641—155.5 (125,135) Application procedures. The department shall provide an application to all applicants for licensure. An on-site visit for licensure of an initial applicant shall occur before the program opens and admits client/patients for services. For initial applicants, if technical assistance has been provided, the on-site visit may be waived at the discretion of the department. The division shall prepare a report with a recommendation for licensure to be presented at a committee meeting within 60 days from the site visit. Public notice for committee meetings will be made in accordance with Iowa Code section 21.4. The division shall provide notice to the program ten days prior to the committee meeting notifying the program director and program board chairperson of the time, place, and date the committee will review and act upon the application for the program along with the results of the inspection. The division shall provide to all committee members reports of the on-site program licensure inspection and a final recommendation for each application to be acted upon at the next committee meeting.
	 155.5(1) Application information for comprehensive programs. An applicant for licensure shall submit the following information on forms available at the Iowa Department of Public Health, Division of Behavioral Health, Lucas State Office Building, 321 East 12th Street, Des Moines, Iowa 50319-0075.
	  a.   	 The name and address of the applicant treatment program.
	  b.   	 The name and address of the executive director of such treatment program.
	  c.   	 The names, titles, dates of employment, education, and years of current job-related experience of staff and a copy of the table of organization. Where multiple components and facilities exist, the relationship between components and facilities must be shown, as well as a description of the screening and training process for volunteer workers.
	  d.   	 The names and addresses of members of the governing body, sponsors, or advisory boards of such treatment program and current articles of incorporation and bylaws.
	  e.   	 The names and addresses of all physicians, other professionally trained personnel, medical facilities, and other individuals or organizations with whom the treatment program has a direct contractual or affiliation agreement.
	  f.   	 A description of the treatment services provided by the treatment program and a description of weekly activities for each treatment modality or component.
	  g.   	 Copies of reports substantiating compliance with federal, state and local rules and laws for each facility, to include appropriate Iowa department of inspections and appeals rules, state fire marshal’s rules and fire ordinances, appropriate local health, fire, occupancy code, and safety regulations.
	  h.   	 Information required under Iowa Code section 125.14A.
	  i.   	 Fiscal management information to include a recent audit or opinion of auditor and program board minutes to reflect approval of budget and insurance program.
	  j.   	 Insurance coverage related to professional and general liability; building; workers’ compensation; and fidelity bond.
	  k.   	 The address and facility code of each office, facility, or program location.
	  l.   	 The program’s current written policies and procedures manual to include the staff development and training program, and personnel policies. Applications for licensure will not be considered complete until a complete policies and procedures manual has been submitted to the division.
	  m.   	 The application information for an initial application for licensure shall be complete and shall be reviewed by the department prior to a scheduled on-site inspection.
	 155.5(2) Application information for substance abuse assessment and evaluation programs. An applicant for licensure shall submit the following information on forms available at the Iowa Department of Public Health, Division of Behavioral Health, Lucas State Office Building, 321 East 12th Street, Des Moines, Iowa 50319-0075.
	  a.   	 The name and address of the applicant substance abuse assessment and evaluation program.
	  b.   	 The name and address of the executive director or sole practitioner of such substance abuse program.
	  c.   	 The names, titles, dates of employment, education, and years of current job-related experience of staff and a copy of the table of organization (if applicable). If multiple components and facilities exist, the relationship between components and facilities must be shown, as well as a description of services.
	  d.   	 The names and addresses of members of the governing body, sponsors, or advisory boards of such substance abuse assessment and evaluation program and current articles of incorporation and bylaws. (This requirement does not apply to a sole practitioner.)
	  e.   	 The name(s) and address(es) of person(s) entered into the affiliation agreement for clinical oversight.
	  f.   	 A description of the assessment and evaluation services.
	  g.   	 Copies of reports substantiating compliance with federal, state and local rules and laws for each facility, to include appropriate state fire marshal’s rules and fire ordinances, occupancy code, and safety regulations.
	  h.   	 Information required under Iowa Code section 125.14A.
	  i.   	 Insurance coverage related to professional and general liability; building; workers’ compensation; and fidelity bond.
	  j.   	 The address and facility code of each office, facility, or program location.
	  k.   	 The program’s current written policies and procedures manual which shall include the staff development and training program, and personnel policies. Applications for licensure will not be considered complete until a complete policies and procedures manual has been submitted to the division.
The application information for an initial application for licensure shall be complete and shall be reviewed by the department prior to a scheduled on-site inspection.
	 155.5(3) Renewal. An application for renewal shall be submitted on forms provided by the department at least 60 calendar days before expiration of the current license. An application for licensure renewal will not be considered complete until a current policies and procedures manual has been submitted to the department by the applicant treatment program.
	 155.5(4) Application update or revision. The department shall be notified, and a request of an application for licensure for update or revision shall be made, by an existing licensed program 30 days prior to any change(s) of address of offices, facilities, or program locations; or additions or deletions of the type(s) of services or programs provided and licensed. A new licensure application form shall be completed to reflect change of address of offices, facilities, or program locations, or additions or deletions of the type(s) of services or program(s) provided or licensed and shall be returned to the division within 10 working days from the date the forms are received. When applicable, as determined by the department, an on-site licensure inspection of a new component, service, program or facility may be conducted by the department within six months, upon receipt of the updated or revised application or during an existing licensed program’s scheduled relicensure on-site inspection, whichever occurs first.
[ARC 8792B, IAB 6/2/10, effective 7/1/10; ARC 9534B, IAB 6/1/11, effective 7/6/11]