Acute Care Licensure Payments

Paying for a license via e-check or credit card:

Directions: Click on the type of license you wish to pay for from the selections below.  Please include your facility’s license number for all amended and renewal application transactions. Once you have submitted payment, you must complete and submit the required form and (if applicable) supporting documentation before our review process can begin.

Important: Online payment alone is not sufficient for our review process to begin. The original, signed forms and any required attachments and/or documentation must be mailed to this office with the proof of online payment attached. Your submission will not be valid until the required forms and documentation have been received by this office.

When you are finished paying:
Print the payment confirmation page or the confirmation e-mail you received as proof of payment. Attach this printout to your application form. No submission will be processed without proof of payment.

Please note that the licensure fees listed below are non-refundable.

Ambulatory Care Facility - Initial Registration
Ambulatory Care Facility- Renewal
Ambulatory Care Facility – Amendments
Home Health Agency - Initial Registration
Home Health Agency - Renewal
Home Health Agency – Amendments
Hospice Care Program (Branch) - Initial Registration
Hospice Care Program (Branch) - Renewal
Hospice Care Program (Branch) - Amendments
Hospice Care Program (Main) - Initial Registration
Hospice Care Program (Main) - Renewal
Hospice Care Program (Main) - Amendments
Hospitals - Initial Registration
Hospitals - Renewal
Hospitals - Amendments
Maternal & Child Health Consortium - Initial Registration
Maternal & Child Health Consortium - Renewal
Maternal & Child Health Consortium - Amendments
Pediatric Transitional Home - Initial Registration
Pediatric Transitional Home - Renewal
Pediatric Transitional Home - Amendments
Last Reviewed: 5/23/2016