| A | B | C | D | E | |
|---|---|---|---|---|---|
1 | From 3/1/2025 to 6/30/2025 there will be two separate fee schedules active. This document is intended to assist you in understanding which fee schedule you should use for the application being submitted. | APPLICATION TYPES | |||
2 | INITIAL LICENSE APPLICATIONS CHANGE OF OWNERSHIP (CHOW) LICENSE APPLICATIONS CHANGE OF INFORMATION (LOI - UPDATE) LICENSE APPLICATIONS | RENEWAL LICENSE APPLICATION ***Renewal fees are determined by the license expiration date NOT the submission date of the renewal application*** | |||
3 | Application & appropriate fees submitted on or before 6/30/2025 | Application & appropriate fees submitted on or after 7/1/2025 | License Expiration Date is on or before 6/30/2025 | License expiration date is on or after 7/1/2025 | |
4 | Ambulatory Surgical Centers (ASC) | Summary Sheet ASC.pdf | Ambulatory Surgical Centers (ASC) - Fee Schedule | Summary Sheet ASC.pdf | Ambulatory Surgical Centers (ASC) - Fee Schedule |
5 | Assisted Living Residences (ALR) | Summary Sheet ALR.pdf | Assisted Living Residences (ALR) - Fee Schedule | Summary Sheet ALR.pdf | Assisted Living Residences (ALR) - Fee Schedule |
6 | Birth Centers (BC) | Summary Sheet BC.pdf | Birth Centers (BC) - Fee Schedule | Summary Sheet BC.pdf | Birth Centers (BC) - Fee Schedule |
7 | Community Clinics (CC) | Summary Sheet CC & CCEC.pdf | Community Clinics (CC) - Fee Schedule | Summary Sheet CC & CCEC.pdf | Community Clinics (CC) - Fee Schedule |
8 | Community Integrated Health Care Service Agency (CIHCS) | Summary Sheet CIHCS.pdf | Community Integrated Health Care Service Agencies (CIHCS) - Fee Schedule | Summary Sheet CIHCS.pdf | Community Integrated Health Care Service Agencies (CIHCS) - Fee Schedule |
9 | Convalescent Centers (CONV) | Summary Sheet ConvCtr.pdf | Convalescent Centers (CONV) - Fee Schedule | Summary Sheet ConvCtr.pdf | Convalescent Centers (CONV) - Fee Schedule |
10 | Critical Access Hospitals (CAH) | N/A | Critical Access Hospitals (CAH) - Fee Schedule | Critical Access Hospitals (CAH) - Fee Schedule | |
11 | Dialysis Treatment Clinics (ESRD) | Summary Sheet ESRD.pdf | Dialysis Treatment Clinics (ESRD) - Fee Schedule | Summary Sheet ESRD.pdf | Dialysis Treatment Clinics (ESRD) - Fee Schedule |
12 | Freestanding Emergency Departments (FSED) | Summary Sheet FSED.pdf | Freestanding Emergency Departments (FSED) - Fee Schedule | Summary Sheet FSED.pdf | Freestanding Emergency Departments (FSED) - Fee Schedule |
13 | General Hospitals (GH) | Summary Sheet GenHosp.pdf | General Hospitals (GH) - Fee Schedule | Summary Sheet GenHosp.pdf | General Hospitals (GH) - Fee Schedule |
14 | Group Homes (Community Residental Homes) (RCF-DD) | Summary Sheet RCFDD.pdf | Group Homes (Community Residential Homes) (RCF-DD) - Fee Schedule | Summary Sheet RCFDD.pdf | Community Residential Homes (RCF-DD) - Fee Schedule |
15 | Home Care Agencies (HCA) & Home Care Placement Agencies (HCPA) | Summary Sheet HCA/HHA/HCPA.pdf | Home Care Agencies & Home Care Placement Agencies (HCA/HHA/HCPA) - Fee Schedule | Summary Sheet HCA/HHA/HCPA.pdf | Home Care Agencies & Home Care Placement Agencies (HCA/HHA/HCPA) - Fee Schedule |
16 | Hospices (HPC) | Summary Sheet Hospice.pdf | Hospices (HPC) - Fee Schedule | Summary Sheet Hospice.pdf | Hospices (HPC) - Fee Schedule |
17 | Intermediate Care Facilities (ICF-IID) | Summary Sheet ICF/IID.pdf | Intermediate Care Facilities (ICF-IID) - Fee Schedule | Summary Sheet ICF/IID.pdf | Intermediate Care Facilities (ICF-IID) - Fee Schedule |
18 | Licensed Hospital Units (HU) | Summary Sheet Hospital Units.pdf | Licensed Hospital Units (HU) - Fee Schedule | Summary Sheet Hospital Units.pdf | Licensed Hospital Units (HU) - Fee Schedule |
19 | Nursing Care Facilities (NF) | Summary Sheet NF/LTC.pdf | Nursing Care Facilities (NF) - Fee Schedule | Summary Sheet NF/LTC.pdf | Nursing Care Facilities (NF) - Fee Schedule |
20 | Psychiatric Hospitals (PH) | Summary Sheet Hospital Psych and Rehab.pdf | Psychiatric Hospitals (PH) - Fee Schedule | Summary Sheet Hospital Psych and Rehab.pdf | Psychiatric Hospitals (PH) - Fee Schedule |
21 | Rehabilitation Hospitals (RH) | Summary Sheet Hospital Psych and Rehab.pdf | Rehabilitation Hospitals (RH) - Fee Schedule | Summary Sheet Hospital Psych and Rehab.pdf | Rehabilitation Hospitals (RH) - Fee Schedule |