Source: http://www.dads.texas.gov/providers/HCSSA/changeownership.html
Timestamp: 2014-04-19 06:51:37
Document Index: 585568609

Matched Legal Cases: ['art 1', '§97', '§97', 'art 1', '§97', '§97', 'art 1', '§97', '§97', '§97']

HCSSA change of ownership (DADS)
A change of ownership application is required if you answer "yes" to either of the following questions:
Has there been a stock or ownership transfer of 50 percent or more?
Has there been a change in the Tax Identification Number?
You must notify the Texas Department of Aging and Disability Services (DADS) Home and Community Support Services Agencies (HCSSA) Licensing Branch 60 days before the effective date of the ownership change, and DADS must receive a completed application postmarked at least 30 days before the expected date of the ownership change. If the license has expired, you may not perform a change of ownership.
If you have had a stock transfer of 49 percent or less, notify the licensing department, in writing, of this transfer, including the new ownership information, any legal documents and percentages of stock.
CHOW application required documents Applications and required fees must be sent to: Regular mail Regulatory Services
Licensing Fees: $1,750 for each parent or branch license and $1,000 for each alternate delivery site license.
A late fee of $250 per license, in addition to the licensing fee, will be assessed if the change of ownership application is postmarked less than 30 days before the effective date of the change of ownership. DADS Form 2021, Home and Community Support Services Agency License Application, with the nonrefundable fee.
Current Letter of Good Standing from the State Comptroller of Public Accounts or an exemption letter for the taxes from the State Comptroller's Office, if nonprofit. DADS Form 2022, Home and Community Support Services Agencies Licensure Criminal History Check, for all owners, administrators, alternate administrators and chief financial officers. Nonprofit and multi-level organizations must identify the controlling individuals, including: name, position, birth date and, preferably, Social Security number. Organizational structure of the agency denoting lines of authority down to and including the patient care level. Current resumes for the administrator, alternate administrator, supervising nurse and alternate supervising nurse, and required continuing education (CE) certificates for the administrator and alternate administrator. (Click here for a list of training providers.) Resumes must include the month, date, year and a detailed description of the duties performed for current and past employment. Plan for providing continuing training and education for personnel during the term of the license. Refer to the Texas Administrative Code, Title 40, Part 1, Chapter 97, §97.259 and §97.260. Job description and personnel qualifications for the administrator, alternate administrator, supervising nurse and alternate supervising nurse. Refer to the Texas Administrative Code, Title 40, Part 1, Chapter 97, §97.244 and §97.259. Plan that provides for the orderly transfer of client care if the applicant cannot maintain delivery of home health, hospice or personal assistance services. Refer to Texas Administrative Code, Title 40, Part 1, Chapter 97, §97.217, §97.291, and §97.295. Certificates from the HCSSA presurvey computer-based training for the administrator, alternate administrator, supervising nurse and alternate supervising nurse. Copy of the legal entity documents; see below for requirements. Copy of the Internal Revenue Service (IRS) Tax Identification Number document/letter issued by the IRS. Copy of the agency’s National Provider Identification (NPI) number issued by the National Plan and Provider Enumeration System (NPPES). Copy of the Bill of Sale or Sales Agreement. A notarized document signed by the previous owner(s) stating agreement with the change of ownership as well as the effective date of the change of ownership. Accreditation letter (if applicable). The accreditation status does not automatically transfer to the new owner; the agency must have a letter from the accrediting body stating that they have been informed of the change of ownership and the accreditation has been transferred to the new owner(s). Contract status (if applicable). The contracts do not automatically transfer to the new owner. The agency must notify the contract manager and request a contract assignment for each contract (Community Based Alternatives, Primary Home Care, Community Living Assistance and Support Services, etc.). Branch and ADS application for CHOW
DADS Form 2023, Home and Community Support Services Agency Application for Medicare Certified Branch DADS Form 2024, Home and Community Support Services Agency Request for an Alternate Delivery Site License.
DADS Form 2025, Home and Community Support Services Agency Request for Branch License.
Required Medicare documents These documents are required if the agency is seeking certification or is currently certified through the Medicare program. Printed CMS 855A Home Health Enrollment Application (Please read the instructions for how to submit this form to the fiscal intermediary) OR
CMS 1561 Health Insurance Benefit Agreement (PDF format); two copies with original signatures, completing the entire top half section and signing under "accepted for the successor provider of services by"
CMS 417 Hospice Request for Certification in the Medicare Program (PDF format); four copies with original signatures (if applicable)
An application from an agency for a change of ownership license is processed in accordance with the following three general time frames:
Upon receipt of a thoroughly complete application in the DADS HCSSA Licensing Branch (this will be after it has gone through the mail room and accounting; about 10 days from mailing), DADS will issue or deny the license within 45 days. If DADS receives an incomplete application, the DADS HCSSA Licensing Branch will notify the HCSSA applicant in writing of any deficient items in the application. The applicant must respond with complete and correct information within 30 days from the date of the letter or the application will be denied. Upon receipt of the application deficiency response in the DADS HCSSA Licensing Branch, DADS will issue or deny the license within 45 days. top of page Once a CHOW license is issued, the agency must notify the DADS regional office within six months of the issuance of the CHOW license and request a CHOW health survey using DADS Form 2020, Notification of Readiness for Initial Survey. Licensing surveys will continue to be done at regular intervals and must be passed for the agency's license to be renewed. For an agency to retain its license, any inspection, survey, follow-up visit or complaint/incident investigation must show that the agency is in compliance with the current state licensure or federal certification laws and rules, or both.
top of page State and federal regulations and requirements Click here for a list of all applicable state and federal regulations and requirements. HCSSA providers are responsible for reading and understanding these regulations prior to becoming a licensed provider.