential care homes is based on the rate for the facility but cannot exceed $1,692 less a personal needs allowance of $90.70. The payment is lower in the assisted living pilot. The PNA is $164 and there is a meal allowance of $300 and up to a $400 allowance for rent.
HI: This rate is for facilities of six or more beds; the rate for five or less is $1066.90.
ID: The room and board amount is a suggested cap. State plan service cap is based on a rate of $13.40 an hour, maximum 16 hours per week.
IL: In addition to the Medicaid payment, participating facilities receive an average of $97 a month in food stamp benefits.
MD: Additional amounts are allowed for assistive equipment and environmental modifications which may be more likely to be applied to in-home settings.
MI: Payment rate for Homes for Aged is $724.30; Adult Family Care, $721.50. PNA is the same for both categories.
MN: Statewide average costs with caps that vary by county.
MT: Actual rate depends on a scoring of functional needs.
NE: Rates vary by urban/rural and single/double occupancy.
NH: Elderly housing with services sites receive $50 a day; licensed facilities receive $1,250 a month.
NY: Payment standards and the PNA varies by groupings of counties.
NC: Rate varies using a base rate and additional components determined by the combination of ADL needs.
RI: A regular waiver and a pilot program are operating. The room and board charge for both programs is set by the facility. The regular waiver pays the difference between $1,400 and the room and board charge. Room and board is not related to the Medicaid payment under the pilot waiver. SSI beneficiaries participating in the two waivers retain a PNA of $100. SSI beneficiaries not in the waiver retain a PNA of $55. Facilities receive one month prospective payment and would hold the unit for the remainder of the month.
VA: The state continues to support residents with state funds who were formerly covered by a Medicaid waiver that was not renewed. The SSI benefit varies by grouping of the counties.
VT: $30.25 for residents receiving Assistive Community Care Services (ACCS); the higher tiers include ACCS and Medicaid waiver services. Room and board of $564 is allowed in facilities participating in the ACCS program. The SSI rates for Level III and IV are in facilities that do not participate in ACCS.
WI: Actual rates negotiated by counties. Cap is based on 85 percent of the cost of nursing facility care. Family supplementation allowed by the state agency; counties set their own policy. PNA amounts are also set by counties. Residents in certified RCACs may qualify for an additional state supplement of $95.99 if they have exceptional needs.
WV: A pilot program in public housing in four counties was approved in August 2004.


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