Application for Endorsement
(1)ENDORSEMENT REQUIRED. Any residential care, assisted living, or nursing facility that offers or provides care to residents with dementias in a memory care community must obtain an endorsement on its facility license.
(2)APPLICATION. At least 60 days prior to the anticipated endorsement, the applicant must submit to the Department a completed Memory Care Community Endorsement Application (form APD 940). The Department shall return incomplete applications to the applicant.
(3)FEE. The non-refundable endorsement application fee is due upon receipt of the application for an initial endorsement and whenever the facility’s license and endorsement are renewed. Endorsement application fees are in addition to fees required for facility licensure. Fees shall be as follows:
(a)$50 for each facility with a total memory care community endorsed capacity of 16 or fewer residents;
(b)$75 for each facility with a total memory care community endorsed capacity of 17 to 50; or
(c)$100 for each facility with a total memory care community endorsed capacity of 51 or more.
(4)The applicant must also include the following with the initial application and fee:
(a)Memory Care Community Uniform Disclosure Statement (form SDS 9098 MC);
(b)Employee training curricula;
(c)Policies and procedures;
(d)Floor plan of the memory care community;
(e)Residency or admission agreement;
(f)Copy of the service or care planning tool; and
(g)Copies of brochures or advertisements that are used to advertise the facility and the facility’s services.
(5)DEMONSTRATED CAPACITY. The applicant must demonstrate to the satisfaction of the Department, the ability to provide services in a manner that is consistent with the requirements of these rules.
(a)The Department shall consider the following criteria including but not limited to:
(A)The experience of the applicant in managing a memory care community or previous long-term care experience; and
(B)The compliance history of the applicant for endorsement or management company in the operation of any care facility licensed, certified, or registered under federal or state laws.
(b)If the applicant does not have experience in the operation of a memory care community, the applicant must employ a consultant or management company for at least the first six months of operation.
(A)The consultant or management company must have experience in dementia care operations and must be approved by the Department.
(B)The applicant must implement the recommendations of the consultant or management company or present an acceptable plan to the Department to address the consultant’s identified concerns.
(6)The Department shall conduct an on-site inspection prior to the issuance of an endorsement to ensure the memory care community is in compliance with the physical plant requirements as outlined in these rules.
(7)The endorsement shall be identified on the facility’s license.
(8)ENDORSEMENT RENEWAL. Renewal for endorsement must be made at the time of the renewal for the facility’s license (form APD 940).
(9)RELINQUISHMENT OF ENDORSEMENT. The licensee must notify the Department in writing at least 60 days prior to the voluntary relinquishment of the endorsement of a memory care community. For voluntary relinquishment, the facility must:
(a)Give all residents and their designated representatives a 45-day notice. The notice must include:
(A)The proposed effective date of the relinquishment;
(B)Changes in staffing;
(C)Changes in services including the elimination or addition of services; and
(D)Staff training that shall occur when the relinquishment becomes effective.
(b)Submit a transitional plan to the Department that demonstrates how the current residents shall be evaluated and assessed to reside in a memory care community that is not endorsed and is unsecured or would require move-out or transfer to other settings;
(c)Change in each resident’s service or care plans as appropriate to address any needs the residents may have with the transition;
(d)Notify the Department when the relinquishment process has been completed; and
(e)Revise advertising materials and disclosure information to remove any reference that the facility is an endorsed memory care community.
Rule 411-057-0120 — Application for Endorsement,