Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 137 - BIRTHING CENTERS › Subchapter B - LICENSING PROCEDURES › Section 137.11 - Application Procedures and Issuance of Licenses

Current through Reg. 49, No. 28; July 12, 2024
(a) The application.
(1) An applicant shall not misstate a
				  material fact on any documents required to be submitted under this
				  subsection.
(2) The application
				  form must be accurate and complete and must contain original signatures. The
				  nonrefundable license fee must be submitted with the application.
(3) The following information must be
				  submitted on the original application form and the application shall be
				  notarized:
(A) information on the applicant
				  including name, street address, mailing address, social security number or
				  federal tax identification number, and if applicable, date of birth and
				  driver's license number;
(B) the
				  name, mailing address, and street address of the center. The street address
				  provided on the application must be the address from which the center will be
				  operating and providing services;
(C) a list of names and business addresses of
				  all persons who own any percentage interest in the applicant including:
(i) each limited partner and general partner
				  if the applicant is a partnership; and
(ii) each shareholder, member, director, and
				  officer if the applicant is a corporation, limited liability company or other
				  business entity;
(D) a
				  list of any businesses with which the applicant subcontracts and in which the
				  persons listed under subparagraph (C) of this paragraph hold any percentage of
				  the ownership;
(E) if the applicant
				  has held or holds a center license or has been or is an affiliate of another
				  licensed center, the relationship, including the name and current or last
				  address of the other center and the date such relationship commenced and, if
				  applicable, the date it was terminated;
(F) if the center is operated by or proposed
				  to be operated under a management contract, the names and addresses of any
				  person and organization having an ownership interest of any percentage in the
				  management company;
(G) a written
				  plan for the orderly transfer of care of the applicant's clients and clinical
				  records if the applicant is unable to maintain services under the
				  license;
(H) the organizational
				  structure of the staffing for the center;
(I) the names and addresses of the
				  physicians, certified nurse-midwives, licensed midwives and other clinical care
				  providers who will provide services at the center;
(J) the following data concerning the
				  applicant, the applicant's affiliates, and the managers of the applicant:
(i) any orders of denial, suspension, or
				  revocation of a center license, a license for any health care facility in any
				  state, or documentation as a midwife; or any other enforcement action, such as
				  (but not limited to) court civil or criminal action;
(ii) any orders of denial, suspension, or
				  revocation of or other enforcement action against a center license, a license
				  for any health care facility in any state, or documentation as a midwife which
				  is or was proposed by the licensing agency and the status of the
				  proposal;
(iii) surrendering a
				  license before expiration of the license or allowing a license to expire in
				  lieu of the department proceeding with enforcement action;
(iv) federal or state (any state) criminal
				  felony arrests or convictions;
(v)
				  federal or state Medicaid or Medicare sanctions or penalties relating to the
				  operation of a health care facility;
(vi) operation of a health care facility that
				  has been decertified in any state under Medicare or Medicaid; or
(vii) debarment, exclusion, or contract
				  cancellation in any state from Medicare or Medicaid;
(K) for the two-year period preceding the
				  application date, the following data concerning the applicant, the applicant's
				  affiliates, and the managers of the applicant:
(i) federal or state (any state) criminal
				  misdemeanor arrests or convictions;
(ii) federal or state (any state) tax
				  liens;
(iii) unsatisfied final
				  judgement(s);
(iv) eviction
				  involving any property or space used as a center or health care facility in any
				  state;
(v) injunctive orders from
				  any court; or
(vi) unresolved final
				  state or federal Medicare or Medicaid audit exceptions; and
(L) the telephone number, and fax
				  number (if available) of the center and the telephone number where the
				  administrator can usually be reached when the center is closed.