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Psychiatric Hospitals & Units

Psychiatric Hospitals & Units

State Licensing

State licensing is required for psychiatric hospitals/units under the Michigan Mental Health Code.

New License

To begin operation of a new psychiatric hospital/unit, 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 applicationlicensure 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
Psychiatric Hospital/Unit                         $500 plus $10/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 formlicensure 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
Bed Designation Change                         No Fee
Bed Capacity Decrease                            No Fee
Bed Capacity Increase                              $500 plus $10/added beds

 

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 at eLicense (michigan.gov).    

Fees for Renewal
Psychiatric Hospital/Unit $500 plus $10/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 licenseboth hospiceresidence beds andlong term care beds)
Michigan Department of Health & Human Services (MDHHS)
Lewis Cass Building, 3rdFloor
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

 

Federal Certification

Psychiatric hospitals 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. Hospitals must be licensed with the State of Michigan before Medicare certification is approved.

Initial certification, relocations, or change of ownership

For initial certification, relocations, or change of ownership:

  • Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC)
  • Contact CMS approved accrediting organization (AO) to schedule initial certification survey
  • 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)
  • Hospital/CAH Medicare Database Worksheet (Exhibit 286)

Change in Administrator

If your facility or agency is state licensed or federally certified, we request that you update the Federal Survey and Certification Division when there is a change in administrator.  The information requested below will allow us to keep both the state licensing and federally certification data bases current.  Email BCHS_FedDivision@michigan.gov the following:

  • Facility or agency name, address, and federal (CCN) provider # (23-xxxx) or state facility ID (xx-xxxx)
  • New administrator full nameych
  • Effective start date of administrator
  • Best contact number for our office to reach this facility or agency
  • Best email address for our office to reach this facility or agency

Federal PPS-Exempt Units

This information is to assist with Prospective Payment System (PPS) exemption.

  • Complete Provider Enrollment Application (CMS-855A)
  • Psychiatric Criteria Unit Worksheet CMS-437

 Information for PPS-excluded psychiatric units only:

  • Medical record protocols to permit verification that each patient receives a psychiatric evaluation within 60 hours of admission.
  • Documentation that each patient has a comprehensive treatment plan.
  • Documentation progress notes are routinely recorded.
  • Documentation each patient has discharge planning and discharge summary.
  • Description of the type and number of clinical staff, including a qualified medical director of inpatient psychiatric and a qualified director of psychiatric nursing services, registered nurses, licensed practical nurses, and mental health workers to provide care necessary under their patients' active treatment plans.

Note: An annual attestation is required for compliance with federal regulations.

State and Federal Death Reporting Requirements

Hospital Restraint/Seclusion Deaths - CMS requires all hospitals to report deaths associated with restraint and/or seclusion on the electronic CMS-10455 form.  The only reporting requirement exceptions are deaths associated with 2-point soft wrist restraints. See QSOG-20-04-Hospital-CAH-DPU.

Hospitals must report the following information to CMS no later than the close of business on the next business day following the acknowledgment of the restraint and/or seclusion associated patient death:

  • Death that occurs while a patient is in restraint or seclusion.
  • Death that occurs within 24 hours after the patient has been removed from restraint or seclusion.
  • Death known to the hospital that occurs within 1 week after restraint or seclusion where it is reasonable to assume that the use of restraint or placement in seclusion contributed directly or indirectly to a patient's death.

2-Point Soft Wrist Restraint Exception - When the patient was not in seclusion and when the only restraints used on the patient were those applied exclusively to the patient's wrist(s), the death could be considered a 2-point soft wrist restraint situation. To be a soft wrist restraint, the restraint on the patient's wrist must be composed solely of soft, non-rigid, cloth-like materials. In these cases, the hospital staff must record the death in an internal log or other system. The hospital must record no later than seven (7) days after the date of death, the following information:

  • Death that occurs while a patient is in such restraints.
  • Death that occurs within 24 hours after a patient has been removed from such restraints.
  • Death entry must document the patient's name, date of birth, date of death, name of attending physician or other licensed practitioner who is responsible for the care of the patient, medical record number and primary diagnoses.

Questions regarding reporting of hospital restraint or seclusion deaths may be directed to the CMS Chicago Regional Office at ChicagoNLTCPOC@cms.hhs.gov.

Psychiatric Notification of Death - Effective March 24, 2021, MCL 330.1720 and 330.1721 require state licensed psychiatric hospitals and units to report to the Department of Health and Human Services (DHHS) all deaths of mental health care recipients occurring in a psychiatric hospital or psychiatric unit and within 48 hours of discharge, as well as the cause of death, if known. DHHS must investigate the deaths of mental health care recipients that resulted from suicide or unknown causes. Please use the new reporting form (MDHHS-5949) that providers will be responsible to complete and email directly to DHHS-ORR at MDHHS-5949.dotx (live.com) or by FAX to 248-348-9963.  Should you have questions and/or need additional information, please contact: Andrew Silver, MDHHS-ORR Director of Education, Training and Compliance at silvera@michigan.gov or (248) 756-6610 or visit the MDHHS-ORR website at michigan.gov/recipientrights.

 

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

 

Non-Long Term Care State Licensing Section
Phone: 517-241-1970
Email: 
LARA-BCHS-NLTCSLS@michigan.gov

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

EmailBCHS_FedDivision@michigan.gov