Adult Brain Injury

An applicant shall submit a completed initial licensing packet to LDH, to include: 

• a completed licensure application 
• a non-refundable licensing fee of $250 (plus $250 for each offsite location) 
• Required Letters and Report from the Office of the State Fire Marshall
  • a copy of the approval letter of the architectural facility plans
  • a copy of the on-site inspection report with approval for occupancy
• Required Report from Office of Public Health
  • a copy of the health inspection report with approval of occupancy
• a copy of a statewide criminal background check 
• proof of financial viability as evidenced by one of the following:
  • verification of sufficient assets equal to $100,000 or the cost of 3 months of operation, whichever is less; or
  • a letter of credit from a federally insured, licensed lending institution in the amount equal to $100,000 or the cost of 3 months operation, whichever is less
• proof of general and professional liability insurance of at least $300,000
• proof of worker’s compensation insurance
• if applicable, clinical laboratory improvement amendments (CLIA) certificate
• disclosure of ownership and control information
• a readable 11x17 minimum copy floor sketch of the premises to be licensed, including room usage and dimensions (residential and outpatient only)
• a copy of the articles of organization or articles of incorporation
• qualifications for program director & director of nursing

The department will notify the applicant of any missing information and the deadline to submit the additional requested information. 

If the additional requested information is not submitted to the department within 90 days of notification, the application will be closed.

The facility shall submit a completed license renewal application packet to the department at least 30 days prior to the expiration of the existing current license.

The license renewal application packet shall include:

• a completed licensure application 
• a non-refundable licensing fee of $250 (plus $250 for each offsite location) 
• Required Letters and Report from the Office of the State Fire Marshall
  
  • a copy of the on-site inspection report with approval for occupancy
• Required Report from Office of Public Health
  
  • a copy of the health inspection report with approval of occupancy

Failure to submit prior to the expiration of the current license will result in the voluntary surrender of the ABI facility license.

The provider shall submit a new license application showing the transaction being requested is a name change.

Please submit the following to complete this process:

• a “letter of intent” describing the specifics of the change and the effective date of change
• a completed licensure application 
• a fee of $25 (name change per printed license)
• a copy of documents or articles of incorporation from the Secretary of State’s Office indicating the change

Please submit the following to complete this process:

• a “letter of intent” describing the specifics of the change and the effective date of change
• a completed licensure application 
• a fee of $250 (plus $250 for each offsite location) 
• Required Letters and Report from the Office of the State Fire Marshall 
  • a copy of the approval letter of the architectural facility plans
  • a copy of the on-site inspection report with approval for occupancy
• Required Report from Office of Public Health
  • a copy of the health inspection report with approval of occupancy
• disclosure of ownership and control information
• a readable 11x17 minimum copy floor sketch of the premises to be licensed, including room usage and dimensions (residential and outpatient only)

Once the information is received, the LDH Health Standards Section must conduct an onsite physical environment inspection before final approval can be given to the provider to move into the new location. 

Changes to a facility’s key administrative personnel shall be reported in writing to the department within five (5) working days of the change.

Key administrative personnel include:

• facility director
• director of nursing

Key administrative personnel changes should be reported by completing and submitting the following HSS form: 

• HSS Key Personnel Change Form

Please submit a written notification to the department of any mailing address, email, phone, or fax number changes for the facility.