Pain Management Clinics

Initial Licensure

The provider must submit a Letter of Intent to HSS via US mail. Required documents may be submitted with the Letter of Intent.

Below is a list of documents that are required for Initial License Application of a Pain Management Clinic. Submit documents to Health Standards Section.

1. Completed Pain Management Clinic Application Form
2. Completed fire marshal's approval from the Office of the State Fire Marshal
3. Completed health approval from the Louisiana Office of Public Health
4. Appropriate licensing fee: Payment Procedure
5. Zoning approval from local government - 8" x 10" floor sketch of your facility showing the required rooms and their sizes.
6. Copy of the clinic's occupational license.
7. Copy of criminal background check from the Louisiana State Police or their authorized agent on all owners.
8. Verification of the physician owners' certification in the subspecialty of pain management in accordance with Section 7803 of the Pain Management Clinic licensure rules

NOTE: LA R.S. 40:2198.12 D. (2) A Pain management clinic that is not licensed by or has not made an application to the department for licensure under this Part on or before August 1, 2014, shall not be licensed under the exemption to Subsection A of this Section as provided for in this Subsection.

Renewals

Providers will be notified 75 days prior to their license expiration date.

The following are required by Health Standards Section for renewal:

1. completed license application
2. license renewal requirements checklist

Once all requirements are met a new license will be mailed to the provider before the current license expires.

 

Change of Ownership Information

Providers must complete this document when they have a change in their ownership structure. This document would be used for both a change of ownership (CHOW) as defined by state and/or federal regulations, or a change of ownership information (CHOI) that does not meet the state and/or federal regulations CHOW definition.

 For Health Standards to make a CHOW/CHOI determination, all providers must submit the following documents:

1. *Letter of Intent (including d/b/a and entity name of the previous and the new owner, the effective date of transfer of ownership, address and phone number)
2. *A diagram showing the ownership structure “before” and “after” the change
3. *Copy of the executed Bill of Sale
4. *CHOW/CHOI License Application
5. *855A/B approval letter for the following providers: Home health, hospice, hospitals, RHCs, ASCs,   

ESRDs, portable x-ray, community mental health and OPT.

Note: If this action is a CHOI, the documents above are the only documents you need to submit, however the Department may, at its discretion, request additional documentation in support of the CHOI. If so, you will be contacted for any of said additional documents. There is no fee for a CHOI. 

If this action is a CHOW, the following documents are also needed:

1. Does your facility have a CLIA Certificate? If yes, contact the CLIA program by clicking here.
2. *Licensing Fee: Click here for the link for the Health Standards Fee Schedule

The fee for a CHOW is usually the same as a license renewal unless the facility is making additional changes. For the providers completing an acquisition/merger, please contact the program desk for assistance. 

For all other Change of Ownership Information, please contact the HSS Ownership Group