In September 2023, the Administration for Community Living (ACL) – a part of the United States Department of Health and Human Services (HHS) – issued a Notice of Proposed Rulemaking announcing their intention to modify the regulations of the Older Americans Act of 1965 (‘‘the Act’’ or OAA) by creating new guidance related to Adult Protective Services (APS).
Historically, APS programs, which support older adults and adults with disabilities who experience, or who are at risk of, abuse, neglect, self-neglect, or financial exploitation, have been designed and administered at the state or local level. This piecemeal state-level administration model has led to large variations and discrepancies between APS programs across the country. In 2016, the ACL attempted to remedy this by creating a core set of principles and expectations for APS services across the country called the National Voluntary Consensus Guidelines. However, because adoption and implementation of the guidelines was voluntary, they did not achieve the desired uniformity across APS programs.
In addition to establishing standard definitions for foundational terms in APS practice (e.g., “adult maltreatment,” “exploitation,” “abuse,” and more), the recently published Notice of Proposed Rulemaking establishes mandatory minimum standards that would apply to APS programs across the country. These mandates would formalize and expand on the existing voluntary guidelines but would do more to ensure uniformity and quality across APS programs.
The proposed rules would require the state entities that implement the APS programs, and conduct related investigations, to:
- Ensure that APS clients are informed, in plain language and accessible formats, of their rights at their first contact with the APS program. This includes confidentiality, privacy requirements, the right to refuse services, and the right to refrain from speaking with APS. Develop policies, procedures, and mechanisms for coordinating and sharing of information with other entities (i.e., state long-term care ombudsman, law enforcement agencies, state departments of health, state Medicaid agencies, financial institutions, community-based forensic accountants, and other involved entities).
- Provide a person-directed approach to service delivery based on concepts of least restrictive alternatives.
- Meet minimum requirements for data collection, retention, and reporting.
- Meet minimum requirements for staff training and ongoing education on core competencies for APS staff and supervisors.
- Establish policies and procedures to prevent, recognize, and promptly address both real and perceived conflicts of interest.
- Create clear and specific parameters of the settings, locations, and types of perpetrators for which maltreatment will be investigated and establish processes to ensure they are implemented consistently across the state’s APS programs.
- Establish a standardized and systematic approach to investigations of adult maltreatment, from initiation of a case through post-investigation services.
- Establish and manage a tiered risk-based assessment system to differentiate between cases that represent immediate risk (defined as those that are life-threatening or likely to cause irreparable harm or significant loss of income, assets or resources) and those that do not.
- Respond quickly to reports of maltreatment representing immediate risk (should occur within 24 hours) and respond to reports assessed to represent non-immediate risk (should occur within seven calendar days).
Interested parties may submit comments on these proposed rules here until November 13, 2023.
The Bonadio Group has significant experience working with state and local health, human, and social services agencies to complete operational assessments, efficiency reviews, and internal controls evaluations to ensure controls are appropriately designed, monitor adherence to regulations, improve workflow efficiencies and mitigate the risk of internal fraud and noncompliance for government agency operations.
More than just operational support, Bonadio supports APS units across the country with:
- Forensic accounting services – outsourcing financial exploitation investigations to our certified forensic accountants, so case workers can focus on their clients
- Proprietary software FraudFindr.com – empowering case workers to investigate financial exploitation cases on their own via a cloud-based, easy to use platform for analyzing bank statements
- Medicaid long term care assistance – chronic care determinations, lookbacks, income assessment, and analyzing trusts
Is your agency ready for the proposed changes? Let our experts help. Please do not hesitate to reach out if you need further guidance or have any questions on this topic.
This material has been prepared for general, informational purposes only and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. Should you require any such advice, please contact us directly. The information contained herein does not create, and your review or use of the information does not constitute, an accountant-client relationship.
