Senate committee advances bill to ease assisted-living licensing, shift penalty funds to grants

Senator Camille Blaylock, who represents District 11, told the Senate Health and Welfare Committee that Senate Bill 1102 aims to reduce what she called “over regulation” of assisted-living and residential care communities and to update statute by folding some IDAPA rule language into code. "This seeks to address the over regulation of residential care and assisted living communities in Idaho," Blaylock said in her presentation.

The nut of Blaylock's proposal is threefold: make it easier for providers to open and expand facilities, reduce operational burdens for existing providers, and foster a partnership model between the Department of Health and Welfare and providers rather than an adversarial compliance posture. "First making it easier for providers to open communities and expand here. Second making it easier for providers to operate those communities. And then third, fostering a partnership between the Department of Health and Welfare and those providers," Blaylock said.

Under the bill as described to the committee, licensing procedures would be simplified for new facilities and for existing licensees opening additional buildings; fire, life and safety inspections could carry over when ownership changes; administrators licensed by the state could oversee up to three facilities under a single license; administrators could delegate day-to-day operational duties to on-site managers; and some administrative requirements would be removed or clarified.

A prominent operational change Blaylock described is scheduling routine licensing surveys: rather than always allowing an unannounced visit for the scheduled 12-to-18-month licensing survey, the bill would require notice approximately 30 days in advance for those routine licensing surveys while preserving the department’s right to conduct unannounced investigations in response to complaints. "The department still has the authority to go into communities, if they have a complaint, they're able to go in unannounced still and be able to do a full investigation; this is simply for the licensing survey that will be scheduled," Blaylock said.

The bill also would change how penalties are handled. Blaylock said facilities could still be cited and fined, but penalty money would be required to be used to remedy the cited deficiencies (for example, repairing trip-hazard carpet) rather than be paid to the department. She said existing penalty funds (about $300,000) and future penalty funds would be placed into a grant fund for assisted-living communities to apply for reinvestment. "So if they see that the carpet in the foyer is bunching...they can use that money to get their carpet stretched out and reduce that issue," Blaylock said.

Testimony from the Idaho Healthcare Association and providers supported many of the changes. Robert Vandermer, executive director of the Idaho Healthcare Association, noted the regulatory framework had not kept pace with changes in assisted-living care and said some statutory language and rule interpretations were outdated. He described changes the bill would make to the definition of "inadequate care," restraint language, assessment delegations and licensing that he said would relieve small providers. "Some of these statutes were written...when assisted living was really something different," Vandermer said, adding that the association assisted in drafting the bill and sought to make statute less punitive for routine, nonharmful lapses.

Angela Hillis, a registered nurse and licensed assisted-living administrator who said she owns assisted-living properties in multiple states, told the committee many current rules are clinically antiquated and limit the ability of facilities to care for patients following modern outpatient procedures. She urged removal of obsolete items that prevent facilities from admitting residents who no longer require institutional-level stays. "A lot of these rules are very old and the nursing and the doctor progress and we've progressed much past them," Hillis said.

Committee members asked for clarifications about which IDAPA rule sections are incorporated into statute and which specific rule text is being deleted; Blaylock said the bill includes a list of the IDAPA sections it incorporates and that she and stakeholders could walk the committee through page-by-page. Senate Wintrow asked for those specifics and Blaylock pointed the committee to the bill's list of IDAPA sections on the second-to-last page.

Committee members also raised unresolved issues the bill does not solve. Vandermer and others described difficulty finding placements and care for residents with severe behavioral issues or dementia who may be discharged from assisted living; they said a durable systemwide solution for where such residents should be placed remains to be developed. "That is a big issue...we'd like to come back with a solution of where do they go," Vandermer said.

After testimony and brief discussion, Senator Sandra Harris moved and Senator Maryanne Wintrow seconded to send Senate Bill 1102 to the Senate floor with a do-pass recommendation. The committee approved the motion by voice vote. "Moved by Senator Harris, seconded by Senator Wintrow to send Senate Bill 11 02 to the floor with the do pass recommendation...all those in favor say aye. Aye," the transcript records.

The bill text, the list of IDAPA sections the bill incorporates, and stakeholder notes were made available during the hearing and committee members said they are available to review the bill line-by-line in subsequent work.

Ending: The committee's action sends the bill to the full Senate for further consideration; committee members and stakeholders indicated follow-up work remains on rule deletions and on solutions for residents who cannot be retained in assisted living because of behavioral or clinical needs.