Rural Health Clinics

State licensing is not required for rural health clinics. Individual health professionals should check on licensure requirements with the Bureau of Professional Licensing.

State licensing is not required for rural health clinics. Individual health professionals should check on licensure requirements with the Bureau of Professional Licensing.

Rural health clinics 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.

FEDERAL CERTIFICATION PROCESS

For initial certification or change of ownership:

• Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC)/Federal Fiscal Intermediary (FI).
• Complete and submit to BCHS:
  • One (1) signed Verification of Clinic Data - Rural Health Clinic Program (CMS-29)
  • Two (2) signed originals Health Insurance Benefit Agreement (CMS-1561A)
  • Supplemental Application Info (BCHS-HFD-152)
  • Provider Based must also complete 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)
    • Provider Based Info (BCHS-HFD-601
    • Contacting Accrediting Organization (AO) to schedule survey (for initial certification only)

    For relocation:

    • Complete Provider Enrollment Application (CMS-855A) and submit to MAC/FI within 90 days after relocation.
    • One (1) signed Verification of Clinic Data - Rural Health Clinic Program (CMS-29)
    • BSC will verify new location continues to meet location requirements.

     

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

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

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

Phone: 517-284-8953
FAX: (517) 763-0214 

• 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
• American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) – AO
• The Compliance Team (TCT) – AO