Psychiatric Residential Treatment Facilities

Initial Licensure

The following forms and fees must be submitted to the Health Standards Section:

1. Initial application and non-refundable fee (click here)
2. Copy of approval letter of Architectural Review (AR) of the facility plans from the Office of the State Fire Marshal (OSFM)
3. Copy of approval letter of Department of Health (DH) facility plans review from the Office of the State Fire Marshal (OSFM)
4. Cautionary codes from the Office of the State Fire Marshal (OSFM)
5. Attestation for compliance with plan review Cautionary Codes
6. Copy of on-site inspection report with approval for occupancy by the Office of the State Fire Marshal
7. Copy of health inspection report with approval for occupancy from the Office of Public Health (OPH)
8. Copy of statewide criminal background checks on all individual owners with 5% or more owner interest in the PRTF entity, and on all members of PRTF's board of directors, if applicable, and administrators;
9. Proof of financial viability, comprised of the following:
   a.  line of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000
   b.  general professional liability insurance of at least $300,00; and
   c.  worker's compensation insurance
10. Floor sketch or drawing of the premises to be licensed
11. Disclosure of Ownership form

Email your licensing packet to: HSS-PRTF-TGH-Licensing@la.gov

Renewals

The following required forms and fees must be submitted to the Health Standards Section at least 30 days prior to the expiration of the current license:

1. License application and non-refundable fee (click here.)
2. Copy of on-site inspection report with approval for occupancy by the Office of the State Fire Marshal
3. Copy of health inspection report with approval for occupancy from the Office of Public Health (OPH)
4. Proof of financial viability, comprised of the following;
   
   1. Line of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000
   2. General professional liability insurance of at least $300,00; and
   3. Worker's compensation insurance

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 (doing business as) and entity name of the previous and the new owner, the effective date of change of ownership, address and phone number).
2. A diagram showing the ownership structure “before” and “after” the change
3. Copy of the executed legal transaction documents (Bill of Sale, lease, etc.)
4. CHOW/CHOI License Application
5. Change of Ownership Application
6. 855A/B approval letter for the following Medicare Certified providers: Home Health, hospice, hospitals, RHCs, ASCs, ESRDs, portable x-ray, community mental health, CORF, Nursing Facilities, 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 are also needed:

1. Does your facility have a CLIA Certificate? If yes, you may also be required to complete a CHOW for CLIA.
2. Licensing Fee: Click here for the link for the Health Standards Fee Schedule 

Note: The fee for a CHOW is usually the same as a license renewal unless the facility is making additional changes. For providers completing an acquisition/merger, please contact the program desk for assistance.

Additional Documents Required:

• License Application Emergency Preparedness Addendum form

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

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