Oregon - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Oregon Department of Human Services (ODHS) licenses Assisted Living Facilities under Oregon Administrative Rules Chapter 411, Division 54, funding these settings through the Oregon Health Plan's K Plan (Community First Choice) and Aging and People with Disabilities (APD) waivers. Facilities provide private wheelchair-accessible apartments, dining, housekeeping, and registered nurse consultation for older adults and people with physical disabilities.

Prospective providers must clear the state's architectural plan review and submit the Licensing Process for New Construction form (APD 0570A) before applying for local building permits. Once built, applicants submit the initial licensing application (SE 0570) at least 60 days prior to opening, followed by Medicaid enrollment through the Oregon Health Authority's MMIS portal using the Provider Enrollment Agreement (LE 3975).

1. Service Definition and Scope

Assisted Living Facilities (ALFs) in Oregon are community-based care settings offering individualized services in a home-like environment for older adults and individuals with disabilities. Under OAR 411-054, ALFs are distinct from Residential Care Facilities by requiring fully wheelchair-accessible private apartments rather than shared rooms.

These facilities combine housing with personal care, health care supervision, and 24-hour emergency response. They are designed to support residents' independence while providing necessary assistance with Activities of Daily Living (ADLs).

• Target Population: Older adults, people with physical disabilities, and individuals with dementia or Alzheimer's disease.
• Setting Requirement: Six or more private apartments that are fully wheelchair accessible.
• Core Services: Personal care, full dining room services, housekeeping, organized activities, and transportation.
• Clinical Support: Registered nurse consultation and health care supervision.
• Consumer Summary Statement: Mandatory document outlining the specific services the facility provides and the circumstances under which a resident must relocate.

2. Regulatory and Oversight Agencies

ODHS and the Oregon Health Authority (OHA) share oversight of ALFs. ODHS handles physical licensure, architectural review, inspections, and background checks through its Community-Based Care Licensing division.

OHA manages the Medicaid funding and provider enrollment infrastructure. The ODHS Aging and People with Disabilities (APD) program coordinates the specific waiver and K-Plan authorizations for Medicaid-eligible residents.

• Licensing Agency: Oregon Department of Human Services (ODHS) Community-Based Care Licensing (https://www.oregon.gov/odhs/licensing/community-based-care/pages/default.aspx)
• Medicaid Agency: Oregon Health Authority (OHA) (https://www.oregon.gov/oha/hsd/ohp/pages/provider-enroll.aspx)
• Program Division: ODHS Aging and People with Disabilities (APD) (https://www.oregon.gov/odhs/providers-partners/seniors-disabilities/pages/default.aspx)
• Inspection Portal: ODHS Licensed Long-Term Care Settings Search (https://ltclicensing.oregon.gov/)
• Enrollment Portal: Oregon Medicaid Provider Enrollment Portal (https://www.or-medicaid.gov/ProdPortal/Providers/Enrollment/tabId/84/Default.aspx)

3. Gatekeeping Prerequisites: Who Can Even Apply

Oregon does not impose a Certificate of Need (CON) moratorium on Assisted Living Facilities; CON rules in Oregon generally apply to nursing facilities and hospitals. However, the state enforces a strict architectural and construction gatekeeping process for new ALFs.

Applicants cannot legally apply for local building permits for a new ALF until ODHS approves the initial project concept. Medicaid enrollment is strictly gated behind the issuance of the active ODHS license.

• Certificate of Need: None required for ALFs in Oregon.
• Pre-Construction Gate: Submission of Licensing Process for New Construction (Form APD 0570A) required before applying for local building permits.
• Architectural Review: Mandatory state review of facility blueprints to ensure compliance with OAR 411-054-0012 physical plant standards.
• Medicaid Enrollment Prerequisite: Active ODHS ALF license required before OHA will process the Medicaid provider enrollment application.

4. Licensure and Certification Requirements

Initial licensure is governed by OAR 411-054-0012. Applicants must submit a complete application packet to ODHS well in advance of their target opening date to allow for life safety and health inspections.

The physical plant must meet specific square footage, accessibility, and emergency call system requirements to qualify as an ALF rather than a standard residential care facility.

• Regulation Citation: Oregon Administrative Rules Chapter 411, Division 54 (OAR 411-054).
• Application Form: Initial Licensure / Change of Ownership Application (Form SE 0570).
• Submission Timeline: Must be submitted to ODHS at least 60 days before expected licensure.
• Physical Plant Standards: Must include private, fully wheelchair-accessible apartments with emergency call systems.

5. Medicaid Provider Enrollment

After obtaining the ODHS license, ALF providers enroll in the Oregon Health Plan (OHP) via the MMIS Provider Portal. Organization enrollments require specific ownership disclosures and agreements.

Providers targeting APD waiver populations must coordinate directly with the APD Provider Relations Unit to ensure their specific provider type and specialty codes are correctly mapped in MMIS.

• Enrollment System: OHA MMIS Provider Enrollment Portal.
• Required Agreement: Provider Enrollment Agreement (Form LE 3975).
• Ownership Disclosure: Ownership and Control Interest Disclosure (Form DE 3974) required for Type 2 NPIs.
• APD Coordination: Providers must email the APD Provider Relations Unit ([email protected]) for APD-specific program enrollment.
• Document Upload Limits: Electronic attachments in the portal must be PDF, TIF/TIFF, or TXT, under 10 MB, with filenames under 256 characters.

6. Staffing, Training and Background Checks

Oregon requires ALFs to maintain acuity-based staffing levels sufficient to meet the scheduled and unscheduled needs of all residents. Strict fixed ratios are replaced by dynamic staffing requirements based on resident assessments.

All staff must clear background checks through the state system and complete specific training, particularly regarding dementia care if serving memory care populations.

• Background Checks: Mandatory processing through the ODHS Background Check Unit (BCU).
• Staffing Ratios: Acuity-based staffing required to ensure coverage for 24-hour emergency response and scheduled care.
• Clinical Staff: Must have Registered Nurse (RN) consultation available to staff and residents.
• Specialized Training: Mandatory Dementia Care Training for staff interacting with memory care residents.

7. Documentation, Policies and Records

ALFs must maintain comprehensive operational policies and resident records subject to ODHS survey. A critical Oregon-specific requirement is the Consumer Summary Statement.

Facilities must also maintain detailed service plans that align with APD case manager assessments for Medicaid-funded residents.

• Consumer Summary Statement: Mandatory document given to new residents detailing provided services and relocation triggers.
• Service Plans: Individualized care plans matching assessed ADL/IADL needs, updated regularly.
• Abuse Reporting Policy: Mandatory protocols for resident protection and mandatory abuse reporting to ODHS.
• Corrective Action Plans: Required documentation in response to any substantiated violations during ODHS inspections.

8. Billing, Rates and Claims

Medicaid reimbursement for ALFs is processed through the OHA MMIS system. Rates are determined by the resident's assessed acuity level and authorized by APD case managers.

All services must be prior authorized before delivery. Ancillary services funded under the K-Plan require separate bids and Central Office approval.

• Payment System: Oregon Medicaid Management Information System (MMIS).
• Rate Structure: Acuity-based tiered rates established by ODHS APD.
• Prior Authorization: All Medicaid-funded services must be prior authorized by the local APD office or Central Office (CO).
• Ancillary Services: K-Plan ancillary services require separate bids and CO approval via [email protected].

9. Approval Sequence and Timeline

The end-to-end process spans from pre-construction architectural review to final Medicaid enrollment. The timeline is heavily dependent on construction phases and ODHS survey schedules.

Providers cannot bill Medicaid for any services provided prior to the official MMIS enrollment effective date, which follows licensure.

• Step 1: Submit Form APD 0570A and architectural plans to ODHS for new construction approval.
• Step 2: Obtain local building permits and complete facility construction.
• Step 3: Submit Form SE 0570 at least 60 days prior to the target opening date.
• Step 4: Pass ODHS initial life safety and health inspections to receive the ALF license.
• Step 5: Submit Medicaid enrollment via MMIS portal with Forms LE 3975 and DE 3974.

10. Common Denials and Survey Findings

ODHS publishes inspection reports and substantiated violations on its Long-Term Care Settings Search portal. Facilities facing severe or repeated violations may be placed under specialized oversight.

Application delays frequently stem from skipping the pre-construction review or submitting incomplete ownership disclosures during Medicaid enrollment.

• Premature Construction: Applying for local building permits before ODHS approves Form APD 0570A.
• Incomplete Applications: Missing the 60-day submission window for Form SE 0570 or omitting the DE 3974 ownership form.
• Staffing Deficiencies: Failing to demonstrate adequate acuity-based staffing to meet resident needs during surveys.
• Regulatory Actions: ODHS may restrict new admissions for facilities requiring additional oversight due to safety violations.

11. Key Contacts and Resources

Primary contacts include the ODHS Community-Based Care Licensing division for physical plant and survey issues, and the APD Provider Relations Unit for Medicaid enrollment.

Providers should regularly check the ODHS Provider Alerts page for updates to OAR 411-054 and MMIS billing guidance.

• ODHS Community-Based Care Licensing: https://www.oregon.gov/odhs/licensing/community-based-care/pages/default.aspx
• Oregon Medicaid Provider Enrollment: https://www.or-medicaid.gov/ProdPortal/Providers/Enrollment/tabId/84/Default.aspx
• APD Provider Relations Unit Email: [email protected]
• ODHS Licensed Long-Term Care Settings Search: https://ltclicensing.oregon.gov/
• K-Plan Ancillary Requests Email: [email protected]

See all Oregon services · Oregon Medicaid consulting · book a consultation.