Assisted Living Licensure Presentation Notes - Minnesota ...
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Assisted Living Licensure Presentation Notes Date: Thursday, April 8, 2021 Time: 10:00 am – 11:30 am Agenda Lindsey Krueger (MDH) – Application Process Amy Hyers (MDH) – Uniform Disclosure of Assisted Living Services and Amenities (UDALSA) Amy Chantry (MDH) – Change of Ownership (CHOW), Variance Applications, Proposed Rules Update Welcome Lindsey Krueger, program manager in the Health Regulation Division, welcomed everyone to the Minnesota Department of Health’s Home Care and Assisted Living Teleconference for April 8, 2021. She thanked everyone for joining. Reminder that the Minnesota Bookstore closed in August of 2020. Allegra is the new printing company that MDH is working with. New Home Care and Assisted Living Laws book is available to order here: Minnesota Government Publications DBA Allegra Eagan (www.mngovpublications.com/home.asp). MDH is mindful of the amount of information that 144G and Assisted Living Licensure brings and the time it takes to review, think about, and discuss. MDH is committed to helping you understand and prepare. We will be holding many WebEx presentations over the next several months to provide information and education. If there is a certain topic you would like MDH to cover, please send an email to health.assistedliving@state.mn.us. Participants were encouraged to place questions in the chat feature. Your questions guide us in what content areas you would like covered, or where confusion lies within certain topics. We are using these questions to build out content on our webpage. It was mentioned at the beginning of the WebEx series that the department would work to put out answers to the questions in the chat. We are working to do that, organized by topic instead of placing it in a word document where you must search for content. We will have more updates about this over the next several weeks. Notice and Planning for Discharge/Closures MDH has been asked by stakeholders to review and emphasize the importance and necessity of providing a smooth transition for all residents. Section 144G.191 subd. 3 (c) provides the transition notice requirements for current comprehensive home care providers that DO NOT
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intend to transition into assisted living licensure or DO NOT intend to continue providing home
care services after July 31, 2021. In these scenarios, the provider must give notice of that
decision according to the statutory requirements. This notice must be provided to the clients at
least 60 days before the expiration of the provider’s license or by May 31, 2021, whichever
occurs earlier. This is to provide the clients enough time to locate a different service provider
for their needs.
Application Types
Conversion vs. Provisional
A conversion applicant refers to a currently registered HWS and a current comprehensive home
care provider providing services to at least one client. These applications are going to be
electronic and will be completed via the Improved Customer Service Delivery (ICSD) portal. This
is the same portal that HWS registrants and home care providers renew in currently. The HFID
number will be used as the identification number for the Assisted Living Facility. This is the ID
number that is already being used for the location/address of the building.
June 1st is a very important date! MDH currently has a banner with this language on our ALL
webpage: If you are registered as a housing with services establishment under chapter
144D and you are providing home care services or have contracted with a comprehensive home
care provider providing services to at least one resident and you intend to provide assisted living
services on or after August 1, 2021, you must apply for an assisted living facility license no later
than June 1, 2021. You can find this cutoff date in the December Special Session language
under 144A.191 subd. 4 (a). This is also included in the addendum in the back of the Statute
book. Completed applications must be into the office no later than June 1st. You are
encouraged to submit your application as early as possible. This will allow MDH time to review
the application and follow up if there are any areas of concern. Conversion applications will not
be able to be submitted or worked on after June 1st.
A provisional license or initial license is a new license. This would be for any new business
applicants. Meaning, you are not a currently a registered HWS, and you are not a current
comprehensive home care provider, you are new to providing assisted living services. Also, any
current providers that miss the conversion date of June 1st, can still apply for Assisted Living
Licensure, but would be coming in as a provisional license. Not someone who is able to convert
your current license.
How and When to Apply
For the conversion application, the agent on file for the Housing with Services registration at
the address of where the Assisted Living Facility will be located will be receiving an email that
provides login information for ICSD. Please note, if the address on file at MDH is not correct,
please use the Housing with Services Change of Information Form (PDF)
(www.health.state.mn.us/facilities/regulation/hws/docs/hwschange.pdf) to update the
information. If for some reason the email is displaced, we can regenerate the message, but
would like to ensure this process goes smoothly as possible from the start. If you are NOT the
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person who will be filling out the application, please pass on this information so they are
informed of the process.
If you will be a provisional applicant, a fillable PDF application will be posted to our webpage.
We are working hard to have these applications viewable prior to May 1st. Both applications
are very similar, however there will be more physical environment requirements with the
provisional application. MDH will communicate when and where the applications are posted.
Please plan to attend our WebEx on April 29th as we will be covering applications more
extensively.
Background Studies
Background studies are a required part of the application process. Conversion applications will
only need background checks ran on anyone that is new to the management structure.
For provisional applicants, all owners, managerial officials, your assisted living director,
consultant (if you need one per 144G.80 for a dementia care application), and the clinical nurse
supervisor must complete and pass background studies.
Due to the peacetime emergency, DHS is currently only conducting emergency background
checks. MDH will provide more information as we get closer to May 1 if we remain under the
COVID-19 peacetime emergency. This will not hold up the processing of applications. The
license will be issued, contingent on passing the background check later.
Capacity
Capacity is a section that is on both application types (conversion and provisional). As a
reminder, a resident is defined in 144G.08 Subd. 59. "Resident" means a person living in an
assisted living facility who has executed an assisted living contract. The definition of an Assisted
Living Contract is defined in 144G.08 Subd. 5. "Assisted living contract" means the legal
agreement between a resident and an assisted living facility for housing and, if applicable,
assisted living services.
Total Licensed Resident Capacity for License Period. Are the residents you will have, or may
you have, during the license period.
Total Maximum Resident Capacity. Are the number of residents you would have if all your
beds were filled. This may or may not be the same as the total licensed resident capacity.
For Example, you have a building that has maximum resident capacity of 100. Remember,
resident and assisted living contract includes housing, so this does not necessarily equal bed
count because a married couple can share a bed.
1. You have 50 beds that you have no intention to fill during the license period for one
reason or another. Perhaps you are not currently using certain floors or units in your
building and you have no intention to do so in the next year. You would not include
those in your Total Licensed Resident Capacity for the license period. That number
would be 50, and your Total Maximum Capacity would be 100.
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2. You have 100 beds and currently 50 residents, AND you intend to seek out residents for
your facility over the next year of your license period, you may want to have the option
to add 25 more residents throughout the year. In this situation, you would indicate
Total Licensed Capacity for 75 and a Total Maximum Capacity of 100. This allows for
growth of numbers of residents you are serving.
This allows you to not pay the per resident fee ($75 or $100) for a maximum capacity you have
no intention of filling during the license period. But you should think ahead and license for a
capacity you are interested in filling. You are not allowed to go over licensed capacity. If you
pay for the capacity of 50, but over the year you get up to 75 residents, that can be citable by
MDH as you are over what you are licensed for and what you paid for. You are not able to
update the Total Licensed Resident Capacity during a license period, this will only be adjusted
on renewals.
Licensed Assistant Living Director
Assisted Living Director is on both application types. What happens if your LALD (Assisted
Living Director, or Assisted Living Director in Residence) does not hear back from BELTSS prior
to submitting your assisted living license application? Fill in the planned LALD or ALDIR who is
currently applying for licensure or permit. MDH will be following up on this during the
application review process and can reach out to BELTSS to check on status. We suggest that the
LALD applies as soon as BELTSS opens the application process.
Attachments
MDH will acknowledge receipt of the application in an email to the applicant. Incomplete or
inaccurate applications may be rejected and will be sent back to the applicant (Minn. Stat. sect.
144G.15(a)(1). Once MDH determines it has all required application information, signatures,
and attachments, MDH will contact the applicant to request payment of the application fee.
Attachments will be uploaded right into ICSD or into the portal on MDH’s website. Nothing will
be mailed in to MDH.
Uniform Disclosure of Assisted Living Services and Amenities
(UDALSA)
Amy Hyers presented a sneak peak of a tool that you will be using; the Uniform Disclosure of
Assisted Living Services and Amenities which has been affectionately termed “UDALSA” by one
of the participating stakeholders. Even though there is some language in the proposed rules
about the form, it would be considered best practice to be prepared to meet these
requirements.
Although you will be getting small segments of each section here, this will be a fillable PDF that
you can fill out, download, and print for your marketing materials, or upload it to your website
for consumers to view. It will be posted on our website soon.
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General Information
Unique building/unit descriptive (if applicable):
If the indicated services are provided for more than one building/unit (on the campus), list all
additional buildings/units this applies to. Use additional pages if necessary.
Example, you have 3 buildings on your campus; Brandon House, The Jacob House, and The Ryan
House. If you will be providing the same services in all (3) buildings, then list all three in the
additional spaces. [There is space for 3 on the form]. IF, however, one building (or it could be
unit) is going to have different services offered, then it would be best to check the box for “No
additional buildings/units” and plan on a separate UDALSA for each “unique” unit. Under
License choice, it would be exceptionally easier to complete a UDALSA for each “building” if a
campus is going to hold both licenses.
Staffing
Staffing is a major concern to families and residents, and they want to know what the staffing
models look like.
Availability of Unlicensed Staff: As we know from 144G.81 Subd. 4, 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. So, this first section pertains more to facilities without a
secured unit. Will staff be spread throughout various areas at times or will there always be
someone within a given unit?
Availability of Licensed Staff: Here you will be letting residents know if a nurse (in addition to
RN on call) will be on site either in the specific unit, or within a campus.
The last staffing question here pertains to number of staff you anticipate being scheduled for
each timeframe of the day. This is just a typical, or average number to give the resident’s an
idea of what to anticipate. You may also need to add some additional verbiage to clarify if you
DO have a unique staffing model.
Services and Amenities Available
The UDALSA is separated out into 10 sections and each section will have a list of services or
amenities that are allowable for an assisted living to provide or offer. The facility will indicate by
placing a “yes” or “X” in the “Available” column if the service is provided or available at/on the
campus/unit of the location listed above. If the “Available” column is blank, the facility does
not provide that service.
Section 1: Dementia Care
As the section denotes, this only pertains to those holding an Assisted Living Facility with
Dementia Care License.
One thing to consider noting in the “other” comments space is the size of the given unit. The
number of residents in any one unit can be an important factor for consumers.
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Section 2: Medication Management
One item to consider is the administration of Medical Cannabis. Refer to Minn. Stat. 144G.70
Subd. 6. Assisted living facilities may exercise the authority and are subject to the protections
in Minn. Stat. 152.34 Health Care Facilities (www.revisor.mn.gov/statutes/cite/152.34). This
does not say you must provide the service; it iterates the protections under which you can. This
is “new” in that it was not so blatantly spelled out in 144A homecare law. Consumers will be
looking for facilities willing to provide this service.
Section 3: Treatment & Therapies
This section, includes items like trach cares, oxygen cares, vitals, catheter cares, and integrative
health services. Other hot topic items are access and training on use of an automatic electronic
defibrillators (AED) and training of and use of Cardiopulmonary Resuscitation (CPR). If you are a
newer facility and perhaps have not fully determined what the level of response for ULP’s to a
no pulse/no breathing situation is (the options vs. calling 911), now would be a good time to
finalize that decision.
Section 4: Assistance with Activities of Daily Living
Speaking of bathtubs…
144G.45 MINIMUM SITE, PHYSICAL ENVIRONMENT, AND FIRE SAFETY REQUIREMENTS
Subd. 4. Design requirements.
(a) All assisted living facilities with six or more residents must meet the provisions relevant to
assisted living facilities in the most current edition of the Facility Guidelines Institute
"Guidelines for Design and Construction of Residential Health, Care and Support Facilities" and
of adopted rules. This minimum design standard must be met for all new licenses, new
construction, modifications, renovations, alterations, changes of use, or additions. In addition
to the guidelines, assisted living facilities shall provide the option of a bath in addition to a
shower for all residents.
From MDH Engineering: The law requires the inclusion of at least one bathtub 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. It would not require a bath to be installed in HWS that converts to assisted living.
Section 5: Mobility Support
Regarding transfers with assist of two staff:
In 144G.41 Subd. 1 (11) All assisted living facilities shall: develop and implement a staffing plan
for determining its staffing level that always ensures sufficient staffing to meet the scheduled
and reasonably foreseeable unscheduled needs of each resident.
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In 144G.70 Subdivision 1. Acceptance of residents. An assisted living 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.
So, make sure, if you are indicating that you offer services that require two staff members, that
you have always at least two staff members scheduled.
Section 6: Security and Monitoring
There have been several questions asked about door entry keypads, and does having them
mean that you have a secured unit?
144G.08 Subd. 62. Secured dementia care unit. "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.
So, if a resident is unable to leave a given area on his/her own accord, then that would equal
secured unit.
Section 7: Dining and Nutrition
Also included in this section is a list of therapeutic diets such as diabetic, gluten free, low
sodium, renal, and kosher.
Section 8: Supportive Services
In 144G.41 MINIMUM ASSISTED LIVING FACILITY REQUIREMENTS. Subd 1, (13) vii. have a daily
program of social and recreational activities that are based upon individual and group interests;
thus “required” is in the column. Other “required” items come from Subd. 1, (13) iv, v. provides
direct or reasonable assistance with arranging for transportation to medical and social services
appointments, shopping, and other recreation, and provide the name of or other identifying
information about the persons responsible for providing this assistance; (v) upon the request of
the resident, provide reasonable assistance with accessing community resources and social
services available in the community.
Another item in this section asks for the primary language spoken by staff at a facility. This
would be a primary language a facility wants to be recognized for, that wants to really market
that for their clientele.
Section 9: Staffing
This will be useful in determining staff member categories and overall availability.
Included are access to other disciplines such as a dietician, physical therapist, or speech
therapist. Some of these may be available on site due to the sharing of a campus with a rehab
center or nursing home. Or, more typically, services that may be arranged through a Medicare
provider if the resident qualifies for a given intervention.
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Section 10: Amenities
A lot of this was taken from the previous form titled Uniform Consumer Information Guide
(UCIG).
Additional Information
Additional information for residents is at the end of the document.
First, you must provide residents a 60-day notice before eliminating or decreasing services.
Second, residents have the freedom to choose alternate service providers from outside of the
facility.
Last, we want to share some information with you about the Senior Linkage Line. MDH received
this question from a provider: In the past we have been required to put the SLL number on our
leases to confirm residents have contacted the SLL. Will that be required under the new
regulations? The answer is somewhat of a “yes but…”. It is not required within 144G for
providers to include that. There is, however, Minn. Stat. 256.975 Minnesota Board on Aging
(www.revisor.mn.gov/statutes/cite/256.975) that requires prospective residents to call the SLL
prior to making a “long term care” choice. We added language to the UDALSA, so consumers
are aware of this. The current statute is being updated to reflect the new license changes for
August 1st, so this will continue when the AL licenses are in place. Therefore, providers should
inform perspective residents that they need to call the SLL before they sign a lease and be
offered objective counseling and support to make an informed decision.
Proposed Rules Update
On March 29, 2021, Administrative Law Judge (ALJ) Ann O’Reilly issued a Report regarding the
Minnesota Department of Health’s (MDH’s) proposed rules governing assisted living
licensure. Because ALJ O’Reilly disapproved some of the rules, she gave a copy of her Report
and the hearing record to Chief Judge Jenny Starr. On April 8, 2021, Chief Judge Starr approved
ALJ O’Reilly’s finding of defects. Chief Judge Starr provided her actions for MDH to take to
correct the defects for the rule to be approved.
If MDH elects to adopt the actions suggested by Chief Judge Starr, makes no further changes,
and Chief Judge Starr determines that the defects have been corrected, MDH may proceed to
adopt the rules. MDH may also request that Chief Judge Starr reconsider ALJ O’Reilly’s findings
of defects and disapproval of a rule.
Both Reports can be viewed on our website MDH Assisted Living Licensure
(www.health.state.mn.us/facilities/regulation/assistedliving/).
Innovation Variance
Innovation variance means a specified alternative to a Chapter 144G requirement. MDH may
only grant an innovation variance to a licensed assisted living facility under Minn. Stat. §
144G.33, subd. 1(b). Variance must allow an assisted living facility to offer services of a type or
manner that is innovative. Not just explain why a licensed assisted facility should not be
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required to follow a Chapter 144G requirement. The assisted living facility must show that the
innovation variance will not adversely affect the health, safety, or welfare of its residents. It
must also show how the innovation is likely to improve services. An innovation variance cannot
change any of the resident’s rights under the assisted living bill of rights as outlined in Minn.
Stat. § 144G.91. Keep in mind that residents have the right to care and assisted living services
that are appropriate based on the resident’s needs and according to an up-to date service plan
subject to accepted health care standards under Minn. Stat. § 144G.91, subd. 4.
A licensed assisted living facility may apply for an innovation variance at any time and must be
in writing to the Commissioner of Health, and specify the following:
1. The specific requirement for which the variance or waiver is requested;
2. The reasons for the request;
3. The alternative measures that will be taken if a variance or waiver is granted;
4. The length of time for which the variance or waiver is requested; and
5. Other relevant information deemed necessary by the commissioner to properly
evaluate the request. Minn. Stat. § 144G.45 subd. 7(a)(1)-(5).
The commissioner must deny a variance or waiver if it is determined that the above-
referenced criteria are not met under Minn. Stat. 144G.45 subd. 7(f). The commissioner shall
grant or deny each request for an innovation variance in writing within 45 days of receipt of a
complete application. The Notice of Denial shall contain the reasons for the denial. The terms of
the requested variance may be modified by agreement of the commissioner and the facility.
Minn. Stat. § 144G.22, subd. 5.
Minimum Site, Physical Environment, and Fire Safety Variance
or Waiver
Minn. Stat. § 144G.45, subd. 7(b)(1)-(3) outlines the criteria the commissioner must use in
determining whether to grant or deny a variance or waiver.
Specifically, the commissioner must address:
1. whether the waiver will adversely affect he health, treatment, comfort, safety, or well-
being of a resident;
2. Whether the alternative measures to be taken, if any, are equivalent to or superior to
those permitted under section 155G.81, subd. 5 AND
3. Whether compliance with the requirements would impose an undue hardship on the
facility.
Change of Ownership (CHOW)
A home care license issued by the commissioner may not be transferred to another party. A
change of ownership is a transfer of operational control of the home care provider business
under Minn. Stat. § 144A.472, subd. 5. A transfer in ownership includes:
1. The transfer of the business to a different or new corporation
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2. In the case of a partnership, the dissolution or termination of the partnership under
chapter 323A, with the business continuing by a successor partnership or other entity
3. The relinquishment of control of the provider to another party, including to a contract
management firm that is not under the control of the owner of the business’ assets;
4. Transfer of the business by a sole proprietor to another party or entity; or
5. Transfer of ownership or control of 50 percent or more of the controlling interest of a
home care provider business not covered by clauses (1)-(4) Minn. Stat. § 144A.472, subd
5(1)-(5).
Upcoming Presentations
WebEx previously scheduled for May 27th has been moved to May 20th instead. This has been
updated on our call page Home Care and Assisted Living Teleconference Calls
(www.health.state.mn.us/facilities/regulation/homecare/providers/calls.html).
Minnesota Department of Health
Assisted Living Licensure
Health Regulation Division
PO Box 3879
St. Paul, MN 55101
651-539-3049 or 844-926-1061
health.assistedliving@state.mn.us
www.health.state.mn.us
04/08/2021
To obtain this information in a different format, call: 651-201-4101.
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