End Stage Renal Disease Facility Initial Licensure Requirements
End Stage Renal Disease (ESRD) treatment facilities shall be licensed by the Department of Health (DHH). LDH is the only licensing authority for ESRD facilities in the State of Louisiana. It shall be unlawful to operate an ESRD facility without possessing a current, valid license issued by DHH.
In order to be licensed as an ESRD facility in Louisiana the facility must also be in continuous compliance with federal regulatory requirement applicable to ESRD facilities, including, but not limited to 42CFR Part 494 Conditions for Coverage for ESRD facilities (§ 494.1 - 494.180).
Once a provider is licensed, the license is valid for one year from the date of issue unless otherwise revoked, suspended, or terminated.
Licensing application process:
Please submit Initial Applications and Documentation to:
Attention: Debby Franklin, RN
PO Box 3767
Baton Rouge, LA 70821
- Provider Checklist (Please insure all documents on checklist have been completed before submission.)
- A Licensing Application Form approved by Health Standards Section must be completed.
- Applicable licensing fees ($600 plus $5 per station). Payment Procedure This fee is not refundable in the event the facility fails to meet the licensing requirements and HSS determines that a license could not be issued.
- A Letter of Intent must accompany each licensing application describing the DBA name of the facility to be licensed, the geographical address of the ESRD requesting to be licensed, the anticipated date of completion of the ESRD or the anticipated date by which the facility would be ready for licensing, and the types of surgical specialties to be provided in the ESRD.
- Please complete and submit the CMS-855A to you Fiscal Intermediary as soon as possible.
- Ownership Structure Example
- Architectural plan approval letter from Plan Review
- HSS-ESRD-09 Attestation Form
- Office of State Fire Marshal certificate for occupancy.
- Office of Public Health certificate for occupancy.
- ESRD Application and Survey and Certification Report (Form CMS 3427)
- Life Safety Code Attestation for Exempt ESRD Facilities Form (HSS-LSC-ESRD)
- Attestation for Compliance with Plan Review Directives Form (HSS-PR-ESRD)
An on-site announced licensing survey will only be scheduled and conducted by HSS after submission of all required documents.