Residential Care and Assisted Living Compendium: 2007

SECTION 2. COMPARISON OF STATE POLICIES

November 30, 2007

PDF Version: http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.pdf (21 PDF pages)


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   2007 2004 2002   CON  
  Facilities     Units/Beds     Facilities     Units/Beds     Facilities     Units/Beds  
AL Assisted living facilities 307 9,509 335 9,876 327 9,738 N*
AK Assisted living homes 229 1,912 162 1,650 143 1,497 N
AR Residential long-term care facilities 92 3,616 111 4,369 122 4,647 Y
Assisted living facilities 27 1,402 6 275 NA NA Y
AZ Assisted living facilities 1,951 27,000 1,509 24,500 1,524 24,002 N
CA Residential care facilities for elderly 7,471 161,586 6,543 154,830 6,207 147,580 N
CO Assisted living residences 495 14,237 525 13,799 538 14,291 N
CT Assisted living service agencies 63* NA 65 NA 63 NA N
Residential care homes 100 2,808 101 2,753 109 2,949 Y
DC Community residence facilities 22* 509* 200 1,866 NR NR N
DE Rest residential homes 3 NR 3 NR 6 160 N
Assisted living 29 1,804 29 1,738 27 1,300 N
FL Assisted living facilities standard 2,400 75,450 2,250 74,762 2,328 78,348 N
Limited nursing services
Assisted living extended congregate
GA Personal care homes 1,860 26,500 1,687 25,434 1,648 25,563 Y/M
HI Assisted living facilities 10 1,744 7 1,008 3 354  
Adult residential care home 480 2,540 542 2,882 545 2,882 N
ID Residential and assisted living facilities 278 6,819 266 6,160 253 5,815 N
IL Assisted living facilities 184 8,988 120 5,830 24 1,667 N
Shared housing 25 202 13 92 NR NR N
Shelter care facilities 137 7,610 149 8,484 156 8,240 N
IN Residential care facilities 190 14,665 147 11,767 140 11,555 N
IA Assisted living programs 209 10,332 184 8,246 154 6,199 N
Assisted living dementia programs 18 468 NA NA NA NA  
KS Assisted living 120 5,539 191 7,971 129 5,658 N
Residential health care facility 49 1,647 98 2,918 N
KY Assisted living communities 97 NA 83 NA 73 NA N
Personal care homes 192 6,802 204 7,389 204 7,792 N
LA Personal care homes 30 189 44 286 29 176 N
Assisted living 75 4,700 67 4,157 66 3,906 N
ME Assisted living programs 34 1,624 30 1,429 24 1,133 N
Residential care facilities: I (I-IV 2004) 647 7,079 711 7,593 473 1,711 N
Residential care facilities: II-IV 192 5,220 N
MD Assisted living programs 1,366 20,093 1,248 17,148 2,000 14,273 N
MA Assisted living residences 190 11,900 171 10,585 139 9,796 Y
MI* Homes for the aged 190 14,653 190 14,588 191 14,656 N
Adult foster care: family group homes 1,201 5,663 1,247 5,825 1,266 5,913 N
Adult foster care: small group homes 2,809 18,967 2,527 17,610 2,529 17,727 N
Adult foster care: large group homes 495 6,414 485 9,001 477 8,839 N
Adult foster care: congregate homes 11 398 13 491 13 491 N
MN Housing with services establishments 1,239 NA 931 NA 600 NA N
MO Residential care facilities 502 15,661 280 6,363 285 6,533 Y
Assisted living facilities 114 5,505 363 15,434 363 15,106 Y
MS Personal care homes 185 5,133 194 4,197 207 5,137 Y
MT Personal care facilities 184 4,351 177 3,730 149 3,276 N
NE Assisted living facilities 276 10,063 259 9,187 227 8,369 N
NV Residential care facilities for groups 258 3,941 300 4,021 374 NR N
NH Assisted living residence: supported residential health care facilities 142 4,283 137 4,013 148 3,936 N
Assisted living residence: residential care facilities N
NJ Assisted living residences 170 15,571 152 13,696 129 11,645 Y
Assisted living programs 14 NA 13 NA 17 NA Y
Comprehensive personal care homes 38 2,190 43 2,388 41 2,642 Y
NM Adult residential care 284 NR 346 NR 305 NR N
NY Adult care homes 389 39,170 431 32,859 449 34,805 N
Enriched housing programs 105 90 7,227 83 5,308 N
Residences for adults 6 6 200 8 345 N
NC Adult care homes 635 36,294 629 35,247 631 34,776 Y
Family care homes 647 3,612 648 3,642 682 3,816 N
Multi-unit housing with services 25 1,736 23 1,053 20 1,538 N
ND Basic care facilities 55 1,529 46 1,490 47 1,490 N
Assisted living facilities 56 1,943 42 1,361 NA NA N
OH Adult care facilities (3-16) 658 5,213 712 5,666 805 5,783 N
Residential care facilities (17+) 547 38,792 510 36,255 462 31,937 N
OK Residential care home 91 2,809 103 3,358 210 8,620 N
Assisted living centers 115 6,493 115 6,308 8 1,253 N
OR Assisted living facilities 202 13,589 190 12,566 180 11,998 M
Residential care facilities 227 8,541 236 8,504 220 8,227 M
PA Personal care homes 1,550 71,831 1,718 76,385 1,786 79,929 N
RI Assisted living facilities 63 3,574 73 3,676 68 3,270 N
SC Community residential care facilities 480 16,279 504 16,641 545 17,761 N
SD Assisted living centers 157 3,578 162 3,360 153 3,084 N
TN Assisted care facilities 201 13,769 184 10,699 178 10,495 N
Homes for the aged 127 2,520 155 3,230 166 3,307 N
TX Assisted living facilities 1,433 45,853 1,378 42,245 1,324 41,424 N
UT Assisted living facilities type I 87 1,733 92 1,678 108 1,886 Y
Assisted living facilities type II 64 3,523 49 2,800 43 2,460 Y
VA Assisted living facilities 577 31,964 636 34,598 669 34,200 N
VT Residential care facilities 112 2,317 110 2,302 109 2,213 N
Assisted living residences 6 293 3 108 NA NA N
WA Boarding homes 551 26,829 538 24,498 525 23,830 N
WV Personal care homes NA NA NA NA 50 2,310 N
Residential board and care homes NA NA NA NA 82 1,498 N
Residential care communities 3 130 3 88 3 88 N
Assisted living residences 117 3,380 113 3,197 NA NA N
WI Residential care apartment complexes 220 9,229 151 6,001 122 4,452 N
Community-based residential facilities 1,379 22,553 1,359 21,374 1,350 21,242 N
WY Assisted living facilities 15 286 15 970 14 1,005 N
Boarding homes 20 1,150 17 315 NR NR  
TOTAL   38,373 974,585 36,2181 935,3642 36,2781 908,4882  
M = Moratorium; NR = Not reported; NA = Not applicable. Units/Beds = the licensed capacity reported by the state.
  1. The totals reflect revisions reported by Michigan for 2004 and 2002 and other adjustments.
  2. Totals for 2004 and 202 were adjusted to include the capacity of Iowa’s units and other adjustments.
* STATE NOTES:
AL: A CON is required for specialty care facilities.
AZ: Figures represent combined supply for three categories.
CT: Not included in total.
DC: Previous reports included facilities and beds serving individuals with developmental disabilities. The 2007 report only includes facilities serving older adults.
GA: CON applies to facilities serving more than 24 residents.
IA: Previous reports included the number of units rather than the capacity.
MI: The number of licensed facilities and capacity was revised by the reporting agency for 2004 and 2002 from what was included in the previous report.
NM: Previous information reported may have included ADC providers.


TABLE 2-2. Comparison of State Residential and Assisted Living Regulations: Characteristics
  State     Category   Size
  Definition1  		 Apt
  Required  		   Sharing by  
Choice?2		 Max #
  Occupants  		   Sq Foot  
Single		   Sq Foot  
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 NS NS NA NA
FL Assisted living facilities (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 4 100 160 8 15
Adult foster care: small group homes <12 N N 2 80 170 8 8
Adult foster care: larger 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
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 Assisted living residences/supported residential health care 2 N N 2 100 160 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 homes 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
Residences 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 ** ** 2 ** ** ** **
Adult care facilities 3-16 N N 2 80 60 8 8
OH 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 10
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
NR = Not reported; NA = Not applicable; NS = Not specified.
  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 ALSAs. 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.
NH: Apply to units in facilities serving 17 or more residents; smaller facilities must offer 80 and 160 square feet for single and semi-private occupancy respectively.
NY: ALPs comply with the relevant requirements under which the contracting facility is licensed(i.e., adult home or enriched housing program (EHP)).
ND: Rooms for three or more, 70 square feet per bed. There are no unit requirements for ALFs. New rules define a living unit as a portion of an ALF occupied as the living quarters of an individual who has entered into a lease agreement with an ALF.
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. Requirements 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 x  
Staffing x     x         x       x   x    
Activities 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   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  
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       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    
Staffing x x x x x       x   x     x      
Activities 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 x      
Other x   x x x   x x   x x   x   x x  
* STATE NOTES:
CA: Some provisions are included in the disclosure statement.
DE: Facilities must develop policies to prevent wandering and safe storage of medications.
IA: Resident agreements includes a description of the services and programming that is available.
IL: Manager qualifications, minimum service hours and others.
KY: Lease agreements contain a description of special programming, staffing or training for serving clients with special needs.
MD: Training, staffing, activities and environment provisions are included in the disclosure statement.
MA: Must have a plan to operate the residence that covers specified areas.
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 a special needs assisted living certificate. Must submit a special needs plan that includes staffing, training, and environmental modifications.
NC: Must develop policies that address specific features of a SCU.
OH: Must describe specific features of the SCU in the application.
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.
UT: See state summary.
WI: RCACs must have training. Other licensed facilities offering dementia special care must complete a disclosure form.
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
Period covered 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                    
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    
Refund policy x x x x x   x   x x   x x       x
Provisions for changing rates     x 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
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
Terms of occupancy     x x           x              
Period covered       x   x 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   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
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 x x x
Refund policy x x x x x   x   x   x       x x x
Provisions for changing rates x x x   x x x   x     x   x x x x
Termination provisions       x           x   x     x x x
Purpose of deposits/advance payments   x             x     x     x    
Grievance process   x x x   x     x           x x  
Other 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 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       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    
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     *  
Payment/billing provisions x   x x             x x          
Statement of resident’s rights x   x x x x     *         x      
Admission/discharge criteria x* x x   x x   x* x x       x   *  
Refund policy x   x x         x x x     x x    
Provisions for changing rates     x x x x       x x     x x    
Termination provisions x x x x           x       x   *  
Purpose of deposits/advance payments     x   x           x       x    
Grievance process   x x   x x x             x   x  
Other   x x 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 on-going resident assessments; provisions for transportation services; authorization to release medical records.
ID: Staffing patterns and qualifications; liability insurance carried; the resident’s and facility’s role and responsibilities for assistance with medication administration; 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: ALRs: 30-day notice of move-out for nonpayment, 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; LOC 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: Some provisions are included in the resident’s rights section -- 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; policies concerning pets and smoking.
NE: Included in the terms of occupancy requirement.
NH: Responsibility for discharge planning; information about nursing, supplies and other health care services not included in the core services (availability of services; the facility’s responsibility for arranging services; and the fee and payment for services if known); policies and procedures regarding arranging/providing transportation, arranging for third-party services (i.e., television, hairdresser); handling resident funds, bed hold, storage and smoking; medication management services; and the list of grooming and personal hygiene supplies providing as part of the basic rate.
NJ: Some information is provided during admission interviews.
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.
OR: Uniform disclosure form and other topics -- see summary.
PA: Amount of PNA; 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.
SC: Transportation policy.
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) PCHs: 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 Requirements1
  State   Initial Annual   State   Initial Annual   State   Initial Annual
AL Topics Topics KY Topics Not specified ND Topics Topics
AK Topics 12 hours LA Topics Annual plan OH Training course   6 hours/topics  
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   10 hours/Topics     4 hours/topics   MA 7 hours/topics 10 hours/topics PA Topics 12 hours
CO Topics Topics MI Topics Not specified RI* 10 hours/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 Topics
DC 40 hours 12 hours MO* 1 hour/topics Not specified TN Not specified Not specified
FL 26 hours* Not specified MT   Topics/16 hours*   Not specified TX 16 hours 6 hours/topics
GA Topics 16 hours NE 4 hours 12 hours UT Topics Topics
HI Topics 6 hours NV 4 hours 8 hours VT* Topics 20 hours
ID 16 hours 8 hours NH Topics Topics VA Topics 8 hours
IL Topics 8 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 40 hours* 12 hours WI Topics Not specified
KS Topics Topics NC 80 hour course Not specified WY Topics Not specified
  1. 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 ECC (2)).
IN: Nursing staff, eight hours per year; non-nursing staff, four hours per year.
MD: For Medicaid waiver programs, 8 hours on medication administration is also required.
MO: Complete course for medication administration. Additional topics required for ALF staff.
MT: Topics are listed for category A and 16 hours of training in services provided by category B facilities.
NV: Three hours additional training every three years for staff who assist with medications.
NJ: 20 hours every two years; medication aides, ten hours every two years.
NY: Topics are specified in the Department’s curriculum.
OK: For residential care homes (RCHs).
RI: Medicaid waiver: one hour orientation; 12 hours annual.
VT: For RCHs.


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   Withdrawn             $30.00 $623.00
AK 1993 Waiver Tiered $70.54 - $93.70 N No   No policy   $100.00 $654.00
AZ 1989 Waiver Tiered $41.23-$143.78* Y   $512.55   Y $90.45 $623.00
AR 1993
2003		 State plan
Waiver		 Care plan
Tiered		 $885.76 cap
$43.19-$54.61		 N
N		 No
$566.00		 No policy $30.00
$57.00		 $623.00
$623.00
CA 2006 Waiver Tiered $52-$82/day with add-ons N $936.00   $119.00 $1,035.00
CO 1984
1987		 Waiver
State funds		 Flat $47.58/day N $571.00 Y $97.00 $668.00
CT 2003
NR		 Waiver
State funds		 Tiered $27.33-$73.19/day N % of income* Y $164.10 $1869 cap*
DE 1999 Waiver Tiered $1,034-$1,154 N $598.00 N $114.00 $763.00
DC   Approved   Waiver Flat $60/day TBD TBD No policy $70.00 $623.00
FL 1997
2001		 Waiver
State funds		 Flat
Flat		 $32.20/day
$9.28/day		 N No Y $54.00 $691.40
GA 1981 Waiver Flat $35.04/day N $528.00 Y $95.00 $623.00
HI 2000 Waiver AL-Flat
  EARCH-Tiered  		 $66.77/day
$24.98-$66.77		 N $418.00 No policy $50.00 623.00
ID 1999
2000		 Waiver
State plan		 Care plan
Tiered		 Capped/NF cost
  $125.30-$225.54  		 N
N		 $542.00*
$542.00*		 Y $67.00 $623.00
IL 1999 Waiver Regional variations $50.76-$66.92 N $533.00* N $90.00 $623.00
IN 2001 Waiver Tiered $45.86-$61.68 N $512.00 No policy $52.00 $623.00
IA 1990 Waiver Care plan Cap of $1,083 N No Y $50.00 $623.00
KS 1997 Waiver Care plan Varies N No Y $30.00 $623.00
ME 1990 State plan Cost-based/ case-mix Varies Y % income Y $50.00 $623.00
MD 1993
1986		 Waiver
State funds		 Tiered $1,672-$2,109* N $420.00 N $64.00 $623.00
MA 1992 State plan Flat $37.75 per day N N No policy NS $1077.00
MI 1983 State plan Flat $184.50 N N Y $44.00 $802.30*
$780.50
MN 1988
1991		 Waiver
State funds		 Case-mix $1,086-$2,524* N $737.00 Y $82.00 $811.00
MS 2001 Waiver Flat $33.18/day N $520.00 No policy $44.00 $623.00
MO 1993
1973		 State plan
State funds		 Care plan Varies/capped at NF cost N N Y $25.00 $779.00
$875.00
MT 1994 Waiver Care plan $63.35 per day cap* N $495.00 Y $100.00 $717.00
NE 1998 Waiver Flat (rural/urban variations) $1,641-$2,310* Y $563.00 N $60.00 $623.00
NV 1993 Waiver Tiered $20, $45, $60/day N N No policy $102.00 $1014.00
NH 1999 Waiver Flat $50/day $1,250/month* N Y N Y Y $56.00 $817.00
NJ 1997 Waiver Flat bv setting* $50-$70/ day Y $680.55 Y $92.50 $773.05
NM 1996 Waiver Flat $49.99/day N $1,024.00 No policy $30.00 $664.00
NY NA State plan Case-mix Varies by county and case-mix N N Y $200.00 $1,264.00
NC 1995 State plan Case-mix Varies N $1,083.00 Y $65.00 $1,148.00
ND NA Waiver
State funds		 Care plan
Care plan		 $80/day cap
$49.23/day cap		 N N $375.00
NR		 Y Y $60.00
NS		 $623.00
OH 2006 Waiver Tiered $49.98-$69.98/day N $573.00 N $50.00 $850.00*
OR 1990 Waiver Tiered $1,195-$2,493 Y $483.70 N $110.00 $624.70
PA   Waiver authorized         $60.00 $1,062.30  
RI 1999 Waiver
Waiver		 Flat
Flat		 $36.32/day*
$1800		 N
Y		 N
N		 N $100.00 $1,218.00
SC 2002 State plan Flat $14.80/day N $1,003.00 N $53.00 $1,056.00
SD 1988 State funds
Waiver		 Flat
Flat		 $1,212
$30.64/day		 Y
N		 $583.00 Y
N		 $60.00 $1,212.00
$623.00
TX 1994
1985		 Waiver
State funds		 Tiered $25.13-$67.76/day N $538.00 N $85.00 $623.00
UT 2006* 1915(c) Flat $69.75 Y NA Y NS $623.00
VT 1996
1999		 Waiver
State plan		 Tiered
Flat		 $48.76-$67.44
$34.25*		 N $623.00 N $47.76 $670.76 III
$794.66 IV
WA 1991 Waiver Tiered See summary Y $562.22 N $60.78 $623.00
WI 1997 Waiver Care plan Cap $88.02* N $626.77 Y $65.00* $802.77*
WY 2001 Waiver Tiered $42-50/day N N No policy NS $623.00
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 PNA. The PNA varies by state.
* STATE NOTES:
AK: Figures include an “augmented factor.” The basic rate ranges from $44.52 to $67.68 a day.
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 RCHs is based on the rate for the facility but cannot exceed $1,869 less a PNA 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.
ID: The room and board amount is a suggested cap.
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.
MI: Payment rate for Homes for Aged is $802.30; Adult Family Care, $780.50. 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.
OH: The SSI payment rate listed is available for individuals who are not enrolled in a Medicaid waiver. The payment standard for waiver participants is $623 a month.
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.
UT: The state covered services in licensed settings through a Medicaid section 1915(a) managed long-term care program prior to the 2006 waiver.
VT: $34.25 for residents receiving ACCS; the higher tiers include ACCS and Medicaid waiver services. Room and board of $623 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% 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.


REPORT FILES AVAILABLE:
  • Main Table of Contents -- http://aspe.hhs.gov/daltcp/reports/2007/07alcom.htm#ToC
  • SECTION 1. Overview of Residential Care and Assisted Living Policy -- http://aspe.hhs.gov/daltcp/reports/2007/07alcom1.htm
  • SECTION 2. Comparison of State Policies -- http://aspe.hhs.gov/daltcp/reports/2007/07alcom2.htm
  • SECTION 3. State Summaries -- http://aspe.hhs.gov/daltcp/reports/2007/07alcom3.htm
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