Application for a License

(A) Applications for licensure shall be made on forms prescribed by the Department. The term “application” as used in 105 CMR 140.102 shall include initial and renewal applications. (B) In support of an application for an original or renewal license, each applicant shall submit the following information, updated as required by 105 CMR 140.107: (1) Information concerning ownership or control that identifies: (a) If owned by an individual, partnership or trust, the names and ownership percentages of such individual, partners or trustees, except, in the case of a limited partnership, such information shall be provided only for those limited partners owning 5% or more of the partnership interest and the general partner. (b) If owned by a privately held for-profit corporation, the names of all stockholders who hold 5% or more of any class of the outstanding stock, specifying the percentage owned. (c) If owned by a not-for-profit corporation, the names of the members and directors of the corporation. (d) The name and ownership percentage of each individual who directly or indirectly has any ownership interest of 5% or more, unless otherwise provided pursuant to 105 CMR 104.102(B)(1)(a), (b) or (c). (2) If ownership of the clinic has been transferred, satisfactory documentary evidence (such as a contract or a deed) showing ownership of the clinic has been transferred to the applicant. (3) Anyinformation required by the Commissioner as part of the application, including such additional information concerning ownership or control as the Commissioner may require. (C) Deemed-by-accreditation Licensure for AmbulatorySurgeryCenters. The Department may deem the conditions of original or renewal licensure in 105 CMR 140.000 satisfied for an ambulatory surgery center (ASC) meeting the requirements of 105 CMR 140.102(C). (1) Deemed-by-accreditation Original License. An ASC meeting the following criteria shall be eligible to apply for a deemed-by-accreditation original license from the Department. 140.102: continued (a) on the date of application, the entity is accredited to provide ambulatory surgery services by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), the Joint Commission, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or any other national accrediting body as determined by the Department; and (b) on the date of application, the entity is certified or has applied for certification as an ASC by the Centers for Medicare and Medicaid Services for participation in the Medicare program; (2) Deemed-by-accreditation Renewal License. An ASC meeting the following criteria shall be eligible to applyfor a deemed-by-accreditation renewal license from the Department: (a) on the date of application, the entity is accredited to provide ambulatory surgery services by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), the Joint Commission, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or any other national accrediting body as determined by the Department; and (b) on the date of application, the entity is certified as an ASC by the Centers for Medicare and Medicaid Services for participation in the Medicare program; (3) Application for Deemed-by-accreditation License. An application for a deemed-by- accreditation original or renewal license shall be made on forms prescribed by the Department. The applicant or licensee shall: (a) submit the information required by 105 CMR 104.102(B); (b) release to the Commissioner a copy of the applicant or licensee’s current accreditation letter and the accrediting agency’s explanation of its survey findings; and (c) for a deemed-by-accreditation original license, comply with the requirements of 105 CMR 140.103(A), (B), (C)(2), and (D). (4) Evaluation of Deemed-by-accreditation License Application. The Department shall not approve an application for deemed-by-accreditation original or renewal license, unless it determines: (a) the requirements of 105 CMR 140.108(B) and 105 CMR 140.109 relating to responsibility and suitability are met; and (b) for a deemed-by-accreditation original license, the requirements of 105 CMR 140.108(C) relating to determination of need or exemption there from are met. (5) Obligations of Deemed-by-accreditation Licensee. Upon issuance of a deemed-by- accreditation original or renewal license, a licensee is subject to all of the requirements of 105 CMR 140.000, unless otherwise specified. In addition, a deemed-by-accreditation licensee shall: (a) permit Department staff to participate in any summation conference(s) scheduled at the completion or renewal of accreditation; and (b) release to the Commissioner any other accreditation information requested or specified in guidelines of the Department. (6) Suspension, Denial, Refusal to Renew, or Revocation of Deemed-by-accreditation License. (a) Following the procedures in 105 CMR 140.132 through 140.134, the Commissioner may suspend, deny, refuse to renew, or revoke a deemed-by-accreditation license on any of the grounds specified in 105 CMR 140.130 or 105 CMR 140.131. (b) In addition the Commissioner may suspend, deny, refuse to renew, or revoke a deemed-by-accreditation license under the following circumstances: 1. the licensee loses its accreditation status; 2. the Commissioner finds the licensee is out of compliance with one or more conditions of accreditation or determines a significant deficiency exists; 3. the licensee’s application for Medicare certification is denied; or 4. the Commissioner finds the licensee is out of compliance with one or more Medicare Conditions of Participation or determines a significant deficiency exists.