Ariz. Admin. Code § 9-9-104

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Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-9-104 - Application for Licensure

A. An applicant applying for a procurement organization license shall submit an application packet that contains:

1. An application, in a Department-provided format, according to A.R.S. § 36-851.01(A) that includes:

a. The applicant's name, mailing address, email address, and telephone number;

b. The name or proposed name of the procurement organization, including the:

i. Business street address;

ii. Business mailing address, if different from the street address;

iii. Telephone number;

iv. Email address; and

v. Tax ID number;

c. If part of a business institution, the institution's:

i. Name;

ii. Street address;

iii. Mailing address, if different from the street address;

iv. Telephone number; and

v. Email address;

d. Whether the procurement organization is ready for a licensing inspection by the Department, if applicable;

e. If the procurement organization is not ready for a licensing inspection specified in (d), the date the Department may perform a licensing inspection, if applicable;

f. The name and contact information of an individual acting on behalf of the applicant specified in R9-9-103, if applicable;

g. If applicable, the medical director's:

i. Name,

ii. Telephone number,

iii. Email address, and

iv. License number;

h. Whether the applicant complies with local zoning ordinances, building codes, and fire codes;

i. Whether the applicant agrees to allow the department to submit supplemental requests for information under R9-9-108; and

j. The applicant's signature and the date signed;

2. A copy of the procurement organization's current certificate of accreditation from an accrediting body, if applicable;

3. Documentation for the applicant that complies with A.R.S. § 41-1080;

4. A copy of the procurement organization labeled floor plan, including technical and administrative function areas, if applicable; and

5. A licensing fee of $2,000.

B. Upon receipt of the application packet in subsection (A), the Department shall conduct an inspection of the procurement organization, if applicable.

C. The Department shall issue or deny a license to an applicant as specified in R9-9-108.

Ariz. Admin. Code § R9-9-104

New Section made by final rulemaking at 28 A.A.R. 1517, effective 6/8/2022.