C. Application. An
applicant for approval of a program shall:
(2) Submit the application on the written or
electronic form approved by the Department, with all questions answered and all
required documents attached;
(3)
Include in the application, at a minimum, the following information:
(a) Documentation of the applicant's program
service plan, as outlined in Regulation .05 of this chapter;
(b) A written business plan that clearly
demonstrates the program's ability to provide services in accordance with
applicable Maryland regulations and Medicaid and Medicare funding
requirements;
(c) Information to
demonstrate the program's financial viability, including, but not limited to:
(i) Salary structure;
(ii) Client mix;
(iii) Anticipated administrative
expenses;
(iv) Necessary cash
reserves to maintain the program during the start-up phase and a financial
crisis;
(v) Identification of the
individual responsible for providing the required financial information;
and
(vi) Other information deemed
necessary by the Department;
(d) A summary of the program's demonstrated
experience in the field of mental health;
(e) Prior licensing reports issued within the
previous 10 years from any in-State or out-of-State entities associated with
the program, including deficiency reports and compliance records from which the
Department may make reasoned decisions about the qualifications of the
program;
(f) Disclosure of:
(i) Any license or approval revocation within
the previous 10 years by the Department or other licensing agency;
(ii) Whether the program, or corporation or
entity associated with the program, has surrendered or defaulted on its license
or approval for reasons related to disciplinary action, within the previous 10
years; and
(iii) Any corporate
officer who has served as a corporate officer for a corporation or entity that
has had a license revoked, or has surrendered or defaulted on its license or
approval for reasons related to disciplinary action within the previous 10
years;
(g) A written
quality assurance plan that addresses how the organization will ensure the
health and safety of the individuals served by the program and the quality of
services provided to individuals by the program; and
(h) For
26 U.S.C. § 501(c)(3) organizations, a
statement of how the organization intends to satisfy its charitable mission;
and
(4) Forward a copy
of the:
(a) Completed application to the:
(i) CSA of the jurisdiction where the program
services are to be delivered; or
(ii) For programs providing services in
multiple jurisdictions, lead CSA identified under §B of this regulation;
and
(b) Application
cover letter to the Administration and all CSAs of the jurisdictions where the
program plans to deliver services.