Licensing and Certification
Supervised Living Facility

This page contains information and forms required to operate as a licensed Supervised Living Facility in Minnesota. These forms are intended to be downloaded and completed by individuals and organizations seeking to be licensed as a Supervised Living Facility, or for licensees who need to renew a current license or request a change of ownership.

• Required Forms and Documents
• License Renewal
• Related Statutes and Rules
• Department of Human Services (DHS) Information on Supervised Living Facilities
• CMS Resources

Required Forms and Documents

• Application for a License to Operate a Supervised Living Facility (PDF): Complete and submit this form with payment to apply for an initial license, renew an existing license, or request a change of ownership.
• Example Form: Certificate of Liability Insurance (PDF): Providers are required to submit evidence of workers' compensation coverage with their application; this example shows how the form should be filled out.
• Transfer Agreement:
  • Metro Counties: Community-Wide Transfer Agreement between Hospitals and Related Health Facilities in the Minnesota Seven-County Metropolitan Area (PDF)
  • Non-Metro Counties: Transfer Agreement between a Hospital and a Related Health Facility in Minnesota (PDF)

License Renewal

Supervised Living Facility licenses are renewed annually. Licensees will receive a renewal notification approximately 60-90 days prior to the expiration date of the license. If you do not receive a renewal notification within 30 days of the expiration date, please contact Health.HRD-FedLCR@state.mn.us.

• Application for a License to Operate a Supervised Living Facility (PDF): Complete and submit this form with payment to renew an existing license.
• Example Form: Certificate of Liability Insurance (PDF): Providers are required to submit evidence of workers' compensation coverage with their application; this example shows how the form should be filled out.
• Transfer Agreement:
  • Metro Counties: Community-Wide Transfer Agreement between Hospitals and Related Health Facilities in the Minnesota Seven-County Metropolitan Area (PDF)
  • Non-Metro Counties: Transfer Agreement between a Hospital and a Related Health Facility in Minnesota (PDF)

The completed application, supporting documents, and fee payment can be mailed to:

Minnesota Department of Health
Health Regulation Division
P.O. Box 64900
St. Paul, MN 55164-0900

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Related Statutes and Rules

Read and understand all applicable statutes and rules listed below before submitting the application.

• Minnesota Statutes 144.651 - Health Care Bill of Rights
• Minnesota Statutes 144.652 - Bill of Rights Notice to Patients or Resident; Violation
• Minnesota Statutes 626.557 - Reporting of Maltreatment of Vulnerable Adults
• Minnesota Statutes 144.122 - License, Permit and Survey Fees
• Minnesota Statutes 144.50, Subd. 6. Supervised Living Facility licenses
• Minnesota Rules, Chapter 4665 - Supervised Living Facilities

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Department of Human Services (DHS) Information on Supervised Living Facilities

The Minnesota Department of Human Services (DHS) provides licensure for various treatment and rehabilitation programs. Additional information can be found at the links below.

• Substance Use Disorder Treatment
• Residential Adult Mental Health Programs
• Intermediate Care Facilities (ICF/DDs)
• Enrollment with Minnesota Health Care Programs (MHCP)

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CMS Resources

The Centers for Medicare and Medicaid Services (CMS) provides the following resources:

• Quality, Safety and Oversight - General Information (cms.gov)
• 100-07 Medicare State Operations Manual (cms.gov)

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