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Assisted Living Regulations

NCAL will not be publishing its state regulatory review in 2014 because the Federal government is working on a similar report this year. 


The US Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE), has contracted with RTI International to update the "State Residential Care and Assisted Living Policy" compendium, which was last updated in 2007. The material will include information similar to that included in NCAL's annual Assisted Living Regulatory Review, as well as detailed regulatory information for each state and a discussion of relevant Medicaid policy.


The ASPE report will be available early 2015 and will be posted on the ASPE website. Links will be provided on the NCAL website.​​



Published in March 2013, this report offers a state-by-state summary of assisted living regulations covering 21 categories; provides contact information for state agencies that oversee assisted living activities; and includes each agency’s Web site address.  An analysis of regulatory and legislative changes in 2012 and state-by-state highlights can be downloaded here​.

Eighteen states reported making regulatory, statutory, or policy changes impacting assisted living/residential care communities from January 2012 through January 2013.  At least nine of these states made major changes, including Colorado, Georgia, Michigan, Missouri, New Jersey, New York, Ohio, Oregon, and Washington.  In 2012, states continued developing new models for surveys, expanding disclosure and reporting requirements, addressing life safety and infection control issues, and allowing increased delegation of medication admistration to non-nurse staff.

  • New Jersey and Colorado joined the small but growing number of states with innovative survey approaches, developed in part to help better target resources.  New Jersey’s Department of Health (DOH) collaborated with The Health Care Association of New Jersey Foundation to create a voluntary program called Advanced Standing.  To receive this distinction, a facility must comply with all applicable regulations as well as submit quality data reaching benchmarks established by a peer review panel.  Participating facilities do not receive a routine survey, but any time a facility falls below DOH standards, it can be removed for cause from the program.  The state also performs follow-up surveys based on a random sample. In January 2013, Colorado began conducting risk-based re-licensure inspections for assisted living residences (ALRs), initially on a pilot basis.  Under the new system, ALRs meeting criteria specified in the law will be eligible for an extended survey cycle.  In 2012, Michigan also began using a new renewal inspection system.
  • After creating an additional level of licensure for assisted living communities a year earlier, Georgia updated rules for personal care homes in January 2013, including new requirements for additional staff training, staffing above minimal standards, and a resident needs assessment upon move-in.  Also effective in January 2013, New York adopted rules stating that no adult home with a capacity of 80 residents or greater may admit or retain more than 25 percent census of residents with serious mental illness.
  • Several states made changes to policies and rules for care provided to residents receiving Medicaid services, some to accommodate managed care contracting.  In 2012, the state of Washington changed its licensure term to “assisted living facility” from the outdated “boarding home.”  Oregon began requiring facilities to adopt policies for the treatment or referral of acute sexual assault victims.