Applications
Requests for New Provider Packets or Change of Ownership Packets should be submitted via mail, email or fax. Please be sure to identify which type Provider Packet (New or Change of Ownership) is required.
New Provider Packet: This packet will contain forms to begin the process to become licensed and/or Medicare Certified and must be submitted to the Health Facility Services section of ADH.
Change of Ownership Packet: This packet will contain forms for existing providers needing to notify ADH’s Health Facility Services section of a change in ownership.
Types of Providers Licensed by Health Facility Services or Certified by Medicare:
- Alcohol/Drug Abuse Units – licensed only
- Ambulatory Surgery Centers/Outpatient Surgery Centers – licensed & Medicare certified
- Critical Access Hospitals – licensed & Medicare certified
- End Stage Renal Dialysis Units – Medicare certified only
- Free-Standing Birthing Centers – licensed only
- Home Health Agencies – licensed & Medicare certified
- Hospitals – licensed & Medicare certified
- Hospices – licensed & Medicare certified
- Infirmaries – licensed only
- In-Vitro Fertilization Facilities – licensed only
- IPPS – Exempt Psychiatric Units – Medicare certified only
- IPPS – Exempt Rehabilitation Units – Medicare certified only
- Laboratories and Laboratory Services – Medicare certified only
- Organ Procurement Organizations – Medicare certified only
- Orthotic, Prosthetic, Pedorthic Providers – licensed only
- Outpatient Physical Therapy or Speech Pathology – Medicare certified only
- Outpatient Psychiatric Centers – licensed only
- Perfusionists – licensed only
- Portable X-ray Services – Medicare certified only
- Private Care Agencies – licensed only
- Psychiatric Hospital – Licensed & Medicare Certified
- Recuperation Centers – Medicare certified only
- Rural Health Clinics – Medicare certified only
- Swing Bed Units – Medicare certified only
- Utilization Review Providers – licensed only
Contact Information
Health Facility Services
5800 W. 10th St., Suite 400
Little Rock, AR 72204
Phone: 501-661-2201
Fax: 501-661-2165
adh.hfs@arkansas.gov
