TX HHS Form 3240. Limited Services Rural Hospital (LSRH) License Application

The TX HHS Form 3240, Limited Services Rural Hospital (LSRH) License Application, is a crucial document for rural hospitals seeking to operate in Texas. This form helps solve the problem of obtaining a license to provide essential healthcare services to rural communities. The application is typically used by general or special hospitals applying for an LSRH license and must meet all rule requirements under Texas Administrative Code Title 26 (26 TAC) Chapter 511 and Code of Federal Regulations Title 42 (42 CFR) Section 485, Subpart E.

The form requires key information such as the hospital's name, mailing address, and ownership details. The applicant must provide their legal name, direct owner contact information, and proof of ownership structure. Additionally, the application includes sections for current license information, Medicare or CMS certification, and architectural project numbers. It is essential to note that previously operating LSRHs under emergency rule 26 TAC Section 600.1 must use this application to reapply for an initial license.

To ensure a successful application process, applicants should carefully review the instructions and provide all required information. Key points to consider include:

• Meeting rule requirements under Texas Administrative Code Title 26 (26 TAC) Chapter 511 and Code of Federal Regulations Title 42 (42 CFR) Section 485, Subpart E.
• Providing accurate and complete ownership information.
• Notifying the agency of any changes to the facility's license status or ownership structure.