144G.12 APPLICATION FOR LICENSURE.
Subdivision 1. License applications. Each application for an assisted living facility license, including
provisional and renewal applications must include information sufficient to show that the applicant meets
the requirements of licensure, including:
(1) the business name and legal entity name of the licensee, and the street address and mailing address
of the facility;
(2) the names, e-mail addresses, telephone numbers, and mailing addresses of all owners, controlling
individuals, managerial officials, and the assisted living director;
(3) the name and e-mail address of the managing agent and manager, if applicable;
(4) the licensed resident capacity and the license category;
(5) the license fee in the amount specified in section 144.122;
(6) documentation of compliance with the background study requirements in section 144G.13 for the
owner, controlling individuals, and managerial officials. Each application for a new license must include
documentation for the applicant and for each individual with five percent or more direct or indirect ownership
in the applicant;
(7) evidence of workers’ compensation coverage as required by sections 176.181 and 176.182;
(8) documentation that the facility has liability coverage;
(9) a copy of the executed lease agreement between the landlord and the licensee, if applicable;
(10) a copy of the management agreement, if applicable;
(11) a copy of the operations transfer agreement or similar agreement, if applicable;
(12) an organizational chart that identifies all organizations and individuals with an ownership interest
in the licensee of five percent or greater and that specifies their relationship with the licensee and with each
other;
(13) whether the applicant, owner, controlling individual, managerial official, or assisted living director
of the facility has ever been convicted of:
(i) a crime or found civilly liable for a federal or state felony-level offense that was detrimental to the
best interests of the facility and its resident within the last ten years preceding submission of the license
application. Offenses include: felony crimes against persons and othersimilar crimes for which the individual
was convicted, including guilty pleas and adjudicated pretrial diversions; financial crimes such as extortion,
embezzlement, income tax evasion, insurance fraud, and other similar crimes for which the individual was
convicted, including guilty pleas and adjudicated pretrial diversions; any felonies involving malpractice that
resulted in a conviction of criminal neglect or misconduct; and any felonies that would result in a mandatory
exclusion under section 1128(a) of the Social Security Act;
(ii) any misdemeanor conviction, under federal or state law, related to the delivery of an item or service
under Medicaid or a state health care program, or the abuse or neglect of a patient in connection with the
delivery of a health care item or service;
(iii) any misdemeanor conviction, under federal or state law, related to theft, fraud, embezzlement,
breach of fiduciary duty, or other financial misconduct in connection with the delivery of a health care item
or service;
(iv) any felony or misdemeanor conviction, under federal or state law, relating to the interference with
or obstruction of any investigation into any criminal offense described in Code of Federal Regulations, title
42, section 1001.101 or 1001.201;
(v) any felony or misdemeanor conviction, under federal or state law, relating to the unlawful manufacture,
distribution, prescription, or dispensing of a controlled substance;
(vi) any felony or gross misdemeanor that relates to the operation of a nursing home or assisted living
facility or directly affects resident safety or care during that period;
(vii) any revocation or suspension of a license to provide health care by any state licensing authority.
This includes the surrender of such a license while a formal disciplinary proceeding was pending before a
state licensing authority;
(viii) any revocation or suspension of accreditation; or
(ix) any suspension or exclusion from participation in, or any sanction imposed by, a federal or state
health care program, or any debarment from participation in any federal executive branch procurement or
nonprocurement program;
(14) whether, in the preceding three years, the applicant or any owner, controlling individual, managerial
official or assisted living director of the facility has a record of defaulting in the payment of money collected
for others, including the discharge of debts through bankruptcy proceedings;
(15) the signature of the owner of the licensee, or an authorized agent of the licensee;
(16) identification of all states where the applicant or individual having five percent or more ownership,
currently or previously has been licensed as an owner or operator of long-term care, community-based, or
health care facility or agency where its license or federal certification has been denied, suspended, restricted,
conditioned, refused, not renewed, or revoked under a private or state-controlled receivership, or where
these same actions are pending under the laws of any state or federal authority;
(17) statistical information required by the commissioner; and
(18) any other information required by the commissioner.
Subd. 2. Authorized agents. (a) An application for an assisted living facility license or for renewal of
a facility license must specify one or more owners, controlling individuals, or employees as authorized
agents who can accept service on behalf of the licensee in proceedings under this chapter.
(b) Notwithstanding any law to the contrary, personal service on the authorized agent named in the
application is deemed to be service on all of the controlling individuals or managerial officials of the facility,
and it is not a defense to any action arising under this chapter that personal service was not made on each
controlling individual or managerial officials of the facility. The designation of one or more control
individuals or managerial officials under this subdivision shall not affect the legal responsibility of any other
controlling individual or managerial officials under this chapter.
Subd. 3. Fees. (a) An initial applicant, renewal applicant, or applicant filing a change of ownership for
assisted living facility licensure must submit the application fee required in section 144.122 to the
commissioner along with a completed application.
(b) Fees collected under this section shall be deposited in the state treasury and credited to the state
government special revenue fund. All fees are nonrefundable.
Subd. 4. Fines and penalties. (a) The penalty for late submission of the renewal application less than
30 days before the expiration date of the license or after the expiration of the license is $200. The penalty for
operating a facility after the expiration of the license and before a renewal license is issued is $250 each day
after the expiration of the license until the renewal license issuance date. The facility is still subject to the
misdemeanor penalties for operating after license expiration.
(b) Fines and penalties collected under this subdivision shall be deposited in a dedicated special revenue
account. On an annual basis, the balance in the special revenue account shall be appropriated to the
commissioner to implement the recommendations of the advisory council established in section 144A.4799