HCBS provider: Add a Service Module

Home and Community Based Service (HCBS) providers may offer one or more of the following service modules:

1. Personal Care Assistant (PCA) *
2. Respite Care *
    a. In home
    b. Center-Based (CBR)
3  Supervised Independent Living (SIL) *
    a. SIL Shared Living Conversion
4.  Adult Day Care (ADC)
5.  Family Support
6.  Substitute Family Care (SFC)
7.  Supported Employment

A licensed HCBS provider may request approval from Health Standards to add service modules.
PCA, Respite Care and SIL require Facility Need Review approval prior to submitting an application to Health Standards to add one or more of these services.  The FNR approval letter must accompany the application submitted to Health Standards.

Addition of Service Module Fees

$200  ADC
$200  Center-Based Respite
There is a $25 license print fee to add other service modules.
Fees must be in the form of certified check, company check, or money order made payable to the Department of Health and Hospitals.

Steps to Add a Service Module

1. Complete license application
2. Mark "X" next to "Add or Delete a Service"
3. Circle "Add"
4.  Mark "X" next to service module(s) you are adding in the section titled "Service Modules"
5.  Submit the completed application form, fees, FNR approval letter(s) if applicable to:

Health Standards Section
P.O. Box 3767
Baton Rouge, LA 70821

Please refer to the HCBS Providers Minimum Licensing Standards published in the Louisiana Register for service module definitions, general provisions and operational requirements. A link to the regulations and HCBS program desk contacts are located on the HCBS home page.