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.
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:
- 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 general liability insurance of at least $300,000 per occurrence
- Proof of worker's compensation insurance as required by state law
- Proof of professional liability insurance of at least $100,000 per occurrence/$300,00 per annual aggregate, or proof of self-insurance of at least $100,00, along with proof of enrollment as a qualified health care provider with the Louisiana Patient's Compensation Fund (PCF):
- If the ARCP is self-insured and is not enrolled in the PCF, professional liability limits shall be $1,000,000 per occurrence/$3,000,000 per annual aggregate
- NOTE: The LDH/HSS shall specifically be identified as the certificate holder on any policies and any certificates of insurance issued as proof of insurance by the insurer or producer (agent)
For all other Change of Ownership Information, please contact the HSS Ownership Group
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.