(b) Upon written or verbal request, the
department shall furnish a person with an application form for an ASC license.
The applicant shall submit to the department a completed original application
and the nonrefundable license fee.
(1) The
applicant shall provide:
(A) the name and
address of the owner of the ASC, or a list of names and addresses of persons
who own an interest in the ASC;
(B)
the name, Texas license number, and license expiration date of the medical
chief of staff;
(C) the number of
physicians, dentists, podiatrists and advanced practice registered nurses on
staff at the ASC;
(D) the name,
Texas license number, and license expiration date of the director of nursing of
the ASC;
(E) whether the ASC has
applied for certification under Title XVIII of the Social Security Act;
and
(F) number of surgery
suites.
(G) the following data
concerning the applicant, the applicant's affiliates, and the managers of the
applicant:
(i) denial, suspension, probation,
or revocation of an ambulatory surgical center license in any state, a license
for any health care facility or a license for a home and community support
services agency (agency) in any state; or any other enforcement action, such as
(but not limited to) court civil or criminal action in any state;
(ii) denial, suspension, probation, or
revocation of or other enforcement action against an ambulatory surgical center
license in any state, a license for any health care facility in any state, or a
license for an agency in any state 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)
Medicare or Medicaid sanctions or penalties relating to the operation of a
health care facility or agency;
(vi) operation of a health care facility or
agency that has been decertified or terminated from participation in any state
under Medicare or Medicaid; or
(vii) debarment, exclusion, or contract
cancellation in any state from Medicare or Medicaid; and
(H) 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
judgments;
(iv) eviction involving
any property or space used as an ambulatory surgical center or health care
facility in any state;
(v)
injunctive orders from any court; or
(vi) unresolved final federal or state (any
state) Medicare or Medicaid audit exceptions.
(2) Upon receipt of the application, the
department shall review the application to determine whether it is complete.
All documents submitted to the department shall be originals. The address
provided on the application shall be the address at which the ASC is
operating.
(3) If the department
determines that the application for an unlicensed ASC is complete and correct,
a representative of the department shall schedule a pre-survey conference with
the applicant in order to inform the applicant of the standards for the
operation of the ASC. A pre-survey conference may, at the department's
discretion, be waived for an applicant of a licensed ASC for which a change of
ownership is anticipated.
(4) After
a pre-survey conference has been held or waived at the department's discretion
and the facility has received an approved architectural inspection conducted by
the department, the department may issue a license to an ASC to provide
ambulatory surgical services in accordance with these sections.