Medicare Certifcation Program 

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New Provider Packets

New providers must request a new provider packet from Health Facility Services.  This packet will contain all required packet from Health Facility Services. This packet will contain all required forms to start the process to become Medicare Certified and if applicable Licensed.

  • Hospitals
  • Home Health Agencies
  • Hospices
  • End-Stage Renal Dialysis Facilities
  • Rural Health Clinics
  • Outpatient Surgery Centers/Ambulatory Surgery Centers
  • Swing-Beds
  • Rehab PPS Units
  • Psy PPS Units
  • Psychiatric Hospitals
  • Rehabilitation Hospitals
  • Recuperation Centers
  • Portable X-ray Facilities
  • Outpatient Physical/Speech Therapy Centers
  • Comprehensive Rehabiliation Facilities

Change of Ownership Packets

Providers who are already Licensed and/or Medicare Certified and are undergoing a change o f ownership must notify Health Facility Services and request a packet. This packet will contain all required forms to start the CMS approval process for the change of ownership and/or lcensure of the new owner.

  • Hospitals
  • Home Health Agencies
  • Hospices
  • End-Stage Renal Dialysis Facilities
  • Rural Health Clinics
  • Outpatient Surgery Centers/Ambulatory Surgery Centers
  • Swing-Beds
  • Rehab PPS Units
  • Psy PPS Units
  • Psychiatric Hospitals
  • Rehabilitation Hospitals
  • Recuperation¬†Centers¬†
  • Portable X-ray Facilities
  • Outpatient Physical/Speech Therapy Centers
  • Comprehensive Rehabilitation Facilities

Request for New Provider Packets or Change of Ownership Packets should be submitted via mail, or fax. Please be sure to identify which type of provider packet(s) is required.

Contact:

Health Facility Services
Arkansas Department of Health
5800 West Tenth, Suite 400
Little Rock, AR 72204
Phone: 501-661-2201
Fax: 501-661-2165