Assisted Living
Resources and Frequently Asked Questions (FAQs)

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, subdivision 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.

Yes. Assisted living contracts may include contract language to limit the licensee’s liability regarding the actions of third parties, such as third-party health care providers and resident guests.

Yes; if it is simply a recommendation only and does not indicate the licensee has no responsibility related to the personal property of the resident.

Yes; but it is not necessary. Nothing in statute indicates the licensee is liable when the resident chooses to leave the premises of their own volition.

No. The statute prohibits the contract from including a waiver of the licensee’s liability for the health, safety, and personal property of the resident, or from implying a lesser standard of care or responsibility than required by law. A section heading does not violate those provisions if the content within that section is otherwise permissible.

Yes, that is acceptable. The statute requires the contract to adhere to Minnesota law, and to applicable federal and local law, so including that requirement does not violate the prohibition on choice of law provisions within the arbitration agreement.

This is typically written as a 21-day correction period. MDH recognizes changing an assisted living contract can take longer than 21 days due to the need for legal consultation. If upon revisit to the facility the assisted living contract itself is not corrected, the surveyor will ask what steps the licensee is taking to come into compliance. Changes to the contract language are not required until resolution of the appeal supporting MDH’s determination.

MDH compliance expectations are based on Minnesota Statutes 144G so if the licensee is compliant with the statutory requirements, then MDH should find the citation is corrected.

No. This is not a statutory requirement; however, this does not preclude a licensee from having a policy.

No. Minnesota Statutes 144G does not explicitly prohibit indemnification clauses; however, assisted living contract language may not waive or shift the responsibility from the licensee for certain incidents onto the resident. Indemnification clauses that apply universally to all behavior by the resident are likely prohibited because, depending on the resident’s needs and services, the licensee may be responsible for preventing that specific behavior or outcome from occurring, or at least from negatively impacting others. An indemnification clause is only acceptable if it contains language that specifies that indemnity obligations only relate to those events for which the resident is legally responsible.

The following is an example of assisted living contract language MDH has cited and upheld in the reconsideration process as violating Minnesota Statutes 144G: “As an occupant of the Facility, Resident assumes the risk for the Resident’s own safety and for the safety of the Resident’s personal property….Resident will indemnify and hold harmless Facility, its employees and agents from and against any and all claims, actions, damages, and liability and expense in connection with the loss of life, personal injury or damage to the property, arising from or out of the use by the Resident…”

This indemnification language requires the resident to assume the risk of their own health, safety, and personal property and protects the licensee from “any and all” responsibility for the resident and the resident’s property, which would be interpreted as a waiver of liability under 144G.

As another example: “Resident will indemnify and hold harmless Facility, its employees and agents from and against any and all claims, actions, damages, and liability and expense in connection with loss of life, personal injury or damage to property, arising from or out of the use by Resident or Resident’s guests of the Apartment or any other part of Facility, or caused wholly or in part by an action or omission of Resident or Resident’s guests or agents.” “Hold harmless” means to excuse from liability.

The statute requires no waiver of liability or provisions that imply a lesser standard of care of responsibility than is required by law. An assisted living contract may include language indicating that intentional, negligent or careless acts of residents or their guests may not result in licensee’s liability.

Yes; however, if an assisted living contract refers to a resident handbook, the handbook language must also be in compliance and not waive the licensee’s liability.

No. An assisted living contract must not contain any waiver of facility liability with the health, safety and personal property of resident. While there are many situations such as natural disasters and acts of third parties which would not be the responsibility of the licensee, an assisted living licensee could be liable depending on the licensee’s role in the resident’s loss, and those narrow instances may not be waived.

No. Typical landlord-tenant contract clauses and commonly accepted landlord-tenant laws often hold the landlord is not responsible for the actions of their tenants. This ignores that assisted living facilities have heightened responsibilities with respect to their resident-tenants, who are vulnerable adults. While there are many situations, such as natural disasters and acts of third parties which would not be the responsibility of the facility, an assisted living licensee could be liable depending on the licensee’s role in the resident’s loss, and those narrow instances may not be waived.

An assisted living facility must give a complete copy of the signed assisted living contract to the resident promptly after it is signed. This signed copy must include any addendums, all supporting documents, and attachments. The resident must agree in writing to any additions or amendments to the contract.

If a resident is receiving services, their assisted living contract must include their assisted living service plan. This plan must include parts listed in Minnesota Statutes 144G.50, subdivision 4.

Yes. An assisted living facility must provide a Uniform Disclosure of Assisted Living Services and Amenities (UDALSA) to all prospective residents under Minnesota Statutes 144G.40 before an assisted living contract is signed. The UDALSA must be provided separately from all other documents and forms. Whenever a facility changes the services it offers under the assisted living contract, the facility must submit an updated UDALSA to the Minnesota Department of Health within 30 calendar days of the change in services.

No. Assisted living contracts executed prior to August 1, 2022, will not require contract amendment. Instead, MDH surveyors will review contracts executed on August 1, 2022, and after to apply the new statutory language.

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 HFID’s 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 .

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

In summary, what is the best way for my survey to pass with flying colors related to the use of portable bedrails?

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.

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.

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.

Minnesota Statutes, section 342.09, subdivision 1(a)(7)(ii), permits the owner of a private property to prohibit the consumption of cannabis flower, cannabis products, lower-potency hemp edibles, or hemp-derived consumer products by individuals on that property. This includes medical cannabis flower and medical cannabinoid products. The law does not address how this impacts nursing homes and assisted living facilities, specifically.

Effective March 1, 2025, Minnesota health care facilities are not generally permitted to prohibit the use of medical cannabis or medical cannabinoid products by patients enrolled in the medical cannabis program, although they are allowed to institute reasonable restrictions on the use of those products by residents in the facility (Minnesota Statutes, section 342.56). Should a facility change its policy from one that permits adult-use cannabis to one that does not, the facility should work with their interdisciplinary team, Office of Ombudsman, and residents to ensure protocols reflect Quality of Life for the residents the facility serves. Facilities should communicate their policies prior to a resident’s admission.                                                                       

Yes. For example, a facility could prohibit the use of smokable adult-use cannabis (either flower/bud or vaped), the use of cannabis products, or both. Facilities should have clear protocols in place per their policies and procedures.

Beginning March 2025, Minnesota Statutes, section 342.56 subdivision 2, does not require health care facilities to store, maintain, or provide adult-use cannabis for patients. However, requiring secured storage could protect other cognitively impaired residents, your staff, and others from misuse and/or allegations of missing cannabis product. Your facility policy should require that cannabis products be secured at all times.

A resident/resident representative should sign an acknowledgement of the facility’s medical cannabis/adult-use cannabis policies and that those policies include language that the resident/resident’s representative understands the facility may communicate with the resident’s treating physician/PA/NP if the facility believes that to be in the best interests of the resident.

Facilities should comply with State and Federal requirements for medical record keeping.

The resident or the resident’s designee is responsible for cannabis disposal. Residents should not give cannabis to facility employees for disposal. Disposal of a resident’s adult-use cannabis due to death or discharge should be addressed in facility policy, similar to other resident possessions.

Minnesota Statutes, section 342.09 subdivision 1(a) permits a person 21 years of age or older to:

• Use, possess, or transport cannabis paraphernalia.
• Possess or transport two ounces or less of adult-use cannabis flower in a public place.
• Possess two pounds or less of adult-use cannabis flower in the individual's private residence.
• Possess or transport eight grams or less of adult-use cannabis concentrate.
• Possess or transport edible cannabis products or lower-potency hemp edibles infused with a combined total of 800 milligrams or less of tetrahydrocannabinol.

Facilities could include a reasonable restriction on the maximum amount stored in their policies. Just as they might limit the amount of alcohol stored in a room. Storage limitations may differ between smaller nursing facility rooms compared to assisted living apartments.

Facilities should address this in their policies. In addition, facilities should ensure the resident’s assessment reflects a review of this. For example, the facility should be able to demonstrate their efforts to determine whether the use of adult-use cannabis will affect the resident’s ability to operate a mobility device safely. For further clarification, see Minnesota Statute, section 169.011.42.

A long-term care setting should develop policies and procedures related to this issue. A long-term care facility may need to apply considerations based on roommate preference, safety concerns, and space limitations as identified in facility policies. Safety concerns, such as the use of a heat lamp or storage of growth chemicals, should be taken into account when developing policies and procedures.

Per Minnesota Statute: Adults are permitted to grow up to eight (8) cannabis plants per single residence, with no more than four (4) being mature and flowering at the same time. Cannabis plants must be kept in an enclosed, locked space that is not open to public view.

This should be handled the same way the facility handles use of alcohol by residents.

This should be handled the same way the facility handles alcohol brought in by family members or guests for residents. All facility restrictions would still apply as outlined in the facility policies (e.g., smoking/vaping restrictions).

Yes – this is their money to spend on any legal personal purchases.

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.

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

• Option one: Purchase the Alzheimer's Association Person-Centered Dementia Care Training Program, which includes the essentiALZ® exam. Dementia Care Training Program & essentiALZ® Exam | alz.org. This training was developed with evidence from the Alzheimer's Association Dementia Care Practice Recommendations listed here: Alzheimer's Association Dementia Care Practice Recommendations | The Gerontologist | Oxford Academic (oup.com)
• Option two: Purchase a training program recognized by the Alzheimer's Association and essentiALZ® Exam from the Alzheimer's Association.
  You can find Recognized Dementia Care Training Programs that have been recognized by the Alzheimer's Association as reflecting the five topic areas of the Dementia Care Practice Recommendations. Providers using these training programs are eligible to purchase essentiALZ® exams for their staff.
• Option three: Purchase a curriculum review from the Alzheimer's Association and essentiALZ® Exam from Alzheimer's Association. Providers and training companies using proprietary training materials may submit their training programs for review. See the Dementia Care Training Curriculum Review page of the Alzheimer's Association website (alz.org) for a link to the Curriculum Review Guidelines.
• Option four: For subscribers of EduCare, EduCare's 5-part Dementia Series and test may be used to meet the statutory requirement. For more information, see the EduCare website.

• Option five: Purchase one of the HealthCare Interactive CARES Dementia Care Training options that meets the statutory requirements:

  • CARES Basics (4 hours) CARES Advanced (6 hours)
  • CARES Activities of Daily Living (ADL) (4 hours or 10 hours)
  • CARES Dementia Related Behavior (4 hours)

  For more information, see the HealthCare Interactive Online website.

• Option six: Purchase the Care Fundamentals courses from RTasks, which includes 8-hour and 4-hour bundles to meet the statutory requirements, as well as a 2-hour bundle to meet the annual training requirements.See the RTasks Care Fundamentals LMS website for more information.

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.

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.

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.

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).

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.

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.

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.

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.

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.

How should I send proof of SS-4 or the 147C letter once I receive it and have already completed my application?

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

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.

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.

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.

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.

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:

• Tuberculin Skin Test (TST) - Minnesota Dept. of Health
• Baseline TB Screening Tool for Health Care Personnel (DOCX)
• Tuberculin Skin Testing (TST) Protocol for Screening Health Care Workers (DOCX)

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:

• Regulations for TB Control in Minnesota Health Care Settings
• Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019 | MMWR
• Subscribe to Tuberculosis (TB) Updates from Minnesota Department of Health

Whenever a facility changes the services that they offer under the assisted living facility contract, the facility must submit an updated UDALSA to the commissioner within 30 calendar days of the change in services. A current UDALSA must be provided 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.

No. Only submit one UDALSA per HFID. If you are licensed as a campus or hold an assisted living with dementia care license, and the indicated services are provided at more than one building/unit/address, list all additional buildings/units/addresses this applies to. Utilize the “Comments” section to list any differences in offerings between buildings/units/addresses.