Home and Community Based Service Provider (HCBS) Initial Licensing Checklist

The initial licensing application packet shall include:

  1. completed HCBS licensure application, mailed to Health Standards Section, P.O. Box 3767, Baton Rouge, Louisiana, 70821-3767;
  2. non-refundable licensing fee (see payment transmittal form for more information)
  3. copy of the approval letter of the architectural facility plans from the Office of the State Fire Marshal, and any other office/entity designated by the department to review and approve the facility’s architectural plans (Adult Day Care and Center Based Respite modules);
  4. copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshal (Adult Day Care and Center Based Respite modules);
  5. copy of the health inspection report with approval of occupancy from the Office of Public Health (Adult Day  Care and Center Based Respite modules);
  6. copy of floor sketch;
  7. copy of a statewide criminal background check, including sex offender registry status, on all owners and  administrators.  Click here for list of approved vendors.     
  8. proof of financial viability, comprised of:
    • a line of credit letter issued from a federally insured, licensed lending institution in the amount of at least $50,000. *For the purposes of an HCBS licensure, personal loans or bank balances of $50,000 or more do not meet this requirement.  No waiver of this requirement will be granted.
    • certificate of general and professional liability insurance of at least $300,000. Certificate holder must state: Louisiana Department of Health, Health Standards Section, P. O. Box 3767, Baton Rouge, Louisiana  70821-3767; and
    • certificate of worker’s compensation insurance. Certificate holder must state: Louisiana Department of Health, Health Standards Section, P. O. Box 3767, Baton Rouge, Louisiana 70821-3767.
  9. completed disclosure of ownership and control information form located at: click here
  10. copy of organizational chart, including names and position titles of key administrative personnel and governing body;
  11. copy of certificates of completion of mandatory initial provider training (owners and administrators), Part 1-3. Click here to access regulatory training modules.
  12. any other documentation or information required by the department for licensure. Please refer to the HCBS Providers Minimum Licensing Standards published here.