Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part I - General Administration › Subpart 3 - Licensing and Certification › Chapter 77 - Nursing Staffing Agencies Licensing Standards › Subchapter A - General Provisions › Section I-7707 - Initial Licensure Application Process

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 An initial application for licensing as an NSA shall be made to the department
					 on forms provided by the department. A completed initial license application
					 packet for NSAs shall be submitted to and approved by the department prior to
					 an applicant providing NSA services.
B. The initial licensing application packet
					 shall include:
1. a completed NSA licensure
					 application and the appropriate non-refundable licensing fee as established by
					 statute. The license application shall contain the name and address of the
					 person, partnership, corporation, unincorporated association, or other legal
					 entity that is the applicant, and the name and address of the registered
					 agent;
2. if applicable, a copy of
					 the NSA's articles of incorporation or organization, a copy of its current
					 bylaws, and the names and addresses of its officers, administrator/director,
					 and shareholders owning more than 5 percent of the corporation's
					 stock;
3. a copy of verification of
					 current active business with the Secretary of State, or equivalent state
					 business registry, which references the current registered agent;
4. a copy of the organizational chart of the
					 NSA, including the names and addresses of the person or persons under whose
					 management or supervision the NSA will be operated;
5. a statement detailing the experience and
					 qualifications of the applicant to operate an NSA;
6. a statement of financial solvency,
					 comprised of the following:
a. a line of
					 credit issued from a federally insured, licensed lending institution in the
					 amount of at least $25,000 that is:
i. current
					 and in effect at the time of submission of the application for licensure;
					 and
ii. issued to and in the name
					 of the applicant shown on the application for licensure;
b. general and professional liability
					 insurance in an amount sufficient to provide coverage in accordance with the
					 total amount recoverable for all malpractice claims as indicated in
					 R.S.
					 40:1231.2, or current law; and
c. worker's compensation insurance that is in
					 compliance with the Louisiana Workers' Compensation Law,
					 R.S.
					 23:1020.1 et seq., or current law, with a
					 minimum coverage in the amount of $1,000,000 that is current and in effect at
					 the time of submission of the license application;
7. proof that the LDH, HSS is specifically
					 identified as the certificate holder on any policies and any certificates of
					 insurance issued as proof of insurance by the insurer or producer
					 (agent);
8. a copy of a statewide
					 criminal background check including sex offender registry status, on all
					 applicant(s), owner(s) with 5 percent or more ownership interest, and
					 administrator/director, for any state lived in within the last five
					 years;
9. a completed disclosure of
					 ownership and control information form;
10. a statement of the days and hours of
					 operation; and
11. any other
					 relevant documentation or information required by the department for
					 licensure.