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Change of Agency Name, Geographic Address, or Key Personnel
Providers licensed by the Health Standards Section (HSS) must notify the appropriate department of any changes regarding facility name, geographical address, or key personnel and pay applicable fees. Also, HSS must be notified of a new email address, telephone or fax number. Notification shall be in writing, on facility or agency letterhead (or by application as instructed below) and sent to:
Health Standards Section
Attn: HCBS Program Desk
P.O. Box 3767
Baton Rouge, LA 70821
**payments, if applicable, must be made to a separate address.
Agency name changes (without a change in ownership) require the issuance of a new license. The new agency name must be reported to HSS no later than five (5) days prior to the change. To report the change, you must submit a new HCBS licensure application with “name change” selected, along with other required documents. Please click on the links below to access the application, checklist and fee schedule.
Because an HCBS license is only valid for the provider’s geographical location, and is not transferrable or assignable, changes in physical address must be reported to HSS no later than five (5) days prior to the change.
Steps:
- Visit the Facility Need Review webpage and follow the instructions under Change of Location. Click here for more information.
- Submit a new HCBS licensure application with “change of address” selected, along with other required documents, and applicable fees.
Note: a change in the geographical address results in a new license renewal anniversary date.
A change in key personnel, such as the Administrator, must be reported to HSS no later than ten (10) working days, subsequent to the change. To report the change, you must submit a Key Personnel Change Form and other required documents. There is no fee for this service.
A new email address, telephone number or fax number, must be reported to HSS no later than five (5) days prior to the change. Notification shall be in writing on facility or agency letterhead. There is no fee for this service.
Please refer to the HCBS Providers Minimum Licensing Standards for service module definitions, general provisions, operational requirements and branch/satellite requirements. A link to the regulation and HCBS program desk contacts are located on the HCBS home page.