State licensing is required for freestanding surgical outpatient facilities (FSOF).

To begin operation of a new Freestanding Surgical Outpatient Facility, all of the following steps must be completed:

1. Complete state licensure application LARA-SLACR-101 and email completed application to LARA-BCHS-NLTCSLS@michigan.gov

2. Payment:  For electronic payments, visit LARA BCHS NLTC LICENSE - Electronic Payment.  Paying electronically is the fastest way to have your application processed.  There is a 1.75% processing fee for electronic payments.  Paying electronically expedites the application process.  If you do not agree to pay the processing fee, a written check may be submitted by mail.  Please note, submitting by mail may delay processing 4-6 weeks.  When submitting for a new license by mail, you must submit the application, licensure invoice (only required for written check submissions) and written check to:

Department of Licensing and Regulatory Affairs
Bureau of Community and Health Systems
Health Facilities Licensing, Permits and Support Division
P.O. Box 30664
Lansing, MI 48909

Fees for New Licensure
Freestanding Surgical Outpatient Facility                        $2,500

To make changes to an existing licensed facility including relocation, facility name change, change of ownership, and change in bed capacity (residence only).  See below for Change of Administrator information.

1. Complete the state licensure application and change request form LARA-SLACR-101

2. Fees/Payment:  To make your payment electronically for changes to an existing license, visit LARA Change Request Payments.  Paying electronically is the fastest way to have your application processed.  There is a 1.75% processing fee for credit card payments or $0.15 processing fee for electronic check payments.  Paying electronically expedites the process for changes to existing licenses.  If you do not agree to pay the processing fee, a written check may be submitted by mail.  Please note, submitting by mail may delay processing 4-6 weeks.  When submitting a change request by mail, you must submit the change request form, licensure invoice (only required for written check submissions) and written check to:

Department of Licensing and Regulatory Affairs
Bureau of Community and Health Systems
Health Facilities Licensing, Permits and Support Division
P.O. Box 30664
Lansing, MI 48909

Fees for Changes to an Existing License

► License (facility/DBA) name change $500

► CHOW or corporate name change $500

► Relocation                 $500

All State Licenses must be renewed annually.  Annual renewal letters and invoices are sent in June of each year.  License renewals must be paid online no later than July 31st at eLicense (michigan.gov).    

Fees for Renewal
Freestanding Surgical Outpatient Facility          $500

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

Surgery centers 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 certification surveys and complaint investigations.  Surgery centers must be licensed with the State of Michigan before Medicare certification is approved.

Initial certification or change of ownership:

• Complete Provider Enrollment Application (CMS-855B) and submit to Medicare Administrative Contractor (MAC)/Fiscal Intermediary (FI)
• Complete and submit the following to Federal Survey & Certification Division LARA-BSCSupport@michigan.gov
  
  • Ambulatory Surgical Center Request for Certification in Medicare (CMS-377)
  • Signed originals Health Insurance Benefits Agreement-Ambulatory Surgical Center (CMS-370)

Contact Accrediting Organization (AO) to schedule survey for initial certification

Change in Administrator

For a change in administrator, please email LARA-BSCSupport@michigan.gov the following:

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

State Licensing Administrative Rules - State

Michigan Public Health Code –  State (emphasis on Parts 201 and 208)

CMS Conditions of Participation/for Coverage – Federal

CMS Forms – Federal

HHS Forms (Civil Rights) – Federal

State Operations Manual – Federal

Wisconsin Physician Services (WPS) – MAC/FI

CMS Approved Accreditation Organizations

Closure Plan

Michigan Department of Licensing & Regulatory Affairs
Bureau of Community and 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: LARA-BCHS-NLTCSLS@michigan.gov

Federal Survey and Certification Division
Phone: 517-284-8953
FAX: 517-763-0214

Email: LARA-BSCSupport@michigan.gov