Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 264 - BIRTH CENTER LICENSING CODE › Subpart A - GENERAL REQUIREMENTS › Section 264.1300 - Application for Initial and Renewal License

Current through Register Vol. 48, No. 28, July 12, 2024
a)
An applicant for a
				license
to establish or operate a birth center
under
the Act
shall submit an application on forms prescribed by the
				Department.
(Section 15(a) of the Act)
.
b) The application shall be accompanied by a
				copy of the Certificate of Need to establish and operate a birth center issued
				by the Health Facilities and Services Review Board under the Illinois Health
				Facilities Planning Act.
c)
				Application forms and other required information shall be submitted and
				approved pursuant to Subpart B of this Part, prior to surveys of the physical
				plant or review of building plans and specifications, and prior to submission
				of the license application.
d)
Each application shall be accompanied by a non-refundable
				license
application
fee
of $500 plus $100 for each
				licensed birthing bed
.
(Section 15(a) of the Act)
e) The application shall contain, at a
				minimum, the following information:
1) The
				name, address, and telephone number of the applicant, if the applicant is an
				individual; in the case of a firm, partnership, or association, the name,
				address, and telephone number of every member thereof; in the case of a
				corporation, the name, address, and phone number thereof and the name of its
				officers and its registered agent; and in the case of a unit of local
				government, the name, address, and telephone number of its chief executive
				officer.
2) The name of the person
				or persons who will manage or operate the birth center.
3) The location of the birth center,
				including the name, address, and number of beds (not to exceed 10).
4) Information regarding any felony
				conviction, or conviction of any misdemeanor involving moral turpitude in the
				last five years, of the applicant; or, if the applicant is a firm, partnership,
				or association, of any of its members; or, if the applicant is a corporation,
				of any of its officers or directors; or of the person designated to manage or
				operate the birth center.
5) The
				name, address, telephone number, experience, credentials and any professional
				licensure or certification of the clinical director.
6) A list of all clinical staff, including
				name and license number.
7) A list
				of the number and type of proposed staff.
8) A detailed description of the services to
				be provided by the birth center, including the admission criteria (see Section
				264.1550).
9) Letter demonstrating compliance with
				requirements in Subpart B.
10) A
				copy of the contract between the birth center and referral hospital, including
				a transfer agreement pursuant to Section
				264.2250.
11) A written narrative on the prenatal care
				and community education services offered by the birth center and how these
				services are being coordinated with other health services in the
				community.
12) An admission
				protocol specifying the criteria for admitting a client to the birth center
				shall be included in the application as provided in this
				Section.