(Amendments to 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter VII, Assisted Living Residences – adopted by the State Board of Health on November 19, 2008.  NOTE:  Items in parentheses preceding the amendments are notes/instructions for the CCR Publisher and are not part of the Rules)

(Amendments to section 1.103 - Instructions:  Replace existing subsections 1.103(1) through 1.103(6)(a)(i) and footnote 8 – Par. IDs 1203694 through 1203770, with the following:)

1.103	Department Oversight
1.103(1)	General
103(1)(a)	Issuing Licenses
(i)	The Department shall issue or renew a license when it is satisfied that the applicant or licensee is in compliance with the requirements set out in these regulations.  An initial license, other than a provisional, shall be valid for one year from the date of issuance unless voluntarily relinquished by the facility, revoked, suspended or otherwise sanctioned pursuant to these regulations.  A renewal license shall be valid for one year from the prior expiration date unless voluntarily relinquished by the facility, revoked, suspended or otherwise sanctioned pursuant to these regulations.
(ii)	No license shall be issued or renewed by the Department if the owner, applicant, or licensee of the assisted living residence has been convicted of a felony or of a misdemeanor, which felony or misdemeanor involves moral turpitude, as defined by law, or involves conduct that the Department determines could pose a risk to the health, safety, and welfare of residents of the assisted living residence.
103(1)(b)	Provisional Licenses
(i)	The Department may issue a provisional license to an applicant for the purpose of operating an assisted living residence for a period of ninety days if the applicant is temporarily unable to conform to all the minimum standards required under these regulations, except no license shall be issued to an applicant if the operation of the applicant's facility will adversely affect the health, safety, and welfare of the residents of such facility.
(ii)	As a condition of obtaining a provisional license, the applicant shall show proof to the Department that attempts are being made to conform and comply with applicable standards. No provisional license shall be granted prior to the submission of a criminal background check in accordance with 25-27-105 (2.5), C.R.S.
(iii)	A provisional license shall not be renewed.
103(1)(c)	Action Against a License
(i)	 General. The Department may suspend, revoke, or not renew the license of any facility which is out of compliance with the requirements of these regulations in conformance with the provisions and procedures specified in article 4 of title 24, C.R.S.
(ii)	 Denials.  When an application for an original license has been denied by the Department, the Department shall notify the applicant in writing of the denial by mailing a notice to the applicant at the address shown on the application. Any applicant aggrieved by such a denial may pursue the remedy for review provided in article 4 of title 24, C.R.S., by petitioning the Department, within thirty days after receiving such notice.
1.103(2)	License Fees 
Unless otherwise specified in this chapter, all licensing and plan review fees paid to the Department shall be deemed non-refundable.
103(2)(a)	High Medicaid Utilization Facilities
(i)	Fee.  High Medicaid utilization facilities shall pay a modified license fee as set forth below.
(ii)	Eligible facilities.  Facilities identified as high Medicaid utilization are those that have:
(A)	no less than 35 percent of the licensed beds occupied by Medicaid enrollees as indicated by complete and accurate fiscal year claims data; and
(B)	served Medicaid clients and submitted claims data for a minimum of nine (9) months of the relevant fiscal year.
103(2)(b)	Facilities Serving a Disproportionate Share of Low Income Residents
(i)	Fee.  Facilities serving a disproportionate share of low-income residents shall pay a reduced initial license fee of $2,500.
(ii)	 Eligible facilities.  Facilities eligible for the reduced initial license fee shall:
(A)	have qualified for federal or state low income housing assistance;
(B)	plan to serve low income residents with incomes at or below 80 percent of the area median income; and
(C)	submit evidence of such qualification, as required by the Department.
103(2)(c)	Initial License
(i)	The appropriate fee, as set forth below, shall accompany a facility’s application for initial license.
		Three to eight licensed beds:  $5,000.
		Nine beds or more:  $6,000.
103(2)(d)	License Renewal
(i)	For licenses with a renewal date between January 1, 2009 and December 31, 2009, the appropriate fee, as set forth below, shall accompany the application:  
(A)	$150 per facility plus $43 per bed.  
(B)	for a high Medicaid utilization facility, $150 per facility plus $15 per bed.
(ii)	For licenses with a renewal date after December 31, 2009, the appropriate fee, as set forth below, shall accompany the application:
(A)	$150 per facility plus $56 per bed.  
(B)	for a high Medicaid utilization facility, $150 per facility plus $15 per bed.
103(2)(e)	Provisional Licensure
(i)	Any facility approved by the Department for a provisional license, shall submit a fee of $1,000 for the provisional licensure period.
103(2)(f)	Other License Fees 
(i)	In addition to any other applicable fees, the following fees shall apply to the circumstances described.
(A)	Any facility applying for a change of address, shall submit a fee of $360 with the application.
(I)	For purposes of this subsection, a corporate change of address for multiple facilities shall be considered one change of address.
(B)	Any facility applying for a change of name shall submit a fee of $360 with the application.
(C)	Any facility applying for an increased number of licensed beds shall submit a fee of $360 with the application.
(D)	Any facility applying for a change of administrator shall submit a fee of $500 with the application.
(E)	Any facility seeking to open a secured unit shall submit a fee of $1,600 with the first submission of the applicable building plans.
(F)	Any facility applying for a change of ownership shall submit a fee of $5,000 with the application.  
(I)	If the same purchaser buys more than one facility from the same seller in a single business transaction, the change of ownership fee shall be $5,000 for the first facility and $2,800 for each additional facility included in the transaction.  The appropriate fee total shall be submitted with the application.
103(2)(g)	Fee Cap
	Notwithstanding the fees that become effective January 1, 2009, any fee increases requested by the Department for adoption by the Board of Health before June 30, 2014, shall be subject to the following restriction:  the dollar amount increase in total annual revenue generated by the changed fees shall not be more than a dollar amount equal to 37 percent of the total annual revenue generated during state fiscal year 2010-11.
1.103(3)	 Plan Review 
In reference to the National Fire Protection Association requirements, the Department is the authority having jurisdiction for state licensure.
103(3)(a)	 When Plan Review is Required
(i)	Application for an initial license, when such initial license is not a change of ownership, addition of previously uninspected or unlicensed square footage to an existing occupancy, or relocation of a currently licensed facility to a different physical plant.  This includes new facility construction and new occupancy of existing structures.
(ii)	Remodeling that commences on or after January 1, 2009,1 and that includes, but is not limited to:
1 Instances where remodeling shall be deemed to have commenced before January 1, 2009 are: a) when the local jurisdiction issued a building permit for such remodeling on or before December 31, 2008; or b) if a building permit is not required by the local jurisdiction, where architectural and engineering plans have been drafted and/or onsite construction began on or before December 31, 2008, with a completion date of June 31, 2010.
(A)	Structural alterations of any size to the resident sleeping area.
(B)	Alteration of an existing area of the facility into space for a secured environment.  
(C)	Relocation, removal or installation of walls that results in alteration of 25% or more of the existing habitable square footage. 2
2 Areas such as unfinished basements and garages that have not been used as habitable space shall not be included in the calculation of existing habitable square footage.
(D)	Conversion of existing space not previously used for providing resident services, including storage space, to space used for the delivery of services to residents. 
(E)	Addition, alteration or relocation of any egress component including, but not limited to, corridors, stairwells, exit enclosures, or points of refuge.
(F)	Installation of any new sprinkler systems or the addition, removal or relocation of 20 or more sprinkler heads.
(G)	Installation of any new fire alarm system; or addition, removal or relocation of 20 or more fire alarm appliances including, but not limited to, pull stations, detectors and notification devices.
(H)	Installation, removal or renovation of any kitchen hood suppression system.
103(3)(b)	Process for Submission and Approval of Building Plans
(i)	General. The building plans subject to plan review under this Chapter VII shall be submitted in accordance with 6 CCR 1011, Chapter II, Part 1, Review of Building Plans and Specifications, Sections 1.1.1, 1.1.4, and 1.3.
(ii)	 Secured Environments. If the addition, remodeling or new construction involves areas to be used for secured environments, information about the following shall also be submitted as part of the plan review:
(A)	locking devices for egress and egress access doors.
(B)	location of locked egress and egress access doors.
(C)	how the fencing or other enclosure around the secured outdoor area will be installed such that it prevents elopement and protects the safety and security of the residents.
103(3)(c)	Plan Review Fees
 (i)	The fee for review of a building plan as described in section 1.103(3)(a)(i) of this Chapter shall be determined as follows:
Licensed beds:	 0 - 8	 9 -16	17 – 30	31- 50	50 -100	101-150	150 - 200	201- 250	251+	
Fee:	$2,500	$3,200	$4,000	$4,400	$4,800	$5,200	$5,600	$6,000	$6,300	
(A)	If a facility has more than one structure used for providing client services on its campus, each structure shall be assessed a separate fee based upon the above chart.  The fees for all structures shall be combined to determine the total facility plan review fee.
(B)	The appropriate plan review fees shall accompany the facility’s first submission of building plans to the department.
(ii)	The fee for review of a remodeling plan as described in section 1.103(3)(a)(ii) of this Chapter shall be based upon the following chart and shall accompany the facility’s first submission of remodeling plans to the Department:
Project size:	Fee:	
Up to 1,500 square feet	$1,875	
1,501 to 4,500 sq. ft	$2,250	
4,501 to 15,000 sq. ft,	$2,625	
15,001 to 30,000 sq. ft.	$3,000	
30,001 to 45,000 sq. ft.	$3,375	
45,001 to 60,000 sq. ft.	$3,750	
60,001 to 75,000 sq. ft.	$4,125	
75,000+ sq. ft	$4,500	
1.103(4)	Citing Deficiencies
103(4)(a) The level of the deficiency shall be based upon the number of sample residents affected and the level of harm, as follows:
Deficiency level	Number of Sample 3	Level of Harm	
Level A	Isolated 4	Potential harm to the resident(s)	
Level B	Pattern 5	Potential harm to the resident(s)	
Level C	Isolated	Actual harm to the resident(s)	
Level D	Pattern	Actual harm to the resident(s)	
Level E	Isolated or Pattern	Life threatening to the resident(s)	
3 Sample may consist of residents, rooms, staff, etc.
4 One or a limited number of the sample is affected.
5 More than a limited number of the sample is affected.
103(4)(b)	When a Level E deficiency is cited, the facility shall immediately remove the cause of the life-threatening risk and provide evidence, either verbal or written as required by the Department, that the risk has been removed.
1.103(5)	Plans of Correction (POCs)
The Department shall require a plan of correction by facilities pursuant to Section 25-27-105 (2), C.R.S.
103(5)(a)	 General
(i)	The facility shall develop a POC, in the format required by the Department, for every deficiency cited by the Department in the deficiency list.
(ii)	The POC shall be typed or printed legibly in ink.
(iii)	The date of correction shall be no longer than 30 calendar days from the date of the mailing of the deficiency to the facility, unless otherwise required or approved by the Department.
103(5)(b)	 Process for Submission and Approval of POC
(i)	A facility shall submit a POC to the Department no later than ten (10) working days of the date of the deficiency list letter sent by the Department.
(ii)	If an extension of time is needed to complete the POC, the facility shall request an extension in writing from the Department prior to the POC due date. An extension of time may be granted by the Department not to exceed seven (7) calendar days.
(iii)	The POC is subject to Department approval.
1.103(6)	Intermediate Restrictions or Conditions
The Department may impose intermediate restrictions or conditions on a licensee as provided in Section 25-27-106, C.R.S.
103(6)(a)	General. The Department may impose intermediate restrictions or conditions on a licensee that may include at least one of the following:
(i)	Retaining a consultant to address corrective measures.	The consultant shall not be affiliated with the corporation or the facility on which the intermediate restriction/condition is required; 6
6 A facility may be required to retain a consultant in order to address deficient practice resulting from systemic failure. Systemic failure involves violations regarding a facility system, where such violations resulted or could have resulted in physical or emotional harm to residents. It will be the responsibility of the facility to select the consultant and the consultant's services.  An example of a facility system is the facility's medication administration program.

(Amendments to section 1.113(2) – Instructions:  replace existing subsection 1.113(2)(c) and footnote 9 – Par IDs 1519416 and 1519417, with the following:)
113 (2)(c)  Chapter 33, NFPA 101 (2003) or NFPA 101-A Guide on Alternative Approaches to Life Safety (2004).  The following facilities shall meet the requirements of either Chapter 33, Existing Residential Board and Care Occupancies, NFPA 101 (2003) or NFPA 101-A Guide on Alternative Approaches to Life Safety (2004) 7 unless otherwise specified. 

7 For those facilities complying with NFPA 101-A, Guide on Alternative Approaches to Life Safety (2004), the requirements for existing facilities shall apply.