Assisted Living Residences

C.R.S. tit. 25, art. 27
in effect

C.R.S. § 25-27-101 Legislative declaration

25-27-101. Legislative declaration. (1) In order to promote the public health and welfare of the people of Colorado, it is declared to be in the public interest to establish minimum standards and rules for assisted living residences in the state of Colorado and to provide the authority for the administration and enforcement of such minimum standards and rules. These standards and rules shall be sufficient to assure the health, safety, and welfare of assisted living residents. (2) The general assembly further finds that the department of public health and environment, as the executive branch agency assigned to administer and enforce minimum standards for assisted living residences, is in a position to provide technical assistance, educational materials, and training information to residences. The general assembly determines that a proactive approach by the department, acting as a mentor and educator for residences, will enhance the quality of care of residents of assisted living residences. Additionally, the general assembly finds that the department should explore whether risk-based inspections may be implemented to allocate resources more effectively and at the same time adequately protect the health and safety of the residents. (3) Further, the general assembly determines and declares that, in administering and enforcing standards for assisted living residences, the department of public health and environment should focus on the outcome related to measures and treatment of residents.

C.R.S. § 25-27-102 Definitions

25-27-102. Definitions. As used in this article 27, unless the context otherwise requires: (1) Repealed. (1.3) "Assisted living residence" or "residence" means a residential facility that makes available to three or more adults not related to the owner of such facility, either directly or indirectly through an agreement with the resident, room and board and at least the following services: Personal services; protective oversight; social care due to impaired capacity to live independently; and regular supervision that shall be available on a twenty-four-hour basis, but not to the extent that regular twenty-four-hour medical or nursing care is required. The term "assisted living residence" does not include any facility licensed in this state as a residential care facility for individuals with developmental disabilities, or any individual residential support services that are excluded from licensure requirements pursuant to rules adopted by the department of public health and environment. (2) "Department" means the department of public health and environment of the state of Colorado. (2.5) [Editor's note: Subsection (2.5) is effective January 1, 2025.] "Direct care worker" means an employee who provides hands-on care, services, and support to residents of an assisted living residence. (2.7) [Editor's note: Subsection (2.7) is effective January 1, 2025.] "Fit test" means a test protocol conducted to verify that a respirator or mask is both comfortable and provides the wearer with the expected protection. (3) to (5) Repealed. (6) "Local board of health" means any county, district, or municipal board of health. (6.5) "Local ombudsman" has the same meaning as set forth in section 26-11.5-103 (2). (7) Repealed. (8) (Deleted by amendment, L. 2002, p. 1317, § 2, effective July 1, 2002.) (9) "Personal services" means those services that the operator and employees of an assisted living residence provide for each resident, including, but not limited to: (a) An environment that is sanitary and safe from physical harm; (b) Individualized social supervision; (c) Assistance with transportation; and (d) Assistance with activities of daily living, including but not limited to bathing, dressing, and eating. (9.3) [Editor's note: Subsection (9.3) is effective January 1, 2025.] "Portable test" means the following tests for which, when successfully completed by an individual, the individual is provided a certification of completion that may be transferred from one assisted living residence to another in accordance with this section: (a) A fit test; and (b) A tuberculosis test. (9.5) [Editor's note: Subsection (9.5) is effective January 1, 2025.] "Portable training" means the following training for which, when successfully completed by an individual, the individual is provided a certification of completion that may be transferred from one assisted living residence to another in accordance with this section: (a) Hand hygiene and infection control; (b) Basic first aid; (c) Resident rights; (d) Person-centered care; (e) Fall prevention; (f) Lift assistance; and (g) Food safety. (10) "Protective oversight" means guidance of a resident as required by the needs of the resident or as reasonably requested by the resident, including the following: (a) Being aware of a resident's general whereabouts, although the resident may travel independently in the community; and Resident rights; (d) Person-centered care; (e) Fall prevention; (f) Lift assistance; and (g) Food safety. (10) "Protective oversight" means guidance of a resident as required by the needs of the resident or as reasonably requested by the resident, including the following: (a) Being aware of a resident's general whereabouts, although the resident may travel independently in the community; and (b) Monitoring the activities of the resident while on the premises to ensure the resident's health, safety, and well-being, including monitoring the resident's needs and ensuring that the resident receives the services and care necessary to protect the resident's health, safety, and well-being. (10.5) [Editor's note: Subsection (10.5) is effective January 1, 2025.] "Qualified medication administration personnel" means an individual who has passed a competency evaluation administered by an approved training entity on or after July 1, 2017, and whose name appears on the department's list of individuals who have passed the requisite competency evaluation. (11) "State board" means the state board of health. (12) "State long-term care ombudsman" has the same meaning as set forth in section 26-11.5-103 (7).

C.R.S. § 25-27-103 License required - criminal and civil penalties

25-27-103. License required - criminal and civil penalties. (1) On or after July 1, 2002, it is unlawful for any person, partnership, association, or corporation to conduct or maintain an assisted living residence without having obtained a license therefor from the department of public health and environment. Any person who violates this provision: (a) Commits a civil infraction; (b) May be subject to a civil penalty assessed by the department of not less than fifty dollars nor more than one hundred dollars for each day the residence violates this section. The assessed penalty shall accrue from the date the residence is found by the department to be in violation of this section. The assessment, enforcement, and collection of the penalty shall be by the department in accordance with article 4 of title 24, C.R.S., for credit to the assisted living residence cash fund created pursuant to section 25-27-107.5. Enforcement and collection of the penalty shall occur following the decision reached in accordance with procedures set forth in section 24-4-105, C.R.S.

C.R.S. § 25-27-104 Minimum standards for assisted living residences - rules

25-27-104. Minimum standards for assisted living residences - rules. (1) On or before November 1, 2002, the state board shall promulgate rules pursuant to section 24-4-103, C.R.S., providing minimum standards for the location, sanitation, fire safety, adequacy of facilities, adequacy of diet and nutrition, equipment, structure, operation, provision of personal services and protective oversight, and personnel practices of assisted living residences within the state of Colorado. Such rules shall differentiate between homes of different sizes. In formulating such rules, the state board shall seek recommendations from the advisory committee established pursuant to section 25-27-110. (2) State board rules promulgated pursuant to subsection (1) of this section must include, at a minimum, rules requiring the following: (a) Compliance with all applicable zoning, housing, fire, sanitary, and other codes and ordinances of the city, city and county, or county where the residence is situated, to the extent that such codes and ordinances are consistent with the federal "Fair Housing Amendments Act of 1988", as amended, 42 U.S.C. sec. 3601 et seq.; (b) Annual inspection of assisted living residences by the department or its designated representative; (c) That the premises to be used are in fit, safe, and sanitary condition and properly equipped to provide good care to the residents; (d) That the Colorado long-term care ombudsman, designated by the department of human services, have access to the premises and residents during reasonable hours for the purposes set out in the federal "Older Americans Act of 1965"; (e) Protection of the individual rights of residents either through a written board and care plan or by means of contracts executed with the residents, which board and care plan or contract shall meet the requirements stated in section 25-27-104.5; (f) Responsibility of the assisted living residences for social supervision, personal services, and coordination with community resources as needed by the residents; (g) That the administrator and staff of a residence: (I) (A) Meet minimum educational, training, and experience standards established by the state board. (B) On and after January 1, 2024, the state board's minimum standards for administrators must require, at a minimum, that each administrator, regardless of the administrator's hire date, have at least one year experience supervising the delivery of personal care services that includes activities of daily living or has attained the education or experience established by the state board in lieu of that supervisory experience. (II) Are of good, moral, and responsible character. In making the determination, the owner or licensee of a residence shall have access to and shall obtain any criminal history record information from a criminal justice agency, subject to any restrictions imposed by the agency for any person responsible for the care and welfare of residents of the residence and shall obtain a check of the Colorado adult protective services data system pursuant to section 26-3.1-111 for any person who is an employee of the residence, as defined in section 26-3.1-111 (2), who will provide direct care to residents. (h) Intermediate enforcement remedies as authorized by section 25-27-106 (2); (i) Written plans, to be submitted by residences to the department for approval, detailing the measures that will be taken to correct violations found as a result of inspections; (j) The definition for high medicaid utilization facility as a basis for a modified fee schedule. A high medicaid utilization residence shall be a residence in which no less than thirty-five percent of the available beds are occupied by medicaid enrollees as indicated by the most complete claims data available. he measures that will be taken to correct violations found as a result of inspections; (j) The definition for high medicaid utilization facility as a basis for a modified fee schedule. A high medicaid utilization residence shall be a residence in which no less than thirty-five percent of the available beds are occupied by medicaid enrollees as indicated by the most complete claims data available. (k) A modified fee schedule for residences that serve a disproportionate share of low-income residents. The board may adopt a standard for determining residences that serve a disproportionate share of low-income residents. Such standard may require a residence to submit documentation determined appropriate by the department for verification. (l) That the assisted living residence comply with the provisions of section 25-27-104.3 concerning the involuntary discharge of residents; and (m) That the state board establish, not later than January 1, 2024, a range of fines for violations, which amounts may vary based on the size of the assisted living residence and the potential for harm to one or more persons, and shall permit the department to consider factors set forth in section 25-27-106 (4) in determining the amount of the fine. Prior to the board's adoption of rules concerning the range of fines for violations, the department shall make recommendations to the board, including a proposed schedule of fines that vary the range of fines by the severity and frequency of the violations and that may include a different range of fines based on the size of the residence. The department shall first present the recommendations to and seek feedback from the advisory committee established in section 25-27-110.

C.R.S. § 25-27-104.3 Involuntary discharge - notice - grievance process - appeal - hearing - rules - definition

25-27-104.3. Involuntary discharge - notice - grievance process - appeal - hearing - rules - definition. (1) (a) (I) Except as provided in subsection (1)(c) of this section, an assisted living residence shall provide written notice of any involuntary discharge of a resident at least thirty calendar days in advance of the discharge to: (A) The resident; (B) The resident's legal representative; and (C) Any relative or other person listed as a contact person for the resident or designated to receive notice of a discharge. (II) Within five days after providing written notice to the resident, the residence shall send the discharge notice to the state long-term care ombudsman and the local ombudsman. (b) (I) At a minimum, the notice of discharge must include a detailed explanation of the reason or reasons for the involuntary discharge, including: (A) Facts and evidence supporting each reason given by the residence; (B) A recounting of events leading to the involuntary discharge, including interactions with the resident over a period of time prior to the notice, and actions taken to avoid discharge and the timing of those actions; (C) A statement that the resident or a person listed in subsection (1)(a)(I) of this section has the right to file a grievance with the residence challenging the involuntary discharge within fourteen days after the written notice, that the residence's designee must provide a response to the grievance within five business days after receiving the grievance, and, if the resident or person filing the grievance is dissatisfied with the response, that the resident or person filing the grievance may appeal to the executive director of the department or the executive director's designee pursuant to subsection (3) of this section; and (D) Names and contact information, including telephone numbers, addresses, and e-mail addresses, for the state long-term care ombudsman, the local ombudsman, and the department. (II) If the residence's involuntary discharge of the resident is due to a medical or physical condition resulting in a required level of care that cannot be treated with medication or services routinely provided by the residence's staff or an external service provider, the notice must also include an assessment by the resident's physician or applicable health-care or behavioral health provider of the resident's current needs in relation to the resident's medical and physical condition. (c) If the stated reason for the involuntary discharge is because the resident requires a level of care that cannot be met by the residence or the resident has demonstrated that the resident is a danger to the resident or others, thirty days' notice is not required. However, the residence shall give as much advance notice as is reasonable under the circumstances prior to the resident's removal from the residence. The residence must still provide written notice of the involuntary discharge pursuant to subsection (1)(b) of this section as soon as possible to the resident, other persons listed in subsection (1)(a)(I) of this section, and the state long-term care ombudsman and the local ombudsman. Notwithstanding the resident's removal from the residence pursuant to this subsection (1)(c), the resident may file a grievance relating to the involuntary discharge within fourteen days after the resident's receipt of the written notice of involuntary discharge required pursuant to subsection (1)(b) of this section. of this section, and the state long-term care ombudsman and the local ombudsman. Notwithstanding the resident's removal from the residence pursuant to this subsection (1)(c), the resident may file a grievance relating to the involuntary discharge within fourteen days after the resident's receipt of the written notice of involuntary discharge required pursuant to subsection (1)(b) of this section. (2) (a) (I) Each assisted living residence shall designate an individual to receive grievances, pursuant to subsection (2)(a)(II) of this section, relating to the involuntary discharge of a resident. (II) A resident or any person listed in subsection (1)(a)(I) of this section may file a grievance with the designee within fourteen days after written notice is given to the resident pursuant to subsection (1)(b) or (1)(c) of this section challenging the involuntary discharge of the resident and the reasons for the discharge. (III) A resident or a person listed in subsection (1)(a)(I) of this section filing a grievance shall submit the grievance in writing, cause it to be written, or state it orally to the designee, with the person filing the grievance providing some evidence of the oral submission of the grievance or a witness attesting to the oral submission. (b) No later than five business days after a grievance has been submitted pursuant to subsection (2)(a) of this section, the designee shall provide a written response to the grievance to the resident, the persons listed in subsection (1)(a)(I) of this section, and the state long-term care ombudsman and the local ombudsman. The designee's written response must be accompanied by an oral explanation to the resident or person filing the grievance if appropriate because of the mental or physical condition of the resident or person filing the grievance. (c) The state long-term care ombudsman or the local ombudsman may provide assistance to a resident or person filing a grievance in investigating, preparing, and filing the grievance pursuant to this subsection (2) or investigating, preparing, and filing an appeal of the designee's response to the grievance pursuant to subsection (3) of this section. (3) If the resident or person filing the grievance is dissatisfied with the designee's written response, the resident or the person filing the grievance may appeal to the department for review of the designee's response to the grievance by filing the same grievance, the original notice and supporting documentation given to the resident pursuant to subsection (1)(b) or (1)(c) of this section, and the designee's written response pursuant to subsection (2)(b) of this section, including supporting documentation, along with any additional information or documentation, to the executive director of the department for the department's review. An appeal to the executive director of the department must be filed within five business days after the resident or person filing the grievance receives the designee's written response. The department shall review the grievance and response as soon as possible, but no later than sixty days after receiving the appeal, to determine whether the involuntary discharge complies with the law and the process established in this section. The department may confer with or receive information from the resident, the residence, and the state long-term care ombudsman and the local ombudsman concerning the involuntary discharge. (4) (a) The assisted living residence shall not take any punitive or retaliatory action against a resident due to the resident filing a grievance or appeal pursuant to this section and shall continue to assist with planning a discharge or transfer of the resident while the grievance or appeal to the department is pending. are ombudsman and the local ombudsman concerning the involuntary discharge. (4) (a) The assisted living residence shall not take any punitive or retaliatory action against a resident due to the resident filing a grievance or appeal pursuant to this section and shall continue to assist with planning a discharge or transfer of the resident while the grievance or appeal to the department is pending. (b) If the stated reason for the involuntary discharge is for nonpayment of monthly services or room and board, the residence may discharge the resident on the thirty-first day after the written notice of discharge has been provided to the resident. If it is determined through the grievance and appeal process that the resident substantially complied with payments due to the residence, the residence shall allow the resident to return to the residence. (5) If the resident, the person filing the grievance or the appeal, or the assisted living residence is dissatisfied with the findings and recommendations of the department, that resident, person, or residence may request a hearing conducted by the department pursuant to section 24-4-105. (6) (a) No later than January 1, 2024, the state board shall promulgate rules necessary to implement the grievance process set forth in this section. (b) Prior to the board's adoption of rules for the implementation of the grievance process, the department shall confer with the advisory committee established in section 25-27-110 for the purpose of making recommendations to the board concerning rules relating to the grievance process. (7) As used in this section, "designee" means the individual designated by the assisted living residence to receive grievances relating to an involuntary discharge of a resident pursuant to subsection (2)(a)(I) of this section.

C.R.S. § 25-27-104.5 Requirements governing forfeiture of security deposits and rent

25-27-104.5. Requirements governing forfeiture of security deposits and rent. If a lease provision in a resident care plan or in a contract signed by a resident of an assisted living residence results in or requires forfeiture of more than thirty days of rent if a resident moves due to a medical condition or dies during the term of the plan, then the plan shall be deemed to be against public policy and shall be void; except that inclusion of such a provision shall not render the remainder of the plan or contract void. A lease provision in a written board and care plan or in a contract that requires forfeiture of rent for thirty days after the resident moves due to a medical condition or dies does not violate this section. The provisions regarding forfeiture of rent shall appear on the front page of the plan or contract and shall be printed in no less than twelve-point bold-faced type. The provisions shall read as follows: This lease agreement is for a month-to-month tenancy. The lessor shall not require the forfeiture of rent beyond a thirty-day period if the lessee moves due to a medical condition or dies during the term of the lease. In circumstances in which the resident moves due to a medical condition or dies during the term of a plan or contract, the assisted living residence shall return that part of rent paid in excess of thirty days' rent after a patient moves or dies to the resident or the resident's estate. The assisted living residence may assess daily rental charges for any days in which the former or deceased resident's personal possessions remain in the resident's room after the time period for which the resident has paid rent and for the usual time to clean the room after the resident's personal possessions have been removed. For purposes of this section, "daily rental charges" means an amount not to exceed one-thirtieth of thirty days' rental amount plus reasonable expenses.

C.R.S. § 25-27-105 License - application - inspection - issuance

25-27-105. License - application - inspection - issuance. (1) An application for a license to operate an assisted living residence shall be submitted to the department annually upon such form and in such manner as prescribed by the department. (2) The department shall investigate and pass on each original application and each renewal application for a license. The department shall inspect or cause to be inspected the residences to be operated by an applicant for an original license before the license is granted and shall annually thereafter inspect or cause to be inspected the residences of all licensees. The department shall make such other inspections as it deems necessary to insure that the health, safety, and welfare of the residents are being protected. The residence shall submit in writing, in a form prescribed by the department, a plan detailing the measures that will be taken to correct any violations found by the department as a result of inspections undertaken pursuant to this subsection (2). (2.5) (a) On July 1, 2002, as part of an original application and on and after July 1, 2002, on the first renewal of an application for assisted living residences licensed before July 1, 2002, for a license, an owner, applicant, or licensee shall request from a criminal justice agency designated by the department criminal history record information regarding such owner, applicant, or licensee. The information, upon such request and subject to any restrictions imposed by such agency, shall be forwarded by the criminal justice agency directly to the department. (a.5) On and after July 1, 2002, the department may require that an administrator request from a criminal justice agency designated by the department a criminal history record on such administrator. The information, upon such request and subject to any restrictions imposed by such agency, shall be forwarded by the criminal justice agency directly to the department. (a.7) When the results of a fingerprint-based criminal history record check of an applicant performed pursuant to this section reveal a record of arrest without a disposition, the department shall require that applicant to submit to a name-based judicial record check, as defined in section 22-2-119.3 (6)(d). (b) The information shall be used by the department in ascertaining whether the person applying for licensure has been convicted of a felony or of a misdemeanor, which felony or misdemeanor involves moral turpitude or involves conduct that the department determines could pose a risk to the health, safety, and welfare of residents of the assisted living residence. Information obtained in accordance with this section shall be maintained by the department. (c) All costs of obtaining any information from a criminal justice agency pursuant to this section shall be borne by the individual who is the subject of such check. (2.8) No license shall be issued or renewed by the department if the owner, applicant, or licensee of the assisted living residence has been convicted of a felony or of a misdemeanor, which felony or misdemeanor involves moral turpitude or involves conduct that the department determines could pose a risk to the health, safety, and welfare of the residents of the assisted living residence. (3) Except as otherwise provided in subsection (4) of this section, the department shall issue or renew a license when it is satisfied that the applicant or licensee is in compliance with the requirements set out in this article and the rules promulgated thereunder. Except for provisional licenses issued in accordance with subsection (4) of this section, a license issued or renewed pursuant to this section shall expire one year from the date of issuance or renewal. he department shall issue or renew a license when it is satisfied that the applicant or licensee is in compliance with the requirements set out in this article and the rules promulgated thereunder. Except for provisional licenses issued in accordance with subsection (4) of this section, a license issued or renewed pursuant to this section shall expire one year from the date of issuance or renewal. (4) The department may issue a provisional license to an applicant for the purpose of operating an assisted living residence for a period of ninety days if the applicant is temporarily unable to conform to all the minimum standards required under this article; except that no license shall be issued to an applicant if the operation of the applicant's residence will adversely affect the health, safety, and welfare of the residents of such residence. As a condition of obtaining a provisional license, the applicant shall show proof to the department that attempts are being made to conform and comply with applicable standards. No provisional license shall be granted prior to the submission of a criminal background check in accordance with subsection (2.5) of this section. A provisional license shall not be renewed.

C.R.S. § 25-27-105.5 Compliance with local government zoning regulations - notice to local governments - provisional licensure

25-27-105.5. Compliance with local government zoning regulations - notice to local governments - provisional licensure. (1) The department shall require any assisted living residence seeking licensure pursuant to this article to comply with any applicable zoning regulations of the municipality, city and county, or county where the residence is situated. Failure to comply with applicable zoning regulations shall constitute grounds for the denial of a license to a residence; except that nothing in this section shall be construed to supersede the provisions of sections 30-28-115 (2), 31-23-301 (4), and 31-23-303 (2), C.R.S. (2) The department shall assure that timely written notice is provided to the municipality, city and county, or county where an assisted living residence is situated, including the address of the residence and the population and number of persons to be served by the residence, when any of the following occurs: (a) An application for a license to operate an assisted living residence pursuant to section 25-27-105 is made; (b) A license is granted to an assisted living residence pursuant to section 25-27-105; (c) A change in the license of an assisted living residence occurs; or (d) The license of an assisted living residence is revoked or otherwise terminated for any reason. (3) Notwithstanding the provisions of section 25-27-105 (4), in the event of a zoning or other delay or dispute between an assisted living residence and the municipality, city and county, or county where the residence is situated, the department may grant a provisional license to the residence for up to one hundred twenty days pending resolution of the delay or dispute.

C.R.S. § 25-27-106 License denial, suspension, or revocation

25-27-106. License denial, suspension, or revocation. (1) When an application for an original license has been denied by the department, the department shall notify the applicant in writing of such denial by mailing a notice to the applicant at the address shown on his or her application. Any applicant believing himself or herself aggrieved by such denial may pursue the remedy for review provided in article 4 of title 24, C.R.S., if the applicant, within thirty days after receiving such notice, petitions the department to set a date and place for hearing, affording the applicant an opportunity to be heard in person or by counsel. All hearings on the denial of original licenses shall be conducted in conformity with the provisions and procedures specified in article 4 of title 24, C.R.S. (2) (a) The department may suspend, revoke, or refuse to renew the license of any residence that is out of compliance with the requirements of this article or the rules promulgated thereunder. Such suspension, revocation, or refusal shall be done after a hearing thereon and in conformance with the provisions and procedures specified in article 4 of title 24, C.R.S. (b) (I) The department may impose intermediate restrictions or conditions on a licensee that may include at least one of the following: (A) Retaining a consultant to address corrective measures; (B) Monitoring by the department for a specific period; (C) Providing additional training to employees, owners, or operators of the residence; (D) Complying with a directed written plan, to correct the violation; or (E) Paying a civil fine not to exceed ten thousand dollars per violation; except that the department may exceed the cap for an egregious violation that results in death or serious injury to a resident after considering the circumstances surrounding the violation and the factors set forth in subsection (4)(a) of this section. (II) (A) If the department imposes an intermediate restriction or condition that is not a result of a life-threatening situation or due to serious injury or harm to a resident, the licensee shall receive written notice of the restriction or condition. No later than ten days after the date the notice is received from the department, the licensee shall submit a written plan that includes the time frame for completing the plan and addresses the restriction or condition specified. (B) If the department imposes an intermediate restriction or condition that is the result of a life-threatening situation or is due to serious injury or harm to a resident, the department shall notify the licensee in writing, by telephone, or in person during an on-site visit. The licensee shall implement the restriction or condition immediately upon receiving notice of the restriction or condition. If the department provides notice of a restriction or condition by telephone or in person, the department shall send written confirmation of the restriction or condition to the licensee within two business days. (III) (A) After submission of an approved written plan, a licensee may first appeal any intermediate restriction or condition on its license to the department through an informal review process as established by the department. (B) If the restriction or condition requires payment of a civil fine pursuant to this paragraph (b), the licensee may request that the informal review be conducted in person. In addition, the licensee may request and the department shall grant a stay in payment of the fine until final disposition of the restriction or condition. (C) In the event a licensee is not satisfied with the result of the informal review or chooses not to seek informal review, no intermediate restriction or condition on the licensee shall be imposed until after an opportunity for a hearing has been afforded the licensee pursuant to section 24-4-105, C.R.S. grant a stay in payment of the fine until final disposition of the restriction or condition. (C) In the event a licensee is not satisfied with the result of the informal review or chooses not to seek informal review, no intermediate restriction or condition on the licensee shall be imposed until after an opportunity for a hearing has been afforded the licensee pursuant to section 24-4-105, C.R.S. (IV) (A) In the event that the department assesses a civil fine pursuant to this paragraph (b), moneys received by the department shall be transmitted to the state treasurer, who shall credit the same to the assisted living residence improvement cash fund, which fund is hereby created. (B) The general assembly shall make annual appropriations from the assisted living residence improvement cash fund for expenditures of the department pursuant to subparagraph (V) of this paragraph (b). (C) Notwithstanding any provision of section 24-36-114, C.R.S., to the contrary, all interest derived from the deposit and investment of moneys from the assisted living residence improvement cash fund created in sub-subparagraph (A) of this subparagraph (IV) shall remain in the assisted living residence improvement cash fund. (V) Civil fines collected pursuant to this paragraph (b) shall be used for expenses related to: (A) Continuing monitoring required pursuant to this paragraph (b); (B) Education for licensees to avoid restrictions or conditions or facilitate the application process or the change of ownership process; (C) Education for residents and their families about resolving problems with a residence, rights of residents, and responsibilities of residences; (D) Providing technical assistance to any residence for the purpose of complying with changes in rules or state or federal law; (E) Relocating residents to other facilities or residences; (F) Maintaining the operation of a residence pending correction of violations, as determined necessary by the department; (G) Closing a residence; or (H) Reimbursing residents for personal funds lost, as determined necessary by the department. (3) The department shall revoke or refuse to renew the license of a facility where the owner or licensee has been convicted of a felony or misdemeanor involving moral turpitude or involving conduct which the department determines could pose a risk to the health, safety, and welfare of the residents of such facility. Such revocation or refusal shall be made only after a hearing is provided in accordance with article 4 of title 24, C.R.S. (4) (a) (I) Notwithstanding the department's discretion pursuant to subsection (2)(b)(I) of this section concerning the imposition of intermediate restrictions or conditions on a licensee, the department shall impose a fine, in an amount per violation that is calculated to deter further violations, for any violation resulting in actual harm or injury to a resident. Consistent with state board rules pursuant to section 25-27-104 (2), the amount of the fine may vary depending on the size of the residence, the potential for harm or injury to one or more residents, and whether there is a pattern of potential or actual harm or injury to residents. (II) In determining the amount of a fine, the department shall consider: (A) The history of harm or injury at the residence; (B) The number of injuries to residents for which the cause of the injury is unknown; (C) The adequacy of the residence's occurrence investigations and reporting; (D) The adequacy of the administrator's supervision of employees to ensure employees are keeping residents safe from harm or injury; and (E) The residence's compliance with required mandatory reporting of the mistreatment of residents. B) The number of injuries to residents for which the cause of the injury is unknown; (C) The adequacy of the residence's occurrence investigations and reporting; (D) The adequacy of the administrator's supervision of employees to ensure employees are keeping residents safe from harm or injury; and (E) The residence's compliance with required mandatory reporting of the mistreatment of residents. (b) Notwithstanding the department's discretion pursuant to subsection (2)(b)(I) of this section, the department shall impose a fine, in an amount determined by the department, for any residence that is found to be without an administrator, or an interim administrator, as defined by the state board by rule, on or after January 1, 2024, who meets the requirements established by the state board pursuant to section 25-27-104 (2)(g)(I)(B). (5) Except as provided in subsection (2)(b)(III) of this section, the department may suspend, revoke, or refuse to renew the license of a residence if: (a) A resident is subject to mistreatment, as defined in section 26-3.1-101 (7), that causes injury to the resident; (b) The residence's owner or administrator directly caused the mistreatment or the mistreatment resulted from the administrator's failure to adequately train or supervise employees; and (c) A directed written plan required by the department pursuant to subsection (2)(b)(I)(D) of this section to correct the violation, in addition to the assessment of civil fines, has not corrected or is not reasonably expected to correct the violations. (6) On and after January 1, 2024, the department may refuse to renew the license of a residence if the residence's administrator does not meet the requirements established by the state board pursuant to section 25-27-104 (2)(g)(I)(B).

C.R.S. § 25-27-107 License fees - rules

25-27-107. License fees - rules. (1) Repealed. (1.5) (a) No later than January 1, 2009, the state board shall promulgate rules establishing a schedule of fees sufficient to meet the direct and indirect costs of administration and enforcement of this article 27. The rules shall set a lower fee for facilities with a high medicaid utilization rate as defined by the state board. The rules shall be adopted in accordance with article 4 of title 24. On or after August 1, 2019, but before July 1, 2025, fees established pursuant to this section are subject to the limitations specified in section 25-3-105 (1)(a)(I)(B). The state board may increase a fee on the schedule established pursuant to this section that is in effect on August 1, 2019, only in accordance with section 25-3-105 (1)(a)(I). (b) Prior to setting a fee by rule pursuant to this subsection (1.5), the department shall hold public stakeholder meetings on behalf of the state board to discuss issues pertaining to setting fees, including, without limitation, a phased-in fee schedule based upon expected licensing program costs, maximum yearly fee increases, risk-based assessments, and technical assistance that may be met by or in collaboration with the private sector. (c) The department shall assess and collect, from assisted living residences subject to licensure, fees in accordance with the fee schedule established by the state board. (d) (Deleted by amendment, L. 2010, (HB 10-1422), ch. 419, p. 2108, § 133, effective August 11, 2010.) (1.7) For state fiscal year 2025-26 and each state fiscal year thereafter, the schedule of fees adopted by the state board pursuant to section 25-3-105 (1)(a)(I)(A) must be updated and published by March 1 of the year that the fees will take effect. The fees are not subject to rule-making by the state board. The fees must increase: (a) For state fiscal year 2025-26, eight percent from the fees on the schedule of fees established pursuant to subsection (1.5)(a) of this section; (b) For each of state fiscal years 2026-27, 2027-28, and 2028-29, six percent; and (c) For state fiscal year 2029-30 and for each state fiscal year thereafter, an amount that is equal to the annual percentage change in the United States department of labor's bureau of labor statistics consumer price index, or a successor index, for Denver-Aurora-Lakewood for all items paid by urban consumers. (2) The fees collected pursuant to this section shall be transmitted to the state treasurer, who shall credit the same to the assisted living residence cash fund created in section 25-27-107.5. (3) Notwithstanding the amount specified for any fee in this section, the state board by rule or as otherwise provided by law may reduce the amount of one or more of the fees if necessary pursuant to section 24-75-402 (3), C.R.S., to reduce the uncommitted reserves of the fund to which all or any portion of one or more of the fees is credited. After the uncommitted reserves of the fund are sufficiently reduced, the state board by rule or as otherwise provided by law may increase the amount of one or more of the fees as provided in section 24-75-402 (4), C.R.S. (4) Fees collected pursuant to subsection (1.5) of this section shall be used by the department, in addition to regulatory and administrative functions, to provide technical assistance and education to assisted living residences related to compliance with Colorado law. The department may contract with private entities to assist the department in providing such technical assistance and education.

C.R.S. § 25-27-107.5 Assisted living residence cash fund created

25-27-107.5. Assisted living residence cash fund created. (1) The fees collected pursuant to section 25-27-107, plus any civil penalty collected pursuant to section 25-27-103 (1)(b), shall be transmitted to the state treasurer, who shall credit the same to the assisted living residence cash fund, which fund is hereby created. The moneys in the fund shall be subject to annual appropriation by the general assembly for the direct and indirect costs of the department in performing its duties under this article. Notwithstanding subsection (2) of this section, at the end of any fiscal year, all unexpended and unencumbered moneys in the fund shall remain therein and shall not be credited or transferred to the general fund or any other fund. (2) Notwithstanding subsection (1) of this section, on July 1, 2013, any moneys remaining in the fund from fees collected by the department for assisted living residence building and structure code plan reviews and inspections are transferred to the health facility construction and inspection cash fund created in section 24-33.5-1207.8, C.R.S.

C.R.S. § 25-27-108 Enforcement - ability to contract

25-27-108. Enforcement - ability to contract. (1) The department is responsible for the enforcement of the provisions of this article and the regulations adopted thereunder. (2) The department may contract with a local board of health to investigate and inspect the facilities to be licensed under this article and may accept reports on such investigations or inspections as a basis for licensing. The department may also contract with local boards of health to enforce the provisions of this article and the regulations adopted thereunder and is required to transfer license fees and additional fees collected in this article to the local boards of health if a contract is so negotiated.

C.R.S. § 25-27-109 List of licensed residences maintained by department

25-27-109. List of licensed residences maintained by department. The department shall maintain a current list of assisted living residences that have been licensed and shall make such list available to individuals upon request.

C.R.S. § 25-27-110 Advisory committee

25-27-110. Advisory committee. (1) There is hereby established an advisory committee to the department for the purposes of making recommendations to the department and reporting to the house and senate committees on health and human services, or any successor committees, concerning the rules promulgated by the state board pursuant to this article, implementation of the licensing program, the impact of the program, and the effectiveness of enforcement. The advisory committee shall consist of not fewer than nine members to be appointed by the executive director of the department. The committee shall elect its own chairperson. Such members shall be representatives from assisted living residences, the Colorado commission on the aging, county, district, or municipal public health agencies, or local boards of health, and consumer and other agencies and organizations providing services to or concerned with residents of assisted living residences. Members of the advisory committee shall serve on a voluntary basis and shall serve without compensation. (2) and (3) Repealed.

C.R.S. § 25-27-111 Rules

25-27-111. Rules. The state board shall promulgate such rules as are necessary to implement this article pursuant to the provisions of article 4 of title 24, C.R.S.

C.R.S. § 25-27-112 Treatment - religious belief

25-27-112. Treatment - religious belief. Nothing in this article shall authorize the department to impose any mode of treatment inconsistent with the religious faith or belief of any person.

C.R.S. § 25-27-113 Fees for providers with high medicaid utilization and disproportionate low-income residences

25-27-113. Fees for providers with high medicaid utilization and disproportionate low-income residences. (1) The general assembly hereby finds, determines, and declares that assisted living residences provide necessary services to many residents who receive medicaid benefits pursuant to articles 4, 5, and 6 of title 25.5, C.R.S. Because so many Coloradans benefit from assisted living centers that serve medicaid recipients, the general assembly hereby finds, determines, and declares that assisted living residences that have high medicaid utilization should receive a modified fee schedule for fees required by this article. (2) Residences identified as high medicaid utilization residences by the department shall be subject to a modified fee schedule as determined by the board. (3) Residences identified as servicing a disproportionate number of low-income residents may be subject to a modified fee schedule as determined by the board.

C.R.S. § 25-27-114 Direct care workers in assisted living residences - training - portability - rules

25-27-114. Direct care workers in assisted living residences - training - portability - rules. [Editor's note: This section is effective January 1, 2025.] (1) (a) If an operator of an assisted living residence provides or pays for a portable test for a direct care worker or for qualified medication administration personnel employed by the assisted living residence, the operator shall make the results of the test available to the direct care worker or qualified medication administration personnel upon completion of the test. (b) If, upon hire by an assisted living residence, a new employee provides proof of completion of a portable test, the operator of the assisted living residence may determine that the individual has satisfied related testing requirements or require the individual to complete new testing. (c) The results of a tuberculosis test may be accepted for purposes of new employment records if presented to the new employer within two years after the testing date. Notwithstanding any provision of this section, the department may require additional testing as determined through administrative action, notice, rule, or state law. (2) If an operator of an assisted living residence provides or pays for portable training for a direct care worker or qualified medication administration personnel employed by the operator, upon completion of the portable training, the operator or the entity that provides the portable training shall provide the individual who completes the portable training with a certificate of completion. The certificate of completion must include: (a) The portable topic covered; (b) The date of the portable training; (c) The individual or entity that provided the portable training; (d) Documentation of competency in the specific portable topic of the portable training; and (e) Additional elements as determined by rule. (3) (a) If, upon hire by an assisted living residence, a new direct care worker provides proof of completion of portable training, the assisted living residence shall ensure, in a form and manner determined by the operator, that the direct care worker has satisfied the related portable training requirements in order to ensure that each direct care worker can safely carry out the duties and responsibilities for the care and provision of services to residents. (b) In addition to portable training, the operator of an assisted living residence shall ensure that each direct care worker receives any training required by rules adopted by the state board, or as set forth in state law, within the timelines set by state law or rule. (4) The state board shall accept proof of a portable test or a certificate for portable training that is deemed sufficient by an assisted living residence operator as proof of completion of a portable test or portable training. The state board may, but is not required to, promulgate rules to define other portable tests or portable trainings as portable. (5) If an assisted living residence operator accepts proof of portable training conducted by another entity, the assisted living residence operator shall ensure competency in a form and manner to be determined by the operator in order to ensure prior education and portable training are sufficient for the direct care worker to safely carry out the direct care worker's duties and responsibilities. An assisted living residence that currently employs a direct care worker is liable for any acts or omissions by the direct care worker employee that are directly related to the employee's previous portable training and the acceptance of the certification of completion of that training by the assisted living residence.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://leg.colorado.gov/sites/default/files/images/olls/crs2024-title-25.docxFetched: 10/6/2026