Health Care Facility Licensing and Certification

Contact Us

Phone: (916) 552-8632
Email: CAB@cdph.ca.gov

For application status requests, please include the following in your email:

Name of Facility or Agency
License or Facility/Agency # (if applicable)
Address
Facility or Provider Type
Date Documentation Sent
Contact Number

Skilled Nursing Facility Change of Ownership Application Packet

A state license is required to operate a Skilled Nursing Facility (SNF) in California, which is defined as:

A SNF is “a health facility that provides skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis,” pursuant to Health and Safety Code (HSC) section 1250(c).

Pursuant to HSC section 1253.3(a), no person, nor an applicant for licensure shall acquire, either directly or indirectly, an ownership interest in a skilled nursing facility nor operate, establish, manage, conduct, or maintain a skilled nursing facility prior to department review, approval, and issuance of a license.

Pursuant to HSC section 1253.3(i), if the department approves the application, the applicant and licensee shall notify the department within 10 days of the final transactions effecting the orderly transfer of the health facility operations from the licensee to the applicant. The final orderly transfer of the health facility operations shall occur no later than 120 days after the department’s notice of approval of the application for licensure.

Refer to the provider checklist to determine what final transaction documents are required to complete the end process after the sale is finalized.

To apply for a Change of Ownership, you must complete the required application packet.

How to Apply

An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The provider instructions are a resource to guide you through the process. The provider checklist identifies the required forms and supporting documents needed to apply for initial approval and final transaction approval.

Please refer to the following links to get started:

Provider Instructions (PDF)
Provider Checklist

Application Packet Forms

HS 200 - Licensure and Certification Application (PDF, 1.5MB)
HS 215A - Applicant Individual Information (PDF)
HS 309 - Administrative Organization and Organizational Structure (PDF)
HS 400 - Affidavit Regarding Patient Money (PDF)
HS 402 - Surety Bond Verification (PDF)
HS 602 - Transfer Agreement (PDF)
CDPH 609 - Bed or Service Request (PDF)
HS 328 - Notice of Effective Date of Provider Agreement (PDF)
DHCS 9098 - Medi-cal Provider Agreement (PDF)
CMS 671 - Long Term Care Facility Application for Medicare & Medicaid (PDF)
CMS 1561 - Health Insurance Benefits Agreement (PDF)
HHS 690 - Assurance of Compliance (PDF)
CMS 855A - Medicare General Enrollment Health Care Provider/Supplier Application (PDF)

Where to Submit Applications

Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.

          California Department of Public Health
          Licensing and Certification Program
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377

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