|
Requirements
Applicants interested in operating a Licensed Hospice Residence are required to have been licensed as a hospice program pursuant to Public Act 368 of 1978, as amended, and be in compliance with the conditions and standards set forth in the
Conditions of Participation for Medicare Hospice Certification (42 CFR, Part 418) for not less than two years immediately preceding the date of application for licensure.
Additionally, to qualify as a hospice residence, facilities must also be in compliance with the Life Safety Code and Construction/Design Requirements set forth in Public Act 368 of 1978, as amended.
The individuals listed below must be contacted to obtain the necessary Life Safety Code and Construction/Design approvals before returning the application. Approval from the Bureau of Fire Services is required prior to granting a construction permit. The approval processes should be coordinated with these individuals:
Department of Energy, Labor & Economic Growth
Bureau of Fire Services
P.O. Box 30700, Lansing MI 48909
Contact Person: Kim Osborn
Telephone #: 517-335-5804
and
Michigan Department of Community Health
Health Facilities Evaluation Section
P.O. Box 30664, Lansing, MI 48909
Contact Person: Jim Scott
Telephone #: 517-241-3420
Application
Complete and return the
Application for a Hospice Residence License (BHS-LC-107c) form and request a survey. Once the required information and documents have been received and approval of the physical plant/design from the Health Facilities Evaluation Section has been given, notification will be sent which will permit the facility to admit and operate as a Hospice Residence. Allow at least 15 working days from the date of the application submission for receipt of license and invoice. After the issuance of the license, an unannounced on-site survey will be conducted to verify compliance.
Relicensure
Annual fees ($200 + $20/bed) are based on a billing cycle of 8/1-7/31. Please provide updated facility information by completing the Health Facility Information Sheet (BHS-LC-101) form and sending it to the Division of Licensing & Certification by either faxing it to 517-241-3354, e-mailing the attachment to dch-bhs-l&c@michigan.gov or by mailing it to the address shown below.
Contact Information
Please contact the office if you have other questions at (517) 241-3830 or write to:
Michigan Department of Community Health
Bureau of Health Systems
Division Of Licensing & Certification
P.O. Box 30664, Lansing, Michigan 48909
123976
|