Health Facilities Administration Applications & Forms
Applications
- Adult Family Care
- Change in Ownership
- For a Change in Ownership, certified health facilities also need to complete the CMS 855 A form. Completed CMS 855A forms need to be sent to your fiscal intermediary for processing.
- Individual Home Care Service Provider
- Laboratories & Collection Stations
- New Health Care Facility (under currently adopted rules)
- New Health Care Facility (not under currently adopted rules)
Forms
Adobe Acrobat Reader format. You can download a free reader from Adobe.