HCBS Provider: Delete a Service Module

Home and Community Based Service (HCBS) providers may offer one or more of the following service modules:

1. Personal Care Assistant (PCA) *
2. Respite Care *
    a. In home
    b. Center-Based (CBR)
3  Supervised Independent Living (SIL) *
    a. SIL Shared Living Conversion
4.  Adult Day Care (ADC)
5.  Family Support
6.  Substitute Family Care (SFC)
7.  Supported Employment

An HCBS provider may discontinue, or delete, a service module by notifying Health Standards Section.

Delete a Service Module Fee

 Deleting a service module will require a new license to be printed that reflects the change in service modules.
$25 license print fee must be submitted with the "Delete Service Module" request.
Fee must be in the form of certified check, company check, or money order made payable to the Department of Health and Hospitals.

Steps to Delete a Service Module

1.  Complete license application form
2.  Mark "X" next to "Add or Delete a Service"
3.  Circle "Delete"
4.  Mark "X" next to service module(s) you are deleting in the section titled "Service Modules"
5.  Submit the completed application form and $25 fee to Health Standards

Mail to:
Health Standards Section
P.O. Box 3767
Baton Rouge, LA 70821

HCBS program desk contacts are located on the HCBS home page.