Health Standards Section
NH CHOW Packet
For more information call: 225.342.0114
This packet is designed to assist the nursing home provider in completing and submitting the required information, forms and fees for a nursing home Change of Ownership (CHOW). Please complete all required information before submitting the packet and fees. If you have questions regarding the packet please call: 225.342.0114.
A Letter of Intent should be submitted prior to the effective date of the Change of Ownership. The letter shall plainly describe exactly what is occurring through the CHOW process(lease, purchase of assets, etc.). The letter should include; the facilities current DBA name and legal entity (corporation) name; the new owner DBA name and legal entity (corporation) name with its address and contact information; and the effective date of the transfer of ownership.
The Nursing Home license is not transferable; therefore, another licensing application and fee must be submitted. The fee of $600.00 plus $5.00 per room must be in the form of a company check, certified check, or money order payable to the Department of Health and Hospitals. If more than one CHOW occurs the fee is applicable to each.
Please be sure to mail or deliver the entire packet to:
Mail To:
LA-DHH Health Standards Section
NH CHOW
P.O. Box 3767
Baton Rouge, LA 70821-1811
OR; Ship To:
LA-DHH Health Standards Section
NH CHOW
602 N. Fifth Street, 2nd Floor
Baton Rouge, LA 70802
Documents that are provided in this packet follow:
Documents that are not provided in this packet but may be needed to complete the CHOW follow:
1. Letter of Intent (Submitted prior to Effective date, can be seperate from CHOW Packet)
2. Signed/Dated legal documentation of Sale, Lease, or Merger, etc.
3. Resident Trust Fund Balance Information
4. A copy of the signed and dated Surety Bond agreement been included in name of the new provider.
5. A Copy of letter from Office of Management & Finance (225-342-4175) regarding outstanding fees.
6. A Copy of the COVER LETTER for the CMS 855A Medicare Enrollment App. sent to Fiscal Intermediary (FI). (or assurance that the FI has been contacted regarding the 855)
7. A copy of the facility's Hospital Transfer Agreement(s)
8. Assurance of Compliance with Civil Rights Form HHS-690
Please Note:
Health Standards does not have the CMS 855A Medicare Enrollment Application. The Fiscal Intermediary should be contacted regarding the CMS 855A Medicare Enrollment Application. All questions regarding the CMS 855A Medicare Enrollment Application should be directed to the fiscal intermediary or CMS.
