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General Information
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About the Unit​
Career Opportunities
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State Regulations

Applications & Forms
Licensing Applications
Civil Money Penalty (CMP) Funds
General Variance (State)
General Waiver (Federal)
Complaint Form

Facility Specific Information
Ambulatory Surgical Centers
Critical Access Hospitals
End-Stage Renal Disease
Home Health Agency
Hospitals
Hospice
Long Term Care
Subacute Mental Health Facilities

Questions or Comments?
References
Contact Us

State License Applications for

Health Facilities

Application for Licensure text

The document below provides links and other vital information for those who are interested in becoming Medicare & Medicaid participates.


License Fee Schedule


Provider Type Provisional Biannual Renewal
Hospital$2,000 + $85/bed$4,000 + $170/bed
Nursing Home$1,000 + $125/bed$2,000 + $250/bed
Ambulatory Surgical Center$650$1,300
Free-Standing Birth Center$250$500
Home Health Agency≤ 5 FTEs: $1,000;
6-15 FTEs: $1,500;
16-50 FTEs: $2,000;
≥ 51 FTEs: $3,000;
+ $500 per branch/subunit		≤ 5 FTEs: $2,000;
6-15 FTEs: $3,000;
16-50 FTEs: $4,000;
≥ 51 FTEs: $6,000;
+ $1,000 per branch/subunit
Volunteer Hospice$100
+ $100 per each additional
branch/subunit		$200
+ $200 per each additional branch/subunit
Non-Volunteer Hospice  $250
+ $100 per each additional branch/subunit		$500
+ $200 per each additional branch/subunit
Inpatient Hospice Facility $250 + $75/bed
+ $100 per each additional branch/subunit		$500 + $150/bed
+ $200 per each additional branch/subunit
Frontier Extended Stay Clinic $250 + $100/bed$500 + $200/bed
 

License Applications

 

Did You Know?

State licensed facilities who are accredited by a nationally recognized organization may be eligible to waive the biennial State licensing survey during the current/upcoming licensing period. To review related regulations for survey waivers, see 7 ACC 12.925 and AS 47.32.030(a)(9)(A-C).
 
To apply, complete theInspection Waiver Application, attach the required documents and email to: dhcs.hflc@alaska.gov.
 
If you have any questions, contact us at 907-334-2483.
State Licensure Modification Application
Modification Application
This application should be utilized when changing information or services on a previously approved licensure application.

Change of Leadership
This application is used for modifying leadership contact information for a previously submitted initial or renewals licensure application.

Ambulatory Surgical Centers (ASC)
 
Free-Standing Birth Centers
 
Rural Health Clinics (RHC) / Frontier Extended Stay Clinics (FESC)
 
Home Health Agencies (HHA)
 
Hospice Agencies
 
Hospitals (This application applies to all hospitals including General Acute Care, Rural Primary Care, Critical Access, Long Term Acute Care, and Specialized Hospitals.)
 
Nursing Homes (LTC) (New facilities must complete the LTC Application AND the Initial LTC documents located below. Facilities that are renewing their bi-annual license are only required to complete the LTC Application.)
LTC Renewal Application
 
State License Fees - Please review the following memorandum from the Office of the Lieutenant Governor regarding the adoption of new licensing fees for health facilities in Alaska.  The effective date for the new licensing fees was June 29th, 2017.

Licensing Fees Memorandum
 
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