February 6, 2023  
VIA E-MAIL  
Attn: Tammy Bagby  
Lara-bchs-training@michigan.gov  
RE:  
Comments on Proposed Changes to Administrative Rules for Adult Foster Care Family  
Homes, Rule Set 2022-45 LR  
Dear Ms. Bagby,  
Disability Rights Michigan (DRM) is the private, nonprofit, nonpartisan protection and advocacy  
program mandated to serve Michigan’s disability community. DRM is pleased to have the  
opportunity to comment on the Proposed Administrative Rule changes for Adult Foster Care  
Family Homes as presented by the Department of Licensing and Regulatory Affairs, Bureau of  
Community and Health Systems.  
ADULT FOSTER CARE FAMILY HOMES  
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R 400.1401 (1)(c) Chemical restraint. Modify the definition to mirror the definition from  
the Centers for Medicare and Medicaid Services (CMS). That definition is “any drug  
used for discipline or convenience and not required to treat medical symptoms”.  
DRM appreciates the new language proposed in the definition of “elopement” (R  
400.1401 (1)(f)) as it supports HCBS Rules and doesn’t presume all individuals who live  
in an AFC require constant supervision or that they need permission to leave their  
home.  
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•
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R 400.1401 (1)(J) Incident. Modify the proposed definition to include medication errors  
(…elopes or medication errors) in addition to what is already proposed. This would be  
consistent with the definition of incident used in MCL 333.20106 as it applies to licensed  
homes for the aged.  
R 400.1416a Resident healthcare – 400.1417 Absence without notice. DRM is deeply  
concerned about changes proposed under R 400.1416 (A)(4) – (5), more specifically, the  
removal of the requirements to report an incident/accident to the department 400.1416  
(4), and the removal of the requirement to report an elopement to the department  
400.1417 (1)(a). Removing this layer of reporting weakens protections for residents and  
eliminates the department’s oversight responsibility for reasons that do not support  
vulnerable individuals residing in these facilities. Eliminating the department’s  
opportunities to quickly intervene and/or investigate an incident or elopement  
increases risks unnecessarily to residents and can be interpreted as a convenience and  
in the interest of AFC staff and the department. Additionally, it does nothing to protect  
individuals who do not have an authorized representative or if the incident or  
elopement occurs outside of normal business hours when their representative or  
responsible agency can reasonably be reached. Further, while the proposed language  
in R 400.1416a(4) references what the department can do during a renewal inspection,  
DRM believes this follow-up may occur too long after the event occurred which may  
make interventions and remedies moot.  
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R 400.1416a(1) Incident notification, incident records. Add (f) Medication errors.  
ADULT FOSTER CARE CONGREGATE HOMES  
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R 400.2404(3). Keep language requiring reporting to the department when a serious  
accident requiring medical attention occurs. This allows for timely review and follow-up  
by the department. Eliminating the department’s opportunities to quickly intervene  
and/or investigate an accident increases risks unnecessarily to residents and can be  
interpreted as a convenience and in the interest of AFC staff and the department.  
Removing this layer of reporting weakens protections for residents and eliminates the  
department’s oversight responsibility for reasons that do not support vulnerable  
individuals residing in congregate settings.  
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•
•
DRM appreciates the new language proposed in the definition of “elopement” (R  
400.2404a (1)(b)) as it supports HCBS Rules and doesn’t presume all individuals who live  
in a congregate setting require constant supervision or that they need permission to  
leave their home.  
R 400.2404a (1)(c) Incident. Modify the proposed definition to include medication  
errors (…elopes or medication errors) in addition to what is already proposed. This  
would be consistent with the definition of incident used in MCL 333.20106 as it applies  
to licensed homes for the aged.  
R 400.2404a (2) Incident notification, incident records. Add (f) Medication errors.  
ADULT FOSTER CARE SMALL GROUP HOMES  
•
DRM appreciates the new language proposed in the definition of “elopement” (R  
400.14102 (1)(k)) as it supports HCBS Rules and doesn’t presume all individuals who live  
in an AFC require constant supervision or that they need permission to leave their  
home.  
•
R 400.14102 (1)(o) Incident. Modify the proposed definition to include medication  
errors (…elopes or medication errors) in addition to what is already proposed. This  
would be consistent with the definition of incident used in MCL 333.20106 as it applies  
to licensed homes for the aged.  
•
•
R 400.14311 (1) Incident notification, incident records. Keep language requiring  
reporting to the responsible agency and the department. This allows for timely review  
and follow-up by all parties. Eliminating the responsible agency and department’s  
opportunities to quickly intervene and/or investigate increases risks unnecessarily to  
residents and can be interpreted as a convenience and in the interest of AFC staff and  
the department. Removing this layer of reporting weakens protections for residents  
and eliminates oversight responsibility for reasons that do not support vulnerable  
individuals residing in AFC settings.  
R 400.14311 (1) Add (f) Medication errors.  
ADULT FOSTER CARE LARGE GROUP HOMES  
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•
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DRM appreciates the new language proposed in the definition of “elopement” (R  
400.15102 (1)(k)) as it supports HCBS Rules and doesn’t presume all individuals who live  
in an AFC require constant supervision or that they need permission to leave their  
home.  
R 400.14102 (1)(o) Incident. Modify the proposed definition to include medication  
errors (…elopes or medication errors) in addition to what is already proposed. This  
would be consistent with the definition of incident used in MCL 333.20106 as it applies  
to licensed homes for the aged.  
R 400.15311 (1) Incident notification, incident records. Keep language requiring  
reporting to the responsible agency and the department. This allows for timely review  
and follow-up by all parties. Eliminating the responsible agency and department’s  
opportunities to quickly intervene and/or investigate increases risks unnecessarily to  
residents and can be interpreted as a convenience and in the interest of AFC staff and  
the department. Removing this layer of reporting weakens protections for residents  
and eliminates oversight responsibility for reasons that do not support vulnerable  
individuals residing in AFC settings.  
•
R 400.15311 (1) Add (f) Medication errors.  
Thank you for considering these comments. Please contact Michelle Roberts at DRM,  
mroberts@drmich.org, if you have any questions.  
February 22, 2023  
Department of Licensing and Regulatory Affairs  
Bureau of Community and Health Systems  
Comments on Administrative Rules for Adult Foster Care Providers  
Rule Set 2022-(45 – 48)  
LeadingAge Michigan appreciates the department’s continued efforts to streamline incident and accident  
reporting for Adult Foster Care (AFC) facilities. LeadingAge Michigan supports the proposed changes to AFC  
incident and accident reporting.  
The proposed rule changes will free up hundreds of staff hours. Allowing providers more time to focus on  
providing direct care and a greater ability to fix the root cause of an incident ensuring the health, safety, and  
welfare of the residents being served. We would also like to thank LARA for their communication and time  
conducting the AFC workgroups and we will continue to follow these rules changes as they make their way  
through the administrative rules process.  
In closing, LeadingAge Michigan would like to thank LARA and the AFC workgroup for their time developing these  
rule changes and support the rule changes.  
Sincerely,  
Dalton Herbel  
Vice President of Public Policy  
dalton@leadingagemi.org  
517-323-3687  
201 N. Washington Square | Suite 920 | Lansing, MI 48933  
P 517-323-3687 | F 517-323-4569 | LeadingAgeMI.org  
Expanding the world of possibilities for aging.  
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