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Adult Care Home Licensure Information

State Initial Licensure Packet:

Below you will find the necessary documents needed to submit an application for initial licensure of an adult care home with the State of Kansas.

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Adult Care Homes - Nursing Facility

• Complete Nursing Facility Licensure Packet (All the below individual documents - total of 223 pages)

Individual Documents:

• Licensure Additional Information
• Important Notice To Nursing Facility Applicants - Certification Information
• Application (Parts I-III) and Instructions for Adult Care Home License
• Nursing Facility Regulations
• Kansas State Fire Marshal's Residential Board and Care/Home Plus Requirements
Forwards directly to the Plans Review & Code Footprint webpage at www.ksfm.ks.gov/plans-review-code-footprint/
• Regulation Interpretation - Shower Accessibility for Resident with Disabilities
• Focus on Food Safety

Adult Care Homes - Assisted Living / Residential Health Care Facility

• Complete Assisted Living / Residential Health Care Licensure Packet (All the below individual documents - total of 212 pages)

Individual Documents:

• Licensure Additional Information
• Policy and procedure letter for new applicants
• Application (Parts I-III) and Instructions for Adult Care Home License
• Assisted Living Facilities/Residential Health Care Regulations
• Regulation Interpretation - Shower Accessibility for Resident with Disabilities
• Resident Functional Capacity Screening Manual
• Fillable Resident Functional Capacity Screen Form
• Kansas State Fire Marshal's Residential Board and Care/Home Plus Requirements
Forwards directly to the Plans Review & Code Footprint webpage at www.ksfm.ks.gov/plans-review-code-footprint/
• Focus on Food Safety

Adult Care Homes - Intermediate Care Facilities for Persons with Mental Retardation Facility

• Complete Intermediate Care Facilities for Persons with Mental Retardation Licensure Packet (All the below individual documents - total of 194 pages)

Individual Documents:

• Licensure Additional Information
• Application (Parts I-III) and Instructions for Adult Care Home License
• Intermediate Care Facilities for Persons with Mental Retardation Regulations
• Regulation Interpretation - Shower Accessibility for Resident with Disabilities
• Kansas State Fire Marshal's Residential Board and Care/Home Plus Requirements
Forwards directly to the Plans Review & Code Footprint webpage at www.ksfm.ks.gov/plans-review-code-footprint/
• Focus on Food Safety

Home Plus

• Complete Home Plus Licensure Packet (All the below individual documents - total of 194 pages)

Individual Documents:

• Licensure Additional Information
• Home Plus Policy and procedure letter for new applicants
• Application and Instructions (Part I-II) for Home Plus License
• Home Plus Regulations
• Resident Functional Capacity Screening Manual
• Fillable Resident Functional Capacity Screen Form
• Kansas State Fire Marshal's Residential Board and Care/Home Plus Requirements
Forwards directly to the Plans Review & Code Footprint webpage at www.ksfm.ks.gov/plans-review-code-footprint/
• Focus on Food Safety

Boarding Care Homes

• Complete Boarding Care Home Licensure Packet (All the below individual documents - total of 134 pages)

Individual Documents:

• Licensure Additional Information
• Boarding Care Home Policy and procedure letter for new applicants
• Application and Instructions (Part I-II) for Boarding Care Home License
• Boarding Care Regulations
• Kansas State Fire Marshal's Residential Board and Care/Home Plus Requirements
Forwards directly to the Plans Review & Code Footprint webpage at www.ksfm.ks.gov/plans-review-code-footprint/
• Focus on Food Safety

Adult Day Care

• Complete Adult Day Care Licensure Packet (All the below individual documents - total of 201 pages)

Individual Documents:

• Licensure Additional Information
• Adult Day Care Policy and procedure letter for new applicants
• Application and Instructions (Part I-II) for Adult Day Care License
• Adult Day Care Regulations
• Resident Functional Capacity Screening Manual
• Fillable Resident Functional Capacity Screen Form
• Kansas State Fire Marshal's Residential Board and Care/Home Plus Requirements
Forwards directly to the Plans Review & Code Footprint webpage at www.ksfm.ks.gov/plans-review-code-footprint/
• Focus on Food Safety

Fee Payment

Submission of many of the state licensure forms below also requires submission of an accompanying fee. Fees must be paid by either check, money order or credit card payment authorization made payable to the Kansas Department on Aging (KDOA) for adult care homes (including assisted living/residential health care facilities, boarding care homes, home plus facilities and adult day care).

No fees are currently associated with payment by credit card. To make credit card payments to KDOA, use the Credit Card Application form.

KDOA currently accepts:

• American Express
• Discover Card/Novus
• MasterCard
• VISA

Other Adult Care Home Forms:

• Change Forms
• Medicaid Enrollment Forms
• Medicare Certification Forms

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