State Regulation 

of

Residential Facilities 

for Adults 

with Mental Illness

Henry Ireys

Lori Achman

Ama Takyi

State Regulation of Residential Facilities for Adults with Mental Illness iii

Acknowledgments

This report was prepared by Mathematica Policy Research, Inc., for the Substance Abuse and 

Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and 

Human Services (DHHS) under Contract No. 282-98-0021 (36). The authors of the report are 

Lori Achman, M.P.P., Henry Ireys, Ph.D., and Ama Takyi, M.A. Judith Teich, M.S.W., of the 

Center for Mental Health Services (CMHS), SAMHSA, served as government project officer, 

and Jeffrey A. Buck, Ph.D., Associate Director for Organization and Financing, CMHS, served 

as advisor. 

Disclaimer

Material for this report was prepared by Mathematica Policy Research, Inc., for SAMHSA, 

DHHS, under Contract Number 282-98-0021, Task Order No. 36. The content of this publication does not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or 

DHHS.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied 

without permission from SAMHSA or CMHS. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication can be accessed electronically through the following Internet World Wide 

Web address: www.samhsa.hhs.gov. For additional free copies of this document, please call 

SAMHSA’s National Mental Health Information Center at 1-800-789-2647 or 1-800-228-0427 

(TTD).

Recommended Citation

Ireys H, Achman L, Takyi A. State Regulation of Residential Facilities for Adults with Mental 

Illness. DHHS Pub. No. (SMA) 06-4166. Rockville, MD: Center for Mental Health Services, 

Substance Abuse and Mental Health Services Administration, 2006.

Originating Office

Office of the Associate Director for Organization and Financing, Center for Mental Health 

Services, Substance Abuse and Mental Health Services Administration, One Choke Cherry 

Road, 6-1065, Rockville, MD 20857. 

DHHS Publication No. (SMA) 06-4166

Printed 2006 

State Regulation of Residential Facilities for Adults with Mental Illness 

Table of Contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

A. Mental Health Organizations Providing Residential Care . . . . . . . . . . . . . . 4

B. Characteristics of Residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

C. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

II. Methods and Data Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

A. Criteria for Including Residential Facilities in the Present Study . . . . . . . . . 7

B. Questionnaire Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

C. Fielding the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

D. Assessing Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

III. Number and Characteristics of Residential Facilities for Adults 

with Mental Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

A. Number of Facilities and Associated Beds . . . . . . . . . . . . . . . . . . . . . . . . . 13

B. Average Number of Residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

C. Average Length of Stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

D. Organizations that Operate Residential Facilities . . . . . . . . . . . . . . . . . . . 18

E. Secure Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

IV. State Oversight: Requirements, Licensing, Regulations . . . . . . . . . . . . . . . . . 19

A. Basic Requirements for Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

1. Staff-to-Resident Ratio Requirements . . . . . . . . . . . . . . . . . . . 19

2. Minimum Education of Facility Directors . . . . . . . . . . . . . . . 20

3. Critical Incident Reporting Requirements . . . . . . . . . . . . . . . . 20

B. Licensing Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

C. Regulatory Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

D. Agencies Responsible for Reviewing Complaints . . . . . . . . . . . . . . . . . . . 23

E. Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

V. Services and Financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

A. Services Provided . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

B. Funding Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

VI. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Appendix A: Expert Advisory Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Appendix B: Survey Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
vi State Regulation of Residential Facilities for Adults with Mental Illness

List of Tables

I.1. Average Daily Census of Adults 21 Years and Older and Number 

of Beds in 24-Hour Residential Care Organizations Funded and 

Operated by State Mental Health Agencies, 2002 . . . . . . . . . . . . . . . . . . . 4

II.1. Criteria for Residential Facilities to Be Included in the Study . . . . . . . . . . 8

II.2. Percentage of Respondents Using Estimates or Record Reviews

for Selected Survey Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

III.1. Types of Residential Facilities for Adults with Mental Illness, 

Average Number of Residents, and Total Beds, by State, 

September 30, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14–15

III.2. Number of Beds in Residential Facilities for Selected States for 

Selected Months as Reported in Two Data Sources . . . . . . . . . . . . . . . . 16

III.3. Average Number of Residents per Residential Facility for Adults 

with Mental Illness, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

III.4. Average Length of Stay in Residential Facilities for Adults with 

Mental Illness, by Number of Facilities, 2003 . . . . . . . . . . . . . . . . . . . . . 17

III.5. Ownership of Residential Facilities for Adults with Mental Illness, 

by Number of Facilities, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

IV.1. Daytime Staff-to-Resident Ratio Requirements in Residential 

Facilities for Adults with Mental Illness, 2003 . . . . . . . . . . . . . . . . . . . . . 20

IV.2. State Regulations Requiring Minimum Education for Residential 

Facility Directors, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

IV.3. Requirements for Reporting Critical Incidents to the State in 

Residential Facilities for Adults with Mental Illness, 2003 . . . . . . . . . . . 21

IV.4. Number of Agencies Involved in Licensing or Certifying Residential 

Facilities for Adults with Mental Illness, 2003 . . . . . . . . . . . . . . . . . . . . . 21

IV.5. State Agencies Involved in Licensure or Certification of Residential 

Facilities for Adults with Mental Illness, 2003 . . . . . . . . . . . . . . . . . . . . . 22

IV.6. Procedures Required by States for Initial Licensure or Certification 

and Renewal of Licensure or Certification for Residential Facilities 

for Adults with Mental Illness, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
State Regulation of Residential Facilities for Adults with Mental Illness vii

IV.7. Number of Agencies Responsible for Reviewing Complaints Against 

Residential Facilities for Adults with Mental Illness . . . . . . . . . . . . . . . . . 23

IV.8. State Agencies that Review Complaints Against Residential Facilities 

for Adults with Mental Illness, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

V.1. Services that Residential Facilities Must Provide per State 

Requirements, Either by Staff or Through Contractual 

Arrangements, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

V.2. Funding Sources for Residential Facilities for Adults with Mental 

Illness, 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Executive Summary

State Regulation of Residential Facilities for Adults with Mental Illness 

There is little national information on the policies and procedures used by States to regulate residential treatment facilities for adults with mental illness. As a result, policymakers and 

program administrators face major difficulties in determining both the effectiveness of current policies and the potential need for new policies that are 

responsive to emerging trends in mental health care. Based on a survey of 

State officials, this report provides the most accurate national data available 

concerning methods that States use to license, regulate, and monitor residential facilities for adults with mental illness. The information in this report 

can help Federal and State policymakers improve procedures for monitoring 

quality of care provided in these facilities.

The specific purpose of this study was to 

conduct a national survey of State officials to 

identify methods that States use to monitor 

residential facilities for adults with mental 

illness. Officials in departments of mental 

health, social services, and health and human 

services responded to structured questions on 

facility characteristics and programs, licensing and oversight procedures, and sources of 

financing. The survey was fielded between 

November 2003 and March 2004. This 

report presents the results of the survey.

Residential Facilities in the Study

To be included in the study, residential facilities for adults with mental illness had to be 

licensed or certified by the State as providing some therapeutic services in addition to 

room and board. States vary widely in the 

types of residential facilities that they license 

or certify, the names of these facility types, 

and the number of associated facilities. 

Because this study focuses on State regulations, facility type is the primary unit of 

analysis, but the study also covers the number of facilities in each type and the number 

of licensed beds. Many States license multiple 

types of residential facilities for adults with 

mental illness. For example, in one State, 

the two types of residential facilities meeting 

study criteria are referred to as “long-term 

structured residential facilities” and “community residential rehabilitation group homes.” 

The first type includes 25 facilities with 359 

associated beds; the second type includes 545 

facilities and 2,726 associated beds. 

In 2003, the number of facilities associated with each facility type included in the 

study varied by State from 1 to more than 

1,300. The average number of residents 

per facility ranged from 3 to 99. About 39 

percent of the facilities housed between 3 

and 8 residents, and 79 percent of facilities averaged fewer than 17 residents each. 

About 43 percent of all facilities are owned 

wholly or predominantly by not-for-profit 

organizations, and about 6 percent by forprofit organizations. 

The study data derive from responses 

by officials in 34 States and the District of 
 State Regulation of Residential Facilities for Adults with Mental Illness

Columbia who provided information on 63 

types of residential facilities. These 63 types 

account for 7,327 facilities that, in total, 

had 103,393 beds as of September 30, 2003. 

These numbers exceed counts based on the 

Survey of Mental Health Organizations 

(cf. Manderscheid et al., 2004) because 

the present study covered a wider range of 

residential settings. Overall, the study adds 

substantially to existing information on the 

number and characteristics of mental health 

organizations providing residential care to 

adults with mental illness. 

Major Findings on States’ 

Monitoring Methods

The analysis of survey data led to two major 

findings. First, States use a variety of methods for monitoring residential facilities for 

adults with mental illness, and they vary in 

the extent to which they use one method 

or another. Typical methods include onsite 

inspections, documentation of staff qualifications and training, record reviews, resident 

interviews, critical-incident reports, and 

standards for resident-to-staff ratios and 

educational levels of facility directors. All 

States use at least several of these methods, 

but few States use all of them.

Second, the regulatory and monitoring 

environment for residential facilities that 

serve adults with mental illness is complex 

because in most States, several agencies, each 

with a different mission and function, are 

involved in facility licensing, funding, and 

oversight. These agencies include State mental 

health authorities, departments of health, and 

departments of social services. For 61 percent 

of the types of residential facilities covered 

by the survey, two or more State agencies are 

involved in reviewing complaints, and for 

37 percent of all facility types, licensing or 

certification is required from more than one 

agency. Furthermore, in some States, agencies 

that provide major financial support play a 

minor regulatory role.

Other findings include the following:

n Slightly less than 60 percent of facility 

types, accounting for 25 percent of facilities, were subject to State requirements 

limiting the maximum number of residents 

allowed per staff person in 2003. 

n To obtain initial licenses or license renewals, virtually all facilities were required to 

undergo a site inspection, and between 55 

and 90 percent were required to (1) provide documentation of staff qualifications 

and (2) permit State review of clinical 

records.

n States conducted unannounced visits for 

monitoring purposes to at least some 

facilities within 65 percent of all facility 

types; States conducted announced visits to 

at least some facilities within 70 percent of 

all facility types.

n More than 85 percent of facilities were 

required to report adverse events or critical 

incidents to the State, but the specific types 

of adverse events or incidents that must be 

reported vary somewhat across facilities. 

n State and local mental health agencies were 

the most common funding source for residential facilities for adults with mental illness; 79 percent of facility types, accounting for 84 percent of associated facilities, 

receive at least some funding from the 

State or local mental health agency.

n Residents use Supplemental Security 

Income payments to pay for services in 

70 percent of facility types, accounting 

for 84 percent of associated facilities; residents also use Social Security Disability 

Insurance payments in 59 percent of facility types, accounting for 47 percent of 

associated facilities.
I. Introduction

This report presents the results of a survey of State agencies about current State 

licensing and regulatory procedures for residential facilities for adults with mental illness. (A companion report, State Regulation 

of Residential Facilities for Children with 

Mental Illness, provides information about 

residential treatment facilities for children.) 

This chapter summarizes information from 

previous studies on the number of these facilities and the characteristics of their residents. 

Specifically, it reviews data from four sources: 

n the Survey of Mental Health 

Organizations (SMHO) for 2002, 

n reports from the Research Institute of 

the National Association of State Mental 

Health Program Directors (NASMHPD) 

based on 2002 data from the States, 

n the National Survey of Community 

Residential Programs for Persons with 

Prolonged Mental Illness (NSCRP) fielded 

in 1986–1987, and 

n analyses of data from the 1997 Client/

Patient Sample Survey (CPSS). 

Chapter II provides an overview of the 

methods used to obtain data from the States 

and includes the criteria used to identify residential facilities for the survey. Chapters III to 

V present the findings of the survey in a series 

of tables, with important findings discussed 

in the text: Chapter III focuses on the numbers and characteristics of residential facilities, Chapter IV on State regulatory methods, 

and Chapter V on services and financing. 

Chapter VI presents conclusions based on the 

findings. The appendix includes the survey 

used to collect data from the States.

State Regulation of Residential Facilities for Adults with Mental Illness 

Since deinstitutionalization of individuals with mental illness 

began in the 1960s, residential facilities for adults with mental 

illness have changed substantially and are now an important 

component of State mental health service systems. For example, over the 

past two decades, residential programs have moved from simply providing 

custodial care to an emphasis on independent living and self-sufficiency, and 

larger congregate facilities have been replaced by smaller residential settings 

(O’Hara & Day, 2001; Ridgway & Zipple, 1990). Despite the importance of 

residential facilities for adults with mental illness, comprehensive information on their characteristics and number of residents is sparse (Salzer, Blank, 

Rothbard, & Hadley, 2001, Fleishman, 2004). Moreover, States have long 

held the primary responsibility for regulating these facilities, but there has 

never been a systematic survey of the States’ regulatory methods. 
 State Regulation of Residential Facilities for Adults with Mental Illness

A. Mental Health Organizations 

Providing Residential Care

The SMHO, conducted every 2 years by the 

Center for Mental Health Services at the 

Substance Abuse and Mental Health Services 

Administration (SAMHSA), is a count of 

specialty mental health organizations and 

psychiatric services of non-Federal general 

hospitals and a survey of a sample of these 

organizations that collects information on 

services, beds, staffing, expenditures, and 

sources of revenue. Analyses of data from 

the SMHO conducted in 2002 indicate that 

781 mental health organizations (excluding 

all types of psychiatric hospital or inpatient 

settings) had 44,886 beds for residential care 

for adults (Manderscheid et al., 2004). The 

SMHO focuses specifically on organizations 

that operate under the authority of mental 

health agencies and have the provision of 

clinical mental health services as their primary mission (J. Maedke, Social and Scientific 

Systems, Inc., personal communication, 

April, 2005). It does not include many other 

residential facilities that are not under the 

authority of State mental health agencies or 

that serve as homes to adults with mental illness who may need only supportive services, 

such as case management, training in activities of daily life, or medication management. 

In addition to the SMHO, some information on the number of individuals in residential treatment beds operated and funded by 

State mental health authorities is available 

for selected States through the NASMHPD 

Research Institute’s State Profile Report for 

2002. As Table I.1 shows, States that submitted data vary widely in the daily average of 

adults who were in residential settings owned 

or operated by State mental health agencies. 

The NASMHPD study defines residential 

beds as providing (1) overnight mental health 

care in conjunction with psychiatric treatment services in a setting other than a hospital or (2) overnight mental health care in 

conjunction with supervised living and other 

supportive services in a setting other than a 

hospital (NASMHPD, 2005).

Table I.1. Average Daily Census 

of Adults 21 Years and Older 

and Number of Beds in 24-Hour 

Residential Care Organizations 

Funded and Operated by State 

Mental Health Agencies, 2002

State

Average Daily 

Census of Clients 

Number 

of Beds

Alabama 1,877 2,086

California 4,268 —

Colorado 642 —

Connecticut 949 1,176

Delaware — 180

Florida 1,960 —

Hawaii 132 240

Massachusettsa 6,990 —

Michigan 2,880 —

Minnesota 606 —

Missouri 65 81

Nevadab 708 —

New Hampshire 29 —

New Jersey 3,284 —

New Mexico 39 44

New York 6,395 6,914

Oklahoma 101 199

Oregon 934 1,186

Rhode Islandb 304 314

South Carolina 23 30

Texas 272 —

Utah 417 459

Vermont 336 —

Wyoming 7 —

Total — 12,909

Source: NASMHPD, 2005

Notes: Other States did not provide any information for these items or 

had no residential care organizations funded and operated by the 

State’s mental health organization. Dashes (—) indicate State did 

not respond to the specific item. Average daily census is for fiscal 

year 2002. Number of beds is as of the last day of fiscal year 2002. 

Twenty-four-hour residential care is defined as overnight mental 

health care in conjunction with (1) psychiatric treatment services 

in a setting other than a hospital or (2) supervised living and other 

supportive services in a setting other than a hospital. Examples 

include halfway houses, community residences, and group homes. 

The average daily census of clients in Connecticut is based on the 

State’s 2004 report.

a

 Adults 20 years and older.

b

 Adults 18 years and older.
State Regulation of Residential Facilities for Adults with Mental Illness

Finally, although it is quite dated, the 

NSCRP provides a comprehensive view of 

the residential treatment system in 1986–87. 

The purpose of the survey was to develop 

a national database to describe how mental health systems across the country had 

responded to the housing needs of adults 

with mental illness (Randolph, Ridgway, 

Sanford, Simoneau, & Carling, 1988). 

Information gathered in the survey focused 

on what agencies developed residential 

programs, the types of programs that were 

implemented, the services provided, and 

staff and client characteristics. The survey 

identified more than 2,500 agencies that 

provided community residential programs 

to adults with psychiatric disabilities and 

found that about 60,000 adults were residing in community residential programs in 

1986–87.

The following types of residential programs were included in the survey: shelter 

programs, crisis programs, foster care programs, supervised apartments, group homes, 

board and care facilities, halfway houses, 

intermediate care facilities, nursing homes, 

and supportive housing arrangements. 

According to the NSCRP, in 1986–87, most 

of the agencies providing residential services 

were private, nonprofit organizations that 

relied heavily on state funds to start and 

operate their programs (Randolph et al., 

1988). The most frequent types of programs 

offered by the agencies were group homes 

and supervised apartment programs. 

B. Characteristics of Residents

The 1997 CPSS provides information on 

characteristics of persons served by residential care programs. This survey included 

residential care programs of State and county 

mental hospitals, private psychiatric hospitals, non-Federal general hospitals, Veterans 

Administration medical centers, and multiservice mental health organizations that were 

included in the 1994 Inventory of Mental 

Health Organizations and General Hospital 

Mental Health Services (Milazzo-Sayre et al., 

2001). According to the CPSS, 55,274 adults 

were under the care of residential programs 

on May 1, 1997, and there were 128,042 

admissions during 1997 (Milazzo-Sayre et al., 

2001). Males represented about 60 percent 

of the client population. Overall, persons 

diagnosed with schizophrenia were the most 

likely to be under the care of residential 

programs, representing 50 percent of clients 

served in these facilities.

C. Summary

Existing information provides a foundation 

for understanding the nature and scope of 

residential care for adults with mental illness, 

but major gaps in data on these residential 

settings remain. In particular, certain types 

of residential settings were not included in 

existing surveys or profiles, such as settings 

that provide a minimum level of therapeutic 

services beyond room and board and that 

were not operated under the auspices of 

State mental health agencies. Furthermore, 

existing studies or surveys do not address 

the methods States use to regulate or monitor 

these facilities.

The present study builds on the existing 

foundation of data by gathering information 

on State methods of regulating residential 

facilities for adults with mental illness. The 

types of facilities that States regulate include 

facilities that do not meet criteria for inclusion in the SMHO, and therefore this study 

reports on a larger number of facilities than 

have been included in studies based on 

SMHO data.

II. Methods and Data Issues

A. Criteria for Including Residential 

Facilities in the Present Study

The present study uses a structured survey 

to gather information about State-regulated 

residential facilities specifically designed to 

serve adults with mental illness (as opposed 

to settings that serve individuals with physical disabilities and the elderly) and that 

provide some therapeutic service beyond 

room and board. Adults with mental illness 

live in a wide variety of community settings, 

including subsidized apartments, short-stay 

residences, and their own homes, but this 

study was not designed to gather information on these settings. In addition, the survey 

was not intended to cover psychiatric inpatient facilities, nursing homes, residential 

substance abuse treatment programs (unless 

the program was specifically for individuals 

dually diagnosed with a mental disorder and 

a substance abuse disorder), or individual 

care arrangements.

One of the obstacles to collecting national 

information on residential facilities for adults 

with mental illness is the absence of a standard nomenclature. Because responsibility 

for monitoring residential settings for adults 

with mental illness lies with State governments, each State has evolved its own terms 

to describe the types of facilities available 

in the State. As Fleishman (2004) notes, 

residential care facilities “are also known 

as board-and-care homes, adult residential 

facilities, adult foster homes, adult homes, 

community care homes, supervisory care 

homes, sheltered care facilities, continuing 

care facilities, transitional living facilities, 

group homes, domiciliary care homes, personal care homes, family care homes, and 

rest homes, among others.” 

In this report, “residential facility” refers 

to any entity that meets the criteria listed 

in Table II.1. These criteria were developed 

with guidance from the project’s advisory 

committee following a review of descripState Regulation of Residential Facilities for Adults with Mental Illness

I

n the absence of national data on policies and procedures that 

States used to regulate and monitor residential facilities for adults 

with mental illness, this study required a systematic approach to 

gathering relevant information from officials in State departments of mental 

health, social services, and health and human services, and other agencies 

involved in monitoring these facilities. The study was organized around the 

following steps to accomplish its goals:

n Determining the criteria for including residential facilities

n Developing the survey questionnaire

n Fielding the survey

n Assessing the quality of the data
State Regulation of Residential Facilities for Adults with Mental Illness

tions of State mental health systems. Some 

States support other residential arrangements 

for adults with mental illness that would not 

meet these criteria. For instance, supported 

housing arrangements in which individuals 

live alone in scattered apartments across a 

city would not meet our study criteria but 

nonetheless remain an important, emerging 

type of housing assistance for adults with 

mental illness. Although this report does 

not include all possible types of residential 

settings for adults with mental illness, it 

provides the most comprehensive effort to 

date to examine the regulatory methods that 

States use for residential treatment facilities 

available for adults with mental illness.

B. Questionnaire Development

The goal of the questionnaire was to gather 

descriptive information on specific aspects 

of residential facilities for adults with mental 

illness for comparison across States. As a 

first step, information was obtained from a 

review of Web sites of 10 States of different 

sizes from different regions of the country. 

Specifically, information was gathered on the 

rules and regulations promulgated by these 

States for residential facilities for adults with 

mental illness. 

This task made it clear that States relied 

on different regulations and monitoring practices for different types of licensed facilities. 

Accordingly, a survey method was developed 

that allowed State officials to respond separately for each type of facility.

The review of information available on the 

States’ Web sites also was used to develop 

specific items in the following five topic 

areas:

1. Facility characteristics (including number of residents, number of beds, average 

length of stay, and staffing ratios)

2. Licensing, certification, and accreditation 

(including the agencies responsible for 

licensing/certifying facilities and the steps 

associated with the provision and renewal 

of licenses and certifications)

3. Facility programs and treatment services 

(including requirements for individualized 

treatment plans and services that must be 

available to residents)

4. Methods used for monitoring and oversight (including the agencies responsible 

for conducting monitoring visits, handling 

grievances and complaints, and criticalincident reporting)

5. Financing (including funding sources and 

per diem rates)

Table II.1. Criteria for 

Residential Facilities to 

Be Included in the Study

To be included in this study, facilities had to:

n	 Specialize in the treatment of adults 

with mental illness including individuals 

who are dually diagnosed (mental illness 

and substance abuse or mental illness 

and developmental disability) as long as 

mental illness was the primary problem

n	 Be an establishment that furnished (in 

single or several facilities) food, shelter, 

and some treatment or services to three 

or more adults unrelated to the proprietor

n	 Provide staffing 24 hours per day, 7 days 

per week

n	 Operate under some State authority, such 

as a State office granting pertinent licenses 

or a State mental health authority

n	 Include at least 50 percent of residents 

whose need for placement was based on 

mental illness 

n	 Include individuals with average stays of 

30 days or longer

n	 Provide at least some on-site therapeutic 

services beyond room and board (e.g., 

training in activities of daily living, vocational 

training, medication management) either by 

staff or under contract
State Regulation of Residential Facilities for Adults with Mental Illness

With these five topics in mind, an initial 

draft of the questionnaire was developed and 

sent to a group of mental health experts for 

comment. On the basis of the experts’ input, 

the questionnaire was revised and pilot-tested 

in three States. The questionnaire underwent 

further modification after the pilot test to 

make the questions more concise and less 

burdensome to respondents. The appendix 

includes the final version of the survey.

C. Fielding the Survey 

The survey implementation phase of the project involved the following tasks:

n Web searches were conducted for all States 

to identify (1) a preliminary list of program types that met the study’s criteria 

and (2) State officials (e.g., the director of 

the mental health agency) who potentially 

could serve as primary contacts.

n These individuals, or the persons who 

were in the same position if the initial 

contacts had left, were contacted by mail 

and telephone to verify the list of program 

types, amend the types as needed, and ask 

the person to serve as the primary contact. (An average of four to five telephone 

calls or emails per State were made before 

establishing a primary contact and, after a 

contact person was identified, an average 

of three to four telephone or email contacts were needed to verify the list of program types. Overall, an average 4 hours 

per State were needed to conduct initial 

Web searches, identify the contact person, 

and compile a final list of program types.)

n Each person who agreed to be a primary 

contact received a formal letter from the 

project officer at SAMHSA detailing the 

purpose of the study and thanking him or 

her for supporting the project.

n The contact person was sent one or more 

questionnaires, depending on the number 

of program types in the State. (The specific 

name of the program type was included 

on a cover page and strategically embedded in the questionnaire to ensure that 

respondents knew to which program type 

the questions applied. A comprehensive 

instruction guide assisted respondents in 

completing the survey.)

Depending on the preference of the contact person, surveys were mailed, faxed, 

or emailed. Respondents could return the 

completed questionnaire by mail, fax, or 

email or complete the questionnaire in a 

telephone conversation with an interviewer. 

Surveys sent by email were based on an Excel 

spreadsheet so that respondents could reply 

to the questions on screen, save the survey, 

and return it in the spreadsheet format. In all 

cases, the material included a second cover 

letter from the project officer at SAMHSA, 

the list of criteria that defined the types of 

programs of interest to the study, and specific 

instructions regarding the survey. 

The first questionnaire was mailed in 

October 2003, and the last completed one 

was received in March 2004. Most of the 

questionnaires were sent out and returned 

by email; most were completed and returned 

within 2 to 3 weeks, although several months 

were needed to obtain a completed questionnaire from some States. Although a 

primary contact was available in each State, 

several individuals typically were involved 

in responding to the questionnaire because, 

in most States, no one person was familiar 

with all topics covered in the questionnaire. 

For example, one individual was familiar 

with service requirements while another was 

familiar with financing. After a survey was 
10 State Regulation of Residential Facilities for Adults with Mental Illness

received, it was reviewed, and followup telephone calls or emails were made to clarify 

ambiguous responses or fill in missing data, if 

possible. When all questions were resolved, a 

questionnaire was considered complete, and 

a thank-you card was mailed to the primary 

contact. 

A total of 86 surveys were mailed to 44 

of the 51 States (including the District of 

Columbia); 35 States returned at least one 

usable questionnaire. Of the remaining 16 

States:

n Six States did not respond to our request 

to participate in the survey (repeated calls 

and emails to the contact person went 

unanswered, or no primary contact could 

be located).

n Two States opted to provide a brief explanation of the housing options for adults 

with mental illness, rather than completing 

a questionnaire.

n Eight States (Alaska, Arizona, Arkansas, 

Kentucky, Michigan, New Hampshire, 

New Mexico, and Ohio) had programs 

that did not fit our criteria (e.g., the State 

used only foster homes or assisted living 

apartments; the programs provided only 

room and board; less than 50 percent of 

residents had mental illness; or facilities 

included fewer than three persons). 

Overall, of the 50 States and the District 

of Columbia, usable information was provided by 43 States (84 percent): the 35 States 

completing at least one questionnaire and 

the 8 States indicating that they did not 

regulate facilities that met the study criteria. Information from the questionnaires 

was entered into a standard SAS database. 

Several rounds of detailed data verification with State officials occurred between 

July and October 2004. The final database 

included information on 63 types of residential facilities for adults with mental illness in 35 States (including the District of 

Columbia). 

D. Assessing Data Quality

Survey respondents had several opportunities to verify the submitted data and to 

complete as much of the questionnaire as 

possible. As questionnaires were received, 

research staff performed quality checks to 

see if any responses did not seem plausible. 

If staff members had questions about survey 

responses, they called the respondents to 

clear up any confusion. A final data check 

was conducted by downloading information from completed questionnaires into 

2-page templates, which were sent back to 

the appropriate contact person for final verification and with a request for any missing 

information on facility characteristics. Several 

States suggested minor changes. 

Although the data are the best available 

to date, States frequently did not have all 

the statistical data needed to respond to the 

survey questions. For instance, one State 

could not respond to the survey because the 

requested information spanned a number of 

agencies and the State was unable to coordinate a response. In other cases, States do not 

collect the necessary data, such as average 

length of stay, occupancy rates, and the average number of residents per facility. In some 

States, officials indicated that they could not 

provide the data on facility characteristics 

owing to the impracticality (i.e., too timeconsuming) or impossibility (i.e., the relevant 

data were not available) of collecting the 

information.

As a check of data quality, researchers 

asked respondents to indicate whether their 
State Regulation of Residential Facilities for Adults with Mental Illness 11

responses to seven of the survey questions 

were based on experience-based estimates or 

reviews of specific records or statistical data. 

Depending on the item, between 11 and 75 

percent of respondents indicated that they 

based their response on reviews of specific 

records or statistical data (see Table II.2). 

Hence, some numbers in this report—such 

as the number of facilities nationwide, the 

average number of residents, or the average 

length of stay—should be viewed as estimates 

rather than as precise figures. 

Table II.2. Percentage of Respondents Using Estimates or Record Reviews

for Selected Survey Items

Survey Item

Percentage 

Unable to 

Answer 

Item

Percentage 

Using 

Estimate

Percentage 

Using Record 

Reviews

Percentage 

Answering 

but Not Indicating 

Whether Response 

Was Based 

on Record 

Review or Estimate

Number of facilities 4.8 17.5 74.6 3.2

Average number of residents 6.3 50.8 27.0 15.9

Average length of stay 39.7 46.0 11.1 3.2

Percentage of facilities with secure units, 

if the facility is allowed secure units 0.0 25.0 75.0 0.0

Percentage of facilities with an unannounced 

visit, if the State conducted unannounced visits 4.8 57.1 38.1 0.0

Percentage of facilities with an announced 

visit, if the State conducted announced visits 9.3 46.5 44.2 0.0

Medicaid per diem, if State has a Medicaid 

per diem 0.0 50.0 50.0 0.0

Source: Surveys received from 34 States and the District of Columbia.

Note: Percentages are based on the number of facility types.

Overall, the quality of the information 

presented in this report depends on the extent 

and accuracy of the information available 

to respondents. Because of extensive efforts 

to check questionable data through telephone calls and emails to State officials and 

State approval of the final data used for the 

analyses, the report reflects the most accurate 

national data available on characteristics of 

the facilities that meet the study’s criteria and 

the methods that States use to monitor these 

residential facilities. 

A. Number of Facilities 

and Associated Beds

As Table III.1 indicates, the number of facilities per facility type ranged from 1 facility 

in Delaware (in a type of facility referred to 

as “dual-diagnosed residential”) to 1,373 

facilities in Wisconsin (in a type of facility 

referred to as “community-based residential 

facilities”). In total, the responding States 

reported 7,327 residential facilities, accounting for 103,393 beds. 

As noted previously, analyses based on 

data from the SMHO indicate that 781 

nonhospital mental health organizations provided 24-hour care in 2002 and that these 

organizations had 44,886 beds in operation 

(Manderscheid et al., 2004). The numbers 

from the present study are substantially 

higher because it includes a larger range of 

facilities than did the SMHO. Specifically, 

the SMHO was developed to provide counts 

of mental health organizations, including 

III. Number and 

Characteristics of 

Residential Facilities for 

Adults with Mental Illness

The survey yielded information on 63 types of residential facilities 

in 34 States and the District of Columbia. There was considerable variation in the number of facilities associated with each 

facility type, the average number of residents in a single facility within each 

type, and the total number of beds in operation in all facilities within a facility type (see Table III.1). For example, Connecticut has developed regulations for two types of residential facilities that meet study criteria: “mental 

health residential living centers” and “mental health community residences.” 

The first type includes 20 facilities, with an average number of 10 residents 

per facility and a total number of 203 beds; the second type includes 6 

facilities with an average number of 8 residents and a total number of 48 

beds. Oklahoma also has developed regulations for two types of residential 

facilities (“residential care homes for adults” and “enhanced residential care 

homes for adults”); the first includes more than 100 facilities that had on 

average 32 residents, and the second includes 3 facilities with an average 

number of 26 residents. 

State Regulation of Residential Facilities for Adults with Mental Illness 13
14 State Regulation of Residential Facilities for Adults with Mental Illness

Table III.1. Types of Residential Facilities for Adults with Mental Illness, 

Average Number of Residents, and Total Beds, by State, September 30, 2003

State Name of Facility Type

Number 

of 

Facilities

Average 

Number of 

Residents 

per Facility

Total 

Number

of Beds

California Long-Term Residential Treatment Facilities N/A N/A 83

Transitional Residential Treatment Facilities N/A 6 627

Skilled-Nursing Facilities with Special Treatment Programs 31 99 3,081

Mental Health Rehabilitation Center 21 73 1,550

Connecticut Mental Health Residential Living Centers 20 10 203

Mental Health Community Residences 6 8 48

Residential Care Homes 106 15 2,874

Delaware Licensed Mental Health Group Homes 14 8 122

Dual-Diagnosed Residential 1 13 16

District of 

Columbia Mental Health Community Residential Facilities 148 8 1,033

Florida Level I-A Residential Treatment Facilities 8 13 106

Level I-B Residential Treatment Facilities 4 30 118

Level II Residential Treatment Facilities 63 10 634

Level III Residential Treatment Facilities 28 23 653

Hawaii 24-Hour Group Homes 11 8 272

Idaho Residential and Assisted Living Facilities 261 18 6,085

Illinois Community Integrated Living Arrangement 119 5 583

Supervised Residential 105 10 910

Indiana Semi-Independent Living Program N/A 6 1,008

Alternative Families for Adults 36 4 144

Transitional Residential Facilities 32 13 429

Supervised Group Living Facility 75 14 1,025

Subacute Facilities 13 20 258

Kansas Residential Care Facilities—Adults 34 12 428

Louisiana Supportive Housing Apartments—Adults 15 20 316

Maine Residential Program for Adults 32 6 176

Maryland Group Homes for Adults with Mental Illness 99 6 645

Massachusetts 24-Hour Group Homes—Adults 360 10 2,730

Supported Housing—Adults 335 12 316

Minnesota Rule 36 Residential Facilities for Adults with Mental Illness 71 33 2,360

Mississippi Group Homes 44 16 514

Halfway Houses 3 9 35
State Regulation of Residential Facilities for Adults with Mental Illness 15

Table III.1. (continued)

State Name of Facility Type

Number 

of 

Facilities

Average 

Number of 

Residents 

per Facility

Total 

Number

of Beds

Missouri Residential Care Facility (RCF II) 70 N/A N/A

Residential Care Facility (RCF I) 70 N/A N/A

Mental Health RCF II 7 N/A N/A

Psychiatric Group Home I 2 8 8

Psychiatric Group Home II 2 8 16

Montana Group Homes—Adults 10 8 76

Nebraska Psychiatric Residential Rehabilitation Center—Adults 7 10 75

Nevada Group Homes for Adults 64 5 849

New Jersey Group Homes for Adults 159 6 1,054

New York Impacted Adult Homes 219 67 17,347

Community Residential Programs for Adults 532 21 11,248

Community-Based Family Care Homes 560 3 2,000

North Carolina Supervised Living Facilities for Adults 184 6 816

Oklahoma Residential Care Homes for Adults 102 32 3,218

Enhanced Residential Care Homes for Adults 3 26 77

Oregon Intensive Foster Care for Adults 100 4 447

Residential Treatment Facilities for Adults 53 14 722

Pennsylvania Long-Term Structured Residential Facilities for Adults 25 14 359

Community Residential Rehabilitation Group Homes for 

Adults

545 5 2,726

Rhode Island Adult Group Homes 24 8 212

South Carolina Level II Community Residential Care Facilities 24 14 340

Structured Community Residential Care Facilities 17 9 159

Tennessee Mental Health Supportive Living Facilities 231 9 2,141

Mental Health Adult Residential Treatment 8 9 74

Utah Residential Treatment Facilities—Adult 41 17 843

Virginia Adult Group Homes 26 6 154

Washington Adult Residential Treatment Facilities 18 27 492

West Virginia Residential Facilities Serving the Adult Mentally Ill 12 9 103

Wisconsin Adult Family Homes 740 4 2,864

Community-Based Residential Facilities 1,373 16 21,843

Wyoming Adult Group Homes 4 7 24

Total 63 Facilities 7,327 — 103,393

Source: Surveys submitted by 34 States and the District of Columbia.

Note: N/A indicates data not available.
16 State Regulation of Residential Facilities for Adults with Mental Illness

outpatient mental health clinics, psychiatric 

hospitals, general hospitals with separate 

psychiatric services, and other mental health 

organizations. Other mental health organizations include freestanding psychiatric 

outpatient clinics, freestanding partial care 

organizations, and multiservice mental health 

organizations, which are organizations that 

provide services in both 24-hour and lessthan-24-hour settings and are not classifiable 

to other organizations such as psychiatric hospitals. Overall, the SMHO focuses on counting organizations whose primary mission is 

to provide clinical mental health services.

The present study has a different focus 

from the focus of the SMHO, and leads to 

the inclusion of a wider range of facilities. 

For example, Louisiana has developed regulations for a type of facility called “supportive housing apartments for adults.” In 2003, 

this facility type had 15 licensed facilities, 

with an average of 20 persons per facility. 

The maximum length of stay is 5 years for 

residents in facilities within this facility type, 

with an average of 2 years. Facilities are 

required to provide training in activities of 

daily living, case management, and medication management. Formal counseling services 

are not provided. Although the survey data 

from the present study does not indicate 

whether any of these facilities are owned by 

mental health organizations as defined by the 

SMHO, it is possible that these facilities and 

their associated beds would not be included 

in the SMHO count. 

It is also useful to compare results 

from the present study with data from 

NASMHPD’s State profiles, as illustrated 

in Table III.2. As this comparison shows, 

for most of the States that provided data 

in both studies, the number of beds identified in the present study either exceeds or 

is close to the number of beds identified in 

NASMHPD’s State profiles. For example, in 

the present study, Connecticut reported that 

it had developed regulations for facility types 

that included facilities with a total number 

of 3,025 beds as of September 2003, whereas in the State profile data, Connecticut 

reported 1,176 beds in facilities funded and 

operated by State mental health agencies on 

the last day of fiscal year 2002. Again, the 

difference is likely to result from the fact that 

the present study includes a greater number 

of facilities (and therefore a greater number 

of associated beds) because it incorporates 

facilities beyond those that are funded and 

operated by State mental health agencies. 

Delaware and Rhode Island are exceptions 

to the pattern, and the reasons for this finding may involve reporting error, the differences in the time period between the studies, 

or some other factors.

In summary, in contrast to data from the 

SMHO and the profiles developed by the 

NASMHPD Research Institute, the present 

Table III.2. Number of Beds in 

Residential Facilities for Selected 

States for Selected Months as 

Reported in Two Data Sources

State

Number of Beds as Reported in the

Present 

Study* 

NASMHPD’s 

Profiles**

Connecticut 3,025 1,176

Delaware 138 180

Hawaii 272 240

New York 30,595 6,914

Oklahoma 3,295 199

Oregon 1,169 1,186

Rhode Island 212 314

South Carolina 499 30

Utah 843 459

Sources: Data from the present study are drawn from surveys 

submitted by State officials. Data from the NASMHPD’s 

profiles can be found at www.nri-inc.org.

*As of September 30, 2003.

**As of last day of fiscal year 2002.
State Regulation of Residential Facilities for Adults with Mental Illness 17

study was designed specifically to examine 

methods that States use to regulate residential facilities that meet the criteria listed in 

Table III.1. These criteria led to the inclusion 

of a wide range of facilities, including facilities that would not be counted in the SMHO 

data or the NASMHPD’s State profiles. 

Because it included more residential facility types, the present study also includes a 

greater number of beds.

B. Average Number of Residents

Approximately 39 percent of the facilities averaged between 3 and 8 residents 

(see Table III.3). Another 40 percent of the 

facilities had an average of 9 to 16 residents. 

Only about 19 percent of facilities averaged 

17 or more residents. For the facility types 

for which States were able to report occupancy rate information, rates ranged from 

42 to 100 percent, although the rate for 

most was 85 percent or higher.

C. Average Length of Stay

Length of stay is an important characteristic 

of a residential facility because of concerns 

that long lengths of stay are associated with 

more difficulty in returning to self-sufficient, 

independent living after discharge. However, 

many States do not appear to collect data on 

average length of stay. States were unable to 

provide the average length of stay for 38 percent of facility types and 43 percent of facilities (see Table III.4).

Table III.3. Average Number of Residents per Residential Facility for Adults 

with Mental Illness, 2003

All

Average Number of Residents 

per Facility Percentage

Between

3 and 8 

Between 

9 and 16 

17 or 

more 

Not 

Available All

Between

3 and 8 

Between 

9 and 16 

17 or 

more 

Not 

Available

By number 

of facility 

types 63 23 22 14 4 100.0 36.5 34.9 22.2 6.3

By number 

of facilities 7,327 2,885 2,936 1,359 147 100.0 39.4 40.1 18.5 2.0

By beds 103,393 15,904 39,760 47,646 83 100.0 15.4 38.5 46.0 0.1

Source: Surveys submitted by 34 States and the District of Columbia.

Note: States were asked the average number of residents in a given type of residential facility. If a State provided a range, Mathematica Policy 

Research (MPR) used the midpoint to determine the size category. For 12 types of residential facilities, the State did not provide an average number 

of residents, but MPR imputed one based on the number of reported facilities and beds in the State.

Table III.4. Average Length of Stay in Residential Facilities for Adults with 

Mental Illness, by Number of Facilities, 2003

Facility Type Facilities Beds

Number Percentage Number Percentage Number Percentage

1–6 months 11 17.5 638 8.7 8,643 8.5

7–12 months 6 9.5 138 1.9 4,709 4.6

13 or more months 22 34.9 3,426 46.8 47,122 45.5

Data unavailable 24 38.1 3,125 42.7 42,919 41.5

Total 63 100.0 7,327 100.0 103,393 100.0

Source: Surveys submitted by 34 States and the District of Columbia.

Note: “Data unavailable” indicates that the State did not provide information on average length of stay.
18 State Regulation of Residential Facilities for Adults with Mental Illness

Average lengths of stay longer than 1 year 

were common. Nearly 47 percent of facilities 

had an average length of stay of more than 

1 year.

Eight of the 63 types of facilities (accounting for just 1 percent of the total number of 

facilities) were subject to a State-mandated 

maximum length of stay. In these facilities, 

the maximum ranged from 3 to 18 months.

D. Organizations that Operate 

Residential Facilities

The types of organization that operate residential facilities for adults with mental illness 

may vary within facility type. The survey 

asked States to indicate what percentage of 

facilities within a particular facility type were 

operated by selected ownership arrangements 

(i.e., not-for-profit, for-profit, State or local 

government). Facility types were then classified by the dominant ownership arrangement, defined as the type of organization 

operating 75 percent or more of facilities 

within a facility type.

The majority of facilities were predominantly or wholly operated by not-for-profit 

organizations (see Table III.5). States reported

that facilities in 30 of the 63 facility types 

were predominantly or wholly operated by 

not-for-profit organizations. In contrast, State 

and local governments operated only a small 

share of residential facilities. States reported 

that State or local governments predominantly 

or wholly owned facilities in just 4 facility 

types. States were unable to report ownership 

information for 6 facility types, or 10 percent.

E. Secure Units

The study found that a very small number of 

facility types (8) were allowed to have locked 

units under State regulations. Moreover, 

just because a type of residential facility was 

allowed to have locked units did not necessarily mean that all facilities within that type 

had them. In many cases, respondents indicated that fewer than 50 percent of facilities 

within a facility type allowed to have locked 

units actually had these units. The survey 

did not gather information on the number 

of beds in locked units in facilities that were 

allowed to have locked units.

Larger facilities were more likely than 

smaller facilities to be allowed to have locked 

units. Five of the 18 facility types with more 

than 16 residents were allowed to have 

locked units as compared with no facility 

types whose average number of residents 

ranged from 3 to 8.

Table III.5. Ownership of Residential Facilities for Adults with Mental 

Illness, by Number of Facilities, 2003

Facility Type Facilities Beds

Number

Per­cen­tage NumberPer­cen­tage NumberPer­cen­tage

Wholly or predominantly operated by not-for-profit organizations 30 47.6 3,129 42.7 32,880 31.9

Wholly or predominantly operated by for-profit organizations 7 11.1 420 5.7 9,355 9.0

Wholly or predominantly operated by State or local government 4 6.4 645 8.8 2,885 2.8

Wholly or predominantly operated by other entities 1 1.6 71 1.0 2,360 2.3

Varied ownership 15 23.8 910 12.4 27,309 26.4

Ownership information not available 6 9.5 2,152 29.4 28,604 27.6

Total 63 100.0 7,327 100.0 103,393 100.0

Source: Surveys submitted by 34 States and the District of Columbia.

Note: “Varied ownership” indicates that no given type of organization operates 75 percent or more of these 15 types of residential facilities.
IV. State Oversight: 

Requirements, 

Licensing, Regulations

To regulate standards of care received by residents of facilities for 

adults with mental illness, many States stipulate basic requirements for, among other aspects of care, minimum staff-to-resident 

ratios, minimum education of facility directors, and requirements for reporting critical events to the State. In addition, States rely on several agencies to 

license, monitor, and review complaints against residential facilities for adults 

with mental illness. In many States, more than one agency is responsible for 

these tasks. This chapter presents findings in the following areas:

n Basic requirements for facilities

n Licensing agencies

n Monitoring practices

n Agencies reviewing complaints

n Accreditation requirements

A. Basic Requirements for Facilities

States have varied laws or regulations that 

govern operational requirements for residential facilities for adults with mental illness. 

Three requirements frequently included in 

these State laws involve staff-to-resident 

ratios, minimum education requirements 

for facility directors, and requirements for 

reporting critical events to the State. 

1. Staff-to-Resident Ratio Requirements

Thirty-six of the 63 facility types (57 percent) captured by the survey were subject 

to State requirements for staff-to-resident 

ratios during daytime hours (see Table 

IV.1). These types accounted for 25 percent of the total number of facilities and 

30 percent of beds. Among those types 

with a requirement, about a third had a 

requirement that there could be no more 

than 5 to 8 residents per staff person 

during daytime hours; for approximately 

another third, the ratio was 9 or higher. 

Staff-to-resident ratio requirements 

were more common in larger facilities. 

About 43 percent of larger residential 

facilities (17 or more residents) were subject to a staff-to-resident ratio requirement 

as compared with 16 percent of facilities 

with an average of 3 to 8 residents. 

State Regulation of Residential Facilities for Adults with Mental Illness 19
20 State Regulation of Residential Facilities for Adults with Mental Illness

2. Minimum Education of Facility Directors

Fifty-six percent of facility types, accounting 

for 52 percent of facilities, were subject to 

a State requirement mandating a minimum 

level of education for the facility director (see Table IV.2). Among those facilities 

with a requirement, 62 percent of facilities 

accounting for 79 percent of beds had a 

requirement for less than a bachelor’s degree, 

generally an associate’s degree. Twentysix percent of facilities were subject to a 

requirement that the facility director must 

hold at least a bachelor’s degree and, in 3 

percent of facilities, the director must hold a 

master’s degree.

3. Critical Incident Reporting Requirements

Reports of critical incidents, such as a death, 

suicide attempt, or hospitalization of a resident, were used by numerous States to monitor facility operations. States indicated that 

most facility types were required to report 

critical events that affect the health and 

safety of residents (see Table IV.3).

Table IV.1. Daytime Staff-to-Resident Ratio Requirements in Residential 

Facilities for Adults with Mental Illness, 2003

Facility Type Facilities Beds

Number

Per­centage NumberPer­centage NumberPer­centage

State-mandated staff-to-resident ratio 36 57.1 1,832 25.0 31,462 30.4

Of those with a requirement:

 1 staff to 2–4 residents 6 18.8 56 3.1 1,692 5.4

 1 staff to 5–8 residents 12 33.3 735 40.1 9,301 29.6

 1 staff to 9 or more residents 13 36.1 603 32.9 11,081 35.2

Other requirement* 1 2.8 70 3.8 N/A N/A

Information not provided 4 11.1 368 20.1 9,388 29.8

Source: Surveys submitted by 34 States and the District of Columbia.

Note: This table presents information on daytime staff-to-resident ratios. Survey data indicate that evening and overnight ratios are slightly higher 

(i.e., a single staff member is responsible for more residents). N/A indicates data not available.

*Requirement does not set specific ratio. Requirement mandates one staff person per housing unit.

Table IV.2. State Regulations Requiring Minimum Education for 

Residential Facility Directors, 2003 

Facility Type Facilities Beds

Number

Per­centage NumberPer­centage NumberPer­centage

State minimum education requirement 

for facility director 35 55.6 3,789 51.7 68,054 65.8

Of those with a requirement, 

minimum requirement is:

Less than a bachelor’s degree 12 34.3 2,342 61.8 53,813 79.1

Bachelor’s degree 8 22.9 990 26.1 10,963 16.1

Master’s degree 8 22.9 117 3.1 1,758 2.6

Special certification 3 8.6 240 6.3 447 0.7

Combination of education and experience 1 2.9 14 0.4 122 0.2

Experience requirement only 3 2.9 86 2.3 951 1.4

Source: Surveys submitted by 34 States and the District of Columbia.

Notes: “Less than a bachelor’s degree” means high school diploma, associate degree, or some college. A State requiring a combination of education 

and experience may require a certain number of years of experience for one level of education and a lower level of experience if the individual 

has a higher level of education. “Experience requirement only” indicates that the State requires only a specified number of years of experience.
State Regulation of Residential Facilities for Adults with Mental Illness 21

States indicated that facilities were 

required to report resident deaths in 55 of 

the 63 facility types (87 percent). Suicide 

attempts were to be reported in 46 of the 

facility types (73 percent). Fewer facilities 

were required to report the hospitalization 

of a resident. Twenty-three of the 63 facility 

types were required to report resident hospitalizations, which accounted for 46 percent 

of facilities and 38 percent of beds.

B. Licensing Agencies

The survey found that, depending on the 

particular State, several types of agencies 

licensed or certified residential facilities for 

adults with mental illness. Agencies included 

the State mental health authority, State 

department of health, and State department 

of social services.

In some cases, more than one State agency 

was involved in licensing or certifying residential facilities for adults with mental illness. In 23 of the 63 facility types (37 percent), the State reported that two agencies 

were involved in licensing and/or certification 

(see Table IV.4). For example, in California, 

many of the facility types must be licensed by 

the State department of social services and 

receive certification from the State mental 

health authority. Two States did not require 

a license or certification, although they did 

exercise some oversight authority through 

monitoring visits or other means.

For the majority of facility types (34 of 

the 63), the State mental health authority 

had some role in licensing or certifying each 

residential facility (see Table IV.5). A number 

of States also cited the State department of 

health, which had some licensing or certification role for 37 percent of facility types, 43 

percent of facilities, and 55 percent of residential beds.

Table IV.3. Requirements for Reporting Critical Incidents to the State 

in Residential Facilities for Adults with Mental Illness, 2003

Critical Incidents

Facility Types Facilities Beds

Number Percentage Number Percentage Number Percentage

Death 55 87.3 6,437 87.9 91,511 88.5

Suicide 56 88.9 6,698 91.4 97,596 94.4

Suicide attempt 46 73.0 4,025 54.9 64,655 62.6

Allegations of abuse or neglect 53 84.1 6,411 87.5 91,260 88.3

Hospitalization of a resident 23 36.5 3,350 45.7 39,125 37.8

Source: Surveys submitted by 34 States and the District of Columbia.

Note: Percentages add to more than 100 because States may require facilities to report more than one type of event.

Table IV.4. Number of Agencies Involved in Licensing or Certifying 

Residential Facilities for Adults with Mental Illness, 2003

Number of Agencies

Facility Types Facilities Beds

Number Percentage Number Percentage Number Percentage

Zero* 2 3.2 109 1.5 934 1.0

One 38 60.3 6,117 83.5 88,829 85.8

Two 23 36.5 1,101 15.0 13,630 13.2

Total 63 100.0 7,327 100.0 103,393 100.0

Source: Surveys submitted by 34 States and the District of Columbia.

*In two facility types, the State does not license or certify, though it does have some oversight authority and conducts monitoring visits.
22 State Regulation of Residential Facilities for Adults with Mental Illness

C. Regulatory Practices

The study found that to obtain licenses or 

certifications, States often required facilities 

to undergo a review that could involve a site 

visit, record review, documentation of staff 

qualification and training, or other procedures. In nearly all facility types, the State 

required a site inspection before issuing a 

license or certification (see Table IV.6). About 

94 percent of facilities were required to have 

a site inspection. Slightly fewer (90 percent) 

were required to undergo a site inspection 

in order to renew their license or certification. Resident interviews were the least commonly required activity. Forty-one percent of 

facility types, accounting for 55 percent of 

residential facilities, had a resident interview 

requirement for either licensure or certification. Those numbers increased somewhat, to 

59 percent of facility types and 73 percent of 

facilities, at renewal. Resident interviews were 

Table IV.5. State Agencies Involved in Licensure or Certification of 

Residential Facilities for Adults with Mental Illness, 2003

Facility Types Facilities Beds

Number Percentage Number Percentage Number Percentage

State mental health authority 34 54.0 3,601 49.2 38,545 37.2

Local mental health agency 8 12.7 654 8.9 5,921 5.7

Department of social services 5 7.9 141 1.9 2,140 2.1

Department of health 23 36.5 3,112 42.5 57,340 55.4

Department of health and 

human services 4 6.4 469 6.4 7,099 6.9

Department of human services 2 3.2 190 2.6 2,943 2.8

Other 8 12.7 152 2.1 2,101 2.0

Source: Surveys submitted by 34 States and the District of Columbia.

Note: Percentages add to more than 100 because States may have indicated that more than one State agency was involved in licensure or certification 

of residential facilities.

Table IV.6. Procedures Required by States for Initial Licensure or 

Certification and Renewal of Licensure or Certification for Residential 

Facilities for Adults with Mental Illness, 2003

Facility Types Facilities Beds

Number Percentage Number Percentage Number Percentage

Onsite 

inspection

Initial 59 93.7 6,935 94.7 84,263 81.4

Renewal 55 87.3 6,619 90.3 93,418 90.3

Documentation of 

staff qualifications

Initial 49 77.8 5,227 71.3 69,647 67.3

Renewal 44 69.8 4,075 55.6 48,612 47.0

Documentation

of staff training

Initial 37 58.7 4,118 56.2 56,224 54.4

Renewal 41 65.1 3,997 54.6 44,658 43.2

Record 

review

Initial 43 68.3 5,780 78.9 61,499 59.4

Renewal 50 79.4 6,685 91.2 94,131 91.0

Resident

interviews

Initial 26 41.3 3,993 54.5 44,834 43.3

Renewal 37 58.7 5,326 72.7 80,762 78.0

Source: Surveys submitted by 34 States and the District of Columbia.
State Regulation of Residential Facilities for Adults with Mental Illness 23

not usually required for the initial license or 

certification because before the facility opens 

there are no residents to interview.

Announced and unannounced visits to 

facilities also were a common practice in 

monitoring facility performance and were 

used to assess living conditions, safety issues, 

and services provided. In 41 of the 63 types 

of residential facilities identified by States, 

States conducted unannounced visits for 

monitoring purposes to at least some facilities 

within the given facility type. States conducted

announced visits to 44 of the 63 facility 

types. For three facility types, States indicated 

that they did not conduct any announced or 

unannounced visits.

Although monitoring visits were common, 

the percentage of facilities that received a visit 

in 2003 varied significantly by facility type. 

In some cases, a State visited just 1 percent of 

facilities within a facility type; in other cases, 

the State visited all of the facilities. 

D. Agencies Responsible for 

Reviewing Complaints

The survey found that in many cases, more 

than one State agency or office was responsible for reviewing complaints against facilities (see Table IV.7). According to survey 

respondents, more than one agency reviewed 

complaints against 32 percent of residential 

facilities whereas three or more agencies were 

responsible for reviewing complaints against 

9 percent of facilities.

Just as with licensing and certification, 

States most often cited the State mental 

health agency and the State department of 

health as the agencies responsible for reviewing complaints against facilities (see Table 

IV.8). The State mental health agency was 

at least one of the agencies responsible for 

reviewing complaints against two-thirds 

of the facility types included in the study, 

accounting for slightly more than half (53 

percent) of all facilities. The department of 

health reviewed complaints for about 30 percent of facility types, accounting for about 

41 percent of all facilities.

In addition to the agencies listed in Table 

IV.8, States mentioned that the following 

State entities reviewed complaints: a human 

rights advocacy group, a long-term health 

care ombudsman, and the Medicaid agency.

E. Accreditation

In addition to requiring licensure or certification, a few States required residential facilities to be accredited by one of the national 

accrediting organizations. About 5 percent 

of the residential facilities captured by the 

Table IV.7. Number of Agencies Responsible for Reviewing Complaints 

Against Residential Facilities for Adults with Mental Illness

Facility Types Facilities Beds

Number of Agencies Number Percentage Number Percentage Number Percentage

Not available 2 3.2 46 0.6 1,909 1.8

One 22 34.9 4,961 67.7 59,521 57.6

Two 27 42.8 1,669 22.8 35,429 34.2

Three 9 14.3 578 7.9 5,859 5.7

Four 3 4.8 73 1.0 675 0.7

Total 63 100.0 7,327 100.0 103,393 100.0

Source: Surveys submitted by 34 States and the District of Columbia.
24 State Regulation of Residential Facilities for Adults with Mental Illness

Table IV.8. State Agencies that Review Complaints Against Residential 

Facilities for Adults with Mental Illness, 2003

Facility Types Facilities Beds

Number Percentage Number Percentage Number Percentage

State mental health authority 42 66.7 3,889 53.1 42,348 41.0

Local mental health agency 16 25.4 1,470 20.1 16,121 15.6

Department of children and families 6 9.5 215 2.9 4,433 4.3

Department of social services 6 9.5 247 3.4 3,099 3.0

Department of health 19 30.2 3,037 41.5 49,252 47.6

Department of health and human services 3 11.1 285 19.2 6,283 17.6

Department of human services 5 18.5 529 35.7 5,605 15.7

Other 19 70.4 668 45.1 23,831 66.7

Source: Surveys submitted by 34 States and the District of Columbia.

Note: Percentages may add up to more than 100 because more than one agency may be involved in reviewing complaints against residential facilities 

for adults with mental illness.

survey were required to obtain accreditation 

from a national accrediting organization. 

Some of the accrediting organizations listed by respondents were the 

Joint Commission on Accreditation of 

Health­care Organizations, the Commission on Accreditation of Rehabilitation 

Facilities, the Council on Accreditation for 

Children and Family Services, the Utilization Review Accreditation Commission, 

and the National Committee for Quality 

Assurance. Generally, facilities were 

allowed to choose which organization 

would provide their accreditation.
V. Services and Financing

States vary considerably in terms of the services that residential 

facilities for adults with mental illness are required to provide 

to residents. Whereas some facilities are required to provide 

any service identified in an individual’s treatment plan, other facilities are 

required to do little more than manage medication. This chapter describes 

the services provided by residential facilities for adults with mental illness 

and the funding sources for the facilities. 

A. Services Provided

As Table V.1 shows, the most common 

services provided in the residential facilities covered by the survey were assistance 

with activities of daily living (provided in 

95 percent of facilities), training in activities of daily living (88 percent of facilities), 

and medication management (87 percent of 

facilities). The least frequently provided service was occupational therapy, which just 6 

percent of residential facilities were required 

to provide. Generally, States reported that 

facilities were required to provide more in 

the way of personal care services than clinical programs. 

Individual counseling was required in 34 

facility types (54 percent), which represented 

about 57 percent of all facilities and beds. 

Medication management was required in 79 

percent of facility types, accounting for 87 

percent of facilities and 92 percent of residential beds.

A majority of facilities, 60 percent, were 

required by the State to complete a comprehensive discharge plan when a client leaves 

a facility. About 46 percent of facilities were 

required to provide either discharge medications or a specific medication plan when a 

client left the facility. The least commonly 

required discharge service was a followup 

visit at the client’s next residence. Only 1 

percent of facilities were required to conduct 

a followup visit.

B. Funding Sources

Facilities appeared to draw funds from a 

variety of funding sources (see Table V.2), 

indicating that they provided care to individuals who were involved with many different State, local, and private programs and 

health insurance plans. According to the 

survey results, State and local mental health 

agencies were the most common funding 

source for facilities for adults with mental 

illness. Fifty of the 63 facility types (79 percent) typically received at least some funding 

from the State or local mental health agency. 

These 50 facility types accounted for 84 

percent of facilities and 64 percent of beds 

reported by States. Federal income assistance programs were also a common funding source. Supplemental Security Income 

payments were a funding source in about 

70 percent of facility types and 84 percent of 

State Regulation of Residential Facilities for Adults with Mental Illness 25
26 State Regulation of Residential Facilities for Adults with Mental Illness

facilities. Social Security Disability Insurance 

payments were a funding source in 59 percent of facility types, accounting for 47 percent of facilities and 54 percent of beds.

Medicaid was a funding source in just 26 

of the 63 facility types, accounting for 65 

percent of facilities and 55 percent of beds. 

Medicaid’s restrictions on services for adults 

between ages 22 and 64 may be the reason 

that many facilities did not appear to receive 

Medicaid funding. Facilities with more than 

16 residents were probably designated as 

Table V.1. Services that Residential Facilities Must Provide per State 

Requirements, Either by Staff or Through Contractual Arrangements, 2003

Facility Type Facilities Beds

Number Percentage Number Percentage Number Percentage

Counseling Services

Individual counseling 34 54.0 4,199 57.3 59,330 57.4

Group counseling 24 38.1 1,475 20.1 22,317 21.6

Family counseling 19 30.2 1,306 17.8 16,933 16.4

Financial management counseling 26 41.3 5,223 71.3 59,817 57.9

Medication Services

Medication management 50 79.4 6,346 86.6 95,077 92.0

Dispensing of medication 39 61.9 5,230 71.4 70,761 68.4

Education and Training Services

Education 21 33.3 2,029 27.7 30,413 29.4

Assistance with ADLs 46 73.0 6,925 94.5 97,046 93.9

Training in ADLs 46 73.0 6,428 87.7 69,936 67.7

Vocational training 22 34.9 1,908 26.0 31,936 31.0

Occupational therapy 10 15.9 459 6.3 6,237 6.0

Case Management/Advocacy

Case management 33 52.4 4,968 67.8 76,617 74.1

Client advocacy 30 47.6 5,272 72.0 66,664 64.5

Discharge Services

Comprehensive discharge plan 39 61.9 4,371 59.7 64,460 62.3

Discharge medications or 

medication plan 23 36.5 3,384 46.2 59,242 57.3

Followup plan 9 14.3 870 11.9 9,950 9.6

Discharge interview or satisfaction survey 11 17.5 892 12.2 10,634 10.3

Followup visit at home/other residence 4 6.4 92 1.3 983 1.0

Source: Surveys submitted by 34 States and the District of Columbia.

Note: If a State indicated that facilities were required to provide all services specified in an individual’s treatment plan, all individually listed services 

were assumed to be required. ADLs are activities of daily living.

an institution for mental diseases and therefore not eligible for Medicaid funds; many 

facilities with 16 or fewer residents also did 

not qualify for coverage under Medicaid. 

For those facility types where Medicaid was 

indicated as a funding source, the State was 

asked to provide the average Medicaid per 

diem for the facility type. Of the eight facility types for which States were able to provide an answer, the average per diem ranged 

from $10 to $300. Half had per diems of 

more than $100 per day.
State Regulation of Residential Facilities for Adults with Mental Illness 27

Table V.2. Funding Sources for Residential Facilities for Adults with 

Mental Illness, 2003

Facility Types Facilities Beds

Number

Per­centage NumberPer­centage NumberPer­centage

State/local mental health agency 50 79.4 6,149 83.9 65,824 63.7

Supplemental Security Income (SSI) payments 44 69.8 6,123 83.6 84,741 82.0

Social Security Disability Insurance (SSDI) payments 37 58.7 3,434 46.9 55,684 53.9

Self-pay 35 55.6 5,112 69.8 71,602 69.2

Medicaid 26 41.3 4,732 64.6 57,097 55.2

Other third party 27 42.9 3,319 45.3 53,902 52.1

State Supplemental Payment (SSP) 15 23.8 1,977 27.0 38,771 37.5

Federal grants 11 17.5 341 4.7 5,388 5.2

Private grants 10 15.9 316 4.3 5,334 5.2

State welfare payments 5 7.9 393 5.4 17,539 17.0

Department of defense 3 4.8 324 4.4 20,642 20.0

Department of child and family services 4 6.4 2,273 31.0 26,133 25.3

Department of education 1 1.6 44 0.6 514 0.5

Source: Surveys submitted by 34 States and the District of Columbia.

Note: Numbers add up to more than 100 percent because facilities often receive funding from more than one source.

VI. Conclusions

This study provides new information on methods that States use 

to monitor residential facilities for adults with mental illness. 

The findings underscore the substantial variation across States 

in the regulatory methods they employ to monitor residential facilities for 

adults with mental illness. The study found that although all States use at 

least several regulatory methods, no State uses all of the possible methods, 

which include a wide range of specifications and requirements, such as

n Requirements for announced and unannounced visits

n Mandated staff-to-resident ratios

n Requirements for minimum levels of education for facility directors

n Requirements for continuing education for direct care staff

n Specifications for critical-incident reporting

n Specific licensing practices

n Mandated complaint-review procedures

n Accreditation from designated State or national organizations

States differ widely in the types of residential facilities that they regulate. Some 

States, for example, have developed regulations for facility types that include only 

small facilities whereas other States have 

focused on regulating larger congregate settings. Some States regulate facilities that provide a limited number of therapeutic services 

beyond room and board; other States regulate facilities that offer a comprehensive set 

of counseling activities. The types of facilities that States regulate differ along numerous dimensions, such as mission, administrative structure, size, ownership arrangements, 

typical length of stay, services provided, and 

mix of funding sources. States also refer to 

facilities by different names, making it difficult to identify the extent to which facilities 

in different States are similar. 

The study findings demonstrate that 

the organizations that operate facilities for 

adults with mental illness typically face a 

complex regulatory environment. A wide 

variety of State agencies with different missions and functions, including State mental 

health authorities, departments of health, 

and departments of social services, oversee 

these residential facilities. For 61 percent of 

the types of residential facilities covered by 

the survey, two or more State agencies are 

involved in reviewing complaints, and for 

37 percent of all facility types, licenses or 

certification are required from more than 

one agency.

At the State level, the study showed that 

many States lack ready access to important 

data about residential facilities for adults 

with mental illness. For example, about 

40 percent of respondents were unable to 

provide information on the average length 

of stay in the facilities they were overseeing, and respondents could not provide 

State Regulation of Residential Facilities for Adults with Mental Illness 29
30 State Regulation of Residential Facilities for Adults with Mental Illness

ownership information for about 10 percent 

of facility types, accounting for almost 30 

percent of facilities. Moreover, respondents 

often indicated that they were relying on 

administrative estimates rather than specific 

records or documents to report on certain 

types of descriptive data such as average 

number of residents per facility, frequency 

of announced visits, or Medicaid per diems. 

Finally, although the present study was 

not designed to provide a national count of 

residential facilities for adults with mental 

illness, its results on the number of facilities 

for adults with mental illness and associated 

beds can be compared with data from other 

studies, such as studies based on SMHO data 

(see, for example, Manderscheid et al., 2004). 

Because of its focus on regulatory methods, 

the present study covered a wider range of 

residential settings than did the SMHO, and 

hence it identified a larger number of settings 

and associated beds. Specifically, the present 

study examined the types of facilities that 

States regulate, regardless of what organizations operate these facilities; it included facilities that provide some therapeutic services 

beyond room and board, but not necessarily 

a broad set of clinical psychiatric or psychological services. The SMHO, in contrast, 

focuses specifically on mental health organizations operated under the auspices of State 

mental health agencies, and gathers information on the number of these organizations 

that provide major clinical services in a residential venue. Using yet another approach, 

the survey of State mental health agencies 

conducted by the NASMHPD Research 

Institute asks State agencies to report on the 

number of beds and the average daily census 

for residential programs operated and funded 

by State mental health agencies.

Overall, the present study builds on and 

extends previous studies of residential settings for adults with mental illness. Each of 

the available studies contributes somewhat 

different views of residential facilities for 

adults with mental illness, but the picture 

remains incomplete. For example, better 

information is needed on the link between 

regulatory methods and client outcomes 

in different types of facilities or organizations. In addition, many States could develop 

improved reporting methods for residential 

facilities to ensure that policymakers have 

reliable information needed for policy and 

program reforms. 

The study’s findings also relate directly 

to the recommendation in the report from 

the President’s New Freedom Commission 

on Mental Health that each State develop 

a comprehensive State mental health plan 

(New Freedom Commission on Mental 

Health, 2003). As a continuation of the 

Commission’s efforts, SAMHSA, in partnership with key Federal agencies, recently 

issued the Federal Mental Health Action 

Agenda (SAMHSA, 2005). One of the five 

principles outlined in the Action Agenda 

is to “ensure innovation, flexibility, and 

accountability at all levels of government.” 

The action steps related to this principle 

include the initiation of State Mental 

Health Transformation Grants (first

awarded in September 2005) and the 

pro­vision of technical assistance to help 

States develop their comprehensive State 

Mental Health Plans. If these plans include 

com­prehensive and coordinated methods 

for regulating res­idential treatment facilities for adults with mental illness, States 

should be able to minimize redundant and 

potentially con­flicting administrative burdens on such facilities, leverage resources 

across multiple agencies, and foster a coherent continuum of services for adults with 

mental illness. 
References

Fleishman, M. (2004). The problem: How 

many patients live in residential care 

facilities? Psychiatric Services, 55, 620–

622.

Ireys, H., Achman, L., Takyi, A. (2006). 

State Regulation of Residential Facilities 

for Children with Mental Illness. DHHS 

Pub. No. (SMA) 06-4167. Rockville, 

MD: Center for Mental Health Services, 

Substance Abuse and Mental Health 

Services Administration.

Manderscheid, R., J., Atay, A., Male, B., 

Blacklow, C., Forest, L., Ingram, et 

al. (2004). Highlights of organized 

mental health services in 2000 and 

major national and state trends. In R. 

Manderscheid & M. Henderson (Eds.), 

Mental Health, United States, 2002.

DHHS Pub No. (SMA) 3938. Rockville, 

MD: Substance Abuse and Mental Health 

Services Administration.

Milazzo-Sayre, L. M., Henderson, R., 

Manderscheid, M., Bokossa, C., 

Evans, A., & Male, B. (2001). Persons 

treated in specialty mental health care 

programs, United States, 1997. In R. 

W. Manderscheid & M. J. Henderson 

(Eds.), Mental Health, United States, 

2000. DHHS Pub No. (SMA) 01-3537. 

Washington, DC: Superintendent of 

Documents, U.S. Government Printing 

Office.

National Association of State Mental Health 

Program Directors (NASMHPD). (n.d.). 

The NASMHPD Research Institute’s 

State Mental Health Agency Profiling 

System. Retrieved May 2005 from http://

www.nri-inc.org/defprofiles.cfm.

New Freedom Commission on Mental 

Health. (2003). Achieving the Promise: 

Transforming Mental Health Care in 

America. Final Report. DHHS Pub. 

No. SMA-03-3832. Rockville, MD.

O’Hara, A., & Day, S. (2001). Olmstead 

and Supportive Housing: A Vision for 

the Future. Lawrenceville, NJ: Center for 

Health Care Strategies.

Randolph, F., Ridgway, P., Sanford, C., 

Simoneau, & Carling, P. (1988). A 

national survey of community residential 

programs for persons with prolonged 

mental illness. Boston, MA: Community 

Residential Rehabilitation Project, Center 

for Psychiatric Rehabilitation, Boston 

University and Center for Community 

Change Through Housing and Support, 

University of Vermont.

Ridgway, P., & Zipple, A. (1990). The 

paradigm shift in residential services: 

From the linear continuum to supported 

housing approaches. Psychosocial 

Rehabilitation Journal, 13(4).

Salzer, M., Blank, M., Rothbard, A. & Hadley, 

T. (2001). Adult mental health services in 

the 21st century. In R. W. Manderscheid 

& M. J. Henderson (Eds.), Mental Health, 

United States, 2000 (pp. 99–112). DHHS 

Pub No. (SMA) 01-3537. Washington, 

DC: Superintendent of Documents, U.S. 

Government Printing Office. 

Substance Abuse and Mental Health Services 

Administration (SAMHSA). (2005). Transforming Mental Health Care in America. 

The Federal Action Agenda: First Steps.

Washington, DC: United States Department of Health and Human Services.

State Regulation of Residential Facilities for Adults with Mental Illness 31

The authors are grateful to the members of the expert advisory 

panel who provided thoughtful input into study questions, survey methods, and criteria for the residential facilities included 

in the study; members of this panel are listed below. The authors would 

like to extend particular thanks to Joy Midman, Sandra Newman, and 

Tom Harmon for their careful review of an early draft of the survey instrument and for guidance at strategic stages of the study. Jeff Horton of North 

Carolina, Brenda Harvey of Maine, and Alfred Nichols of California also 

provided useful feedback during the pilot test of the survey. James Maedke 

and Nancy Darrow of Social and Scientific Systems, Inc., provided assistance 

in understanding definitions of mental health organizations used in the 

Survey of Mental Health Organizations. 

At Mathematica Policy Research, 

Debra Draper played an important leadership role in the first phase of the project. 

Jesse Gregory and Kathy Bencio spent 

many hours contacting State officials as 

part of the survey effort. Myles Maxfield 

gave us insightful comments on an early 

draft of the report, and Sharon Clark 

provided unmatched secretarial assistance 

in producing the report. The authors 

extend special thanks to the individuals in the various States who took time 

to complete the survey and provide the 

needed information. 

Appendix A

Expert Advisory Panel

State Regulation of Residential Facilities for Adults with Mental Illness 33
34 State Regulation of Residential Facilities for Adults with Mental Illness

Expert Advisory Panel List of Participants

Panel Members

Karen Saltus Armstrong

Senior Public Health Advisor

Protection & Advocacy for 

Individuals with Mental Illness 

(PAIMI) Program 

Substance Abuse and Mental Health 

Services Administration (SAMHSA)

Collete Croze

Consultant 

Technical Assistance Collaborative 

(TAC) Housing Center

Joe Dziobek

President/CEO

Fellowship Health Resources, Inc.

Steve Fields

Director

Progress Foundation

Brian Fitzmaurice

Director of Community Assistance 

Programs

U.S. Department of Housing and 

Urban Development (HUD)

Tom Harmon

Commission Staff

New York Commission on the Quality 

of Care for the Mentally Ill

Jeff Horton

Chief of Mental Health Licensure and 

Certification

North Carolina Division of Facilities

Bonnie Kirkland

Special Secretary

Maryland Governor’s Office for 

Children, Youth, and Families

Martha Knisley

Director

DC Department of Mental Health

Joy Midman

Executive Director

National Association for Children’s 

Behavioral Health

Sandra Newman

Director

Institute for Policy Studies

Johns Hopkins University

Fran Randolph

Acting Branch Chief

Homeless Programs Branch

Substance Abuse and Mental Health 

Services Administration (SAMHSA)

John Rio

Program Director

Corporation for Supportive Housing

Sam Tsemberis

Executive Director

Pathways to Housing

Deborah Wilkerson

Director of Research and Quality 

Improvement

Commission on Accreditation of 

Rehabilitation Facilities (CARF)

SAMHSA Project Staff

Jeffrey Buck

Associate Director 

Office of Organization and Financing

Judith Teich

Office of Organization and Financing

William Wallace

Office of Organization and Financing

Mathematica Policy Research, Inc. Staff

Debra Draper

Senior Researcher

Myles Maxfield

Senior Fellow

Henry Ireys

Senior Researcher

Deborah Bukoski

Survey Researcher

Lori Achman

Research Analyst

Ama Takyi

Research Assistant
Appendix B

Survey Questionnaire

State Regulation of Residential Facilities for Adults with Mental Illness 35
36 State Regulation of Residential Facilities for Adults with Mental Illness

OMB Number: 0930-0251

Expiration Date: 10/31/2004

Case ID:

Agency Name:

Address:

City, State, Zip:

Respondent Name:

Respondent Title:

Respondent Email:

INTRODUCTION:

or

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

FACILITY TYPE HERE

NATIONAL SURVEY OF ADMINISTRATION AND FINANCING OF GROUP 

HOMES AND RESIDENTIAL FACILITIES FOR PERSONS WITH MENTAL 

ILLNESS

Thank you for agreeing to complete this questionnaire. Your participation is critical to the success of this 

important project. Instructions for completing and returning the questionnaire are included in a separate 

document. If you have any questions, please do not hesitate to contact:

DEPARTMENT OF HEALTH AND HUMAN SERVICES

600 Maryland Avenue, S.W., Suite 550

Washington, DC 20024-2512

Lori Achman

Research Analyst, Mathematica Policy Research

600 Maryland Avenue, S.W., Suite 550

Washington, DC 20024-2512

Henry Ireys

Senior Researcher, Mathematica Policy Research

hireys@mathematica-mpr.com lachman@mathematica-mpr.com

Tel: 202.554.7536

Fax: 202.863.1763

Tel: 202.264.2464

Fax: 202.863.1763

Public reporting burden for this collection of information

is estimated to average 1 hour per response, including

the time for reviewing instructions, searching existing

data sources, gathering and maintaining the data

needed, and completing and reviewing the collection of

information. Send comments regarding this burden

estimate or any other aspect of this collection of

information, including suggestions for reducing this

burden to SAMHSA Reports Clearance Officer;

Paperwork Reduction Project (0930-0251); Room 16-

105, Parklawn Building; 5600 Fishers Lane, Rockville,

MD 20857. An agency may not conduct or sponsor, and 

a person is not required to respond to, a collection of

information unless it displays a currently valid OMB

control number. The OMB contro l number for this

project is 0930-0251.
State Regulation of Residential Facilities for Adults with Mental Illness 37

Helpful Hints to Complete Your Survey

Remember to save often!

Use the arrow keys to the left of the Section Tabs at the bottom of the page to navigate left to

right to see the sections (tabs).

Click on the Section Tabs at the bottom of the screen to get to that section. You can skip around

between sections and instructions if needed.

Follow any skips you see after questions. They may be in one of two formats:

(after a choice) GO TO Q3_a

(at the end of a section) GO TO SECTION C

There are 4 types of questions: Fill-in; Yes/No; Select One; Check All That Apply.

Below are examples of each and how to answer them.

Yes/No:

In this type of question you will move the mouse (which appears as a hand) 

over the circle next to the response you’d like, and click. Once you do that, 

the circle will be filled in. If you’d like to change your answer, simply click on the other choice.

Fill-In:

ENTER NUMBER OF HOURS PER YEAR:

In this type of question, you may be entering a number – such as a percent or you may

be typing text for an Other (specify) answer.

Select One:

This type of question is similar to Yes/No. Rather than an arrow appearing 

over the choices, a hand will appear. As with the Yes/No questions, 

While there are many types of facilities in your state, this survey is only asking about [FILL TYPE] .

Yes

No

Associate Degree

Some College

Bachelor's Degree

Master's Degree

Doctorate/Ph.D.

M.D.

Special Certifications

OTHER (SPECIFY):

High School Diploma

SELECT ONE
38 State Regulation of Residential Facilities for Adults with Mental Illness

you may only choose one (by clicking on the circle beside your choice).

You may change your answer by clicking on a different answer.

Check All That Apply:

For this type of question, you will also see a hand when you move the mouse 

over the choices. To select the choices you’d like, click your mouse 

over the box next to your desired answer. Repeat for all your choices.

To change any answer, click again in the box already filled in. It will become blank again.

Assessing Data Quality

We recognize that some items may require you to estimate a number. For a limited number of 

items, we are asking you to indicate whether your answers are based on an estimate or on actual 

figures in an existing report or database. This will help SAMHSA evaluate the precision and 

accuracy of the data. Whenever possible, please use actual figures.

Physician

Psychologist

Nurse

OTHER (SPECIFY):

CHECK ALL THAT APPLY

Social Worker
State Regulation of Residential Facilities for Adults with Mental Illness 39

A1.

ENTER NUMBER:

A2.

 TOTAL NUMBER OF BEDS:

A2_a.

ENTER PERCENT:

A3.

ENTER AVERAGE NUMBER OF RESIDENTS:

A4.

 GO TO A4_a

 GO TO A5

A4_a.

ENTER NUMBER OF BEDS:

A5. What is the usual age range of residents in these facilities?

ENTER AGE RANGE:

A6.

 GO TO A6_a

 GO TO A7

A6_a. What is the maximum length of stay for residents of these facilities?

ENTER NUMBER:

Of these beds, what percent were occupied as of September 30, 2003?

What was the average number of residents in a single facility of this type as of September 30, 2003?

Is there a law or regulation in the state that limits the number of beds in a single facility of this type?

What is the maximum number of beds allowed by law or regulation for a single facility of this 

type?

Is there a state law or regulation that specifies the maximum length of stay for residents in these facilities?

 A. FACILITY CHARACTERISTICS

We would like to start by asking some questions about the characteristics of [FILL TYPE] in your State.

How many of these facilities were licensed in your state as of September 30, 2003?

What were the total number of beds in operation in all of these facilities as of September 30, 2003?

Please indicate whether this figue is an 

estimate or is the result of record review.

Please indicate whether this figue is an 

estimate or is the result of record review.

Days Weeks Months Years

SELECT ONE

Yes

No

Yes

No

Estimate Record Review

Estimate Record Review
40 State Regulation of Residential Facilities for Adults with Mental Illness

A7. What is the average length of stay for residents of these facilities?

ENTER NUMBER:

A8. Is there a state law or regulation requiring minimum patient-to-staff ratios for these facilities?

 GO TO A8_a

 GO TO A9

A8_a. What are the minimum patient-to-staff ratios during daytime hours?

ENTER NUMBER OF PATIENTS PER STAFF MEMBER:

A8_b. What are the minimum patient-to-staff ratios during evening hours?

ENTER NUMBER OF PATIENTS PER STAFF MEMBER:

A8_c. What are the minimum patient-to-staff ratios during overnight hours?

ENTER NUMBER OF PATIENTS PER STAFF MEMBER:

A9. What percentage of these facilities are operated by...

0% MUST EQUAL 100%

A10.

at these facilities?

 GO TO A10_a

 GO TO A11

NOTE: A direct care worker is defined as an individual who provides active direct care, treatment, 

rehabilitation or habilitation services to clients.

Is there a state law or regulation requiring clinical supervision of direct care workers

State or Local Governmental Units

Not-for-Profit Organizations

For-Profit/Proprietary Organization

TOTAL

OTHER (SPECIFY):

Please indicate whether this figue is an 

estimate or is the result of record review.

Not Applicable

Not Applicable

Not Applicable

Days Weeks Months Years

SELECT ONE

Yes

No

Yes

No

Estimate Record Review
State Regulation of Residential Facilities for Adults with Mental Illness 41

A10_a.

ENTER NUMBER OF HOURS PER MONTH:

A10_b.

A11.

 GO TO A11_a

 GO TO A12

A11_a. What is the minimum education required for facility directors?

A12.

 GO TO A12_a

 GO TO A13

A12_a.

ENTER NUMBER OF HOURS PER YEAR:

What is the minimum number of hours per month that direct care workers must be clinically 

supervised?

What is the minimum number of hours required per year?

Are facilities required to provide in-service or continuing education for direct care staff?

What type of individual is allowed to provide this clinical supervision?

Is there a state law or regulation that requires a minimum amount of education for facility directors?

Associate Degree

Some College

Bachelor's Degree

Master's Degree

Doctorate/Ph.D.

M.D.

Special Certifications

OTHER (SPECIFY):

High School Diploma

SELECT ONE

Physician

Psychologist

Nurse

OTHER (SPECIFY):

CHECK ALL THAT APPLY

Social Worker

Yes

No

Yes

No
42 State Regulation of Residential Facilities for Adults with Mental Illness

A12_b.

confidentiality issues; first aid training) be covered for all or most direct care staff?

 GO TO LIST BELOW

 GO TO A13

A13.

A14. Are these facilities allowed to have locked units?

 GO TO A14_a

 GO TO PART B

A14_a. What percent of these facilities have locked units?

GO TO PART B: LICENSING, CERTIFICATION, & ACCREDITING

Does state law or regulation require that specific topics (e.g., training on 

Please List Topics:

What agency or entity has the authority to hire and terminate facility directors?

Please indicate whether this figue is an 

estimate or is the result of record review

ENTER PERCENT OF FACILITIES

WITH LOCKED UNITS:

State Mental Health Agency

Local Mental Health Agency

Department of Health

Children and Family Services Agency

Social Services Agency

Board of Directors of Private Entities

No One

OTHER (SPECIFY):

CHECK ALL THAT APPLY

Senior Management in Private Entities

Yes

No

Yes

No

Estimate Records Review
State Regulation of Residential Facilities for Adults with Mental Illness 43

Is this license...?

CHECK ALL THAT APPLY

Duration of Licensure 

Period (in years)

Duration of Licensure 

Period (in years)

Duration of Licensure 

Period (in years)

Duration of Licensure 

Period (in years)

 B. LICENSING, CERTIFICATION, AND ACCREDITATION

Duration of Licensure 

Period (in years)

Duration of Licensure 

Period (in years)

B1. LICENSURE

What is the duration of 

the licensure period?

The next questions are about licensure, certification, and accreditation requirements for [FILL TYPE] .

Which of the following agencies/departments license 

these facilities in your state?

CHECK ALL THAT APPLY

Required to Operate

Required to Receive Public Funding

Optional

State Mental Health Agency

Local (i.e., city or county) Mental Health Agency Required to Operate

Required to Receive Public Funding

Optional

Required to Operate

Required to Receive Public Funding

Optional

Department of Social Services

Required to Operate

Required to Receive Public Funding

Optional

Department of Children and Families

Department of Health Required to Operate

Required to Receive Public Funding

Optional

OTHER (SPECIFY): Required to Operate

Required to Receive Public Funding

Optional
44 State Regulation of Residential Facilities for Adults with Mental Illness

Is this certification...?

CHECK ALL THAT APPLY

B2. CERTIFICATION

CHECK ALL THAT APPLY

What is the duration of 

the certification 

period?

Duration of Certification 

Period (in years)

Which of the following agencies/departments certify 

these facilities in your state?

Duration of Certification 

Period (in years)

Duration of Certification 

Period (in years)

Duration of Certification 

Period (in years)

Duration of Certification 

Period (in years)

Duration of Certification 

Period (in years)

Required to Operate

Required to Receive Public Funding

Optional

State Mental Health Agency

Local Mental Health Agency Required to Operate

Required to Receive Public Funding

Optional

Required to Operate

Required to Receive Public Funding

Optional

Department of Social Services

Required to Operate

Required to Receive Public Funding

Optional

Department of Children and Families

Department of Health Required to Operate

Required to Receive Public Funding

Optional

OTHER (SPECIFY): Required to Operate

Required to Receive Public Funding

Optional
State Regulation of Residential Facilities for Adults with Mental Illness 45

Is this Accreditation...?

CHECK ALL THAT APPLY

What is the duration of 

the accreditation 

period?

Duration of Accreditation 

Period (in years)

Duration of Accreditation 

Period (in years)

Duration of Accreditation 

Period (in years)

Duration of Accreditation 

Period (in years)

CHECK ALL THAT APPLY

 Organizations (JCAHO)

B3. ACCREDITATION

Which of the following entities accredit these facilities 

in your state?

 (CARF)

 (CACFS)

Duration of Accreditation 

Period (in years)

Required to Operate

Required to Receive Public Funding

Optional

Utilization Review Accreditation Commission (URAC)

Commission on Accreditation of Rehabilitation Facilities Required to Operate

Required to Receive Public Funding

Optional

Required to Operate

Required to Receive Public Funding

Optional

Joint Commission on Accreditation of Healthcare

Required to Operate

Required to Receive Public Funding

Optional

Council on Accreditation for Children and Family Services

OTHER (SPECIFY): Required to Operate

Required to Receive Public Funding

Optional
46 State Regulation of Residential Facilities for Adults with Mental Illness

On-Site State 

Inspection/

Visit

Record

Review

Resident

Interviews

B6.

 GO TO B6_a, then B6_b

 GO TO C1

B6_a. How many?

ENTER NUMBER:

B6_b. What were the reasons?

GO TO PART C: FACILITY PROGRAMS & TREATMENT SERVICES

License Renewal

Certification

Submission of 

Documentation

of Staff Training

Submission of 

Documentation of 

Staff

Qualifications

Re-Certification

Were any licenses for these facilities in your state revoked or suspended in 2002?

CHECK ALL THAT APPLY

Initial Licensure

B4. Is there a provisional license process for first-time applicants?

B5. What is required for initial licensure, license renewal, certification, and re-certification?

OTHER (SPECIFY)

Client Neglect

Unsafe conditions

Failure to report critical events

Lack of qualified staff

Fraud

OTHER (SPECIFY):

CHECK ALL THAT APPLY

Yes

No

Yes

No
State Regulation of Residential Facilities for Adults with Mental Illness 47

C1.

 GO TO C1_a then C1_b

 GO TO C2

C1_a.

ENTER NUMBER:

C1_b.

C2.

 C. FACILITY PROGRAMS AND TREATMENT SERVICES

How often must the individualized treatment/service plans be updated?

In this section we'd like you to answer some questions about the services provided to residents and 

requirements governing service provision in [FILL TYPE] .

Is the client or parent/guardian required to provide written acknowledgement of the 

individualized treatment plan?

Which of the following services does the state require these facilities to provide, either by staff or 

through contractual arrangements?

Are these facilities required to develop individualized treatment/service plans for residents?

Days Weeks Months Years

PLEASE SPECIFY

Individual Counseling

Group Counseling

Family Counseling

Assistance with Activities of Daily Living

Financial Management Counseling

Vocational Training

Training in Activities of Daily Living

Education

Client Advocacy

Case Management

Dispensing of Medication

Medication Management

OTHER (SPECIFY):

OTHER (SPECIFY):

OTHER (SPECIFY):

CHECK ALL THAT APPLY

Occupational Therapy

Yes

No

Yes

No
48 State Regulation of Residential Facilities for Adults with Mental Illness

C3.

 GO TO C3_a

 GO TO C4

C3_a.

ENTER NUMBER:

C4.

GO TO PART D: FACILITY MONITORING & OVERSIGHT

Are these facilities required to provide any of the following services upon discharging residents?

Are these facilities required to provide a minimum number of service/treatment hours to residents?

What is the minimim number of service/treatment hours required per resident?

PLEASE SPECIFY

Days Weeks Months Years

CHECK ALL THAT APPLY

Comprehensive Discharge Plan

Followup Visit at Home/Other Residence

Followup Treatment or Aftercare Plan Post Discharge

Discharge Interview or Satisfaction Survey

OTHER (SPECIFY):

Discharge Medications or Specific Medication Plan

Yes

No
State Regulation of Residential Facilities for Adults with Mental Illness 49

D1.

 GO TO D1_a then D1_b and D1_c

 GO TO D2

D1_a.

ENTER PERCENT: %

D1_b.

D1_c.

ENTER NUMBER:

D2.

 GO TO D2_a then D2_b and D2_c

 GO TO D3

D2_a.

ENTER PERCENT: %

The following questions involve procedures for monitoring and overseeing [FILL TYPE] .

D. FACILITY MONITORING AND OVERSIGHT

What percent of these facilities did the state make unannounced visits to in 2002?

Did the state make unannounced visits to any of these facilities in 2002?

What agency or agencies conducted these site visits?

What is the minimum required frequency of these visits per facility?

Did the state make announced visits to any of these facilities in 2002?

What percent of these facilities did the state make announced visits to in 2002?

Please indicate whether this figue is an estimate or 

is the result of record review

Please indicate whether this figue is an estimate or 

is the result of record review

Days Weeks Months Years

PLEASE SPECIFY

CHECK ALL THAT APPLY

State Mental Health Agency

Local (i.e., city or county) Mental Health Agency

Department of Social Services

Department of Children and Families

Department of Health

OTHER (SPECIFY):

No Frequency Rate Required

Yes

No

Yes

No

Estimate

Estimate Records Review

Records Review
50 State Regulation of Residential Facilities for Adults with Mental Illness

D2_b.

D2_c.

ENTER NUMBER:

D3.

D4.

 GO TO D4_a

 GO TO D5

D4_a. What types of adverse events or incidents must be reported?

Are these facilities required to report adverse events or incidents to the state?

What agency (or agencies) reviews complaints and/or grievances about these facilities?

What agency or agencies conducted these site visits?

What is the minimum required frequency of these visits per facility?

Days Weeks Months Years

PLEASE SPECIFY

CHECK ALL THAT APPLY

Deaths

Suicides

Suicide Attempts

Hospitalization of a Resident

Allegations of Abuse or Neglect

Other Critical Incidents:

CHECK ALL THAT APPLY

State Mental Health Agency

Local (i.e., city or county) Mental Health Agency

Department of Social Services

Department of Children and Families

Department of Health

OTHER (SPECIFY):

CHECK ALL THAT APPLY

State Mental Health Agency

Local (i.e., city or county) Mental Health Agency

Department of Social Services

Department of Children and Families

Department of Health

OTHER (SPECIFY):

No Frequency Rate Required

Yes

No
State Regulation of Residential Facilities for Adults with Mental Illness 51

D5.

 GO TO D5_a



D5_a.

GO TO PART E: FINANCING

Is there a court order in effect that is influencing any monitoring or oversight procedures for these 

facilities?

GO TO PART E

Please describe the nature of any court orders in place.

Yes

No
52 State Regulation of Residential Facilities for Adults with Mental Illness

These questions involve financing of services in [FILL TYPE] .

E1.

E. FINANCING

Private 3rd Party Payments

Self Pay

OTHER (SPECIFY):

SSI Payments

For a typical facility, where does financial support come from? Check all the apply.

Medicaid

State/Local Mental Health Agency Funds

State/Local Family/Child Service Agency Funds

State Welfare Agency

OTHER (SPECIFY):

Juvenile Justice

OTHER (SPECIFY):

SSDI Payments

State Supplemental Payments (SSP)

Federal Grants

Department of Education

Department of Defense

Private Grants
State Regulation of Residential Facilities for Adults with Mental Illness 53

E2.

 GO TO E2_a

 GO TO E3

E2_a.

ENTER THE RANGE: to

E3.

OR

Please indicate whether this figue is an 

estimate or is the result of record review.

MAIL IT TO [RESEARCHER] AT 600 MARYLAND AVE., SW STE. 550, WASHINGTON, DC 20024

PLEASE EMAIL IT TO [RESEARCHER] AT [EMAIL] .

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS SURVEY.

For a typical facility of this type, what is the Medicaid per diem for treatment services?

ENTER AVERAGE DAILY RATE:

What is the range?

For these facilities, are there different per diem rates for treatment services applied to different groups of 

Medicaid patients (for example, a group of residents with more severe problems might be charged a 

higher rate)?

Yes

No

Estimate Record Review




DHHS Publication Number (SMA) 06-4166

Printed 2006