Practical guide · Starting an agency
Group home policies and procedures: what to include.
Published 2026-10-28 · Updated 2026-10-29
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.
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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.
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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.
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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.
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What is the difference between a policy, a procedure and a protocol?
A policy states the rule, a procedure gives the steps to follow it, and a protocol gives instructions for one person or one situation. All three belong in your system, but they live in different places and are approved by different people.
For example, your medication policy says only trained staff give medications. The medication pass procedure lists the steps every staff member follows. A seizure protocol for one resident, written with that person's clinician, says exactly what to watch for and when to call 911 for him.
Keep person-specific protocols in the person's record and plan, not in the agency manual. The manual should say how protocols are written, who approves them, how staff are trained on them and where staff find them on shift.
- Policy: what the agency does and why. Approved by leadership.
- Procedure: the numbered steps staff follow. Owned by the manager responsible.
- Protocol: instructions for one person or one situation, often from a clinician.
11 · Starting an agency
How do you write a policy staff will actually follow?
Write it the way the work is really done, in short steps a new DSP can follow on a busy shift. A policy that describes an ideal nobody practices is a finding waiting to happen, because reviewers compare the words with what staff do.
Start by watching the task. Ask two or three experienced staff to walk you through it, then write the steps in the order they happen. Read the draft to a new hire and ask them to do the task from the page. Wherever they stop or guess, the procedure needs another step or plainer words.
Think about who reads it. If many of your staff read English as a second language, keep sentences short and avoid idioms, and consider a translated quick reference with the English policy as the approved version. Pictures of the actual equipment, forms or screens staff use can help more than another paragraph.
- Use plain words and short sentences; define any term a new hire might not know.
- Put one action in each numbered step, and name the role that does it.
- Say what to do when something goes wrong, not only the normal path.
- Say what record the step produces and where it is kept.
- Turn the key steps into a one-page quick reference for the home.
12 · Starting an agency
Which policies should be ready first before a licensing review?
Finish the policies that protect people from the most serious harm first, and keep the records that prove each one is followed beside it. Your state's licensing rules list what is required, so use that list as the final check.
A policy is only half the answer in a review. For each one, be ready to show the training records, the forms it produces and a few real examples, such as a completed incident report with its follow-up or a month of medication records.
Do a practice run. Ask a manager from another home to play the reviewer, request each policy and its proof, and time how long it takes to find them. Anything that takes a long search, or turns up an old version, is worth fixing before the real visit.
- Abuse, neglect and exploitation prevention and reporting.
- Incident reporting, notification and follow-up.
- Medication administration, errors and storage.
- Emergencies, fire drills and evacuation.
- Rights, the HCBS settings rule and grievances.
- Staff screening, training and supervision.
13 · Starting an agency
How do you roll out a new or changed policy to staff?
Tell staff what changed, why it changed and when it takes effect, then train them before the effective date and record that they understood. Emailing a new version and hoping it is read rarely changes practice.
Train by role. A DSP needs the steps they will do on shift; a house manager also needs to know how to check the work. Where a step is hands-on, such as a medication pass or an evacuation, have a supervisor watch each person do it once.
On the effective date, remove the old version from every home binder and shared folder, and keep it in your version history. After a few weeks, pull a sample of records to see whether practice changed.
- Summarize the change in a few sentences staff can read on shift.
- Train before the effective date, by role.
- Check competency for hands-on steps.
- Collect a signed or electronic acknowledgment.
- Retire the old version everywhere it was posted.
- Check real records afterward.
14 · Starting an agency
What should you do when your state changes a rule?
Log the change, find every policy and form it touches, update them, and train staff before the new rule takes effect. Assign one person to watch for changes so updates do not depend on someone noticing by chance.
Useful sources include your state's provider manual and bulletins, your licensing agency, your Medicaid program and federal notices from CMS. Federal changes often reach you through your state: for example, the federal critical incident definition applies to HCBS waivers beginning July 9, 2027, and your state may change its incident categories and forms to match.
Keep a simple change log with the date you learned of the change, the source, the policies affected, the new effective date and the date staff were trained. That log shows a reviewer that your manual keeps up with the rules.
15 · 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.
What is a protocol in a group home?
A protocol is a set of instructions for one person or one situation, such as a seizure or choking protocol written with the person's clinician. It is kept in the person's record and plan, and staff are trained on it before they support that person.
Can we use another agency's policy manual?
You can learn from one, but copying it rarely works. Another agency's manual reflects its own services, staffing and state rules. Write procedures that match how your homes actually work, and check every policy against your own state's requirements.
What happens if staff do not follow a policy?
First make sure the person is safe and the event is reported if required. Then find out why: unclear steps, missing training or a choice. Retrain, fix the procedure or use your agency's discipline process, and record what you did.
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.
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