Change of Information Form available on MDH website for Assisted Living Providers

The Minnesota Department of Health (MDH) has made the Change of Information Form available on the Assisted Living web page.

The form can be used to submit changes in the following:

• Closure of a campus building (one building that is under a campus license)
• Change of company name
• Change of contact information
• Change/add of manager: “Manager” means an individual or legal entity designated by the licensee through a management agreement to act on behalf of the licensee in the on-site management of the assisted living facility.
• Change/add of Authorized Agent: “Authorized Agent” means the person upon whom all notices and orders shall be served and who is authorized to accept service of notices and orders on behalf of the assisted living provider. A new agent cannot authorize adding their name to the license.

It is not necessary to notify MDH of a change of the Licensed Assisted Living Director or the Clinical Nurse Supervisor. It is, however, required that a Licensed Assisted Living Director or permitted ALDIR notify their licensing board, the Board of Executives for Long-term Services and Supports (BELTSS), if they have changed positions. BELTSS will then notify MDH of the new Director of Record.

There is currently no mechanism to change licensed capacity until license renewal.

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