Assisted Living Resources & FAQs - Minnesota Department of Health

Assisted Living Resources & Frequently-Asked Questions (FAQs)

Application Process

All information related to the application process is available on the Application Materials page.

Assisted Living Contract

An "assisted living contract" means the legal agreement between a resident and an assisted living facility for housing and, if applicable, assisted living services.

The contract should include all the terms concerning the provision of:

  • housing
  • assisted living services
  • the resident's service plan, if applicable
Related Statutes: 144G.08 Subd. 5, 144G.50

Refer to 144G.50 for the items required in an assisted living contract.

No. Each provider will be responsible for drafting their own contract with all the required elements.

Yes. It doesn't matter if someone is receiving services or not, they are all considered residents. Please refer to the definition of resident in statute 144G.09, Subd. 59. A resident will have a contract for housing at the very least. A service agreement may be added later as needed.

Adding this information to the assisted living contract is not required per 144G. There is a statute under the Minnesota Board on Aging (256.975) that requires prospective residents to call the Senior Linkage Line (SLL) prior to making a "long term care" choice. MDH has added this language to the Uniform Disclosure of Assisted Living Services & Amenities (UDALSA) so prospective residents call the SLL before signing an assisted living contract for objective counseling and support in making an informed decision.

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Background Studies

Each application must include documentation of compliance with the background study requirements in section 144G.13 for the owner, controlling individuals, and managerial officials.

Prior to a license being issued, a managerial official or a natural person who is an owner with direct ownership interest is required to undergo a background study under section 144.057.

A license will not be issued if any controlling individual, including a managerial official, has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C.

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.

Definitions:

144G.08 Subd. 48. Owner: means an individual or legal entity that has a direct or indirect ownership interest of five percent or more in a licensee. For purposes of this chapter, "owner of a nonprofit corporation" means the president and treasurer of the board of directors or, for an entity owned by an employee stock ownership plan, means the president and treasurer of the entity. A government entity that is issued a license under this chapter shall be designated the owner.

245A.02 Subd. 5a. Controlling individual: means an owner of a program or service provider licensed under this chapter and the following individuals, if applicable:

  • (1) each officer of the organization, including the chief executive officer and chief financial officer;
  • (2) the individual designated as the authorized agent under section 245A.04, subdivision 1, paragraph (b);
  • (3) the individual designated as the compliance officer under section 256B.04, subdivision 21, paragraph (g);
  • and
  • (4) each managerial official whose responsibilities include the direction of the management or policies of a program.
  • (5) For purposes of this subdivision, "managerial official" means an individual who has the decision-making authority related to the operation of the program, and the responsibility for the ongoing management of or direction of the policies, services, or employees of the program. A site director who has no ownership interest in the program is not considered to be a managerial official for purposes of this definition.

144G.08 Subd. 15. Controlling individual: means an owner and the following individuals and entities, if applicable:

  • (1) each officer of the organization, including the chief executive officer and chief financial officer;
  • (2) each managerial official;
  • and
  • (3) any entity with at least a five percent mortgage, deed of trust, or other security interest in the facility.

144G.08 Subd. 36. Managerial official: means an individual who has the decision-making authority related to the operation of the facility and the responsibility for the ongoing management or direction of the policies, services, or employees of the facility. Per 144G.13, for purposes of background studies, this only pertains to individuals who provide direct contact.

245C.02 Subd. 11. & 144G.08 Subd. 22 Direct contact: means providing face-to-face care, training, supervision, counseling, consultation, or medication assistance to persons served by the program.

Related Statutes: 144G.12 Subd. 1 (6), 144G.13, 144.057, 245C

No. If there is already a background check completed from the homecare ownership it simply needs to be "affiliated" with the 144G licensure via NetStudy 2.0 portal.

Providers will want to affiliate the controlling individual under that identification number. With that affiliation, a new background study request will not be needed. See the previous question and answer.

Yes. Section 144G.13, subd. 1(b) makes it clear that a license cannot be issued if "any controlling individual, including a managerial official, has been unsuccessful in having a background study disqualification set aside under section 144.057 and chapter 245C." This implies those individuals must have either a clear background study or be successful in having a disqualification set aside under the stated statutes.

Per the definition of "Owner" noted in Minn. Stat. § 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 Conversion 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 Minn. Stat. § 144G.08, Subd. 15; however, pursuant to Minn. Stat. § 144G.13, Subd 1 (a), only managerial officials who provide direct contact as defined by Minn. Stat. § 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 Minn. Stat. § 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 Minn. Stat. Chapter 245C.

No. If there is already a background check completed it simply needs to be "affiliated" with the 144G licensure via NetStudy 2.0 portal.

Once MDH has receipt of payment, a notice is sent to DHS/NetStudy with the Applicant's information so DHS can send the applicant information to onboard for Background Studies.

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Bedrails

Assisted living and home care providers must ensure residents or clients choosing to use portable bed rails are assessed for appropriateness and safety.

Per the FDA: "Bed rails are used by many people to help create a supportive and assistive sleeping environment in homes, assisted living facilities and residential care facilities. This type of equipment has many commonly used names, including side rails, bed side rails, half rails, safety rails, bed handles, assist bars, or grab bars, hospital bed rails, and adult portable bed rails."

References for accepted health standards:

Related Statutes: 144G.91 Subd. 4, 144G.41 Subd. 1(2), 144A.44 Subd. 1

Consumer Bed Rails

Unlike hospital beds, there is no current published guidance related to portable bed rails used on non-hospital style beds ("consumer beds"), so licensees should refer to individual manufacturer's guidelines for appropriate installation, maintenance and use. In addition, licensees should refer to the Consumer Product Safety Commission (CSPC) for the most up-to-date information related to portable bed side rail recall information.

To ensure an individual is an appropriate candidate for a bed rail, the licensee must assess the individual's cognitive and physical status as they pertain to the bed rail to determine the intended purpose for the bed rail and whether that person is at high risk for entrapment or falls. This may include assessment of the individual's incontinence needs, pain, uncontrolled body movement or ability to transfer in and out of bed without assistance. The licensee must also consider whether the bed rail has the effect of being an improper restraint.

Additionally, the licensee must ensure the bed rail is securely attached to the bed frame per manufacturer guidelines. This includes consideration of any identified contradictions of use such as height/weight restrictions, age, mattress, bed frame set up, etc.

Per the Uniform Assessment Tool, the need for assistive devices, such as bed rails, must be assessed upon initial installation, with each 90-day assessment and change of condition. (Please refer to Rule 4659.0150 where it directs assessment of mobility, including ambulation, transfers, and assistive devices.) Bed rail assessment should also be conducted whenever the type of bed rail is changed or if the rails is observed to not maintain a consistent secure attachment to the bed frame.

Even when bed rails are used according to manufacturer's guidelines, they can present a hazard. The licensee must ensure the resident and/or resident's responsible party has been educated on the risk for injury up to and including death due to entrapment.

The licensee is responsible for the safety and appropriateness of all portable bed rails in the licensee's facility for residents/clients receiving assisted living/home care services. Licensees should have a process in place for monitoring and unlicensed personnel reporting new bed rails for nurse assessment. This is also true for hospital beds delivered to the licensee's facility (for example, upon a resident's admission to a hospice service).

If a problem is found, both the assisted living facility and the home care or hospice agency can be held responsible if proper protocols are not followed.

The licensee should offer alternatives, discuss and offer interventions to mitigate safety risks, and ensure the portable bed rail is installed and secured per manufacturer's guidelines. If the licensee elects to utilize a negotiated and/or mitigated risk agreement, the licensee must maintain documentation of the offer of alternative, interventions to mitigate safety risks and conduct ongoing reassessment for the appropriate use of a bed rail.

If a licensee is unable to locate manufacturer's guidelines, they are unable to assess and determine if the portable bed rail is being used appropriately and installed properly. This results in an imminent safety risk for the resident/client.

The United States Consumer Product Safety Commission (CSPC) works to save lives and ensure safety by reducing the unreasonable risk of injuries and deaths associated with consumer products, such as portable bed rails. The CSPC posts information on its website related to portable bed rail recalls. Licensees should review the CSPC website regularly for updates on recalled portable bed rails. The opportune time to do this would be with the 90-day assessment due to the requirement included in the uniform assessment tool for assessing assistive devices.

One such element/performance/skill a prudent nurse performs is the documentation of all assessed data. If any aspect of patient care is not documented, it is viewed as not having been completed. Based on the above-mentioned statutes, the nurse must also abide by accepted health care standards, and the use of portable bed rails according to manufacturer's guidelines is one of those accepted standards. Documentation about a resident's bed rails includes, but is not limited to:

  • Purpose and intention of the bed rail
  • Condition and description (i.e., an area large enough for a resident to become entrapped) of the bed rail
  • The resident's bed rail use/need assessment
  • Risk vs. benefits discussion (individualized to each resident's risks)
  • The resident's preferences
  • Installation and use according to manufacturer's guidelines
  • Physical inspection of bed rail and mattress for areas of entrapment, stability, and correct installation
  • Any necessary information related to interventions to mitigate safety risk or negotiated risk agreements

Ensure that:

  • An assessment was completed;
  • the bed rails were determined to not act as a restraint;
  • the portable bed rails were installed and maintained according to the manufacturer's guidelines;
  • the manufacturer's guidelines are accessible upon request (hint: you may need to search the bed rail for identifying manufacture and model number, and/or do a Google search to download the installation and maintenance instructions);
  • and the risk vs. benefits were discussed and documented with the resident/responsible party.

Hospital-style Bed Rails

To ensure an individual is an appropriate candidate for a bed rail, the licensee must assess the individual's cognitive and physical status as they pertain to the bed rail to determine the intended purpose for the bed rail and whether that person is at high risk for entrapment or falls. This may include assessment of the individual's incontinence needs, pain, uncontrolled body movement or ability to transfer in and out of bed without assistance. The licensee must also consider whether the bed rail has the effect of being an improper restraint.

Additionally, the licensee must ensure the bed rail measurements are documented and that the bed rail has not shifted and is securely attached to the bed frame per manufacturer recommendations.

Per FDA recommendations, the need for bed rails must be assessed on a "frequent, regular basis." At a minimum this would include assessment of the bed rail upon initial installation, with each 90-day assessment, or with a change of condition. (Please refer to Rule 4659.0150 where it directs assessment of mobility, including ambulation, transfers, and assistive devices to be completed as part of the uniform assessment.)

Even when bed rails meet the FDA guidelines and are used appropriately, they can present a hazard. The licensee must ensure the resident and/or resident's responsible party has been educated on the risk for injury up to and including death due to entrapment.

Per the FDA guidelines, "High-risk people include those with pre-existing conditions such as confusion, restlessness, lack of muscle control, or a combination of these factors. Additionally, people who are cognitively impaired from the use of medication or from a medical condition, such as Alzheimer's or dementia, are at a higher risk of entrapment and injury."

The licensee is responsible for the safety and appropriateness of all portable bed rails in the licensee's facility for residents/clients receiving assisted living/home care services. Licensees should have a process in place for monitoring and unlicensed personnel reporting new bed rails for nurse assessment. This is also true for hospital beds delivered to the licensee's facility (for example, upon a resident's admission to a hospice service).

If a problem is found, both the assisted living facility and the home care or hospice agency can be held responsible if proper protocols are not followed.

Per the FDA recommendations, "evaluating the dimensional limits of the gaps in hospital beds is one component of an overall assessment and mitigation strategy to reduce entrapment," and "regardless of mattress width, length, and/or depth, the bed frame, bed side rail, and mattress should leave no gap wide enough to entrap a patient's head or body." The licensee should offer alternatives, discuss and offer interventions to mitigate safety risks, and ensure the bed rail is installed and secured per manufacturer's recommendations. If the licensee elects to utilize a negotiated and/or mitigated risk agreement, the licensee must maintain documentation of the offer of alternative interventions to mitigate safety risks and conduct ongoing reassessment for the appropriate use of a bed rail.

One such element/performance/skill a prudent nurse performs is the documentation of all assessed data. If any aspect of patient care is not documented, it is viewed as not having been completed. Based on the above-mentioned statutes, the nurse must also abide by accepted health care standards, and the FDA requirements related to the safety of bedrails is one of those accepted standards. Best practice for documentation about a resident's bed rails includes, but is not limited to:

  • Purpose and intention of the bed rail
  • Measurements
  • The resident's bed rail use/need assessment
  • Risk vs. benefits discussion (individualized to each resident's risks)
  • The resident's preferences
  • Physical inspection of bed rail and mattress for areas of entrapment, stability, and correct installation
  • Any necessary information related to interventions to mitigate safety risk or negotiated risk agreements

Ensure that:

  • An assessment was completed;
  • measurements were completed and documented;
  • the rails were FDA compliant;
  • and the risk vs. benefits were discussed and documented with the resident/responsible party.

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Campus Definition

The definition for a campus is contained in the 7th Special Session language under 144G.08 Subd. 4a: "Assisted living facility campus" or "campus" means:

  1. a single building having two or more addresses, located on the same property with a single property identification number;
  2. two or more buildings, each with a separate address, located on the same property with a single property identification number; or
  3. two or more buildings at different addresses, located on properties with different property identification numbers, that share a portion of a legal property boundary.
Related Statutes: 144G.08 Subd. 4a

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.

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Change of Ownership (CHOW)

An assisted living facility license may not be transferred to another party. A prospective licensee must apply for a license prior to operating a currently licensed assisted living facility. The applicant is required to submit "written notice" to the department at least 60 days prior to the anticipated CHOW date. Preferably this notice would be in the form of the application and attachments.

A new license is required whenever one of the following events occur:

  • the form of the licensee's legal entity structure is converted or changed to a different type of legal entity structure;
  • the licensee dissolves, consolidates, or merges with another legal organization and the licensee's legal organization does not survive;
  • within the previous 24 months, 50 percent or more of the licensee is transferred, whether by a single transaction or multiple transactions, to:
    • a different person;
    • a person who had less than a five percent ownership interest in the facility at the time of the first transaction;
  • any other event or combination of events that results in a substitution, elimination, or withdrawal of the licensee's responsibility for the facility.

If you have a specific scenario you would like to discuss, email the details of your scenario, along with the facility HFID to health.assistedliving@state.mn.us.

Related Statutes: 144G.19, 144G.90 Subd. 5

Complete the Provisional Assisted Living Licensure Information and Application (PDF). Under Type of Application, select Initial license resulting from a change in ownership. 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.

It is recommended that CHOW applicants submit a Sections 144G.45 or 144G.81 Waiver Request (PDF) for the physical environment section of your application. Without an approved waiver, CHOW applicants are subject to the applicable minimum site, physical environment, and fire safety requirements noted in 144G.45 and 144G.81. The waiver should be uploaded along with the application into the MDH Facility and Provider Licensing System and submitted under "Other" document type. The waiver must be filled out completely and must be appropriately verified via signature by the applicant owner or authorized agent to be considered. Waiver requests will be evaluated based upon criteria noted in 144G.45 Subd. 7(b).

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Dementia Care Training

An assisted living facility with dementia care must provide residents with dementia-trained staff who have been instructed in the person-centered care approach. All direct care staff assigned to care for residents with dementia must be specially trained to work with residents with Alzheimer's disease and other dementias. The persons providing or overseeing staff training are required per statute to have experience and knowledge in the care of individuals with dementia, including:

  • two years of work experience related to Alzheimer's disease or other dementias, or in health care, gerontology, or another related field; and
  • completion of training equivalent to the requirements in this section and successfully passing a skills competency or knowledge test required by the commissioner per 144G.83 Subd. 3(2).

Related Statutes: 144G.83

Per 144G.83 Subd. 3 anyone providing or overseeing staff training pertaining to dementia care must pass a skills competency or knowledge test required by the commissioner. MDH recommends the essentiALZ® Exam from Alzheimer's Association.

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Food Code Requirements

All assisted living facilities shall offer to provide or make available at least the following services to residents:

  • At least three nutritious meals daily, with snacks available seven days per week.
  • Food is prepared according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines.
  • Facilities must include seasonal fresh fruit and fresh vegetables.
  • Menus must be prepared at least one week in advance, and made available to all residents.
  • The facility must encourage residents' involvement in menu planning.
  • Meal substitutions must be of similar nutritional value if a resident refuses a food that is served.
  • Residents must be informed in advance of menu changes.
  • Food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626.

As a result of the new licensing requirements, kitchens in licensed Assisted Living facilities are regulated under the ALL laws and exempt from obtaining food licenses from Minnesota Department of Health's Environmental Health Division (MDH EH) and local delegated partners. At this time, all inspections of kitchens/food service at Assisted Living facilities in the state will move to MDH EH. MDH EH will continue to ensure facilities comply with the Minnesota Food Code, Minnesota Rules Chapter 4626.

For more information, please see the Assisted Living Kitchen/Food Servicee Transition page.

Related Statutes: 144G.41 Subd. 1(13) (i); Minnesota Food Code, Minnesota Rules, Chapter 4626

Resources

MDH has created the following documents to for you to reference with information about the food code:

More detailed information is available here: Food Business Fact Sheets. Please note the following ones to view:

  • Minnesota Certified Food Protection Manager
  • Person in Charge
  • Specialized Processes in Retail Food Establishments
  • Cleaning & Sanitizing
  • Cooling time/Temperature Control for Safety Foods (TCS)
  • Date Marking
  • Employee Personal Hygiene
  • Equipment Requirements
  • Handwashing for Employees
  • Reheating Ready-to-Eat Foods
  • Temperature and Time Requirements for Food
  • Time/Temperature Control for Safety Foods

All assisted living facilities that prepare and serve food need a CFPM. Only those not preparing food will not require a CFPM.

The food code does not give an exception for a CFPM based on the size of the facility. The exceptions are based on the risk of the practice being done. If food is being prepared, a CFPM is required.

No, a CFPM is not required to be on site at all times food is being prepared and served, however there does need to be someone that has been trained in food safety present at all times.

HACCP plans are required when specialized processes are being done, such as vacuum packaging foods.

A person in charge is someone that has been trained in foodborne disease prevention. The Certified Food Protection Manager (CFPM) can train individuals designated as the PIC. The PIC is responsible for ensuring safe food handling practices at all times.

No, the requirement is for one full-time CFPM at each licensed facility.

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Licensed Assisted Living Director (LALD)

All licensed assisted living facilities require a Licensed Assisted Living Director (LALD). Requirements can be found at the BELTSS Assisted Living Director website. Any questions regarding the licensed assisted living director can be emailed directly to beltss.hlb@state.mn.us.

Related Statutes: 144G.08 Subd. 6 144G.12 Subd. 1 (2), (13), and (14) 144G.82 Subd. 2

Yes, each Minnesota licensed assisted living facility must employ an assisted living director licensed by the Minnesota Board of Executives for Long Term Services and Supports (BELTSS) under Minn. Stat. 144G.08 Subd. 6. Under Minn. Stat. 144G.10 Subd. 1a, each assisted living facility must employ an assisted living director licensed or permitted by the BELTSS.

All health care professional licenses indicate that a credential holder has met the minimum knowledge, skills, and abilities of an entry level practitioner. The legislature establishes those minimums in statute and rules are created by the assigned agency to provide greater detail to the law's framework. A Registered Nurse, Medical Doctor, Social Worker, Alcohol Drug Counselor, plus 13 other professions in Minnesota, have met the minimum education and prior experience requirements to obtain a professional individual license. The ongoing practice standards are established by the Professional Practice Analysis of the National Association of Long Term Care Administrator Boards (NAB) every five years to assure a contemporary community standard developed from a practitioner perspective.

Licensees who serve as directors for two or more facilities must obtain approval for a secondary license(s) from the board. You can find the Shared Director form required to apply for a secondary license on the Forms and Tutorials page of the BELTSS website.

Leadership of organizations and management of daily operations continues to evolve. BELTSS intentionally does not identify a minimum number of hours for the Licensed Assisted Living Director but expects that the LALD has assessed how to communicate, interact, monitor for quality control, delegate, investigate, monitor safety and environment controls while being the Director of Record.

You are required to notify BELTSS within five (5) days of a change of LALD in the facility per 6400.7050C. You can find information about how to update your Director of Record on the Forms & Tutorials page of the BELTSS website.

Yes. The individual would be required to possess both licenses.

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License Renewal

All information related to the license renewal process is available on the License Renewal page.

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Licensed Resident Capacity

Per 144G.08 Subd. 31, "licensed resident capacity" means the resident occupancy level requested by a licensee and approved by the commissioner.

The total licensed resident capacity is what is or could be the number of residents you will be or plan to be serving in the license period without going over. Or in other words, your census (or desired census).

Related Statutes: 144G.08, 144G.12

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, during your license renewal period is when you will have the opportunity to increase (or decrease) that number to fit your business plans more adequately for the next license period.

No. Please refer to the campus definition in 144G.08 Subd. 4a: "a single building having two or more addresses, located on the same property."

There are three criteria that must be met if a provider has an independent living unit under the same roofline as the rest of the building.

  • Must have a separate entrance to the outdoors.
  • Must have a separate address for the above-mentioned door.
  • Must have a firewall/door between the independent living unit and the rest of the building.

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License Fees

The fee structure for the new license will be:

  • Assisted Living Facility License: $2,000 plus $75 per planned resident capacity.
  • Assisted Living Facility with Dementia Care License: $3,000 plus $100 per planned resident capacity.
Related Statutes: 144G.12 144.122

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 Minn. Stat. § 144G.191, Subd. 3(c)(1)-(5) for the specific information you must include in the notice.

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License Options

There are two license options for assisted living facilities:

  • Assisted living facility (144g.08 Subd. 7): a licensed facility that provides sleeping accommodations and assisted living services to one or more adults.
  • Assisted living facility with dementia care (144G.08 Subd. 8): 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.
Related Statute: 144G.80-84

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.

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. If you want to continue to receive payment, you must be licensed as an assisted living facility.

If you have questions for the Department of Human Services (DHS) regarding customized living services provider enrollment, please contact Samuel Acquaah at samuel.acquaah@state.mn.us.

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Meals and Dietary Requirements

Providers must offer to provide (or make available) the following services to residents:

  • At least three nutritious meals daily with snacks available seven days per week
  • Seasonal fresh fruit and fresh vegetables
  • Menus must be prepared at least one week in advance
  • Meals prepared according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines
  • Meal substitutions must be of similar nutritional value
  • Residents must be informed in advance of menu changes
  • Food must be prepared and served according to the Minnesota Food Code
Providers cannot require a resident to include and pay for meals in their contract (if they do not want to purchase them).

Related Statutes: 144G.41 Subd. 1 (13); Minnesota Food Code, Minnesota Rules, Chapter 4626

Statute indicates all assisted living facilities shall offer to provide or make available at least three nutritious meals daily. As a provider you are required to have the availability to provide at least three meals per day. The provider cannot have a blanket "one size fits all" meal charge.

Statute indicates all assisted living facilities shall offer to provide or make available at least three nutritious meals daily. There is no language that indicates where the meals should be served.

Statute indicates all assisted living facilities shall offer to provide or make available at least three nutritious meals daily. Using "Mom's Meals" would meet the "make available" option, but will not negate the menu requirement, nor the seasonal fresh fruit and vegetable requirement. A provider would still be responsible to ensure the entire statute is met.

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Physical Environment

Assisted living facilities shall comply with all applicable state and local governing laws, regulations, standards, ordinances, and codes for fire safety, building, and zoning requirements.

Related Statutes: 144G.45 144G.81 Subd. 1, 2, & 3

Fire protection for assisted living facilities must be met per 144G.45 Subd. 2, as amended. This subdivision does not reference a sprinkler mandate. However, the assisted living with dementia care license requires the building to be sprinklered by August 2029 (144G.81 Subd. 1 (2)). Please keep in mind that you must stay in compliance with all other local or state codes and standards.

In December of 2020, the legislature passed an amendment to 144G.45 Subd. 2, a law that added clarity to the assisted living licensure law that originally passed in the spring of 2019. This law defines the design requirements for assisted living construction. If the construction project applies for a building permit prior to August 1, 2021, then that project needs to comply with the construction requirements at that time, the 2020 Minnesota State Building Codes. If a construction project applies for a building permit on August 1 or later, the project must comply with the 2020 Minnesota State Building Codes and the design requirements in 144G (Life Safety Code and Facility Guidelines Institute).

The law requires the inclusion of at least one bath to allow residents the option of a bath. One possible design option would be to have a central bath that all residents are able to use. This requirement is in a subdivision for new construction or new licenses. Refer to statute 144G.45 Subd. 4 for more information.

Most (small) facilities do not have an extinguishing or alarm system and would not be expected to install a system to meet this requirement. If you do have one of those systems (larger facility), a general requirement of the Minnesota Fire Code is a backup system, and that system is usually a battery backup. A battery backup system meets this emergency preparedness requirement.

A generator is generally not required in any assisted living facility. Generators are usually installed when a loss of power would cause major injury or death. If your emergency plan calls for a generator, then that generator must be installed, maintained, and tested in accordance with codes.

No. If you have a fire alarm system and/or emergency lighting, then you most likely have a battery backup system in accordance with the Minnesota Fire Code. Typically, facilities with 1-5 residents (usually single-family home) or 6-16 residents (usually duplex, triplex or fourplex) do not have emergency lighting and would not require an alternate source of energy to maintain that system in the event of a power outage. If you have a generator then you must maintain, inspect, and test it in accordance with all codes and standards.

You need a plan to deal with a power outage if you have some sort of sewage pump that requires electricity. Some facilities may have toilets that flush and then are pumped to the sanitary sewer or septic system. These types of systems must have backup power. In most cases, the backup power used for this is battery.

The statute does not specify that a facility must have a generator that would support the operations of a "whole building." The generator (if installed or required by the facility) must serve the building as described in the emergency plan. Portable generators may meet those requirements if written into the emergency plan.

Fire drills and staff training must comply with 144G.45 Subd. 2, as amended, and should be documented in the facility's standard operating procedures. Staff training for fire drills and performing fire drills are two different things. Staff must be trained as indicated in statute and the fire drill requirements test the staff training. Staff will evaluate their performance on fire drills and update their training based on performance on the drills.

The law does not require a Fire Marshal to participate in assisted living facility fire drills. MDH recommends involving the local fire department, fire chief and or state fire marshal with fire drill planning. MDH believes it is very beneficial to introduce the responding fire official to your building.

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Reconsiderations and Appeals

Under Chapter 144G, there are circumstances where licensees and applicants have rights to appeal or contest actions being taken against them through either a reconsideration or hearing.

A reconsideration is an internal review conducted by the MDH's Reconsideration Unit. This unit is entirely separate from any survey or investigation function to maintain impartiality when conducting reviews of challenged MDH actions. Licensees may request reconsideration of any correction order issued against them or any maltreatment finding for which they were found to be responsible. Applicants may request reconsideration of a denial of a provisional license or when their provisional license is extended with conditions.

Alternatively, a right to a contested case hearing through the Office of Administrative Hearings is available for licensees in cases where a license is suspended, revoked, or not renewed; when a variance has been denied, revoked, or not renewed; or when the facility has been assessed a fine because of a correction order. Please note, the licensee has a right to contest a correction order through either a reconsideration or contested case hearing, not both.

Related Statutes: 144G.16 Subdivision 4, 144G.20, 144G.32, 144G.45, 144G.81

A reconsideration request or appeal should be sent to:
Reconsideration Unit
Health Regulation Division
PO Box 64970
St. Paul, MN 55164-0970
Fax: 651-215-5963
Email: Health.HRD.Appeals@state.mn.us

We recommend you include three items in your reconsideration request:

  • An affirmative, clear statement of what you are challenging.
  • Clear, supporting argument as to why your position is correct and/or why the MDH conclusion was incorrect.
  • Any documentary evidence that supports your argument.

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Scope and Severity

All correction orders (sometimes referred to as "tags" or "deficiencies") are assigned both a scope and severity. The table below defines the scope and severity for each level of violations.

Related Statutes: 144G.31

Level State Scope and Severity Statement
A This practice resulted in a level one violation (a violation that has no potential to cause more than a minimal impact on the resident and does not affect health or safety) and was issued at an isolated scope (when one or a limited number of residents are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally).
B This practice resulted in a level one violation (a violation that has no potential to cause more than a minimal impact on the resident and does not affect health or safety) and was issued at a pattern scope (when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly; but is not found to be pervasive).
C This practice resulted in a level one violation (a violation that has no potential to cause more than a minimal impact on the resident and does not affect health or safety) and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all the residents).
D This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety) and was issued at an isolated scope (when one or a limited number of residents are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally).
E This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety) and was issued at a pattern scope (when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly; but is not found to be pervasive).
F This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety) and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all the residents).
G This practice resulted in a level three violation (a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death), and was issued at an isolated scope (when one or a limited number of residents are affected or one or a limited number of staff are involved or the situation has occurred only occasionally).
H This practice resulted in a level three violation (a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death) and was issued at a pattern scope (when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly; but is not found to be pervasive).
I This practice resulted in a level three violation (a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death) and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has potential to affect a large portion or all of the residents).
J This practice resulted in a level four violation (a violation that results in serious injury, impairment, or death), and was issued at an isolated scope (when one or a limited number of residents are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally).
K This practice resulted in a level four violation (a violation that results in serious injury, impairment, or death), and was issued at a pattern scope (when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly; but is not found to be pervasive).
L This practice resulted in a level four violation (a violation that results in serious injury, impairment, or death), and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has potential to affect a large portion or all of the residents).

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SS-4 Document

For applicants who have an existing Federal Employment Identification Number (FEIN), the preferred method of confirming the FEIN is via the 147C letter issued by the IRS. Applicants may request that the IRS search for their FEIN by calling the Business & Specialty Tax Line at 1-800-829-4933. The applicant should then receive the 147C letter via mail or fax with the FEIN number.

Assisted living facility license applicants who require a new FEIN should visit IRS.GOV for information concerning Employer ID numbers. A business may apply for an FEIN in various ways, and you may apply online. This is a free service offered by the Internal Revenue Service and you can get your FEIN immediately.

If the applicant is not able to provide a 147C letter with the Assisted Living Facility License Application, MDH will accept the below noted documentation as evidence of the FEIN. All documentation must be issued by the IRS and include information sufficient to confirm the identity of the business and the corresponding FEIN. Any confidential information should be redacted prior to submission.

All applicants should continue to request a 147C letter from the IRS and submit a copy of the letter to the Minnesota Department of Health as soon as possible.

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.

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Staffing

All assisted living facilities must have a clinical nurse supervisor who is a registered nurse licensed in Minnesota. The positions of both the assisted living director and the clinical nurse supervisor may be held by the same individual if the individual holds both licenses.

The staffing plan must be evaluated at least twice per year and include sufficient staffing at all times to meet the scheduled and reasonably foreseeable needs of each resident

A facility may not accept a person as a resident unless the facility has staff, sufficient in qualifications, competency, and numbers, to adequately provide the services agreed to in the assisted living contract.

Related Statutes: 144G.41 Subd. 1 (11-12) 144G.81 Subd. 4 144G.83 Subd. 1 (c) 144G.70 144G.81 Subd. 4

Under the statute it does NOT give staff ratios that the facility must follow. They must be able to satisfy the requirement to meet the scheduled and reasonably foreseeable needs of each resident.

Statute does not address whether a nurse can have more than one place of employment. Statute does address a nurse and the services provided must comply with the Nurse Practice Act in 148.71 to 148.285. Statute also defines a clinical nurse supervisor as a Registered Nurse (RN) licensed in Minnesota. The statute dictates certain duties that must be completed by the RN:

  • Resident assessments
  • Delegation of nursing tasks
  • Training and competency testing of unlicensed personnel
  • Be available for consultation to staff performing delegated nursing tasks (either in person, by telephone, or by other means)
  • Supervision of staff based on statute requirements in 144G.62 Subd. 4
  • Certain policy development

Statute does not address whether unlicensed personnel can have more than one place of employment. If the "organization" is the "W-2 holder" and is responsible for the provision of such staff across several locations, the "organization's" requirement is to ensure adequate staffing at all its facilities.

For assisted living licensure, under 144G.41, subdivision 1 (12): ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be:

  • awake;
  • located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time;
  • capable of communicating with residents;
  • capable of providing or summoning the appropriate assistance; and
  • capable of following directions.
So at an assisted living licensed entity, the staff must be awake, however one staff member could be responsible for covering more than one unit.

For an assisted living with dementia care license, under 144G.81 Subd. 4. Awake staff requirement: An assisted living facility with dementia care providing services in a secured dementia care unit must have an awake person who is physically present in the secured dementia care unit 24 hours per day, seven days per week, who is responsible for responding to the requests of residents for assistance with health and safety needs, and who meets the requirements of section 144G.41 Subd. 1, clause (12).

None. See 144G.41 Subd. 1 (12): "ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be:

  1. awake;
  2. located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time…"
A nurse who is not on site but is available for consultation to staff performing delegated nursing tasks (either in person, by telephone, or by other means), may be asleep (at home) if the nurse is able to respond accordingly when summoned.

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Survey Process

The MN Department of Health (MDH) is the exclusive state agency charged with the responsibility and duty of surveying and investigating all facilities required to be licensed under Minnesota Statutes, chapter 144G. The commissioner shall conduct a survey of each assisted living facility on a frequency of at least once every two years. Surveys and investigations shall be conducted without advance notice to the facilities.

Related Statutes: 144G.16 Subd. 2 144G.19 Subd. 3 144G.30

Provisional applicants will be surveyed within one year of notifying the department they are providing services to a resident.

Immediately upon the new Assisted Living Licensure becoming effective on Aug. 1, 2021.

The survey process will be similar to the process for homecare surveys under 144A. You can learn more about the survey process and see example forms on the Assisted Living Forms and Self-Audit Tools page.

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Terminations

Termination means a facility-initiated termination of housing provided to the resident under the contract; or a facility-initiated termination or nonrenewal of all assisted living services the resident receives from the facility under the contract.

Related Statutes and Rules: 144G.52, 4659.0120

A pre-termination meeting is still required. See Rule 4659.0120, Subpart 11.A. "A facility seeking an expedited termination under Minnesota Statute section 144G.52, must comply with all of the requirements of this part." This includes pre-termination meeting requirements discussed in subpart 1.

  1. The resident receives written notice of the pre-termination meeting.
  2. There is a 5-business-day waiting period.
  3. The predetermination meeting occurs.
  4. The resident receives a written summary of the meeting within 24 hours.
  5. The termination notice given to the resident must be 7 days after the pre-termination meeting.

It is only considered a resident-initiated termination if the resident has made a formal notice that they are moving and have taken the steps to relocate themselves. If the resident merely discusses wanting to move, but the facility takes the initiative of terminating the contract based on that discussion, that is considered a facility-initiated termination and the requirements of statute section 144G.52 and rule part 4659.0120 must be met.

The table below shows the acceptable reasons for a facility to inititate termination and the required timing of notices of termination.

Reason Termination from Housing or Services Timing of Notice Comments
Nonpayment Both 30 Days An interruption to a resident's public benefits that lasts more than 60 days does not constitute nonpayment.
Violation of AL Contract Both 30 Days without a cure Resident has right to cure the violation in most cases.
Danger to Other Residents Both 15 Days Substantially interferes with the rights, health, or safety of other residents.
Danger to Staff Both 15 Days Substantially and intentionally interferes with the safety or physical health of facility staff
Danger to Self Services Only 15 Days Substantially interferes with the resident's health or safety
Can No Longer Meet Needs Services Only 15 Days
  1. exceeds the scope of services agreed upon in the AL contract, and
  2. are not included in the services the facility disclosed in the UDALSA
  1. The resident receives the termination notice.
  2. The resident has 15 days (expedited) or 30 days to appeal.
  3. The resident has a right to a hearing. The hearing is held within 14 calendar days of the Office of Administrative Hearings receiving the request to appeal.
  4. The Administrative Law Judge gives its decision to the Commissioner of Health no later than 10 days following the hearing.

No. Per Minnesota Statute § 144G.52 subdivision 10 If a resident is absent from a facility for any reason, including an emergency relocation, the facility shall not refuse to allow a resident to return if a termination of housing has not been carried out.

The facility must continue providing all housing and services under the contract while the appeal is pending. However, the facility is not obligated to provide any additional services that the resident may require. The resident is responsible to contract for those additional services, either with the facility or another provider.

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Tuberculosis (TB) Screening

Each facility must establish and maintain a comprehensive tuberculosis (TB) infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in the CDC's Morbidity and Mortality Weekly Report. The program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors, students, and regularly scheduled volunteers.

For more information, see the MDH website: Tuberculosis.

Related Statutes and Rules: 144G.41 Subd. 3, 144G.42 Subd. 9

Each provider licensed by MDH is required to complete a TB risk assessment annually. Completion of this assessment will assist providers in the development of an infection control committee and in determining the frequency of screening.

Resource: Facility Tuberculosis (TB) Risk Assessment Instructions and Worksheet for Health Care Settings Licensed by MDH (DOCX)

All Minnesota health care personnel should receive TB education annually, regardless of facility risk level classification. TB education should include information on TB exposure risk factors (both occupational and nonoccupational), the signs and symptoms of TB disease, and TB infection control policies and procedures.

Baseline TB screening is required at the time of hire for all health care personnel in Minnesota.

Baseline TB screening includes:

  • assessing for current symptoms of active TB disease
  • assessing TB history
  • testing for the presence of Mycobacterium tuberculosis by administering either a two-step tuberculin skin test (TST) or single TB blood test

Resources:

A test should be dated with 90 days of hiring is acceptable.

All settings that require TB screening for employees, employers must cover the costs of those tests. Refer to Occupational Safety and Health Standards 182.655 Subd. 10a regarding protective equipment, monitoring exposure levels, and medical exams.

A CXR alone is not acceptable documentation. You either need

  • documentation of a positive two-step Tuberculin Skin Test (TST) or Interferon-Gamma Release Assay (IGRA) test, and
  • a CXR with provider evaluation after that date
or
  • documentation of refusal of both the two-step TST and IGRA
  • followed by a new CXR and provider evaluation.

If the health care worker had a prior positive TB test result, and they only have the CXR but no other test documentation, then they need to take a new TB test. If the result is positive, a new CXR needs to be completed. The CXR needs to be done within 90 days of the positive test date or dated any time after the positive test date.

Resources:

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Uniform Disclosure of Assisted Living Services and Amenities (UDALSA)

It is by statutory requirement that facilities provide any prospective resident a disclosure of their available services. This is a uniform document created by the commissioner in consultation with stakeholders. Every facility is required to utilize this document in lieu of creating their own. This is a fillable PDF and will be a required element of the application process. Because it is downloadable, a facility can print versions to hand out to prospective residents, and they can post it on their websites for consumers to view.

In addition to assisted living services that a provider can choose to provide, the form also lists several amenities that may be available. Consumer feedback indicated this is a highly valued tool allowing side by side comparison of facilities with similar structure.

An applicant or licensee shall submit a completed checklist with the license application or renewal. The form can be found in the Forms section of the Assisted Living Licensure Application Materials page.

Related Statutes and Rules: 144G.40 Subd. 2, 4659.0090

Whenever a facility changes the services that the facility offers under the assisted living facility contract, the facility must submit an updated checklist to the commissioner within 30 calendar days of the change in services. You also need to provide an up-to-date checklist to each prospective resident and each prospective resident's representative who requests information about the facility.

144G.40, subdivision 2, states that an assisted living facility must provide the UDALSA to prospective residents before a contract is executed. As long as that condition is met, yes. The key is to make sure the language or date of signature indicates the UDALSA was received before the contract is signed. Another option could be to photocopy the signature page and place that in the resident record.

You will want to indicate in the comments section if there are any limits such as you will only do mechanical soft vs. a pureed diet.

Yes. In fact, it is highly recommended that you do have different ones if there is a large difference between care levels in different units or buildings within your entity.

Yes, make sure they are clearly labeled as to which building or unit they apply to.

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Updated Wednesday, 15-Jun-2022 18:44:19 CDT