Form 3228, Application for a License to Operate a General or Special Hospital

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Effective Date
05/2021
3228.pdf (137.25 KB)

 

Instructions

Updated: 5/2021

 

Purpose

Form 3228 is used to apply for an initial, change of ownership or relocation license for a general or special hospital. 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 25 Texas Administrative Code (TAC), Chapter 133, Hospital Licensing Rules, §133.22 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/hospitals-general-hospitals.

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

Initial Application

  • A hospital license application submitted approximately 60 calendar days prior to the projected opening date of the hospital.
  • A license fee of $39 per bed shall be submitted. License fees are not refundable.
  • Patient transfer documents that include:
    • A copy of the hospital’s patient transfer policy that is in accordance with TAC §133.44, Hospital Patient Transfer Policy, and signed by the chairman and secretary of the governing body shall be submitted.
    • A copy of the hospital’s Memorandum of Transfer that is in accordance with §133.44(c)(10)(B) shall be submitted.
    • 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, shall be submitted. This agreement is required and is separate from any voluntary patient transfer agreements the hospital may enter into in accordance with §133.61 (relating to Hospital Patient Transfer Agreements).
  • A completed fire safety survey report shall be submitted 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 status.
  • Approval for occupancy shall be obtained from Texas Health and Human Services Commission, Architectural Review Unit, at phone 512-834-6649 or fax 512-834-6620 or https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation/architectural-review.
  • The hospital CEO or administrator shall attend a presurvey conference at the Health Facility Compliance Regional Office designated by the department. Contact the designated Regional Office to schedule attendance. https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/health-facility-compliance-zones.pdf Note: It is required that an individual listed on the license application attend the conference.

Relocation Application

  • A hospital license application submitted approximately 60 calendar days prior to the projected opening date of the hospital.
  • A license fee of $39 per bed shall be submitted. License fees are not refundable.
  • Patient transfer documents that include:
    • A copy of the hospital’s patient transfer policy that is in accordance with §133.44, Hospital Patient Transfer Policy, and signed by the chairman and secretary of the governing body shall be submitted.
    • A copy of the hospital’s Memorandum of Transfer that is in accordance with §133.44(c)(10)(B) shall be submitted.
    • 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, shall be submitted. This agreement is required and is separate from any voluntary patient transfer agreements the hospital may enter into in accordance with §133.61 (relating to Hospital Patient Transfer Agreements).
  • A copy of the letter or certificate of accreditation from an authorized accrediting agency which includes effective dates of accreditation.
  • A completed fire safety survey report shall be submitted 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 status.
  • Approval for occupancy shall be obtained from Texas Health and Human Services Commission, Architectural Review Unit, at phone 512-834-6649 or fax 512-834-6620 or https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation/architectural-review.

Change of Ownership (CHOW) Application

  • A hospital license application 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 $39 per bed shall be submitted. License fees are not refundable.
  • Patient transfer documents that include:
    • A copy of the hospital’s patient transfer policy that is in accordance with §133.44, Hospital Patient Transfer Policy, and signed by the chairman and secretary of the governing body shall be submitted.
    • A copy of the hospital’s Memorandum of Transfer that is in accordance with §133.44(c)(10)(B) shall be submitted.
    • 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, shall be submitted. This agreement is required and is separate from any voluntary patient transfer agreements the hospital may enter into in accordance with §133.61 (relating to Hospital Patient Transfer Agreements).
  • A copy of the letter or certificate of accreditation from an authorized accrediting agency which includes effective dates of accreditation.
  • A completed fire safety survey report shall be submitted 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 status.
  • The hospital CEO or administrator shall attend a presurvey conference at the Health Facility Compliance Regional Office designated by the department. Contact the designated regional office to schedule attendance 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 Note: It is required that an individual listed on the license application attend the conference.
  • A Bill of Sale or other legal document shall be submitted. The document shall include the effective date of the CHOW and both parties signed agreement to the transaction.

Important Items to Note

  • The D/B/A or assumed name listed on the application must match the D/B/A or assumed name listed on applications filed with the Texas State Board of Pharmacy and the Drug Enforcement Agency.
  • The D/B/A 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 D/B/A or assumed name, continue with the legal name (direct owner) and end with any additional ownership levels. An example is below.
  • The 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

Additional Information

Medicare certification information may be obtained from the regional office for your location (https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/health-facility-compliance-zones.pdf). 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 one of Texas Health and Human Services Commission’s responsibilities. For information on obtaining provider certification, contact regional office staff.

Clinical Laboratory Improvement Amendments (CLIA) information is located on the website at https://hhs.texas.gov/doing-business-hhs/provider-portals/health-care-facilities-regulation/laboratories-clinical-laboratory-improvement-amendments. For more information, contact the regional office for your location. https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/facilities-regulation/health-facility-compliance-zones.pdf

The Health Facility Licensing Unit can answer your questions. Contact the Health Facility Licensing Unit at phone 512-834-6648 or fax 512-834-4514.

Mailing Address

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