HSS Change of Ownership Information: ARCP
Providers must complete this document when they have a change in their ownership structure. This document would be used for both a change of ownership (CHOW) as defined by state and/or federal regulations, or a change of ownership information (CHOI) that does not meet the state and/or federal regulations CHOW definition.
For Health Standards to make a CHOW/CHOI determination, all providers must submit the following documents:
- *Letter of Intent (including d/b/a and entity name of the previous and the new owner, the effective date of transfer of ownership, address and phone number)
- *A diagram showing the ownership structure “before” and “after” the change
- *Copy of the executed Bill of Sale
- *CHOW/CHOI License Application
- *855A/B approval letter for the following providers: Home health, hospice, hospitals, RHCs, ASCs,
ESRDs, portable x-ray, community mental health and OPT.
If this action is a CHOI, the documents above are the only documents you need to submit. There is no fee for CHOI.
If this action is a CHOW, the following documents are also needed:
- Does your facility have a CLIA Certificate? If yes, contact the CLIA program by clicking here.
- *Licensing Fee: Click here for the link for the Health Standards Fee Schedule
The fee for a CHOW is usually the same as a license renewal unless the facility is making additional changes. For the providers completing an acquisition/merger, please contact the program desk for assistance.
Additional Documents Required:
- CHOW Application
- Payment Transmittal Form and Payment
- Letter of Intent
- Bill of Sale/Legal CHOW Documents
- Criminal background checks for all owners
- Proof of Financial Viability: a. A letter of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000 or the cost of three months of operation, whichever is less; or b. affidavit of verification of sufficient assets equal to $100,000 or the cost of three months operation, whichever is less
- Secretary of State Articles of Incorporation
- Proof of professional liability insurance of at least $300,000
- Proof of general liability insurance of at least $300,000
- Proof of workers' compensation insurance
Contact James H. Taylor, JamesH.Taylor@la.gov or 225-342-5457, regarding Change of Ownership Information for ARCP.
Note: All ARCPs are required to file an electronic report with the ESF-8 Portal (EMSTAT) during a declared emergency, disaster, or public health emergency. Please visit the ESF-8 website to register your ARCP. Website (click here)
Once all application requirements are completed and approved by LDH, a new license shall be issued to the new owner.