Practical guide · Starting an agency
Group home policies and procedures: what to include.
Published 2026-10-28 · Updated 2026-10-28
Policies say what your agency does; procedures say how staff do it, step by step. Licensing reviewers, Medicaid auditors and your own staff all rely on them. This guide lists the policy areas most IDD residential providers need and what each should cover. It is not legal advice: your state's licensing rules, provider manual and Medicaid program decide what is required, so check them and have a qualified advisor review your manual.
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Key points
The short version.
- Use one format for every policy, with version dates.
- Build rights and the HCBS settings rule into the manual.
- Name the reporting agencies and deadlines your state sets.
- Write medication procedures the way the pass is actually done.
- Keep proof of screening and training for every employee.
- Train, review yearly and test policies against real records.
01 · Starting an agency
Write each policy in the same format.
A consistent format makes a manual easier to follow, train on and audit. Most agencies use the same headings for every policy, and keep a version history so they can show which rules applied on a given date.
- Purpose and scope: why the policy exists and who it applies to.
- Definitions of the terms used.
- The policy statement.
- Procedure: numbered steps, with the role responsible for each.
- Forms and records the procedure produces.
- Related state rules and federal requirements.
- Effective date, review date and approval.
02 · Starting an agency
Rights, choice and the HCBS settings rule.
Homes paid through Medicaid HCBS must meet the federal HCBS settings rule (42 CFR 441.301(c)(4)). Your rights policy should cover a lease or residency agreement, privacy in each person's room with lockable entrance doors, choice of roommates, freedom to furnish and decorate, control of schedules and access to food at any time, visitors at any time, physical accessibility and access to the wider community.
Include how a right may be limited: only through the person's plan, with the eight documented conditions the rule requires. Add a grievance procedure that explains how the person or their family can complain, who responds and how quickly, and that no one is punished for complaining.
03 · Starting an agency
Abuse, neglect and exploitation.
Define abuse, neglect and exploitation the way your state does, and explain prevention, recognition and reporting. State law decides who must report, to which agency and how fast; your procedure should name them.
Procedures usually cover making the person safe first, getting medical care, reporting to the required agencies, preserving evidence, separating the accused staff member from the person where required, cooperating with investigations and protecting the person who reports from retaliation.
04 · Starting an agency
Incident reporting and follow-up.
List the incident categories and deadlines your state uses, who writes the report, who reviews it, who notifies the guardian, case manager and state, and how corrective actions are assigned and tracked to completion.
Federal Medicaid rules adopted in 2024 set a minimum definition of critical incidents for HCBS waivers, which states must apply beginning July 9, 2027. Write your policy to match your state's categories now and update it as your state changes them.
05 · Starting an agency
Medication administration.
Cover who may give medications and the training or certification your state requires, how orders are received and checked, how each dose is documented on the medication administration record (MAR), PRN (as-needed) medications, refusals, errors and how they are reported, storage, disposal and counts for controlled substances.
Make the procedure match what staff actually do on a medication pass, step by step, so it can be trained and observed.
06 · Starting an agency
Health, safety and emergencies.
Include fire safety and evacuation drills, medical emergencies and when to call 911, a missing-person procedure, severe weather and loss of power, infection control and nutrition or special diets.
If anyone in the home has a behavior support plan, add how plans are developed by qualified professionals, how staff are trained on them and the limits on restrictive interventions under your state's rules and the federal settings rule.
07 · Starting an agency
Staff hiring, training and supervision.
Describe screening before anyone works alone: criminal background checks, registry checks your state requires and the federal OIG List of Excluded Individuals/Entities. Cover required training and how competency is checked, supervision, staffing coverage for each shift, conduct and confidentiality.
Say where proof is kept: completion dates, expiration dates and supervisor sign-off belong in each employee's file.
08 · Starting an agency
Records, privacy and documentation.
Cover HIPAA privacy and security for health information, how long records are kept (your state and Medicaid program set minimums), documentation standards for daily notes and corrections, who may access records and how the person can see their own.
Include how late entries and corrections are made, because reviewers look for erased or overwritten records.
09 · Starting an agency
Personal funds and property.
If staff help people manage money, describe how funds are kept, how purchases are approved and receipted, how balances are reconciled and who reviews them. Keep a personal property inventory for each person, updated when items are added or lost.
10 · Starting an agency
Keep policies working, not just written.
Train staff on each policy at hire and when it changes, and keep their acknowledgment. Review the manual at least once a year and when your state's rules change.
Then test it: pick a policy, follow one real event through the records and see whether staff did what the procedure says. That gap is what a reviewer will find.
Questions people ask
Short answers.
Is there a free group home policies and procedures template?
Templates can help you start, but every policy has to match your state's licensing rules and Medicaid program. Use this guide's list as an outline, then check each section against your state's requirements.
How often should group home policies be updated?
Review the manual at least once a year and whenever state or federal rules change. Record the effective date of each version.
Do staff need to sign the policies?
Reviewers commonly expect proof that staff were trained on current policies. A signed acknowledgment or training record in each employee file is the usual evidence.
Who approves group home policies?
Your agency's governing body or administrator, as your bylaws and state rules require. Keep the approval date with each version.
Where does LunahUP fit with policies and procedures?
LunahUP keeps the records your policies produce connected, such as staff requirements, incident follow-up, medication documents and daily notes. Your agency writes and approves its own policies.
Sources
Check the official source.
Requirements change and differ by state. Confirm current rules with your state agencies and payers.
Keep the work connected
Related LunahUP workflows.
Plan the records your policies require
Bring the policy your reviewers check most.
Inspect fictional staff, incident and medication records, and the follow-up each one leaves for your team.
Book a 30-minute compliance demoUse sample data. No patient or employee records needed for the demo. Booking does not create an account or start billing.