Form 3229, License Application to Operate a Multiple Location General or Special Hospital

Instructions for Opening a Form

Some forms cannot be viewed in a web browser and must be opened in Adobe Acrobat Reader on your desktop system. Click here for instructions on opening this form.

Documents

Effective Date: 1/2023

Instructions

Updated: 1/2023

Purpose

Form 3229 is used to apply for an initial, change of ownership or relocation license for a multiple location general or special hospital.

Procedure

When to Prepare

An applicant must submit the application form, license fee, and other applicable documents, and complete all actions as required by Texas Administrative Code Title 25 (25 TAC) Section 133.22. Information regarding licensure for general hospitals is located on the HHSC General Hospitals webpage and information regarding licensure for special hospitals is located on the HHSC Special Hospitals webpage.

For Health Care Regulation contact information, visit the Health Care Facilities Regulation Contact Us webpage.

Texas Health and Human Services Commission must approve all required application materials received before HHSC will issue a license to the applicant.

Initial Application

An applicant for an initial license must complete the following requirements.

  • Submit the following to HHSC:
    • A completed Form 3229 no earlier than 60 calendar days before the projected opening date of the hospital.
    • A license fee of $39 per bed. 
      • Make checks payable to the Texas Health and Human Services Commission.
      • License fees are not refundable.
    • A copy of the following patient transfer documents for the hospital:
      • Patient Transfer Policy, signed by the chairman and secretary of the hospital’s governing body, that meets the requirements of 25 TAC Section 133.44, Hospital Patient Transfer Policy.
      • Memorandum of Transfer that meets the requirements of 25 TAC Section 133.44(c)(10)(B).
      • Note: Patient transfer agreements between general hospitals are voluntary. If the application is for a special hospital, a copy of a written agreement the special hospital has entered into with a general hospital, which provides for the prompt transfer to, and the admission of, any patient when special services are needed but are unavailable at the special hospital, must be submitted. This agreement is required and is separate from any voluntary patient transfer agreements the hospital may enter into in accordance with 25 TAC Section 133.61, Hospital Patient Transfer Agreements.
    • A completed Fire Safety Survey Report indicating approval by the local fire authority in whose jurisdiction the facility is based that is dated no earlier than one year prior to the opening date.
      • Annual fire safety inspections are required for continued licensure.
  • Obtain approval for occupancy from the Architectural Review Unit.
  • Attend a pre-licensure conference (previously called pre-survey conference) conducted by the Health Facility Compliance unit. HFC holds pre-licensure conferences once a month and requires one or more of the following individuals to attend: the hospital CEO, administrator, or another individual listed on the application. For more information or to schedule the pre-licensure conference, contact the designated Regional Office.

Relocation Application

A currently licensed facility applying for relocation must complete the following requirements.

  • Submit the following to HHSC:
    • A completed Form 3229 no earlier than 60 calendar days before the projected opening date of the hospital.
    • A license fee of $39 per bed. 
      • Make checks payable to the Texas Health and Human Services Commission.
      • License fees are not refundable.
    • A copy of the following patient transfer documents for the hospital:
      • Patient Transfer Policy, signed by the chairman and secretary of the hospital’s governing body, that meets the requirements of 25 TAC Section 133.44, Hospital Patient Transfer Policy.
      • Memorandum of Transfer that meets the requirements of 25 TAC Section 133.44(c)(10)(B).
      • Note: Patient transfer agreements between general hospitals are voluntary. If the application is for a special hospital, a copy of a written agreement the special hospital has entered into with a general hospital, which provides for the prompt transfer to, and the admission of, any patient when special services are needed but are unavailable at the special hospital, must be submitted. This agreement is required and is separate from any voluntary patient transfer agreements the hospital may enter into in accordance 25 TAC Section 133.61, Hospital Patient Transfer Agreements.
    • A copy of the letter or certificate of accreditation from an authorized accrediting agency which includes effective dates of accreditation (if applicable).
    • A completed Fire Safety Survey Report indicating approval by the local fire authority in whose jurisdiction the facility is based that is dated no earlier than one year prior to the application date.
      • Annual fire safety inspections are required for continued licensure.
  • Obtain approval for occupancy from the Architectural Review Unit. 

Change of Ownership (CHOW) Application

A currently licensed facility applying for a CHOW must complete the following requirements.

  • Submit the following to HHSC:
    • A completed Form 3229 before the date of the CHOW or not later than 10 calendar days following the date of the CHOW.
    • A license fee of $39 per bed.
      • Make checks payable to the Texas Health and Human Services Commission. 
      • License fees are not refundable.
    • A copy of the following patient transfer documents for the hospital:
      • Patient Transfer Policy, signed by the chairman and secretary of the hospital’s governing body, that meets the requirements of 25 TAC Section 133.44, Hospital Patient Transfer Policy.
      • Memorandum of Transfer that meets the requirements of 25 TAC Section 133.44(c)(10)(B).
      • Note: Patient transfer agreements between general hospitals are voluntary. If the application is for a special hospital, a copy of a written agreement the special hospital has entered into with a general hospital, which provides for the prompt transfer to, and the admission of, any patient when special services are needed but are unavailable at the special hospital, must be submitted. This agreement is required and is separate from any voluntary patient transfer agreements the hospital may enter into in accordance with 25 TAC Section 133.61, Hospital Patient Transfer Agreements.
    • A copy of the letter or certificate of accreditation from an authorized accrediting agency which includes effective dates of accreditation (if applicable).
    • A copy of the following completed Fire Safety Survey Reports indicating approval by the local fire authority in whose jurisdiction the facility is based: 
      • A fire inspection report conducted within the last 12 months.
      • A second report conducted within the year prior.
    • A Bill of Sale or other legal document that includes the effective date of the CHOW and both parties’ signed agreement to the sale.
  • Attend a pre-licensure conference (previously called pre-survey conference) conducted by the Health Facility Compliance unit. HFC holds pre-licensure conferences once a month and requires one or more of the following individuals to attend: the hospital CEO, administrator, or another individual listed on the application. For more information, to schedule the pre-licensure conference or request a waiver, contact the designated Regional Office.

Important Items to Note

  • The Doing Business As (DBA) or assumed name listed on the application must match the DBA or assumed name listed on applications filed with the Texas State Board of Pharmacy and the Drug Enforcement Agency.
  • The DBA or assumed name of the facility is the name that will appear on the license certificate and should match advertisements and signage of the facility.
  • The legal name is the name of the direct owner legally responsible for the day-to-day operation of the facility, whether by lease or ownership. The legal name and Employer Identification Number (EIN) on the application should be an exact match with the IRS letter.
  • The organizational chart showing ownership structure should reflect all levels of ownership and include EIN numbers. The chart should start with the DBA or assumed name, continue with the legal name (direct owner), and end with any additional ownership levels. 
  • Below is an example of ownership structure:
    • Higher Level of Ownership and EIN
    • Legal Name and EIN Number
    • DBA or Assumed Name

Additional Information

The Social Security Act directs the Secretary of the Department of Health and Human Services to use the help of state health agencies or other appropriate agencies to determine if health care entities meet federal standards. This task is a Texas Health and Human Services Commission responsibility. For information on obtaining provider certification, contact the Regional Office for your location. 

Visit the HHSC Clinical Laboratory Improvement Amendment (CLIA) webpage for information on CLIA.

Mailing Address for Applications with Fees:    

HHSC AR Mail Code 1470 
P.O. Box 149055 
Austin, TX 78714-9055

Overnight Address for Applications with Fees:

HHSC AR Mail Code 1470
4601 W. Guadalupe Street
Austin, TX 78751