House Bill 2665 Online Portal

Instructions:
Please select the facility/hospital you are applying for a maximum rate waiver for as well as the county it is located in. You must select the county first and the facility/hospital name second. After you have selected both, click the ‘Find Facility’ button.

Please note, in the next stages of this application the email address you provide must be a domain that is associated with the hospital/facility you are applying for.

Instructions:
Search for the facility by entering the Authorization Number. This number is unique to each facility and is granted by .

Ensure the Authorization Number is entered correctly. Even a small mistake can prevent successful retrieval of information.

You are allowed a maximum of 4 search attempts. If the information is incorrect after 4 attempts, you will be temporarily locked out for 30 minutes. Please wait 30 minutes before trying again if you reach the maximum number of attempts.

Instructions:
Please enter your original application confirmation number. The application number is unique to each application and was provided to you via confirmation screen and email when you originally submitted your waiver request. Note: The selected licensing agency above must match the originally submitted application selection.

Ensure the application number and licensing agency are entered correctly. Even a small mistake can prevent successful retrieval of information.

You are allowed a maximum of 4 search attempts. If the information provided is incorrect after 4 attempts, you will be temporarily locked out of the system for 30 minutes. If you reach the maximum number of attempts, please wait for 30 minutes before trying again.