1. (1) A completed, written application must be submitted by the applicant in a form and manner required by the Division along with the required $20 per bed non-refundable fee. The application is not complete until all information is received by the Division.
2. (2) Incomplete initial applications are void after 60 calendar days from the date the Division receives the application and non-refundable fee. The Division will deny the incomplete application if not withdrawn.
3. (3) An applicant must submit a separate complete application packet for each location operated as an AFH (Adult Foster Home)

4. (4) The application must include the following:

   1. (a) The location of the AFH;
   2. (b) A brief description of the physical characteristics of the home;
   3. (c) The name, address, telephone number, and email address of the provider;
   4. (d) The distinct name of the AFH;
   5. (e) The maximum capacity requested and a written statement describing family members needing care, residents who receive respite care, persons who receive day care, or residents who receive room and board only;
   6. (f) A written statement from a physician, nurse practitioner, or physician assistant regarding the mental and physical ability of the applicant to provide care and services to residents and to operate the AFH. If the applicant employs a resident manager, the applicant must provide a written statement from a physician, nurse practitioner, or physician assistant regarding the mental and physical ability of the resident manager to provide personal care and services to residents and to operate the AFH;
   7. (g) A completed financial information form provided demonstrating to the Division the applicant’s financial ability and resources necessary to operate the AFH. Demonstration of financial ability must include, but is not limited to, providing the Division with a current credit report, list of unsatisfied judgments, pending litigation, unpaid taxes, and notifying the Division if the applicant is in bankruptcy. If the applicant is unable to demonstrate the financial ability and resources required, the Division may require the applicant to furnish a financial guarantee as a condition of initial licensure in accordance with ORS 443.735(3)(e);
   8. (h) Certification in writing, under penalty of perjury, that to the best of the person’s knowledge the provider or owner is not in violation of any tax laws described in ORS 305.380
   9. (i) A completed Tax Compliance Certification issued by the Oregon Department of Revenue for each owner with 20 percent or more ownership in the AFH, certifying the owner is not in violation of any tax laws described in ORS 305.380;
   10. (j) A signed letter of acknowledgment from the Community Mental Health Program or designee for the applicant to be licensed to operate the AFH;
   11. (k) Proof of experience providing direct care and services to adults with mental illness;
   12. (l) Documentation of an approved check in accordance with OAR Chapter 943 Division 007 for the provider, the resident manager, caregivers, volunteers, and other occupants 16 years of age or older, excluding residents and other persons as defined in ORS 443.735;

   13. (m) Written background information pertaining to any current or previous licensure or certification by a state agency, including those licenses or certificates granted to a business or person affiliated with the business, including:

       1. (A) Copies of all current licenses or certificates;
       2. (B) Disclosure of any adverse action taken or proposed on any current or previous license or certificate, and documentation showing the final disposition of any suspension, denial, revocation, or other disciplinary actions initiated on any current or previous license or certificate, including settlement agreements, where applicable; and
       3. (C) Documentation of any substantiated allegations of abuse or neglect pertaining to the applicant or anyone employed by or contracted with the applicant.

   14. (n) Verification of completion of all required trainings for the provider, resident manager if applicable, and all substitute caregivers including, but not limited to:

       1. (A) Division-approved AFH Provider Orientation;
       2. (B) All required training as outlined in OAR 309-040-0335(8) and (9).

   15. (o) Verification of home ownership or copy of current lease or rental agreement that includes;

       1. (A) The owner and landlord’s name;
       2. (B) Verification that the rent is a flat rate; and
       3. (C) Signatures of the landlord and applicant and the date signed.
   16. (p) A floor plan of the AFH containing the required components as outlined in OAR 309-040-0370(3).
   17. (q) One copy of written approved certificate of occupancy based on the change of use of the setting, issued by the city or county building codes authority having jurisdiction;
   18. (r) A completed AFH Self-Inspection related to HCBS compliance and Fire Safety, using division approved forms;

   19. (s) The AFH plan of operation, including:

       1. (A) The use of substitute caregivers and other staff;
       2. (B) A description of how the providers or substitute caregivers will be directly involved with residents daily;
       3. (C) How the providers and substitute caregivers will be prepared to communicate with all residents who live in the home including residents with limited English proficiency; and
       4. (D) Details of how transportation and community engagement will occur.

   20. (t) Proposed policies and procedures regarding:

       1. (A) Staff training,
       2. (B) Service planning, medication administration, food preparation and distribution; and
       3. (C) Safety, emergency response, succession planning and facility closure.
       4. (D) Communication and services for persons with limited English proficiency.
5. (5) The Division must determine compliance with these rules based on receipt of the completed application material and fees, a review and investigation of information submitted, an in-person inspection of the AFH, and interviews with the applicant and other individuals as determined necessary by the Division.
6. (6) The applicant may withdraw the application at any time during the application process by notifying the Division in writing.

7. (7) The Division may elect to deny an application when the applicant, or any person with an ownership interest in the AFH, has:

   1. (a)  Previously had any adverse action taken on a certificate or license by an oversight body or action taken on a certificate or license which may include but is not limited to denial, suspension, conditions, intent to revoke, nonrenewal, or revocation by the Division, the Authority, the Oregon Department of Human Services, or any other state agency in this or any other state;
   2. (b) The applicant fails to provide accurate information;
   3. (c) Has been sanctioned by the Oregon Health Authority or is excluded, terminated, or suspended from the Medicaid program in Oregon;
      
      (d) Is listed on any Office of Inspector General exclusion list under sections 1128 or 1128A of the Social Security Act; or
   4. (e) Has been convicted of a criminal offense in the last 10 years related to the person's involvement in any program established under Medicare, Medicaid, or Title XX.
8. (8) The AFH must be in full compliance with all Home and Community Based required qualities of 42CFR §441.710(a)(1), OAR 410-173-0035, and OAR 411-004.

Statutory/Other Authority

ORS 413.042, ORS 443.420 & SB 739 (2025)

Statutes/Other Implemented

ORS 443.705 - 443.825

History

BHS 11-2026, temporary amend filed 05/28/2026, effective 06/05/2026 through 12/01/2026
BHS 26-2025, amend filed 12/23/2025, effective 01/01/2026
BHS 5-2025, amend filed 02/28/2025, effective 03/01/2025
BHS 6-2018, amend filed 03/21/2018, effective 03/30/2018
MHS 12-2017, temporary amend filed 10/03/2017, effective 10/03/2017 through 03/30/2018
MHS 9-2017, f. 6-29-17, cert. ef. 7-1-17
MHS 3-2017(Temp), f. 3-3-17, cert. ef. 3-4-17 thru 8-30-17
MHS 14-2016(Temp), f. 9-6-16, cert. ef. 9-7-16 thru 3-3-17
Renumbered from 309-040-0015, MHD 3-2005, f. & cert. ef. 4-1-05
MHD 6-1999, f. 8-24-99, cert. ef. 8-26-99
MHD 1-1992, f. & cert. ef. 1-7-92 (and corrected 1-31-92)