Adult Day Health Care

Initial Licensure

The Department of Health (LDH) shall not process any application until all completed forms, required applicable accompanying information and the application fee (where required) is received.

All applicable fees must be submitted by way of Company Check, Cashier's Check or Money Order payable to DHH. Application fees are non-refundable.

If the initial licensing packet is incomplete, the applicant will be notified of the missing information and will have 90 days to submit the additional requested information. If the additional request is not submitted to the department within 90 days, the application will be closed. After an initial licensing application is closed, an applicant who is still interested in becoming an ADHC provider shall submit a new initial licensing packet with a new initial licensing fee to start the initial licensing process.

Step 1

Obtain Health Care Licensing Plan Review approval from the Office of State Fire Marshal

Health Care Licensing Plan Review Internet Site (click on link to open web page)

Office of State Fire Marshal Plan Review Contact Information: Phone- 225-925-4920 or Fax- 225-925-4414

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Step 2

Please submit the following requested information with your application.

1. ADHC Licensing Application form
2. Application fee of $600.00.
3. Payment Transmittal Form (click link to open form)
4. Letter of Intent (include the ADHC name; address and if new construction, the construction completion date)
5. Form HSS-1513L (Disclosure of Ownership) (click link to open form)
6. Copy of Health Care Licensing Plan Review Approval Letter
7. Copy of approved floor plan diagram with green stamp approval from the office of state fire marshal
8. A copy of criminal background checks for all owners of the facility. Approved background check agencies.
9. Proof of financial viability to include: a line of credit issued from a federally insured, licensed lending institution in the amount of at least $50,000
10. Proof of professional liability insurance of at least $300,000
11. Proof of general liability insurance of at least $300,000
12. CLIA (Lab Memo & Application Packet) (Level 4 ARCP)
13. On-site Inspection Approvals (Office of Public Health & State Fire Marshal)
    1. Office of Public Health Inspection Report - To request recommendation for licensure form sanitarian services- Phone 225-342-8954
    2. Office of State Fire Marshal Inspection Report - To request an inspection for notify the District Fire Marshal Office in your area:
       Baton Rouge District Office - 225-925-4914
       Lafayette District Office - 337-886-1273
       New Orleans District Office - 504-219-4600
       Shreveport District Office - 318-676-7145
       Monroe District Office - 318-362-4696
    3. OPH Plan Review Questionaire  - click here
14. 8x11 floor sketch or drawing of the premises
15. Copy of the Articles of Incorporation
16. PACE Providers ONLY - Effective March 1, 2018, all initial license applications shall include a completed Emergency Preparedness Attestation form. 
17. Other Licenses - approval from any pertinent local agencies as required in your areas. (Zoning, occupation license, local fire ordinance, etc.)

Step 3

Health Standards Section will conduct an initial licensing survey to verify compliance with the minimum licensing regulations prior to issuing the ADHC license.

IMPORTANT:

1. Payments (payable to LDH or DHH Licensing) & Payment Transmittal form must be submitted to Chase Bank P.O. Box Below:

LDH Licensing Fee
P.O. Box 734350
Dallas, TX 75373-4350

2. Documentation, such as the application form, Disclosure of Ownership, OPH reports must be sent to the Health Standards Section at:

Health Standards Section
P.O. Box 3767
Baton Rouge, LA 70821-3767

License Renewal

The following is required to complete the Adult Day Health Care renewal process:

1. Adult Day Health Care Provider Renewal Application;
2. HSS Payment Transmittal Form- Listed on the HSS Payment Procedure website
3. Application license fee;
4. $600.00 license renewal fee;
5. Proof of continuous financial viability without interruption, including the maintenance of a line of credit issued from a federally insured, licensed lending institution in the amount of at least $50,000;
6. Current State Fire Marshall Report.  Facilities located in New Orleans must also submit the city Fire Marshall Report;
7. Current Office of Public Health inspection report;
8. For PACE ADHC Providers (only):
   1. proof of PACE program agreement, if accredited;
   2. Licensing Application Addendum for PACE. Effective April 1, 2018, all license renewal applications shall include a completed emergency preparedness attestation form; 
9. HSS Payment Procedure website: http://new.dhh.louisiana.gov/index.cfm/page/1737. 

IMPORTANT:

 1. Payments & Payment Transmittal form must be submitted to Chase Bank P.O. Box Below:

LDH Licensing Payments
P.O Box 734350
Dallas, TX 75373-4350

2. Documentation, such as the application form, Disclosure of Ownership, OPH reports must be sent to the Health Standards Section at:  

Health Standards Section
P.O Box 3767
Baton Rouge, LA 70821-3767

Change of Ownership Information

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:

1. *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)
2. *A diagram showing the ownership structure “before” and “after” the change
3. *Copy of the executed Bill of Sale
4. *CHOW/CHOI License Application
5. *855A/B approval letter for the following providers: Home health, hospice, hospitals, RHCs, ASCs,   

ESRDs, portable x-ray, community mental health and OPT.

Note: If this action is a CHOI, the documents above are the only documents you need to submit, however the Department may, at its discretion, request additional documentation in support of the CHOI. If so, you will be contacted for any of said additional documents. There is no fee for a CHOI. 

If this action is a CHOW, the following documents are also needed:

1. Does your facility have a CLIA Certificate? If yes, contact the CLIA program by clicking here.
2. *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:

1. License Application Emergency Preparedness Addendum form (PACE Providers Only)
2. Criminal Background Checks (new owners) completed by a LSP authorized agency
3. Articles of Incorporation
4. Line of Credit at least $50,000
5. General & Professional Liability Insurance at least $300,000

For all other Change of Ownership Information, please contact the HSS Ownership Group