Continuing Care Retirement Community Licensing

Licensing and Expansions

  • The North Carolina Department of Insurance licenses and regulates Continuing Care Retirement Communities (CCRCs) and Continuing Care at Home (CCAH) programs under Article 64A of Chapter 58 of the North Carolina General Statutes.
    This page explains the approval pathways, licensing stages, and regulatory requirements applicable to:
  • New and existing CCRCs
  • Continuing Care at Home programs
  • Expansions of existing CCRCs
    Applicants should use this page to understand which approvals apply, when Commissioner approval is required, and where to access required forms and instructions.

Overview of Approval Pathways

Depending on activities, one or more of the following approval processes may apply:

  • Initial CCRC development and licensure
  • Licensure to provide Continuing Care at Home
  • Expansion of an existing CCRC
  • Ongoing regulatory obligations following licensure
  • Each pathway has distinct statutory requirements, review standards, and approval sequencing.

Initial Licensing of a Continuing Care Retirement Community (CCRC)

Article 64A establishes a multi-stage approval process for the development and operation of a new CCRC. Commissioner approval is required at each stage before a provider may proceed to the next phase.

Licensing Stages

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Required before marketing a proposed CCRC or collecting deposits.
Allows a provider to:

  • Market the proposed community
  • Enter into nonbinding reservation agreements
  • Collect limited deposits held in escrow

Required before entering into binding reservation agreements or continuing care contracts.
Allows a provider to:

  • Enter into binding reservation agreements and continuing care contracts
  • Accept entrance fees and larger deposits held in escrow
  • Begin site preparation
  • Construct model independent living units for marketing

Required before constructing or converting a facility into a CCRC.
Allows a provider to:

  • Begin construction or convert an existing structure or structures into a CCRC

Required before opening and operating the CCRC.
Allows a provider to:

  • Open the community
  • Provide continuing care to residents
  • Each application is reviewed for financial viability, market feasibility, governance integrity, and statutory compliance.

Continuing Care at Home (CCaH Licensing)

Continuing Care at Home is a separately licensed program that permits a provider to deliver continuing care services to individuals living outside a CCRC.
When a CCAH license is required, a provider must obtain a CCaH license before arranging or providing continuing care at home services.
Only a provider that already holds:

  • A permanent license, or
  • A restricted permanent license may apply for a CCaH license.

Continuing Care at Home (CCaH) Licensing

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A provider must obtain a CCaH license before arranging or providing continuing care at home services.
Only a provider that already holds:

  • A permanent license, or
  • A restricted permanent license may apply for a CCaH license.
     

A CCaH license application includes, as applicable:

  • An amended Disclosure Statement describing the CCaH program
  • The proposed CCaH contract
  • Actuarial materials (or actuarial projections, if exempt)
  • A market study demonstrating consumer interest
  • Prospective financial statements showing program impact
  • Evidence of licensure or contracting authority to provide home care services

Once licensed, providers must:

  • File amended Disclosure Statements

Submit periodic reports as prescribed by the Commissioner

Expansions are regulated separately from initial licensure to protect existing residents and ensure continued financial stability.

Do I Need Expansion Approval?

You must obtain Commissioner approval if you plan to:

  • Add 20% or more of your existing independent living units; and
  • Market, collect deposits for, or construct those units

Expansion Approval Process (Two Stages)

Stage 1: Expansion Notification (Pre-Marketing Approval)

Required before marketing or collecting deposits for a qualifying expansion.

Includes:

  • A description of the proposed expansion
  • Proposed reservation agreements, if applicable
  • Proposed escrow agreement
  • Updated Disclosure Statement
  • Written notice to existing residents

Approval allows the provider to market the expansion and collect deposits in escrow.

Stage 2: Expansion Application (Construction Approval)

Required before beginning construction of a qualifying expansion.

Includes:

  • A feasibility study
  • Five-year prospective financial statements
  • Actuarial materials, if applicable
  • Updated Disclosure Statement
  • Financing and lease approvals, if applicable

Construction may not begin until approval is granted.

Expansion-Related Safeguards

  • All entrance fees and deposits must be escrowed unless exempted
  • Providers must submit periodic sales and development reports
  • Approval is conditioned on financial viability and resident protection

The Commissioner reviews applications, notifications, and requests for approval in accordance with statutory timelines. Applicants are notified when materials are complete and when decisions are issued.

If an application is denied, the provider is entitled to written notice and applicable review rights under State law.

All applications, notifications, and reports must be submitted using forms prescribed by the Commissioner and made available on this page.
Applicants should carefully review all instructions and ensure that required information and supporting documentation are complete. Incomplete submissions may delay review.
 

Public Disclosure

Disclosure Statements filed in connection with licensing actions are posted by the Department for public access, as required by law. These disclosures are intended to support informed decision-making by residents and prospective residents.

Questions

Questions regarding licensing requirements, application forms, or submission procedures may be directed to the Department’s Financial Oversight and Special Entities Division.

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