Checklist for Initial Licensure- Adult Brain InjuryA completed initial license application packet for an ABI facility shall be submitted to, and approved by, LDH prior to an applicant providing adult brain injury services.  An applicant shall submit a completed initial licensing packet to LDH, which shall include:

  1. a completed Adult Brain Injury licensure application (HSS Form)
  2. a non-refundable licensing fee of $250 (plus $250 for each offsite location) (Payment Procedure)
  3. a copy of the approval letter of the architectural facility plans from the Office of the State Fire Marshal (OSFM) Health Care licensing plan review internet site - http://sfm.dps.louisiana.gov/pr_healthcare.htm  OSFM plan review contact information: Phone 225-925-4920 or Fax 225-925-4414
  4. a copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshall (residential and outpatient facilities only) 
  5. a copy of the health inspection report with approval of occupancy from the Office of Public Health (residential and outpatient facilities only)
  6. a copy of a statewide criminal background check conducted by the Louisiana State Police, or its authorized agency, on all owners. (Criminal Background Check website)
  7. proof of financial viability as evidenced by one of the following:
    1. verification of sufficient assets equal to $100,000 or the cost of 3 months of operation, whichever is less; or
    2. 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;
  8. proof of general and professional liability insurance of at least $300,000;
  9. proof of worker’s compensation insurance; 
  10. if applicable, clinical laboratory improvement amendments (CLIA) certificate;
  11. disclosure of ownership and control information; 
  12. a readable 11x17 minimum copy floor sketch of the premises to be licensed, including room usage and dimensions (residential and outpatient only);
  13. a copy of the articles of organization or articles of incorporation; 
  14. qualifications for program director & director of nursing

If the initial licensing packet is incomplete, the department will notify the applicant of the 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.