How to Get Licensed/Certified

KEY

This flowchart guides you through the initial licensure/certification process. Note that both licensure and certification are initiated by submitting a letter of intent.

Owner: licensure/certification applicant CMS: Centers for Medicare and Medicaid Services CPDHE: Colorado Department of Public Health and Environment

Application for Federal Certification££

Application for State Licensure*

DPS: determines LSC compliance and issues certificate of compliance. DPS sends a copy of the certificate of compliance to CDPHE. CDPHE conducts FGI plan review on facility types identified below. Facility must meet all requirements of applicable chapters of FGI.

CDPHE:

DPS construction plans and fees for plan review and to CDPHE the Letter of Intent (LOI) requesting licensure or certification, or both. *For new construction and certain renovations owner should also submit floor plans and associated documents on facility types listed below to CDPHE.

Sends initial license application or initial certification packet, or both as requested in the LOI

MAC: Medicare Administrative Contractor

requests additional information needed. After receiving certificate of compliance from DPS, a health survey is conducted and FGI compliance has been assured.

FGI: Facilities Guidelines Institute LSC: Life Safety Code Denotes the Medicare/Medicaid certification process

CDPHE:

Owner: Submits to

DPS: Colorado Department of Public Safety

CDPHE: reviews license application and if incomplete,

requires corrections?

Owner: submits to CDPHE and MAC completed license application and/or certification documentation in accordance with instructions in the packet. (Note that the Form 855 is submitted to the MAC.)

N

Y

Owner: makes corrections

CDPHE: issues license Owner: is licensed and may conduct business

Y

CDPHE: approves corrections?

MAC: reviews Form 855 and notifies Department and the applicant of approval. This process can take 90120 days.

CDPHE: recommends CDPHE: after applicant is licensed and meets any other CMS requirements, CDPHE or a deeming agency schedules and conducts a certification survey (varies by facility type). For facilities that must first be licensed, CMS requires the survey to occur once a certain number of consumers have been served

CDPHE: requires corrections?

N

to CMS that applicant be Medicare/ Medicaid certified

CMS: notifies facility that it is Medicare/ Medicaid certified

Y Y

Owner: makes corrections

CDPHE: approves corrections?

Owner: is eligible for Medicare/Medicaid reimbursement

£

The flowchart shows the certification process for facilities that are both Medicare and Medicaid certified. Assisted living residences (ALRs) and intermediate care facilities for the developmentally disabled (ICFDDs) are not subject to Medicare certification – they are Medicaid certified only. The process for these facilities is similar, but instead of working with the MAC or CMS, facilities must interface with the Colorado Department of Health Care Policy and Financing (HCPF). £* Section 25-1.5-103 (5)(c), C.R.S., provides that CDPHE shall not issue or renew any license unless it has received from DPS a certificate of compliance certifying that the building or structure of the health facility are in conformance with DPS standards. *Compliance with requirements of the Facilities Guidelines Institute (FGI) required as per 6 CCR-1011-1 for facilities related to Chapters 4, 5, 8, 9, 10, 15, 18, 19, 20, 21, 22. Plans and associated documents must be submitted and approved prior to initial licensure being approved. Please request FGI guidance for further information or a list of associated documents. Submissions can be independent of the Letter of Intent. It is strongly recommended that documents be submitted as early as possible. 04/20/2017