How to submit change information

To facilitate review of an ownership change, please submit: 

1. A narrative describing the ownership change, the organization name change,  and/or additions and changes to key staff members as a result of this change
2. Most recent organizational chart
3. Previous and updated list of owners along with percentage changes
4. Governance administration list
5. Changes in policies and procedures

Organizations in the AAAHC/Medicare deemed status program, must also submit evidence that CMS was notified of the ownership change (CHOW) and/or the approval letter. If you have applied for a new CCN, please provide one of the following:

1. From the Medicare Enrollment Application CMS-855B for a new CCN, a copy of the page identifying your organization’s name and address
2. PECOS page with a copy of the page identifying your organization’s name and address
3. CMS approval letter

To determine if an on-site visit will be necessary, please submit:

1. A narrative describing additions/changes in key staff members, services provided, and policies and procedures developed to support any new services
2. 8 ½” x 11” architectural floor plans including:
   a. Room sizes
   b. Locations of procedure and/or operating rooms, as well as emergency exits and patient flow through the facility
3. Facility structure details including:
   a. Locations of “clean” and “dirty” areas with a description of material and staff flow through each space
   b. Photographs (up to but no more than 9) of the pertinent patient care areas, as well as “clean” and “dirty” areas to be sent to AAAHC via CD-ROM or email to the address listed below
4. Occupancy Permit
5. Fire inspection report
6. Confirmation of notification to the applicable state authority and CMS, if Medicare certified
7. Any other applicable inspection reports from local, state, or federal agencies

To determine if an on-site visit will be necessary, please submit:

1. Policies and procedures that have been updated and/or developed in regard to the renovations
2. 8 ½” x 11” architectural floor plans including:
   a. Room sizes
   b. Locations of procedure and/or operating rooms, as well as emergency exits and patient flow through the facility
3. Facility structure details including:
   a. Locations of “clean” and “dirty” areas with a description of material and staff flow through each space
   b. Photographs (up to but no more than 9) of the pertinent patient care areas, as well as “clean” and “dirty” areas to be sent to AAAHC via CD-ROM or email to the address listed below
4. Occupancy Permit
5. Fire inspection report
6. Confirmation of notification to the applicable state authority
7. Any other applicable inspection reports from local, state, or federal agencies

To determine if an on-site visit will be necessary, please submit:

1. A narrative describing additions/changes in key staff members, services provided, and policies and procedures developed to support any new services
2. 8 ½” x 11” architectural floor plans including:
   a. Room sizes.
   b. Locations of procedure and/or operating rooms, as well as emergency exits and patient flow through the facility.
3. Facility structure details including:
   a. Locations of “clean” and “dirty” areas with a description of material and staff flow through each space.
   b. Photographs (up to but no more than 9) of the pertinent patient care areas, as well as “clean” and “dirty” areas to be sent to AAAHC via CD-ROM or email to the address listed below. 
4. Occupancy Permit.
5. Fire inspection report.
6. Copy of any applicable licenses or certifications.
7. Any other applicable inspection reports from local, state, or federal agencies.
8. Completed Satellite Facility Form.

To determine whether an on-site visit will be necessary, please submit:

1. Changes made to policies and procedures to support the expansion of service(s)
2. A list of procedures approved by the governing body
3. A description of the physicians providing the new service(s) (with specialty, if appropriate), including a brief description of the process by which they are credentialed and privileged by the organization.
4. A description of health care professionals including a brief description of the process by which they are credentialed and privileged by the organization. Note that each state may have its own delineation of scope of service for the provider; please address any limitations that were a factor in the privileging. 
5. A description of any new equipment used, including a brief description of privileging and/or training of the health care professionals who use it.
6. A description of any changes to the facility, if applicable.
7. As appropriate, confirmation of notification to the applicable state authority.

When an organization’s accreditation has expired and the organization is not seeking reaccreditation, AAAHC requires that the organization:

• Return all AAAHC accreditation certificates to the AAAHC office at 5250 Old Orchard Road, Suite 200, Skokie, IL  60077. 
• Review its website and any other sites to remove the AAAHC logo.
• Review its internal information, e.g., letterhead, fax forms, internal recorded phone messages, etc., to ensure that the AAAHC name or logo has been removed.
• Review marketing materials, radio or television ads, yellow pages or other advertisements to ensure that the AAAHC name or logo has been removed. 

For all other significant organizational changes, please submit a description of what has occurred, and your organization's plan of action.