Licensure Application Information
The link below applies to all facility and license/permit types and contains important instructions for completing your new application.
Fee Schedules
Background Check Requirements
Use the forms below to assist with required background checks for the following facility types.
- Instructions for Owners to Complete Background Check to Obtain a Health Facility License (For Initial of CHOW applications, complete step 1, within the instructions for each designated owner)
- Civil Applicant Waiver Form (must be fully executed for each designated owner and uploaded to the license application)
- An agency to provide personal care services in the home (PCS)
- Intermediary Service Organizations (ISO)
- An agency to provide nursing in the home (HHA)
- A facility for intermediate care (ICF)
- A facility for skilled nursing (SNF)
- A residential facility for groups/assisted living(AGC)
- A program of hospice care
- A home for individual residential care
- A facility for the care of adults during the day
- A facility for hospice care
- A nursing pool
- Medical facilities such as hospitals that provide residential services to children Facilities for the treatment of abuse of alcohol or drugs that provide residential services to children
- Hospitals that:
- Plan on becoming federally designated as a long-term acute care hospital
- Plan on having a distinct part skilled nursing facility or nursing facility
- Plan on providing swing-bed services
- Provide residential services to children
Plan Review Requirements
The following facility types are subject to a Plan Review.
Visit this page linked here for the Construction and Plan Review Application and Requirements.
- Facility for the Care of Adults during the Day (ADC)
- Residential Facility for Groups with more than ten beds (AGC)
- Hospital, any type or classification
- Hospital (HOS)
- Rural Hospital (RUH)
- Facility for Skilled Nursing (SNF)
- Obstetric Center (OBC)
- Facility for Intermediate Care (ICF)
- Facility for the Treatment of Abuse of Alcohol or Drugs (ADA)
- Independent Center for Emergency Medical Care (ICE)
- Surgical Center for Ambulatory Patients (ASC)
- Facility for Modified Medical Detoxification (MDX)
- Mobile Unit (MBU)