Adult Day Health Care 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.
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.
If the initial licensing packet is incomplete, the applicant will be notified of the missing information and will have 90 days to submit the additional requested information. If the additional requested is not submitted to the department within 90 days, the application will be closed. After an initial licensing application is closed, an applicant who is still interested in becoming an ADHC provider shall submit a new initial licensing packet with a new initial licensing fee to start the initial licensing process.
Information to be included in the completed Initial Licensing Packet:
1. Obtain Facility Need Review Approval. On February 20, 2010, the Department of Health and Hospitals, Bureau of Health Services Financing amended LAC 48:I.12501, 12503, 12505 and adopted 12525 in the Medical Assistance Program. This rule requires all applicants for Adult Day Health Care licenses to first obtain a facility need approval before a license can be issued.
2. 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. Facility Need Review Approval Letter
2. ADHC Licensing Application form
3. Application fee of $600.00.
4. Payment Transmittal Form (click link to open form)
5. Letter of Intent (include the ADHC name; address and if new construction, the construction completion date)
6. Form HSS-1513L (Disclosure of Ownership) (click link to open form)
7. Copy of Health Care Licensing Plan Review Approval Letter
8. Copy of approved floor plan diagram with green stamp approval from the office of state fire marshal
9. A copy of criminal background checks from Louisiana State Police for all owners of the facility
10. Proof of financial viability to include: a line of credit issued from a federally insured, licensed lending institution in the amount of at least $50,000
11. Proof of professional liability insurance of at least $300,000
12. Proof of general liability insurance of at least $300,000
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 Inspection Report - To request recommendation for licensure form sanitarian services- Phone 225-342-8954
B. Office of State Fire Marshal Inspection Report - 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 the Articles of Incorporation
17. HSS Mandatory Preparatory Training Class - Copy of Certificate
18. 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 ADHC 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