Oklahoma assisted living center license: OSDH establishment, fees and rules

A low threshold: two residents is enough

Oklahoma’s Continuum of Care and Assisted Living Act defines an assisted living center as “any home or establishment offering, coordinating or providing services to two or more persons” who live there, are unrelated to the operator, and need help with personal care or nursing supervision. They need that help either by choice or because of functional impairment. They may also need intermittent or unscheduled nursing care, medication assistance, or help with transfers and walking.⁠¹ The definition sets no upper size limit, so a converted four-bedroom house and a 120-unit building need the same license.

The license also controls what you call yourself. Without an assisted living center license, no one may “use in its name, logo, contracts, or literature the phrase ‘continuum of care facility’ or ‘assisted living’,” imply that it is one, or hold itself out as one.⁠¹ OSDH prints this prohibition at the top of the application form.⁠⁴

The Act does not apply to residential care homes, adult companion homes, Department of Veterans Affairs domiciliary units, or the private residences of people with developmental disabilities served through DHS or Medicaid waivers. It also excludes hotels, motels, boardinghouses and rooming houses, and VA-approved medical foster homes caring for three or fewer veterans. Facilities that charge no periodic fee and receive no county, state or federal assistance are excluded too.⁠¹

Assisted living center or residential care home?

This is the line most small-home founders have to draw. OSDH describes a residential care home as offering housing, food service and “supportive assistance”. It may help with meals, dressing, bathing and other personal needs, and it may assist with medications, “however, it cannot provide medical care.”⁠⁵ An assisted living center may also provide nursing supervision and intermittent or unscheduled nursing care. That means skilled care by an LPN or RN that is not needed 24 hours a day.⁠²⁠⁵ Neither license allows 24-hour skilled nursing. That belongs to a nursing facility.⁠⁵ If your plan includes nurse oversight, nurse-delegated care or residents with skilled needs, you need the assisted living license. If you will offer only supportive help, read our Oklahoma residential care home license guide.

Continuum of care facilities

A continuum of care facility combines nursing facility services with assisted living, adult day care, or both, and it is licensed under the same Act and Form 624.⁠¹⁠⁴ The nursing component needs a certificate of need under the Long-Term Care Certificate of Need Act. A stand-alone assisted living center does not.⁠⁴⁠⁵ Adding an adult day program means filing a separate adult day care license application under OAC 310:605 as well.⁠² See our Oklahoma adult day care center license guide.

Who regulates you

Health Facility Systems, part of OSDH Protective Health Services, processes licenses and renewals for assisted living centers, continuum of care facilities, residential care homes, adult day care centers and nursing facilities.⁠³ Its contact details as printed on Form 624 are P.O. Box 268823, Oklahoma City, OK 73126-8823, phone 405-426-8175, email [email protected].⁠⁴ The operating rules are in Oklahoma Administrative Code Chapter 310:663, which OSDH posts as a PDF on the Health Facility Systems page.⁠²⁠³

The OSDH copy of Chapter 310:663 shows amendments through September 11, 2022, and the official code site could not be read when this guide was checked on 2026-10-12. Any later amendment is therefore unconfirmed. Ask Health Facility Systems whether Chapter 310:663 has been amended since then and request the current text.

Two approvals: establishment, then the initial license

Oklahoma separates approval to establish a center from the license to operate it. Both are requested on ODH Form 624, where you tick “Establishment”, “Initial license” or “Amendment”.⁠⁴

• Establishment must be filed “at or before the time when the application for an initial license is filed.” A buyer taking over a center that is already licensed does not need a new establishment approval.⁠²
• Initial license applications for a new center must be filed “at least thirty (30) days before beginning operations.” After a change of ownership, the filing is due at least 30 days before the final transfer.⁠²

The applicant must be “the person or entity responsible for providing or arranging all required services and care.”⁠² Neither the establishment approval nor the license can be transferred to anyone else.⁠² Your filing date counts from the day OSDH receives both the application and the fee, so an application sent without a check does not start the clock.⁠² OSDH must approve or disapprove establishment, or issue or deny the license, “within thirty (30) days after receipt of application.” Both sides can agree to extend that by 90 days.⁠² If OSDH denies the application, it must send written reasons within 10 days.⁠²

What goes into Form 624

Most answers are separate, labelled attachments, and the form must be signed before a notary.⁠⁴

Part I, establishment:⁠⁴

• Disclosure Statement of Owner, Lessee and Manager (ODH Form 953-B), plus the Detail (953-C) and Affirmation (953-D) attachments
• Schedule B, Long Term Care Facilities Projected Budget of Revenues and Expenses
• Admission criteria describing the population you will admit across six need areas. These are personal care, nursing supervision, intermittent or unscheduled nursing, medication administration, cognitive orientation and dementia care, and transfer or ambulation.
• A description of services across 11 areas, including any specialized dementia or disability unit you intend to market and your plan for evacuating residents
• Staffing Projection and Professional Certification (ODH Form 953-E), showing types and hours of staff
• Copies of your marketing materials
• Scaled, dimensioned floor plans, life safety plans and a building code analysis for an existing building, or floor plans and specifications for new construction

Part II, initial license:⁠⁴

• A statement of assets, liabilities and net worth for the most recent year (audited if available)
• Your resident service contract, which must contain the admission criteria and service descriptions from Part I
• Your procedure for receiving and resolving resident grievances
• The OSDH Resident Needs Chart
• State Fire Marshal Inspection Form 7A, or a report from an authorized representative, showing maximum occupancy and that deficiencies are corrected
• A completed Form 953-E with your actual shift times
• The license or certificate of your dietitian or qualified nutritionist
• Contracts with outside providers for services your own staff will not deliver
• A list of your background operating assisted living or continuum of care facilities
• The administrator’s license or certificate

The form also has two items that founders often overlook. A facility that has never been licensed must attach a statement from the local government confirming the site does not violate zoning ordinances.⁠⁴ If you will run a specialized Alzheimer’s unit or program, you must file the Alzheimer’s Disease or Related Disorders Special Care Disclosure Statement (ODH Form 613) before you offer those services and again each year with renewal.⁠⁴ An applicant applying as an individual, rather than as an entity, also files the ODH Form 301 Affidavit of Lawful Presence.⁠³

When the surety rules apply

The Act requires rules on surety bonds or deposits.⁠¹ In Chapter 310:663 they reach only centers that contract to provide “an unlimited term of services based on a fixed, prepaid fee.”⁠² If that describes your model, you need three things:⁠²

• an errors and omissions policy of at least $500,000 annual aggregate, kept in force for a year after licensure ends
• a fidelity bond of the greater of $50,000 or 10% of the prior year’s services
• liability insurance

You must also complete Part III of Form 624.⁠⁴ A center billing month to month does not fall under this subchapter.⁠²

Fees, and the initial-fee discrepancy

The statute sets the license fees, and facilities run by the Oklahoma Department of Veterans Affairs are exempt:⁠¹

• Establishment: a nonrefundable application fee on a sliding scale by bed count, not over $1,000. The rule sets it at $10 per bed, capped at $1,000.⁠¹⁠²
• Initial license: $10 for each bed in maximum capacity.
• Renewal: $10 per bed per year of licensure.

The renewal fee is consistent across OSDH documents: beds × $10 × 3 years.⁠³⁠⁴ For the initial license fee, OSDH’s own publications give three different formulas:

Scroll the table sideways to see every column.

Sources: ⁠¹⁠²⁠³⁠⁴

The official sources do not say which formula the office applies. Ask Health Facility Systems at 405-426-8175 for the exact initial license and establishment amounts for your bed count before you mail payment. Checks are payable to the Oklahoma State Department of Health.⁠⁴ A facility with an adult day care component pays an extra $75, which the statute caps at $75 per year of licensure.⁠¹⁠³⁠⁴ The fee for the first renewal after the 180-day license, and for adding beds, is prorated by the days left on the license.⁠²

Construction plan review has its own fees: 0.02% of the design and construction cost, minimum $50 and maximum $1,000. Requests for exceptions or waivers, self-certification applications and courtesy construction inspections cost $500 each, and technical consultation costs $500 per eight hours of staff time.⁠²

The building

A center must meet the construction and safety standards of 74 O.S. §§ 317 to 324.21. Its design must suit the disabilities of the residents it will serve. Any center newly licensed, or undergoing design changes, must meet the accessibility requirements of Chapter 11 of the 2003 International Building Code. It must also meet the hot water standards in Appendix A of the chapter.⁠² In a continuum of care facility, assisted living residents must have separate wings or buildings, with separate exterior entrances, dining and common areas, from nursing residents.⁠²

Chapter 310:663 sets privacy rules that drive floor plans:⁠²

• No more than two residents in a sleeping room
• No more than four residents sharing a toilet, and no more than four sharing bathing facilities, unless OSDH approves more based on the bathing room’s design
• Bathing facilities used by one resident at a time
• Lockable doors on sleeping rooms or units unless contraindicated, and documented
• A way for each resident to control the temperature in their own unit
• The right to use personal furnishings

Plan review. Before construction starts, you must submit plans for new buildings and for major alterations. That includes changes to egress, occupancy, structure, HVAC, the essential electrical system, fire alarms, sprinklers or egress-control devices.⁠² Review runs in two stages. Stage one is preliminary plans. Stage two is construction documents sealed by an architect registered in Oklahoma, and you may skip stage one at your own risk. Floor plans are drawn at 1/8 inch to 1 foot.⁠² OSDH has 10 calendar days to decide whether a submission is complete and 45 days for technical review. A submission is treated as withdrawn if you do not answer a request for more information within 90 days.⁠²

The administrator: Tier 2 under OSDH

Every center must designate an administrator.⁠² The 1998 rule text in 310:663-9-3 lists three acceptable credentials: a nursing home administrator license, a residential care home administrator certificate, or a nationally recognized assisted living certificate approved by OSDH.⁠² The statute has since changed. Laws 2023, chapter 271, effective November 1, 2023, gave OSDH the authority to license administrators and created two tiers. A “Tier 2 long-term care administrator” is licensed or certified to run an assisted living facility, residential care facility, adult day care center or small ICF/IID.⁠¹ An applicant must be at least 21 and “of reputable and responsible character.”⁠¹ OSDH’s program page also requires an OSDH-approved training program.⁠⁶ Administrators already lawfully serving keep their authorization.⁠¹

OSDH’s administrator program lists the steps for the Tier 2 Residential Care/Assisted Living (RCAL) license:⁠⁶

1. Apply on the OSDH portal first

   Do this before you begin training. The application carries a fee paid to OSDH.

2. Complete an OSDH-approved training program

   You pay the program directly.

3. Pass the Oklahoma State Standard Exam

   The exam fee goes to the testing center.

4. Skip the internship

   OSDH says “Tier 2 ADC and RCAL licenses do not require internship.”

5. Pass the NAB exams

   RCAL candidates take both the Core and Line of Service exams, and fees are paid to NAB.

After licensure, a Tier 2 RC/AL administrator needs 16 continuing education units a year, with the first year possibly prorated.⁠⁶ The administrator program’s contact line, as published, is 405-426-8970. Form 624 asks for the administrator’s license number, and a copy of the license goes in Part II.⁠⁴

Staffing, medications and training

The rules set no numeric staff-to-resident ratio. They set conditions instead:⁠²

• Around the clock. “Adequate trained staff shall be on duty, awake, and present at all times, 24 hours a day, 7 days a week.” That staffing must be enough to carry out your emergency and disaster plan.
• One-person staffing. A center with only one direct care worker on duty must tell residents before admission. It also needs an OSDH-approved plan for urgent situations, including falls.
• Secured units. A unit that limits residents’ access to other areas needs at least two staff awake on every shift, with at least one direct care worker inside the unit at all times.
• Nursing. RN supervision of skilled nursing interventions must be provided or arranged, consistent with the Oklahoma Nursing Practice Act.
• Medications. You must provide or arrange qualified staff to give medications. An RN or pharmacist reviews them monthly, and a consultant pharmacist reviews them quarterly. Unlicensed staff who give medications must complete an OSDH-approved training program.
• Diet. A licensed dietitian or qualified nutritionist develops the diet plan.
• Screening and training. Every employee is subject to the criminal arrest check that applies to nurse aides under 63 O.S. § 1-1950.1. Direct care staff need first aid and CPR training.

Statute directs OSDH rules requiring at least one hour a year of Alzheimer’s and dementia in-service training for medical and direct care staff.⁠¹ Any nurse aide trainee you employ must be supervised by at least a consulting nurse licensed in Oklahoma.⁠¹ When an antipsychotic is prescribed, the resident must be reassessed at least quarterly. As-needed (PRN) antipsychotic use must be monitored at least monthly by a licensed health care professional.⁠¹

Admission, assessments and keeping residents

Your admission criteria and service descriptions go into both the license application and the resident service contract, and you must deliver every service the contract lists.⁠² A person cannot be placed with you if any of these is true:⁠²

• their needs exceed what you offer
• a physician requires restraints outside emergencies
• they pose a threat to themselves or others
• you cannot meet their need for privacy or dignity

You complete the admission assessment within 30 days before admission or at admission. A comprehensive assessment follows within 14 days after admission, then every 12 months and after any significant change.⁠²

Residents may bring in a licensed home care agency or hospice, and you must monitor and assure the delivery of those services.⁠¹ If a resident’s condition meets your discharge criteria, the statute provides for a written plan of accommodation, agreed by the physician, the center and the resident, so the resident can stay. A licensed health care professional reviews the plan at least quarterly.⁠¹ Involuntary discharge requires 30 days’ written notice, except in emergencies. For reasons other than inappropriate placement, the notice also goes to OSDH.⁠¹⁠²

Inspections, incidents and penalties

Before the 180-day initial license ends, OSDH fully inspects the center. If you meet the rules, you receive the three-year renewal license. If you do not, the initial license can be extended once, for up to 120 days.⁠² After that, OSDH makes unannounced inspections at least every 15 months, with a statewide average of 12 months.⁠²

Reportable incidents include abuse, neglect, misappropriation and unplanned fires. You report them to OSDH within one business day of discovery, file a follow-up within five business days and a final report within ten.⁠² Violations bring a statement of deficiencies and a plan of correction, with up to 60 days to correct. Fines for violations below “actual harm” apply only if you miss the correction deadline. The maximum administrative penalty is $500 per day.⁠¹ Renewal is filed by the date on your license. You report changes in the meantime on ODH Form 958, Notice of Change.⁠²⁠³

Medicaid: the ADvantage assisted living option

An assisted living center is not Medicare- or Medicaid-certified as a facility type.⁠⁵ Medicaid pays for assisted living services through the ADvantage waiver. ADvantage members can request the Assisted Living Service option through their case manager.⁠⁸ To bill, you need a signed SoonerCare contract with the Oklahoma Health Care Authority and certification from the ADvantage Administration. The ADvantage Administration checks licensure, training, business practices and financial stability, and it re-evaluates financial certification at least once a year.⁠⁷ Form 624 asks how many of your beds are “Assisted Living/Advantage Waiver Certification beds,” so decide before you apply whether you will seek certification.⁠⁴

Changes in 2023 and 2025

• November 1, 2023: Laws 2023, chapter 271 gave OSDH the authority to license long-term care administrators and created the Tier 1 and Tier 2 structure described above.⁠¹
• November 1, 2025: Laws 2025, chapter 357 added 63 O.S. § 1-890.9. It writes the quarterly quality assurance committee into statute, adds an owner or the owner’s designee as a required member, and tasks the committee with recommending policies, including on medication administration.⁠¹ The same law amended § 1-890.3. That section now requires the medication rules to cover qualified staff, following prescriber orders, monthly and quarterly reviews, medication administration records, and storage and disposal policies.⁠¹ The OSDH copy of OAC 310:663 predates this law, so whether the rules have been amended to match is unconfirmed. Ask Health Facility Systems which rule text it enforces for medications and quality assurance committees.

Sources

1. 1
   Oklahoma Legislature, Oklahoma Statutes, Title 63 (Continuum of Care and Assisted Living Act, §§ 1-890.1 to 1-890.9; §§ 1-891, 1-1949.2, 1-1949.3, 1-1991) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Oklahoma State Department of Health, Oklahoma Administrative Code, Chapter 310:663 (Continuum of Care and Assisted Living) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Oklahoma State Department of Health, Health Facility Systems (fees, laws, rules and forms) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Oklahoma State Department of Health, Assisted Living Center or Continuum of Care Facility License Application (ODH Form 624, revised 3/05/2025) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Oklahoma State Department of Health, Long Term Care Programs in Oklahoma Checked 12 Oct 2026 · Back to text ↑
6. 6
   Oklahoma State Department of Health, Long Term Care Administrator Licensing Program Checked 12 Oct 2026 · Back to text ↑
7. 7
   Oklahoma Health Care Authority, OAC 317:30-5-761, ADvantage program eligible providers (revised 09-01-24) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Oklahoma Human Services, Assisted Living Service Option Checked 12 Oct 2026 · Back to text ↑

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