Assisted Living FAQs: Application and Licensing

New background studies are not necessary for those that have a current eligible study affiliated with the license being renewed. New background studies will need to be completed for any recently added owners or managerial officials with direct contact.

If you have an existing background study for someone at one facility, you can affiliate the person’s background study to another facility if the Sensitive Information Person (SIP) is the same.

Affiliation is the process of adding a subject with a completed study onto another's HFID roster without submitting a new study. For instructions on how to add an affiliation record when permissible, refer to the Help section in NETStudy 2.0: NETStudy 2.0 User Manual, page 79 or training video Roster part 2.

When a license is closed, the record is removed from NETStudy 2.0, and the roster is made inactive. Affiliation records to add background study subjects to an active roster must be completed prior to the license closing.

DHS Background Studies are not able to re-open your license once it has been closed. If you have individuals that require a DHS background study and they are not on an active NETStudy 2.0 roster, you must submit new background studies.

Pursuant to Minnesota Statutes § 144G.13, Subd 1 (a), only managerial officials who provide direct contact as defined by Minnesota Statutes § 144G.08, Subd. 22, and owners, are subject to the background study requirements. Notwithstanding the individual background study requirements during the license application process, no person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C.

Note that this response is specific to the background study requirements noted in Minnesota Statutes § 144G.13 concerning ownership, managerial officials, and controlling individuals. Applicants are subject to all other background study requirements noted in statute, including those noted in Minnesota Statutes Chapter 245C.

Per the definition of "Owner" noted in Minnesota Statutes § 144G.08, Subd. 48, "owner of a nonprofit corporation" means the president and treasurer of the board of directors. For the purpose of filling in ownership information for a nonprofit corporation on a Renewal or Provisional Assisted Living Facility License Application, applicants should list the nonprofit corporation as holding 100% of the ownership interest. The President of the Board of Directors and the Treasurer should be listed as owners with 0% ownership interest. The President and Treasurer will be subject to background study requirements.

Although not considered owners, other members of the board of directors may be controlling individuals under Minnesota Statutes § 144G.08, Subd. 15; however, pursuant to Minnesota Statutes § 144G.13, Subd 1 (a), only managerial officials who provide direct contact as defined by Minnesota Statutes § 144G.08, Subd. 22, and owners, are subject to the background study requirements. Notwithstanding the individual background study requirements, no person may be involved in the management, operation, or control of an assisted living facility if the person has been disqualified under chapter 245C.

Please note that this response is specific to the background study requirements noted in Minnesota Statutes § 144G.13 concerning ownership, managerial officials, and controlling individuals. Applicants are subject to all other background study requirements noted in statute, including those noted in Minnesota Statutes Chapter 245C.

Once MDH has received your license fee payment, DHS/NETStudy is notified with the applicant’s information. DHS then provides the authorized agent all relevant information via the onboarding email.

The Authorized Agent will log into NETStudy 2.0. Under Applications, click on Application Forms and find the document for SIP changes (Request to Change Background Studies Sensitive Information Person (SIP)). Complete the form and submit it electronically.

The Authorized Agent will click on this link: Request to Change Background Study SIP .

No. You can hold an assisted living license in one building and an assisted living with dementia care for another one.

Yes, unless you meet the campus definition as above.

No. Per definition you will be required to license each of these entities separately.

Complete the Assisted Living Facility Change of Ownership (CHOW) Application. Remember to include the existing licensee's Health Facility ID (HFID).

Any updates to ownership that do not require a new license can be noted on your next license renewal. Any required background studies should be completed immediately.

Per 144G.90 Subd. 5 a facility must provide written notice to the resident, legal representative, or designated representative of a change of ownership within seven calendar days after the facility receives a new license.

The current licensee is responsible for the operation of the facility in compliance with 144G until the new license is issued.

The Minnesota Department of Human Services (DHS) oversees the customized living services program.

Yes. The new assisted living licensure law impacts all customized living services funded by Elderly Waiver (EW), Brain Injury Waiver (BI) and Community Access for Disability Inclusion (CADI) Waivers. The provider requirements for delivering customized living services are found in Minnesota Statutes 256S.20, subd. 1.

If you have questions for the Minnesota Department of Human Services (DHS) regarding customized living services provider enrollment, please contact the DHS Provider Resource Center at 651-431-2700 (option 3).

The Elderly Waiver (EW), Brain Injury Waiver (BI) and Community Access for Disability Inclusion (CADI) customized living service is the Medicaid Home and Community-Based Services (HCBS) waiver assisted living service. The provider requirements for delivering customized living services are found in Minnesota Statutes 256S.20 subd. 1. Additionally, the customized living services policy page communicates the service requirements, including the HCBS setting requirements and the location, size, and age limitations specific to the BI and CADI waiver programs in the setting requirements section.

In order to receive Medicaid reimbursement for delivery of customized living services, a provider must complete the provider enrollment process for each customized living service setting with the Minnesota Department of Human Services (DHS). If all program and service policies requirements are not met, Medicaid reimbursement is not allowed.

The Minnesota Department of Health (MDH) is responsible for the assisted living license requirements. If you have questions for MDH regarding assisted living license requirements, please contact health.assistedliving@state.mn.us.

DHS is responsible for the HCBS waiver program and services. If you have questions for DHS regarding customized living policies for customized living services, please use the DSD contact form for questions related to the BI and CADI or email Dhs.aasd.hcbs@state.mn.us for questions related to the EW. If you have questions regarding DHS provider enrollment, please contact the DHS Provider Resource Center at 651-431-2700 (option 3).

Yes. The size limitation applies to CL, or 24-hour CL settings operational on or after May 1, 2001, and before Jan. 11, 2021. The size limitation does not apply to:

• CL settings developed before May 1, 2001, that have continuously provided CL waiver services.
• CL or 24-hour CL services funded by the Elderly Waiver (EW).

For residents younger than age 55, up to four residents who are unrelated to the principal care provider may reside in a CL setting.

Yes. Although an assisted living license allows a provider to admit persons aged 18 and above, if a provider is enrolled with DHS as a CL provider, an age restriction exists. If the provider is operational on or after Jan. 11, 2021, and serves persons on a CADI or BI waiver, then the provider may only serve people aged 55 and older. For a list of settings, refer to CBSM – CL provider settings only allowed to serve people on the BI and CADI waivers who are age 55 and older.

For questions about customized living, call the MHCP Provider Resource Call Center at 651-431-2700 (option 3). This contact form may be helpful as well for policy-specific questions: DSD Contact Form.

These are also some helpful website links:

• CBSM - Customized living (including 24-hour customized living)
• License requirement changes for customized living services providers / Minnesota Department of Human Services

It is the number of residents a facility chooses to be licensed for. Please refer to the definition of "resident." "Resident" means a person living in an assisted living facility who has executed an assisted living contract (related statute: 144G.08 Subd. 59). Therefore, any individual residing in the facility will be counted in the planned resident capacity.

Facilities are required to license to the highest denominator as there is only one license allowed per building. In this scenario, the building would be required to hold the assisted living with dementia care license. Referring to the top then, the fee would be the $3,000 plus $100 per planned resident capacity.

Current comprehensive home care providers who do not intend to provide home care services under 144A on or after August 1, 2021:

• Shall be issued a comprehensive home care license for a prorated license period upon renewal, effective for license renewals beginning on or after September 1, 2020.
• The prorated license period shall be effective from the provider's current comprehensive home care license renewal date through July 31, 2021.
• Comprehensive home care providers with prorated license periods shall pay a prorated fee based on the number of months the comprehensive home care license was in effect.
• Comprehensive home care providers using the prorated license or who otherwise do not intend to provide home care services after August 1, 2021, must notify the recipients of changes to their home care services in writing at least 60 days before the expiration of the provider's home care license, or no later than May 31, 2021, whichever is earlier.

Please see Minnesota Statutes § 144G.191, Subd. 3(c)(1)-(5) for the specific information you must include in the notice.

In statute definition 144G.08 Subd. 8, "Assisted living facility with dementia care" means a licensed assisted living facility that is advertised, marketed, or otherwise promoted as providing specialized care for individuals with Alzheimer's disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care.

If you do not plan to market or promote providing specialized care for dementia, and will not have a secured unit, then you will apply for the Assisted Living License. If your "dementia unit" is secured in any way, then the entire building will need to be licensed as an Assisted Living with Dementia Care license.

Facilities are required to license to the highest denominator as there is only one license allowed per building. In this scenario, the building would be required to hold the assisted living with dementia care license.

In statute definition 144G.08 Subd. 8: "Assisted living facility with dementia care" means a licensed assisted living facility that is advertised, marketed, or otherwise promoted as providing specialized care for individuals with Alzheimer's disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care.

In statute definition 144G.08 Subd. 62: "Secured dementia care unit" means a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident's ability to exit, the secured area or setting. A secured dementia care unit is not solely an individual resident's living area.

In conclusion, if the 4–5-bedroom house meets the above two definitions, then yes. The determining factor is, does the resident have the freedom to leave the "unit" of their own volition.

In statute definition 144G.08 Subd. 62: "Secured dementia care unit" means a designated area or setting designed for individuals with dementia that is locked or secured to prevent a resident from exiting, or to limit a resident's ability to exit, the secured area or setting. A secured dementia care unit is not solely an individual resident's living area.

Please use the definition to determine the unique specifications for your facility.

In statute definition 144G.08 Subd. 8: "Assisted living facility with dementia care" means a licensed assisted living facility that is advertised, marketed, or otherwise promoted as providing specialized care for individuals with Alzheimer's disease or other dementias. An assisted living facility with a secured dementia care unit must be licensed as an assisted living facility with dementia care.

Based on the above definition, if the plan is to market the facility as "providing specialized care for individuals" with dementias, then yes.

You will not be penalized if you pick a number too high to be licensed for and do not fill to that number, but fines will be issued if you indicate your capacity is lower than what your census truly is at any point.

Yes, your licensed resident capacity can be changed one of two ways:

• During your next license renewal, you will have the opportunity to increase or decrease your licensed resident capacity to fit your business plans more adequately for the next license period. In addition to making changes to your application in ICSD, you will need to submit a formal request along with supporting documentation for review and approval to health.assistedliving@state.mn.us.
• At any point during your current licensing period, you can submit a formal request to increase or decrease your current licensed resident capacity, along with supporting documentation to MDH for review and approval.

The request forms can be found under the Requests section of the Assisted Living Forms and Self-Audit Tools page.

The 2021 Minnesota Legislature established a customized living setting moratorium affecting new BI and CADI customized living settings developed in single-family homes. Effective July 1, 2021, DHS cannot enroll any new customized living settings licensed to serve four or fewer people in single-family homes for delivery of BI and CADI customized living or 24-hour customized living, per Minnesota Statutes §256B.49, subd. 28.

For more information about the customized living moratorium, see the customized living services policy page.

The assisted living license allows the license holder to serve an adult, as defined in Minnesota Statutes 144G.08 subd. 2, up to the licensed resident capacity. Customized living is Minnesota’s Medicaid Home and Community-Based Services (HCBS) waiver assisted living service. There are additional requirements the license holder must follow to be eligible for Medicaid reimbursement through the Elderly Waiver (EW), Brain Injury Waiver (BI) and Community Access for Disability Inclusion (CADI) waiver programs customized living service.

To receive Medicaid reimbursement for the customized living services, the provider must comply with the assisted living license requirements and the HCBS waiver customized living services requirements. When supporting people on the BI and CADI waiver programs, providers must follow the customized living services requirements, including the location, size, and age limitations as communicated in the setting requirements section. There is no exception to the BI and CADI waiver age limitation.

For more information about the customized living service, see the customized living services policy page.

If you have questions for the Minnesota Department of Human Services (DHS) regarding customized living services provider enrollment, please contact the DHS Provider Resource Center at 651-431-2700 or 800-366-5411 (option 3).

The following are acceptable alternatives to submit with your application while you wait for the SS-4:

• Computer-generated notice that was issued by the IRS when the applicant first applied for the FEIN. This notice is issued as a confirmation of the application for, and receipt of an FEIN.
• If the applicant used the FEIN to open a bank account or apply for any type of state or local license, they may contact the bank or agency to secure the FEIN and send confirmation to MDH.
• Appropriately redacted first page of an as-filed tax return (1120, 990, 1065, 941, 943, 1099-NEC, W-4, 5500).
• IRS determination letter for tax-exempt organizations.
• Printout/screenshot of search results showing the organization as listed in IRS Pub 78 for tax-exempt organizations (see https://www.irs.gov/charities-non-profits/search-for-tax-exempt-organizations)
• Listing in an as-filed 990 group return.
• S-Corp election confirmation.
• Any other correspondence from the IRS that includes the organization's tb and FEIN (for example, an audit notice letter, a request for documents, a notice of late filing of a tax return, etc.) provided the documentation is issued by the IRS and include information sufficient to confirm the identity of the business and the corresponding FEIN.

You can email it to the health.assistedliving@state.mn.us email box and we will attach it to your application file.