Medical and Health Services Listings

The listings assembled within this directory catalog the medical and health service categories available within licensed assisted living communities across the United States. Each entry maps to a defined service type, identifies the regulatory frameworks governing that service, and provides structured reference data for researchers, administrators, policy reviewers, and family members conducting comparative evaluations. The scope spans clinical services, therapy disciplines, specialty care programs, and health technology infrastructure as documented through state licensure requirements and federal program guidance.

Geographic Distribution

Assisted living communities operate under state-specific licensure frameworks, with no single federal licensure standard governing the full scope of medical and health services at the community level. As of the 42 U.S. Code § 1396r-5 framework and CMS guidance documents, Medicaid home- and community-based services (HCBS) waivers create a secondary layer of service eligibility that varies by state. The National Center for Assisted Living (NCAL) identifies 50 distinct state regulatory structures, meaning that any service listed here may be required in one jurisdiction and optional or prohibited in another.

Geographic clustering of entries in this directory follows three broad patterns:

1. High-density regulatory states — California, New York, Florida, and Texas maintain among the most detailed assisted living medical service codes, including specific staffing ratio mandates and documented care plan requirements.
2. Certificate-of-need states — 35 states retain some form of certificate-of-need (CON) law (per the National Conference of State Legislatures), which can restrict access to certain skilled clinical services within assisted living settings.
3. Waiver-expansion states — States that have adopted expanded HCBS waiver programs under the Medicaid 1915(c) authority may permit a broader range of nursing and clinical services within non-skilled assisted living environments.

The assisted living medical services overview provides additional context on how these jurisdictional variations affect service availability at the community level.

How to Read an Entry

Each listing in this directory follows a uniform structure to enable consistent comparison across service types and regulatory categories.

1. Service Name — The formal or regulatory name as it appears in state licensure codes or federal program definitions.
2. Service Category — Classification into one of four tiers: Clinical/Nursing, Therapy/Rehabilitation, Specialty/Condition-Specific, or Ancillary/Supportive.
3. Regulatory Anchor — The primary named authority governing the service (e.g., CMS Conditions of Participation, state Department of Health administrative code, or OBRA 1987 requirements for federally certified beds).
4. Staffing Prerequisite — The minimum credential type associated with service delivery, such as Registered Nurse (RN), Licensed Practical Nurse (LPN), Certified Nursing Assistant (CNA), or licensed therapist.
5. Payer Intersection — Whether the service has documented Medicare Part A, Part B, or Medicaid coverage pathways within assisted living settings, based on CMS benefit policy manuals.
6. Scope Boundary — Explicit notation of what the service does not include, distinguishing assisted living delivery from skilled nursing facility (SNF) delivery.

The distinction between service tiers matters operationally. Clinical/Nursing services such as medication management and wound care require licensed personnel at the point of delivery. Therapy/Rehabilitation services such as physical therapy, occupational therapy, and speech therapy require licensed therapists credentialed under state practice acts, distinct from nursing licensure.

What Listings Include and Exclude

Included:

• Services delivered within or arranged by a licensed assisted living community under documented care plan authority
• Services with identifiable regulatory definitions in at least one state's administrative code or in CMS program manuals
• Services commonly addressed in the state regulations governing medical services in assisted living, including infection control protocols (infection control), fall prevention programs (fall prevention medical protocols), and advance directive implementation (advance directives)
• Services with a documented payer pathway through Medicare, Medicaid, or long-term care insurance, as defined in the CMS Medicare Benefit Policy Manual (Publication 100-02)

Excluded:

• Acute hospital services, emergency department services, or intensive care unit-level interventions
• Services exclusively delivered under skilled nursing facility Conditions of Participation (42 CFR Part 483, Subpart B) that have no assisted living analog
• Services offered only in licensed home health agency settings with no community-based assisted living parallel
• Experimental, investigational, or non-covered services under CMS national coverage determinations (NCDs)

The boundary between assisted living and skilled nursing is not uniform across states. The skilled nursing vs. assisted living medical care reference page documents where regulatory overlap and divergence are most pronounced.

Verification Status

Listings carry one of three verification designations based on the currency and specificity of the regulatory source:

• Confirmed — The service category is explicitly named and defined in a current state administrative code, CMS program manual, or published federal statute accessible through the Electronic Code of Federal Regulations (eCFR) at ecfr.gov.
• Cross-Referenced — The service is identified in secondary guidance documents, NCAL surveys, or state ombudsman program records, but lacks a direct eCFR or state code citation at the time of compilation.
• Pending Review — The service has been identified in industry operational contexts (e.g., AHCA/NCAL member surveys or LeadingAge policy briefs) but has not been matched to a named regulatory definition.

No listing in the Confirmed tier constitutes a certification that any individual community provides the service. Regulatory permission to offer a service differs from actual implementation. The care plan development framework and the health assessment at admission process each represent points at which actual service availability is documented at the individual community level, separate from what state code permits in the abstract.