The Maryland Department of Health’s (DOH) Office of Health Care Quality (OHCQ) recently announced revisions to the regulations that govern Assisted Living Programs (ALPs). These updates, which initially began over ten years ago, are “intended to maximize independence and promote the principles of individuality, personal dignity, freedom of choice, and fairness for all individuals residing in assisted living programs while establishing reasonable standards to promote individuals’ health and safety.”
Unlike nursing homes, ALPs do not operate under the Federal regulatory umbrella. Rather, they generally result from private pay contractual arrangements between a provider and resident. According to OHCQ, as of May 1, 2025, there are 1,625 licensed ALPs, with 82 percent classified as small businesses (i.e., licensed for 15 or fewer beds).
Here are some of the changes that were effective on April 28, 2025 with the updated regulations:
- Changed the definition of ALP to mean a residential or facility-based program for two or more beds that provides housing and supportive services;
- Clarified that state hospice regulations and Federal regulations apply when an assisted living resident is under the care of a licensed general hospice program but is physically located in an assisted living facility; and
- Prohibited discrimination in admitting or providing care because of race, color, national origin, sexual orientation, gender identity, religion, physical disability, or mental disability.
Additionally, the updated regulations address a wide-range of topics such as:
- Ensuring that assisted living managers (ALMs) complete an 80-hour training course covering various topics and be licensed with the State Board of Long-Term Care Administrators. ALMs also have expanded duties including those related to, but not limited to, the following areas: resident assessments, staffing and quality assurance, and DOH reporting. The targeted licensure implementation date is July 1, 2026.
- Having awake overnight staff on an approved Alzheimer’s Special Care Unit. The ALP must also keep staffing schedules onsite/on file (date, shift, staff member name) for 18 months;
- Having nutritionally adequate menus reviewed by a dietician or nutritionist prior to licensure, with substantive changes, and at least every three years. Menus must be posted weekly, kept on file for six months, and snacks must be offered between meals;
- Providing the Resident Bill of Rights prior to or upon admission and posting the same in a conspicuous place. The Bill of Rights must also highlight the right of residents to be free from financial exploitation and involuntary seclusion; and
- Prohibiting an ALP staff member from being both a resident representative and the representative payee. The ALP must notify OHCQ if an ALP staff member is designated as a resident’s representative payee.
The updated regulations also strengthened criminal penalties, including immediate prosecution and injunctive relief, if an ALP operates without a license, and when allegations of resident neglect, abuse, or financial exploitation are substantiated.
An executive summary of the new regulations can be found here.
Given the depth and breadth of these updated regulations, ALPs would be well-served to ensure that:
- their current policies, procedures, and processes satisfy these new requirements; and
- they make any necessary modifications of the same.
Should you have any questions regarding the above or would like guidance on complying with these regulatory updates, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].
