The Indiana Department of Health (“IDOH”) has issued a second public comment notice regarding its proposed amendments to Indiana’s Residential Care Facility (“RCF”) regulations. The proposal, first published earlier this year, would significantly expand resident rights, incorporate federal Home and Community-Based Services (“HCBS”) concepts into Indiana assisted living regulations and establish a new eviction framework governing involuntary resident removals. See our alert on the first published notice here.
While the second notice includes a few limited technical revisions to the proposed rule language, it also contains an extensive summary of stakeholder comments and IDOH’s responses, offering providers important insight into how the agency views the proposal and the likelihood that key provisions will remain in the final rule.
IDOH Rejects Requests for Broader Clinical Exceptions
Providers, trade associations and operators raised concerns regarding several proposed resident rights provisions, including unrestricted visitation, access to food at any time, resident movement and exit rights, medication self-administration and community integration requirements.
Commenters generally requested broader authority to impose clinically necessary restrictions and stronger deference to facility clinical judgment.
IDOH largely declined those requests. In response, the agency repeatedly emphasized that the proposed rule already permits individualized restrictions when supported by physician documentation, person-centered service planning and resident consent. According to IDOH, additional broad “clinical override” language is unnecessary because the proposal already contains mechanisms to address resident-specific safety and care concerns
The agency specifically maintained that provisions concerning visitation, access to food, resident autonomy, room access and medication self-administration appropriately balance resident rights with operational and clinical realities.
Eviction Terminology
Several commenters urged IDOH to abandon the proposal’s shift from traditional “transfer and discharge” terminology to an “eviction” framework. Provider groups expressed concern that the terminology creates confusion and may import landlord-tenant concepts into assisted living operations. Consumer advocates also raised concerns regarding the scope of eviction authority.
IDOH nevertheless elected to retain the eviction structure. The agency explained that federal HCBS requirements contemplate tenant-equivalent protections in residential settings and stated that the eviction framework is intended to align Indiana regulations with those federal expectations while preserving procedural protections for residents.
As proposed, facilities would be limited to specified grounds for eviction, including danger to self or others, certain care needs exceeding facility capabilities, failure to pay, material breach of a resident agreement and facility closure. Residents would continue to receive notice and hearing rights before many involuntary removals.
IDOH’s Regulatory Direction
The second notice suggests that IDOH remains firmly committed to the proposal’s core HCBS principles, including:
- Expanded resident autonomy and self-determination.
- Community integration and employment opportunities.
- Greater resident control over daily schedules and activities.
- Expanded visitation and access rights.
- Enhanced tenant-style protections through rental and resident agreements.
- Formalized eviction review and hearing procedures.
Although providers submitted substantial operational and clinical concerns during the first comment period, IDOH’s responses indicate the agency believes those concerns can be addressed through individualized service planning rather than broad regulatory exceptions.
Key Takeaways for Assisted Living Providers
Providers should view the second notice as a strong indication that IDOH intends to move forward with the proposed HCBS-driven framework substantially as drafted. Facilities should begin assessing how the proposed requirements could affect:
- Residency and rental agreements.
- Resident rights policies.
- Memory care and secured environment practices.
- Medication self-administration policies.
- Visitor and house-rule provisions.
- Discharge and involuntary removal procedures.
- Person-centered service planning processes.
Comment Deadline
The second public comment period remains open through October 9, 2026. RCF providers, trade associations and other stakeholders that continue to have concerns regarding the proposal should consider submitting comments before the deadline.
If you have any questions regarding the proposed Residential Care Facility rule changes, or would like assistance preparing comments for submission to IDOH, please contact:
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- Sean Fahey at (317) 977-1472 or sfahey@hallrender.com;
- Todd Selby at (317) 977-1440 or tselby@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
