Long Term 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.

*If you provide more than one service the combined payment should not exceed $4,000

Adult/Pediatric Day Health Services – Initial License
Adult/Pediatric Day Health Services – Renewal
Adult/Pediatric Day Health Services – Amendments
Alternate Family Care - Initial License
Alternate Family Care - Renewal
Assisted Living Program – Initial License
Assisted Living Program – Renewal Application
Assisted Living Program – Amendments
Assisted Living Residence/Comprehensive Personal Care – Initial License
Assisted Living Residence/Comprehensive Personal Care – Renewal
Assisted Living Residence/Comprehensive Personal Care – Amendments
Dementia Care Home – Initial License
Dementia Care Home – Renewal
Dementia Care Home – Amendments
Residential Health Care – Initial License
Residential Health Care – Renewal
Residential Health Care – Amendments
Skilled Nursing Facility – Initial License
Skilled Nursing Facility – Renewal
Skilled Nursing Facility – Amendments
Skilled Nursing Facility - Add-A-Bed – Amendment
Sub-Acute Fee-Health Care Quality Monitoring Fee

 

Last Reviewed: 5/16/2018