How to start an assisted living facility in Nevada

Nevada requires a Residential facility for groups license (from 3-bed homes to communities of 150+ beds), with optional endorsements including assisted living and Alzheimer's/dementia care from Nevada Division of Public and Behavioral Health, Bureau of Health Care Quality and Compliance to operate an assisted living facility.

License required

Yes

License

Residential facility for groups license (from 3-bed homes to communities of 150+ beds), with optional endorsements including assisted living and Alzheimer's/dementia care

Issuing agency

Nevada Division of Public and Behavioral Health, Bureau of Health Care Quality and Compliance

Medicaid waiver coverage

HHS's 2015 compendium reported that Nevada covered augmented personal care in residential facilities for groups under the Frail Elderly 1915(c) waiver, and assisted living under the waiver for persons with physical disabilities.

Regulation

NRS Chapter 449; NAC Chapter 449 (residential facilities for groups)

Training

• Caregivers must be CPR certified and complete 8 hours of basic caregiving training, with more training or staffing for each endorsement

Program

Nevada Medicaid and Nevada Check Up (Nevada Health Authority)

Enrollment portal

Provider Flex (new enrollments, re-enrollments, ownership changes); Provider Web Portal (revalidations and updates)

Fiscal agent

Gainwell Technologies

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Nevada's enrollment page and booklet do not list a separate state fee.

Fingerprinting

Provider types 19, 29, 33, 58 (specialty 205), 63, 64, 65 and 93 (specialty 708) must send a signed Nevada Department of Public Safety fingerprint background waiver for each owner holding 5% or more, because those owners may need a fingerprint-based criminal background check under 42 CFR 455.434. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. Nevada's enrollment booklet does not describe a separate state site visit process.

Revalidation

At least every 5 years; DMEPOS providers (provider type 33) every 3 years. Notices go out 120, 90, 60 and 20 days before the due date. A provider can revalidate up to one year early through the Provider Web Portal ('Revalidate-Update Provider'). The application must be approved before the due date, or the contract ends and the provider cannot serve fee-for-service or MCO members. Nevada also runs an accelerated revalidation of high-risk providers (Web Announcement 3935).

Full Nevada Medicaid enrollment guide →

CON program

Yes

Program

Approval of Director for certain projects (NRS 439A.100), commonly called certificate of need

Agency

Nevada Department of Health and Human Services, Director (health planning); licensing withheld by the Health Care Purchasing and Compliance Division of the Nevada Health Authority

Services covered

• new construction by or for any health facility costing more than the greater of $2,000,000 or a regulatory amount, but only in counties under 100,000 population or in cities/towns under 25,000 inside larger counties
• closure of a hospital, or its conversion to another facility type, in counties of 100,000 or more (NRS 439A.102)

Nevada certificate of need details →

State minimum wage

$12.00 an hour

Effective

2024-07-01

Scheduled increases

No scheduled change found in the official sources reviewed.

Direct-care wage floor

SB 511 (2023): to get the $25/hour personal care services rate, providers must pay direct care workers at least $16.00/hour (from 2024-01-01) and sign a wage attestation.

Rate pass-through

Of the $25/hour PCS rate, not less than $16 must be paid as hourly wages to direct care workers (SB 511, s. 68).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

181 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

711,617 (as of Jun 1, 2026)

All Nevada Home care Medicaid rates, ranked →

• NV HCBS Waiver for Individuals with Intellectual and Developmental Disabilities (1915(c))
• NV Home and Community Based Services (HCBS) Waiver for Persons with Physical Disabilities (1915(c))
• NV Waiver for Structured Family Caregiving (1915(c))
• NV Waiver for the Frail Elderly (1915(c))

Nevada waivers and waiting lists →