STATE OF LOUISIANA

DEPARTMENT OF HEALTH AND HOSPITALS

Questions and Answers about Completing the Application for Bed

Changes in Hospitals

1. What beds/rooms need to be licensed? A licensed bed is defined as an adult

and/or pediatric bed set up or capable of being set up within 24 hours (in a
hospital) for the use of patients, based upon bedroom criteria expressed in the
licensing standards. A unit is defined as a licensed patient room. All hospital
beds/rooms into which patients are admitted and discharged should be licensed
with the exception of recovery rooms/beds, Nursery/NICU bassinets, Emergency
Department rooms/beds, Observation rooms/beds (stays less than 23 hours) and
Labor/Delivery (L/D) rooms/beds. LDRP (Labor/Delivery/Postpartum/Recovery)
rooms/beds are counted as licensed beds if patients are admitted into these beds
upon admission and discharged from the hospital from these beds. The facility
should notify DHH of bed changes even if the rooms/beds are not required to be
licensed.

2. When should a hospital make application for a bed change? As soon as the
facility feels that the bed change is a feasible possibility, and all information
required for the packet is complete, the hospital should submit the bed change
packet to DHH. Provide time for DHH review and approval of the packet as well
as the on-site survey prior to establishment of an effective date.

3. Where do I write to get the application for a bed change? You can submit
your request to: Department of Health & Hospitals, Health Standards Section,
P.O. Box 3767, Baton Rouge, LA 70821, along with a money order or
corporate check made out to Department of Health & Hospitals for $10.00.
You can also visit the website at www.dhh.louisiana.gov/offices/?ID=112, select
publications and then go to the area titled hospitals.

4. Who should be responsible for completing and filing the application with
DHH? The facility should designate one person to be responsible for handling
this project and all communication should be routed through him/her. This is
most important when a hospital is attempting to make multiple changes.

5. What is involved in making an application for bed changes? When the

Hospital Desk at the Health Standards Section of DHH receives the completed
packet of forms and required paperwork, the paperwork will be reviewed for
completeness and appropriateness. Once determined to be complete, the packet
will be placed in line for processing. When the hospital program manager has
processed the packet, a letter will be sent to you informing you of whether or not

OFFICE OF MANAGEMENT & FINANCE • BUREAU OF HEALTH SERVICES FINANCING•HEALTH STANDARDS SECTION
500 LAUREL STREET •SUITE 100 (70801-1811) P.O. BOX 3767 • BATON ROUGE, LOUISIANA 70821-3767
PHONE #: (225) 342 • 0138 • FAX #: (225) 342-0157 www.dhh.louisiana.gov
“AN EQUAL OPPORTUNITY EMPLOYER”
 STATE OF LOUISIANA
DEPARTMENT OF HEALTH AND HOSPITALS

an on-site survey will be conducted. After the survey, if required, you will
receive a letter telling you whether your bed changes were licensed or not, and if
not, the reason why the requested changes were not licensed. If licensed, you will
receive a new license reflecting the new bed number.

6. What are the telephone numbers of people that I may need to get in touch
with to assist with the application process?
a. DHH Department of Engineering (Plan Review) – 225-342-9029 (To
arrange review of building plans)
b. State Fire Marshall – 225-925-4296 (To arrange the fire inspection)
c. Public Health Department – 225-925-7200 (To arrange the public health
inspection)
d. Joint Commission – 630-916-5019 (To extend accreditation to your
rooms/beds)
e. Louisiana Board of Pharmacy – 225-925-6496 (To arrange for your
Controlled Dangerous Substances license if applicable)
f. Drug Enforcement Agency – 504-840-1061 (To arrange for your
Controlled Dangerous Substances license if applicable)
g. Hospital Program Desk – 225-342-6194 or 225-342-5782 (For questions
concerning application)
h. CMS Regional Office in Dallas – 214-767-4423 (For information related
to provider-based designation criteria)

7. What are the required documents that need to be returned to DHH to

process the bed change application? The following items need to be submitted
in the packet to DHH in the order listed below:
a. Checklist for Hospital Bed Changes – This form must be on top of all
paperwork submitted and all areas must be completed except for the area
designated “For DHH Use Only.”
b. Letter of Intent – This letter should be on hospital letterhead and include
a description of the intent of the hospital, effective/opening date, physical
description of the area/building, description of the purpose of the
rooms/beds, explanation of decrease/increase/change and description of
services offered. If the services provided in the beds/rooms are changing,
provide an explanation of the prior and future use of the rooms/beds.
c. Hospital License Application – This form must be completed in its
entirety and include all offsite campuses. Please circle the main campus
and/or any offsite campuses where beds are being
added/decreased/changed. Also follow additional instructions attached to
this application.

Revised 10/15/09
OFFICE OF MANAGEMENT & FINANCE • BUREAU OF HEALTH SERVICES FINANCING•HEALTH STANDARDS SECTION
500 LAUREL STREET •SUITE 100 (70801-1811) P.O. BOX 3767 • BATON ROUGE, LOUISIANA 70821-3767
PHONE #: (225) 342 • 0138 • FAX #: (225) 342-0157 www.dhh.louisiana.gov
“AN EQUAL OPPORTUNITY EMPLOYER”
 STATE OF LOUISIANA
DEPARTMENT OF HEALTH AND HOSPITALS

d. License Fees – If the only change on the application involves a change in

rooms/bed numbers, a money order or corporate check made out to the
Department of Health & Hospitals should be submitted for $25.00 plus
$5.00 per inpatient room for each room added to the license.
e. Worksheet for Hospital Bed Addition/Change to be completed by
Hospital (if applicable) – You may need to make multiple copies of this
form depending on how many beds/rooms you are adding. Please total the
number of rooms/beds and compare to the number of licensed rooms/beds
you already have licensed. Place the rooms you are
adding/decreasing/changing service type on a separate worksheet.
f. Plan Review Approval Letter – This letter will be sent to you once the
plan review division has approved your building’s plans for the bed
changes. Please remember to submit this form early in your licensing
process to allow time (6 to 8 weeks) for the receipt of the approved letter.
g. Small (letter size) floor plan – Submit this for each floor where bed
changes are being made and specify room numbers, number of beds in
each room, square footage, care stations (i.e. nurse’s station, soiled/clean
utility, etc).
h. Letter from Joint Commission (if applicable) –Please submit a letter
from Joint Commission indicating that accreditation will be extended upon
licensure by DHH.
i. Office of State Fire Marshal Plan Review Approval- Please submit a
copy of the plan review from the Office of State Fire Marshall.
j. Fire Marshal Inspection Approval – This form must indicate the address
where the bed changes are being made as well as the areas being reviewed
(i.e. 6th floor patient rooms 601, 602, 603, etc and care areas)
a. Public Health Inspection Approval – This form must indicate the
address where the bed changes are being made as well as the areas being
reviewed (i.e. 6th floor patient rooms 601, 602, 603, etc and care areas)
b. Lease agreement (if applicable) – If the hospital owns the building
where bed changes are being made then submit a letter on hospital
letterhead indicating that the hospital is the owner and that the licensed
areas will not be subleased.
c. Letter from Lessor (if applicable) – If the applying hospital is leasing
space/rooms from another DHH licensed health care provider, a letter
from the Lessor is required indicating the effects that this lease will have
in their facility, i.e., decreasing the Lessor’s licensed bed capacity, having
to move licensed beds to another area, etc. Also include the effective date
of the Lessor’s changes.
d. Organizational Chart – If inpatient rooms/beds are being added to an
off-site location that previously had no inpatient rooms/beds, submit an
Revised 10/15/09
OFFICE OF MANAGEMENT & FINANCE • BUREAU OF HEALTH SERVICES FINANCING•HEALTH STANDARDS SECTION
500 LAUREL STREET •SUITE 100 (70801-1811) P.O. BOX 3767 • BATON ROUGE, LOUISIANA 70821-3767
PHONE #: (225) 342 • 0138 • FAX #: (225) 342-0157 www.dhh.louisiana.gov
“AN EQUAL OPPORTUNITY EMPLOYER”
 STATE OF LOUISIANA
DEPARTMENT OF HEALTH AND HOSPITALS

organizational chart indicating how this off-site campus fits into the
organization of the main campus.
e. Attestation Letter – signed by the administrator or designee.
f. Copy of the cover letter that was sent to the Fiscal Intermediary
notifying them of the bed/room addition if applicable – Remember that
it is the hospital’s responsibility to notify the fiscal intermediary. Please
submit this early in your planning process to allow time for the fiscal
intermediary to process it.

8. How is the effective date determined for the bed change to be extended under
the hospital’s license? The earliest effective date to include the bed change
under your hospital license would be the latest date that is on any of the required
documents or the date of the on-site inspection if required.

9. Who grants the approval for the bed change to be included under the
hospital’s license? The State Office grants approval for the license. However, if
the hospital is also certified for Medicare and Medicaid, and requests that the bed
changes be certified, CMS will also need to approve the bed changes.

10. Who else do we need to notify? In order to determine if there are any additional
requirements for reimbursement, you must contact your Medicare and Medicaid
Fiscal Intermediary.

11. Caveat: Hospital licensing law states “Each license issued hereunder shall be for
a period of one year from date of issuance unless sooner revoked, shall be on a
form prescribed by the Department, shall not be transferable or assignable, shall
be issued only for the person and premises named in the application.

Revised 10/15/09
OFFICE OF MANAGEMENT & FINANCE • BUREAU OF HEALTH SERVICES FINANCING•HEALTH STANDARDS SECTION
500 LAUREL STREET •SUITE 100 (70801-1811) P.O. BOX 3767 • BATON ROUGE, LOUISIANA 70821-3767
PHONE #: (225) 342 • 0138 • FAX #: (225) 342-0157 www.dhh.louisiana.gov
“AN EQUAL OPPORTUNITY EMPLOYER”