Rhode Island assisted living residence license: RIDOH levels, fees and steps

Six residents is the line

Rhode Island defines an assisted living residence as a publicly or privately run residence that provides personal assistance, lodging and meals to six or more adults who are not related to the licensee or the administrator. The residence can deliver the services itself or through contracts, and it may also offer limited health services.⁠¹⁠² “Personal assistance” means one or more of: help with activities of daily living, help with self-administration of medication (or administration by licensed staff), arranging health and support services, monitoring residents while they are on the premises, and recreational and social services.⁠¹

If you plan to serve two to five adults, this is the wrong license. That size falls under R.I. Gen. Laws chapter 23-17.24, the Adult Supportive Care Home law, and only an operator that already holds a RIDOH license (home nursing care provider, nursing facility, assisted living residence or adult day services provider) can open one. See the adult supportive care home guide. If you want daytime-only care, look at the adult day care program license.

Some settings fall outside chapter 23-17.4 entirely: facilities licensed by or under the jurisdiction of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), facilities under the Department of Children, Youth and Families, certain Christian Science institutions, and health care facilities such as nursing homes that are licensed under chapter 23-17.⁠²

You also cannot market your way around the license. No one may call a building an assisted living residence, or use “residential care” or a similar term in its name or advertising, without this license.⁠¹ Running an unlicensed residence, or operating after a suspension, revocation or curtailment order, carries a penalty of $1,000 for each day.⁠² Public agency employees may not refer anyone to an unlicensed residence and must report one if they know of it. The Department of Human Services also sends RIDOH a yearly list of every address where two or more Supplemental Security Income recipients live, which is how unlicensed group settings come to light.⁠²

Rhode Island’s certificate of need law covers hospitals, nursing facilities, hospice and some other providers. Home nursing care and home care providers were on that list until P.L. 2026, ch. 84 removed them on June 12, 2026 ⁠¹². The list of “healthcare facilities” does not include assisted living residences.⁠⁸

Who you can admit, and who you cannot keep

A Rhode Island assisted living resident is someone who does not need the medical or nursing care given in a health care facility, but who needs personal assistance, lodging and meals and may need medication administration or limited health services.⁠¹ The rule rules out three groups:

• people who need medical or skilled nursing care, including daily professional observation and evaluation;
• people who are bedbound;
• people who need more than one person to help them walk.⁠¹

There are three exceptions. First, a resident may receive daily skilled nursing or therapy from a licensed provider for up to 45 days for a temporary illness or injury, and the Department can approve more days. Second, residents on hospice may stay even if they become bedbound or need two-person assistance, but only in an F1 residence that holds the limited health services endorsement and treats stage I and II pressure ulcers.⁠¹ Third, RIDOH grants variances on its own form: six months for a resident with an in-dwelling Foley catheter and no signs of infection, and six-month hospice variances. A resident with a chronic non-pressure ulcer, such as a venous stasis ulcer, may also stay while there is no sign of infection.⁠¹⁠⁴

Residents must also be able to get out of the building on their own in an emergency, unless your building meets the stricter Life Safety Code that comes with F1 licensure.⁠¹⁠²

Your license is a combination of levels

You do not apply for a generic license. RIDOH licenses each residence, or each separately licensed area of a residence, at a fire level and a medication level, and the license itself states which areas may take which residents.⁠¹

The dementia trigger is broad. You need the dementia care level once one resident’s dementia causes elopement risk or other safety concerns, inappropriate social behavior that affects others, inability to self-preserve, or a physician’s recommendation for dementia support. You also need it as soon as you advertise dementia services or keep residents with dementia in a separate area.⁠¹⁠² A dementia unit needs:

• a registered nurse on site full-time (at least 35 hours a week) and available for consultation at all times;
• direct-care staff who are nursing assistants, LPNs or RNs (staff hired before January 1, 2015 are grandfathered);
• menus developed under a RIDOH-licensed nutritionist or dietitian;
• a secure, distinct living area;
• emergency power for exit lighting and for the detection, alarm and extinguishing systems.⁠¹

Limited health services are stage I and II pressure ulcer care, simple wound care (including postoperative suture care and stasis ulcers), ostomy care for established stomas, and urinary catheter care. A physician must order them and qualified licensed staff must deliver them. The residence needs a full-time RN (35 hours a week minimum), a physician, nurse practitioner or physician assistant on its quality improvement committee, and the same emergency power as a dementia unit. Residents must be told in writing that they can use a licensed home nursing care provider or hospice instead.⁠¹ The statute makes this endorsement optional.⁠² Under RIDOH’s application instructions, you can add services only once per annual licensing period, and you must give 30 days’ notice before you stop offering one.⁠⁵

Line up a licensed administrator early

The application asks for your administrator of record and that person’s Rhode Island assisted living administrator license number or Rhode Island nursing facility administrator license number. Without one, you cannot complete Section I.⁠⁵ The administrator runs the residence, staffs it, writes its policies and is responsible for compliance with fire, zoning, building, sanitation, food and disability laws.⁠¹

Under 216-RICR-40-05-18 (amended effective July 2, 2026), RIDOH certifies an assisted living residence administrator who is at least 18, of good moral character, and meets one of three training routes:⁠⁶

1. Approved program

   Complete a training program run by a Department-approved organization, pass the administrator licensing exam, and complete at least 80 hours of field experience within 12 months in a Rhode Island licensed assisted living residence.

2. Health care degree

   Hold a health care-related degree from an accredited school that included gerontology, personnel management and financial management, then complete the same 80-hour field experience and pass the exam.

3. Nursing home administrator

   Hold a current Rhode Island nursing home administrator license in good standing.

The field experience must cover administration, nursing, activities, admissions, dietary, and environment and maintenance. The supervising administrator signs an attestation at the end.⁠⁶ Applicants by endorsement must already be licensed by examination in a jurisdiction with substantially equivalent standards.⁠⁶ File the application at least 30 days before the Board meeting where you want it considered.⁠⁶ RIDOH runs its own criminal background check. The application form also asks for an original BCI check from the Attorney General’s office, transcripts and two letters of good moral character, and an application expires one year after RIDOH receives it.⁠⁶⁠⁷ The fee is $220, and renewal is another $220.⁠³

Certification lasts two years and expires on June 30 of the next even-numbered year. To renew, the administrator needs 32 hours of approved continuing education, at least 16 of them contact hours.⁠⁶ One licensed administrator may oversee no more than three residences with 120 residents in total. They must delegate authority before leaving the premises.⁠¹

The building: fire marshal first

The State Fire Marshal, not RIDOH, decides whether your building passes. The application requires:⁠⁵

• a State Fire Marshal Life Safety Code inspection report (for an initial license, a move or a bed increase);
• the local certificate of occupancy;
• Fire Marshal documentation of occupancy approval for each F1 and F2 area you list.

To admit residents who cannot evacuate on their own, you elect the stricter code and the Fire Marshal must approve it.⁠¹⁠² New construction, modifications, additions and room conversions must meet the Fire Safety Code, the State Building Code, ANSI A117.1-2009 and the ADA. Where they differ, the stricter standard applies.⁠¹ RIDOH may still license a residence with fire code deficiencies if the Fire Marshal accepts a plan of correction and the deficiencies do not endanger residents.⁠¹⁠²

Section 2.4.30 of the rule sets room standards:⁠¹

• Bedrooms: no more than two beds per room. Single rooms need at least 100 square feet and 8 feet of width; doubles need 160 square feet and 10 feet, not counting toilet rooms, closets or vestibules.
• Windows: every bedroom needs a window that opens easily, with the sill no higher than 3 feet and above ground level.
• Bathrooms: at least one bath per 10 beds and one toilet per 8 beds on each floor with resident rooms, unless rooms have their own.
• Heat and water: central heating that holds at least 70°F in the coldest weather. Hot water in resident areas must be between 100°F and 118°F.
• Common space: a dining and activity room large enough for all residents at once.
• Safety: master-keyed bedroom locks, bathroom doors that open from outside, no portable space heaters, and an accessible non-pay telephone.

You must run fire drills at least six times a year, every other month. At least two must happen at night while residents sleep, and at least half must be obstructed drills. Every drill must evacuate all residents to the assembly point.⁠¹ After licensure, the Fire Marshal inspects every year, and you file that report with each renewal.⁠¹

The kitchen is licensed separately

An initial application must include a license from RIDOH’s Office of Food Protection (401-222-2750) for operating the kitchen.⁠⁵ The rule requires three balanced meals a day, posted weekly menus, diets that fit residents’ medical needs, and compliance with the Rhode Island Food Code.⁠¹ If you prepare potentially hazardous foods, you need at least one full-time, on-site manager certified in food safety, and a certified manager must be present whenever hot potentially hazardous foods are prepared for the elderly. Residences licensed for 26 or more residents that have 10 or more full-time-equivalent food staff need two certified managers.⁠¹

What goes in the application packet

RIDOH uses a paper form, “Licensing Application and instructions for Assisted Living Residences” (Version 2.26). For an initial license you complete Sections I to III. Add Section IV for a dementia special care unit and Section V for limited health services.⁠⁵ You mail it to RIDOH at 3 Capitol Hill, Room 306, Providence, RI 02908-5097, with a check payable to “General Treasurer, State of Rhode Island.” Incomplete forms are sent back.⁠⁵ Application materials are public records.⁠⁵

The basic packet:⁠¹⁠⁵

• the residence name, administrator of record, and a facility-specific email address (the rule requires one for Department notices);
• ownership type, any parent organization, and the land and building owner if different from the operator;
• a notarized list of all direct and indirect owners with ownership percentages, including officers and directors for a corporation, updated at least every 12 months;
• total bed capacity, numbers of single and double bedrooms, F1 and F2 bed counts and locations, M1 or M2, and the services you provide yourself or by contract;
• the Fire Marshal report, Food Protection kitchen license and certificate of occupancy;
• your SSN or FEIN and a sworn statement that you have filed all Rhode Island tax returns and paid what is due.

A dementia special care unit adds your written disclosure, which covers eight topics including philosophy, staffing and training, environment and costs. It also needs your quality assurance plan, the names of the full-time RN and the licensed dietitian, an emergency power policy, and admission and discharge criteria.⁠¹⁠⁵ Limited health services adds:

• the written notice of residents’ right to use a home nursing care provider;
• a disclosure form;
• the Rhode Island physician who will direct your policies;
• the physician, NP or PA on the quality committee;
• the full-time RN;
• an emergency power policy and an infection prevention program;
• policies for each service.⁠⁵

Fees as published on 2026-10-12

Using those figures, a 20-bed residence with no endorsements pays $330 + (20 × $70) = $1,730 a year. The same residence with both endorsements pays $2,930. License fees are non-refundable.⁠¹

The order that works

1. Settle the size and the levels

   Count beds, decide F1 or F2 for each area, M1 or M2, and whether you will advertise or segregate dementia care. Those decisions shape the building, the staffing and the fee.⁠¹

2. Secure an administrator

   Hire a licensed administrator or start the 80-hour route. Board review needs a 30-day lead time.⁠⁶

3. Build or convert to code

   Meet the Fire Safety Code, State Building Code and ANSI A117.1, and get the certificate of occupancy.⁠¹⁠⁵

4. Get the Fire Marshal’s Life Safety Code report and the Office of Food Protection kitchen license

   ⁠⁵

5. Write the required policies

   Prepare the policy manual, admission and discharge criteria, quality improvement plan, disclosure statement, residency agreement and emergency plans (next sections).⁠¹

6. File the application with the fee and attachments

   RIDOH may inspect any premises for which it has received an application, without notice.⁠¹

7. License issued

   RIDOH issues the license when you meet the Act and the rule. It names the owner and operator, the levels, and the areas where each level applies, and you post it in a conspicuous place.⁠¹

RIDOH does not publish a processing time for assisted living applications. The rule says RIDOH issues the license once you meet the Act and the rule, and it may inspect any premises for which it has received an application, without notice.⁠¹ The sources do not say whether RIDOH always surveys a new residence before issuing an initial license, so ask the Center for Health Facilities Regulation ((401) 222-2566) whether to expect a survey and how long review is running.⁠⁵

Staffing, nurses and training

Rhode Island sets no numeric staff-to-resident ratio for basic assisted living. Staffing must be enough to give each resident the care their licensure level requires.⁠¹ It does set these fixed minimums:

• A responsible adult, at least 18, awake and on the premises at all times.⁠¹
• At least one staff member on the premises at all times who has completed the required employee training, and one person on site at all times with Heartsaver-level CPR from the American Heart Association, American Red Cross or National Safety Council.⁠¹
• A registered nurse visit at least every 30 days. The RN reviews medications, new orders, each resident’s health and placement, and leaves a signed report. If you have at least one full-time-equivalent RN on site (35 hours), the review is every 90 days.⁠¹
• A quality improvement committee that includes the administrator, an RN and a dietary representative. It meets at least quarterly and approves a written QI plan every 12 months.⁠¹

Training has fixed deadlines:⁠¹

• All new employees: at least 2 hours within 10 days of hire, before working alone. Topics include fire prevention, abuse and neglect reporting, residents’ rights, emergencies, infection control and elopement.
• Staff giving personal care: at least 10 more hours within 30 days, before working alone, covering sanitation, food service, dementia, personal assistance, medication assistance, body mechanics, record keeping and service plans. F1 residences add resident transfers.
• Dementia unit staff: 4 hours before working alone, then 12 hours of continuing education every 12 months.
• Limited health services staff: 4 hours before working alone with those residents, then 2 hours every 12 months.
• Everyone: in-service training at least every 12 months.

For M1 residences, a licensed nurse must evaluate each medication aide monthly for the first three months, then quarterly.⁠¹ Every employee hired after September 30, 2014 who has routine contact with residents or access to their belongings or funds needs a national fingerprint check through the Attorney General’s Bureau of Criminal Identification. The check must be processed before employment or within one week of it.⁠¹

Paperwork before the first move-in

The rule requires these steps for each admission:⁠¹

• Written disclosure before the admission decision. It must cover the owner and operator, your license levels and what they mean, admission and discharge criteria, services, all fees and deposits, and contact details for RIDOH, the Attorney General’s Medicaid Fraud and Patient Abuse Unit, the State Ombudsman and local police.
• An RN assessment before admission. An RN conducts and signs a comprehensive assessment on RIDOH’s Assisted Living Resident form, or on a form RIDOH has approved. You repeat it at least every 12 months and after any significant change.⁠¹⁠⁴
• A signed residency agreement before any money changes hands. It lists the unit, services, rates, extra charges, deposits, rate increase policy and discharge terms. Rate changes need 30 days’ written notice.
• A service plan within 7 days of move-in. The RN and/or the administrator write and sign it.

Your admission criteria must state that no qualified applicant will be refused because of source of income or source of payment, among other protected traits.⁠¹

Since January 30, 2025, R.I. Gen. Laws chapter 23-17.29 lets residents install electronic monitoring devices in their rooms with written consent from the resident and any roommate. RIDOH publishes the consent and withdrawal forms.⁠⁴

Inspections, deficiencies and renewal

RIDOH inspectors may enter at any time without notice, and refusing entry is grounds for suspension or revocation.⁠¹ After an inspection, RIDOH sends a notice of deficiencies within 15 days, and you have 15 days to return a plan of correction. You may request informal dispute resolution within 10 business days of a written finding, and RIDOH meets with you within 10 business days of the request.⁠¹

Every license expires on December 31 after it is issued and renews yearly, subject to inspection.⁠¹ Renewal goes through RIDOH’s online system and must include the year’s State Fire Marshal inspection documentation.⁠¹⁠⁴ Variances last no longer than the license and must be requested again with each renewal.⁠¹

A license cannot be transferred. When ownership changes, the old license becomes void. The new owner files a new application, and RIDOH can license without inspecting if nothing else changes. RIDOH can also extend the prior license for up to six weeks while it processes the application.⁠¹ Closing requires an immediate call to RIDOH, a meeting before residents are told, a closure plan, and at least 60 days’ notice to residents.⁠¹

How Medicaid pays for assisted living in Rhode Island

Medicaid long-term services and supports (LTSS) pay for assisted living through the Office of Healthy Aging Assisted Living Program, billed as per diem tiers: Tier A (basic/core), Tier B (enhanced) and Tier C (intensive/highly specialized). A resident needs Medicaid eligibility and an active OHA assisted living segment. A residence must be authorized after application before it can bill Tiers B and C, and EOHHS publishes the certification standards.⁠⁹ Providers enroll electronically through the EOHHS Healthcare Portal.⁠¹¹

Room and board is set separately from the service tiers. From January 1, 2026, the monthly room-and-board amount for LTSS assisted living participants with income below $2,982 (300% of the federal benefit rate) is $1,326. For residents with income below $1,326 the amount may be lower, and EOHHS encourages residences to help them apply for Category D.⁠¹⁰ Here is how referrals work:⁠¹⁰

• New Medicaid admissions start with a referral form emailed to DHS at [email protected], followed by an on-site functional assessment.
• Category D applications and questions about tier certification go to the EOHHS Office of Community Programs ([email protected]).
• For residents in PACE or the Neighborhood FIDE-SNP, you coordinate directly with that plan instead.

What changed recently

• July 2, 2026: RIDOH amended the administrator rule, 216-RICR-40-05-18, to update an organization’s name in the continuing education section. The qualification routes did not change.⁠⁶
• March 25, 2026: The current version of the fee rule took effect; it is the source of the assisted living fees shown above.⁠³
• January 1, 2026: The Medicaid room-and-board amount was reset to $1,326.⁠¹⁰
• January 30, 2025: The electronic monitoring law took effect for assisted living and nursing homes.⁠⁴
• March 18, 2024: The current version of the assisted living licensing rule took effect.⁠¹

If your plans expand to home-based services, Rhode Island licenses them separately, and both needed a certificate of need until June 12, 2026, when the FY2027 budget removed them from that law (RIDOH’s rule still describes the step): see the home care provider and home nursing care provider guides.⁠⁸

Sources

1. 1
   Rhode Island Department of State, 216-RICR-40-10-2, Licensing Assisted Living Residences (effective 03/18/2024) Checked 12 Oct 2026 · Back to text ↑
2. 2
   State of Rhode Island General Assembly, R.I. Gen. Laws chapter 23-17.4, Assisted Living Residence Licensing Act Checked 12 Oct 2026 · Back to text ↑
3. 3
   Rhode Island Department of State, 216-RICR-10-05-2, Fee Structure for Licensing, Laboratory and Administrative Services (effective 03/25/2026) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Rhode Island Department of Health, Assisted Living Checked 12 Oct 2026 · Back to text ↑
5. 5
   Rhode Island Department of Health, Licensing Application and Instructions: Assisted Living Residences, ALR Special Care Units, ALR Limited Health Services (Ver. 2.26) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Rhode Island Department of State, 216-RICR-40-05-18, Assisted Living Residence Administrators (effective 07/02/2026) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Rhode Island Department of Health, Assisted Living Residence Administrator application Checked 12 Oct 2026 · Back to text ↑
8. 8
   State of Rhode Island General Assembly, R.I. Gen. Laws § 23-15-2, Determination of need for new healthcare equipment and new institutional health services: definitions Checked 12 Oct 2026 · Back to text ↑
9. 9
   Rhode Island Executive Office of Health and Human Services, RI Medicaid Provider Reference Manual: Home and Community Based Services (V1.12, 12/2024) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Rhode Island Executive Office of Health and Human Services, Provider Update, Rhode Island Medicaid Program, February 2026 (Vol. 397) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Rhode Island Executive Office of Health and Human Services, Provider Enrollment Checked 12 Oct 2026 · Back to text ↑
12. 12
    State of Rhode Island General Assembly, P.L. 2026, ch. 84, Article 12 (Relating to Health Care), Sections 10 and 20 Checked 11 Nov 2026 · Back to text ↑

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