HSS Change of Ownership Information: Case Management
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
For all other Change of Ownership Information, please contact the HSS Ownership Group
Fee schedule information: click here