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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. Initial Application
  2. Disclosure of Ownership
  3. CMS 29
  4. CMS 1561A
  5. Intermediary Preference/Fiscal Year End Date

In addition to the forms listed above, you must include a bill of sale and if applicable, a certified copy of articles of incorporation.  If you have any questions, please contact the program manager at (225) 342-0158.