6 Colo. Code Regs. § 1011-1 Chapter 07, pt. 3

Current through Register Vol. 47, No. 20, October 25, 2024

Part 3 - DEPARTMENT OVERSIGHT

Licensure

3.1 Applicants for an initial or renewal license shall follow the licensure procedures outlined in 6 CCR 1011-1, Chapter 2, Part 2.

(A) In addition, each license renewal applicant shall annually submit, in the form and manner prescribed by the Department, information about the facility's operations, resident care, and services.

3.2 The Department may issue a provisional license to an applicant for the purpose of operating an assisted living residence for one period of 90 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.

(A) As a condition of obtaining a provisional license, the applicant shall provide the Department with proof that it is attempting 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 Section 25-27-105 (2.5), C.R.S.

3.3 Each owner or applicant shall request a criminal history record check.

(A) If an owner or applicant for an initial assisted living residence license has lived in Colorado for more than three (3) years at the time of the initial application, said individual shall request from the Colorado Bureau of Investigation (CBI) a state fingerprint-based record check with notification of future arrests.

(B) If an owner or applicant for an initial assisted living residence license has lived in Colorado for three (3) years or less at the time of the initial application, said individual shall:

(1) Request from the Colorado Bureau of Investigation (CBI) a state fingerprint-based criminal history record check with notification of future arrests; and

(2) Obtain a name-based criminal history report for each additional state in which the applicant has lived for the past three years, conducted by the respective states' bureaus of investigation or equivalent state-level law enforcement agency or other name-based report as determined by the Department.

(C) The cost of obtaining such information shall be borne by the individual or individuals who are the subject of such check.

(D) The results of the check shall be forwarded to the Department as follows:

(1) For results from CBI, the information shall be forwarded by CBI to the Department.

(2) For equivalent agencies in other states, the information shall be forwarded by the agency to the Department if authorized by such state. If such authorization does not exist, the results shall be forwarded to the Department by the individual.

(E) When the results of a fingerprint-based criminal history record check of an applicant reveal a record of arrest without a disposition, the applicant shall submit to a name-basedjudicial record check.

3.4 No license shall be issued or renewed by the Department if an owner, applicant, and/ or licensee of the assisted living residence has been convicted of a felony or of a misdemeanor, which felony or misdemeanor involves moral turpitude or involves conduct that the Department determines could pose a risk to the health, safety, or welfare of residents of the assisted living residence.

3.5 An assisted living residence shall not care for more residents than the number of beds for which it is currently licensed.

License Fees

Unless otherwise specified, all license fees paid to the Department shall be non-refundable.

3.6 Initial Licenses

The applicable fee, as set forth below, shall accompany the license application.

3 to 8 licensed beds:	$6,804.63
9 to 19 licensed beds:	$7,884.73
20 to 49 licensed beds:	$9,450.88
50 to 99 licensed beds:	$12,475.16
100 or more licensed beds:	$15,931.48
Qualifying disproportionate share facility:	$3,240.30

3.7 Renewal Fees

The applicable fee(s), as set forth below, shall accompany the renewal application:

$388.84 per facility plus $111.25 per bed.

$388.84 per facility plus $41.04 per bed for a high Medicaid utilization facility.

$378.04 per secure environment that is separate and distinct from a non-secure environment.

3.8 Provisional Licensure. Any facility approved by the Department for a provisional license, shall submit a fee of $1,080.10 for the provisional licensure period.

3.9 Change of Ownership

(A) The applicable fee, as set forth below, shall accompany a facility's application for change of ownership.

Three to 19 licensed beds:	$6,750.63
20 to 49 licensed beds:	$8,424.78
50 to 99 licensed beds:	$11,449.06
100 licensed beds and more:	$14,797.37

(B) 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 the fee noted above for the largest facility and $4,860.45 for each additional facility included in the transaction. The appropriate fee total shall be submitted with the application.

3.10 Other License Fees

(A) A facility applying for a change of mailing address, shall submit a fee of $81.01 with the application. For purposes of this subpart, a corporate change of address for multiple facilities shall be considered one change of address.

(B) A facility applying for a change of name shall submit a fee of $81.01 with the application.

(C) A facility applying for an increased number of licensed beds shall submit a fee of $540.05 with the application.

(D) A facility applying for a change of administrator shall submit a fee of $540.05 with the application.

(1) If the change of administrator application is due to the appointment of an interim administrator, the facility shall pay the fee no later than 90 days after the appointment.

(a) If an administrator is appointed during the 90 days and the required change of administrator application is submitted ruing that time, the facility shall owe a single payment of $540.05.

(b) If an administrator is appointed more than 90 days after the appointment of the interim administrator, the facility shall pay separate fees for each change of administrator application.

(E) A facility seeking to open a new secure environment shall submit a fee of $1,728.16 with the first submission of the applicable building plans.

Fine for Lack of Administrator

3.11 Any assisted living residence found to be without an administrator or interim administrator compliant with the requirements in Part 4.5 shall be fined $1,000.

Citing Deficiencies

3.12 The level of the deficiency shall be based upon the number of sample residents affected and the level of harm, as follows:

Level A - isolated potential for harm for one or more residents.

Level B - a pattern of potential for harm for one or more residents.

Level C - isolated actual harm affecting one or more residents.

Level D - a pattern of actual harm affecting one or more residents.

Level E (Immediate Jeopardy) - actual or potential for serious injury or harm for one or more residents.

In determining the level of deficiency to be cited, potential for harm shall mean there is a reasonable expectation that the noncompliance will result in an adverse outcome.

3.13 When a Level E deficiency is cited, the assisted living residence shall immediately remove the cause of the immediate jeopardy risk and provide the Department with written evidence that the risk has been removed.

Plans of Correction

3.14 Pursuant to Section 25-27-105 (2), C.R.S., an assisted living residence shall submit a written plan detailing the measures that will be taken to correct any deficiencies.

(A) Plans of correction shall be in the format prescribed by the Department and conform to the requirements set forth in 6 CCR 1011-1, Chapter 2, Part 2.10.4(B);

(B) The Department has the discretion to approve, impose, modify, or reject a plan of correction as set forth in 6 CCR 1011-1, Chapter 2, Part 2.10.4(B).

Intermediate Restrictions or Conditions

3.15 Section 25-27-106, C.R.S., allows the Department to impose intermediate restrictions or conditions on a licensee that may include at least one of the following:

(A) Retaining a consultant to address corrective measures including deficient practice resulting from systemic failure;

(B) Monitoring by the Department for a specific period;

(C) Providing additional training to employees, owners, or operators of the residence;

(D) Complying with a directed written plan, to correct the violation; and/or

(E) Paying a civil fine not to exceed ten thousand dollars per violation; except the cap may be exceeded at the department's discretion for an egregious violation that results in death or serious injury to a resident after considering the circumstances around the violation. In determining the amount of the fine, in accordance with Section 25-27-106(4)(a), C.R.S.:

(1) The Department shall consider:

(a) The history of harm or injury at the residence;

(b) The number of injuries to residents for which the cause of the injury is unknown;

(c) The adequacy of the residence's occurrence investigations and reporting;

(d) The adequacy of the administrator's supervision of employees to ensure employees are keeping residents safe from harm or injury; and

(e) The residence's compliance with required mandatory reporting of the mistreatment of residents, in accordance with Part 13.11(A).

(2) The Department may vary the amount of the fine depending on the size of the residence, the potential for harm or injury to one or more residents, and whether there is a pattern of potential or actual harm or injury to residents. For these variations, potential for harm shall mean there is a reasonable expectation that the assisted living residence's noncompliance will result in an adverse outcome.

3.16 Intermediate restrictions or conditions may be imposed for Level A and B deficiencies when the Department finds the assisted living residence has violated statutory or regulatory requirements. The factors that may be considered include, but are not limited to, the following:

(A) The level of potential harm to a resident(s);

(B) The number of residents affected;

(C) Whether the conduct leading to the imposition of the restriction are isolated or a pattern; and

(D) The licensee's prior history of noncompliance in general, and specifically with reference to the cited deficiencies.

3.17 For all cases where the deficiency list includes Level C, D, or E deficiencies, the assisted living residence may be required to comply with one or more of the intermediate restrictions or conditions in Part 3.15(A) through (D), and shall be assessed a civil fine in accordance with Part 3.15(E), within the following ranges:

(A) For each Level C deficiency, the fine shall be between $100 and $5,000.

(B) For each Level D deficiency, the fine shall be between $500 and $7,500.

(C) For each Level E deficiency that is cited based on the likelihood of serious injury, serious harm, serious impairment, or death, the fine shall be between $1,000 and $10,000.

(D) For each Level E deficiency that is cited based on actual serious injury, serious harm, serious impairment, or death, the fine shall be between $2,000 and $10,000, except that the Department may exceed $10,000 for any egregious violation(s) or ongoing pattern of egregious violations resulting in serious injury or death.

Appealing the Imposition of Intermediate Restrictions/Conditions

3.18 A licensee may appeal the imposition of an intermediate restriction or condition pursuant to procedures established by the Department and as provided by Section 25-27-106, C.R.S.

(A) Informal Review

Informal review is an administrative review process conducted by the Department that does not include an evidentiary hearing.

(1) A licensee may submit a written request for informal review of the imposition of an intermediate restriction no later than ten (10) business days after the date notice is received from the Department of the restriction or condition. If an extension of time is needed, the assisted living residence shall request an extension in writing from the Department prior to the submittal due date. An extension of time may be granted by the Department not to exceed seven (7) calendar days. Informal review may be conducted after the plan of correction has been approved.

(2) For civil fines, the licensee may request, in writing that, the informal review be conducted in person, which would allow the licensee to orally address the informal reviewer(s).

(B) Formal Review

A licensee may appeal the imposition of an intermediate restriction or condition in accordance with the Administrative Procedure Act (APA) at Section 24-4-105, C.R.S. A licensee is not required to submit to the Department's informal review before pursuing formal review under the APA.

(1) For life-threatening situations, the licensee shall implement the restriction or condition immediately upon receiving notice of the restriction or condition.

(2) For situations that are not life-threatening, the restriction or condition shall be implemented in accordance with the type of condition as set forth below:

(a) For restriction/conditions other than fines, immediately upon the expiration of the opportunity for appeal or from the date that the Department's decision is upheld after all administrative appeals have been exhausted.

(b) For fines, within 30 calendar days from the date the Department's decision is upheld after all administrative appeals have been exhausted.

Supported Living Program Oversight

3.19 An assisted living residence that is certified to participate in the Supported Living Program administered by the Department of Healthcare Policy and Financing (HCPF) shall comply with both HCPF's regulations concerning that program and the applicable portions of this chapter. The Department shall coordinate with HCPF in regulatory interpretation of both license and certification requirements to ensure that the intent of similar regulations is congruently met.

6 CCR 1011-1 Chapter 07, pt. 3

46 CR 24, December 25, 2023, effective 11/15/2023, exp. 3/14/2024 (Emergency)

46 CR 24, December 25, 2023, effective 1/14/2024

47 CR 10, May 25, 2024, effective 7/1/2024