R9-10-1002. Supplemental Application and Documentation Submission Requirements

A. In addition to the license application requirements in A.R.S. § 36-422 and 9 A.A.C. 10, Article 1, a governing authority applying for a license as an outpatient treatment center shall submit, in a Department-provided format: 1. The days and hours of clinical operation and, if different from the days and hours of clinical operation, the days and hours of administrative operation; and 2. A request to provide one or more of the following services: a. Behavioral health services and, if applicable; i. Behavioral health observation/stabilization services, ii. Children’s behavioral health services, iii. Court-ordered evaluation, iv. Court-ordered treatment, v. Counseling, vi. Crisis services, vii. Opioid treatment services, viii. Pre-petition screening, ix. Respite services, x. Respite services for children on the premises, xi. DUI education, xii. DUI screening, xiii. DUI treatment, or xiv. Misdemeanor domestic violence offender treatment; b. Diagnostic imaging services; c. Clinical laboratory services; d. Dialysis services; e. Emergency room services; f. Pain management services; g. Physical health services; h. Rehabilitation services; i. Sleep disorder services; or j. Urgent care services provided in a freestanding urgent care center setting. B. In addition to the license application requirements in A.R.S. § 36-422 and 9 A.A.C. 10, Article 1, a governing authority of an: 1. Affiliated outpatient treatment center applying for a license for the affiliated outpatient treatment center shall submit, in a Department-provided format, the following information for each counseling facility for which the affiliated outpatient treatment center is providing administrative support: a. Name, and b. Either: i. The license number assigned to the counseling facility by the Department; or ii. If the counseling facility is not currently licensed, the: (1) Counseling facility’s street address, and (2) Date the counseling facility submitted to the Department an application for a health care institution license; and 2. Outpatient treatment center, applying for a license that includes a request for authorization to provide respite services for children on the premises, shall include the requested respite capacity. C. A licensee of an affiliated outpatient treatment center shall submit to the Department the information required in subsection (B)(1) with the relevant fees required in R9-10-106(C) or (D), as applicable. D. A licensee of an outpatient treatment center authorized to provide respite services for children on the premises shall submit to the Department with the relevant fees in R9-10-106(C) or (D), as applicable: 1. The respite capacity, and 2. The specific 10 continuous hours per day during which the outpatient treatment center provides respite services on the premises. E. A licensee of an outpatient treatment center authorized to operate as a collaborating outpatient treatment center shall submit to the Department with the relevant fees in R9-10- 106(C) or (D), as applicable: 1. The information and documentation required in R9-10- 1031(D)(1); and 2. A floor plan that shows: a. Each colocator’s proposed treatment area, and b. The areas of the collaborating outpatient treatment center shared by a colocator and collaborating outpatient treatment center.