3701-19-03 Initial license application process.

(A) This rule prescribes the procedures for applying for a license to provide a hospice care program. Application shall be made on forms prescribed and provided by the director, shall include such information as the director requires, including the information prescribed by paragraph (C) of this rule, and shall be accompanied by a non-refundable license fee of six hundred dollars in the form of a cashier's check or a postal money order payable to the "Treasurer, State of Ohio."

(B) Any person or public agency seeking to be licensed to provide a hospice care program shall submit an application for licensure at least sixty days prior to the requested date for the inspection required by paragraph (A) of rule 3701-19-05 of the Administrative Code.

(C) An application for a license to provide a hospice care program shall include:

(1) The name, address, and business telephone number of the hospice care program.

A hospice care program that operates from multiple locations shall include the addresses and telephone numbers for all locations on the application for license. The application shall indicate which location is to be issued the license;

(2) The names and addresses of the persons having an ownership or control interest in the hospice care program and other information pertaining to ownership or control of the program;

(3) The corporate name of the hospice care program, if any, and the names, titles, addresses, and telephone numbers of its officers and statutory agent;

(4) A list of the services which are or will be provided by the hospice care program either directly or indirectly through written contracts, the identities of any contractors and the services they will provide, and the date the program will be operational;

(5) A description of the geographic area in which the hospice care program will provide services;

(6) If the applicant is requesting a waiver of the requirement for providing physical therapy, occupational therapy, or speech or language therapy services pursuant to paragraph (B) of rule 3701-19-19 of the Administrative Code, the documentation required by that paragraph.

(7) If a hospice care program operates an inpatient hospice facility, documentation of compliance with the building code standards required by paragraph (C) of rule 3701-19-27 of the Administrative Code.

(D) The applicant or an authorized representative shall sign an affidavit included in the application certifying that, to the best of his or her knowledge, the information in the application and any accompanying material is true and accurate. If a representative signs the affidavit, he or she shall include documentation that he or she is the applicant's authorized representative.

(E) When reviewing a license application, the director may request, in writing, that an applicant furnish any additional information that the director determines to be necessary to assess compliance with Chapter 3712. of the Revised Code and this chapter. The applicant shall furnish any requested information within fourteen days after the mailing of the director's request.

(F) Licensure of a hospice care program providing services from multiple locations in Ohio.

(1) Except as prohibited by section 3712.08 of the Revised Code, the director may grant a license to a hospice care program which provides services from multiple locations in Ohio, if the applicant complies with all the following:

(a) Each location provides the same full range of services that is required of the hospice care program location issued the license;

(b) Each location is responsible to the same governing body and central administration that governs the hospice care program location issued the license, and the governing body and central administration is able to adequately manage each location;

(c) The hospice care program maintains clinical records for all patients served by the hospice care program regardless of where services are provided; and

(d) All hospice patients' clinical records requested by the director during an inspection are available at the hospice care program location issued the license.

(2) A hospice location that does not comply with the requirements of paragraph (F) (1) of this rule is operating as a separate hospice care program and shall obtain a separate license and pay the appropriate license fee.

(G) A hospice care program operating in another state seeking to provide services to patients in Ohio shall establish an administrative office in Ohio and comply with the rules of Chapter 3701-19 of the Administrative Code in order to obtain a license. All Ohio hospice patients' clinical records shall be maintained at the Ohio administrative office.

Effective: 06/20/2010
R.C. 119.032 review dates: 03/18/2010 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.03 , 3712.04
Prior Effective Dates: 12/31/1990, 10/17/99, 1/1/05, 8/23/09