Home and Community Based Service Provider (HCBS) Initial Licensing Checklist
The initial licensing application packet shall include:
- completed HCBS licensure application, mailed to Health Standards Section, P.O. Box 3767, Baton Rouge, Louisiana, 70821-3767;
- non-refundable licensing fee (see payment transmittal form for more information)
- copy of the approval letter of the architectural facility plans from the Office of the State Fire Marshal, and any other office/entity designated by the department to review and approve the facility’s architectural plans (Adult Day Care and Center Based Respite modules);
- copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshal (Adult Day Care and Center Based Respite modules);
- copy of the health inspection report with approval of occupancy from the Office of Public Health (Adult Day Care and Center Based Respite modules);
- copy of floor sketch;
- copy of a statewide criminal background check, including sex offender registry status, on all owners and administrators. Click here for list of approved vendors.
- proof of financial viability, comprised of:
- a line of credit letter issued from a federally insured, licensed lending institution in the amount of at least $50,000. *For the purposes of an HCBS licensure, personal loans or bank balances of $50,000 or more do not meet this requirement. No waiver of this requirement will be granted.
- certificate of general and professional liability insurance of at least $300,000. Certificate holder must state: Louisiana Department of Health, Health Standards Section, P. O. Box 3767, Baton Rouge, Louisiana 70821-3767; and
- certificate of worker’s compensation insurance. Certificate holder must state: Louisiana Department of Health, Health Standards Section, P. O. Box 3767, Baton Rouge, Louisiana 70821-3767.
- completed disclosure of ownership and control information form located at: click here
- copy of organizational chart, including names and position titles of key administrative personnel and governing body;
- copy of certificates of completion of mandatory initial provider training (owners and administrators), Part 1-3. Click here to access regulatory training modules.
- any other documentation or information required by the department for licensure. Please refer to the HCBS Providers Minimum Licensing Standards published here.