How to Complete a Change of Ownership (CHOW) for CLIA
A CHOW packet for CLIA is independent of any change of ownership notification to other programs within the Health Standards Section and must be completed.
For your information, CMS considers the following scenarios changes of ownership:
1. The formation, removal, addition or substitution of a partner,
2. Transfer of title and property to another party;
3. The merger of the provider corporation into another corporation or the consolidation of two or more corporations, resulting in the creation of a new corporation; (transfer of corporate stock or the merger of another corporation into the provider corporation does not constitute change of ownership);
4. The lease of all or part of a provider facility;
5. A change in Federal Tax Identification Number.
If your laboratory meets one of the scenarios listed, please complete and/or submit the following:
1. CLINICAL LABORATORY IMPROVEMENT AMENDMENTS (CLIA) APPLICATION FOR CERTIFICATION AND LIST OF TESTS PERFORMED IN THE FACILITY: With a CHOW the new laboratory owners will keep the same CLIA Identification Number and update the information to that of the new owners. Complete the CLIA application following the instructions provided with the new owner’s information.
2. Disclosure of Ownership Form: The Disclosure of Ownership form should be completed with the updated information for the new laboratory owners.
3. A copy of the executed contract governing the CHOW, i.e., Bill of Sale, Articles of Organization, Lease Agreement, Contract of Employment, etc. The executed contract must demonstrate that the CLIA certificate has been legally transferred from the old owners to the new in order for the CHOW packet to be processed.
Once the information is complete you may submit via email to firstname.lastname@example.org, by fax to (225) 342-0157, or mail to CLIA Laboratory Program, P O BOX 3767, Baton Rouge, LA 70821.