Massachusetts assisted living residence certification: rules, fees and steps

Certification, not a license, but just as mandatory

Massachusetts does not license assisted living. It certifies it. The Executive Office of Aging & Independence (EOAI, the former Executive Office of Elder Affairs) does this under M.G.L. c. 19D and 651 CMR 12.00. Many of EOAI’s own web pages and forms still say “EOEA” or “Elder Affairs.” The certification is not optional. No person or entity may advertise, operate or maintain an Assisted Living Residence until EOAI has certified it.⁠¹ Operating without certification carries a civil penalty of up to $500 for each day, which the Superior Court assesses. EOAI can also go to court for an injunction.⁠¹⁠³ The statute also reaches people who send residents your way: knowingly referring someone to an uncertified residence violates the consumer protection law (chapter 93A) and carries a civil penalty of up to $500 per violation.⁠³

The rulebook changed recently. EOAI reissued 651 CMR 12.00 in the Massachusetts Register on July 31, 2026 (Register #1579). That text contains the Basic Health Services framework, the on-site AED, naloxone and epinephrine requirements, the designated licensed nurse, and a CPR/AED staffing rule that starts January 1, 2027.⁠¹ Work from the 2026 text, not older copies.

Does your project need ALR certification?

Under 651 CMR 12.00, an Assisted Living Residence is any entity, for profit or not, that does all three of the following:⁠¹

• provides room and board;
• provides Personal Care Services to three or more adults who are not related by blood or marriage to their care provider, either through its own employees or through arrangements with another organization; and
• collects payments or third-party reimbursements, from residents or on their behalf, for help with activities of daily living, or arranges for those payments.

“Personal Care Service” is broader than hands-on care. It means help with bathing, dressing, grooming, ambulation, eating, toileting or self-administered medication management, “either through physical support or supervision.” Supervision includes reminding or observing residents.⁠¹ A house that rents rooms to three unrelated older adults and has staff remind them to take their pills is therefore in ALR territory.

Massachusetts has no separate small adult family home license. A home that serves three or more unrelated adults in this way needs ALR certification whatever its size. Two neighbouring categories are easy to confuse with it:

• Rest homes are licensed by the Department of Public Health (DPH) under M.G.L. c. 111, §71. A rest home provides “care incident to old age to 4 or more persons who are ambulatory” who do not need routine nursing care.⁠¹⁵ Rest homes, nursing homes and other c. 111 facilities are outside 651 CMR 12.00 for the services they were licensed for. If they want to run part of their premises as assisted living, they must apply for ALR certification.⁠¹ Converting licensed long-term care space also requires a DPH conversion approval, which goes in with the ALR application.⁠¹
• Adult day health is a non-residential DPH-licensed program. It is covered in the Massachusetts adult day health guide.

Certification also fixes what you may not do. An ALR may not admit a resident who requires 24-hour skilled nursing supervision. The exception is a resident who chooses to receive Basic Health Services from a certified residence, or skilled nursing care from a qualified third party.⁠¹ ALR staff may not deliver other skilled services unless they work for a certified provider of ancillary health services or a licensed agency.⁠¹

Why there is no Determination of Need step

Under M.G.L. c. 19D, §18(a), as restated in 651 CMR 12.15, certified ALR premises are not subject to the Determination of Need process in M.G.L. c. 111, §§25B-25H. They are also outside the c. 111, §71 licensing rules for nursing homes and rest homes, and outside several other health-facility statutes.⁠¹ You do not need state approval of need before building an ALR. A rest home, by contrast, is a DPH-licensed long-term care facility under c. 111, §71.⁠¹⁵

What you do need are the local approvals. The operating plan must include copies of all required current building, fire safety and locally approved state sanitary code certificates and permits.⁠¹ After its first review, EOAI may ask for a certificate of occupancy.⁠⁴ Every residence must also have an approved annual fire inspection by the local fire department.⁠¹ You must hold enough property rights, as owner or lessee, to operate the residence.⁠¹

The building: units, bathrooms and safety equipment

651 CMR 12.04(1) sets physical standards that decide whether an existing building will work.⁠¹

A building converted from another use does not count as “newly constructed” for the bathroom rule if it ever provided services other than assisted living. It must still meet the half-bath and bathing-facility standard.⁠¹ Medications may not be stored centrally outside residents’ units. If a resident’s medication needs refrigeration, the residence must provide a refrigerator in that resident’s unit.⁠¹

A Special Care Residence (a secure dementia or other cognitive-support unit) has extra requirements. Common-area entry and exit doors must be alarmed and secured, and must unlock automatically in a fire, power outage or emergency. The unit needs a multipurpose activity space. Any Special Care Residence that began initial certification after October 1, 2015 must have a secure outdoor space.⁠¹

Who runs it: director, care director and nurse

The regulation requires a set of named roles.

• Executive Director. Must be at least 21 and have demonstrated experience in administration, supervision and management. Must also have a bachelor’s degree or equivalent experience in human services, housing or nursing home management. Must be of good moral character and never convicted of a felony.⁠¹⁠⁸
• Resident Care Director (also called the Service Coordinator). Required in every residence. For a Resident Care Director hired before January 1, 2027, 651 CMR 12.06(2) requires at least two years’ experience with older adults or people with disabilities. For one hired on or after that date it requires five years’ experience, or a nursing degree plus two years. Either way the person needs a bachelor’s degree or equivalent experience, knowledge of aging and disability issues, and training to develop and carry out individualized service plans.⁠¹ EOAI’s staffing page, which still lists only the two-year standard, calls the role the Service Coordinator.⁠⁸ If the Resident Care Director is not a licensed nurse, they must work with a licensed nurse, who signs each service plan.⁠¹
• Designated licensed nurse. The nurse may be employed or under written agreement. The nurse conducts the pre-move-in assessments, oversees self-administered medication management, delivers 20 hours of the personal care training, evaluates personal care staff twice a year and develops service plans. The nurse must be on site for a minimum number of hours each week, scaled to the residence’s size and resident acuity, and on call 24 hours a day.⁠¹ The rule sets no fixed number of hours.
• AED responsible clinician. A Massachusetts-licensed RN, nurse practitioner or physician, employed or contracted, who oversees AED maintenance, training and policies.⁠¹
• Special Care Residence Manager. Required if you run a secure unit. Must be at least 21 with two years’ experience with older adults or people with disabilities, plus a bachelor’s degree or equivalent experience. The same character and felony bar apply.⁠¹

No one working in an ALR may have a felony conviction for theft or illegal sale of a controlled substance. No one may work there who has been found by a board or court to have violated a law related to resident or patient safety.⁠¹ Personnel records must document criminal offender record information (CORI) reports.⁠¹ Each residence must also ensure that its personnel are vaccinated annually against influenza and have received the COVID-19 vaccination, subject to the exemptions in 651 CMR 12.06(9)(g).⁠¹

Staffing levels and the January 2027 CPR rule

Massachusetts sets no resident-to-staff ratio for the general ALR. Staffing must be sufficient at all times to meet scheduled and reasonably foreseeable unscheduled needs, as shown in residents’ assessments and service plans, 24 hours a day. Staff must be awake whenever on duty.⁠¹ Residents must get timely help through 24-hour on-site staff and, where the service plan requires it, a personal emergency response system. No emergency call response may exceed ten minutes.⁠¹ If you use agency staff, either one of your own trained employees must be on the premises at all times, or the agency staff must have completed your orientation.⁠¹

Two hard numbers apply:

• Special Care Residences must never have fewer than two staff members on duty. The EOAI Secretary may grant an overnight exemption allowing one staff member plus a “Floater.” The exemption expires with the certification, and you must reapply at least 30 days before the expiration date.⁠¹ SCR units also need documented hourly safety checks for twelve hours overnight.⁠¹
• CPR/AED coverage. Starting January 1, 2027, at least one staff member certified in CPR and AED use must be available at all times. The course must meet American Heart Association or American Red Cross standards.⁠¹

Training hours before and after hire

651 CMR 12.07 is detailed. Build these hours into your hiring timeline before opening, because EOAI may ask for proof that orientation is complete before it certifies you.⁠⁴

Massachusetts-licensed RNs and LPNs are exempt from the 54-hour training. So are nurse aides and certified home health aides with proof of training, and personal care homemakers who completed a 54-hour program. All of them still need the orientation and annual in-service hours.⁠¹⁠⁹ Training completed within the past 18 months at another ALR or similar agency can count if you document it.⁠¹ Each residence must also do an annual training needs assessment.⁠¹ EOAI asks for the last two years of these assessments at renewal.⁠⁶

The application package and operating plan

EOAI has required electronic filing since May 2023. Email the application to [email protected] and put the residence name in the subject line. If you send attachments across several emails, include an index of documents.⁠⁴ The application must be notarized and signed under the pains and penalties of perjury. Each residence needs its own application. Under 651 CMR 12.03(2), the initial application is due at least 90 days before you plan to open.⁠¹

EOAI’s checklist asks for:⁠⁴

• the notarized Assisted Living Certification Application Form;
• the $200 application fee;
• the operating plan;
• your Individual Service Plan form, Assessment form and Resident Satisfaction Survey form;
• printed marketing materials;
• the Disclosure of Rights and Services required by 651 CMR 12.08(3); and
• a resident handbook, if you use one.

The ownership disclosure covers every officer, director and trustee, and every owner, partner or shareholder with an interest of 5% or more. For each one you must list every multifamily housing, assisted living or health care facility they have been involved in, any enforcement actions, and any Medicare or Medicaid fraud conviction, false claims judgment or settlement, or program termination.⁠¹⁠² EOAI may deny certification to an applicant who held an ownership interest in a c. 111 facility, medical provider or Medicare home health agency with a history of receivership, license revocation, substantiated abuse or neglect, or repeated serious violations.⁠¹ Since July 17, 2026, leaving out a required disclosure from this application is also an unfair or deceptive act under the Attorney General’s 940 CMR 40.⁠¹¹

The operating plan has 26 required elements under 651 CMR 12.03(2)(c).⁠¹ Among them:

• the number of single and double units, and Special Care units, mapped by floor with common spaces and exits;
• the fee structure for lodging, meals and every service, written so residents can work out their weekly or monthly cost;
• a self-administered medication management plan, plus limited medication administration if you will offer it;
• staffing numbers, qualifications and duties;
• the residency agreement;
• building, fire and sanitary certificates;
• your quality improvement program, disaster and emergency preparedness plan, communicable disease control plan and controlled substances policy;
• your fiscal year dates;
• policies on lift devices, CPR and AED use, naloxone and epinephrine, oxygen, and smoking.

From filing to opening, in order

1. Notify EOAI before marketing

   You may advertise before certification only after you start the application process with EOAI. Every advertisement must say that certification is not complete.⁠¹ EOAI’s application page specifies the wording “Pending EOEA certification” in at least 14-point type.⁠⁴

2. File at least 90 days before opening

   EOAI will not review an application that lacks any required information, attachment or fee, or while you owe outstanding fines.⁠¹

3. Answer EOAI’s clarification letter

   After reviewing the materials, EOAI sends a letter within 10 business days listing the changes and missing documents. Typical requests are a certificate of occupancy or proof that staff orientation is done.⁠⁴

4. Pass the pre-certification on-site review

   EOAI staff tour the residence, review personnel files and interview the Director and the Resident Care Coordinator.⁠⁴ EOAI can approve only after it has reviewed both the premises and the applicant.⁠¹

5. Pay the per-unit fee within 10 days of approval

   The certificate to operate costs $125 per certified unit, payable every two years, as published on 2026-10-12.⁠⁵ Paying late counts as noncompliance.⁠¹

6. Open, then expect a follow-up review

   No resident may move in until certification is complete. EOAI may return after opening to interview residents and review their records.⁠⁴

The certificate covers only the sponsor and building named on it and cannot be sold or transferred. It must be displayed in the residence and on the residence’s website.⁠¹ A residence created under the HUD Assisted Living Conversion Program pays no certification fee.⁠¹

Fees are set under 801 CMR 4.02 and can be paid by mail to the Assisted Living Certification and Compliance Unit, One Ashburton Place, 10th floor, Boston. Since November 1, 2024 they can also be paid online, where the third-party processor adds a non-refundable convenience fee.⁠⁵ Residences certified for Basic Health Services also pay an annual Basic Health Services fee, due within ten days of the certification and of each anniversary of it. Under 651 CMR 12.03(8) the amount is set by the Secretary of Administration and Finance under M.G.L. c. 7, §3B.⁠¹ The EOAI fees page, as published on 2026-10-12, lists no dollar figure for it, so ask the Certification Unit ([email protected]) for the amount before you budget.

Basic Health Services: a second certification

The long-term care and assisted living law (S.2889) made Basic Health Services permanent. ALRs had been allowed to provide these services during the COVID emergency.⁠¹² The 2026 regulation defines Basic Health Services as five things, delivered under a medical order: injections; applying or replacing simple non-sterile dressings; regular oxygen management; specimen collection and FDA-approved home diagnostic tests, such as glucose or INR testing; and applying ointments or drops.⁠¹

• You may not advertise or provide these services until EOAI certifies the residence for them. The application is due at least 90 days before you start.⁠¹
• It needs its own operating plan. The plan covers staff qualifications and competencies, supplies and medication storage, an organizational chart naming the clinical lead, policies for each service, resident assessment standards, emergency procedures, and an internal quality assurance and performance improvement committee.⁠¹
• Once certified, you must offer all five services. You may not restrict residents’ choice of an outside provider or retaliate against a resident who uses one.⁠¹⁠²
• The services must be provided by clinical professionals working within their scope of practice. Those staff need two hours of training before they start, and personal care staff need two hours every year.⁠¹
• A certified residence must have a licensed nurse on the premises at least 16 hours a day (the rule’s example is 7:00 a.m. to 11:00 p.m.), plus a nurse available for consultation at all times. Its clinical professionals must hold Basic Life Support certification.⁠¹
• Before providing these services to a resident you need written consent, an RN-updated service plan, a fee discussion and an amended residency agreement.⁠¹

Separately, a residence may offer limited medication administration: non-injectable medications given by a Massachusetts-licensed nurse employed by the residence, from the original pharmacy-labeled container. This is an optional service. It is not part of Basic Health Services.⁠¹

Resident-facing rules that shape your paperwork

Two sets of rules govern what you put in front of residents.

Under 651 CMR 12.04, every move-in starts with a nurse’s assessment before the resident arrives. The assessment covers functional and cognitive status, which medication program fits (with a written statement on the resident’s ability to self-administer), elopement risk, Special Care suitability, and the help the resident would need in an evacuation. It must include an evaluation by the resident’s physician or another authorized practitioner.⁠¹ The residence must provide up to three regularly scheduled meals daily, with a minimum of one meal per day.⁠¹ Staff may not manage residents’ money. At a resident’s request, the sponsor may hold and pay out up to $200 for the resident’s personal use.⁠¹

The Attorney General’s first ALR regulations, 940 CMR 40, took effect when published in the Massachusetts Register on July 17, 2026.⁠¹⁰ Under them it is an unfair or deceptive practice to:

• misrepresent or fail to disclose clearly the total cost of any fee, service or rent;
• misrepresent or fail to disclose staffing levels;
• fail to itemize bills, including the components of bundled fees.⁠¹¹

At the start of each tenancy you must disclose in writing what happens if the resident’s money runs short. You must also post the Long-Term Care Ombudsman’s contact details and the Elder Abuse Hotline number.⁠¹¹ If you have a Special Care unit, you must give residents a written statement of its philosophy and of the qualifications of the people providing services there.⁠¹¹ Draft your residency agreement and marketing against both 651 CMR 12.00 and 940 CMR 40 before you file.

Renewal, reviews and reporting

Certification lasts two years.⁠¹⁠² If EOAI receives and date-stamps your renewal application at least 30 days before expiration, the certificate stays in force until EOAI tells you it has been denied.⁠¹ Renewal is filed by email and includes:⁠⁶

• the application;
• a Recertification Application Supplement;
• the last two annual training needs assessments;
• your e-call policy;
• your fee schedule;
• your marketing materials.

EOAI does a compliance review at least every two years, and at other times if it suspects violations. Results come within 10 days, and you have 10 days to respond to a notice of noncompliance with a corrective plan.⁠⁷ Corrective orders can include:⁠⁷

• stopping new admissions;
• reducing the number of residents;
• staffing changes;
• additional training.

If EOAI refuses or revokes certification, the applicant cannot apply again for five years.⁠⁷

Ongoing filings under 651 CMR 12.04(14):⁠¹

• Fiscal statement. An annual statement and opinion from a CPA or comparable reviewer on whether the residence is fiscally sound, with enough cash flow and reserves. It is due within 90 days of fiscal year-end; EOAI may extend that by up to 30 days.
• Annual resident report. An aggregate report on residents for January 1 through December 31, due to EOAI by March 1 of the next year. A late report is a finding of noncompliance.
• Changes. Notice at least 30 days before any alteration of the residence, its units or its operating plan.
• Code citations. Copies of sanitary, building or fire code citations within seven days.
• Staff changes. Contact details for a new or interim Executive Director or Resident Care Director within 5 business days.

Change of ownership. Anyone acquiring a 5% or greater interest must file a certification application at least 30 days before the change. On time, the new owner is treated as temporarily certified from the date of the change.⁠¹

Closure. Residents and EOAI must receive written notice at least 120 days before closing or selling.⁠¹

Getting paid: private pay and MassHealth Group Adult Foster Care

The long-term care and assisted living law (S.2889) directed the Executive Office of Health and Human Services (EOHHS) to report on whether a federal Medicaid waiver could let people at risk of nursing home entry live in a certified ALR, and what it might save.⁠¹² The public payment route that exists runs through MassHealth’s Group Adult Foster Care (GAFC) program. GAFC is daily help with activities of daily living, ordered by the member’s primary care provider and delivered by a qualified GAFC direct care aide.⁠¹³

Since July 1, 2022, GAFC rules have been part of 130 CMR 408.000. MassHealth has posted revised 130 CMR 408.000 text under the title “emergency adoption, date filed September 25, 2026.” The copy on mass.gov carries draft placeholders in its transmittal header, so confirm with MassHealth that it is in effect before you rely on the provider-eligibility wording below.⁠¹³⁠¹⁴ To enroll as a GAFC provider, an organization must meet several conditions in 130 CMR 408.504:⁠¹³

• contract with MassHealth;
• keep a Massachusetts business office;
• accept MassHealth payments as payment in full for GAFC services;
• submit a fiscal soundness statement;
• either be certified as an ALR under 651 CMR 12.00 and serve only members who live in the residence, or be accredited by NCQA, COA or CARF.

The 2022 bulletin gives newly enrolled AFC and GAFC providers 24 months to reach full accreditation after an interim accreditation.⁠¹⁴ The bulletin’s accreditation deadlines are written for AFC and GAFC providers that enrolled through accreditation. The 130 CMR 408.504(A)(9) text lets a GAFC provider qualify by ALR certification (serving only its own residents) or by accreditation, and ties the requirement to be “actively billing for and serving at least eight (8) individuals” to “the time of accreditation and re-accreditation” in (A)(11).⁠¹³ The text does not say in so many words whether that eight-member evidence applies to an ALR-certified provider that is not accredited, so ask MassHealth’s GAFC provider contact before you plan around either route.

For the same founder, other Massachusetts care businesses work differently: child care is licensed by the Department of Early Education and Care (see the family child care and group and school age child care guides), and adult day health is licensed by DPH.

Sources

1. 1
   Executive Office of Aging & Independence, 651 CMR 12.00: Certification Procedures and Standards for Assisted Living Residences (Mass. Register #1579, 07/31/2026) Checked 12 Oct 2026 · Back to text ↑
2. 2
   The General Court of the Commonwealth of Massachusetts, M.G.L. c. 19D, section 4 (Certification; operating plan; basic health services) Checked 12 Oct 2026 · Back to text ↑
3. 3
   The General Court of the Commonwealth of Massachusetts, M.G.L. c. 19D, section 8 (Operating without certification; penalty) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Executive Office of Aging & Independence, Apply to certify an Assisted Living Residence Checked 12 Oct 2026 · Back to text ↑
5. 5
   Executive Office of Aging & Independence, Assisted Living Fees Checked 12 Oct 2026 · Back to text ↑
6. 6
   Executive Office of Aging & Independence, Renew your Assisted Living Residence Certification Checked 12 Oct 2026 · Back to text ↑
7. 7
   Executive Office of Aging & Independence, Compliance reviews of Assisted Living Residences Checked 12 Oct 2026 · Back to text ↑
8. 8
   Executive Office of Aging & Independence, Staffing regulations (Assisted Living Residences) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Executive Office of Aging & Independence, Training requirements of Assisted Living Residence staff Checked 12 Oct 2026 · Back to text ↑
10. 10
    Office of the Attorney General, AG Campbell Announces Final Regulations For Assisted Living Residences Checked 12 Oct 2026 · Back to text ↑
11. 11
    Office of the Attorney General, 940 CMR 40: Assisted Living Residences (final regulations) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Massachusetts Senate, Fact Sheet: An Act relative to long term care and assisted living (S.2889) Checked 12 Oct 2026 · Back to text ↑
13. 13
    MassHealth, 130 CMR 408.000: Adult Foster Care, including Group Adult Foster Care (emergency adoption filed September 25, 2026) Checked 12 Oct 2026 · Back to text ↑
14. 14
    MassHealth, Adult Foster Care Bulletin 25: accreditation requirements for AFC and GAFC providers (July 2022) Checked 12 Oct 2026 · Back to text ↑
15. 15
    The General Court of the Commonwealth of Massachusetts, M.G.L. c. 111, section 71 (Licensing of long-term care facilities, including rest homes) Checked 12 Oct 2026 · Back to text ↑

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