Questions and Answers Adult Care Facility Common Application

1. Our Company is looking at building an Adult Care Facility (ACF) in New York. We are seeking information on the licensing process, including turnaround time for project approval and resident admissions.

There are many variables affecting project approval. Processing an application for new construction may take anywhere from 18 months to 2 years to receive full approval, including the local permits and NYS Department of Health (DOH) licensing. The approval of an application will also depend on factors such as financial feasibility and character and competency of the members of the operator, as well as whether the correct documentation for the legal structure and program information (Part 2 requirements) have been submitted.

The applicant may consider to commence early construction at its own risk if Schedule 5E is submitted along with a complete ACF Common Application. The applicant must attest to building according to the Building Codes of NYS and the environmental and structural standards required by DOH regulations for Adult Care Facilities. DOH approval is required for early commencement. Final approval for Part 1 and Part 2 (licensing) is required prior to admitting residents.

If the applicant is a current operator in NYS, is in "good standing" and meets all requirements set forth in Schedule 8, the applicant may submit the Operator in Good Standing application (for like facilities).

Please see the instructions within the ACF Common Application or the Power Point presentation which describes in detail the requirements for submitting a specific licensure/certification application. The application is located here:

2. Dear Administrator Letter (DAL) 14-13 describes the "ACF Common Application". The DAL indicates that the application forms may now be used. The DAL further indicates that statewide training sessions would be held to educate homes on the new processes, and forms. Please respond to the questions below.

1 - When and where will the training sessions be held?

The training sessions for the Adult Care Facility Common Application were conducted between September and November. The Power Point presentation used at this training is available on the DOH website at:

2 - Are the new CON forms, Part 1 and 2, available for our review? Where may we access them?

The Common Application is available on the DOH website at:

3. We spoke about the ACF Common Application. We have a question about Schedule 6, Part 2, Item 7e—Palliative Care Policies. This is on page 3 of 5 of Schedule 6, Part 2. We'd like to know what the DOH Regional Office is looking for, precisely. Are they looking for particular elements in place, or a specific template? We would appreciate any guidance about what should be submitted.

Please refer to the Dear Administrator Letter (DAL) dated December 14, 2011 regarding the Palliative Care Access Act.

4. Our office manager is having difficulties converting the ACF Common Application into a Word document with fillable fields. If we cannot get this Common Application into a fillable document, I will have to handwrite all of the applications I have pending. We always try to be cost efficient where our clients are concerned and handwriting will certainly increase time spent, not to mention the extra cost of mailing or scanning the documents to our consultant's office.

Currently the application is not in type-able form. You can consider downloading Adobe software to be able to convert to fillable fields. The goal is to have the ACF Common Application become a fillable application on the DOH website as well as the Health Commerce System (HCS). Until the fillable application is available, you will need to fill out a hardcopy and submit 1 original and 2 copies to the address indicated within application instructions.

5. I represent an entity that is considering the purchase of real property upon which a licensed Assisted Living Residence (ALR) is situated. We are trying to determine whether this transaction would have any licensure implications. The operator of the facility will not change. 10 NYCRR 1001.4(i)(3) indicates that an operator needs prior written approval of the department before conveying title to or amending a lease to the real property. But I understand that DAL # LTC 12-08 applies to this situation, and that a new license application is not needed for real property transfers. Can you confirm whether this understanding is correct? If not, can you please advise which portions of the common application would need to be submitted in advance of the transaction?

The Department requires a copy of the documentation for conveying title to or amending a lease to the real property. This includes, but is not limited to, a revised deed, a mortgage, a new amended lease, or Purchase and Sale Agreement. While an application is not required, there are specific lease requirements and provisions that must be included in the lease for the Department to approve. The provisions may be found on page 1 of Schedule 3, the legal component of the ACF Common Application. A cover letter with the facility's information, i.e. facility address and Operating Certificate (OC) number, should accompany the supporting documentation. The Department will review the documentation and will respond accordingly.

6. I would like to obtain information on opening an Assisted Living Residence (ALR) and Adult Care Facility (ACF) in New York State. I am currently a provider in the state of Florida. I am now in the process of purchasing a home in Hicksville, Long Island that is currently being operated as a Hospice. It is my intention to convert the home to an ALR/ACF. Please provide information on how to obtain an application.

The NYS Department of Health (DOH) public website provides information about Adult Care Facilities and Assisted Living Residences in New York State. Also on the DOH website, the ACF Common Application and Training Power Point presentation provide useful information for completing the application to establish an ACF and ALR in NYS. The information can be found at the following site:

7. Is the ACF Common Application used to apply for ALP beds? If so, is the application accepted at any time or is there a timeframe to submit an application for ALP beds?

The Department periodically issues ALP beds that are statutorily made available, typically through a competitive process as announced on the Department's website. Requests for ALP beds are accepted only when received in response to these announcements. When the next Solicitation or Request for Applications (RFA) is posted, applicants will use the ACF Common Application to submit their proposals.

8. Should providers submit Schedule 7C to DOH's Central Office, Regional Office, or both?

Schedule 7C should be submitted to DOH's Central Office along with the appropriate documentation to the Bureau of Licensure and Certification, 875 Central Avenue, Albany New York 12206.

9. Where can we access the ACF Common Application?

The ACF Common Application can be accessed on the DOH website:

10. We are currently a licensed ALR, EALR and SNALR. We are interested in increasing our EALR beds from 10 to 20. Are we required to use the ACF Common Application to request this increase? Or, should we work with our DOH Regional Office, providing the documentation that they request and a Common Application is not required?

Assisted Living Residences (ALR), and those with Enhanced Assisted Living Residence (EALR) and Special Needs Assisted Living Residence (SNALR) certifications are required to submit the ACF Common Application to the DOH Central Office along with 2 copies. You may be eligible to apply using the abbreviated application (Schedule 7C) depending on the specifics of the bed increase.

11. On Schedule 1C, Checklist of Schedules included in the Application, Schedule #4C states the projected 12-month Operating Budget at 90% occupancy. When we reviewed 4C, we projected our budget a little more conservatively, is that okay or does it need to be projected at 90%? We are applying for an AH, ALR, SNALR and EALR. Thank you.

The applicant may provide budget information up to the point of either: (1) 90% occupancy; or (2) financial profitability or sustainability.