R9-10-202. Supplemental Application, Notification, and Documentation Submission Requirements

A. In addition to the license application requirements in A.R.S. § 36-422 and Article 1 of this Chapter, an applicant for a hospital license shall include: 1. On the application the requested licensed capacity for the hospital, including: a. The number of inpatient beds for each organized service, not including well-baby bassinets; and b. If applicable, the number of inpatient beds for each multi-organized service unit; 2. On the application, if applicable, the requested licensed occupancy for providing behavioral health observation/ stabilization services to: a. Individuals who are under 18 years of age, and b. Individuals 18 years of age and older; and 3. A list, in a Department-provided format, of medical staff specialties and subspecialties, as in a specific branch of medicine practiced by a licensed individual who has obtained education or qualifications in the specific branch in addition to the education or qualifications required for the individual’s license. B. For a single group license authorized in A.R.S. § 36-422(F), in addition to the requirements in subsection (A), a governing authority applying for a license shall submit the following to the Department, in a Department-provided format, for each satellite facility under the single group license: 1. The name, address, email address, and telephone number of the satellite facility; 2. The class or subclass of the satellite facility, according to R9-10-102; 3. The name and email address of the administrator; 4. A list of services to be provided at the satellite facility; and 5. The hours of operation during which the satellite facility provides medical services, nursing services, behavioral health services, or health-related services. C. For a single group license authorized in A.R.S. § 36-422(G), in addition to the requirements in subsection (A), a governing authority applying for a license shall submit the following to the Department in a Department-provided format for each accredited satellite facility under the single group license: 1. The name, address, email address, and telephone number of the accredited satellite facility; 2. The class or subclass of the accredited satellite facility, according to R9-10-102; 3. The name and email address of the administrator; 4. A list of services to be provided at the accredited satellite facility; 5. The hours of operation during which the accredited satellite facility provides medical services, nursing services, behavioral health services, or health-related services; and 6. A copy of the accredited satellite facility’s current accreditation report. D. A licensee with a single group license shall submit to the Department, with the relevant fees required in R9-10-106(D) and in a Department-provided format, the following, as applicable: 1. The information required in subsections (B)(1) through (5), or 2. The information and documentation required in subsections (C)(1) through (6). E. A governing authority shall: 1. Notify the Department: a. At least 30 calendar days before a satellite facility or an accredited satellite facility on a single group license terminates operations; b. Within 30 calendar days after adding a satellite facility or an accredited satellite facility under a single group license and provide, as applicable: i. The information required in subsections (B)(1) through (5), or ii. The information and documentation required in subsections (C)(1) through (6); and c. At least 60 calendar days before a satellite facility or an accredited satellite facility licensed under a single group license anticipates providing medical services, nursing services, behavioral health services, or health-related services under a license separate from the single group license; and 2. Upon notifying the Department according to subsection (E)(1)(c), submit an application, according to the requirements in 9 A.A.C. 10, Article 1, at least 60 calendar days but not more than 120 calendar days before a satellite facility or an accredited satellite facility licensed under a single group license anticipates providing medical services, nursing services, behavioral health services, or health-related services under a license separate from the single group license.