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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



211 - Get Connected. Get Answers.

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.

Mail Payment & Payment Transmittal Form to:

Mail ALL other CHOW Documentation to:

DHH Licensing Fee

P.O. Box 62949

New Orleans, LA 70162-2949

Health Standards Section

P.O. Box 3767

Baton Rouge, LA 70821-3767

 

Click HERE for Payment Transmittal Form

 

Please be sure to mail or deliver the ONLY the CHOW Documents  packet NO FEES 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.