An operator can request a change in level of care by submitting a letter of request to the Licensure Unit in the Section for Long-Term Care Regulation. A fee of $25.00 must be included with the request. In addition, if the request is for a change from residential care facility or assisted living facility to skilled nursing facility or intermediate care facility or from skilled nursing facility or intermediate care facility to assisted living facility or residential care facility, the request shall include documentation from the Certificate of Need program indicating approval for the change. After the Licensure Unit receives the request with required documentation and fee, an inspection will be conducted by staff from one of the Section for Long-Term Care regional offices to determine if the appropriate requirements for the level of care requested are met.

If the change is from a skilled nursing or intermediate care facility to any other level, or if the change is from an assisted living facility to a residential care facility, the facility must comply with construction, fire safety and physical plant rules applicable to an existing or existing licensed facility as defined in 19 CSR 30-83.010. If the change is from a residential care facility to any other level or if an assisted living facility changes to an intermediate care or skilled nursing facility, the facility must comply with construction, fire safety and physical plant rules applicable to a new or newly licensed facility as defined in 19 CSR 30-83.010. An original license for the change in level of care will be issued if the facility is in compliance with appropriate requirements.