Hospice Initial Licensure

Hospice facilities shall be licensed by the Department of Health (DHH). LDH is the only licensing authority for hospice facilities in the State of Louisiana. It shall be unlawful to operate a Hospice facility without possessing a current, valid license issued by DHH. Once a license has been issued it shall be valid until its expiration date, unless otherwise revoked, suspended, or terminated.

Effective March 20, 2012 Facility Need Review approval is required for intial licensure, change of address and change of ownership.

Initial License Application
Letter of Intent

Hospice Required Documentation
The provider must submit a Letter of Intent to HSS via e-mail.  Required documents may be submitted with the Letter of Intent.
Below is a list of documents that are required for Initial License Application of a Hospice:

  1. a copy of the approval letter of the architectural facility plans from the LDH Department of Engineering and Architectural Services (if an inpatient facility)
  2. a copy of the approval letter of the architectural facility plans from the Office of the State Fire Marshal; (if an inpatient facility)
  3. a copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshal; (if an inpatient facility)
  4. a copy of the health inspection report with approval of occupancy from the Office of Public Health; (if an inpatient facility)
  5. a copy of criminal background checks on all owners and the administrator;
  6. Line of Credit ($75,000) from a federally insured lending agency 
  7. proof of general and professional liability insurance of at least $300,000;
  8. proof of worker’s compensation insurance;
  9. if applicable, Clinical Laboratory Improvement Amendments (CLIA) certificate or CLIA certificate of waiver;
  10. a completed disclosure of ownership and control information form;
  11. a floor sketch or drawing of the premises to be licensed; (if an inpatient facility)
  12. qualifications for the Administrator, Director of Nursing, and Medical Director
  13. a copy of the Articles of Incorporation
  14. Intermediary Preference/Fiscal Year End Date form
  15. Form CMS-417 Hospice Request for Certification in the Medicare Program
  16. Form CMS-1561 Health Insurance Benefit Agreement (three copies with original signatures)
  17. completed License Application form