Waiver of Specific Rule Requirements in Response to the Passage of House Bill 25-1213, Concerning Changes to the Medical Assistance Program

 

To: All Licensed Assisted Living Residences and Other Interested Parties From: HFEMSD Colorado’s legislature passed House Bill 25-1213 (HB25-1213) during the 2025 legislative session. Signed by Governor Jared Polis on May 28th, 2025, it became effective on August 6, 2025. Though the majority of the bill contained changes to the Medicaid program as operated by the Colorado Department of Health Care Policy and Financing (HCPF), there is a section addressing the Colorado Department of Public Health and Environment’s (CDPHE’s) use of the Facility Guidelines Institute (FGI) for reviews of assisted living residences (ALRs) undergoing renovations without construction. The bill adds the following language to Section 25-27-104, C.R.S.: (3)(a)  Rules adopted by the state board pursuant to subsection (1) of this section must exempt an assisted living residence from complying with the facility guideline institute (FGI) guidelines, except in the case of new construction or major renovations. An assisted living residence must still comply with all other fire and local building codes and the standards outlined in this section.  (b) For purposes of subsection (3)(a) of this section, “major renovations” means additions to a building’s structure or changes that affect the structural integrity of the building. Major renovations do not include changing the functional operation of a space if no construction is completed and the floor plan of the building remains the same. It also does not include adding beds to accommodate more residents or upgrades to the heating or cooling and electrical systems if those improvements do not require construction. While the requirement to undergo an FGI review for new construction or major renovations remains unchanged, the new statutory language supersedes existing language in 6 CCR 1011-1, Chapter 7 rules that currently requires an FGI review for a broader definition of renovations—which includes the addition of beds to existing rooms and changing the functional use of a space and changes to major systems, regardless of whether construction occurred. CDPHE will modify Chapter 7 for consistency with the new statutory language added by HB25-1213 when it next undertakes rule revision activities for that chapter. Until such time, the provisions of the bill will be implemented through a “blanket waiver” which will apply to all licensed ALRs, with no waiver application or approval is necessary.   The waiver is limited to the FGI reviews required by 6 CCR 1011-1, Chapter 7, Part 20.2, with the addition of a subpart (D).  (D) On and after August 6, 2025, an assisted living residence with an existing, current license is exempt from FGI compliance reviews triggered by a renovation unless such renovation meets the criteria of a “major renovation” as defined at Section 25-27-104 (3)(b), C.R.S. Consistent with the language of HB25-1213, this waives the FGI review requirement for renovations that do not meet the bill’s new “major renovation” threshold, but does not waive requirements that remain unchanged under the law, including, but not limited to: 6 CCR 1011-1, Chapter 2, Part 2.9.6: Each licensee shall submit to the Department a letter of intent of any change in the information required by Part 2.3.3 of this Chapter from what was contained in the last submitted license application. (A) Changes to the operation of the facility or agency shall not be implemented without prior approval from the Department. A licensee shall, at least thirty (30) calendar days in advance, submit a letter of intent to the Department regarding any of the following proposed changes.  (1) Increase in licensed capacity.  (a) If a licensee requests an increase in capacity that is approved by the Department, an amended license shall be issued upon payment of the appropriate fee.  (b) The Department has the discretion to deny a requested increase in capacity if it determines that the increase poses a potential risk to the health, safety, or welfare of the licensee’s clients based upon the licensee’s compliance history, or because the licensee is unable to meet the required health and environmental criteria for the increased capacity.  6 CCR 1011-1, Chapter 2, Part 2.8.1, prohibiting the issuance or renewal of a license without a Certificate of Compliance from the Department of Public Safety certifying the building or structure conforms with standards adopted by the Director of the Division of Fire Prevention and Control (DFPC). These standards, at 8 CCR 1507-31, apply to both the construction and maintenance of health facilities. 6 CCR 1011-1, Chapter 2, Part 3.2.1, “Each facility or agency shall be in compliance with all applicable local zoning, housing, fire, and sanitary codes and ordinances of the city, city and county, or county where it is situated, to the extent that such codes and ordinances are consistent with federal law.” Note that these codes, alongside the minimum standards adopted by the DFPC, are independent of FGI standards, and address emergency egress for rooms used for sleeping, among other things. Additionally, the language added by HB25-1213 adds the following language to Section 25-27-104(3)(a) “... An assisted living residence must still comply with all other fire and local building codes and the standards outlined in this section”, ensuring these standards still apply.  6 CCR 1011-1, Chapter 7, Part 12 - Resident Care Services, Part 17 - Food and Dining Services, Part 22 – Interior Environment, Part 23 - Environmental Pest Control, and Part 24 - Waste Disposal. These parts continue to apply to all ALRs in their entirety, regardless of whether an FGI compliance review is required or has occurred in a specific situation. They contain, but are not limited to standards for accessibility for residents using auxiliary aids for mobility purposes, minimum access and egress, size and furnishing of spaces, and sleeping room requirements such as square footage, storage space, and window requirements. If you have any questions regarding this legislation and its impact on ALR licensing, survey, and enforcement, contact Dr. Steve Cox, Home and Community Facilities Branch Chief, at steve.cox@state.co.us. Elaine McManis, RN Division Director Health Facilities and Emergency Medical Services Division