309-008-0400 The Application Process (1) An applicant seeking initial certification or certification renewal and an existing provider seeking to expand its certified scope of services, relocate an existing service delivery location, or open new service delivery location must submit a completed application to the Division. (2) The Division shall furnish an application with instructions and provide appropriate technical assistance to facilitate completion of the application upon: (a) Request from an applicant seeking initial certification; (b) Request from an existing provider seeking certification renewal congruent with timelines established by these rules; (c) Request from an existing provider seeking to add or relocate service delivery locations; and (d) Request from an existing provider seeking to change the scope of services approved on the current certificate. (3) An applicant with multiple service delivery locations must submit documentation with the application sufficient for the Division to evaluate each service delivery location. A separate application for each service delivery location is not required. (4) The application must be legible and completed on the forms furnished by the Division in the manner specified by the Division. Each application must include: (a) A detailed plan outlining the implementation of the proposed services congruent with these rules, applicable service delivery rules, other applicable regulations, and OAR and ORS noted herein; (b) Written attestation by the applicant that all applicable rules of the Division for provision of the proposed services shall be met and maintained in substantial compliance with applicable service delivery rules; (c) Other documentation required by applicable OAR, ORS, other applicable regulations, local regulations, contract or by judgment of the Division to assess applicant’s compliance; and (d) Complete and current copies of the following documents: (A) A description of the applicant’s service delivery locations describing the type and scope of behavioral health treatment services provided or proposed by the applicant at each service delivery location; (B) Applicant’s policies regarding credentialing practices of individual practitioners; (C) Applicant’s liability insurance coverage listing all covered service delivery locations; (D) Applicant’s policies and procedures regarding seclusion and restraint practices; and (E) Applicant’s Code of Conduct. (e) Identification of financial interest of any individual including stockholders who have an incident of ownership in the applicant representing an interest of five percent or more. For purposes of these rules, an individual with a five percent or more incident of ownership is presumed to have an effect on the operation of the provider, unless the individual establishes that the individual has no involvement in the operation of the provider; (f) Background information on all licenses, certifications, and letters of approval held or previously held by the applicant or by any owner disclosed under subsection (e) of this rule to provide care or treatment or engage in a profession or trade. The list shall include every license, certification, and letter of approval regardless of whether it was issued by the Authority or another regulatory body: (A) The type of license or certification; (B) The name of the issuing regulatory body; (C) The name of the individual or business to whom it was issued; (D) The start and end date of the period of license or certification; (E) A list of the dates of any suspensions, revocations, conditions, penalties, denials, nonrenewal, or other adverse actions initiated or taken on a license or certificate, including documentation of the final resolution of those actions; (F) Disclosure of whether any of the licenses or certificates had expired or were relinquished while a suspension, revocation, condition, penalty, denial, nonrenewal, or other adverse action was pending or proposed; and (G) Copies of all current licenses or certificates. (g) Disclosure of any substantiated findings of abuse, neglect, or mistreatment by the applicant, owner, or program staff. (5) Where applicable, the Division shall maintain copies of the documents listed in section (4)(d) of this rule within the Division’s CCO document bank. (6) Timeframe for application submission: (a) An applicant seeking initial certification under these rules must submit a completed application at least six months in advance of the applicant’s desired date of certification; (b) An applicant seeking to renew its certificate must: (A) Request an application from the Division; and (B) Submit a complete application at least six months prior to the expiration of the existing certificate. Statutory/Other Authority: ORS 179.040, 179.505, ORS 413.042, 413.032-413.033, 426.072, 426.175, 426.236, 426.500, 430.010, 430.021, 430.256, 430.357, 430.560, 430.640, 430.870, ORS 743A.168 & 743.556 Statutes/Other Implemented: ORS 413.520, 426.060, 426.140, 430.010, 430.254, 430.335, 430.590, 430.620 & 430.637 History: BHS 11-2018, amend filed 05/10/2018, effective 05/10/2018 MHS 15-2017, temporary amend filed 12/01/2017, effective 12/01/2017 through 05/29/2018 MHS 16-2016, f. 11-28-16, cert. ef. 11-30-16 MHS 6-2016(Temp), f. 6-28-16, cert. ef. 7-1-16 thru 12-27-16