Hospice Agencies & Residences

State Licensing

State licensing is required for hospice agencies and residences.

New License

To begin operation of a new hospice agency or hospice residence, 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
Hospice Agency $2500
Hospice Residence $2500 plus $5/bed

Changes

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

Hospice Agency and Hospice Residence

► License (facility/DBA) name change $500

► CHOW or corporate name change $500

► Relocation $500

Hospice Residence Only

► Bed Capacity Decrease No Fee

► Bed Designation Change No Fee

► Bed Capacity Increase $500 plus $5/bed

Renewals

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.

Fees for Renewal
Hospice Agency $500
Hospice Residence Only $500 plus 5$/bed

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, 3^rd 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)
611 W Ottawa St
4th Floor
PO Box 30700
Lansing, MI 48909
Phone: 517-335-5804

Survey Waivers

The department may waive this required visit if the licensed provider requests a waiver and submits evidence that the facility is fully accredited from an acceptable accrediting body. In the case of nursing homes, a standard federal certification survey was conducted within the immediate preceding nine (9) to fifteen (15) months.
In lieu of performing an unannounced on-site state licensing survey, the department will perform a desk review of documentation submitted through the waiver request. The licensed provider will be contacted by the State Licensing Section with its decision.

For more information pertaining to this waiver process, please go to the waiver process page

Federal Certification

Once licensed, hospice agencies and residences may choose to 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 LARA-BSCSupport@michigan.gov the following:
- An e-mail confirming a successful electronic submission of your Civil Rights Clearance for Medicare Provider Certification from the Office for Civil Rights (OCR)
- Health Insurance Benefit Agreement (CMS-1561)
- Hospice Request for Certification in Medicare (CMS-417)
- Hospice Survey and Deficiencies Report (CMS-643 - Only complete numbers 2-7, and 11-14)
- Contact Accrediting Organization (AO) to schedule survey (initial only)

Change in Administrator

For a change in administrator for Hospice Agencies and Hospice Residences, 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

Multi-site applications (one application packet per site):

Complete Provider Enrollment Application (CMS-855A) and submit to MAC/FI
Complete Multi-Site Application (BCHS-SHCS-804) and submit to LARA-BSCSupport@michigan.gov

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 (BCHS-SHCS-804) and submit to LARA-BSCSupport@michigan.gov

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 LARA-BSCSupport@michigan.gov (the State Agency 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

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.