Application for Approval of a Skilled Nursing or Intermediate Care Facility Management Company

The following forms and documents are required for approval of a skilled nursing facility (SNF) or intermediate care facility (ICF) Management Company.

In addition to the forms below, you are required to submit additional documents for approval of a Management Company.  These documents must be submitted with your completed application.  The required information and instructions are listed on the checklist contained in the “Skilled Nursing or Intermediate Care Facility Management Company Application Request Letter and Instructional Checklist”letter.

Required Forms to be Approved as a SNF or ICF Management Company:

• Licensure & Certification Application:  HS 200 (PDF)
• Applicant Individual Information:  HS 215A (PDF)
• Administrative Organization:  HS 309 (PDF)