Proposed Rule:

Establishing Adult Protective 

Services Regulations 

An Overview for ACL’s Network: 

The Administration for Community Living is seeking input on a proposed rule to establish the first-ever 

federal regulations for adult protective services (APS) programs. Instructions for submitting comments 

and registering for an informational webinar on Sept.18 can be found at ACL.gov/APSrule. 

Summary 

The proposed rule aims to improve consistency and 

quality of APS services across states and support the 

national network that delivers APS services, with the 

ultimate goal of better meeting the needs of adults who 

experience, or are at risk of, maltreatment. To those 

ends, the proposed rule: 

• Establishes a set of national standards for the

operation of APS programs that all state APS systems

must meet. These standards formalize – and build

upon – the existing National Voluntary Consensus

Guidelines for State APS Systems.

• Establishes common definitions for the national

APS system to improve information sharing, data

collection and standardization between and within

states.

• Requires state APS systems to develop policies and

procedures, consistent with state law, for coordination

and sharing of information to facilitate investigations

with other entities, such as state law enforcement

agencies, and state Medicaid agencies.

• Requires state policies and procedures to be persondirected and based on concepts of least restrictive

alternatives.

• Establishes requirements for data collection,

retention, and reporting.

• Establishes requirements for mandatory staff training

and ongoing education on core competencies for APS

staff and supervisors.

The proposed rule is the culmination of many years 

of engagement with stakeholders from APS and longterm care ombudsman programs, as well as aging 

and disability advocates, from across the country. It 

also reflects input received through several listening 

sessions, extensive research, and analysis of data from 

a 2021 survey of 51 APS systems, ACL’s National Adult 

Maltreatment Reporting System, and policy profiles from 

APS programs in all states and territories. 

Background: Adult Maltreatment and 

APS Programs 

Research shows that at least one in 10 older adults 

who live in the community experiences some form 

of maltreatment each year – and this is likely an 

undercount, because only 1 in 14 cases is reported. 

The isolation and loss of services during the COVID-19 

pandemic placed older adults at increased risk, and 

incidents of abuse are estimated to have doubled. We 

also know that adults with disabilities experience abuse 

and neglect far more often than their peers without 

disabilities, although estimates of the prevalence vary 

significantly from one study to the next.

This can have serious physical and mental health, 

financial, and social consequences. People who 

experience abuse have higher rates of depression, 

hospitalization and institutionalization – and they are 

more likely to die prematurely. 

Last Updated: 9/2023

The Administration for Community Living is an operating division of 

the U.S. Department of Health and Human Services. Visit ACL.gov.
APS programs across the country work to support older 

adults and adults with disabilities who experience, or 

who are risk of, abuse, neglect, self-neglect, or financial 

exploitation. APS programs investigate reports of 

maltreatment; conduct case planning, monitoring and 

evaluation; and provide, or connect people who have 

experienced maltreatment to, a variety of medical, social 

service, economic, legal, housing, law enforcement, and 

other protective, emergency, or support services to help 

them recover. 

APS has been designed and administered wholly at the 

state or local level until recently. Consequently, there is 

wide variation in APS services and practices between, 

and even within, states.

Over the past decade, ACL has led federal efforts to 

support the critical work of APS programs through a 

variety of initiatives. Since 2015, ACL has awarded 

discretionary grants to states to test innovations and 

improvements in APS practices, services, data collection, 

and reporting; facilitated sharing of lessons learned and 

promising practices across APS systems; and provided 

technical assistance to support states in developing APS 

systems that are tailored to the needs, goals, culture, 

and preferences of the person being served. 

In 2016, ACL worked with experts across the country to 

develop National Voluntary Consensus Guidelines, which 

provide a core set of principles and common expectations 

to encourage consistency in practice, ensure adults 

are afforded similar protections and APS services 

regardless of locale, support interdisciplinary and 

interagency coordination, and promote effective, efficient, 

culturally competent service delivery. However, because 

implementation of the guidelines is voluntary, they have 

not produced the widespread change in APS systems or 

practices that only mandatory guidelines can. 

In 2021, ACL received appropriations to fund – for the 

first time – the nationwide APS formula grant program 

that was authorized by the Elder Justice Act. These 

appropriations elevate the need for federal leadership, 

guidance, and support for state and local APS programs. 

Key Provisions of the Proposed Rule 

The following is a plainer-language overview of some of 

the core provisions of the proposed rule. It was written 

to be easier to understand for people without an in-depth 

understanding of APS or a legal background. It does 

not include all of the provisions or complete details of 

the summarized provisions. Please use this document 

as a tool to navigate the proposed rule; it should not be 

considered a substitute. 

Establishing a common vocabulary for APS 

The rule proposes definitions for foundational terms in 

APS practice (§ 1324.401). For example, the proposed 

rule defines “adult maltreatment” as including abuse, 

neglect, exploitation, sexual abuse, and self-neglect (and 

proposes definitions for those terms).

Establishing minimum standards for APS programs

The proposed rule codifies and clarifies a set of 

mandatory minimum national standards to ensure 

uniformity across APS programs and to promote high 

quality service delivery. If implemented, these standards 

will ensure that people are afforded similar protections 

and services regardless of where they live. For example, 

the proposed rule requires state APS systems to:

• Ensure a person-directed approach to service

delivery. The proposed rule reflects ACL’s

commitment to ensuring that planning and delivery

of all services provided through its programs respect

the fundamental right of adults to make their own life

choices. For example, the proposed rule requires

states to adopt policies and procedures that:

» Ensure the preservation of the APS client’s

rights, promote the client’s views about safety

and respect the client’s definition of successful

outcomes. (§ 1324.402(a)).

» Ensure APS clients are informed of their rights

under state law, at their first contact with the APS

program. These include confidentiality and privacy

requirements, the right to refuse services, and the

right to refrain from speaking with APS. Providers

must ensure that these rights are communicated

in plain language and formats, including those

accessible to people with disabilities and those

with limited English proficiency (§ 1324.402(b)).

• Establish policies and procedures to prevent,

recognize, and promptly address both real and

perceived conflicts of interest. (§ 1324.404).

• Respond to all reports of adult maltreatment, as

defined in the rule. (Currently, some states define

adult maltreatment differently than the proposed

rule.) (§ 1324.402(a)).

• Create precise, standardized service eligibility criteria

(§ 1324.402(a)).
• Create clear and specific parameters of the

settings, locations, and types of perpetrators

for which maltreatment will be investigated and

establish processes to ensure they are implemented

consistently across the state’s APS programs.

(§ 1324.402(a))

• Establish a standardized and systematic approach to

investigations of adult maltreatment, from initiation of

a case through post-investigation services

(§ 1324.403).

• Establish and manage a tiered risk-based

assessment system to differentiate between cases

that represent immediate risk (defined as those that

are life-threatening or likely to cause irreparable harm

or significant loss of income, assets or resources)

and those that do not. The proposed rule further

establishes that responses to reports of maltreatment

representing immediate risk should occur within 24

hours. Responses to reports assessed to represent

non-immediate risk should occur within seven

calendar days. ((§ 1324.402(a)).

• Establish mechanisms to coordinate with other

entities to detect, prevent, address, and remedy

adult maltreatment. These entities include but are

not limited to state Medicaid agencies, state nursing

home licensing and certification, state department of

health and licensing and certification agencies

(§ 1324.406).

How to Provide Feedback

ACL seeks feedback from all who are seeking to improve 

implementation of APS programs. Input from the aging 

and disability networks, as well as the people served by 

APS programs, is particularly crucial. Comments can be 

submitted:

• Online at Regulations.gov. (Enter “2023-19516 “ in the

search bar, select ACL’s proposed rule, and then click

the blue “comment” box at the top left of the page.)

• By mail to:

HHS Administration for Community Living

Administration on Aging

Attention: Stephanie Whittier Eliason

330 C Street SW, Washington, DC 20201

Comments will be accepted for 60 days, starting on 

September 12. 

Learn More

• An informational webinar will be held on Monday,

September 18 at 11:30 a.m. (Eastern). For details,

please see the Zoom registration page.

• The complete proposed rule can be found on the

website of the Federal Register.

• Links to the above, along with this fact sheet and

other materials as they are developed can be found

at ACL.gov/APSrule.