Accreditation Status Changes of an Ambulatory Surgical Center

A Medicare-certified ambulatory surgical center converting to deemed status or dropping deemed status must provide the following:

Written notice on facility letterhead that includes the following:

• Health Facility Identification Number (HFID)
• CMS Certification Number (CCN)
• Name of facility
• Type of deemed status change
• Date of deemed status change
• Notice will be signed by authorized official

If dropping deemed status, MDH will require the above letter and a letter from the accrediting organization, which will establish the date of the change. See CMS-Approved Accrediting Organizations (PDF).

If changing to deemed status, MDH will require the above letter and the letter from the accrediting organization, which will establish the date of the change.

Email or mail completed documents to:

Minnesota Department of Health
Health Regulation Division
Licensing and Certification Program
P.O. Box 64900
St. Paul, Minnesota 55164-0900
Attn: Certification Specialist
Email address: health.HRD-FedLCR@state.mn.us