Ariz. Admin. Code § 6-5-7411

Current through Register Vol. 30, No. 25, June 21, 2024

Section R6-5-7411 - Application for Renewal of License and Operating Certificates

A. No earlier than 90 and no later than 60 days prior to the expiration date of a license, an agency may apply to the Licensing Authority for renewal of its license and any operating certificates. The Licensing Authority does not have a duty to notify the agency of license expiration. The agency shall contact the Licensing Authority to request a renewal application and to schedule a DHS health and safety inspection. The agency shall schedule its own fire inspection. Failure to timely apply or obtain inspections may result in suspension of the agency's license until the renewal process is completed.

B. An agency shall apply for renewal on a Department application form containing the information required in this Section.

C. An agency shall submit copies of the completed renewal application and supporting documents to the Licensing Authority. If the agency has not amended, changed or updated the information or documentation since the agency last applied for or renewed its license, the agency shall indicate "no change" on the documents submitted with the renewal application.

D. With a renewal application, the agency shall also submit the following documentation:

1. A current financial statement prepared by an independent certified public accountant who is not employed by the agency;

2. A certificate of current insurance coverage as prescribed in R6-5-7426;

3. A copy of the agency's current budget and the agency's audit report for its preceding fiscal year;

4. Identification of and the following background information on the agency, facility, and administrators:

a. Name, address, and telephone and telefacsimile numbers for the agency and all facilities operated by the agency;

b. Name, title, business address, and telephone and telefacsimile number of:

i. The person who serves as the chief executive officer (CEO) as prescribed in R6-5-7432(A);

ii. The person who serves as the program director as prescribed in R6-5-7432(B);

iii. The person with delegated authority to act when the CEO is absent;

iv. The person in charge of each separate facility as prescribed in R6-5-7432(C);

v. Persons holding at least 10% ownership interest in the applicant; and

vi. The agency and facility medical directors, if applicable;

c. The educational qualifications and work history for each person listed in subsection (D)(4)(b), with that person's attached resume, employment application, or curriculum vitae;

d. A list of the members of the agency's governing body described in R6-5-7424, including name, address, position in the agency, term of membership, and any relationship to the applicant;

e. A list of licenses or certificates for provision of medical or social services currently or previously held by the applicant or persons listed in subsection (D)(4)(b), including those held in this state or another state or country; the list shall include the dates the person held the license or certificate;

f. A written description of any proceedings for denial, suspension, or revocation of a license or certificate for provision of medical, psychological, behavioral health, or social services, pending or filed, or brought against the applicant or a person listed in subsection (D)(4)(b), including those held in this state or another state or country; and

g. A written description of any litigation in which the applicant or a person listed in subsection (D)(4)(b) has been a party during the 10 years preceding the date of application, including, collection matters and bankruptcy proceedings.

5. An organizational chart for the agency and each separate facility, showing administrative structure and staffing, and lines of authority.

6. The following information on staff:

a. A list of applicant's paid staff, including:

i. Name;

ii. Position or titles;

iii. Degrees, certificates, or licenses held;

iv. Business address;

v. Date of hire;

vi. Date of last physical; and

vii. Date of submission for fingerprinting and background clearance;

b. For any staff whose primary residence is the facility:

i. The name and date of birth of any persons residing with a staff member;

ii. Evidence that any adult residing with a staff member has submitted fingerprints and criminal background information as prescribed in R6-5-7431 and is free from communicable diseases posing a danger to children in care, as prescribed in R6-5-7431(H); and

iii. Evidence that the staff member's children who reside at the facility have current immunizations.

7. Copies of any written complaints the agency has received about its performance at its facilities during the expiring license year and the agency's response to the complaints; and

8. A written description of any changes in program services or locations, or the children served by the agency.

E. For a renewal application, the administrative completeness review time-frame described in A.R.S. § 41-1072(1) begins when the applicant submits a renewal application form and the required documentation listed in this Section.

Ariz. Admin. Code § R6-5-7411

Adopted effective May 19, 1977 (Supp. 77-3). Former Section R6-5-7411 repealed; new Section R6-5-7411 filed with the Secretary of State's Office May 15, 1997; adopted effective July 1, 1997 (Supp. 97-2). Amended by final rulemaking at 6 A.A.R. 4032, effective September 29, 2000 (Supp. 00-3).