Adult Residential Care Provider Initial Licensure
The Department of Health (LDH) shall not process any application until all completed forms, required applicable accompanying information and the application fee (where required) is received.
The application process will be terminated for applicants who have not completed the submission of all the required forms and supplemental information within ninety (90) days of notification of the request for the missing information. Applicants who are still interested in applying must begin the initial process with the submission of a new application packet with new initial licensing fee.
All applicable fees must be submitted by way of Company Check, Cashier's Check or Money Order payable to DHH. Application fees are non-refundable.
When all of the required forms, fees, and information have been received, the applicant will be notified of approval of the packet. Once approval has been received, the ARCP applicant shall notify LDH of the readiness for an initial survey within 90 days. Failure to notify LDH of readiness for an initial licensing survey within 90 days will result in the application being closed. Once the application is closed, the ARCP provider must restart the application process.
Information to be included in the completed Initial Licensing Packet:
1. Obtain Health Care Licensing Plan Review approval from the Office of State Fire Marshal
Health Care Licensing Plan Review Internet Site (click on link to open web page)
Office of State Fire Marshal Plan Review Contact Information: Phone- 225-925-4920 or Fax- 225-925-4414
Please submit the following requested information with your application.
1. ARCP Licensing Application form
2. Application fee of $600.00 & Facility Unit fee - $5 for every unit. A unit is an apartment or resident room
3. Payment Transmittal Form (click link to open Payment Transmittal Form on Payment Procedure website)
4. Letter of Intent (include the level you plan to license; facility name; facility address and if new construction, the construction completion date)
5. Form HSS-1513L (Disclosure of Ownership) (click link to open form)
6. Copy of Health Care Licensing Plan Review Approval Letter
7. Copy of approved floor plan diagram with green stamp approval from the office of state fire marshal
8. A copy of criminal background checks from Louisiana State Police for all owners of the facility. Approved criminal background check agencies.
9. Proof of financial viability to include: a. A letter of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000 or the cost of three months operation, whichever is less; or b. a notarized affidavit of verification of sufficient assets equal to $100,000 or the cost of three months operation, whichever is less;
10. Proof of professional liability insurance of at least $300,000
11. Proof of general liability insurance of at least $300,000
12. Proof of worker's compensation insurance
13. CLIA (Lab Memo & Application Packet) (Level 4 ARCP)
14. On-site Inspection Approvals (Office of Public Health & State Fire Marshal)
A. Office of Public Health - To request an inspection for approval of occupancy - Phone 225-342-8954
B. Office of State Fire Marshal - To request an inspection for notify the District Fire Marshal Office in your area:
Baton Rouge District Office - 225-925-4914
Lafayette District Office - 337-886-1273
New Orleans District Office - 504-219-4600
Shreveport District Office - 318-676-7145
Monroe District Office - 318-362-4696
15. 8x11 floor sketch or drawing of the premises
16. Copy of Facility Need Review approval if applying for Level 4 ARCP
Copy of the Articles of Incorporation
17. Other Licenses - approval from any pertinent local agencies as required in your areas. (Zoning, occupation license, local fire ordinance, etc.)
Health Standards Section will conduct an initial licensing survey to verify compliance with the minimum licensing regulations, prior issuing the ARCP license.
1. Payments & Payment Transmittal form must be submitted to Chase Bank
P.O. Box Below:
LDH Licensing Fee
P.O. Box 62949
New Orleans, LA 70162-2949
2. Documentation, such as the application form, Disclosure of Ownership, OPH reports must be sent to Health Standards Section at:
Health Standards Section
P.O. Box 3767
Baton Rouge, LA 70821-3767