DC assisted living residence license: DC Health rules, fees and steps

Does your project need an ALR license?

The Assisted Living Residence Regulatory Act of 2000 defines an ALR as any entity, public or private, for profit or not, “that combines housing, health, and personalized assistance, in accordance to individually developed service plans, for the support of individuals who are unrelated to the owner or operator.”⁠¹ The Act sets no minimum number of residents. The insurance schedule even starts at “one to 2 beds,” so a small rowhouse operation falls under the same law as a high-rise.⁠¹

Three rules close the usual escape routes:

• Leases don’t exempt you. DC Health’s rules say that providing housing “under a landlord-tenant arrangement does not, in and of itself,” exclude you from licensure.⁠²
• The name is protected. Only a licensed ALR may describe, market or offer itself as an assisted living residence, and anyone else who does is treated as running an unlicensed ALR.⁠¹ The rule extends this to using the term “assisted living” in advertising at all.⁠²
• One license per location. Each ALR needs its own license, even when one operator runs several or shares premises with another facility. A license is void for any person or address other than the one named on it, and transferring it forfeits it.⁠²

Operating without a license is unlawful under D.C. Code § 44-103.01. DC Health can impose the civil and criminal penalties of D.C. Code § 44-509 on anyone who maintains an unlicensed ALR.⁠¹

Licenses you might confuse it with

The ALR category was created in 2000 to give a uniform standard to community residence facilities (CRFs) under 22 DCMR Chapter 34 and to other facilities “when they provide services that assist residents with the activities of daily living.”⁠¹ If your home offers a sheltered living environment without that level of personal assistance, look at the community residence facility license. The ALR definition specifically excludes group homes for people with intellectual disabilities and mental health community residence facilities.⁠¹ DC Health is not issuing new CRF licenses for intellectual disability group homes at all while DHCF’s 2018 enrollment moratorium continues.⁠⁴

An ALR may not provide services beyond the scope of its license.⁠² Residents can bring in licensed agencies for skilled or extra care. Those agencies hold their own licenses: see the home care agency and home support agency guides.

No Certificate of Need, and why that matters

The Act says plainly: “A Certificate of Need shall not be required for Assisted Living Residences licensed under this chapter.”⁠¹ DC’s Certificate of Need statute also lists the ALR among the facilities that are not a “health care facility.”⁠⁵ So you can skip the State Health Planning and Development Agency review. The Certificate of Need statute still covers home health agencies and comparable health care facilities with an annual operating budget of at least $500,000, so a company that adds such a service line faces that review separately.⁠⁵ Your route runs only through DC Health licensing, plus the building and fire approvals described below.

Who you can admit, and who you can’t

Your service design determines your staffing plan, your policies and your building, so settle it first. The Act sets hard limits on admission:⁠¹

• Residents must be at least 18.
• You may not admit anyone who needs more than intermittent skilled nursing care, treatment of stage 3 or 4 skin ulcers, ventilator services, or treatment for an active, infectious, reportable disease that needs more than contact isolation.
• You may not admit someone at high risk of complications you can’t manage who needs more than 35 hours a week of skilled nursing and home health aide services combined.
• You may not admit someone who is dangerous, or whose behavior significantly harms others, if you can’t eliminate that danger with appropriate treatment. The rule counts physical or mental abuse of others and destruction of property as that kind of behavior.⁠²

The rule also sets a floor. You must deny admission if the pre-admission service plan does not show that the person needs at least a minimal level of help with activities of daily living (ADLs) or instrumental activities (IADLs).⁠² A building that only offers housing to independent adults is not an ALR.

Every ALR must provide or ensure 24-hour supervision, three meals a day plus snacks adapted to individual diets, some help with ADLs and IADLs, laundry and housekeeping, and scheduled transportation to community services.⁠¹ You also cannot have more residents, respite residents included, than the capacity printed on your license.⁠²

The administrator and the nurse

DC’s staffing model rests on two named people, and you need both before DC Health will license you.

The assisted living administrator (ALA). Under the Act, the ALA must be at least 21. An ALA hired on or after June 24, 2000 must have a high school diploma or GED and at least one of the past three years’ experience as a direct care provider or administrator.⁠¹ The ALA must also show knowledge of 14 listed subjects, from fire codes and infection control to human resources and financial management.⁠¹ The 2020 rules added a professional license: your application must include “evidence of a current, valid license issued by the District of Columbia” to the ALA you name, and the ALA must keep that license the whole time they run the residence.⁠² The Health Occupations Revision Act requires a license to practice assisted living administration.⁠⁶ Since July 19, 2024, D.C. Law 25-191 has placed that practice under the Board of Nursing; the former Board of Long-Term Care Administration was repealed.⁠⁶ The 2020 rule text still names the old board.⁠² The official sources reviewed do not describe the application steps or fees for the administrator license after the board change, so ask DC Health’s health professional licensing office, before you name an ALA on your application, which board form, exams and training the license requires now and whether your candidate already holds it.

Day to day, the rules require:⁠²

• On-site coverage. Whenever one or more residents are on the premises, the ALA or a designated Acting Administrator must be there too. The Acting Administrator must be a staff member at least 18 who meets the ALA staffing standards. When away, the ALA must answer staff calls within 1 hour.
• Limits on unlicensed cover. No one other than a licensed ALA may run the residence for more than 6 cumulative weeks in 12 months without DC Health’s prior written approval, or for more than 12 cumulative weeks in any case. You must notify DC Health in advance of any ALA absence longer than 3 consecutive weeks.
• Designation notice. You must report a newly designated ALA to DC Health on its form within 10 days.

The registered nurse. At least one RN must be available to the ALA and staff 24 hours a day, 7 days a week. “Available” means reachable in person or in real time, responding within 1 hour, and able to come to the residence when a resident’s condition changes significantly.⁠² Pre-admission assessments must be done by a DC-licensed RN, and an RN must review each resident’s medications on site every 45 days.⁠¹⁠²

Staff: no fixed ratio, but firm qualifications

DC sets no staff-to-resident ratio. The ALA writes a staffing plan based on residents’ health, mental and psychosocial needs, their 24-hour scheduled and unscheduled needs, the size and layout of the building, and staff capabilities. You give that plan to DC Health at the pre-licensure inspection.⁠¹ Fixed requirements:⁠¹⁠²

• Staff must be at least 21. At least one person certified in first aid and CPR must be on site at all times, and enough staff trained in the evacuation and emergency plans must always be present.
• Before hire, each employee must be a certified nurse aide, a certified home care aide, a holder of a current health care license, or a graduate of a DC-approved training plan of at least 40 hours covering 13 listed topics. Untrained staff work only under trained supervision.
• Orientation within 7 days of hire. After the first year, at least 12 hours of in-service training every year, including 4 hours on cognitive impairment.
• The ALA completes 12 additional hours a year of dementia training approved by a nationally recognized organization.
• New hires document their communicable disease status within 30 days. All employees, the ALA included, document freedom from communicable tuberculosis every year.
• No unlicensed person may work or contract on the premises until a criminal background check under D.C. Code § 44-551 et seq. and 22-B DCMR § 4700 et seq. is complete.
• Every employee wears a visible badge with full name and job title.

Medications. Medications may be given by LPNs, RNs, APRNs, physicians, physician assistants, trained medication employees (TMEs) or certified medication aides.⁠² A TME must complete a DC-approved medication course and a refresher every 2 years.⁠¹ You must start investigating any medication error or adverse drug reaction within 24 hours, and send adverse drug reaction reports to DC Health within 30 days.⁠²

The building: occupancy, fire code and room sizes

An ALR “may be classified as a residential occupancy and may be located in a single or multi-family dwelling.” It must meet DC’s zoning, building, housing, sewer, water and fire codes.⁠¹ The Act ties fire safety to the 1997 edition of NFPA 101: Chapter 22 (new residential board and care occupancies) for new ALRs, and Chapter 23 (existing board and care) for a CRF converting to an ALR.⁠¹ Before licensure you must prove the location passed an inspection by the DC Fire & EMS Department’s Fire Prevention Division. You also need a certificate of occupancy and a floor plan showing dimensions, exits and planned room use.⁠¹⁠²

Residences with sleeping space for more than 16 residents have extra requirements. No more than 4 residents may share a bathroom, and shared bathrooms must be on the same floor as the bedrooms. You need a central dining room, a living room or parlor, and an activity center. The building must meet the accessibility provisions of 12 DCMR § 512.⁠¹

Insurance minimums set by statute

Unusually, the Act fixes coverage amounts. Proof of insurance is part of the application.⁠¹

If you lease the building, you must get proof of the owner’s premises liability coverage or add the owner to your policy as an additional named insured.⁠¹

Policies DC Health must approve

The 2020 rules list 20 written policies, plus matching procedures, that “shall meet the approval of the Director.” You file them with the application.⁠² Beyond the expected admission, discharge, medication and complaint policies, DC requires:⁠²

• emergency preparedness meeting the CMS standard for long-term care facilities at 42 CFR § 483.73
• use of audio-visual monitoring in non-private areas, including how long recordings are kept
• alcohol, tobacco and marijuana use
• private duty nurses and aides, and companions, that residents bring in
• criteria for setting each resident’s care level, including how it affects staffing, emergency triage and fees
• resident falls, visitation, contacting the ALR’s RN, when to call EMS, and how you alert residents to utility outages and other emergencies

You must also have a disaster plan, a system for managing resident funds, an ISP policy, and financial and non-financial resident agreements ready for the inspection.⁠¹ Resident money over $200 that you hold must sit in an interest-bearing account in the resident’s name.⁠²

Applying: the order DC Health works in

1. Line up the property and the ALA

   The application must show you own, lease or control the real property. It must name the ALA with proof of their qualifications and DC license.⁠¹⁠²

2. Get the certificate of occupancy and the Fire Prevention Division inspection

   You need both at the pre-licensure stage.⁠¹⁠²

3. Open a portal account and file at least 60 days before you need the license

   DC Health has not accepted paper facility applications since May 3, 2023. New applications and payments go through the Health Care Facilities licensing portal at dohenterprise.my.site.com/facilities/s/.⁠¹⁠⁴ The Act lists 12 required items: owner identification and proof of control, the ALA and their qualifications, criminal background check information, any prior license denial, suspension or revocation, the location, a program statement, proof of solvency, proof of insurance, the services offered, maximum residents, property control, and your organizational structure with board members and officers.⁠¹

4. Pass the background review

   DC Health may check the applicant’s licensing history and criminal record. For an entity, that covers owners, or for a corporation the directors, officers and anyone holding 10% or more of the stock.⁠²

5. Pre-licensure inspection

   DC Health inspects the premises and records. During this period, after the on-site visit, you hand over the documents: certificate of occupancy, disaster plan, staffing plan, funds system, medication system, ISP policy, admission and discharge policies, resident agreements, floor plan and fire inspection proof.⁠¹⁠²

6. Answer deficiencies

   DC Health sends written violations within 15 working days of an inspection, and you respond in writing within 15 working days with a signed, dated plan of correction.⁠¹⁠²

7. Decision

   DC Health either approves the license unconditionally for 12 months or denies it. The license states its effective date, expiration date and maximum residents.⁠¹ Post it where residents and visitors can see it.⁠²

DC does not publish a processing time beyond the 60-day filing lead.

DC Health’s published address is 2201 Shannon Place SE, Washington, DC 20020, main phone (202) 442-5955. The licensing portal page lists a separate email address for the Health Care Facilities Division and links to an instructional video and reference guides.⁠⁴

Fees as published

For example, a 20-resident ALR pays $220 at application and $220 at each renewal under this schedule.⁠² Fees are paid with the application.⁠²

After you open: inspections, renewal and changes

DC Health inspects at initial licensure, again within 6 months of licensure, at each annual renewal, and whenever it investigates a complaint.⁠¹⁠² Complaints alleging life-threatening danger are investigated within 24 hours, and others within 30 days.⁠² You must correct deficiencies that are not life-threatening within 30 days of the notice, or face sanctions. Sanctions include admission limits, a required management firm, or receivership.⁠¹⁠² Abuse, neglect or exploitation must be reported immediately by phone to DC Health, Adult Protective Services and the Long-Term Care Ombudsman, with written follow-up within 24 hours or the next business day.⁠²

Renewal comes every 12 months. If you file 90 to 60 days before expiration and meet the rules, DC Health must issue the renewal before the old license expires. If you are out of compliance without an immediate hazard, it can issue a provisional license for up to 12 months against an accepted plan of correction.⁠¹

Changes in capacity, name, ownership or location, or a voluntary closure, require a revised license. Request it 60 days ahead and give residents 60 days’ written notice.⁠¹ A buyer must apply for a new license at least 60 days before closing, and the seller stays responsible until it is issued. A transfer of 10% or more of a corporate owner’s stock counts as a change of ownership.⁠¹

Residents get the same protection on exit. An involuntary discharge needs 30 days’ written notice and is canceled if the resident pays what is owed or a new ISP is agreed.⁠¹

Getting paid through the Medicaid EPD Waiver

DC Medicaid pays for assisted living services through its Home and Community-Based Services Waiver for Persons who are Elderly and Individuals with Physical Disabilities (EPD Waiver). Participating ALRs must also comply with 29 DCMR Chapter 42.⁠² Under those rules, as amended April 25, 2025:⁠⁷⁠⁸⁠⁹

• Only DC Health-licensed ALRs qualify, and your ISP doubles as the plan of care that you share with the resident’s waiver case manager.
• The service bundle covers 24-hour supervision, ADL and IADL help, laundry and housekeeping, coordination of social and recreational activities, coordination of access to health and social services, scheduled transportation, and medication administration by an RN or certified medication aide.
• Payment is one all-inclusive rate. Medicaid does not pay room and board, 24-hour skilled care, or facility upkeep. Residents may seek help with room and board through the Optional State Supplemental Payment Program.
• DHCF will not pay for waiver homemaker, chore aide, respite, environmental accessibility adaptation or personal care aide services delivered at the same time as assisted living.

The rule says the rate is one all-inclusive rate but does not state a dollar amount, and it does not describe how an ALR enrolls as a provider. Ask DHCF for the current rate and its provider enrollment steps before you plan around Medicaid residents.

What changed recently

• July 19, 2024: D.C. Law 25-191 repealed the Board of Long-Term Care Administration and moved assisted living administration under the Board of Nursing.⁠⁶ D.C. Law 25-191 is also the latest amendment listed for the staff training section, D.C. Code § 44-107.02, whose annual in-service now includes 4 hours on cognitive impairment under DC’s dementia training standard for direct care workers.⁠¹
• April 25, 2025: DHCF amended the EPD Waiver assisted living sections.⁠⁷⁠⁸
• May 3, 2023: paper facility applications ended; all new applications, renewals and ownership changes go through the online portal.⁠⁴
• April 3, 2020: 22-B DCMR Chapter 101 grew from a fee schedule into full operating rules (67 DCR 3717). The new rules added the ALA license requirement, the 24/7 RN, required policies, and rules for private duty staff and companions.⁠²⁠³

Sources

1. 1
   Council of the District of Columbia, D.C. Code Title 44, Chapter 1 (Assisted Living Residence Regulatory Act of 2000) Checked 12 Oct 2026 · Back to text ↑
2. 2
   DC Health, via DC Office of Documents and Administrative Issuances, Notice of Final Rulemaking, Assisted Living Residences, 22-B DCMR Chapter 101 (67 DCR 3717, April 3, 2020) Checked 12 Oct 2026 · Back to text ↑
3. 3
   DC Office of Documents and Administrative Issuances, 22-B DCMR Chapter 101, Assisted Living Residences (section list) Checked 12 Oct 2026 · Back to text ↑
4. 4
   DC Health, Office of Health Facilities Licensing Portal Checked 12 Oct 2026 · Back to text ↑
5. 5
   Council of the District of Columbia, D.C. Code § 44-401 (Certificate of Need definitions) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Council of the District of Columbia, D.C. Code Title 3, Chapter 12 (Health Occupations Revision Act) Checked 12 Oct 2026 · Back to text ↑
7. 7
   DC Office of Documents and Administrative Issuances, 29 DCMR § 4237, Specific Provider Requirements: Assisted Living Services (EPD Waiver) Checked 12 Oct 2026 · Back to text ↑
8. 8
   DC Office of Documents and Administrative Issuances, 29 DCMR § 4238, Program Services: Assisted Living Services (EPD Waiver) Checked 12 Oct 2026 · Back to text ↑
9. 9
   DC Office of Documents and Administrative Issuances, 29 DCMR § 4216, Reimbursement: Assisted Living Services (EPD Waiver) Checked 12 Oct 2026 · Back to text ↑

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