Change of Address, Key Personnel, or Name

Providers licensed by Health Standards Section (HSS) must notify the department of any changes regarding facility name, email address, phone or fax number and pay associated fees. Notification shall be in writing, on facility or agency letterhead and sent to:

Health Standards Section
Attn: Program Desk
P.O. Box 3767
Baton Rouge, LA 70821

Change of Address

Providers licensed by Health Standards Section (HSS) must notify the department of a change of address. The HCBS license is linked to only one geographical location.  All providers having a change of address shall submit a Letter of intent with the date that the change of address will be effective. Change of physical address requires a new HCBS license application and fee. If the change of address is for a center based service such as center based respite or Adult Day Care, approvals from the State Fire Marshal's Office and Office of Public Health are needed. 

Key Personnel Change

A change in key personnel such as the Administrator requires that the provider notify HSS so that the provider's records can be updated as all communications regarding the agency will be directed to the Administrator. Notification shall be made using the HSS Key Personnel Change form. The forma can be accessed at the following link: 

Name Change 

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

 

Please contact the HCBS Program Desk at 225.219.9776 for additional information.