By : Matthew Bergeron and Julia Page

In what has become something of an annual project, the Minnesota Legislature once again worked to revise and refine the assisted living licensing statute (Chapter 144G) that was originally passed in 2019.  Since the law’s implementation in 2021, stakeholders, including trade associates representing assisted living providers, state agencies, and consumer advocates, have consistently sought modifications to the law.  In 2024, the legislature made a number of changes to the assisted living licensing statute as part of its various health and human services omnibus policy and supplemental appropriation bills.

Rental License Exemption

Small licensed assisted living facilities (and community residential settings licensed under 245D) that have six or fewer residents are exempt from town, municipality, or county rental licensing. Other local laws still apply such as local governing laws, regulations, standards, ordinances, codes for fire safety, building, and zoning requirements. This is change was effective as of May 18, 2024.

Small Assisted Living Relocation

Formerly unable to relocate due to a moratorium on small licensed assisted living facilities providing customized living services, the 2024 legislature amended the law to create a pathway to relocate while maintaining their grandfathered status to serve clients under age 55 on CADI/BI waivers. Details of the changes include:

• Facilities will be allowed to relocate, beginning March 15, 2025, but the process for securing a new location and seeking necessary approvals is allowed as of January 1, 2025 or 90 days after federal approval, whichever is later;
• Only assisted living facilities with a licensed resident capacity of five or fewer can relocate;
• Facilities can only relocate within the same municipality or within the geographic boundaries of a contiguous municipality;
• Facilities cannot relocate more than once within a three-year period, unless there are extenuating circumstances approved by the Minnesota Department of Health (MDH);
• Facilities can maintain their “grandfathered” status as customized living providers serving individuals under age 55 if they are moving under these circumstances:
• Eviction, non-renewal of lease by the property owner, or sale of the property by the owner;
• Inability to make necessary updates or improvements to comply with the physical plant and other requirements under state or federal law;
• The providers monthly rent increases over 3% in a 12-month period;
• The original setting is destroyed or damaged beyond repair and the safety of the residents would be jeopardized; or
• The provider or a related entity purchases a new setting and desires to move the existing license to the new location.
• MDH has 30 days to approve or deny the new location;
• The Department of Human Services (DHS) has 30 days to approve or deny requests to transfer the original setting’s customized living enrollment date to the new setting; and
• Providers must pay a fee for a “new” license in the amount of $3,905 for relocation.

Mental Health and De-Escalation Training

Effective July 1, 2025 licensed assisted living providers will be required to include training on mental health and de-escalation in addition to the current dementia training for all supervisors and staff. Individuals must complete two hours of training on mental illness and de-escalation topics specified below. The training must take place within 120 days of employment start date and one hour of training each year ongoing after that. The content of the training must include:

• Recognizing symptoms of common mental illness diagnoses, including but not limited to mood disorders, anxiety disorders, trauma and stressor-related disorders, personality and psychotic disorders, substance use disorder, and substance misuse;
• De-escalation techniques and communication; and
• Crisis resolution, including a procedure for contacting county crisis response teams and 988 suicide and crisis lifelines.

Assisted Living Food Code Changes

The legislature modify food code requirements for assisted livings effective August 1, 2024 with a particular eye on creating flexibility for small providers. For example:
•    Small assisted living facilities may share certified food protection managers for multiple locations;
•    Facilities can use double basin sink for designated hand washing sink (one side for dishes, one side for hand washing); and 
•    Popcorn ceilings are no longer prohibited in the kitchen of small assisted living facilities.

Minimum Services Requirement Changes

On or after August 1, 2024, assisted livings must offer to provide or make available the following services to residents:

• Weekly housekeeping;
• Weekly laundry services;
• Upon the request of the resident;
  • Provide direct or reasonable assistance with arranging for transportation;
  • Provide reasonable assistance with accessing community resources and social services;
• Provide culturally sensitive programs; or
• Have a daily program of social and recreational activities that are based upon individual and group interests, physical, mental, and psychosocial needs.

Staff Orientation Portability

144G licensed assisted livings are not required to repeat orientation training for staff if the staff transfer to another facility operated by the same licensee or an affiliated licensee with he same corporate organization. This is effective August 1, 2024.

Assisted Living Director Qualifications

Effective August 1, 2024, assisted living directors must apply for licensure within 30 days of hire.

Assisted Living Correction Orders

For correction orders issued on or after August 1, 2024, assisted living facilities must make available, in a manner readily accessible, the most recent plan of correction to comply with any correction orders.

Assisted Living Title Protection

After January 1, 2026, licensed assisted living providers cannot use “home care” or “nursing home” in their provider/company names. Additionally, “assisted living” cannot be used in advertisements, marketing, promotions, service offerings, or title unless the entity is licensed as an assisted living under Chapter 144G.

Closure Plans for Provisionally Licensed Assisted Livings

For assisted livings provisionally licensed and ordered to close by MDH, they must submit a draft closure plan within ten calendar days of receipt of the reconsideration decision, work with the department on any revisions needed, and have final closure plan submitted and approved within 30 calendar days of receipt of reconsideration decision. This is effective August 1, 2024.

If you have questions about these legislative changes, please feel free to contact Matthew Bergeron at mbergeron@larkinhoffman.com.