Ariz. Admin. Code § R6-5-7403 - Letter of Intent - New Applicant
A. The prospective applicant shall prepare a
responsive letter of intent to proceed with licensure, and return it to the
Licensing Authority. The letter of intent shall include the following
information:
1. The applicant's name,
address, and telephone and telefacsimile numbers;
2. The name of the applicant's chief
executive officer or administrator, with a description of that person's
qualifications to operate the agency;
3. A description of community or statewide
need for the service or program the applicant intends to provide;
4. A plan for financing the proposed agency
during the first year of operation;
5. A statement that the applicant has
conferred with the school district where the facility will be located to advise
the district of any special needs that children likely to be in care at the
facility may have; and
6. A
description of the proposed agency's program and services, which shall address
the following areas, if applicable:
a. Any
organization from which the applicant will seek accreditation;
b. The form of on-campus educational programs
the applicant will offer;
c. The
characteristics of the children the applicant plans to serve;
d. The applicant's primary source of
referrals;
e. The frequency and
method by which the applicant will provide or offer psychiatric, psychological,
or counseling services;
f. Whether
the applicant will employ behavioral health practitioners, or contract for
behavioral health services; and
g.
A general description of the number and qualifications of the applicant's
professional staff.
B. Within 10 work days of receiving a letter
of intent, a licensing representative shall contact the applicant.
1. If the Licensing Authority determines that
an applicant may require licensure as a behavioral health service agency under
A.R.S. §
36-405
and 9 A.A.C. 20, the Licensing Authority shall refer the applicant to the
Department of Health Services for evaluation. In determining whether to refer
an applicant to DHS, the Licensing Authority shall consider the factors set
forth on Appendix 1.
2. For all
other applicants, the representative shall schedule an appointment for a
licensing consultation. The appointment shall occur within 45 calendar days of
the date the Licensing Authority receives the letter of intent, unless the
applicant requests a later consultation.
3. If DHS declines to license an applicant as
a behavioral health service agency, and refers an applicant to the Department
for licensure as a child welfare agency, the applicant shall contact the
Licensing Authority to request a licensing consultation. The Licensing
Authority shall schedule the consultation within 45 calendar days of the date
of the request, unless the applicant requests a later consultation.
Notes
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