Applying for initial licensure

Applying for initial licensure

Operating an ALR in the state of Massachusetts requires a license issued by the Executive Office of Elder Affairs, who is the regulatory agency for ALRs in the state. Renewing the operating license is also yearly process for ALRs that requires great attention to detail to ensure the continuation of your ability to care for seniors.  See the following regulation as to how to properly apply for your license and ensure good standing with the issued license:

12.03: Certification

(2) Application for Certification.

Application shall be made on forms and in the manner prescribed by EOEA. Every Application shall be notarized and signed under the pains and penalties of perjury by the Applicant. Except as set forth in 651 CMR 12.03(8), an Application shall be submitted to EOEA at least 60 days prior to the date the Applicant plans to commence operation of the Assisted Living Residence. EOEA shall charge a non-refundable fee set by the Secretary of Administration and Finance pursuant to M.G.L. c. 7, § 3B for the filing of the Application for Certification of an Assisted Living Residence. An Applicant shall file a separate Application for each Assisted Living Residence for which Certification is sought. In support of the Application for Certification each Applicant shall provide:

(a) The name and address of each officer, director, and trustee; and the names and addresses of each owner, general partner, limited partner, or shareholder with a 25% or greater interest in the Assisted Living Residence;

(b) Attestation, under the pains and penalties of perjury, that none of such individuals has ever been found in violation of any local, state or federal statute, regulation, ordinance, or other law by reason of that individual’s relationship to an Assisted Living Residence or health care facility;

(c) A list for each such individual of all multi-family housing or health care facilities or providers in which she or he has been or is an officer, director, trustee, or general partner;

(d) If the Applicant or any person named in the Application as set forth in 651 CMR 12.03(2)(a) has or has had, within the previous five years, an interest in one or more of the entities listed in 651 CMR 12.03(2)(d)1. through 3., evidence from the Massachusetts Department of Public Health (DPH)that the entities have substantially met applicable criteria for licensure or Certification and, if applicable, have corrected all cited deficiencies without de-licensure or de-certification being imposed:

  1. hospital, clinic, long term care facility, mammography facility, institutions for unwed mothers, out of hospital dialysis unit, hospice program, bacteriological laboratory, blood bank, or other entity licensed by the DPH under M.G.L. c. 111;
  2. medical provider licensed under other applicable state statutes; including a facility, halfway house or treatment program unit for alcoholism licensed under M.G.L. c. 111B, ambulance service licensed under M.G.L. c. 111C, clinical laboratory licensed under M.G.L. c. 111D, and drug rehabilitation facility licensed under M.G.L. c. 111E; or
  3. home health agency in Massachusetts certified under Title XVIII of the Social Security Act.

(e) A copy of the conversion approval from the DPH, if an Applicant seeks to convert all or part of a premises licensed as a Long Term Care Facility to an Assisted Living Residence or if an Applicant seeks to add Assisted Living Residences to existing premises licensed as a Long-term Care Facility;

(f) An operating plan which shall include the following information:

  1. The number of single and double occupancy Units for which Certification is sought, the number of single and double occupancy Units designated as Special Care Units, and the number of Residents per Unit;
  2. The location of Units and Special Care Units, common spaces, and egresses by floor;
  3. The fee structure for lodging, meals and services;
  4. The type and extent of services to be offered, arrangements for providing such services, including third party contracts, and linkages with hospital and nursing facilities;
  5. A Plan for Self-administered Medication Management (SAMM) for Residents, including but not limited to, assistance with as-necessary medication (PRN) when part of the SAMM, and, if offered, Limited Medication Administration;
  6. A means for Residents to communicate urgent or emergency needs, and a plan to provide timely assistance to them;
  7. The number of staff to be employed in the operation of the Assisted Living Residence and their minimum qualifications and responsibilities;
  8. A copy of the Residency Agreement that will be used by the Assisted Living Residence. It must clearly describe the rights and responsibilities of the Resident and Sponsor, and comply with all requirements of M.G.L. c. 19D and 651 CMR 12.00;
  9. A copy of all required current building, fire safety, and locally approved state sanitary code certificates and permits;
  10. Procedures to notify a Resident and his or her Legal or Resident Representative, as appropriate, that the Assisted Living Residence is no longer an appropriate environment for the Resident. Such notice shall describe the changes in the Resident’s service needs that justify such a finding, explain when those changes occurred, and describe how the Resident’s needs can no longer be satisfied;
  11. A copy of all policies and procedures related to the design and operation of a Special Care Residence or Residences required under 651 CMR 12.04(4);
  12. A copy of the quality improvement and assurance program required under 651 CMR 12.04(10);
  13. A copy of the disaster and emergency preparedness plan required under 651 CMR 12.04(11);
  14. A copy of the communicable disease control plan required under 651 CMR 12.04(12);
  15. A copy of the Controlled Substances policies and procedures required by 651 CMR 12.04(14);
  16. A statement citing the beginning and ending dates of the Residence’s fiscal year; and
  17. Policies and procedures designed to ensure a safe environment for all Residents.

(g) Applications for renewal Certification must also include a statement that the data required by 651 CMR 12.04(13), information documenting all substantial changes to the operating plan prior to the effective date, and all other information required by EOEA, have been submitted.

(3) Review of Applications. The EOEA shall not review an Application for Certification unless:

(a) The Application includes all information required by EOEA;

(b) The Application includes all required attachments and statements that are required for the Certification; and

(c) The Applicant has paid all required Application fees.

(4) Evaluation of Application.

The EOEA shall not approve an Application for Certification unless:

(a) The Secretary or his or her designee has conducted a compliance review of the Assisted Living Residence as set forth in 651 CMR 12.09 and has reasonably determined that the premises meets the requirements of M.G.L. c. 19D and is in compliance with 651 CMR 12.00; and

(b) The Secretary or his or her designee has conducted a review of the Applicant and has reasonably determined that the Applicant meets the requirements of M.G.L. c. 19D and is in compliance with 651 CMR 12.00.

(c) EOEA may, in its discretion, deny Certification to any Applicant who has directly or indirectly had an ownership interest in an entity licensed under M.G.L. c. 111, or a medical provider licensed under other applicable state statutes, or a home health agency certified under Title XVIII of the Social Security Act, that:

  1. has been the subject of a patient care receivership action;
  2. has ceased to operate such an entity as a result of:
  3. a settlement agreement arising from a decertification action;
  4. a settlement agreement in lieu of a patient care receivership; or
  5. a delicensure action or involuntary termination of participation in either the Medical Assistance program or the Medicare program;
  6. has been the subject of a substantiated case of patient abuse or neglect involving material failure to provide adequate protection or services for a resident in order to prevent such abuse or neglect; or
  7. has over the course of its operation been cited for repeated, serious or willful violations of rules and regulations governing the operation of said health care facility that indicate a disregard for resident safety and an inability to responsibly operate an Assisted Living Residence.

Top Takeaways:

  • Every Application shall be notarized and signed under the pains and penalties of perjury by the Applicant. Except as set forth in 651 CMR 12.03(8), an Application shall be submitted to EOEA at least 60 days prior to the date the Applicant plans to commence operation of the Assisted Living Residence.

You must pay close attention to the time frame that is required by EOEA to submit your application. You do not want a situation where you are up against the proverbial ropes awaiting a decision regarding your license.

  • (f) An operating plan which shall include the following information: 1-17

When you submit your application, you must have an operating plan that covers every nook and cranny of your facility operations. Pay special attention to the emergency plan, residency agreement and the policies for medication management.

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