Form 3227, Special Care Facility License Application

Instructions for Opening a Form

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Effective Date
04/2021
3227.pdf (123.18 KB)

Instructions

Updated:4/2021

Purpose

Form 3227 is used to apply for an initial, change of ownership or relocation license for a special care facility. Contact Health Facility Licensing at 512-834-6648 with any questions.

Procedure

When to Prepare

The application, fees and other documents shall be submitted as required by 26 Texas Administrative Code, Chapter 506, §506.12, Application and Issuance of Initial License. Information regarding licensure for health care facilities, including contact information for the Health Facility Compliance Office for each location, is located on the Texas Health and Human Services website at https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation/special-care-facilities.

The following documents, fees and actions shall be completed and approved before a license will be issued:

Initial Application

  • A license application form submitted approximately 60 calendar days prior to the projected opening date of the facility.
  • A license fee of $70 per bed shall be submitted. The total fee shall not be less than $600 or more than $5,000. License fees are not refundable.
  • A completed fire safety survey report shall be submitted. Annual fire safety inspections are required for continued licensure status. Include a copy of a fire inspection report conducted within the last 12 months indicating approval by the local fire authority.
  • Approval for occupancy shall be obtained from the Architectural Review Unit at 512-834-6649 or https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation/architectural-review.

The administrator shall attend a presurvey conference at the Health Facility Compliance Regional Office designated by the department. Contact the designated office to schedule the presurvey conference. https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/health-facility-compliance-zones.pdf

Relocation Application

  • A license application form submitted approximately 60 calendar days prior to the projected opening date of the facility.
  • A license fee of $70 per bed shall be submitted. The total fee shall not be less than $600 or more than $5,000. License fees are not refundable.
  • A completed fire safety survey report shall be submitted. Annual fire safety inspections are required for continued licensure status. Include a copy of a fire inspection report conducted within the last 12 months indicating approval by the local fire authority.
  • Approval for occupancy shall be obtained from the Architectural Review Unit at 512-834-6649 or https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation/architectural-review.

Change of Ownership (CHOW) Application

  • A license application form submitted prior to the date of the CHOW or not later than 10 calendar days following the date of the CHOW.
  • A license fee of $70 per bed shall be submitted. The total fee shall not be less than $600 or more than $5,000. License fees are not refundable.
  • A copy of two completed fire safety survey reports shall be submitted. Annual fire safety inspections are required for continued licensure status. Include a copy of a fire inspection report conducted within the last 12 months and a second report conducted within the last 13 to 24 months indicating approval by the local fire authority.
  • The administrator shall attend a presurvey conference at the Health Facility Compliance Regional Office designated by the department. Contact the designated regional office to schedule the presurvey conference or to request a waiver. https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/health-facility-compliance-zones.pdf
  • A Bill of Sale, lease agreement or legal/court document of the CHOW shall be submitted.

Important Items to Note:

The D/B/A or assumed name of the facility is the name that will appear on the license and should match advertisements and signage of the facility.

The legal name and Employer Identification Number (EIN) on the application should be an exact match with the IRS letter, Secretary of State documentation and ownership structure.

  • The ownership structure should reflect all levels of ownership and include EIN numbers. The chart should start with the D/B/A or assumed name, continue with the legal name 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

The Health Facility Licensing Unit will assist you through this process and answer questions. Call 512-834-6648 or fax 512-834-4514.


Mailing Address:

HHSC AR
P.O. Box 149055
Austin, Texas 78714-9055