Skip to main content
Ambulatory Surgery Centers (ASC)

Ambulatory Surgery Centers (ASC)

On this Page

Overview

CMS Link to ASC

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

For information on state licensure of surgery centers please visit: Freestanding Surgical Outpatient Facilities (FSAF/ASC).

Resources

CMS State Operations Manual (SOM) Chapter 2

SOM Appendix L for the Regulations

SOM Appendix Z for Emergency Preparedness

Administrator/Leadership Changes

Administrator/Leadership Change Request Form

Submitted form is sent to LARA-BSCSupport@michigan.gov.

Initial Certification

To voluntarily become a Medicare certified provider, you will need to complete the following steps and submit the paperwork electronically to LARA-BSCSupport@michigan.gov, unless otherwise noted in the instructions.

  • Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC). The MAC will provide you a recommendation letter once the initial review is complete.
  • A signed Health Insurance Benefit Agreement (CMS-370). *When completing the form, please include both the facility name and the legal provider name.
  • A completed “Ambulatory Surgical Center Request for Initial Certification or Update of Certification Information in the Medicare Program” form CMS-377 if not provided by your accrediting organization.
  • Currently, CMS has prioritized initial surveys as a lower tier work.  Following the guidance of the CMS Mission and Priority Document, Michigan is currently not performing initial surveys.  A provider can become accredited to obtain certification.
  • Contact Accrediting Organization (AO) to schedule survey.
  • Once the deeming survey is complete, please ensure the Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification (BSC) receives a copy of the survey report and final approval letter from your deeming authority.
  • Once all of the above documents have been received your application will be deemed complete and our office will review and forward the packet to the MAC for final determination and issuance of the Medicare provider number.
  • Please note, this process can take up to 30-60 days from the day of receipt by the MAC.

Change of Ownership (CHOW)

  • Ensure all state licensing Change of Ownership requirements have been completed and approved prior to submitting the federal request.
  • Complete Provider Enrollment Application (CMS-855A) and submit to Medicare Administrative Contractor (MAC). The MAC will provide you a recommendation letter once the initial review is complete.
  • A signed Health Insurance Benefit Agreement (CMS-370) *When completing the form, please include both the facility name and the legal provider name.
  • A completed “Ambulatory Surgical Center Request for Initial Certification or Update of Certification Information in the Medicare Program” form CMS-377 if not provided by your accrediting organization.
  • Once all of the above documents have been received your application will be deemed complete and our office will review and forward the packet to the MAC for final determination and issuance of the Medicare provider number.
Please note, this process can take up to 30-60 days from the day of receipt by the MAC.

Contact Us

Bureau Phone: 517-284-0193

Bureau Fax Number: 517-763-0214

Help for general questions: LARA-BSCHelp@michigan.gov

Certification Support email (document submission): LARA-BSCSupport@michigan.gov