Sec. 10.21.07.05. Application Process

A. Consultation. If the Administration is the designated lead agency, an applicant for licensure for a TGH, before submitting an application, may request assistance from the designated licensure unit of the Department, the appropriate CSA director, or the Administration regarding the proper compilation of application materials and completion of the application.

B. Application. An applicant for licensure of a TGH shall:

(1) Submit, to the Department's designated licensure unit, a signed, notarized application on the form approved by the Department with the requirement that all questions be answered and all required documents be attached;

(2) Include in the application:

(a) The applicant's:

(i) Name;

(ii) Agency affiliation, if any; and

(iii) Address;

(b) Documentation:

(i) Of the applicant's not-for-profit status; and

(ii) That the applicant has sufficient financial resources or that sufficient resources are available to the applicant for the establishment and operation of the residence;

(c) The following information about the property:

(i) The street address of the location of the TGH or, if it has no street address, a description that adequately identifies the location of the property; and

(ii) If the applicant does not own the property, the name and address of the owner;

(d) The satisfactory fire, safety, and health inspection reports, not more than 1 year old, of the TGH that are required by the local jurisdiction;

(e) Written material that describes how the applicant intends to comply with the requirements outlined in:

(i) COMAR 14.31.05; and

(ii) This chapter;

(f) An explanation of the need for the TGH, including, if the jurisdiction in which the TGH is to be located is served by a CSA, a letter of intent that explains how the TGH meets a need identified in the Administration-approved CSA plan;

(g) When applicable, documentation that the TGH will collaborate with the CSA, as required under Regulation .07 of this chapter;

(h) Documentation that the TGH:

(i) Is near transportation facilities, or has a plan for the provision of transportation services based on the individual's need; and

(ii) Meets, or on completion will meet, general zoning requirements regarding size, density, land use, and architectural guidelines that apply to the site; and

(i) The applicant's program service plan, as outlined in §C of this regulation; and

(3) Forward a copy of the:

(a) Application cover letter to the Administration; and

(b) Application to the:

(i) CSA, if the jurisdiction in which the TGH is to be located is served by a CSA; or

(ii) Administration, if the jurisdiction in which the TGH is to be located is not served by a CSA.

C. Program Service Plan (PSP). On the form approved by the Administration, as part of the application, a TGH shall submit a PSP that includes:

(1) If appropriate, a copy of the articles of incorporation, organizational chart, bylaws, and list of the members, including officers, of the governing body;

(2) Documentation that at least 1/3 of the members of either the governing body or an advisory committee includes representation of consumers, former consumers, or family members;

(3) The proposed budget for the TGH;

(4) A description of:

(a) The number of children, as well as their age groups and other relevant characteristics, that the TGH expects to serve;

(b) The geographic area to be served;

(c) The goals, objectives, and expected outcomes of the program;

(d) The plan for the provision of the following services:

(i) Medical;

(ii) Dental;

(iii) Required education;

(iv) Social and recreational;

(v) Nutritional; and

(vi) Mental health treatment;

(e) The method for linkage with service providers and community resources, including, when applicable, written agreements with inpatient facilities and other providers of health, mental health, and social services; and

(f) The methods by which quality, including risk management and utilization review, are assured; and

(5) A list of staff positions, their job descriptions and educational and clinical training requirements, and staffing patterns, including an organizational chart detailing lines of authority and responsibility.