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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



211 - Get Connected. Get Answers.

Rural Health Clinic -  CHOW Process

Federal and State regulations require that copies of all documents relating to the change of ownership (CHOW) be submitted along with a description of the CHOW (lease, purchase of assets, etc.), the effective date and the name and address of the old owner and the new owner.  The change of ownership must be filed within five working days of the effective date. The Rural Health Clinic license is not transferable; therefore, a licensing application and fee must be submitted.

FORMS/INFORMATION INCLUDED:

  1. Letter of Intent
  2. Initial Application
  3. Disclosure of Ownership
  4. CMS 29
  5. CMS 1561A
  6. Intermediary Preference/Fiscal Year End Date
  7. Medicare General Enrollement Application (CMS 855A)
  8. Office of Civil Right (Provider Based Only)
  9. Legal Documentation of the Sale
  10. Articles of Incorporation

If you have any questions, please contact the program manager at (225) 342-2205.