Pediatric Day Health Care Facility

Initial Licensure

A completed initial license application packet for a PDHC facility must be submitted to and approved by the department prior to an applicant providing PDHC facility services.  An applicant must submit a completed initial licensing packet to the department, which shall include:

1. Facility Need Review Approval Letter
2. a completed Pediatric Day Health Care licensure application (HSS Form)
3. a non-refundable licensing fee of $600 (Payment Procedure)
4. a copy of the approval letter of the architectural facility plans from the Office of the State Fire Marshal.
5. a copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshall
6. a copy of the health inspection report with approval of occupancy from the Office of Public Health
7. a copy of a statewide criminal background check conducted by the Louisiana State Police, or its authorized agency, on all individual owners with a 5% or more ownership interest in the PDHC facility, and o all members of the board of directors, and administrator. (Criminal Background Check website)
8. proof of financial viability comprised of the following:
   1. a letter of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000;
   2. proof of general and professional liability insurance of at least $300,000;
   3. proof of worker’s compensation insurance;
9. if applicable, clinical laboratory improvement amendments (CLIA) certificate;
10. disclosure of ownership and control information;
11. a floor sketch or drawing of the premises to be licensed;
12. a copy of the articles of organization or articles of incorporation;
13. qualifications for administrator, director of nursing, and medical director
14. a signed attestation statement from a licensed electrician attesting to the correct installation of a fully functioning generator and that generator is of sufficient wattage to power the facility.

If the initial licensing packet is incomplete when submitted, the applicant will notified of the missing information and will have 90 days from receipt of notification 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.

Checklist for Re-Licensure- Pediatric Day Health Care (PDHC) Facility

In order to renew a license, the PDHC facility shall submit a completed license renewal application packet to the department at least 30 days prior to the expiration of the existing current license.

The license renewal application packet shall include:

1. A completed PDHC licensure application (HSS Form)
2. A non-refundable licensing fee of $600 (Payment Procedure website)
3. A copy of the on-site inspection report with approval for occupancy from the Office of the State Fire Marshall
4. A copy of the health inspection report with approval of occupancy from the Office of Public Health
5. Proof of financial viability comprised of the following:
   1. A line of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000;
   2. General and professional liability insurance of at least $300,000; and
   3. Worker’s compensation insurance

Failure to submit a completed license renewal application packet prior to the expiration of the current license shall result in the voluntary non-renewal of the PDHC license.

Geographical Address Change Process

A PDHC that intends to change the physical address of its geographic location is required to have plan review approval, approval from Office of State Fire Marshall, approval from the Office of Public Health, and an on-site licensing survey by Health Standards Section must be conducted prior to relocation.

Facility Need Review:

1. a PDHC provider undergoing a change of location in the same licensed service area shall submit a written attestation of the change of location and the department shall re-issue the FNR approval with the name and new location;
2. a PDHC provider undergoing a change of location outside of the licensed service area shall submit a new FNR application and appropriate fee and undergo the FNR approval process;
3. FNR approval of a licensed provider shall expire if the provider is moved or transferred to another party, entity or location without application to and approval by the FNR Program.

The relocation application packet shall include:

1. A written “notice of intent” to relocate should be submitted to Health Standards Section at the same time the plan review request is submitted to the Office of the State Fire Marshal’s describing the details of the location change;
2. A completed Pediatric Day Health Care licensure application (HSS Form)
3. A non-refundable licensing fee of $600 as relocation of the facility’s physical address results in a new anniversary date and the full licensing fee must be paid  (Payment Procedure website)
4. A copy of the approval letter of the architectural facility plans from the Office of the State Fire Marshal.
5. A copy of the on-site inspection report with approval for occupancy by the Office of the State Fire Marshall
6. A copy of the health inspection report with approval of occupancy from the Office of Public Health
7. Proof of financial viability comprised of the following:
   1. A letter of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000;
   2. Proof of general and professional liability insurance of at least $300,000;
   3. Proof of worker’s compensation insurance;
8. A floor sketch or drawing of the premises to be licensed;
9. A signed attestation statement from a licensed electrician attesting to the correct installation of a fully functioning generator and that generator is of sufficient wattage to power the facility.

The provider receives written notification of the process to follow in order to schedule the onsite relocation inspection, once all required and approved documentation is. The provider is not to move into the new location until given written approval from the department to do so.

A change in the name of the licensed provider requires that HSS be notified. The provider shall submit a new license application indicating that the transaction being requested is a name change. A fee of $25 will be required to print a new license.

Name Change Process

Please submit the following to complete this process:

1. A “letter of intent” describing the specifics of the change that has occurred and the effective date of that change;
2. A completed license application (HSS Form);
3. The fee of $25, (HSS Payment Procedure); and
4. A copy of documents or articles of incorporation from the Secretary of State’s Office indicating the change. 

Key Administrative Personnel Change

Any change regarding the facility’s key administrative personnel shall be reported in writing to the department with five working days of the change:

Key administrative personnel include the:

1. administrator
2. medical director; and
3. director of nursing

These key administrative personnel changes should be reported by completing and submitting the following HSS form: HSS Key Personnel Change Form

Mailing Address, Email, Phone, or Fax Number Change Process

Please submit a written notification to the department of any mailing address, email, phone, or fax number changes for the facility.

Change of Ownership Information

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:

1. Letter of Intent (including d/b/a (doing business as) and entity name of the previous and the new owner, the effective date of change of ownership, address and phone number).
2. A diagram showing the ownership structure “before” and “after” the change
3. Copy of the executed legal transaction documents (Bill of Sale, lease, etc.)
4. CHOW/CHOI License Application
5. Change of Ownership Application
6. 855A/B approval letter for the following Medicare Certified providers: Home Health, hospice, hospitals, RHCs, ASCs, ESRDs, portable x-ray, community mental health, CORF, Nursing Facilities, and OPT.

Note: If this action is a CHOI, the documents above are the only documents you need to submit, however the Department may, at its discretion, request additional documentation in support of the CHOI. If so, you will be contacted for any of said additional documents. There is no fee for a CHOI. 

If this action is a CHOW, the following are also needed:

1. Does your facility have a CLIA Certificate? If yes, you may also be required to complete a CHOW for CLIA.

2. Licensing Fee: Click here for the link for the Health Standards Fee Schedule 

Note: The fee for a CHOW is usually the same as a license renewal unless the facility is making additional changes. For providers completing an acquisition/merger, please contact the program desk for assistance.

Additional Documents Required:

1. Proof of criminal background check (CBC) on the administrator and all owners
2. Proof of Financial Viability
   1. Line of Credit from a federally insured, licensed lending agency for at least $100,000 and
   2. General & Professional Liability Insurance at least $300,000 and
   3. Worker's Compensation Insurance
3. Days and hours of operation
4. OSFM inspection
5. OPH inspection
6. Completion of key personnel change for if change in administrator of director of nursing
7. A floor sketch or drawing of the premises to be licensed

For all other Change of Ownership Information, please contact the HSS Ownership Group