Colorado assisted living residence license: CDPHE steps, fees and rules

Three unrelated adults is the trigger

Colorado defines an assisted living residence as a residential facility that provides room and board to three or more adults not related to the owner, plus personal services, protective oversight, social care for people with impaired capacity to live independently, and supervision available 24 hours a day. It stops short of residents who need regular 24-hour medical or nursing care.⁠¹ If you house one or two unrelated adults, you are below the definition. Once you reach three, you need a license.

Colorado has no adult foster home, adult family home or “personal care home” license. A three-bed ranch house in a residential neighborhood holds the same ALR license, under the same rules, as a large purpose-built community. The rules do bend for houses in two places: physical-plant exemptions for single-family homes, and the smallest fee band of 3-8 beds.⁠²⁠⁴

There are two variants you may hear about. Neither is a separate license:

• Alternative Care Facility (ACF). An ALR certified by the Department of Health Care Policy and Financing (HCPF) to receive Medicaid payment under 10 CCR 2505-10, Section 8.495.⁠¹
• Supportive Living Program (SLP) residence. An ALR that HCPF also certifies to provide health maintenance, behavioral management and independent living skills training under 10 CCR 2505-10, Section 8.515.⁠¹ An SLP residence must meet both HCPF’s program rules and Chapter 7.⁠²

If you plan to serve older adults in their own homes rather than in a residence you run, you need a home care agency license instead. See the non-medical home care or home health pages.

The rules that govern an ALR

Three chapters of 6 CCR 1011-1 apply together: Chapter 2 (general licensure standards for all CDPHE health facilities), Chapter 7 (assisted living residences), and Chapter 24 (medication administration).⁠¹ The Chapter 7 version in force took effect July 1, 2025. The Chapter 2 version took effect September 14, 2025.⁠²⁠³ Residences licensed for 20 or more beds must also follow the Colorado Retail Food Establishment Regulations (6 CCR 1010-2) for food safety.⁠²

The FGI question: a 2025 law versus the current rules

This is the most important open point for anyone converting an existing house or building.

Under the rules as written, every initial license application needs a “guideline compliance review” against the Facility Guidelines Institute (FGI) design guidelines, “regardless of whether construction or renovation occurs.”⁠³ For ALRs, the review covers FGI Part 1, any Part 2 systems it cross-references, and Part 4.1. For reviews submitted on or after October 1, 2025, the 2022 edition of the FGI residential guidelines applies.⁠²⁠³ The 2026/2027 ALR fee schedule repeats “FGI Plan Review Required” for initial applications.⁠⁴

HB25-1213, signed May 28, 2025, added C.R.S. 25-27-104(3). It says the state board’s rules must exempt an assisted living residence from the FGI guidelines except for new construction or major renovations, and the residence must still meet all other fire and local building codes.⁠⁸ The act defines “major renovations” as additions or changes affecting the building’s structural integrity. Changing how a space is used without construction does not count, and neither does adding beds without construction.⁠⁸

The law took effect August 6, 2025. CDPHE responded with a blanket waiver that adds a subpart (D) to Chapter 7, Part 20.2: on and after August 6, 2025, an ALR “with an existing, current license” is exempt from FGI reviews triggered by a renovation unless it is a “major renovation.” CDPHE says it will amend Chapter 7 at its next rulemaking for that chapter.⁠¹¹ As of October 12, 2026, the posted Chapter 7 is still the July 1, 2025 version, and Part 20.2 still names an “initial license” as a trigger.⁠²

The waiver text covers renovations at already-licensed residences. None of the official pages says in terms that an existing building converted to a first-time ALR, with no construction, is exempt. Ask the FGI team at [email protected] whether your project needs a review before you budget for architectural drawings. CDPHE publishes separate FGI questionnaires for initial ALR licenses and for existing-license renovations.⁠⁶⁠¹¹

Even where FGI applies, Chapter 7 exempts ALRs in single-family homes in single-family neighborhoods from two FGI items: every resident having bathroom access without entering a corridor, and an elevator sized for a gurney or medical carts. Parking follows local requirements only.⁠²

Fire safety, zoning and room standards

CDPHE will not issue or renew a license until it receives a Certificate of Compliance from the Division of Fire Prevention and Control (DFPC) at the Colorado Department of Public Safety, showing the building meets the life safety standards DFPC has adopted.⁠³ DFPC does a plan review and an on-site inspection, then sends the certificate directly to CDPHE, not to you. CDPHE will not schedule your licensing survey until DFPC signs off, so it recommends starting the DFPC process before or alongside your application. DFPC’s certificate unit is at (303) 239-4100 or [email protected].⁠⁶

You must also comply with local zoning, housing, fire and sanitary codes in your city or county.⁠³ Exterior signage must follow local zoning, and the sign must show the distinctive license name you register with CDPHE.⁠³

Chapter 7 sets these room standards:⁠²

Common and dining areas must be large enough for all residents and accessible to residents who use mobility aids.⁠²

Fees on the 2026/2027 schedule

CDPHE now republishes ALR fees every year. The schedule is posted by March 1 and takes effect July 1.⁠¹ The 2026/2027 schedule applies to initial, change-of-ownership and change-of-information applications submitted on or after July 1, 2026.⁠⁵ Fees as published on October 12, 2026:⁠⁴

The reduced Qualifying Disproportionate Share fee is for residences that qualified for federal or state low-income housing assistance, plan to serve residents at or below 80% of area median income, and submit proof.⁠⁴ Application fees are non-refundable.⁠³ DFPC bills separately and annually for Certificates of Compliance.⁠⁶

From letter of intent to license

CDPHE’s own guidance says initial licenses typically take 3 to 12 months from application to issuance. Facilities that need fire and FGI review take longer unless those reviews start early.⁠⁶ The order:

1. Submit the Letter of Intent (LOI)

   Use the online LOI form on CDPHE’s health facilities site. It names the person who will manage your account in COHFI (Colorado Health Facilities Interactive), the portal for applications, survey reports and occurrence reports.⁠⁶ CDPHE asks applicants to submit the LOI only once they have reviewed the requirements and know which license type they need.⁠¹⁰

2. Start DFPC and FGI reviews

   Send the FGI plan review request and documents to [email protected], and open a life safety plan review with DFPC.⁠⁶

3. File the application and fees in COHFI

   The complete application must go in at least 90 calendar days before your planned opening. If you do not complete it and do not respond for 12 months, CDPHE can close it, and you start over with a new fee.⁠³

4. Fix defects within 14 days

   A licensing technician checks the application against your documents. You have 14 calendar days to answer any written defect notice.⁠³⁠⁶

5. Fitness review

   CDPHE reviews the owners’ fitness under Chapter 2, Part 2.7. Changing the application afterward triggers a new fitness review.⁠⁶

6. Final document review

   The file cannot move on until the DFPC Certificate of Compliance and FGI approval arrive.⁠⁶

7. Initial survey

   A CDPHE surveyor calls to schedule a usually on-site survey. Have these ready: proof of administrator qualifications and training, employee background checks, all required policies, and a quality management plan.⁠⁶

8. License issued

   The license is issued after the survey finds zero deficiencies. It is uploaded to COHFI as a PDF and must be displayed where visitors can see it.⁠⁶

If you are making a good-faith effort but do not yet fully comply, CDPHE may issue a provisional license for one 90-day period. ALRs, unlike other facility types, cannot get a second one.⁠²⁠³ No provisional license is granted until the owner’s criminal background check has been submitted.⁠²

What the application must contain

Chapter 2 lists what every applicant must provide:⁠³

• A distinctive license name that does not mislead the public and does not duplicate an unaffiliated licensee’s name
• All controlling interests: officers and stockholders owning 5% or more of a for-profit corporation, all partners, or a nonprofit’s board and officers, plus the CEO
• Proof of professional liability insurance in the applicant’s name under the Colorado Health Care Availability Act, listing CDPHE as certificate holder
• Articles of incorporation or organization and bylaws or an operating agreement
• A floor-by-floor map showing room layout, the proposed licensed area and any adjoining occupancies
• Any management agreement, and any building lease showing who is responsible for the property’s condition
• A signed statement disclosing felony or moral-turpitude convictions, health care fraud or substandard-care judgments, and license or Medicaid/Medicare actions in the past 10 years
• Proof of compliance with Colorado Adult Protective Services (CAPS) data system checks

The insurance certificate may carry a future effective date, but it must be a real date, not “TBD”. A lease must be in effect before the survey.⁠⁶

Each owner or applicant must also request a Colorado Bureau of Investigation (CBI) fingerprint check with notification of future arrests. If you have lived in Colorado three years or less, you also need name-based criminal history reports from each other state you lived in during the past three years. You pay for these checks yourself.⁠² CDPHE will not license an owner convicted of a felony, or of a misdemeanor involving moral turpitude or conduct that could put residents at risk.⁠²

The administrator

You must appoint an administrator before opening. An ALR found without a qualified administrator or interim administrator is fined $1,000.⁠² The administrator must:⁠²

• Be at least 21 and have a high school diploma or equivalent
• Have one year of experience supervising personal care that includes activities of daily living, or one of these alternatives (experience must fall within the past 10 years): an active Colorado nursing home administrator license; an RN license plus 6 months of health care work; an LPN license plus 1 year; a bachelor’s degree in health care or human services plus 1 year; an associate’s degree plus 2 years; 30 college credits in the field plus 3 years; 5 years managing or supervising in geriatrics, human services or disability care; or any college degree plus 2 years of health care experience
• Complete 40 hours of administrator training before taking the job. At least 20 hours must cover Colorado regulations, the rest must cover business operations, physical plant, resident care and psychosocial needs, and the program must include competency testing.
• Pass a CBI fingerprint check before hire and a CAPS check

An interim administrator must meet the same qualifications and complete the 40 hours within 30 days of appointment. You must notify CDPHE within 24 hours of appointing one.⁠² The administrator also appoints a qualified designee for absences. In residences licensed for more than 12 beds, when the designee is acting as administrator, another staff member focused on resident care must be on duty.⁠²

Staffing without a fixed ratio

Chapter 7 sets no numeric staff-to-resident ratio. Instead it requires:⁠²

• At least one staff member on site whenever any resident is present, and that person must hold current CPR certification
• At all times, at least one person on site with current adult first aid certification and one with adult CPR and obstructed-airway certification, with a posted list of who holds each certificate
• At least one safety check of every consenting resident between 10 PM and 6 AM
• Staffing set by residents’ acuity, care plans and resident agreements. Volunteers and resident helpers do not count toward staffing.

Training requirements:⁠²

• Every staff member and volunteer completes an orientation before giving any care. It covers hand hygiene, emergency response and evacuation, first aid, reporting, resident rights, house rules and where to find each resident’s advance directive.
• Personal care workers get added orientation on their duties and on the difference between personal and skilled care. A supervisor must watch and document each worker performing every assigned task competently before the worker does it alone.
• Direct-care staff complete at least four hours of dementia training, free of charge to them, then two hours of dementia continuing education every two years.

Medications are given by qualified medication administration persons (QMAPs) or CNA-Meds under Chapter 24, with a designated QMAP supervisor.⁠² Keep personnel files for three years after an employee leaves.⁠² If hospice serves a resident, you need a signed written agreement with the hospice before care starts.⁠²

Who you can admit, and secure environments

You may admit only people whose needs your current staff, building and services can fully meet, based on a pre-admission assessment.⁠² You may not admit anyone who:⁠²

• Needs regular 24-hour medical or nursing care
• Cannot self-administer medication, if you have no staff licensed or qualified under Chapter 24 to give it
• Has unmanageable incontinence
• Has a stage 3 or 4 pressure sore outside the Part 12.4 criteria
• Needs restraints
• Needs a secure environment that you do not provide

Discharges generally require 30 days’ written notice. A copy of any involuntary discharge notice goes to the state and local long-term care ombudsman within five calendar days.⁠²

A secure environment (memory care with restricted egress) is optional. It must meet extra Chapter 7 Part 25 rules, including a pre-admission assessment that includes a practitioner evaluation from the past 90 days, and written disclosures about restrictions and monitoring.⁠² Opening a new secure unit carries its own $1,978.39 fee, paid with the first building plan submission.⁠²⁠⁴

Getting paid through Medicaid

To receive Medicaid payment for residents, an ALR becomes an Alternative Care Facility through HCPF certification under 10 CCR 2505-10, Section 8.495.⁠¹ CDPHE charges no fee for Medicaid HCBS certification applications, though HCPF may charge a provider enrollment fee.⁠⁷ Residences that qualify as High Medicaid Utilization Facilities, based on HCPF’s annual reporting, pay a lower per-bed renewal fee of $46.98 instead of $127.35.⁠⁴ HCPF says new ACF providers must complete its New ACF Provider Training as part of enrollment, and ACF services are open to members on the Elderly, Blind, and Disabled waiver, the Community Mental Health Supports waiver, and the Medicaid Buy-In Program.⁠¹² HCPF does not publish ACF per diem rates on that page; it points to its provider rate fee schedule under the HCBS heading. Check that schedule and ask HCPF ([email protected]) for the enrollment steps before you set prices.⁠¹²

Renewal, surveys and enforcement

Licenses expire one year after issuance, and each location needs its own license.⁠³ Submit the renewal application and fees in COHFI 60 days before expiration, along with annual information on your operations, resident care and services.⁠²⁠⁴ Late renewals cost an extra 10% (6-29 days late), 50% (30-59 days) or 75% (60-89 days). If nothing arrives by day 90, the license is invalid: you must stop operating and file a new initial application.⁠⁴

Licensees with three clean years may move to a survey cycle of up to three years or a tiered inspection.⁠³ A clean re-licensure inspection earns a performance incentive of 10% of the renewal fee.⁠³ Deficiencies are graded from Level A (isolated potential harm) to Level E (immediate jeopardy). Fines per deficiency run $100-$5,000 at Level C and $500-$7,500 at Level D. At Level E they reach up to $10,000, and more for egregious violations causing death or serious injury.⁠²

Other reporting deadlines: report suspected abuse, exploitation or caretaker neglect of at-risk persons to law enforcement within 24 hours. Report resident relocations caused by an uninhabitable building to CDPHE within 48 hours. Submit final occurrence investigation reports within five business days.⁠² A buyer must file the change-of-ownership application and fees at least 60 days before closing, after the seller submits an LOI.⁠⁴

Changes in 2025 and 2026

• Annual fee schedules (since March 1, 2025). CDPHE now publishes ALR fees each year, effective July 1.⁠⁵
• Chapter 7 amended July 1, 2025, and Chapter 2 amended September 14, 2025. The 2022 FGI edition applies to plan reviews submitted from October 1, 2025.⁠²⁠³
• HB25-1213 (signed May 28, 2025). Requires rules exempting ALRs from FGI guidelines except for new construction or major renovations. CDPHE implemented it by waiver for licensed residences; the posted rules had not been updated as of October 12, 2026.⁠⁸⁠¹¹
• HB26-1107 (signed by the governor May 4, 2026). CDPHE must create a dementia care services information form by July 1, 2027. From October 1, 2027, every licensed facility offering dementia care must give its completed form to anyone who contacts it seeking dementia care. The form covers extra staff training, restraint guidelines, security features, and placement and discharge criteria.⁠⁹

CDPHE’s health facilities licensing staff can be reached at [email protected]. The main office is at 4300 Cherry Creek Drive South, Denver, CO 80246, (303) 692-2000.⁠¹⁠¹⁰

Sources

1. 1
   Colorado Department of Public Health and Environment, Assisted Living Residences Checked 12 Oct 2026 · Back to text ↑
2. 2
   Colorado Secretary of State, Code of Colorado Regulations, 6 CCR 1011-1, Chapter 7: Assisted Living Residences (effective July 1, 2025) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Colorado Secretary of State, Code of Colorado Regulations, 6 CCR 1011-1, Chapter 2: General Licensure Standards (effective September 14, 2025) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Colorado Department of Public Health and Environment, Assisted Living Residences (ALR) Fee Schedule, 7/1/2026 to 6/30/2027 Checked 12 Oct 2026 · Back to text ↑
5. 5
   Colorado Department of Public Health and Environment, Facility Fees Checked 12 Oct 2026 · Back to text ↑
6. 6
   Colorado Department of Public Health and Environment, Initial Health Facility/Agency Licensing: Guidance and Instructions (All License Types) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Colorado Department of Public Health and Environment, Learn More About The Process and Requirements for Health Facility Licensure and/or Certification Checked 12 Oct 2026 · Back to text ↑
8. 8
   Colorado General Assembly, HB25-1213, Updates to Medicaid (signed act) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Colorado General Assembly, HB26-1107, Health Care in Regulated Facilities Checked 12 Oct 2026 · Back to text ↑
10. 10
    Colorado Department of Public Health and Environment, I am Ready to Apply: Begin the License/Certification Application Process Checked 12 Oct 2026 · Back to text ↑
11. 11
    Colorado Department of Public Health and Environment, Health Facilities Community blog, Waiver of Specific Rule Requirements in Response to the Passage of House Bill 25-1213 (Assisted Living Residences) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Colorado Department of Health Care Policy and Financing, Alternative Care Facilities Checked 12 Oct 2026 · Back to text ↑

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