Hospice Agencies and Residences

  • This page is designed to assist providers through the state licensure and federal certification processes, as well as provide additional resources to maintain compliance.

State Licensing

  • State licensing is required for hospice agencies and residences.

    A state licensure application (BCHS-HFD-100 and Appendix A) is required to (Licensure fee required):

    • Begin operation of a new agency or residence ($2,000 application fee/invoice required)
    • Change of ownership (CHOW) for an existing agency or residence
    • Change in bed capacity (adding beds) at a residence

    A state licensure application is also required to (No fee required):

    • Change name of agency or residence
    • Change location of agency or residence



    • Fee: $500, plus $5 per bed
    • Annual renewal invoices sent in June of each year
    • License renewals must be paid online no later than July 31st.

    Hospice Residences Only: Other state agencies may require approval prior to licensing actions. Contact the following state agencies to determine whether their approval is required.

    Certificate of Need
    (Only if a residence plans to license both hospice residence beds and long term care beds)
    Michigan Department of Health & Human Services (MDHHS)
    Lewis Cass Building, 3rd Floor
    320 S. Walnut Street
    Lansing, MI 48913
    Phone: 517-241-3344

    Health Facilities Engineering Section
    Michigan Department of Licensing and Regulatory Affairs (LARA)
    PO Box 30664
    Lansing, MI 48909
    Phone: 517-241-3408

    Bureau of Fire Services
    Michigan Department of Licensing and Regulatory Affairs (LARA)
    3101 Technology Boulevard, Suite H
    PO Box 30700
    Lansing, MI 48909
    Phone: 517-335-5804

Federal Certification

  • Important Note: The Centers of Medicare and Medicaid Services (CMS) has suspended some survey activities in order to prepare for the protentional threat of the 2019 Novel Coronavirus (COVID-19). CMS issued Quality, Safety & Oversight (QSO) Memos with details and guidance for infection control and prevention: QSO-20-13-Hospitals, QSO-20-14-NH, QSO-20-15 Hospital/CAH/EMTALA, QSO-20-16-Hospice, QSO-20-17-All, QSO-20-18-HHA, QSO-20-19-ESRD, QSO-20-20-All, QSO-20-22-ASC,CORF,OPT,RHC/FQHCs, QSO-20-24-ASC, QSO-20-28-NH

  • Hospice agencies and residences may apply for certification to participate in the Medicare/Medicaid programs.  The Centers for Medicare and Medicaid Services (CMS) contracts with LARA to evaluate compliance with the federal regulations by conducting surveys and complaint investigations.  Hospice agencies and residences must be licensed with the State of Michigan before Medicare certification is approved.

    Hospice Agencies

    For initial certification or change of ownership:

    • Complete Provider Enrollment Application (CMS-855A) and submit to and submit to Medicare Administrative Contractor (MAC)/Fiscal Intermediary (FI)
    • Complete and submit to BCHS:
      • An e-mail confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR)
      • Two (2) signed originals Health Insurance Benefit Agreement (CMS-1561)
      • One (1) signed original Hospice Request for Certification in Medicare (CMS-417)
      • One (1) signed original Hospice Survey and Deficiencies Report (CMS-643 - Only complete numbers 2-7, and 11-14)
      • Contact Accrediting Organization (AO) to schedule survey (initial only)

    For multi-site applications (one application packet per site):

    • Complete Provider Enrollment Application (CMS-855A) and submit to MAC/FI
    • Complete Multi-Site Application (BHCS-SHCS-804) and submit to BCHS

    Hospice Residence

    Applicants must provide hospice services for 2 years prior to applying for certification.

    • Complete Provider Enrollment Application (CMS-855A) and submit directly to MAC/FI
    • Complete Multi-Site Application (BHCS-SHCS-804) and submit to BCHS
  • For a change in administrator for Hospice Agencies and Hospice Residences, please email BCHS_FedDivision@michigan.gov the following:

    • Facility name, address, and provider # or state facility ID
    • New administrator full name
    • Effective start date of administrator

    Discharge from Hospice Care

    To discharge a Medicare beneficiary with cause review the State Operations Manual, Chapter 2, Section 2082

    • Notify the MAC/FI of the discharge
    • Send an email to BCHS_FedDivision@michigan.gov (the State Agency (SA)-BCHS) with the following:
      • Facility name, address and provider #
      • Name of patient
      • Description of the circumstances surrounding the impending discharge, including efforts to resolve
      • Name and contact information for point person at the agency

    Administrator Changes
    For a change in administrator, please email the following:‚Äč

    • Facility name, address, and provider #
    • New administrator full name
    • Effective start date of administrator

    For submitting correspondence or application documents, please email BCHS_FedDivision@michigan.gov.

    Federal Reciprocal Agreements - For a federally certified provider in Michigan to provide services in another state, the provider must be federally certified in the other state or the provider must be recognized under a CMS-approved Reciprocal Agreement between the State of Michigan and the other applicable state.  Michigan has no reciprocal agreement with Indiana, Ohio or Wisconsin for Hospice services.  In short, federally certified hospice providers in Michigan cannot offer services within a neighboring state unless certified as a provider within that state.

Contact Information

  • Michigan Department of Licensing and Regulatory Affairs
    Bureau of Community & Health Systems
    611 W. Ottawa Street
    PO Box 30664
    Lansing, MI 48909

    Main Line: 517-335-1980

    State Licensing
    Phone: 517-241-1970
    FAX: 517-241-3354
    Email: bchs-statelicensing@michigan.gov

    Federal Certification
    Phone: 517-284-8953
    FAX: 517-241-2635