North Dakota assisted living facility license: two licenses, rules and fees

Does your building need an assisted living license?

Under N.D.C.C. 50-32-01, an assisted living facility is a building or structure with at least five living units, run as one entity. It serves five or more people who are not related to the owner or manager by blood, marriage or guardianship. It is held out to the public as a place that provides or coordinates “individualized support services” so tenants can stay as independent as possible.⁠¹ Those services are help with bathing, dressing, toileting, transferring, eating, medication management and personal hygiene.⁠¹

The living unit definition does much of the work. Each unit must have:⁠¹

• a sleeping area;
• an entry door that locks;
• a private bath with a toilet, a bathtub or shower, and a sink;
• a tenant who has signed a lease with the facility.

Shared-bath room-and-board homes do not fit this definition, however many people live there. No more than two people may share one bedroom in a unit.⁠¹

The license is also triggered by marketing. An entity may not use the term “assisted living” in its advertising unless it is licensed.⁠¹ After HHS sends written notice that you need a license, it may fine you up to $50 a day once 59 days have passed.⁠¹⁠²

The statute excludes several setting types:⁠¹

• congregate housing;
• licensed basic care facilities;
• facilities licensed under chapters 23-16, 23-17.7 and 25-16;
• facilities licensed under section 50-11-01.4.

Retirement housing that a religious order runs for its own vowed members is exempt.⁠¹ Facilities licensed before August 1, 2005 are protected from the unit definition. That protection carries over to the first change of ownership after July 31, 2005, and no further.⁠¹ If you buy an older building that relies on this exception, you cannot pass it on to a later buyer.

Assisted living, basic care or foster home for adults?

North Dakota has three residential licenses that founders often confuse. Pick the one that matches the care you plan to give:

Scroll the table sideways to see every column.

The basic care column comes from N.D.C.C. 23-09.3-01 and 33-03-24.1-09.⁠¹²⁠¹³ The foster home column comes from N.D.C.C. 50-11-00.1 and 50-11-01.4.⁠¹⁶ A basic care facility also includes one that is attached to a nursing home or assisted living facility and shares its staff.⁠¹²

If your plan is a home for up to four adults, see the North Dakota foster home for adults guide. If you want to deliver skilled nursing to tenants in their apartments through a separate agency, see the home health agency guide.

The basic care moratorium and the memory care line

Promising 24-hour response staff or marketing a dementia or memory care building moves you out of chapter 50-32. You then need a basic care license under 23-09.3.⁠¹⁠¹² N.D.C.C. 23-09.3-01.1 says basic care beds “may not be added to the state’s licensed bed capacity” between August 1, 2025 and July 31, 2029. The exceptions are:⁠¹²

• a nursing facility converts nursing beds to basic care;
• beds are transferred under section 23-16-01.1;
• the applicant shows that basic care is not readily available in an area, or that existing basic care beds within 50 miles have been at least 90% occupied for the previous 12 months;
• the department approves new beds, which must then be licensed within 48 months.

Beds bought from another basic care facility must be licensed within 72 months of the transfer.⁠¹² HHS states that basic care facilities are not certified by CMS for Medicare or Medicaid. Licensure does make them eligible for state basic care funding.⁠¹⁴

The moratorium explains why some North Dakota operators open as assisted living. If your service model fits the lighter chapter 50-32 framework, you avoid the bed freeze. SFN 452 asks whether your facility “specialize[s] in dementia/alzheimer’s”.⁠⁴ Answer it with the basic care definition in mind. Holding a building out as a memory care facility is itself one of the triggers for a basic care license.⁠¹²

Two licenses from two HHS units

The HHS assisted living page says an entity serving five or more people in this setting “must be licensed as an assisted living facility by both Food and Lodging and the Health Response and Licensure Section.”⁠³ They are separate applications with separate fees and rules:

Sources for this table: ⁠¹⁠²⁠³⁠⁴⁠⁵⁠⁶⁠⁹.

The Food and Lodging license may come from a local health department instead of the state. N.D.C.C. 23-09-16 tells the department to waive its license for a facility licensed by a city or district health unit whose sanitation, safety and inspection rules it has approved.⁠⁵ On the HHS list updated August 28, 2025, 39 of the 70 licensed facilities hold a Food and Lodging Unit license. The other 31 are licensed by local units:⁠¹⁰

• Fargo Cass Public Health: 12
• First District Health Unit: 9
• Bismarck Burleigh Public Health: 8
• Grand Forks Public Health Department: 2

If your site is in one of those areas, ask the local unit whether it licenses assisted living there. The same list shows the license expiring March 31, 2026 for all eight Bismarck Burleigh facilities, against December 31, 2025 for the rest, so a local license may not follow the calendar year.⁠¹⁰ The sources reviewed do not publish the local units’ fees. Ask the local unit for its fee and expiration date before you budget.

Contacts as published on October 12, 2026:⁠¹¹

• Assisted Living (Health Response and Licensure): 701-328-8655, [email protected].
• Food and Lodging: 701-328-1291 or 1-800-472-2927, [email protected].

Both share an office at 1720 Burlington Drive, Suite A, Bismarck. SFN 452 itself gives a different mailing address: the Medical Services Division, 600 E Boulevard Ave., Dept. 325, Bismarck, ND 58505-0250.⁠⁴ Use the address on the form version you file. On the HHS assisted living page, the link labeled “SFN 452” opens the Food and Lodging form, SFN 19384; SFN 452 itself is the nd.gov eform in the sources.⁠³⁠⁴⁠⁹

Building, fire and sanitation requirements

Chapter 50-32 sets the unit standard: a lockable door, a private bath, and no more than two people per bedroom.⁠¹ Chapter 23-09 and the Food and Lodging rules set the building requirements:

• Exits. A newly built facility needs adequate exiting under the state building code (N.D.C.C. 54-21.3) and the state fire code (N.D.C.C. 18-01).⁠⁵
• Fire equipment. Fire extinguishers must meet NFPA 10. Sprinklers and standpipes are required where the building and fire codes require them.⁠⁵ Rule 33-33-09-03 says sprinkler systems “should be inspected and maintained” to NFPA 25.⁠⁷
• Elevators. New construction, remodels and additions that have elevators must meet the building code’s fire protection rules.⁠⁵
• Smoke detection. Every sleeping room needs a listed smoke detector.⁠⁸ If sleeping rooms do not open directly outside, hallway detectors must be wired to a fire alarm, with an audible device at least every 30 feet of corridor.⁠⁸ At least one sleeping room needs a detector for people who are hard of hearing. It must produce 85 decibels at ten feet and flash a 250-watt bulb for five minutes.⁠⁸ After installation, the owner or manager certifies in writing that the system was tested.⁠⁸ Afterward, the owner, manager or a designee tests at least 10% of battery-operated detectors weekly and 10% of hard-wired detectors monthly, keeps written test records for two years, and has the whole system tested and inspected at least once a year.⁠⁸
• Emergency lighting. Exit routes need emergency lighting that lasts at least 1.5 hours at an average of one footcandle. This is not required if every unit has its own ground-level exit to the outside.⁠⁷
• Sanitation. Bathrooms, toilet rooms and laundry rooms must vent directly outside. Operable windows need insect screens in summer. Nobody may sleep or dress in the kitchen or dining room. Drinking water must come from an approved public or nonpublic system.⁠⁵ SFN 19384 asks whether your water supply and sewage disposal are municipal, private or rural.⁠⁹

Rule 33-33-09-02 requires a written emergency disaster plan. It must cover evacuation, sheltering in place, temporary relocation sites and staff assignments, and it must be readily available for review by tenants, family members and emergency responders. The rule also says the evacuation route should be posted prominently.⁠⁷

The Food and Lodging fee rule refers to a plan review fee “if a plan review application is required.”⁠⁶ The rule does not say when a plan review is required. Ask Food and Lodging, or the local unit, before construction starts.

The documents HHS wants with SFN 452

Rule 75-03-34-02 and the SFN 452 checklist list what Health Response and Licensure needs before it will process your application:⁠²⁠⁴

1. Signed application

   A sole proprietor signs as owner. A corporation needs signatures from two officers. A government unit needs the head of the department with jurisdiction. Each signer must be at least 18.⁠⁴

2. The $75 fee

   Pay by check or money order to the Department of Health and Human Services. The fee is not prorated or refunded.⁠²⁠⁴

3. Your tenant agreement

   The rule requires rates for rent and services, payment terms, refund policies, rate changes, tenancy criteria and living unit inspections.⁠² The form goes further: it asks for separate rates for rent and for services.⁠⁴ Leases are also subject to the state’s landlord-tenant law, N.D.C.C. 47-16, which the HHS page links.⁠³

4. Your complaint notice

   This written notice tells tenants how to report a complaint. It must include the senior info-line number and the address of the aging services division.⁠² SFN 452 lists the info-line as 1-855-462-5465 and 1-701-328-4601. It gives the State Long-Term Care Ombudsman at 1237 W Divide Ave, Suite 6, Bismarck, phone 701-328-4617.⁠⁴

5. A brochure and resident handbook,

   if you have them.⁠⁴

The form also asks for:⁠⁴

• the number of living units;
• the legal operator and the owner of the premises;
• whether a management company runs the building;
• whether ownership or the operator changed in the last 12 months;
• which services you offer (bathing, dressing, medication management, meals, laundry, transportation and others), and whether you provide each one directly or arrange it through another entity;
• your Qualified Service Provider (QSP) number, if you have one.

By signing, you certify that the facility complies with all applicable federal, state and local laws. You also agree to report changes in writing within 30 days.⁠²⁠⁴

An application is not complete until HHS has every required item. HHS must approve or deny a complete application within 30 days.⁠²

Opening in order

1. Choose the license

   Decide whether your service model is assisted living or basic care before you design the building. Basic care brings the bed moratorium, floor plan approval before opening and 24-hour awake staff.⁠¹²⁠¹³

2. Form the entity

   SFN 19384 tells you to contact the Secretary of State (701-328-4284) before operating.⁠⁹

3. Design to the unit and fire rules

   Plan the lockable units with private baths, the code exits, smoke detection, emergency lighting and sprinkler maintenance.⁠¹⁠⁵⁠⁷⁠⁸

4. Request the Food and Lodging application

   Get it from the state office or your local health unit, and file it with the fee schedule then in force.⁠³⁠⁵⁠⁶

5. File SFN 452

   Include the tenant agreement, complaint notice and $75 fee. The 30-day decision clock starts when the file is complete.⁠²⁠⁴

6. Display the license

   Post it in a conspicuous place on the premises. It covers only the named premises and entity.⁠²

What the law requires once you operate

Chapter 50-32 sets a short list of duties. Neither it nor 75-03-34 sets a staffing ratio or an administrator credential.⁠¹⁠²

• Tenancy criteria. Write clear tenancy criteria and give them to each tenant before the lease is signed. Evaluate each applicant against them before renting a unit.⁠¹
• Administrator education. The administrator completes 12 hours of continuing education a year.⁠¹
• Direct care staff training. Staff need annual training in resident rights, fire and accident prevention, tenants’ mental and physical health needs, behavior problems and prevention, and infection control including universal precautions.⁠¹
• Hiring checks. Before hiring, check references, previous employment and the applicable registries.⁠¹
• Tenant records. Keep the initial evaluation, the signed tenancy agreement, a medication administration record where relevant, and an itemized list of services.⁠¹
• Satisfaction survey. Survey tenants at least once every 24 months and give every tenant the results.⁠¹

The owning entity may provide health services directly to tenants.⁠¹ A tenant who needs hospice and no longer meets your tenancy criteria may stay only by contracting with a third party, such as a hospice agency, or by using family support.⁠¹ The HHS page also links North Dakota’s resident rights law (N.D.C.C. 50-10.2) and the Board of Nursing.⁠³ Chapter 50-32 requires only a medication administration record “consistent with applicable state laws, rules, and practices” and names no staff credential.⁠¹ Ask the Board of Nursing whether the staff who give medications at your facility need a medication assistant registration.

Inspections, complaints and enforcement

Food and Lodging (or the local health unit) inspects at least once every two years. How often depends on a risk score that weighs the food you serve, how it is prepared, volume, population served and compliance history.⁠⁵ On the August 2025 list, most facilities had a last inspection date in 2024 or 2025.⁠¹⁰

Health Response and Licensure receives complaints and forwards them to the appropriate agency or program for investigation, then asks for the findings.⁠² The HHS page links an assisted living complaint intake form.⁠³ If it finds deficiencies or a pattern of deficiencies, it may issue a provisional license for up to 90 days, renewable once for another 90. If problems remain, it may deny or revoke the license.⁠¹

Grounds for denial or revocation include:⁠²

• false statements in the application;
• losing another license that federal, state or local law requires;
• refusing access to records;
• a pattern of failing to honor tenant contracts.

A revocation takes effect 30 days after written notice, unless tenants are in imminent danger. You must notify all tenants and third-party payers within 15 days of the final notice.⁠²

Renewal and ownership changes

HHS sends a renewal notice and form at least 60 days before the license expires. Your complete renewal is due at least 30 days before expiration, with the same documents as an initial application.⁠² The HHS page links an online renewal application for Health Response and Licensure and a separate renewal portal for Food and Lodging.⁠³

The Food and Lodging license expires on December 31. You can renew it within 60 days after that date by paying a late fee of 50% of the license fee. After 60 days you must apply as a new licensee.⁠⁵

The HHS license cannot be sold, assigned or transferred, and covers only the premises and entity named on it.⁠² The Food and Lodging statute reviewed here says nothing on transfers, so ask that office what a buyer must file.⁠⁵ SFN 19384 has a change-of-ownership box that asks for the former owner.⁠⁹ Under 33-33-08-01, a new license application carries a $100 administration fee on top of the annual fee.⁠⁶

How assisted living gets paid with public funds

The 1915(c) waiver application effective January 1, 2026 lists no assisted living service. Its residential service, Adult Residential Care, is available only from agencies licensed as basic care facilities with experience serving people with dementia or brain injury, enrolled as QSPs.⁠¹⁵ SFN 452 asks for a QSP provider number “if enrolled,” so the form expects that an assisted living facility may also be a QSP.⁠⁴ The waiver application names assisted living residents only in its complaint procedure, and the sources reviewed do not say which services a QSP may deliver in an assisted living apartment. Ask HHS Aging Services before you promise tenants any publicly funded service.

Rule changes to watch

• January 1, 2026: the Food and Lodging fee schedule (33-33-08-01) was amended and now lists $170 for an assisted living facility. The application form, last revised in October 2024, still prints $120.⁠⁶⁠⁹ The rule is the law, so plan on $170; the form’s $120 is out of date. Confirm the amount with Food and Lodging when you request the application.
• August 1, 2025: the basic care bed moratorium began. It runs to July 31, 2029.⁠¹²
• October 1, 2022: HHS last amended the assisted living licensing section, 75-03-34-02.⁠²

Sources

1. 1
   North Dakota Legislative Branch, North Dakota Century Code, chapter 50-32 (Assisted Living Facilities) Checked 12 Oct 2026 · Back to text ↑
2. 2
   North Dakota Legislative Branch, North Dakota Administrative Code, chapter 75-03-34 (Licensing of Assisted Living Facilities) Checked 12 Oct 2026 · Back to text ↑
3. 3
   North Dakota Health and Human Services, Assisted Living Checked 12 Oct 2026 · Back to text ↑
4. 4
   North Dakota Health and Human Services, SFN 452, Application for a License to Operate an Assisted Living Facility (Rev. 9-2022) Checked 12 Oct 2026 · Back to text ↑
5. 5
   North Dakota Legislative Branch, North Dakota Century Code, chapter 23-09 (Food and Lodging Establishments and Assisted Living Facilities) Checked 12 Oct 2026 · Back to text ↑
6. 6
   North Dakota Legislative Branch, North Dakota Administrative Code, chapter 33-33-08 (Food Establishment License Fees) Checked 12 Oct 2026 · Back to text ↑
7. 7
   North Dakota Legislative Branch, North Dakota Administrative Code, chapter 33-33-09 (Assisted Living Facilities) Checked 12 Oct 2026 · Back to text ↑
8. 8
   North Dakota Legislative Branch, North Dakota Administrative Code, chapter 33-33-05 (Smoke Detection Devices) Checked 12 Oct 2026 · Back to text ↑
9. 9
   North Dakota Health and Human Services, SFN 19384, Assisted Living Facility License Application (Food and Lodging Unit, 10-2024) Checked 12 Oct 2026 · Back to text ↑
10. 10
    North Dakota Health and Human Services, Statewide Licensed Assisted Living Facilities (updated August 28, 2025) Checked 12 Oct 2026 · Back to text ↑
11. 11
    North Dakota Health and Human Services, Food and Lodging: Contact Us Checked 12 Oct 2026 · Back to text ↑
12. 12
    North Dakota Legislative Branch, North Dakota Century Code, chapter 23-09.3 (Basic Care Facilities) Checked 12 Oct 2026 · Back to text ↑
13. 13
    North Dakota Legislative Branch, North Dakota Administrative Code, chapter 33-03-24.1 (Basic Care Facilities) Checked 12 Oct 2026 · Back to text ↑
14. 14
    North Dakota Health and Human Services, Basic Care Facilities Checked 12 Oct 2026 · Back to text ↑
15. 15
    North Dakota Health and Human Services, Application for a §1915(c) HCBS Waiver, ND.0273 (effective January 1, 2026) Checked 12 Oct 2026 · Back to text ↑
16. 16
    North Dakota Legislative Branch, North Dakota Century Code, chapter 50-11 (Foster Care Homes for Children and Adults) Checked 12 Oct 2026 · Back to text ↑

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