Licensing and Certification
Supervised Living Facility

Application for a License to Operate a Supervised Living Facility (PDF): Complete and submit this form with payment to apply for an initial license, renew an existing license, or request a change of ownership.

Example of Certificate of Liability Insurance (ACORD 25 form) (PDF): Providers are required to submit evidence of workers' compensation coverage with their application; this example shows how the form should be filled out.

Transfer Agreement:

• Metro counties: Community-Wide Transfer Agreement between Hospitals and Related Health Facilities in the Minnesota Seven-County Metropolitan Area (PDF)
• Nonmetro counties: Transfer Agreement between a Hospital and a Related Health Facility in Minnesota (PDF)

Supervised living facility licenses are renewed annually. Licensees will receive a renewal notification approximately 60 to 90 days prior to the expiration date of the license. If you do not receive a renewal notification within 30 days of the expiration date, please contact Health.HRD-FedLCR@state.mn.us.

• Application for a License to Operate a Supervised Living Facility (PDF): Complete and submit this form with payment to renew an existing license.
• Example Form: Certificate of Liability Insurance (PDF): Providers are required to submit evidence of workers' compensation coverage with their application; this example shows how the form should be filled out.
• Transfer agreement:
  • Metro Counties: Community-Wide Transfer Agreement between Hospitals and Related Health Facilities in the Minnesota Seven-County Metropolitan Area (PDF)
  • Nonmetro Counties: Transfer Agreement between a Hospital and a Related Health Facility in Minnesota (PDF)

The completed application, supporting documents, and fee payment can be mailed to:

Minnesota Department of Health
Health Regulation Division
P.O. Box 64900
St. Paul, MN 55164-0900

Read and understand all applicable statutes and rules listed below before submitting the application.

• Minnesota Statutes, section 144.651 - Health Care Bill of Rights
• Minnesota Statutes, section 144.652 - Bill of Rights Notice to Patients or Resident; Violation
• Minnesota Statutes, section 626.557 - Reporting of Maltreatment of Vulnerable Adults
• Minnesota Statutes, section 144.122 - License, Permit and Survey Fees
• Minnesota Statutes, section 144.50, subdivision 6. Supervised Living Facility licenses
• Minnesota Rules, chapter 4665 - Supervised Living Facilities

The Minnesota Department of Human Services (DHS) provides licensure for various treatment and rehabilitation programs. Additional information can be found at the links below.

• Substance Use Disorder Treatment
• Residential Adult Mental Health Programs
• Intermediate Care Facilities (ICF/DDs)
• Enrollment with Minnesota Health Care Programs (MHCP)

The Centers for Medicare and Medicaid Services (CMS) provides the following resources:

• Quality, Safety and Oversight - General Information (cms.gov)
• 100-07 Medicare State Operations Manual (cms.gov)