R9-10-502. Supplemental Application Requirements and Documentation Submission Requirements

A. In addition to the license application requirements in A.R.S. § 36-422 and R9-10-105, an applicant for a license as an ICF/ IID shall include: 1. In a Department-provided format, whether the applicant is requesting authorization: a. To admit residents who: i. Require continuous nursing services, ii. Require intermittent nursing services, or iii. Do not require nursing services; and b. To provide: i. Active treatment to individuals under 18 years of age, including the licensed capacity requested; ii. Seclusion; iii. Clinical laboratory services; iv. Respiratory care services, or v. Services to residents who have a nursing care plan or medical care plan; and 2. Documentation of the applicant’s certification as an ICF/ IID by the federal Centers for Medicare and Medicaid Services. B. A licensee shall submit to the Department, with the relevant fees required in R9-10-106(C) and in a Department-provided format: 1. The information required in subsection (A)(1), as applicable, and 2. The documentation specified in subsection (A)(2).