Initial Licensure

Initial Licensure. For initial licensure, an applicant shall be in compliance with all requirements, as outlined in these regulations, and must submit documents, included but not limited to, those outlined: 1. A completed/signed application, on forms as designated by MSDH. All information submitted on the application forms, or by request for additional information, shall be accurate and current at the time of filing; 2. A non-refundable application/processing fee in an amount set by the Board. The fee shall be made payable to the Mississippi State Department of Health, either by business check, money order, or electronic means. The fee is non-refundable. 3. A licensing fee in an amount set by the Board. The licensing fee shall be made payable to the Mississippi State Department of Health, either by business check, money order or electronic means. The fee is non- refundable. 4. Certificates/letters of approval from the local zoning authority indicating that the location of the PPEC center conforms to local zoning ordinances, if applicable; 5. Certificates/letters of approval from the local/regional/state Fire Marshal that the PPEC center is in compliance with all applicable fire safety standards; 6. Evidence that the PPEC center’s water and sewer systems have been approved by the Mississippi State Department of Health; 7. A licensed facility shall obtain a Food Service Permit from the Mississippi State Department of Health Office of Environmental Health. 8. Certificate of Occupancy; 9. Clinical Laboratory Improvement Amendments (CLIA) certificate or CLIA certificate of waiver. 10. Proof of general and Professional Liability Insurance in the amount of at least $300,000.00 including Workman’s Compensation Insurance; 11. Articles of Incorporation, Disclosure of Ownership and Control Information; 12. Proof of financial viability/contingency plan demonstrating evidence that the applicant processes assets sufficient to establish and sustain all components of a PPEC center to meet the provisions as outlined in these regulations while operating and/or during extraordinary circumstances including but not limited to audited financial statements, an established line of credit issued from a federally insured institution in the amount of at least $100,000.00, a projected twelve (12) month statement of operations and a projected first twelve months statement of cash flow. The requesting PPEC center shall provide evidence of the referenced above review in the form of a certified affidavit or statement resultant of a review from an independent certified public accountant firm. 13. That the center is located within 20 miles or 30 minutes (whichever is greater) of an Emergency Department that has capabilities to handle pediatric emergencies; 14. The name of the PPEC center’s administrator, the name and license number of the Medical Director and Director of Nursing along with proof of available licensed and supportive personnel who will have responsibility for any part of the care given to PPEC center’s clients; as well as proof of ancillary support services such as dietary, housekeeping, maintenance and other personnel either directly or contractually secured to support the PPEC center on a daily basis; 15. The names and titles of personnel who have been affiliated, during the preceding five (5) years with any other PPEC center through ownership or employment, and the listing of names and addresses of the appropriate PPEC center for each. This information shall be provided for the applicant: administrator, and all licensed nurses; and 16. Floor sketch or drawing of premises to be licensed, letter of intent and a detailed functional plan which delineates the proposed use of space, that includes but is not limited to the programmatic design outlined in Rule 2.20.2, the purpose of the project, the key elements of the physical environment, functional requirements and other basic information related to the fulfillment of the services required in the Minimum Standards of Operation for a PPEC Center.