Sec. 10.63.06.02. License Application Process for All Community-Based Behavioral Health Programs

A. An applicant for a license, whether accreditation or non-accreditation-based, to provide community-based behavioral health services shall:

(1) Use the application form required by the Department;

(2) Include the following information with the application:

(a) Verification that the program complies with the program descriptions and criteria set out in this subtitle;

(b) Attestation of compliance with relevant federal, State, or local ordinances, laws, regulations, and orders governing the program;

(c) Disclosure of the following:

(i) Any revocation of a license, certificate, or approval issued within the previous 10 years from any in-State or out-of-State provider previously or currently associated with the applicant, including deficiency reports and compliance records;

(ii) Whether the applicant, or a program, corporation, or provider previously or currently associated with the applicant, has surrendered or defaulted on its license, certificate, or approval for reasons related to disciplinary action, within the previous 10 years;

(iii) The identity of any individual who has served as a corporate officer for the provider who has had a license, certificate or approval revoked, or has surrendered or defaulted on an approval license, certificate or approval, for reasons related to disciplinary action, within the previous 10 years; and

(iv) Any criminal conviction of the applicant, or the owner, program director, or other staff of the applicant;

(3) Include the following documents with the application:

(a) A copy of the agreement to cooperate between the program and the CSA, LAA, or LBHA, as appropriate;

(b) Copies of all applicable permits required by local jurisdictions, including fire, safety, and health, for each proposed site, if the program will provide services at a site whose primary function is the delivery of behavioral health services; and

(c) All documentation supporting or demonstrating the information disclosed under §A(2)(c) of this regulation;

(4) Include any other information considered necessary and requested by the Department; and

(5) Submit the completed application to the Department’s designated approval unit, identifying:

(a) The services that the applicant would provide if licensed; and

(b) The physical sites where the services would be provided;

B. If the application submitted under §A of this regulation is incomplete or missing any of the documentation required by this regulation, the application shall be returned to the program to provide the missing information, and processing of the application shall stop until the information is provided.