(1) An
applicant for a license shall file a request for agency review or license
application with the department on a form, or format furnished by the
department.
(2) An applicant shall
comply with any zoning, fire, safety, sanitation, building and licensing laws,
regulations, ordinances, and codes of the city and county in which the facility
or agency is located.
(3) An
applicant shall obtain the following clearances and submit them as part of the
completed application to the licensing agency:
(a) a certificate of fire clearance from the
state fire marshal or designated local fire authority certifying compliance
with local and state fire codes for:
(i)
initial application;
(ii) renewal
application;
(iii) change of
ownership; and
(iv) any time new
construction or remodeling has occurred;
(b) a food services sanitation clearance
report by a local health department providing food service at;
(c) initial application;
(d) upon a change of ownership; and
(e) certificate of occupancy from the local
building official for:
(i) initial
application;
(ii) change of
location; and
(iii) at the time of
any new construction or substantial remodeling.
(4) An applicant shall submit contact
information for the ownership of the legal entity including the names, phone
numbers, email addresses and mailing addresses and the following written
assurances that none of the listed individuals have:
(a) been convicted of a felony;
(b) been found in violation of any local,
state, or federal law that arises from or is otherwise related to the
individual's relationship to a health care facility;
(c) been convicted of patient abuse, neglect
or exploitation where the facts of the case prove that the licensee failed to
provide adequate protection or services for the person to prevent such abuse;
and
(d) currently, or within the
five years before the date of application, had financial interest in a licensed
health care facility that has been:
(i)
subject of a patient care receivership action;
(ii) closed as a result of a settlement
agreement resulting from a decertification action or a license revocation;
or
(iii) involuntarily terminated
from participation in either Medicaid or Medicare programs.
