Developing Regulations to
Protect Older Adults
Office of Health Care Quality
Student: Grace E. Mandel
Preceptor: Amanda Thomas, MPH
Health Policy Analyst for Regulatory Affairs
Office of Health Care Quality
Monitors the quality of
care in Maryland’s
health care facilities
and community-based
programs through
regulation, surveying
and education
dhmh.maryland.gov/ohcq
Regulatory Process
Formal
Informal
Submit to
Office of
Policy and
Regulations
Develop
Draft
Approval
Process
New
Regulation
1
•
•
•
•
Why revise a regulation?
Adopt new requirements
Amend requirement
Repeal requirements
Remove outdated information
OR
1
Why revise a regulation?
•
•
Respond to request from
Governor
Comply with:
–
–
Regulation Review and
Evaluation Act (RREA)
New legislation
2
Paperwork to Office of Policy and
Regulations (OPR)
All Updates Require:
• Notice of Regulation Development Form
• Background Form
• Proposed Action Form
&
If Mandatory under RREA:
• Work Plan
• Evaluation Form
&
If Incorporation by Reference:
• Incorporation By Reference Form
3
Who Participates in Draft
Development?
Stakeholders & Community Members
-Town Hall Meetings
-One on One Meetings
-Informal Comments
&
Program Coordinators and Managers
-Incorporate feedback to develop a new draft
Submit
to
Approval
Process
Approval Process
4
5
6
• Formal Comment Period
• Administrative, Executive, and Legislative Review
Committee (AELR) Reviews Proposed Updates
• Governor Signs Regulation
Assisted Living
• Defining Characteristics
– Autonomy, choice, and dignity
– Less expensive than long term care
– Designed for adults with limited needs assistance
Stakeholder Involvement
• Forums
• One on One Meetings
• Comment Periods
• Goal: Education & improvement of the
regulation
Attendance at Forums
Satisfaction at Forums
Informal Comments
Stakeholders
OHCQ Surveyor*
11%
Other
3%
Providers
39%
State or Local Government
19%
Training Provider or Educator
13%
Advocacy Organization/
Professional Association
15%
Interest Areas
7%
3%
22%
9%
Clinical Care and Services
Training
5%
Licensing
Resident Protections & Rights
6%
14%
Staffing
Medication
10%
Facility Standards
Definitions
12%
12%
Editing
Other
Manager Training
(1) The assisted living manager shall at a minimum:
(i) A 4-year, college-level degree;
(ii) 2 years experience in a health care related
field and 1 year of experience as an assisted living
program manager or alternate assisted living
manager; or
(iii) 2 years experience in a health care related
field and successful completion of the 80-hour
assisted living manager training program;
Manager Training
Comments on Managers Requirement
“I am unclear how a college degree will impact
one's ability to effectively manage an assisted
living facility. What seems more relative and
appropriate is experience in the field as well as
taking the 80 hour Manager's training Course
through the Beacon Institute.”
Staffing Ratio
• “Clarify what “on site staff sufficient in number
means”. This is impossible to prove.”
• “Appropriate staffing is determined by the
organization providing the services. This
determination is made by careful evaluation of
the resident's needs, type of staffing provided
and possibility of requiring private duty care
givers in situations where appropriate. Too many
details go into making this determination and
cannot be successfully determined by OHCQ by
making a blanket statement for all facilities.”
Public Health Impact
• Protections for residents of Assisted Living
facilities
• Flexibility while also having enforceable
standards
• Easily Interpretable Regulations
Special Thanks!
• Amanda Thomas, MPH
– Health Policy Analyst for Regulatory Affairs
• Dr. John Parrish
– Director of Quality Initiatives Unit
• Dr. Beth Resnick and Paulani Mui, MPH
– Johns Hopkins Bloomberg School of Public Health