Assisted Living Certification Regulations

Learn about Assisted Living Residence (ALR) Certification Regulations.

Table of Contents

Requirements and limitations

  1. No person or legal entity shall advertise, operate, or maintain an ALR until it has been certified by Executive Office of Elder Affairs (EOEA).
  2. Notwithstanding the requirement of 651 CMR 12.03(1), prior to the commencement of operations, an Applicant may advertise an uncertified ALR only if it first initiates the application process for Certification by notification to EOEA, and if it clearly states in all advertising and marketing materials that it has not completed the EOEA Certification process.
  3. An Applicant must have sufficient property rights, as an owner or lessee, as the Secretary or his or her designee finds necessary for the operation of an Assisted Living Residence.
  4. An Application for Certification shall not be approved until the Applicant and premises meet the requirements of 651 CMR 12.03(2).

Please refer to the Assisted Living Regulations  for further details.

Application for Certification

The Certification Application should be notarized and signed under the pains and penalties of perjury by the Applicant.

Except in the case of changing ownership, the Application must be submitted to EOEA at least 60 days prior to the date the Applicant plans to start operation of the ALR. EOEA will charge a non-refundable fee set by the Secretary of Administration and Finance for the filing of the Application for Certification of an Assisted Living Residence. The Applicant must file a separate Application for each Assisted Living Residence for which Certification is sought.

In addition to the Application for Certification the Applicant must include:

  • The name and address of each:
    • officer
    • director
    • trustee
    • owner
    • general partner
    • limited partner
    • shareholder with a 25% or greater interest in the ALR
  • Provide proof 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;
  • 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;
  • If the Applicant or any person named in the Application has or has had, within the previous 5years, 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:
    • 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;
    • 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
    • home health agency in Massachusetts certified under Title XVIII of the Social Security Act.
  • 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;
  • An operating plan which includes the following information:
    • 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;
    • The location of Units and Special Care Units, common spaces, and egresses by floor;
    • The fee structure for lodging, meals and services;
    • 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;
    • 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;
    • A means for Residents to communicate urgent or emergency needs, and a plan to provide timely assistance to them;
    • The number of staff to be employed in the operation of the Assisted Living Residence and their minimum qualifications and responsibilities;
    • 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;
    • A copy of all required current building, fire safety, and locally approved state sanitary code certificates and permits;
    • 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;
    • A copy of all policies and procedures related to the design and operation of a Special Care Residence or Residences;
    • A copy of the quality improvement and assurance program;
    • A copy of the disaster and emergency preparedness plan;
    • A copy of the communicable disease control plan;
    • A copy of the Controlled Substances policies and procedures;
    • A statement citing the beginning and ending dates of the Residence's fiscal year; and
    • Policies and procedures designed to ensure a safe environment for all Residents.
  • 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.

Please refer to the Assisted Living Regulations  for further details.

Review of application

The EOEA will not review an Application for Certification unless:

  • The Application includes all information required by EOEA;
  • The Application includes all required attachments and statements that are required for the Certification; and
  • The Applicant has paid all required Application fees.

Please refer to the Assisted Living Regulations  for further details.

Evaluation of application

The EOEA will not approve an Application for Certification unless:

  • 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
  • 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.
  • 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:
    • has been the subject of a patient care receivership action
    • has ceased to operate such an entity as a result of:
      • a settlement agreement arising from a decertification action;
      • a settlement agreement in lieu of a patient care receivership; or
      • a delicensure action or involuntary termination of participation in either the Medical Assistance program or the Medicare program;
    • 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
    • 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.

Please refer to the Assisted Living Regulations  for further details.

Certification fee

Upon receiving notice of Certification, a Sponsor shall forward within 10 days to EOEA a Certification fee, set by the Secretary for Administration and Finance pursuant to M.G.L. c. 7, § 3B based on the number of Units certified on the date of its most recent Application.

In the event that the Applicant or Sponsor of an Assisted Living Residence alters the Residence by the addition or removal of Units, a fee adjustment may be made by EOEA.

Failure to pay the fee within the 10 day period shall result in a finding of non-compliance by EOEA under 651 CMR 12.09.

No fee for initial certification or certification renewal shall be due from any Assisted Living Residence created under the HUD Assisted Living Conversion Program.

Please refer to the Assisted Living Regulations  for further details.

Designation of Units for Assisted Living

If all units within a facility meet the physical requirements of assisted living regulations, the Residence is not required to designate the specific units for certification.

If units are not being used as assisted living units, and all units do not meet the physical requirements, the residence must designate the specific assisted living units for certification.

However, it is important that the Residence not open additional units to residents above the maximum approved number without completing the certification process in 651 CMR 12.4(8).

Any residence operating assisted living units without certification is subject to a civil penalty of up to $500 per unit/per day, plus additional monetary penalties for referring residents to uncertified units.

Landlord/tenant law

Unless a resident leaves voluntarily, assisted living residences must terminate the residency agreement in accordance with the landlord/tenant law. M.G.L. Chs. 186 and 239 are pertinent to an eviction process.

According to the landlord/tenant law, the Residence must provide at least 14 days notice prior to termination of an agreement for non-payment of rent. All other termination clauses must be specified in the agreement and must state the length of notice that will be given.

Personal care services

Individuals responsible for providing personal care services must either complete personal care training prior to providing personal care services or be exempt from this requirement. See 651 CMR 12.07(6).

Residences are not responsible for any personal care services contracted for privately by the resident and/or their family members if the services are not part of the service plan or if the resident contracts with a provider with no affiliation with the residence. Residences may request that the resident notify the management if any such arrangements are being made between a resident and a private provider but may not establish requirements that would infringe upon a resident's right to privately contract for services.

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