Form 3227, Special Care Facility License Application

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Documents

Effective Date: 1/2023

Instructions

Updated: 1/2023

Purpose

Form 3227 is used to apply for an initial, change of ownership, or relocation license for a special care facility.

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 506.12, Application and Issuance of Initial License. Information regarding licensure for special care facilities is located on HHSC Special Care Facilities webpage.

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

Texas Health and Human Services Commission (HHSC) 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 3227 approximately 60 calendar days before the projected opening date of the facility.
    • A license fee of $70 per bed.
      • The total fee shall not be less than $600 or more than $5,000.
      • Make checks payable to the Texas Health and Human Services Commission.
      • License fees are not refundable.
    • A completed Fire Safety Survey 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 HFC unit. HFC holds pre-licensure conferences once a month and requires one or more of the following individuals to attend: the administrator, medical chief of staff or director of nurses listed on the application. For more information or to schedule the pre-licensure conference, contact the designated HFC regional office.

Relocation Application

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

  • Submit the following to HHSC:
    • A completed Form 3227 approximately 60 calendar days before relocation of the facility.
    • A license fee of $70 per bed.
      • The total fee shall not be less than $600 or more than $5,000.
      • Make checks payable to the Texas Health and Human Services Commission.
      • License fees are not refundable.
    • A completed Fire Safety Survey 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 3227 before the date of the CHOW or within 10 calendar days following the date of the CHOW.
      • A license fee of $70 per bed.
      • The total fee shall not be less than $600 or more than $5,000.
      • Make checks payable to the Texas Health and Human Services Commission.
      • License fees are not refundable.
    • 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 transaction.
  • Attend a pre-licensure conference (previously called pre-survey conference) conducted by the HFC unit. HFC holds pre-licensure conferences once a month and requires one or more of the following individuals to attend: the administrator, medical chief of staff or director of nurses listed on the application. For more information or to schedule the pre-licensure conference, contact the designated HFC regional office.

Important Items to Note:

  • The Doing Business As (DBA) 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 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 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

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