Application For Initial Certification

01. Certification Required. Before any agency can operate and provide services as a DDA, it must apply for, obtain, and maintain DDA certification from the Department. (3-17-22) 02. Department Review Not Guaranteed. The Department may choose not to consider th e application of any operator, administrator, or owner of an agency whose license or certification has been revoke d until five (5) years have lapsed from the date of revocation. (3-17-22) 03. Open Application. An applicant may apply up to three (3) times within a three hundred sixty-fiv e (365) day period starting on the date of the first submission. If the application is incomplete upon a third submission , the application will be denied. The applicant may not resubmit an application for six (6) months from the date of th e denial notice. (3-17-22) 04. Content of Application for Certification. Application for certification must be submitted to th e Department on the Department-approved form with the following information and supporting documents at leas t sixty (60) days prior to the planned opening: (3-17-22) a. An application form that contains name, address, and telephone number of the agency, type o f services to be provided, the geographic service area of the agencies, and the anticipated date for the initiation o f services; (3-17-22) b. An accurate and complete statement of all business names of the agency as filed with the Secretar y of State, whether it is an assumed business name, partnership, corporation, limited liability company, or other entit y that identifies each owner and the management structure of the agency; (3-17-22) c. A statement that the agency will comply with these rules and all other applicable local, state, an d federal requirements, including an assurance that the agency complies with pertinent state and federal requirement s governing equal opportunity and nondiscrimination; (3-17-22) d. A copy of the proposed organizational chart or plan for staffing of the agency; (3-17-22) e. Written policies and procedures addressing qualifications to meet service delivery requirement s including resumes, job descriptions, verification of criminal history clearance, and copies of state licenses an d certificates, when applicable; (3-17-22) f. Written policies and procedures for the development and implementation of personnel training t o meet the requirements of Section 302 of these rules; (3-17-22) g. Personnel and participant illness policy, communicable disease policy, and other health-relate d policies and procedures; (3-17-22) h. Written transportation safety policies and procedures required in Section 402 of these rules; (3-17-22) i. Written participant grievance policies and procedures to meet requirements in Section 406 of thes e rules; (3-17-22) j. Written medication policies and procedures to address medication standards to meet requirement s in Section 405 of these rules; (3-17-22) k. Written policies and procedures that address the development of positive behavior supports to mee t requirements in Section 510 of these rules; (3-17-22) l. Written policies and procedures for reporting incidents to the adult protection, child protectio n authority, or both, and to the Department to meet requirements in Section 404 of these rules; (3-17-22) m. A written code of ethics policy reflecting nationally recognized professional standards of practice . The policy must articulate basic values, ethical principles and standards for confidentiality, conflict of interest , exploitation, and inappropriate boundaries in an agency's relationship with participants, relatives, or with othe r agencies; (3-17-22) n. Complete administrator and supervisor records as required in Subsection 301.04 of these rules; (3-17-22) o. Sample of the following documents: (3-17-22) i. Complete participant record as required in Subsection 301.05 of these rules; (3-17-22) ii. Program billing; (3-17-22) iii. Quality assurance program developed to meet requirements in Section 500 of these rules;(3-17-22) iv. All documents referenced in the application. (3-17-22) p. Any other information requested by the Department for determining the agency's compliance of these rules or the agency's ability to provide the services for which certification is requested; (3-17-22) q. When center-based services are to be provided, the agency must include the following and meet requirements under Section 400 of these rules: (3-17-22) i. Address and telephone number for each service location; (3-17-22) ii. Supporting documentation requirements including the ADA checklist, local fire safety inspection , and local building and zoning compliance; (3-17-22) iii. Written policies and procedures covering the protection of all individuals in the event of fire an d other emergencies to include emergency evacuation procedures; and (3-17-22) iv. A site review completed by the Department prior to the initiation of center-based services verifyin g compliance with these rules. (3-17-22) 102. -- 109. (RESERVED)