States gradually are increasing their oversight of assisted living communities, according to a report released Tuesday by the National Center for Assisted Living.

Seventeen states updated assisted living regulations, statutes and policies between June 2016 and June 2017, according to the 2017 edition of NCAL’s “Assisted Living State Regulatory Review.”

“Over time, states are generally increasing the regulatory requirements for assisted living communities,” wrote the report’s author, NCAL Senior Policy Director Lilly Hummel.

The most common changes increased civil monetary penalty maximums or strengthening oversight requirements, NCAL said. Other changes were made to training requirements, administrator licensing, background checks and medication administration.

The report also found that penalties and oversight were increased via laws in four states:

  • The California legislature increased civil penalties for licensing violations and required the state Department of Social Services to work with licensees to determine the cause of deficiencies and ways to prevent repeat violations.
  • A new Oregon law increases oversight and supervision and changes fee and fine structures. “Specifically, the Department of Human Services will be required to develop an evidence-informed framework for assessing compliance with regulatory requirements and requiring corrective action that accurately and equitably measures compliance and the extent of noncompliance,” according to the report. Additionally, the department will be required to administer an advanced standing program that rewards assisted living communities for positive performance and penalizes poor performance.
  • Rhode Island passed legislation requiring the state licensing agency to conduct unannounced, on-site inspections of all licensed assisted living communities every other year, with at least 10% of the inspections conducted on nights and weekends. The licensing agency also is required to conduct additional on-site inspections and investigations deemed necessary.
  • The Virginia legislature increased the aggregate amount of civil penalties that the state Department of Social Services is allowed to assess against an assisted living community.

The annual regulatory review publication summarizes key selected state requirements for assisted living licensure or certification. Among the 20 areas covered are state agencies that license assisted living, recent legislative and regulatory activity, requirements for resident agreements, admission and discharge policies, scope of care and life safety.

“We anticipate that more than half of states will be proposing, formally reviewing or considering changes that would affect assisted living communities in the coming year. Some may make significant changes, while others may make small updates,” Hummel said.

“States are also in the process of reviewing their regulations to comply with federal requirements for assisted living communities and other home- and community-based settings that are Medicaid providers,” she added.

Approximately 47% of assisted living communities are Medicaid-certified to be HCBS providers, and 15% of residents are Medicaid beneficiaries, according to the report.