| (a) The application. (1) An applicant shall not misstate a material fact on any documents required to be submitted under this subsection. (2) The application form must be accurate and complete and must contain original signatures. The nonrefundable license fee must be submitted with the application. (3) The following information must be submitted on the original application form and the application shall be notarized: (A) information on the applicant including name, street address, mailing address, social security number or federal tax identification number, and if applicable, date of birth and driver's license number; (B) the name, mailing address, and street address of the center. The street address provided on the application must be the address from which the center will be operating and providing services; (C) a list of names and business addresses of all persons who own any percentage interest in the applicant including: (i) each limited partner and general partner if the applicant is a partnership; and (ii) each shareholder, member, director, and officer if the applicant is a corporation, limited liability company or other business entity; (D) a list of any businesses with which the applicant subcontracts and in which the persons listed under subparagraph (C) of this paragraph hold any percentage of the ownership; (E) if the applicant has held or holds a center license or has been or is an affiliate of another licensed center, the relationship, including the name and current or last address of the other center and the date such relationship commenced and, if applicable, the date it was terminated; (F) if the center is operated by or proposed to be operated under a management contract, the names and addresses of any person and organization having an ownership interest of any percentage in the management company; (G) a written plan for the orderly transfer of care of the applicant's clients and clinical records if the applicant is unable to maintain services under the license; (H) the organizational structure of the staffing for the center; (I) the names and addresses of the physicians, certified nurse-midwives, licensed midwives and other clinical care providers who will provide services at the center; (J) the following data concerning the applicant, the applicant's affiliates, and the managers of the applicant: (i) any orders of denial, suspension, or revocation of a center license, a license for any health care facility in any state, or documentation as a midwife; or any other enforcement action, such as (but not limited to) court civil or criminal action; (ii) any orders of denial, suspension, or revocation of or other enforcement action against a center license, a license for any health care facility in any state, or documentation as a midwife which is or was proposed by the licensing agency and the status of the proposal; (iii) surrendering a license before expiration of the license or allowing a license to expire in lieu of the department proceeding with enforcement action; (iv) federal or state (any state) criminal felony arrests or convictions; (v) federal or state Medicaid or Medicare sanctions or penalties relating to the operation of a health care facility; (vi) operation of a health care facility that has been decertified in any state under Medicare or Medicaid; or (vii) debarment, exclusion, or contract cancellation in any state from Medicare or Medicaid; (K) for the two-year period preceding the application date, the following data concerning the applicant, the applicant's affiliates, and the managers of the applicant: (i) federal or state (any state) criminal misdemeanor arrests or convictions; (ii) federal or state (any state) tax liens; (iii) unsatisfied final judgement(s); (iv) eviction involving any property or space used as a center or health care facility in any state; (v) injunctive orders from any court; or (vi) unresolved final state or federal Medicare or Medicaid audit exceptions; and (L) the telephone number, and fax number (if available) of the center and the telephone number where the administrator can usually be reached when the center is closed. (b) Applicant copy. The applicant shall retain a copy of all documentation that is submitted to the department. (c) Application processing. Upon the department's receipt of the application form, the required information described in subsection (a)(3) of this section, and the initial license fee from an applicant, the department shall review the material to determine whether it is complete and correct. (1) The time periods for reviewing the material shall be in accordance with §137.13 of this title (relating to Time Periods for Processing and Issuing a License). (2) If a center receives a notice from the department that some or all of the information required under subsection (a)(3) of this section is deficient, the center shall submit the required information no later than 60 calendar days from the date of the notice. (A) A center which fails to submit the required information within 60 calendar days from the notice date is considered to have withdrawn its application for an initial license. The license fee will not be refunded. (B) A center which has withdrawn its application must reapply for a license in accordance with this section, if it wishes to continue the application process. A new license fee is required. (d) Withdrawal of application process. If an applicant decides at any time not to continue the application process for an initial license, the application will be withdrawn upon written request from the applicant. The license fee will not be refunded. (e) Issuance of an initial license and renewal procedures. (1) Presurvey conference. Once the department has determined that the application form, the information required to accompany the application form, and the license fee are complete and correct, a representative from the department shall schedule a presurvey conference with the applicant in order to inform the applicant of the standards for the operation of the center. The presurvey conference may be waived by the department. (2) Survey recommendation. (A) The survey office shall verify compliance with the applicable provisions of the Act and this chapter and recommend that the center be issued an initial license or that the application be denied pursuant to §137.22 of this title (relating to License Denial, Suspension, Probation, or Revocation). (B) Upon recommendation by the survey office: (i) the department shall issue an initial license to an applicant that has been found to be in compliance with the provisions of the Act and this chapter; or (ii) the department shall deny the application if the center has been found to be out of compliance with the provisions of the Act and this chapter. The procedure for denial of a license shall be in accordance with §137.22 of this title. (3) Effective period of initial license. The initial license is valid for 24 months. The initial license expires on the last day of the month ending the licensure period. (4) General requirements during the initial license period. (A) A center shall comply with the provisions of the Act and this chapter during the initial license period. (B) If an applicant decides not to continue the application process, the application will be withdrawn upon written request. If an initial license has been issued, the applicant shall cease providing services and return the original license certificate to the department with its written request to withdraw. The department shall acknowledge receipt of the request to withdraw. The license fee will not be refunded. (f) Procedures for renewing a license. (1) The department will send notice of expiration to a licensee at least 60 calendar days before the expiration date of a license. If the licensee has not received notice of expiration from the department 45 calendar days prior to the expiration date, it is the duty of the licensee to notify the department and request a renewal form. (2) The licensee shall submit the renewal form to the department postmarked no later than 30 calendar days prior to the expiration date of the license: (A) a complete and correct renewal form which includes updated disclosure information and ownership and management information as required by subsection (a)(3) of this section; and Cont'd... |
