Federal Register / Vol. 88, No. 175 / Tuesday, September 12, 2023 / Proposed Rules 62503 

monitors; propane bottles; or glass 

containers is prohibited. 

7. You must not possess, discharge, or 

use flammable devices, including but 

not limited to gasoline bombs 

commonly referred to as ‘‘Sobe Bombs’’ 

or flammable projectiles discharged 

from a launching tube or other device. 

8. You must not drink an alcoholic 

beverage or possess an open alcoholic 

beverage container while in the 

passenger area of a motor vehicle, 

including off-highway vehicles. 

9. You must not violate any State laws 

relating to the purchase, possession, 

use, or consumption of alcohol. 

10. You must not possess any drug 

paraphernalia in violation of State law. 

11. You must not tow or be in 

possession of a trailer requiring 

registration under Wyoming Revised 

Statues that is either unregistered or has 

an expired registration. 

12. You must not violate any 

Wyoming Revised Statute regarding 

hunting, fishing, boating, or outfitters. 

13. You must not violate any Federal 

or State laws or regulations concerning 

conservation or protection of natural 

resources or the environment, including 

but not limited to those relating to air 

and water quality, protection of fish and 

wildlife, plants, and the use of a 

chemical toxicant. 

14. You must not burn wood pallets 

containing nails or staples. 

15. You must not intentionally engage 

in any activity within any distance that 

disturbs, displaces, or otherwise 

interferes with the free unimpeded 

movement of wild horses. 

16. You must not feed, water, or touch 

any wild horse. 

Exceptions 

The following persons are exempt 

from the supplementary rule: any 

Federal, State, local, or military 

employees or contractors acting within 

the scope of their official duties; 

members of any organized rescue or firefighting force performing an official 

duty; and persons who are expressly 

authorized or approved by the BLM. 

Enforcement 

Any person who violates this 

supplementary rule may be tried before 

a United States Magistrate and fined in 

accordance with 18 U.S.C. 3571, 

imprisoned no more than 12 months 

under 43 U.S.C. 1733(a) and 43 CFR 

8560.0–7, or both. In accordance with 

43 CFR 8365.1–7, State or local officials 

may also impose penalties for violations 

of Wyoming law. 

Andrew Archuleta, 

BLM Wyoming State Director. 

[FR Doc. 2023–19634 Filed 9–11–23; 8:45 am] 

BILLING CODE 4331–26–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Community Living 

45 CFR Part 1324 

RIN 0985–AA18 

Adult Protective Services Functions 

and Grant Programs 

AGENCY: Administration for Community 

Living (ACL), Department of Health and 

Human Services (HHS). 

ACTION: Notice of proposed rulemaking. 

SUMMARY: The Administration for 

Community Living (ACL) within the 

Department of Health and Human 

Services (‘‘the Department’’ or HHS) is 

issuing this Notice of Proposed 

Rulemaking (NPRM) to modify the 

implementing regulations of the Older 

Americans Act of 1965 (‘‘the Act’’ or 

OAA) to add a new subpart (Subpart D) 

related to Adult Protective Services 

(APS). 

DATES: To be assured consideration, 

comments must be received no later 

than November 13, 2023. 

ADDRESSES: You may submit comments, 

including mass comment submissions, 

to this proposed rule, identified by RIN 

Number 0985–AA18, by any of the 

following methods: 

• Electronically. You may submit 

electronic comments on this regulation 

to http://www.regulations.gov. Follow 

the ‘‘Submit a comment’’ instructions. 

• Regular, Express, or Overnight Mail: 

You may mail written comments to the 

following address: Administration on 

Aging, Administration for Community 

Living, Department of Health and 

Human Services, Attention: Stephanie 

Whittier Eliason, 330 C Street SW, 

Washington, DC 20201. 

Do not include any personally 

identifiable information (such as name, 

address, or other contact information) or 

confidential business information that 

you do not want publicly disclosed. All 

comments may be posted without 

change to content to https://

www.regulations.gov and can be 

retrieved by most internet search 

engines. No deletions, modifications, or 

redactions will be made to comments 

received. 

We will consider all comments 

received or officially postmarked by the 

methods and due date specified above. 

Because of the large number of public 

comments we normally receive on 

Federal Register documents, we are not 

able to provide individual 

acknowledgements of receipt. Please 

allow sufficient time for mailed 

comments to be timely received in the 

event of delivery or security delays. 

Electronic comments with attachments 

should be in Microsoft Word or Portable 

Document Format (PDF). 

Please note that comments submitted 

by fax or email, and those submitted or 

postmarked after the comment period, 

will not be accepted. 

Inspection of Public Comments: All 

comments received before the close of 

the comment period will be available for 

viewing by the public, including 

personally identifiable or confidential 

business information that is included in 

a comment. You may wish to consider 

limiting the amount of personal 

information that you provide in any 

voluntary public comment submission 

you make. HHS may withhold 

information provided in comments from 

public viewing that it determines may 

impact the privacy of an individual or 

is offensive. For additional information, 

please read the Privacy Act notice that 

is available via the link in the footer of 

https://www.regulations.gov. Follow the 

search instructions on that website to 

view the public comments. 

FOR FURTHER INFORMATION CONTACT: 

Stephanie Whittier Eliason, Team Lead, 

Office of Elder Justice and Adult 

Protective Services, Administration on 

Aging, Administration for Community 

Living, Department of Health and 

Human Services, 330 C Street SW, 

Washington, DC 20201. Email: 

Stephanie.WhittierEliason@acl.hhs.gov, 

Telephone: (202) 795–7467 or (TDD). 

Assistance to Individuals With 

Disabilities in Reviewing the 

Rulemaking Record: Upon request, the 

Department will provide an 

accommodation or auxiliary aid to an 

individual with a disability who needs 

assistance to review the comments or 

other documents in the public 

rulemaking record for the proposed 

regulations. To schedule an 

appointment for this type of 

accommodation or auxiliary aid, please 

call (202) 795–7467 or email 

Stephanie.WhittierEliason@acl.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Table of Contents 

I. Background 

II. Statutory and Regulatory History and 

Reasons for the Proposed Rulemaking 

III. Adult Protective Services 


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62504 Federal Register / Vol. 88, No. 175 / Tuesday, September 12, 2023 / Proposed Rules 

1Mengting Li & XinQi Dong, Association Between 

Different Forms of Elder Mistreatment and 

Cognitive Change, 33 J. of Aging and Health, 249 

(2020), https://pubmed.ncbi.nlm.nih.gov/33249977/ 

; Russ Neuhart, Elder Abuse: Forensic, Legal and 

Medical Aspects, 163 (Amy Carney ed., 2019); 

Rosemary B. Hughes et al, The Relation of Abuse 

to Physical and Psychological Health in Adults with 

Developmental Disabilities, 12 Disability and 

Health J., 227 (2019), https://doi.org/10.1016/j.dhjo.

2018.09.007; Joy S. Ernst & Tina Maschi, TraumaInformed Care and Elder Abuse: A Synergistic 

Alliance. 30 J. of Elder Abuse & Neglect, 354 (2018), 

https://pubmed.ncbi.nlm.nih.gov/30132733/. 

2Ron Acierno et al., Prevalence and Correlates of 

Emotional, Physical, Sexual, and Financial Abuse 

and Potential Neglect in the United States: The 

National Elder Mistreatment Study, 100 AMER. J. OF

PUB. HEALTH 292 (2010), https://www.ncbi.nlm.

nih.gov/pmc/articles/PMC2804623/; Andre Rosay & 

Carrie Mulford, Prevalence Estimates & Correlates 

of Elder Abuse in the United States: The National 

Intimate Partner and Sexual Violence Survey, 29(1) 

J. of Elder Abuse and Neglect, 1 (2017); E-Shien 

Chang & Becca R Levy, High Prevalence of Elder 

Abuse During the COVID–19 Pandemic: Risk and 

Resilience Factors, 29(11) AMER. J. OF GERIATRIC

PSYCHIATRY (2021), doi.org/10.1016/ 

j.jagp.2021.01.007.https://pubmed.ncbi.

nlm.nih.gov/27782784/#:∼:text=More%20than%201

%20in%2010,both%20intimate%20and

%20nonintimate%20partners; Yongjie Yon et al., 

Elder Abuse Prevalence in Community Settings: A 

Systematic Review and Meta-analysis, 5(2) Lancet 

Global Health 147 (2017); Furthermore, it is 

estimated that for every incident of abuse reported 

to authorities, nearly 24 additional cases remain 

undetected. See Jennifer Storey, Risk Factors for 

Abuse and Neglect: A Review of the Literature, 50 

AGGRESSION AND VIOLENT BEHAVIOR 101339 (2020), 

https://www.sciencedirect.com/science/article/abs/ 

pii/S1359178918303471. 

3Prevalence estimates for abuse subtypes 

reported by institutionalized older residents were 

highest for psychological abuse (33.4%), followed 

by physical (14.1%), financial (13.8%), neglect 

(11.6%), and sexual abuse (1.9%); Yongjie Yon et. 

al., The Prevalence of Elder Abuse in Institutional 

Settings: A Systematic Review and Meta-Analysis, 

29 Eur. J. of Pub. Health 58 (2019). 

4Adult Protective Services Technical Assistance 

Resource Center (2023). National Process 

Evaluation of the Adult Protective Services System. 

Submitted to the Administration for Community 

Living, U.S. Department of Health and Human 

Services. The U.S. Territories are not included in 

the analysis. Extant policy information was not 

available from the Territories, thus were not 

included in the APS Policy Review or APS Systems 

Outcomes Analysis. They were able to participate 

A. Section 1324.400 Eligibility for 

Funding 

B. Section 1324.401 Definitions 

C. Section 1324.402 Program 

Administration 

D. Section 1324.403 Investigation and 

Post-Investigation Services 

E. Section 1324.404 Conflict of Interest 

F. Section 1324.405 Accepting Reports 

G. Section 1324.406 Coordination with 

Other Entities 

H. Section 1324.407 APS program 

Performance 

I. Section 1324.408 State Plans 

J. Regulatory Approach 

K. Effective Date 

L. Request for Comment 

IV. Required Regulatory Analyses 

A. Regulatory Impact Analysis (Executive 

Orders 12866 and 13563) 

B. Regulatory Flexibility Act 

C. Executive Order 13132 (Federalism) 

D. Executive Order 13175 (Consultation 

and Coordination with Indian Tribal 

Governments) 

E. Unfunded Mandates Reform Act of 1995 

F. Plain Language in Government Writing 

G. Paperwork Reduction Act (PRA) 

I. Background 

The Administration for Community 

Living (ACL) within the Department of 

Health and Human Services (HHS) is 

issuing this Notice of Proposed 

Rulemaking to modify 45 CFR part 1324 

of the implementing regulations of the 

Older Americans Act of 1965 (OAA or 

‘‘the Act’’) to add a new subpart 

(Subpart D). The proposed rules 

exercise ACL’s authority to regulate 

Adult Protective Service (APS) systems 

under section 201 of the Act, 42 U.S.C. 

3011(e)(3) and section 2042(a) of the 

Elder Justice Act (EJA), 42 U.S.C. 

1397m–1(a). Currently, there are no 

Federal standards for APS systems, 

leading to wide variation in policies and 

procedures, thus resulting in 

inconsistent service delivery across 

States and confusion for APS systems 

and the general public, including 

victims of adult maltreatment. 

Historically, APS programs and 

administrators have lacked reliable 

information and guidance on best 

practices and standards for conducting 

case investigations and for staffing and 

managing APS programs. These 

challenges have impaired States’ ability 

to respond in an effective and timely 

way to reports of adult maltreatment 

and to assess client outcomes and the 

effectiveness of the services they are 

providing. Nationally, this results in a 

fragmented and unequal system that can 

hinder coordination and lead to the 

absence of critical support for some 

people experiencing maltreatment. The 

proposed regulation will create a 

national standard to elevate evidenceinformed practices, bring clarity and 

uniformity to programs, and improve 

the quality of service delivery for adult 

maltreatment victims and potential 

victims. 

Adult maltreatment is associated with 

significant physical and mental health 

consequences as well as financial losses. 

Older adults and people with 

disabilities may also experience 

deteriorated family relationships, 

diminished autonomy, and 

institutionalization, all of which can 

impact quality of life.1 Studies have 

found that at least one in ten 

community-dwelling older adults 

experienced some form of abuse in the 

prior year.2 In addition, a recent 

systematic review that collected selfreports of abuse by residents found high 

levels of institutional abuse.3

APS programs often link adults 

subject to maltreatment to community 

social, physical health, behavioral 

health, and legal services which help 

them maintain independence in the 

settings they prefer to live. APS 

programs are also often the avenue 

through which adult maltreatment is 

reported to police or other agencies of 

the criminal justice system. As such, 

APS plays a critical role in the lives of 

adults more likely to be subjected to 

maltreatment, particularly older adults 

and adults with disabilities. APS 

programs receive and respond to reports 

of adult maltreatment, and work closely 

with clients and a wide variety of allied 

professionals to maximize safety and 

independence and provide a range of 

services to the people they serve, 

including: 

• receiving and investigating reports 

of adult maltreatment; 

• case planning, monitoring, 

evaluation, and other case work and 

services; and 

• providing, arranging for, or 

facilitating the provision of medical, 

social service, economic, legal, housing, 

law enforcement, or other protective, 

emergency, or support services. 

APS is a social and human services 

program. Working collaboratively and 

with the consent of the victim, APS 

caseworkers develop service plans and 

connect the victim to social, health, and 

human services. The focus of APS is 

entirely on assisting the victim to 

recover from the experience of 

maltreatment. As a social services 

program, the ‘‘findings’’ in an APS case 

are not legal determinations, either civil 

or criminal. Rather, if APS suspects that 

an act of maltreatment falls under a 

State’s criminal statutes, APS will refer 

the case to law enforcement. 

As discussed in greater detail in the 

Statutory and Regulatory History and 

Reasons for the Proposed Rulemaking, 

until 2021 APS systems were funded 

primarily through a variety of local and 

State resources. All States now accept 

Federal funding, including ACL 

funding, for their APS systems in 

addition to their State and local 

funding. However, there are currently 

no mandatory Federal standards 

governing APS policies, procedures, and 

practices, which results in a significant 

program variation across and within 

States and, in some cases, sub-standard 

quality according to APS staff and other 

community members. 

In 2021, ACL fielded a survey (OMB 

Control No. 0985–0071) of 51 APS 

systems (the 50 States and the District 

of Columbia).4 Results from that survey, 


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in the APS Practice Survey, and their data are 

included in internal survey results report to ACL. 5NAMRS is a data reporting system established 

and operated by ACL for the purpose of better 

understanding of adult maltreatment in the United 

States. The data collected is submitted by all APS 

programs in all states, the District of Columbia, and 

the Territories. NAMRS annually collects data on 

APS investigations of abuse, neglect and 

exploitation of older adults and adults with 

disabilities, as well as information on the 

administration of APS programs. The data provide 

an understanding of key program policies, 

characteristics of those experiencing and 

perpetrating maltreatment, information on the types 

of maltreatment investigated, and information on 

services to address the maltreatment. For more 

information, visit: THE ADMIN. FOR CMTY. LIVING, 

National Adult Maltreatment Reporting System, 

www.namrs.acl.gov (last visited April 18, 2023). 6We refer to ‘‘States’’ in this proposed rule to 

encompass all fifty States, the District of Columbia, 

and the five Territories (American Samoa, 

Commonwealth of the Northern Mariana Islands, 

Guam, Puerto Rico, and U.S. Virgin Islands). 

7See infra note 24. In addition to ACL formula 

grants, States may receive Title XX Social Services 

Block Grant (SSBG) funding. However, States have 

discretion whether and how much of their SSBG 

funding they choose to allocate to APS. Not all 

States use SSBG funding for their APS systems. 

8See supra note 4; Numbers sum to 54 because 

five Territories did not report data on their APS 

administrative structure. All fifty States and the 

District of Columbia reported data. Three States 

(Massachusetts, Louisiana, and Pennsylvania) have 

two separate APS systems, one program with 

eligibility based on age and a separate and distinct 

program with eligibility based on disability status. 

The two separate systems were counted in these 

States. 

9See supra note 4 at 21. 

10See supra note 4 at 20; Pennsylvania has used 

a for-profit entity due to a unique circumstance in 

the State related to the State’s aging services 

structure. There are currently no for-profit APS 

entities. 

11For example, 76 percent of APS programs 

indicate that their State exerts ‘‘significant’’ control 

over local APS operations. See supra note 4 at 20. 

12See supra note 4 at 21. 

13 Id. 

14We note eligibility is set in State statute. 

Discretion is exercised, however, on which eligible 

cases to accept—often based on resource 

constraints. 

15See supra note 4. Specifically, 34 States serve 

adults (age 18 and older) with disabilities regardless 

of age. This is the largest eligibility category. 

Twelve States serve older adults (either age 60 and 

older or age 65 and older) regardless of disability 

status, and younger adults with a disability. Four 

States serve only older adults regardless of 

disability status. Two States serve only older adults 

with a disability. Two States have programs that 

only serve young adults with disabilities, and older 

adults are served by a different APS program within 

the State. 

16See supra note 4. 

17See supra note 4. 

18See supra note 4. 

19See supra note 4. 

20See supra note 4. 

21For detailed information on the development 

process for the 2016 and subsequent 2020 

Consensus Guidelines, see THE ADMIN. FOR CMTY. 

LIVING, FINAL NATIONAL VOLUNTARY GUIDELINES FOR

STATE ADULT PROTECTIVE SERVICES SYSTEMS (2016), 

https://acl.gov/sites/default/files/programs/2017- 

03/APS-Guidelines-Document-2017.pdf (last visited 

May, 16 2023); THE ADMIN. FOR CMTY. LIVING, 

VOLUNTARY CONSENSUS GUIDELINES FOR STATE APS 

SYSTEMS (2020), https://acl.gov/programs/elderjustice/final-voluntary-consensus-guidelines-stateaps-systems (last visited Apr. 18, 2023). 

22Off. Of Mgmt. & Budget, Exec. Off. Of the 

President, OMB Circular A–119, Federal 

Participation in the Development and Use of 

Voluntary Consensus Standards and in Conformity 

Assessment Activities, https://www.nist.gov/ 

system/files/revised_circular_a-119_as_of_01-22- 

2016.pdf); National Technology Transfer and 

Advancement Act of 1995, Public Law No. 104–113, 

including amendment Utilization of consensus 

technical standards by Federal agencies, Public Law 

No. 107–107, § 1115 (2001), https://www.nist.gov/ 

standardsgov/national-technology-transfer-andadvancement-act-1995; The Admin. For Cmty. 

Living, Report on the Updates to the Voluntary 

Consensus Guidelines for APS Systems (2020) 

https://acl.gov/sites/default/files/programs/2020- 

05/ACL-Appendix_3.fin_508.pdf (last visited May 9, 

2023). 

along with an analysis of the 2020 

National Adult Maltreatment Reporting 

System (NAMRS) 5 data, and collected 

policy profiles of APS in all States, the 

District of Columbia, and the Territories 

illustrate the wide variability across 

APS programs.6

As discussed in the Definitions 

section, an APS system is made up of 

both the State entity (e.g., the 

department of health and human 

services) that receives State and Federal 

funding for APS, including ACL 

funding, and the local APS programs 

that provide adult protective services.7

All APS systems are organized under a 

State government entity, with 20 

systems located within a State Unit on 

Aging, 14 within a State division or 

department of social services (mostly 

responsible for child welfare), and 20 

within some other State department or 

agency of health and human services.8

Despite all States having a designated 

State office for APS, the degree to which 

the State entity controls and administers 

the APS systems varies across States. In 

78 percent of APS systems, the State 

office sets program policy for, and 

conducts oversight of, the APS 

programs, and in 22 percent of States, 

the authority to set policy and conduct 

oversight rests in the local APS program 

in each county or service area.9 In 70 

percent of APS programs, State 

employees implement the APS program 

and conduct investigations; county and 

non-profit employees conduct 

investigations in the remaining 30 

percent of programs.10

While the State entity establishes APS 

policy, conducts training, administers 

funding, and provides information 

technology infrastructure support to 

local APS programs in almost all APS 

systems,11 27 States have indicated the 

need for greater consistency in 

practice.12 Specific obstacles identified 

included: lack of resources for oversight 

in general or quality assurance 

processes specifically, differing policy 

interpretations across local programs, 

and not enough supervisors.13

Eligibility for APS services varies 

dramatically across the States, Tribal 

Nations, and Territories. States use age 

and terms such as ‘‘disability,’’ 

‘‘dependency,’’ or ‘‘vulnerability’’ to 

define the populations they serve.14 In 

some States, being an older adult (some 

States set the age at 60 and older, others 

at 65 and older) is the only criterion for 

determining whom they serve; in others, 

eligibility is defined by a combination of 

age and ‘‘disability,’’ ‘‘dependency,’’ or 

‘‘vulnerability.’’ States with programs 

that serve younger adults (age 18–59 or 

18–64) always require ‘‘disability,’’ 

‘‘dependency,’’ or ‘‘vulnerability’’ as a 

criterion.15 However, despite eligibility 

being established at the State level, APS 

programs often triage which eligible 

cases they have the capacity to 

investigate based on numerous factors, 

including resources. 

Responsibility for investigations 

involving residents in congregate 

residential facilities such as nursing 

facilities, assisted living facilities, and 

group homes varies across APS systems. 

Most APS systems investigate 

allegations of maltreatment that do not 

involve the facility or its staff, and a few 

APS programs investigate allegations 

involving the staff of the facility.16

Eleven APS systems report they do not 

have authority to conduct investigations 

in congregate residential facilities.17

Forty-two APS systems report they have 

authority to investigate allegations of 

abuse, neglect, or exploitation when 

they occur in congregate residential 

facilities.18 Of those 42, 19 report the 

APS system has authority to conduct 

investigations in congregate residential 

facilities in all situations regardless of 

whether the alleged perpetrator is 

facility staff, visitor, or resident.19

Twenty-three States report the APS 

system has authority to conduct 

investigations in some congregate 

residential settings depending on 

whether a staff person is the alleged 

perpetrator or not.20

In an effort to elevate uniform 

evidence-informed practices across APS 

programs, ACL issued Voluntary 

Consensus Guidelines for State APS 

Systems (Consensus Guidelines) in 

2016, which were subsequently updated 

in 2020.21 In developing the Consensus 

Guidelines, ACL applied Office of 

Management and Budget (OMB) and 

National Institutes of Standards and 

Technology (NIST) standards and 

processes for creating field-developed, 

consensus-driven guidelines.22 The 

development of the 2016 Consensus 

Guidelines and its 2020 update 


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23 Individual input was received from the APS 

community, thus exempting the process from 

Federal Advisory Council Act requirements; 5 

U.S.C. 1001 et. seq. 

24See supra note 4. 

25For example, South Carolina had the highest 

SSBG expenditure for Vulnerable and Elderly 

Adults in FY 2020 at $14,311,707 representing 58 

percent of their entire block grant. The Dep’t. of 

Health and Hum. Servs., Social Services Block 

Grant: Fiscal Year 2020. Ann. Rep. (2020). https:// 

www.acf.hhs.gov/sites/default/files/documents/ocs/ 

RPT_SSBG_Annual%20Report_FY2020.pdf (last 

visited May 11, 2023). 

26 42 U.S.C. 1397k. 

27The Admin. for Cmty. Living, Federal Elder 

Justice Coordinating Council, https://ejcc.acl.gov/ 

(last visited Apr. 18, 2023). 

28 42 U.S.C. 1397m–1. 

29Coronavirus Response and Relief Supplemental 

Appropriations Act of 2021, Public Law 116–260, 

134 Stat. 1182; American Rescue Plan Act of 2021, 

Public Law 117–2, 135 Stat. 4. 

consisted of multiple steps. ACL 

performed a review of research available 

on promising practices in APS systems 

and in other analogous systems 

throughout the United States; convened 

a review group consisting of experts 

selected from the APS, the Long-Term 

Care Ombudsman, and disability rights 

communities; and engaged in an 

extensive and wide-reaching 

community engagement and outreach 

process. Through our community 

engagement process, we received input 

on an individual basis from a variety of 

sources, including the general public, 

the aging network, APS systems, the 

disability community, law enforcement, 

and others. We drafted our guidance 

based on the individual input we 

received.23

The Consensus Guidelines represent 

recommendations from the field based 

on experience and expertise serving 

adults and communities. These 

guidelines 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, and support interdisciplinary 

and interagency coordination. These 

recommendations enhance effective, 

efficient, and culturally competent APS 

service delivery. While the Consensus 

Guidelines have been commended by 

APS systems and the APS community, 

they have yet to produce measurable 

change in APS systems or practice, and 

consistency and uniformity are still 

lacking across and within APS systems. 

Our recently published National Process 

Evaluation Report using 2021 data and 

ongoing NAMRS data collection bear 

out gaps between current State policy 

and practice and the recommendations 

contained in the Consensus Guidelines. 

We have received feedback from the 

APS community that because the 

Consensus Guidelines are voluntary 

recommendations and not regulatory 

requirements, their efficacy is limited. 

These proposed rules are informed by 

the extensive research, analysis, 

community input, and 

recommendations of our Consensus 

Guidelines, as well as experience and 

information from our NAMRS data, and 

the 2021 51 State National Process 

Evaluation Report.24

II. Statutory and Regulatory History 

and Reasons for the Proposed 

Rulemaking 

APS programs have historically been 

administered and primarily funded by 

States. They have been recognized in 

Federal law since 1974 when the Social 

Security Act was amended by the Social 

Services Amendments of 1974 (Pub. L. 

93–647), 42 U.S.C. 1397a(a)(2)(A) to 

permit States to use Social Services 

Block Grant (SSBG) funding under Title 

XX for APS programming. However, 

while most States currently use SSBG 

funding for their APS programs, the 

amount of SSBG funding allocated to 

APS varies and the allocations can be 

very small.25

Through a series of legislative actions, 

Congress designated ACL as the Federal 

entity with primary responsibility for 

providing Federal policy leadership and 

program oversight for APS. This 

includes authority granted by the OAA 

to promulgate regulations, to oversee 

formula grants to State and Tribal APS 

programs, to enhance APS programs, to 

collect data to increase APS 

effectiveness, and to directly link the 

authorities of the EJA with those 

contained in the OAA. 

Title VII of the OAA (Vulnerable 

Elder Rights Protection Activities), 

enacted in 1992, authorizes funding to 

States to address protections for 

vulnerable adults. Some activities are 

specifically identified to be conducted 

with Title VII funding. Section 201(e) of 

the OAA, 42 U.S.C. 3011(e) added in 

2006, vests responsibility for a 

coordinated Federal and national 

response to elder justice issues broadly 

with the Assistant Secretary for Aging. 

ACL has rulemaking authority for elder 

justice activities by virtue of section 

201(e)(3), 42 U.S.C. 3011(e)(3), which 

states, ‘‘the Secretary, acting through the 

Assistant Secretary, may issue such 

regulations as may be necessary to carry 

out this subsection . . .’’ and 

specifically references the responsibility 

of the Assistant Secretary for elder 

abuse prevention and services, 

detection, treatment and response in 

coordination with heads of State APS 

programs. Section 2042(b) of the EJA, 42 

U.S.C. 1397m–1, establishes an APS 

grant program under which the 

Secretary annually awards grants to 

States. The Secretary of HHS has 

designated ACL as the grant-making 

agency for APS. Coupled together, the 

EJA and OAA provide the Assistant 

Secretary with broad authority to 

coordinate, regulate, and fund State APS 

systems. 

Through the enactment of the EJA in 

2010, Congress again recognized the 

need for a more coordinated national 

elder justice and APS system. The EJA 

creates a national structure to promote 

research and technical assistance to 

support Federal, State, and local elder 

justice efforts, as well as authorization 

for dedicated APS funding. A 

component of the EJA is specifically 

designed to address the need for better 

Federal leadership. The Federal Elder 

Justice Coordinating Council (EJCC) is 

established by the EJA 26 to coordinate 

activities across the Federal Government 

that are related to elder abuse, neglect, 

and exploitation. The EJA designates the 

Secretary of HHS to chair the EJCC, and 

continually since the establishment of 

the EJCC in 2012, the HHS Secretary has 

designated that responsibility to the 

Assistant Secretary for Aging and 

Administrator of ACL. Under the 

chairmanship of the Assistant Secretary 

for Aging, and since its establishment, 

the EJCC has met regularly, soliciting 

input from the APS community— 

ranging from individual citizens to 

expert practitioners and industry 

associations—on identifying and 

proposing solutions to the problems 

surrounding elder abuse, neglect, and 

financial exploitation, including for 

strengthening national support for 

APS.27

Since Fiscal Year (FY) 2015, Congress 

has appropriated funds to ACL in 

support of APS through section 2042(a) 

and 2401(c) of the Elder Justice Act. 

This funding is used to collect data, 

disseminate best practices, and provide 

discretionary elder justice 

demonstration grants.28 In FY 2021, 

Congress provided the first dedicated 

appropriation to implement the Elder 

Justice Act section 2042(b), 42 U.S.C. 

1397m–1(b), formula grants to all States, 

the District of Columbia, and the 

Territories to enhance APS, totaling 

$188 million, and another $188 million 

in FY 2022.29 The recent Consolidated 

Appropriations Act of 2023 included an 

annual appropriation of $15 million to 

ACL to continue providing formula 


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30Consolidated Appropriations Act, 2023, Pub. L. 

117–328. FY 21 and 22 funding was one-time 

funding to help with start-up costs and 

infrastructure and the surge of needs during the 

COVID–19 Public Health Emergency. FY 23 funding 

was the first ongoing formula grant funding to State 

grantees. 

31Public and Outside Witness, Hearing Before the 

Subcomm. on Lab., Health and Hum. Servs. Educ. 

& Related Agencies of the House Appropriations 

Comm., 113th Cong. (2014) (statement of Kathleen 

M. Quinn, Exec. Dir. of the Nat’l. Adult Protective 

Servs. Ass’n.) https://www.napsa-now.org/wpcontent/uploads/2014/03/AppropriationsTestimony-NAPSA.pdf. 

32Enhancing Response to Elder Abuse, Neglect, 

and Exploitation: Elder Justice Coordinating 

Council, Testimony of William Benson (Oct. 10, 

2012), http://www.aoa.acl.gov/AoA_Programs/ 

Elder_Rights//Meetings/2012_10_11.aspx. 

33 Kathleen Quinn & William Benson, The States’ 

Elder Abuse Victim Services: A System in Search 

of Support, 36 GENERATIONS 66 (2012). 

34U.S. Gen. Acct. Off., GAO–11–208, Elder 

Justice: Stronger Federal Leadership Could Enhance 

National Response to Elder Abuse (2011) https://

www.gao.gov/products/gao-11-208; U.S. Gen. Acct. 

Off., GAO–13–110, Elder Justice: National Strategy 

Needed to Effectively Combat Elder Financial 

Exploitation (2012) https://www.gao.gov/products/ 

gao-13-110; U.S. Gen. Acct. Off., GAO–13–498, 

Elder Justice: More Federal Coordination and Public 

Awareness Needed (2013) https://www.gao.gov/ 

products/gao-13-498. 

35Since 2011, ACL has received questions and 

comments from Congress, OMB, and others 

regarding comparisons between CPS and APS. For 

example, GAO made comparisons between APS and 

CPS in their 2011 report ‘‘ELDER JUSTICE— 

Stronger Federal Leadership Could Help Improve 

Response to Elder Abuse,’’ (https://www.gao.gov/ 

assets/gao-11-384t.pdf) and the Congressional 

Research Service did a report on this subject as 

recently as 2020: (https://crsreports.congress.gov/ 

product/pdf/R/R43707). 

36Admin. for Child. and Fams., Dep’t. of Health 

and Hum. Servs., About CAPTA: A Legislative 

History (2019) https://www.childwelfare.gov/ 

pubpdfs/about.pdf. 

37Emilie Stoltzfus, U.S. Cong. Rsch. Serv. Child 

Welfare: Purposes, Federal Programs, and Funding 

(2023) https://crsreports.congress.gov/product/pdf/ 

IF/IF10590. 

grants to APS programs under the Elder 

Justice Act section 2042(b), 42 U.S.C. 

1397m–1(b).30

On numerous occasions, the APS 

community has stressed the need for 

more Federal guidance, leadership, 

stewardship, resources, and support for 

State and local APS programs and for 

victims of adult maltreatment. 

Advocates have requested greater 

funding and Federal regulatory 

guidance for APS systems in their 

testimony before Congress,31 in their 

statements to the EJCC,32 and in peerreviewed journals.33

The GAO conducted three studies on 

the topic of abuse, neglect, and 

exploitation between 2010 and 2013 to 

shed light on the need for Federal 

leadership. The studies’ findings 

repeatedly recommend a coordinated, 

Federal response to address the gaps in 

public awareness, prevention, 

intervention, coordination, and research 

of elder maltreatment, as well as a 

Federal ‘‘home’’ for APS.34

This proposed rule represents the first 

exercise of ACL’s regulatory authority 

over APS under the OAA and the EJA. 

While we have issued sub-regulatory 

guidance, including comprehensive 

Consensus Guidelines in 2016 and 2020 

that include APS evidence-informed 

practices, we believe it is necessary to 

codify and clarify a set of mandatory 

minimum national standards to ensure 

uniformity across APS programs and to 

promote high quality service delivery 

that thus far has not been achieved 

under the current Consensus 

Guidelines. 

In determining the scope of the APS 

regulations, we considered modeling 

our regulations after the child protective 

services (CPS) regulations administered 

by the Department’s Administration for 

Children and Families.35 We ultimately 

rejected this approach. The Child Abuse 

Prevention and Treatment Act of 1974 

(Pub. L. 93–247), 42 U.S.C 5116, 

provides Federal funding to States for 

prevention, assessment, investigation, 

prosecution, and treatment of child 

abuse and neglect, and awards grants for 

demonstration projects.36 In FY 2023, 

approximately $12 billion was provided 

for child welfare programs, and of that 

$852 million was appropriated 

specifically for child protection.37 In 

contrast, the appropriation for activities 

under section 2042(b) of the EJA was 

funded for the first time in FY 2021 

with one-time funding at $188 million 

a year for FYs 2021 and 2022 for State 

program start-up costs and to address 

urgent needs related to COVID–19, and 

$15 million in ACL’s FY 2023 annual 

appropriation for ongoing operations. 

Further, the EJA is much smaller in 

scope both in terms of requirements and 

discretionary activities. Given the 

differences in size and scope of 

Federally authorized and supported 

activities, ACL believes it would not be 

appropriate to model the proposed APS 

regulations after CPS regulations. 

Moreover, our approach takes into 

consideration the differences between 

minor children and adults legally, 

developmentally, and specifically with 

regards to rights to make decisions 

about their lives. ACL invites comment 

on both the scope and depth of topics 

proposed for regulatory action and the 

rationale presented. 

Instead of providing detailed and 

broad requirements like those that apply 

to CPS, our proposals require the State 

entity to establish written policies and 

procedures in areas of significant APS 

practice. In the interests of 

transparency, we considered mandating 

that State entities disclose such policies 

and procedures (for example, through 

publication on a State website) except 

where such disclosure might adversely 

affect law enforcement efforts, but we 

ultimately decided to leave such 

disclosure to State discretion. We 

welcome comment on the costs and 

benefits of mandating such disclosure. 

Our proposed standards are a 

minimum floor. States may impose 

additional requirements on their APS 

systems above and beyond these 

proposed minimum Federal standards. 

ACL invites comment on both the scope 

and depth of topics proposed for 

regulatory action and the rationale 

presented. 

III. Adult Protective Services Programs 

A. Section 1324.400 Eligibility for 

Funding 

Proposed § 1324.400 clarifies that 

eligibility for funding is conditioned on 

compliance with all proposed regulatory 

provisions. Under the proposed rules, 

State entities eligible for annual funding 

from ACL through section 2042 of the 

EJA, 42 U.S.C. 1397m–1(b) are required 

to submit a State plan in accordance 

with § 1324.408 detailing their 

activities, which ACL proposes to 

review and approve as a means of 

verifying compliance with the proposed 

rule. A State that failed to submit an 

approvable State plan would no longer 

be eligible for funding under section 

2042(b) of the EJA. 

ACL will provide States support and 

technical assistance in developing an 

approvable State plan. All States are 

afforded an opportunity to appeal the 

Assistant Secretary’s disapproval of a 

State plan submission under proposed 

§ 1324.408(e). If a State declines or fails 

to qualify for section 2042(b) funding, 

ACL will redistribute the funds in 

accordance with the EJA section 2042 

formula. Further information on State 

plan development will be provided in 

sub-regulatory guidance. 

B. Section 1324.401 Definitions 

We propose to define the following 

terms in § 1324.401 to provide clarity on 

the terms used and referenced in this 

proposed rule: ‘‘Abuse,’’ ‘‘Adult,’’ 

‘‘Adult maltreatment,’’ ‘‘Adult 

Protective Services (APS), ’’ ‘‘Adult 

Protective Services (APS) program,’’ 

‘‘Adult Protective Services (APS) 

system,’’ ‘‘Allegation,’’ ‘‘Assistant 

Secretary for Aging,’’ ‘‘At risk,’’ ‘‘Case,’’ 

‘‘Client,’’ ‘‘Conflict of Interest,’’ ‘‘Dual 

Relationship,’’ ‘‘Emergency Protective 

Action,’’ ‘‘Exploitation,’’ 

‘‘Inconclusive,’’ ‘‘Intake or preVerDate Sep<11>2014 17:03 Sep 11, 2023 Jkt 259001 PO 00000 Frm 00033 Fmt 4702 Sfmt 4702 E:\FR\FM\12SEP1.SGM 12SEP1

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38See supra note 4. 

39The Cntrs. for Disease Control and Prevention, 

Elder Abuse Surveillance: Uniform Definitions and 

Recommended Core Data Elements (2016) https:// 

www.cdc.gov/violenceprevention/pdf/EA_Book_

Revised_2016.pdf. 40See 45 CFR 75.321(c)(1). 

screening,’’ ‘‘Investigation,’’ ‘‘Mandated 

Reporter,’’ ‘‘Neglect,’’ ‘‘Perpetrator,’’ 

‘‘Post-investigation services,’’ ‘‘Quality 

assurance,’’ ‘‘Screening,’’ ‘‘Self-neglect,’’ 

‘‘Sexual abuse,’’ ‘‘State entity,’’ 

‘‘Substantiated,’’ ‘‘Trust Relationship,’’ 

‘‘Unsubstantiated,’’ and ‘‘Victim.’’ 

Definitions of note are discussed 

below. 

‘‘Abuse’’ Consistent with definitions 

in section 102(1) of the OAA, 42 U.S.C. 

3002(1), and section 2011 of the EJA, 42 

U.S.C. 1397j(1), we propose to define 

abuse as a component of adult 

maltreatment to encompass the 

knowing psychological, emotional, and/ 

or physical harm or the knowing 

deprivation of goods or services 

necessary to meet essential needs or 

avoid such harm. 

‘‘Adult’’ For purposes of this 

regulation, we propose to define adult to 

mean the eligible APS population in any 

given State. The term ‘‘adult’’ will be 

used in place of ‘‘older adults and 

adults with disabilities who are eligible 

for adult protective services.’’ We have 

chosen to defer to States’ definitions of 

‘‘adult’’ for the purposes of determining 

eligibility for APS services in 

recognition of the complex and 

intersecting nature of social services, 

public benefits, and behavioral health 

care services in States. In many States, 

eligibility for APS services is consistent 

with eligibility for social services, 

behavioral health, and other public 

benefits. A change to eligibility for APS 

in a State to conform with the proposed 

rule’s definition of ‘‘adult’’ may 

potentially disrupt important 

relationships among programs and 

services outside APS. We request 

comments on this approach. 

‘‘Adult maltreatment’’ We propose to 

define adult maltreatment to bring 

uniformity and specificity to a 

foundational term used throughout APS 

systems and this proposed regulation. 

Although there is increasing consensus 

on the core components of adult 

maltreatment, the field has not adopted 

a universally accepted definition. The 

definition of adult maltreatment and its 

component parts has a direct impact on 

the reports accepted for investigation, 

discussed in greater detail below at 

§ 1324.402. Our proposed definition and 

the requirements set out in § 1324.402(a) 

that States investigate, at a minimum, 

the five elements of adult maltreatment 

will establish a comprehensive and 

uniform approach to investigations of 

adult maltreatment while still allowing 

for State flexibility and discretion. Our 

definition represents a consistent 

baseline upon which States may build. 

In developing our definition and the 

requirements contained in proposed 

§ 1324.402(a), we adopted categories 

generally recognized by the field, used 

by the research community, and in 

common use by the vast majority of 

States.38

We propose that adult maltreatment 

encompass five categories further 

defined in this Section: abuse, neglect, 

exploitation, sexual abuse, and selfneglect. Adult maltreatment occurs 

when there is self-neglect or when a 

perpetrator commits abuse, neglect, 

exploitation, or sexual abuse of an adult. 

The adult must have a relationship of 

trust with the perpetrator of abuse, 

neglect, exploitation, or sexual abuse 

and be at risk of harm from the 

perpetrator. 

This proposed rule, in alignment with 

most States’ policies, limits the 

definition of abuse or maltreatment to 

relationships of trust where the alleged 

victim is at risk of harm from the 

perpetrator. A relationship of trust 

includes a caregiving relationship or 

other familial, social, or professional 

relationship where a person assumes 

responsibility for protecting the 

interests of the adult or where 

expectations of care or protection arise 

by law or social convention.39 APS 

systems refer cases outside trust 

relationships to partner organizations 

and services, such as other social 

service programs or law enforcement. 

This distinction acknowledges the 

elevated harm engendered when injury 

occurs within the context of a 

relationship of trust and an adult is 

vulnerable to harm generally and in 

relation to the perpetrator. It prioritizes 

finite APS resources to focus on this 

heightened injury. We further define 

‘‘trust relationship’’ and ‘‘at risk’’ later 

in this proposed rule. We recognize that 

our current proposal narrows the 

universe of required APS investigations 

under proposed § 1324.402(a) and in 

developing our proposal, we considered 

a more expansive definition of adult 

maltreatment. We invite comment on 

our definition and whether it reflects 

current practice in APS programs and 

whether it will resolve confusion. We 

describe some of this confusion 

throughout this discussion. 

‘‘At risk’’ We propose to define ‘‘at 

risk’’ in accordance with Centers for 

Disease Control and Prevention (CDC) 

Elder Abuse Surveillance: Uniform 

Definitions and Recommended Core 

Data Elements (CDC Uniform 

Definitions) as ‘‘the possibility that an 

individual will experience an event, 

illness, condition, disease, disorder, 

injury or other outcome that is adverse 

or detrimental and undesirable.’’ We 

recognize the considerable variation 

among States in determining whether 

maltreatment must include 

‘‘vulnerability’’ or other qualifier, and 

we seek comment on this definition. 

The CDC definition on which ours is 

based was developed through a 

collaborative process among a panel of 

scientists and practitioners representing 

multiple disciplines (e.g., medicine, 

psychology, epidemiology, sociology, 

gerontology), as well as Federal staff. 

‘‘Conflict of Interest’’ means a 

situation that interferes with a program 

or program employee or representative’s 

ability to provide objective information 

or act in the best interests of the adult. 

Such a conflict of interest would arise, 

for example, when an employee, officer, 

or agent, any member of their immediate 

family, their partner, or an organization 

which employs or is about to employ 

any of the parties indicated herein, has 

a financial or other interest in or a 

tangible personal benefit from their 

affiliation with an APS system.40

‘‘Dual Relationship’’ means 

relationships in which an APS worker 

assumes one or more professional, 

personal, or volunteer roles in addition 

to their role as an APS worker at the 

same time, or sequentially, with a client. 

‘‘Exploitation’’ Consistent with 

definitions in section 102 of the OAA, 

42 U.S.C. 3002(18)(A), and section 2011 

of the EJA, 42 U.S.C. 1397j(8), we 

propose to define exploitation as a type 

of adult maltreatment. Financial 

exploitation and exploitation are used 

interchangeably in the OAA, and 

exploitation for the purposes of adult 

maltreatment in this proposed rule is 

likewise confined to illegal, 

unauthorized, or improper acts related 

to the personal finances of an adult (as 

defined above) (for example, 

exploitation does not encompass labor 

rights violations). 

‘‘Neglect’’ Consistent with the 

definitions in section 102 of the OAA, 

42 U.S.C. 3002(38) and section 2011 of 

the EJA, 42 U.S.C. 1397j(16), we propose 

to define neglect as the failure of a 

caregiver or fiduciary to provide the 

goods or services that are necessary to 

maintain the health or safety of an adult 

(as defined above). 

‘‘Self-neglect’’ Consistent with the 

definitions in section 102(48) of the 

OAA, 42 U.SC. 3002(48), and section 

2011 of the EJA 42 U.S.C. 1397j(18) we 

propose to define self-neglect as an 

adult’s (as defined above) inability to 


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41See supra note 4, at 17. Other maltreatment 

type categories exist in State statutes, including 

non-specific exploitation, abandonment, abduction, 

isolation, other maltreatment, and suspicious death. 

42 Id. 

43The total potential universe for any analysis is 

56, however American Samoa and the 

Commonwealth of the Northern Mariana Islands do 

not currently have staffed programs. The unit of 

analysis for this data is 54. This includes APS 

programs in all States and the District of Columbia. 

In three States—Louisiana, Massachusetts, and 

Pennsylvania—APS is provided in two different 

programs for older adults and younger adults. 

44See supra note 4. 

perform essential self-care tasks due to 

physical or mental impairment or 

diminished capacity. 

‘‘Sexual abuse’’ The OAA defines 

‘‘sexual assault’’ at section 102(50), 42 

U.S.C. 3002(50), to have the meaning 

given in section 2003 of the Omnibus 

Crime Control and Safe Streets Act of 

1968, 42 U.S.C. 3796gg–2. Our proposed 

definition encompasses, but is broader 

than, sexual assault as defined in the 

OAA. Consistent with the definition 

outlined in the CDC Uniform 

Definitions, we propose to define sexual 

abuse as the forced and/or unwanted 

sexual interaction (touching and nontouching acts) of any kind with an adult 

(as defined above). 

‘‘Trust relationship’’ Consistent with 

the CDC Uniform Definitions, ACL 

proposes to define ‘‘trust relationship’’ 

as ‘‘the rational expectation or belief 

that a relative, friend, caregiver, or other 

person with whom a [. . .] relationship 

exists can or should be relied upon to 

protect the interests of an adult (as 

defined above) and/or provide for an 

adult’s care. This expectation is based 

on either the willful assumption of 

responsibility or expectations of care or 

protection arising from legal or social 

conventions.’’ Including the 

requirement of a trust relationship for 

purposes of determining when APS 

becomes involved furthers consistency 

of APS interventions in adult 

maltreatment. Furthermore, most APS 

systems apply a standard of ‘‘trust 

relationship’’ in their definition of 

maltreatment. We seek comments on 

this approach. 

C. Section 1324.402 Program 

Administration 

Proposed § 1324.402(a) requires APS 

systems to respond to reports of adult 

maltreatment, which include allegations 

of abuse, neglect, exploitation, sexual 

abuse, and self-neglect. Currently, all 

APS systems are required by State 

statute to investigate allegations of 

neglect and physical abuse, and nearly 

all states investigate allegations of selfneglect, sexual abuse, financial 

exploitation, and emotional or 

psychological abuse.41 Forty-two States 

investigate six or more types of 

maltreatment.42

TABLE C.1—TYPES OF MALTREATMENT INVESTIGATED BY STATES 43

Maltreatment type Physical 

abuse Neglect Exploitation Sexual abuse Self-neglect Emotional abuse 

No. of States ............................................ 54 54 46 52 51 45 

However, definitions of these terms 

vary across States. In certain States, APS 

programs are not required to respond to 

certain forms of adult maltreatment. 

This means that adults are not 

adequately protected by APS throughout 

the United States. 

In addition to our request for 

comment on the definition of adult 

maltreatment, we seek comment as to 

whether a mandatory requirement for 

investigation based on the definitions of 

abuse, neglect, exploitation, sexual 

abuse, and self-neglect is appropriate, 

adequately reflects the needs and 

experiences of APS systems, as well as 

any potential State and local burden 

associated with such a requirement. 

Proposed § 1324.402(a) also requires 

the State entity to adopt certain policies 

and procedures for receiving and 

responding to reports of adult 

maltreatment. These policies and 

procedures must be person-directed and 

rely on concepts of least restrictive 

alternatives. Principles of persondirectedness respect the integrity and 

authority of adults to make their own 

life choices. They promote APS clients’ 

concepts of what safety and quality of 

life mean, and success and positive 

outcomes are defined by the client, not 

the APS worker. This provision sets 

minimum requirements for States as 

they establish or revise policies and 

procedures while still leaving flexibility 

to best meet their unique needs. 

The State entity must create precise, 

standardized criteria for determining or 

assessing eligibility for APS services. 

States must also create clear and 

specific parameters of the settings, 

locations, and types of alleged 

perpetrators for which allegations of 

maltreatment will be investigated by 

their APS system. For example, States 

vary on whether they conduct 

investigations in congregate residential 

settings. In addition, States must 

establish processes to ensure the 

parameters are implemented 

consistently across APS programs in 

their State. 

We propose that States define 

processes for receiving, screening, 

prioritizing, and referring cases based 

on risk and the nature of the adult 

maltreatment in a uniform and 

consistent manner across their State. 

Under this proposal, the State entity 

would be required to establish policies 

and procedures to manage a tiered riskbased assessment system, differentiating 

response requirements for cases that 

represent immediate and nonimmediate risks. As proposed, 

immediate risk would be assessed via 

the likelihood of death, irreparable 

harm, or significant loss of income, 

assets, or resources. Responses should 

occur no later than 24 calendar hours 

(one calendar day) after receiving the 

report for cases representing an 

immediate risk, and no later than seven 

calendar days for cases of nonimmediate risk. 

Currently, there is data on all but one 

APS systems’ tiered report response 

procedures. Two State APS systems 

have no priority levels, and one has two 

priority levels. The rest have three or 

more. States vary widely in their 

response time and not all States address 

high priority cases within 24 hours, 

although most do.44 We seek to bring all 

States into alignment with the 

Consensus Guideline in this area of 

practice; timely response to immediate 

need cases is essential to the health and 

safety of potential maltreatment victims. 

For allegations of adult maltreatment 

outside APS jurisdiction, we propose 

the State entity establish appropriate 

referral mechanisms and information 

and data sharing agreements with the 

state and/or local entity with 

jurisdiction to investigate. 

In proposed § 1324.402(b), we require 

State entities to establish policies and 

procedures to inform potential APS 

clients of their rights at first contact 

with client. With this provision, we seek 

to address concerns that APS programs 

do not regularly inform potential clients 

of their rights under existing State laws, 


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45 Jane E. Ball et. al., Post-operative Mortality, 

Missed Care and Nurse Staffing in Nine Countries: 

A Cross-Sectional Study,78, Int. J. Nursing Studies, 

10 (Feb. 2018) https://pubmed.ncbi.nlm.nih.gov/ 

28844649/; Charlene Harrington et. al. Appropriate 

Nurse Staffing Levels for U.S. Nursing Homes, 13 

Health Serv. Insights (2020) https://www.ncbi.nlm.

nih.gov/pmc/articles/PMC7328494/. 

46Pi-Ju Liua & Leslie Ross, Adult Protective 

Services Training: A Brief Report on the State of the 

Nation, 33 J. of Elder Abuse and Neglect, 82 (2021). 

https://www.tandfonline.com/doi/epdf/10.1080/ 

08946566.2020.1845271?needAccess=true&role

=button. 

47 Kelli Connell-Carrick & Maria Scannapieco, 

Adult Protective Services: State of the Workforce 

and Worker Development, 29(2) Gerontology & 

Geriatrics Education, 189–206 (2008) https://

pubmed.ncbi.nlm.nih.gov/19042235/. 48See supra note 22. 

including confidentiality and privacy 

requirements, the right to refuse 

services, and the right to refrain from 

speaking with APS. This is directly 

responsive to problems that have been 

reported by the APS and disability and 

aging community advocates to ACL in 

listening sessions and other community 

engagement activities. Failure to inform 

potential clients of their rights 

undermines trust between individuals 

and APS and may alienate communities. 

Under this proposal, APS programs 

must inform potential APS clients of 

their rights in the format and language 

preferred by the individual, including 

those with limited English proficiency 

and individuals with disabilities. APS 

programs should take appropriate steps 

to ensure communication with 

individuals with disabilities are as 

effective as communications with others 

More generally, standard plain language 

practice is to write informational 

materials at or near a fourth grade 

reading level and not to exceed an 

eighth grade reading level. We expect 

State entities to meet these standards in 

complying with language proposed at 

§ 1324.402(b). 

Proposed § 1324.402(d) requires the 

State entity to establish policies and 

procedures for the staffing of APS 

systems. We propose to require States to 

establish a minimum staff to client ratio 

appropriate to the circumstances in the 

State. We believe, consistent with the 

literature, that fixed staff to client ratios 

in APS systems will improve health and 

safety outcomes for adult victims of 

maltreatment.45 We also believe that 

establishing fixed staff to client ratios 

will improve the long-term continuity of 

APS programs. We request comment on 

whether staff to client ratios are feasible 

for APS programs and whether required 

workload studies would assist in 

development of appropriate ratios. 

We also propose to require mandatory 

APS training as a part of implementing 

the proposed policies and procedures. 

Findings from a 2015–2018 survey 

completed by 49 APS offices found that 

half of programs were not training on 

core competencies while two had no 

training whatsoever.46 Training and 

ongoing education increases staff 

knowledge, leading to increased rates of 

investigation and substantiation.47

Supervisors provide both clinical and 

administrative oversight, approve key 

casework decisions, and guide the 

caseworkers in overall case 

management. Sufficient training is 

critical to ensuring they can perform 

these functions. 

D. Section 1324.403 Investigation and 

Post-Investigation Services 

Proposed § 1324.403 requires the 

State entity to develop and implement 

a standardized set of policies and 

procedures for essential APS functions 

throughout the lifecycle of a case. The 

purpose of an APS investigation is to 

collect information about the allegations 

of maltreatment, determine if the 

alleged victim is eligible for APS 

services, assess the immediate risk of 

the situation, conduct an investigation, 

and ultimately make a finding as to the 

presence or absence of adult 

maltreatment. If adult maltreatment is 

present, APS then identifies the service 

needs of the client and develops a plan, 

including recommendations or referrals 

to other entities, such as social services. 

Many, but not all, APS systems also 

follow cases post-investigation. If it is 

found the individual seeking APS 

services is ineligible, the APS program 

may develop referrals to appropriate 

services. 

Proposed § 1324.403 sets forth 

requirements for the development of 

standardized, specific policies and 

procedures governing an APS 

investigation from initiation to postinvestigation services. Initiation of the 

investigation encompasses screening 

and triaging reports as well as decisionmaking processes for determining 

immediate safety and risk factors 

affecting the adult. The investigation 

itself includes the collection of relevant 

information and evidence. Policies and 

procedures must also detail methods to 

make determinations on allegations and 

record case findings, including 

consultation with outside experts when 

appropriate. Professional fields for such 

experts include: medicine, social work, 

behavioral health, finance/accounting, 

and long-term care. We likewise 

propose the APS worker provide 

referrals to other agencies and programs, 

as appropriate under State law, such as 

referrals to Area Agencies on Aging 

(AAAs), State Medicaid programs, or 

Centers for Independent Living for 

services. For example, the APS program 

may make a referral to the State 

Medicaid agency for home and 

community-based services to mitigate 

harm and assist the victim in recovery 

from the abuse. During the course of an 

investigation, APS may in limited 

circumstances take emergency 

protective action, which we propose to 

define in § 1324.401. Such action 

should be person-directed and taken as 

a last resort after exploring all other 

viable options, prioritizing community 

integration, autonomy, and individual 

choice. This proposed section also 

requires the APS investigator or 

supervisor to communicate results of 

the investigation to the client. 

Post-investigation services are 

provided through a variety of 

mechanisms and funding sources. APS 

staff may provide services directly (e.g., 

assistance with housing relocation), 

purchase them (e.g., pay for medications 

or utility bills), or make referrals to 

community-based services (e.g., homedelivered meals). Our proposals provide 

a framework for the provision of postinvestigation services that promote the 

dignity and autonomy of the client, 

leverage community resources, and aim 

to prevent future adult maltreatment. 

Proposed § 1324.403 draws heavily 

from the Consensus Guidelines.48 We 

seek comment on whether this approach 

includes all necessary activities for 

investigation and post-investigation 

services as well as examples of 

investigation and post-investigation 

services we have not proposed for 

inclusion. 

E. Section 1324.404 Conflict of Interest 

Proposed § 1324.404 requires the 

State entity to establish policies and 

procedures to prevent, recognize, and 

promptly addresses both real and 

perceived conflicts of interest at the 

organizational and individual level. 

Trust in APS by individuals receiving 

services and the broader community is 

essential to the ability of APS programs 

to effectively perform their functions. 

APS programs form partnerships and 

referral relationships with allied 

organizations and professionals to 

provide necessary services and supports 

to victims of adult maltreatment before, 

during, and after intake and 

investigation. Conflicts of interest may 

arise when a State employee, APS 

worker, or APS system’s financial or 

personal interests influence, or are at 

odds with, the interests of a client or 

cohort of clients. 

Many APS programs that provide 

services for victims of adult 


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49See supra note 4, at 4. State Units on Aging 

house APS in 20 States. Other State health and 

human services agencies (not SUAs or Child 

Welfare) house APS in 20 States. 

50See supra note 4, at 30. 

51See supra note 4. 

52 Kristin Elizabeth Lees, (2018) Elder 

Mistreatment: An examination of formal and 

informal responses to a growing public health 

concern (Mar. 23, 2018) (Ph.D. dissertation, 

Northeastern University) https://repository.

library.northeastern.edu/files/neu:cj82r9210/ 

fulltext.pdf. 

53Olanike Ojelabi et al., Closing the Loop: An 

Environmental Scan of APS-Reporter Feedback 

Policies and Practices, 5(1) Innovation in Aging 931 

(2021) https://doi.org/10.1093/geroni/igab046.3370; 

S. Jackson, Adult Protective services and victim 

services: A review of the literature to increase 

understanding between these two fields, 34 

Aggression & Violent Behavior 214 (2017) https:// 

www.semanticscholar.org/paper/Adult-protectiveservices-and-victim-services%3A-A-of-Jackson/

15e2bbf7e180170443f67e90ae1acfc50ffbdb8a; 

Marguerite DeLiema et al., Voices from the 

Frontlines: Examining Elder Abuse from Multiple 

Professional Perspectives, 40 Health & Social Work 

e15 (2015) https://doi.org/10.1093/hsw/hlv012. 

54Health and Human Serv. Off. of the Insp. Gen. 

Incidents of Potential Abuse and Neglect at Skilled 

Nursing Facilities Were Not Always Reported and 

Investigated (2008) https://oig.hhs.gov/oas/reports/ 

region1/11600509.pdf. 

maltreatment have close relationships 

and shared locations and data systems 

with AAAs, State Units on Aging 

(SUAs), and other health and human 

services agencies.49 Without appropriate 

conflict of interest safeguards, 

familiarity and ease of referral arising 

from proximity and shared data systems 

may create incentives for APS to refer 

clients to the AAA or SUA over another 

more appropriate service provider. 

Individual APS workers may face 

conflicts of interest if they are in a ‘‘dual 

relationship’’ serving multiple roles for 

a single client. For example, an 

individual who serves as both an APS 

worker and a long-term services and 

supports options counselor for the same 

client may be unable to make objective 

findings of adult maltreatment in a case 

where a caregiver is an alleged 

perpetrator of adult maltreatment 

against the client. The individual 

serving as APS worker and options 

counselor may, in their role as APS 

worker, choose not to substantiate 

findings of adult maltreatment against 

the caregiver because, as an options 

counselor, they know the client chooses 

the alleged perpetrator as their 

caregiver. We propose these dual 

relationships be permitted only when 

unavoidable and that conflicts of 

interest be appropriately mitigated. 

We further propose that APS 

programs have policies and procedures 

that ensure conflicts of interests are 

avoided and, if found, remedied. These 

procedures could include firewalls and 

disclosure requirements. We seek 

comment on whether our proposal 

reflects the universe of actual and 

potential conflicts of interest, those who 

may be a party to a conflict, and ways 

in which we may strengthen these 

requirements while not placing undue 

programmatic or administrative burden 

on APS systems. 

F. Section 1324.405 Accepting Reports 

Proposed § 1324.405 requires the 

State entity to have policies and 

procedures for accepting reports of adult 

maltreatment. We propose such policies 

and procedures require prompt receipt 

of reports of alleged maltreatment, 

including multiple methods for 

receiving reports 24 hours a day, 7 

calendar days a week in manners that 

are fully accessible (e.g., using 

augmentative communication devices or 

translation services). Currently 29 

programs meet the Consensus 

Guidelines recommendation to be 

available 24/7 for intake of new 

reports.50 Receiving reports 24 hours a 

day 7 calendar days a week is 

paramount to the safety of victims and 

potential maltreatment victims. For this 

reason, we propose a specific timeframe 

for receiving reports consistent with our 

recommendations in the Consensus 

Guidelines. In the interests of 

accessibility, we considered mandating 

that APS systems establish an online 

reporting mechanism (for example, 

accepting reports of adult maltreatment 

through a website), but we ultimately 

decided to leave such operational 

details to State discretion. We welcome 

comment on the costs and benefits of 

mandating such an online reporting 

mechanism. 

APS receives reports from both the 

general public and individuals 

mandated by the State to report 

suspected adult maltreatment. 

Mandatory reporting is an essential tool 

in combating adult maltreatment; 49 

States currently have mandatory 

reporting statues.51 In one study, 

researchers found that reports made by 

mandatory reporters to APS were more 

likely to be substantiated and less likely 

to result in service refusal than reports 

made by non-mandated reporters.52

However, most APS programs are not 

required to contact mandatory reporters 

with information about the case after a 

report is made. Mandatory reporters 

have stated that the absence of a 

reporting feedback loop creates a 

disincentive for reporting.53 The most 

common complaint ACL receives from 

community providers that work with 

APS is that while they may be required 

under State law to report, they do not 

receive information back on the status of 

their report. We propose mandatory 

reporters be provided information on 

the status of a report consistent with 

State confidentiality laws. In the 

interests of accountability, we 

considered mandating that States 

provide such status information to such 

mandatory reporters within a certain 

timeframe (for example, within 30 

calendar days of the report), but we 

ultimately decided to leave such 

operational details to State discretion. 

We welcome comment on the costs and 

benefits of mandating such a mandatory 

response timeframe. Additionally, we 

invite comment on the type of 

information that might be returned to 

mandatory reporters after a report of 

maltreatment is submitted to an APS 

program, including potential 

administrative burdens to APS programs 

and client confidentiality and privacy 

conflicts that may arise from such 

requirements. 

G. Section 1324.406 Coordination 

With Other Entities 

Proposed § 1324.406(a) requires the 

State APS system to coordinate with 

other State and local governmental 

agencies, community-based 

organizations, and other entities 

engaged in activities to promote the 

health and wellbeing of older people 

and adults with disabilities for the 

purposes of addressing the needs of the 

adult experiencing the maltreatment. 

These entities include, but are not 

limited to, the Long-Term Care 

Ombudsman, State offices that handle 

scams and frauds, State and local law 

enforcement, State Medicaid agencies 

and other State agencies responsible for 

home and community-based services 

(HCBS) programs, and financial services 

providers. Such coordination maximizes 

the resources of APS systems, improves 

investigation capacity, and ensures postinvestigation services are effective. We 

have chosen to require States coordinate 

with these specific entities to ensure 

coordination with critical partners in 

the investigation of abuse, neglect, and 

exploitation. Various non-APS entities 

have authority to investigate 

maltreatment based on who the victim 

and perpetrator of the maltreatment are, 

and where the maltreatment took place. 

An effective, holistic response to adult 

maltreatment must include all 

enumerated entities working in 

coordination with APS. Currently, the 

research suggests this is not taking 

place.54 We seek comment as to whether 

we have accurately captured the scope 

of appropriate entities with which APS 

should collaborate, and whether our 

proposal would create unintended 


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55Elder Justice Act sections 2042, 2042(b)(4), 42 

U.S.C. 1397m–1(a)(1)(B), 1397m–1(b)(4); Older 

Americans Act of 1965 section 201(e)(2)(A)(ii)(I), 42 

U.S.C. 3011. 

56 45 CFR 75.206(d) allows for State plans vs. 

applications for funding, thereby reducing burden. 

The Older Americans Act of 1965 section 

201(1)(e)(A)(ii), 201(1)(e)(A)(iv)–(B), 42 U.S.C. 

3011(e)(1)(A)(ii), 3011(e)(1)(A)(iv) and 42 U.S.C. 

3011(e)(1)(B) directs the Assistant Secretary for 

Aging to collect data and information, and strategic 

plans from States. The Elder Justice Act section 

2042(b)(4), 42 U.S.C. 1397m–1(b)(4) authorizes 

State reports from each entity receiving funding. 

consequences for APS programs. We 

also seek examples of where 

coordination is working and where 

barriers to coordination exist. 

Proposed § 1324.406(b) requires the 

State APS system to develop policies 

and procedures to address coordination 

and information sharing with several 

governmental and private entities both 

within a State and across State lines for 

the purpose of carrying out 

investigations. Coordination could 

include development of memoranda of 

understanding (e.g., for referrals and 

information sharing), establishment of 

multi-disciplinary teams across and 

among governmental and nongovernmental entities (with appropriate 

safeguards for confidentiality to protect 

client privacy and the integrity of APS 

investigations), and collaboration 

regarding training and best practices. 

We recognize that State laws may 

preclude sharing of certain information 

related to individual investigations, but 

we believe that all APS systems at a 

minimum can work with other entities 

around prevention and best practices to 

address adult maltreatment. 

State authority to investigate alleged 

maltreatment of adults resides in 

different entities. Therefore, it is 

imperative to have a clear 

understanding of which entities are 

responsible for which types of 

investigations. Which entity is 

responsible for an investigation will 

depend upon various factors including: 

the location or setting of the 

maltreatment; the category of adult 

maltreatment; the relationship between 

an alleged perpetrator and an alleged 

victim; and the characteristics of the 

alleged victim. To help resolve 

confusion within States, we propose in 

§ 1324.406(b) that the APS programs 

develop and implement information and 

data sharing agreements to ensure 

coordination of investigations and that 

appropriate referrals are made when 

APS receives a report that is outside 

their jurisdiction to investigate, 

including with law enforcement, the 

State Medicaid office, and State 

licensing and certification agencies. 

Coordination between entities reduces 

the imposition of multiple 

investigations on adults who have been 

harmed and helps prevent future 

maltreatment. Such agreements will 

allow one program to share with the 

other information about alleged 

maltreatment by someone who works 

with, or who has a relationship of trust 

with, individuals being served by both 

organizations. Additionally, such 

agreements will allow the sharing of 

information between these entities on 

the outcome of individual 

investigations, as permissible under 

State law. For example, this could 

include communication of the results to 

State Medicaid agencies in instances in 

which a Medicaid provider or direct 

care worker is determined by APS to be 

a perpetrator of the maltreatment. We 

seek comment on our proposals. 

We also believe it is critical to address 

coordination across States given that 

perpetrators may move a victim to 

another jurisdiction or may move to 

another jurisdiction themselves where 

they engage in the same practices 

investigated in the first State. We 

request comments and examples of best 

practices on how coordination and 

collaboration with other States and local 

jurisdictions may be effectively 

achieved, minimizing administrative 

burden. 

H. Section 1324.407 APS Program 

Performance 

Proposed § 1324.407 requires the APS 

State entity to collect and report 

aggregated data annually to ACL.55 We 

anticipate data elements to be similar to 

those already reported voluntarily by 

most States through the NAMRS system. 

However, because NAMRS data 

submission is voluntary, the 

completeness of the data varies widely 

and therefore limits our ability to 

understand incidence of adult 

maltreatment within and across States. 

We will provide future guidance on data 

elements to be collected and seek 

comment on what these data elements 

should be. 

We also propose that the State entity 

develop policies and procedures 

regarding the maintenance of individual 

APS case data. We propose that APS 

systems keep the individual data set for 

at least five years. We believe five years 

is an appropriate timeframe to allow 

APS programs to assess clients across 

time to determine whether repeated 

abuse or recidivism is occurring, 

providing APS knowledge critical to 

prevent future instances of 

maltreatment. In developing our 

proposal, we considered a requirement 

of ten years; while a longer timeframe 

would improve data accuracy, it would 

increase burden for States. We seek 

comment on whether five years is an 

appropriate timeframe or whether a 

greater or lesser duration is optimal. 

I. Section 1324.408 State Plans 

Proposed § 1324.407 requires each 

APS State entity to develop a State plan 

consistent with 45 CFR 75.206(d) and 

requirements set forth in the EJA and by 

the Assistant Secretary for Aging.56

State plans will allow States to 

document the tangible outcomes 

planned and achieved as a result of the 

funding they receive from ACL. Funding 

provided to State APS entities through 

the Elder Justice Act is contingent on 

compliance with our proposed 

regulations. The State plan is the 

mechanism through which States 

demonstrate, and ACL evaluates, this 

compliance. 

State plans also can be used to 

translate activities, data, and outcomes 

into proven best practices, which can be 

used to leverage additional resources. 

State plans promote coordination and 

collaboration to better serve the people 

of a State by providing a blueprint that 

describes what the State will undertake 

to meet the needs of the population it 

serves. The State plan should be 

developed in conjunction with the APS 

programs and with input from 

interested parties and updated at least 

every five years or as frequently as every 

three years at State option.. 

ACL has administrative oversight 

responsibility with respect to the 

expenditures of Federal funds pursuant 

to the EJA. As a condition of approval 

and receipt of Federal funding, APS 

systems must include assurances in 

their State plans that they will develop 

and adhere to policies and procedures 

as defined by these regulations. ACL 

will provide technical assistance to 

States regarding the preparation of State 

plans and are responsible for reviewing 

those that are submitted for compliance. 

Annual State program performance data 

collected and submitted to ACL 

pursuant to § 1324.407 will be used to 

measure performance and assess the 

extent to which State systems are 

meeting State plan objectives. 

State plans will be reviewed and 

approved by the Director of the Office 

for Elder Justice and Adult Protective 

Services (OEJAPS), the position 

designated by Sec. 201(e)(1) of the OAA, 

42 U.S.C. 3011(e)(1). A State entity 

dissatisfied with the Director of 

OEJAPS’ final determination may 

appeal to the Deputy Assistant Secretary 

for review not later than 30 calendar 

days after the date of the determination. 

The State entity will then be afforded an 

opportunity for a hearing before the 


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Deputy Assistant Secretary. If State 

disagrees with the determination of the 

Deputy Assistant Secretary, it may 

appeal to the Assistant Secretary not 

later than 30 calendar days after the date 

of the Deputy Assistant Secretary’s 

decision. 

We seek comment on our proposals 

for the development of State plans as 

well as ACL oversight and monitoring of 

State plan objectives. 

J. Regulatory Approach 

The proposed regulations seek to 

bring States into alignment with 

evidence-informed practices while 

recognizing that States should have the 

flexibility and discretion to tailor 

policies and procedures to their 

circumstances. In general, we have 

provided broad guidelines for the 

required policies and procedures but 

leave States to fill in the details and set 

their own standards as they develop 

new, or amend current, policies and 

procedures. In several areas, we have 

taken a more proscriptive approach to 

establish a uniform national baseline. 

Where we have been more directive, we 

have done so because we believe it is 

critical to the safety of maltreatment 

victims or potential victims, is 

foundational to the functioning of an 

APS system, or because the APS 

community has requested granular 

policy direction. These proscriptive 

requirements have been drawn from the 

evidence-informed Consensus 

Guidelines and represent promising 

practices for APS service delivery. We 

invite comment as to whether we have 

struck the appropriate balance between 

setting a proscriptive minimum floor for 

essential policies and procedures and 

leaving general implementation of the 

policies and procedures to State 

discretion. 

K. Effective Date 

We propose an effective date for these 

provisions of three years from date of 

issuance of the final rule. 

L. Request for Comment 

ACL seeks comment on all issues 

raised by this proposed regulation as 

detailed above. 

IV. Required Regulatory Analyses 

A. Preliminary Regulatory Impact 

Analysis (Executive Orders 12866 and 

13563) 

1. Introduction 

We have examined the impacts of the 

proposed rule under Executive Order 

12866, Executive Order 13563, the 

Regulatory Flexibility Act (5 U.S.C. 

601–612), and the Unfunded Mandates 

Reform Act of 1995 (Pub. L. 104–4). 

Executive Orders 12866 and 13563 

direct agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, select regulatory approaches 

that maximize net benefits (including 

potential economic, environmental, 

public health and safety effects; 

distributive impacts; and equity). 

Executive Order 13563 emphasizes the 

importance of quantifying costs and 

benefits, reducing costs, harmonizing 

rules, and promoting flexibility. 

Under Executive Order 12866, 

‘‘significant’’ regulatory actions are 

subject to review by the Office of 

Management and Budget (OMB). As 

amended by Executive Order 14094 

entitled ‘‘Modernizing Regulatory 

Review’’ section 3(f) of the Executive 

order defines a ‘‘significant regulatory 

action’’ as any regulatory action that is 

likely to result in a rule that may: 

(1) have an annual effect on the 

economy of $200 million or more 

(adjusted every 3 years by the 

Administrator of the Office of 

Information and Regulatory Affairs 

(OIRA) for changes in gross domestic 

product); or adversely affect in a 

material way the economy, a sector of 

the economy, productivity, competition, 

jobs, the environment, public health or 

safety, or State, local, Territorial, or 

Tribal governments or communities; 

(2) create a serious inconsistency or 

otherwise interfere with an action taken 

or planned by another agency; 

(3) materially alter the budgetary 

impacts of entitlement grants, user fees, 

or loan programs or the rights and 

obligations of recipients thereof; or 

(4) raise legal or policy issues for 

which centralized review would 

meaningfully further the President’s 

priorities or the principles set forth in 

this Executive order, as specifically 

authorized in a timely manner by the 

Administrator of OIRA in each case. 

It has been determined that this 

proposed rule is significant. Therefore, 

OMB has reviewed this proposed rule. 

The Unfunded Mandates Reform Act 

of 1995 (section 202(a)) requires us to 

prepare a written statement, which 

includes an assessment of anticipated 

costs and benefits, before proposing 

‘‘any rule that includes any Federal 

mandate that may result in the 

expenditure by State, local, and tribal 

governments, in the aggregate, or by the 

private sector, of $100,000,000 or more 

(adjusted annually for inflation) in any 

one year.’’ The current threshold after 

adjustment for inflation is $177 million, 

using the most current (2022) Implicit 

Price Deflator for the Gross Domestic 

Product. This proposed rule would not 

result in impacts that exceed this 

threshold. 

Summary of Costs and Benefits 

Compared to the baseline scenario 

wherein APS systems continue to 

operate under State law with no Federal 

regulation, we identify several impacts 

of this proposed rule. We anticipate that 

the proposed rule will: require the 

revision of State policies and 

procedures, require training on new 

rules for APS staff, require the 

submission of new State plans, require 

data sharing agreements between APS 

systems and other State entities, require 

APS systems create a feedback loop to 

provide information to mandatory 

reporters, require data reporting to ACL, 

inform potential APS clients of their 

rights under State law, and require new 

or updated record retention systems for 

certain States. We anticipate that the 

final rule will result in improved 

consistency in implementation of APS 

systems within and across States, clarity 

of obligations associated with Federal 

funding for administrators of APS 

systems, and will result in better and 

more effective service delivery within 

and across States with better quality 

investigations in turn leading to more 

person-directed outcomes. 

This analysis describes costs 

associated with issuing APS regulations 

and quantifies several categories of costs 

to grantees (State entities) and subgrantees (APS programs), collectively 

referred to as APS systems, and to ACL 

under the proposed rule. Specifically, 

we quantify costs associated with APS 

systems (1) revising policies and 

procedures, (2) conducting trainings, (3) 

implementing policies and procedures 

(3) reporting data to ACL (4) 

maintaining records retention system (5) 

developing State plans. The proposed 

effective date of this rulemaking is three 

years from the date of final publication. 

This is to allow for variation in the 

timing of State legislative sessions. We 

anticipate that all States will have fully 

implemented the rule by its effective 

date and impacts will be measurable by 

that time. We conclude the proposed 

rule would result in a cost of 

$3,532,916.99 to fully implement. This 

cost will be offset by improved 

investigations and better outcomes for 

the victims of adult maltreatment. This 

represents significant value, particularly 

given the widespread and egregious 

nature of adult maltreatment in the 

United States. 

The analysis also includes a 

discussion of the potential benefits 

under the rule that we do not quantify. 

We request comments on our estimates 


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57The structure and administration of APS in the 

United States is variable and we lack data on the 

number of local APS programs. Some States have 

a single entity that controls and administers the 

program, others have a State entity and local 

programs. There is a staffed APS office in every 

State government, the District of Columbia and 

three Territories which receives ACL grant funding. 

Fifteen States have local level APS programs, the 

others are State-administered and have a single APS 

entity for the entire State. We have used counties 

as a proxy for the 15 with local programs. 

58Wages are multiplied by a factor of 2 for nonwage benefits and indirect costs. 

59Represents adjusted Federal salary in DC–VA– 

MD area, https://www.opm.gov/policy-dataoversight/pay-leave/salaries-wages/salary-tables/ 

pdf/2023/DCB.pdf. 

of the cost and benefits of this proposed 

rule, including the impacts that are may 

not be quantified in this analysis. 

A detailed discussion of costs and 

benefits associated with the rulemaking 

follows. 

a. Costs of the Proposed Rule 

1. Revising Policies and Procedures 

This analysis anticipates that the 

proposed rule would result in one-time 

costs to State entities and APS programs 

to revise policies and procedures. The 

majority of APS systems currently 

maintain policies and procedures, often 

based on State statute. Data from our 

National Process Evaluation Report of 

Adult Protective Services (OMB Control 

Number 0985–0054) and State 

experiences incorporating concepts 

from the Consensus Guidelines suggest 

our proposed rules will establish a 

minimum standard that may reflect 

current practice in many States. For 

example, while all States currently 

require a screening process for intake, 

there is no uniformity or 

standardization in this process across or 

within States and detail contained in 

policies and procedures (if present) 

varies. Therefore, in requiring standard 

policies and procedures for APS 

systems, ACL anticipates that all APS 

programs may create new or revise their 

current policies and procedures under 

the proposed rule; however, the level of 

revision will vary by State. There is 

currently no data on the total number of 

APS programs. Our estimates reflect our 

understanding of the structure of State 

APS systems and the assumption that 

there is one program per county in 

local-level systems, totaling 928 APS 

programs nationwide.57

We estimate that roughly half of these 

entities will require more extensive 

revisions, with the rest requiring limited 

revisions to their current policies and 

procedures. We estimate that programs 

with more extensive revisions will 

spend twenty (20) total hours on 

revisions per entity. Of these, fifteen 

(15) would be spent by a mid-level 

manager equivalent to a first-line 

supervisor (Occupation code 43–1011), 

at a cost of $30.47 unadjusted hourly 

wage, $60.94 per hour adjusted for nonwage benefits and indirect costs (15 × 

$60.94), while an average of five (5) 

hours would be spent by executive staff 

equivalent to a general and operations 

manager (Occupation code 11–1021), at 

a cost of $55.41 per hour unadjusted 

hourly wage, $110.82 per hour adjusted 

for non-wage benefits and indirect costs 

(5 × $110.82).58 For programs with less 

extensive revisions, we assume fifteen 

(15) total hours spent on revisions per 

entity. Of these, ten (10) hours would be 

spent by a mid-level manager equivalent 

to a first-line supervisor (Occupation 

code 43–1011), at a cost of $30.47 per 

hour unadjusted hourly wage, $60.94 

per hour adjusted for non-wage benefits 

and indirect costs (10 × $60.94), while 

an average of five (5) hours would be 

spent by executive staff equivalent to a 

general and operations manager 

(Occupation code 11–1021), at a cost of 

$55.41 unadjusted hourly wage, $110.82 

adjusted for non-wage benefits and 

indirect costs (5 × $110.82). 

We monetize the time that would be 

spent by APS programs on revising 

policies and procedures by estimating a 

total cost per entity of $1,468.02 or 

$1,163.50, depending on the extent of 

the revisions. For the approximately 464 

programs with less extensive revisions, 

we estimate a cost of approximately 

$539,864. For the 464 programs with 

more extensive revisions, we estimate a 

cost of approximately $681,244.80.28. 

We estimate the total cost associated 

with revisions with respect to the 

proposed rule for APS systems of 

$1,221,108.80. 

The above estimates of time and 

number of State entities or APS 

programs that would revise their 

policies under the regulation are 

approximate estimates based on ACL’s 

extensive experience working with APS 

systems, including providing technical 

assistance, and feedback and inquiries 

that we have received from State entities 

and APS programs. Due to variation in 

the types and sizes of State entities and 

incomplete data on local programs, the 

above estimates of time and number of 

entities that would revise their policies 

under the regulation is difficult to 

calculate precisely. 

2. Trainings on New Requirements 

Cost to conduct trainings (ACL staff 

and contractors): ACL estimates that the 

Federal Government will incur a onetime expense with respect to training or 

re-training State entities under the 

proposed rule. 

Senior ACL staff will train State 

entities by the ten (10) HHS regions 

assisted by its technical assistance 

provider the APS Technical Assistance 

Resource Center (TARC). We assume for 

each of the ten (10) regions that 

trainings will take three (3) hours of 

staff time for one Federal GS–14 

equivalent 59 at a cost of $63.64 

unadjusted hourly wage, $127.28 

adjusted for non-wage benefits and 

indirect costs (3 × $127.28), three (3) 

hours of staff time for one GS–13 

equivalent at a cost of $53.85 per 

unadjusted hourly wage, $107.70 per 

hour adjusted for non-wage benefits and 

indirect costs (3 × $107.70), and (3) and 

three hours of staff time for five (5) 

contractors equivalent to training and 

development managers (U.S. 

Department of Labor (DOL) Bureau of 

Labor Statistics (BLS) Occupation code 

11–3131) at a cost of $61.92 per hour 

unadjusted for non-wage benefits, 

$123.84 per hour adjusted for non-wage 

benefits and indirect costs (3 × 5 × 

$123.84). This is inclusive of time to 

prepare and conduct the trainings. 

We monetize the time spent by 

Federal employees and contractors to 

prepare and conduct trainings for State 

entities by estimating a total cost per 

regional training of $2,562.54. For ten 

trainings a total of $25,625.40. 

Cost to conduct training (State entity 

to local APS program): We further 

anticipate in each of the 15 local-level 

systems the State entity would incur a 

one-time expense to conduct a training 

on the new policies and procedures for 

the State’s local APS programs. For each 

State entity to prepare and conduct a 

training (15 trainings total) we 

anticipate two (2) employees per State 

entity each equivalent to a first-line 

supervisor (BLS Occupation code 43– 

1011), would spend two (2) total hours 

(one (1) hour per employee) at a cost of 

$30.47 per hour unadjusted hourly 

wage, $60.94 per hour adjusting for nonwage benefits and indirect costs (2 × 

$60.94). 

We monetize the time spent by State 

entities to prepare and conduct trainings 

for local APS programs at $121.88 per 

training. For 15 State entities we 

anticipate a total of $1,828.20. 

Cost to conduct training (APS 

programs to APS workers): We 

anticipate each of the 928 local APS 

programs will incur a one-time expense 

to conduct a training for APS workers 

on new policies and procedures. For 

each program to prepare and conduct a 

training we anticipate three (3) hours to 

prepare and conduct a training of one 

mid-level manager equivalent to a firstVerDate Sep<11>2014 17:03 Sep 11, 2023 Jkt 259001 PO 00000 Frm 00040 Fmt 4702 Sfmt 4702 E:\FR\FM\12SEP1.SGM 12SEP1

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60See supra note 53. 

line supervisor (BLS Occupation code 

43–1011), at a cost of $30.47 per hour 

unadjusted hourly wage, $60.94 after 

adjusting for non-wage benefits and 

indirect costs (3 × $60.94). We monetize 

the time spent by APS programs to 

prepare and conduct trainings at 

$182.82 (928 × $182.82). We monetize 

the time spent by APS programs to train 

their workers at $169,656.96. 

Cost to receive training: There is no 

data on individual local APS program 

staffing. However, NAMRS does track 

an aggregate number of APS staff at the 

State and local level, from State 

supervisors to local APS workers: 8,287. 

We assume 5 percent of these workers 

are executive staff equivalent to a 

general and operations manager (BLS 

Occupation code 11–1021), at a cost of 

$55.41 unadjusted hourly wage, $110.82 

per hour adjusted for non-wage benefits 

and indirect costs (414 × $110.82), 15 

precent are first-line supervisor 

(Occupation code 43–1011), at a cost of 

$60.94 per hour adjusting for non-wage 

benefits and indirect costs (1,243 × 

$60.94) and 80 percent are Social and 

Human Service Assistants (Occupation 

code 21–1093) at a cost of $19.45 per 

hour unadjusted hourly wage, and 

$38.90 adjusted for non-wage benefits 

and indirect costs. (6,629 × $38.90). 

We monetize the time spent by APS 

staff to receive a one-hour training at 

$379,496. 

We monetize the total amount of time 

spent to give and receive trainings at 

$576,606.56. Of this, $550,981.16 is 

State expense and $25,625.40 is Federal 

expense. 

3. Implementing New Policies and 

Procedures 

The proposed rule requires several 

changes in APS practice which may 

represent a cost to States. 

Cost to implement a two-tiered, 

immediate vs. non immediate risk, 

response system: Forty-nine States 

currently have a two-tiered (or higher) 

system. Forty-nine States currently 

respond to immediate need intakes 

within 24 hours. After consulting former 

APS administrators, we have 

determined that we cannot fully 

quantify how much it would cost a State 

to develop and implement a new twotiered system. However, given that most 

States currently already maintain such a 

system, we anticipate it would be a very 

minor on-going cost in total. 

Cost to implement mandatory staff to 

client ratios: The provision requiring 

States to establish a minimum staffing 

ratio is intended to better enable States 

to ensure long-term continuity of 

programs. We anticipate that this will be 

an on-going, cost neutral provision; 

States have the discretion to set 

minimum staffing ratios consistent with 

current practice, and therefore currently 

available resources. We do not 

anticipate that States would commit to 

increasing staffing ratios without a 

commensurate increase in Federal or 

other funding. Consequently, we 

anticipate that this provision will not 

result in increased cost to APS 

programs. We invite comment as to 

whether our analysis of the potential 

financial burden of this proposal is 

accurate. 

Cost to implement a mandatory 

reporter feedback loop: According to 

2021 ACL Evaluation survey and 

NAMRS data, of all reports nationally 

which resulted in an investigation, 

255,395 (59 percent) were made by 

professionals. However, not all 

professionals are mandated reporters 

and who is a mandated reporter varies 

by State. For example, a home and 

community-based service provider or 

other social service provider would be 

considered a professional but may not 

be a mandated reporter. For this reason, 

we assume 75 percent of reports 

resulting in an investigation made by 

professionals were made by mandated 

reporters (191,546). One such response 

an APS program could make to a 

mandated reporter is to send an email. 

If for each report leading to an 

investigation received by a mandatory 

reporter, an APS program sends an 

email in response, we anticipate a 

Social and Human Service Assistants 

(Occupation code 21–1093) at a cost of 

$19.45 per hour unadjusted hourly 

wage, and $38.90 adjusted for non-wage 

benefits and indirect costs would spend 

ten (10) minutes sending the email. We 

monetize the on-going cost for all 56 

systems to send an email for each report 

of maltreatment from a mandatory 

reporter to be $1,241,856.57 annually. 

81 percent APS programs do not 

currently require a feedback loop for 

mandatory reporters.60 To bring all 

States into compliance (.81 × 

$1,241,856.57) with the proposed rules 

would amount to $1,005,903.82 

annually. 

Cost to implement data sharing 

agreements: Anecdotally we know very 

few States currently have data sharing 

agreements with other maltreatment 

investigatory entities in place. We have 

estimated 50 APS systems currently 

have no data use agreements in place 

while six may have one or more. For 

illustrative purposes we assume each 

State without a data sharing agreement 

will establish three (3) MOUs (with, for 

example, the Medicaid agency, the 

Long-term care ombudsman, and the 

Protection and Advocacy System). Each 

MOU will take one mid-level manager 

equivalent to a first-line supervisor 

(Occupation code 43–1011), at a cost of 

$30.47 per hour unadjusted hourly 

wage, $60.94 after adjusting for nonwage benefits and indirect costs three 

(3) hours to draft (3 × $60.94). It will 

take a privacy officer equivalent to a 

lawyer (Occupation code 23–1011) at a 

cost of $78.74 unadjusted hourly wage, 

$156.80 per hour adjusted for non-wage 

benefits and indirect costs one (1) hour 

to review and approve (1 × $156.80). It 

will take an executive staff equivalent to 

a general and operations manager 

(Occupation code 11–1021), at a cost of 

$55.41 unadjusted hourly wage, $110.82 

per hour adjusted for non-wage benefits 

and indirect costs two (2) hours (2 × 

$110.82) to review and approve. We 

monetize the cost for one (1) State APS 

system to develop one (1) MOU to be 

$561.26. For a State APS system to 

establish three (3) MOUs, we monetize 

the cost to be $1,683.78. For fifty (50) 

State APS systems to develop one 

MOUs we monetize the cost to be 

$84,189. We likewise assume that each 

of the three (3) entities the APS entity 

is entering into an MOU with will incur 

substantially similar costs. We monetize 

the expense of three (3) entities in fifty 

(50) states to enter into MOUs with the 

APS system in their State at $84,189. 

We monetize the one-time total cost of 

establishing data sharing agreements to 

be $168,378. 

Cost to inform individuals of their 

rights under State law: We do not 

currently have data on the number of 

States informing individuals of their 

rights under State law. We know 

anecdotally some States offer potential 

clients a paper brochure informing them 

of their rights. We anticipate costs of 

producing and distributing such 

brochures to be one new pamphlet per 

State system or 56 pamphlets total. It 

will require three (3) hours of staff time 

by a Social and Human Service 

Assistants (Occupation code 21–1093) at 

a cost of $19.45 per hour unadjusted 

hourly wage, and $38.90 adjusted for 

non-wage benefits and indirect costs (3 

× $38.90) and one (1) hour for a first-line 

supervisor (Occupation code 43–1011), 

at a cost of $30.47 per hour unadjusted 

hourly wage, $60.94 to review and 

approve (1 × $60.94) for a total of 

$177.64 per State in staff time to 

develop each pamphlet. We monetize 

the one-time staff cost for 56 State 

systems to develop a pamphlet (56 × 

$177.64) at $9,947.84. According to our 

NAMRS data, 806,219 client 

investigations were performed in FFY 


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61The Admin. for Cmty. Living, Adult 

Maltreatment Report 2020 (2021) https://acl.gov/ 

sites/default/files/programs/2021-10/2020_

NAMRS_Report_ADA-Final_Update2.pdf. 

2022. Each pamphlet will cost 23 cents 

to print and produce. Assuming a 

pamphlet is provided for every new 

client at the initiation of an 

investigation (806,219 × .23) it would 

cost $185,430.37 annually to produce 

and distribute pamphlets nationwide. In 

total, to develop a new pamphlet in all 

56 States and distribute them at the 

beginning of all investigations would 

cost $195,378.21 in staff time and 

materials the first year the policy is in 

place. Subsequently, States would incur 

$185, 430.37 annually to implement this 

provision. 

3. Data Reporting to ACL 

In our proposed regulations, we 

require States to collect and report 

specific data to ACL. As in our NAMRS 

data collection system, this data 

collection uses existing State 

administrative information systems. 

Therefore, States will not incur new 

data collection costs as the result of this 

rulemaking. Most of the data collected 

are standard data used by the agency. 

Operating costs of the information 

systems are part of State agency 

operations and would not maintained 

solely for the purpose of submitting data 

in compliance with the proposed rules. 

For data reporting from the State to 

ACL under the proposed regulations, we 

anticipate a similar system as NAMRS 

case component data currently reported 

voluntarily by States. We performed a 

burden estimate prior to launching this 

reporting system. We estimated for 35 

States staff cost would be a total annual 

burden of 675 hours at $46.00 per hour 

(675 × $46.00) for a total of $31,050. IT 

staff total annual burden was estimated 

at 3,075 hours at $69.00 (3,075 × $69.00) 

per hour for a total of $212,175. Using 

this measure as a proxy, we estimate the 

proposed rule’s data reporting 

requirements will cost a total of 

$339,480 annually for all 56 State 

entities. 

4. Record Retention 

The proposed rule imposes a new 

requirement that APS programs retain 

case data for five years. Many, but not 

all, programs currently retain case data 

for a number of years, but 

comprehensive information does not 

exist on State retention policies. We can 

extrapolate from data reporting in the 

NAMRS that most States retain case 

data for an average of two years.61

NAMRS is a comprehensive, voluntary, 

national reporting system for APS 

programs. It collects quantitative and 

qualitative data on APS practices and 

policies, and the outcomes of 

investigations into the maltreatment of 

older adults and adults with disabilities 

from every State and Territory. All but 

one State currently maintains an IT 

infrastructure that supports the 

retention of electronic APS data and 

maintains it for one year. For this 

reason, the cost to further store it for 

five years will create a de minimis cost 

for APS. 

5. State plans and NAMRS 

This will be the first times State 

entities are required to develop and 

submit State plans under section 2042 

of the Elder Justice Act, 42 U.S.C. 

1397m–1(b). However, States develop 

spending plans under 45 CFR 75.206(d) 

every three to five years and, based on 

our extensive experience working with 

APS systems and OAA grantees on their 

State plans, we do not anticipate a 

significantly greater level of detail for 

the development of State plans. We 

anticipate for each State the equivalent 

of two (2) hour of executive staff 

equivalent to a general and operations 

manager (Occupation code 11–1021), at 

a cost of $55.41 per hour unadjusted 

adjusted hourly wage, $110.82 adjusted 

for non-wage benefits and indirect costs 

(2 × $110.82), and four (4) hours of a 

first-line supervisor (Occupation code 

43–1011), at a cost of $30.47 per hour 

unadjusted hourly wage, $60.94 

adjusting for non-wage benefits and 

indirect costs (4 × $60.94). State plans 

will be updated every three to five 

years. We monetize the cost of drafting 

one State plan at $465.40. We monetize 

56 State plans at $26,062.40. 

1. Total Quantified Costs 

a. One-Time Costs 

Item of cost: 

Policies and Procedures Update ....................................................................................................................... $1,221,108.80 

Policies and Procedures Implementation .......................................................................................................... State ................. Federal 

Training ....................................................................................................................................................... $550,981.16 ..... $25,625.40 

Policies and Procedures Implementation: 

Data Sharing Agreements .......................................................................................................................... $168,378.00 

Policies and Procedures: 

Informing Individuals of Their Rights Under State Law ............................................................................. $9,947.84 

Total ..................................................................................................................................................... $1,976,041.20 

b. Ongoing Costs (Annual) 

Item of Cost: 

Policies and Procedures Implementation: 

Two-Tiered Response System ........................................................................................................................................................ $0 

Policies and Procedures Implementation: 

Staff to Client Ratios ....................................................................................................................................................................... 0 

Policies and Procedures Implementation: 

Mandatory Reporter Feedback Loop .............................................................................................................................................. 1,005,903.82 

Policies and Procedures Implementation: 

Informing Individuals of Their Rights Under State Law .................................................................................................................. 185,430.37 

Data reporting to ACL ............................................................................................................................................................................. 339,480.00 

Record Retention .................................................................................................................................................................................... 0 


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62M.S. Lachs et al. The Mortality of Elder 

Mistreatment, 280(5) JAMA 428–432 (Aug. 1998) 

https://pubmed.ncbi.nlm.nih.gov/9701077/. 63U.S. Consumer. Fin. Protection. Bur., 

Suspicious Activity Reports on Elder Financial 

Exploitation: Issues and Trends (2019); https://

www.gao.gov/assets/gao-21-90.pdf. 64U.S. Gen. Acct. Off., GAO–21–90, HHS Could 

Do More to Encourage State Reporting on the Costs 

of Financial Exploitation (2020) https://

www.gao.gov/assets/gao-21-90.pdf. 

65The Northern Mariana Islands and American 

Samoa currently have no staffed program; they are 

in the process of developing one. 

66See supra note 4, at 20. 

67We have made our calculations based on 2022 

Census Bureau Data. 

State plan ................................................................................................................................................................................................ 26,062.40 

(renewed 

every 

three to 

five years) 

Total ................................................................................................................................................................................................. 1,556,876.59 

d. Discussion of Benefits 

Older adults who experience 

maltreatment are three times more likely 

to experience adverse consequences to 

health, living arrangements, or financial 

arrangements than their counterparts 

who do not experience maltreatment.62

According to 2022 NAMRS data, four 

percent or approximately 36,000 APS 

clients died during the course of an APS 

investigation. According to the 

Consumer Financial Protection Bureau, 

financial institutions reported $1.7 

billion in elder financial abuse in 

2017.63 However, in 2016 three States 

projected the cost could be over $1 

billion in their State alone.64

While this proposed rule does not 

directly affect the underlying causes of 

maltreatment, which are complex and 

multifactorial, it does establish a 

national baseline of quality in APS 

practice to intervene in maltreatment 

and mitigate harm as it is occurring. We 

anticipate this could reduce the number 

of deaths that may occur during the 

course of an APS investigation. 

Generally speaking, the benefits of the 

rule are difficult to quantify. The 

minimum standards proposed by the 

NPRM are in direct response to requests 

from APS systems for more guidance 

and uniformity in policy within and 

among States. We anticipate that if 

implemented, the rule would elevate 

evidence-informed practices, bring 

clarity and consistency to programs, and 

improve the quality of service delivery 

for adult maltreatment victims and 

potential victims. For example, if all 

States implemented 24 hour per day, 7 

days per week reporting acceptance 

protocols, an individual experiencing 

maltreatment may be identified earlier, 

and an investigation could commence 

and intervene sooner. Staffing ratios can 

promote adequate staffing, allowing a 

worker to devote more time to a case. 

Training requirements allow 

caseworkers to better handle and resolve 

cases. It may also decrease repeat abuse 

through post-investigation services. 

Similarly, proposals on APS 

coordination with other entities 

maximize the resources of APS systems, 

improve investigation capacity, ensure 

post-investigation services are effective, 

reduce the imposition of multiple 

investigations on adults who have been 

harmed, and help prevent future 

maltreatment. 

Another example of a difficult to 

quantify benefit is a standardized 

timeframe for case record retention. 

There are currently no minimum 

requirements for States to retain their 

records. The proposed rule’s five-year 

minimum retention period facilitates 

States’ ability to track victims and 

perpetrators across time to deter abuse 

and identify recidivism while 

minimizing administrative burden. 

The proposed rules were informed by 

expert-developed evidence-informed 

practices as articulated in our 

Consensus Guidelines. These evidenceinformed practices, when implemented, 

will result in higher quality 

investigations allowing APS to 

apprehend perpetrators of adult 

maltreatment with greater frequency 

and accuracy, in turn protecting the 

health and wellbeing of older adults and 

adults with disabilities. 

B. Regulatory Flexibility Act 

Under the Regulatory Flexibility Act 

(RFA), as amended by the Small 

Business Regulatory Enforcement 

Fairness Act (SBREFA) (5 U.S.C. 601 et 

seq.), agencies must consider the impact 

of regulations on small entities and 

analyze regulatory options that would 

minimize a rule’s impacts on these 

entities. Alternatively, the agency head 

may certify that the rule will not have 

a significant economic impact on a 

substantial number of small entities. 

ACL does not anticipate that this 

rulemaking will have a significant 

economic impact on a substantial 

number of small businesses. 

APS is a State-based social services 

program controlled centrally by a State 

office. Thirty-nine APS systems are 

State-administered, meaning State staff 

operate programs out of locally placed 

State offices.65 Fifteen States are countyadministered and controlled or a hybrid 

of State and county-administered and 

controlled. In county-administered 

systems, the State entity grants funding 

to local entities, including counties and 

non-profits, but does not perform 

investigatory functions. In hybrid 

systems, the State maintains a more 

active oversight and investigatory role, 

but delegates to local entities. 

Nationally, State employees perform 70 

percent of APS investigations. County 

and non-profit employees perform the 

remainder.66

In State-administered systems, no 

small entities are implicated. State 

Government employees and offices are 

not small entities as defined by 5 U.S.C. 

601. In the 15 county and hybrid 

administered systems, there are 459 

counties of less than 50,000 people.67

The administrative structure of APS is 

complex and data is incomplete. 

However, for illustrative purposes we 

assume that in these 459 counties there 

is one APS program that is a small 

entity under 5 U.S.C. 601, either a small 

government jurisdiction or non-profit. 

Much of the cost of implementation 

will be borne by State entities in both 

State-administered and county and 

hybrid-administered States. In both 

such systems, the State entity exercises 

significant control; the State entity 

receives and distributes Federal funding 

and is responsible for revising policies 

and procedures, training local entities, 

and reporting data to ACL. We monetize 

the average cost per State APS system to 

be $63,087.80. As an example, Colorado 

has an estimated 48 counties under 

50,000 people. Assuming the State 

entity absorbs the 25 percent of the cost 

of implementation, each entity would 

incur $985.75 in implementation 

expenses per year. Much of this would 

be a one-time expense. North Carolina 

has ten counties under 50,000 people. 

On average, assuming the State entity 

absorbs 25 percent of the cost burden of 

the rule, each small entity would incur 

$4,731.58 in expense per year, much of 

this representing a one-time expense. 


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68Report on the Updates to the Voluntary 

Consensus Guidelines for APS Systems, Appendix 

3: 19, https://acl.gov/sites/default/files/programs/ 

2020-05/ACL-Appendix_3.fin_508.pdf. 

Furthermore, many small entities may 

already be in compliance with 

significant portions of these proposed 

regulations whether as written in 

policies and procedures or as informal 

practice. 

Consequently, we have examined the 

economic implications of the proposed 

rule and find that if finalized, it will not 

have a significant economic impact on 

a substantial number of small entities. 

C. Executive Order 13132 (Federalism) 

Executive Order 13132 requires 

Federal agencies to consider the impact 

of their regulatory actions on State and 

local governments. Where such actions 

have federalism implications, agencies 

are directed to provide a statement 

describing the agency’s considerations. 

Policies that have federalism 

implications include regulations that 

have ‘‘substantial direct effects on the 

States, on the relationship between the 

national government and the States, or 

on the distribution of power and 

responsibilities among the various 

levels of government.’’ 

The proposed rule requires State APS 

systems to implement policies and 

procedures reflecting evidence-based 

practices. Receipt of Federal funding for 

APS systems under the EJA Sec. 2042, 

42 U.S.C. 1397m–1(b) is contingent 

upon compliance with these proposed 

rules. Many States are already in 

substantial compliance with this 

proposal, however, some may need to 

revise or update their current APS 

policies, develop new policies or, in 

some cases, pass new laws or amend 

existing State statutes. 

Consultations With State and Local 

Officials 

Executive Order 13132 requires 

meaningful and timely input by State 

and local officials in the development of 

regulatory policies that have federalism 

implications. As detailed in the 

preamble, the proposed regulations 

closely mirror the 2020 Voluntary 

Consensus Guidelines for State Adult 

Protective Services Systems (Consensus 

Guidelines). All specific mandates (for 

example, day and time requirements for 

case response) contained in the 

proposed regulation reflect the 

Consensus Guidelines. 

The Consensus Guidelines were 

developed with extensive input from 

the APS community, including State 

and local officials. Interested parties 

were invited to provide feedback for the 

proposed updates to the Consensus 

Guidelines through a public comment 

period and five webinars. A Request for 

Information was posted on ACL’s 

website and the comment period ran 

from March until May 2019. Five 

webinars were held during April and 

May 2019 hosting approximately 190 

participants, representing 39 states and 

the District of Columbia. Participants 

represented ten fields, with most 

participants representing the APS 

network (66 percent). The vast majority 

of these APS programs are administered 

and staffed by State and local 

government entities. 

The goals of the outreach and 

engagement process were to hear from 

all interested entities, including State 

and local officials, the public, and 

professional fields about their 

experiences with APS. The engagement 

process ensured affected parties 

understood why and how ACL was 

leading the development of the 

Consensus Guidelines and provided an 

opportunity to give input into the 

process and content of the Consensus 

Guidelines. ACL will also review 

comments on the proposed rule from 

State and local officials and consider 

any additional concerns in developing a 

final rule. 

Nature of Concerns and the Need To 

Issue This Proposed Rule 

Community members welcomed the 

Consensus Guidelines and were 

generally in support of the process by 

which they were created and updated as 

well as the substantive content, noting 

that they ‘‘help set the standard and 

support future planning and State 

legislative advocacy.’’ 68

We received comments that the 

Consensus Guidelines were 

‘‘aspirational’’ and would be 

challenging to implement absent 

additional funding. We seriously 

considered these views in developing 

this proposed rule. We also completed 

a regulatory impact analysis to fully 

assess costs and benefits of the new 

requirements. We recognize that some of 

the new proposed regulatory provisions 

will create administrative and monetary 

burden in updating policies and 

procedures as well as potential changes 

to State law. However, much of this 

burden will be a one-time expense and 

States will have significant discretion to 

implement the proposed provisions in 

the manner best suited to State needs. 

Extent To Which We Meet Those 

Concerns 

In FY 2021, Congress provided the 

first dedicated appropriation to 

implement the Elder Justice Act section 

2042(b), 42 U.S.C. 1397m–1(b), formula 

grants to all States, the District of 

Columbia, and the Territories to 

enhance APS, totaling $188 million, and 

another $188 million in FY 2022. The 

recent Consolidated Appropriations Act 

of 2023 included an annual 

appropriation of $15 million to ACL to 

continue providing formula grants to 

APS programs under EJA section 

2042(b), 42 U.S.C. 1397m–1(b). This 

funding is available to States for the 

implementation of the proposed 

regulation and meet the concerns 

commenters raised in 2019 around 

dedicated funding for APS systems. 

Additionally, the regulatory changes we 

propose have already been implemented 

by many States, and we believe the 

benefit of the proposed requirements 

will be significant. 

D. Executive Order 13175 (Consultation 

and Coordination With Indian Tribal 

Governments) 

ACL will fulfill its responsibilities 

under Executive Order 13175, 

‘‘Consultation and Coordination with 

Indian Tribal Governments.’’ Executive 

Order 13175 requires Federal agencies 

to establish procedures for meaningful 

consultation and coordination with 

tribal officials in the development of 

Federal policies that have Tribal 

implications. ACL will solicit input 

from affected Federally recognized 

Tribes as we develop these updated 

regulations and will conduct a Tribal 

consultation meeting [exact date to be 

specified in NPRM when NPRM 

publication date is known]. 

E. Unfunded Mandates Reform Act of 

1995 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 requires 

that a covered agency prepare a 

budgetary impact Statement before 

promulgating a rule that includes any 

Federal mandate that may result in the 

expenditure by State, local, and Tribal 

governments, in the aggregate, or by the 

private sector, of $100 million or more 

in any one year. If a covered agency 

must prepare a budgetary impact 

Statement, section 205 further requires 

that it select the most cost-effective and 

least burdensome alternative that 

achieves the objectives of the rule and 

is consistent with the statutory 

requirements. In addition, section 203 

requires a plan for informing and 

advising any small governments that 

may be significantly or uniquely 

impacted by the rule. We have 

determined that this rulemaking would 

not result in the expenditure by State, 

local, and Tribal governments, in the 

aggregate, or by the private sector, of 

more than $100 million in any one year. 


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Accordingly, we have not prepared a 

budgetary impact Statement, 

specifically addressed the regulatory 

alternatives considered, or prepared a 

plan for informing and advising any 

significantly or uniquely impacted small 

governments. 

F. Plain Language in Government 

Writing 

Pursuant to Executive Order 13563 of 

January 18, 2011, and Executive Order 

12866 of September 30, 1993, Executive 

Departments and Agencies are directed 

to use plain language in all proposed 

and final rules. ACL believes it has used 

plain language in drafting the proposed 

rule and would welcome any comment 

from the public about how to make this 

rulemaking easier to read and 

understand. 

G. Paperwork Reduction Act (PRA) 

The proposed rule contains new 

information collection requirements 

under 5 CFR part 1320. These new 

burdens include: new State plans, new 

program performance data collection 

and reporting, a requirement that States 

generate, maintain, and retain written 

policies and procedures, a requirement 

that State APS systems disclose 

information to clients regarding their 

rights under State law, and a 

requirement that States generate, 

maintain, and retain information and 

data sharing agreements (while also 

disclosing data through such 

agreements). 

As detailed in the regulatory impact 

analysis, we estimate the following total 

burden across all States and Territories 

for such requirements: 

(1) State plans: $26,062.40 (renewed 

every three to five years); 

(2) Program performance data 

collection: $339,480.00 (annually); 

(3) Creation of written policies and 

procedures: $1,221,108.00 (one-time 

expense); 

(4) Disclosure to potential clients their 

rights under State law: $195,378.21 

($9,947.84 in one-time expense and 

$185,430.37 annually); 

(5) Creation and maintenance of data 

sharing agreements: $168,378.00 (onetime expense). 

ACL will submit information to the 

OMB for review, as appropriate. The 

State plans, program performance data, 

written policies and procedures, 

disclosure to potential clients of their 

rights under State law, and the creation 

and maintenance of data sharing 

agreements will be submitted for 

approval as part of a generic clearance 

package for information collections 

related to ACL Administration on Aging 

programs. ACL intends to update 

applicable guidance as needed. 

List of Subjects in 45 CFR Part 1324 

Adult Protective Services, Elder 

Rights, Grant programs to States, Older 

Adults. 

For the reasons discussed in the 

preamble, ACL proposes to amend 45 

CFR part 1324 as follows: 

■ 1. Add subpart D to read as follows: 

PART 1324—ALLOTMENTS FOR 

VULNERABLE ELDER RIGHTS 

PROTECTION ACTIVITIES 

Subpart D—Adult Protective Services 

Programs 

Sec. 

1324.400 Eligibility for funding. 

1324.401 Definitions. 

1324.402 Program administration. 

1324.403 Investigation and postinvestigation services. 

1324.404 Conflict of interest. 

1324.405 Accepting reports. 

1324.406 Coordination with other entities. 

1324.407 APS program performance. 

1324.408 State plans. 

Authority: 42 U.S.C. 3011(e)(3); 42 U.S.C. 

1397m–1. 

§ 1324.400 Eligibility for funding. 

To be eligible for funding under 42 

U.S.C. 1397m–1(b) State entities are 

required to adhere to all provisions 

contained herein. 

§ 1324.401 Definitions. 

As used in this part, the term— 

Abuse means the knowing infliction 

of physical or psychological harm or the 

knowing deprivation of goods or 

services that are necessary to meet 

essential needs or to avoid physical or 

psychological harm. 

Adult means older adults and adults 

with disabilities as defined by State APS 

laws. 

Adult maltreatment means selfneglect or abuse, neglect, exploitation, 

or sexual abuse of an adult at-risk of 

harm from a perpetrator with whom 

they have a trust relationship. 

Adult Protective Services (APS) means 

such services provided to adults as the 

Assistant Secretary for Aging may 

specify in guidance and includes such 

services as: 

(1) Receiving reports of adult abuse, 

neglect, exploitation, sexual abuse, and 

self-neglect; 

(2) Investigating the reports described 

in paragraph (1) of this definition; 

(3) Case planning, monitoring, 

evaluation, and other case work and 

services, and; 

(4) Providing, arranging for, or 

facilitating the provision of medical, 

social services, economic, legal, 

housing, law enforcement, or other 

protective, emergency, or supportive 

services. 

Adult Protective Services Program 

means local Adult Protective Services 

providers within an Adult Protective 

Services system. 

Adult Protective Services (APS) 

System means the totality of both the 

State entity and the local APS programs. 

Allegation means an accusation of 

adult maltreatment associated with each 

adult in a report made to APS. There 

may be multiple allegations in an 

investigation. 

At risk of harm means the possibility 

that an individual will experience an 

event, illness, condition, disease, 

disorder, injury, or other outcome that 

is adverse or detrimental and 

undesirable. 

Assistant Secretary for Aging means 

the position identified in section 201(a) 

of the Older Americans Act (OAA), 42 

U.S.C. 3002(7). 

Case means all activities related to an 

APS investigation of, and response to, 

an allegation of adult maltreatment. 

Client means an adult who is the 

subject of an investigation by APS 

regarding a report of alleged adult 

maltreatment. 

Conflict of Interest means a situation 

that interferes with a program or 

program representative’s ability to 

provide objective information or act in 

the best interests of the adult. A conflict 

of interest would arise when an 

employee, officer, or agent of APS, any 

member of their immediate family, their 

partner, or an organization which 

employs or is about to employ any of 

the parties indicated herein, has a 

financial or other interest in or a 

tangible personal benefit from their 

affiliation with APS systems. 

Dual relationship means relationships 

in which an APS worker assumes one or 

more professional, personal, or 

volunteer roles in addition to their role 

as an APS worker at the same time, or 

sequentially, with a client. 

Emergency Protective Action means 

emergency use of APS funds to 

purchase goods or services, immediate 

access to petitioning the court for 

temporary or emergency orders, and 

emergency out-of-home placement. 

Exploitation means the fraudulent or 

otherwise illegal, unauthorized, or 

improper act or process of a person, 

including a caregiver or fiduciary, that 

uses the resources of an adult for 

monetary or personal benefit, profit, or 

gain, or that results in depriving an 

adult of rightful access to, or use of, 

their benefits, resources, belongings, or 

assets. 


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Inconclusive means a determination 

that there was not sufficient evidence 

obtained during an APS investigation 

for APS to conclude whether adult 

maltreatment occurred. 

Intake or pre-screening means the 

APS process of receiving allegations of 

adult maltreatment and gathering 

information on the reports, the alleged 

victim, and the alleged perpetrator. 

Investigation means the process by 

which APS examines and gathers 

information about an allegation of adult 

maltreatment to determine if the 

circumstances of the allegation meet the 

States ’s standards of evidence for a 

finding of a substantiated, 

unsubstantiated, or inconclusive 

allegation. 

Mandated Reporter means someone 

who is required by State law to report 

suspected adult maltreatment to APS. 

Neglect means the failure of a 

caregiver or fiduciary to provide the 

goods or services that are necessary to 

maintain the health or safety of an adult. 

Perpetrator means the person 

determined by APS to be responsible for 

one or more instances of adult 

maltreatment for one or more victims. 

Post-investigation Services means the 

activities undertaken by APS in support 

of a client after a finding on an 

allegation of adult maltreatment has 

been made. 

Quality assurance means the process 

by which APS programs ensure 

investigations meet or exceed 

established standards, and includes: 

(1) Thorough documentation of all 

investigation and case management 

activities; 

(2) Review and approval of case 

closure; and 

(3) Conducting a case review process. 

Screening means a process whereby 

APS carefully reviews the intake 

information to determine if the report of 

adult maltreatment meets the minimum 

requirements to be opened for 

investigation by APS, or if the report 

should be referred to a service or 

program other than APS. 

Self-neglect means an adult’s 

inability, due to physical or mental 

impairment or diminished capacity, to 

perform essential self-care tasks 

including: 

(1) Obtaining essential food, clothing, 

shelter, and medical care; 

(2) Obtaining goods and services 

necessary to maintain physical health, 

mental health, or general safety, or; 

(3) Managing one’s own financial 

affairs. 

Sexual abuse means the forced and/or 

unwanted sexual interaction (touching 

and non-touching acts) of any kind with 

an adult. 

State entity means the unit of State, 

District of Columbia, or U.S. Territorial 

Government designated as responsible 

for APS programs, including through 

the establishment and enforcement of 

policies and procedures, and that 

receives Federal grant funding from 

ACL under section 2042(b) of the EJA, 

42 U.S.C. 1397m–1(b). 

Substantiated means APS has made 

an investigation disposition that the 

allegation of maltreatment meets state 

law or agency policy for concluding that 

the adult was maltreated. 

Trust relationship means the rational 

expectation or belief that a relative, 

friend, caregiver, or other person with 

whom a relationship exists can or 

should be relied upon to protect the 

interests of an adult (as defined above) 

and/or provide for an adult’s care. This 

expectation is based on either the 

willful assumption of responsibility or 

expectations of care or protection 

arising from legal or social conventions. 

Unsubstantiated means that APS has 

made an investigation disposition that 

the allegation of maltreatment does not 

meet State law or agency policy for 

concluding that the adult was 

maltreated. 

Victim means an adult who has 

experienced adult maltreatment. 

§ 1324.402 Program administration. 

(a) The State entity shall create and 

implement policies and procedures for 

APS systems to receive and respond to 

reports of adult maltreatment in a 

standardized fashion. Such policies and 

procedures, at a minimum, shall: 

(1) Incorporate principles of persondirected services and planning and 

reliance on least restrictive alternatives, 

as well as other policies identified by 

the Assistant Secretary for Aging; 

(2) Define the populations eligible for 

APS services; 

(3) Define the settings, locations, and 

types of alleged perpetrator for each 

adult maltreatment type that are subject 

to APS investigations in the State; 

(4) Define processes for receiving, 

screening, prioritizing, and referring 

cases based on risk and type of adult 

maltreatment consistent with 

§ 1324.403, including: 

(i) Creation of at least a two-tiered 

response system for initial contact with 

the alleged victim based on risk of 

death, irreparable harm, or significant 

loss of income, assets, or resources. 

(A) For immediate risk, response 

should occur in person no later than 

twenty-four hours after receiving a 

report of adult maltreatment. 

(B) For non-immediate risk, response 

should occur no more than seven 

calendar days after report of adult 

maltreatment is received. 

(5) Define investigation and postinvestigation procedures, as identified 

in § 1324.403. 

(b) At first contact APS systems shall 

provide to potential APS clients an 

explanation of their rights, including: 

(1) The right under State law to 

confidentiality of personal information; 

(2) The right under State law to refuse 

to speak to APS; 

(3) The right under State law to refuse 

APS services, and; 

(4) Such other explanations of rights 

as determined by the Assistant Secretary 

for Aging. 

(c) Information shall be provided in a 

format and language understandable by 

the individual, and in alternative 

formats as needed. 

(d) The State entity shall establish 

policies and procedures for the staffing 

of APS systems that include: 

(1) Staff training and on-going 

education, including training on 

conflicts of interest; 

(2) Staff supervision, and; 

(3) Staff to client ratios. 

(e) The State entity shall establish 

such other program administration 

policies and procedures and provide 

other information to APS clients as 

established by the Assistant Secretary 

for Aging. 

§ 1324.403 Investigation and postinvestigation services. 

The State entity shall adopt 

standardized and systematic policies 

and procedures for APS investigation 

and post-investigation activities across 

and within the State including, at a 

minimum: 

(a) Screening, triaging, and decisionmaking criteria or protocols to review 

and assign adult maltreatment reports 

for APS investigation, and to report to 

other authorities; 

(b) Tools and/or decision-making 

processes for APS to review reports of 

adult maltreatment for any emergency 

needs of the adult and for immediate 

safety and risk factors affecting the adult 

or APS worker when responding to the 

report and; 

(c) Practices during investigations to 

collect information and evidence to 

inform allegation disposition and 

service planning that will: 

(1) Recognize acceptance of APS 

services is voluntary, except where 

limited by State law; 

(2) Ensure safety of APS client and 

worker; 

(3) Ensure the preservation of an 

adult’s rights; 

(4) Integrate principles of persondirectedness and trauma-informed 

approaches; 


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(5) Maximize engagement with the 

APS client, and; 

(6) Permit APS to seek emergency 

protective action only as appropriate 

and necessary as a measure of last resort 

to protect the life and wellbeing of the 

client from self-harm or harm from 

others. 

(d) Methods to make determinations 

on allegations and record case findings, 

including: 

(1) Ability for APS programs to 

consult with appropriate experts, other 

team members, and supervisors; 

(2) Protocols for the standards of 

evidence APS should apply when 

making a determination on allegations. 

(e) Provision of APS postinvestigation services, as appropriate, 

that: 

(1) Respect the autonomy and 

authority of clients to make their own 

life choices; 

(2) Respect the client’s views about 

safety, quality of life, and success; 

(3) Hold perpetrators accountable for 

the adult maltreatment and for stopping 

the abusive behavior; 

(4) Develop any service plan or 

referrals in consultation and agreement 

with the client; 

(5) Engage community partners 

through referrals for services or 

purchase of services where services are 

not directly provided by APS, and; 

(6) Monitor the status of client and 

services, and the impact of services. 

(f) Case handling criteria that: 

(1) Establish timeframes for on-going 

review of open cases; 

(2) Establish length of time by which 

investigations should be completed, and 

determinations be made; and 

(3) Documents, at a minimum: 

(i) The APS interventions and services 

delivered; 

(ii) Significant changes in client 

status; 

(iii) Assessment of the outcome and 

efficacy of intervention and services; 

(iv) Assessment of safety and risk at 

case closure; and 

(v) The reason or decision to close the 

case. 

§ 1324.404 Conflict of interest. 

The State entity shall establish 

standardized policies and procedures to 

avoid both actual and perceived 

conflicts of interest for APS. Such 

policies and procedures must include 

mechanisms to identify, remove, and 

remedy any existing conflicts of interest 

at organizational and individual levels, 

including to: 

(a) Ensure that employees and agents 

engaged in any part of an APS 

investigation do not also provide direct 

services to, or oversee the direct 

provision of services, to the client; 

(b) Ensure that employees and agents 

administering APS programs do not 

have a personal financial interest in an 

entity to which an APS program they 

refer clients to services recommended 

by the APS program; 

(c) Ensure that no APS employee or 

agent, or member of an employee or 

agent’s immediate family, is subject to 

conflict of interest; 

(d) Prohibit dual relationships unless 

unavoidable and ensure appropriate 

safeguards are established should such 

relationships occur; 

(e) Establish robust monitoring and 

oversight, to identify conflict of interest, 

and; 

(f) Remove and remedy actual, 

perceived, or potential conflicts that 

arise. 

§ 1324.405 Accepting reports. 

(a) The State entity shall establish 

standardized policies and procedures 

for receiving reports of adult 

maltreatment 24 hours per day, 7 

calendar days per week, using multiple 

methods of reporting to ensure 

accessibility. 

(b) The State entity shall establish 

standardized policies and procedures 

for APS to accept reports of alleged 

adult maltreatment by mandatory 

reporters that: 

(1) Shares information regarding a 

report to APS with the mandated 

reporter which shall include, at a 

minimum: 

(i) Whether a case has been opened as 

a result of the report, and; 

(ii) The disposition or finding of the 

allegation in the report. 

(c) The State entity shall establish and 

adhere to standardized policies and 

procedures to maintain the 

confidentiality of reporters and 

information provided in a report. 

§ 1324.406 Coordination with other 

entities. 

(a) State entities shall establish 

policies and procedures, consistent with 

State law, to ensure coordination and to 

detect, prevent, address, and remedy 

adult maltreatment with other 

appropriate entities, including but not 

limited to: 

(1) Other APS programs in the state, 

when authority over APS is divided 

between different jurisdictions or 

agencies; 

(2) Other governmental agencies that 

investigate allegations of adult 

maltreatment, including, but not limited 

to, the State Medicaid agency, State 

nursing home licensing and 

certification, State department of health 

and licensing and certification, and 

tribal governments; 

(3) Law enforcement agencies with 

jurisdiction to investigate suspected 

crimes related to adult maltreatment; 

State or local police agencies, tribal law 

enforcement, State Medicaid Fraud 

Control Units, and Federal law 

enforcement agencies; 

(4) Organizations with authority to 

advocate on behalf of individuals who 

experienced the alleged adult 

maltreatment, such as the State LongTerm Care Ombudsman Program and/or 

investigate allegations of adult 

maltreatment such as the Protection and 

Advocacy Systems; 

(5) Emergency management systems, 

and; 

(6) Banking and financial institutions. 

(b) Policies and procedures must, at a 

minimum: 

(1) Address coordination and 

collaboration to detect, prevent, address, 

and remedy adult maltreatment during 

all stages of an adult maltreatment 

investigation conducted by APS or by 

other agencies and organizations with 

authority and jurisdiction to investigate 

reports of adult maltreatment; 

(2) Address information sharing on 

the status and resolution of 

investigations between the APS system 

and other entities responsible in the 

state or other jurisdiction for 

investigation, to the extent permissible 

under applicable State law, and; 

(3) Allow for the establishment of 

memoranda of understanding, where 

appropriate, to facilitate information 

exchanges, quality assurance activities, 

cross-training, development of formal 

multidisciplinary and cross agency 

adult maltreatment teams, co-location of 

staff within appropriate agencies, and 

other activities as determined by the 

State entity. 

§ 1324.407 APS program performance. 

The State entity shall develop policies 

and procedures for APS for the 

collection and maintenance of data on 

investigations conducted by APS 

systems. They shall: 

(a) Collect and report annually to ACL 

such APS system-wide data as required 

by the Assistant Secretary for Aging. 

(b) Develop policies and procedures 

to ensure that the APS system retains 

individual case data obtained from APS 

investigations for a minimum of 5 years. 

§ 1324.408 State plans. 

(a) State entities must develop and 

submit to the Director of the Office of 

Elder Justice and Adult Protective 

Services, the position designated by 42 

U.S.C. 3011(e)(1), a State APS plan that 

meets the requirements set forth by the 

Deputy Assistant Secretary for Aging. 


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(b) The State plan shall be developed 

by the State entity in collaboration with 

APS programs. 

(c) The State plan shall be updated at 

least every five years but as frequently 

as every three years. 

(d) The State plan shall contain an 

assurance that all policies and 

procedures described herein will be 

developed and adhered to by the State 

APS system; 

(e) State plans will be reviewed and 

approved by the Director of the Office 

of Elder Justice and Adult Protective 

Services. Any State dissatisfied with the 

final decision of the Director of the 

Office of Elder Justice and Adult 

Protective Services may appeal to the 

Deputy Assistant Secretary for Aging 

within 30 calendar days of the date of 

the Director of the Office of Elder Justice 

and Adult Protective Services’ final 

decision and will be afforded the 

opportunity for a hearing. If the State is 

dissatisfied with the final decision of 

the Deputy Assistant Secretary for 

Aging, it may appeal to the Assistant 

Secretary for Aging within 30 calendar 

days of the date of the Deputy Assistant 

Secretary for Aging’s decision. 

Dated: September 6, 2023. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2023–19516 Filed 9–11–23; 8:45 am] 

BILLING CODE 4154–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Parts 224 and 226 

[Docket No. 230906–0211] 

RIN 0648–BL86 

Endangered and Threatened Wildlife 

and Plants; Designation of Critical 

Habitat for the Rice’s Whale, Public 

Hearing and Extension of Public 

Comment Period 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Notice of public hearing, 

extension of comment period. 

SUMMARY: We, NMFS, have rescheduled 

a public hearing related to the proposed 

rule to designate critical habitat for the 

Rice’s whale under the Endangered 

Species Act (ESA). We are also 

extending the public comment period 

for this proposed rule to October 6, 

2023. 

DATES: A virtual public hearing on the 

proposed rule will be held online on 

September 28, 2023, from 3 p.m. to 5 

p.m. (Eastern Daylight Time). 

The proposed rule to designate 

critical habitat for the Rice’s whale 

under the ESA was published on July 

24, 2023 (88 FR 47453), and provided 

for a public comment period to 

September 22, 2023. The comment 

period is now extended to October 6, 

2023. Comments must be received by 

October 6, 2023. Comments received 

after this date may not be accepted. 

ADDRESSES: The public hearing will be 

conducted as a virtual meeting, and any 

member of the public can join by 

internet or phone regardless of location. 

You may join the virtual meeting using 

a web browser, a mobile app on a phone 

(app installation required), or—to listen 

only—using just a phone call, as 

specified at this link: https://

www.fisheries.noaa.gov/species/

riceswhale#conservationmanagement. 

You may submit comments verbally at 

the public hearing. You may also submit 

comments in writing by any of the 

following methods: 

• Electronic Submissions: Submit all 

electronic comments via the Federal 

eRulemaking Portal. Go to https://

www.regulations.gov and enter NOAA– 

NMFS–2023–0028. Click on the 

‘‘Comment’’ icon, complete the required 

fields, and enter or attach your 

comments. 

• Mail: Submit written comments to 

Assistant Regional Administrator, 

Protected Resources Division, NMFS, 

Southeast Regional Office, 263 13th 

Avenue South, St. Petersburg, FL 33701. 

Instructions: Comments sent by any 

other method, to any other address or 

individual, or received after the end of 

the comment period might not be 

considered by NMFS. All comments 

received are a part of the public record 

and will generally be posted for public 

viewing on https://www.regulations.gov 

without change. All personal identifying 

information (e.g., name, address, etc.), 

confidential business information, or 

otherwise sensitive information 

submitted voluntarily by the sender will 

be publicly accessible. NMFS will 

accept anonymous comments (enter ‘‘N/ 

A’’ in the required fields if you wish to 

remain anonymous). Attachments to 

electronic comments will be accepted in 

Microsoft Word, Excel, or Adobe 

portable document format (PDF) formats 

only. 

Details on the virtual public hearing 

will be made available on our website 

at: https://www.fisheries.noaa.gov/ 

species/riceswhale#conservation

management. The Endangered Species 

Act Critical Habitat Report, geographic 

information system (GIS) data, and 

maps that were prepared to support the 

development of this proposed rule are 

available on our website at: https://

www.fisheries.noaa.gov/species/

riceswhale#conservationmanagement. 

Previous rulemaking documents related 

to the listing of the species can also be 

obtained electronically on our website 

at: https://www.fisheries.noaa.gov/ 

species/rices-whale#conservation

management. 

FOR FURTHER INFORMATION CONTACT: 

Grant Baysinger, NMFS Southeast 

Region, (727) 551–5790; or Lisa 

Manning, NMFS Office of Protected 

Resources, (301) 427–8466. 

SUPPLEMENTARY INFORMATION: On July 

24, 2023, NMFS published a proposed 

rule to designate critical habitat for the 

endangered Rice’s whale (Balaenoptera 

ricei) under the ESA (88 FR 47453). In 

that notice, we also announced a 60-day 

public comment period, two virtual 

public hearings to be held on August 24, 

2023 and August 30, 2023, and an 

option to request an additional public 

hearing made in writing by September 

7, 2023. On August 24, 2023, we held 

a virtual public hearing. On August 28, 

2023, we canceled the public hearing 

scheduled for August 30, 2023, ahead of 

Hurricane Idalia’s expected landfall. We 

have now rescheduled that public 

hearing to September 28, 2023, from 3 

p.m. to 5 p.m. (Eastern Daylight Time), 

as described in this notice. To 

accommodate this second public 

hearing and provide additional time 

needed to submit public comments 

following the disruptions stemming 

from Hurricane Idalia, we are also 

extending the public comment period to 

October 6, 2023. 

Public Hearing 

The public hearing on September 28, 

2023, will be conducted online as a 

virtual meeting, as specified in 

ADDRESSES above. More detailed 

instructions for joining the virtual 

meeting are provided on our web page 

(see https://www.fisheries.noaa.gov/ 

species/riceswhale#conservation

management). The hearing will begin 

with a brief presentation by NMFS that 

will give an overview of the proposed 

critical habitat designation under the 

ESA. After the presentation, there will 

be a question and answer session during 

which members of the public may ask 

NMFS staff questions about the 

proposed rule. Following the question 

and answer session, members of the 

public will have the opportunity to 

provide oral comments on the record 

regarding the proposed rule. In order to 


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