Ariz. Admin. Code § 9-25-1303

Current through Register Vol. 30, No. 40, October 4, 2024

Section R9-25-1303 - Application and Designation Process (A.R.S.Sections 36-2202(A)(4), 36-2209(A)(2), and 36-2225(A)(4))

A. An owner applying for initial designation or to renew designation for a health care institution shall submit to the Department an application including:

1. The following information, in a Department-provided format:

a. The name, address, and telephone number of the health care institution for which the owner is requesting designation;

b. The owner's name, address, e-mail address, telephone number, and, if available, fax number;

c. The name, e-mail address, telephone number, and, if available, fax number of the chief administrative officer, as defined in A.A.C. R9-10-101, for the health care institution for which the owner is requesting designation;

d. The designation Level for which the owner is applying;

e. Whether the owner is requesting designation for the health care institution based on:

i. Verification, or

ii. Meeting the applicable standards specified in R9-25-1308 and Table 13.1;

f. If the owner is requesting designation for the health care institution based on verification:

i. The name of the national verification organization;

ii. The name, telephone number, and e-mail address for a representative of the national verification organization;

iii. The Level of verification held;

iv. The effective date of the verification, and

v. The expiration date of the verification;

g. If the owner is requesting designation for the health care institution based on the health care institution meeting the applicable standards specified in R9-25-1308 and Table 13.1:

i. Whether:

(1) A national verification organization has assessed the health care institution, or

(2) The Department will be assessing the health care institution;

ii. If a national verification organization has assessed the health care institution:

(1) The name of the national verification organization;

(2) The name, telephone number, and e-mail address for a representative of the national verification organization; and

(3) The date the national verification organization assessed the health care institution; and

iii. If the Department will be assessing the health care institution, the date the health care institution will be ready for the Department to assess the health care institution;

h. Unless the owner is an administrative unit of the U.S. government or a sovereign tribal nation, the license number, issued by the Department, for the health care institution for which designation is being requested;

i. The name, e-mail address, telephone number, and, if available, fax number of the health care institution's trauma program manager;

j. Whether the health care institution's trauma registry will be located at the health care institution or be part of a centralized trauma registry;

k. The name, e-mail address, telephone number, and, if available, fax number of the health care institution's trauma registrar;

l. If applying for designation as a Level IV trauma center, whether the health care institution plans to submit, in addition to the information required in R9-25-1309(A), the information specified in R9-25-1309(B);

m. If not already submitting trauma registry information to the Department, the time period for which the health care institution plans to begin submitting trauma registry information;

n. Except for a health care institution applying for designation as a Level IV trauma center, the name, e-mail address, telephone number, and, if available, fax number of the health care institution's trauma medical director;

o. The name, title, address, and telephone number of the owner's statutory agent or the individual designated by the owner to accept service of process and subpoenas;

p. Attestation that:

i. The owner will comply with all applicable requirements in A.R.S. Title 36, Chapter 21.1 and this Article; and

ii. The information and documents provided as part of the application are accurate and complete; and

q. The dated signature of the applicable individual according to R9-25-102;

2. If applicable, documentation demonstrating that the health care institution is operating as a hospital or an outpatient treatment center providing emergency services under federal or tribal law as an administrative unit of the U.S. government or a sovereign tribal nation; and

3. One of the following:

a. Documentation from the national verification organization, identified according to subsection (A)(1)(f)(i), establishing that the owner holds verification for the health care institution at the Level of designation being requested and showing the effective date and expiration date of the verification;

b. Documentation from the national verification organization, identified according to subsection (A)(1)(g)(ii)(1), demonstrating that the health care institution meets the applicable standards specified in R9-25-1308 and Table 13.1; or

c. The information and documents required in R9-25-1307(C), (D), or (F), as applicable.

B. An owner applying to renew designation for a health care institution shall submit the application in subsection (A) to the Department at least 60 calendar days and no more than 90 calendar days before the expiration of the current designation.

C. Within 30 calendar days after receiving an application submitted according to subsection (A), the Department shall review the application submitted for completeness, and, if the application is:

1. Incomplete, provide to the owner a written notice listing each missing item and the information or items needed to complete the application; and

2. Complete and based on:

a. Verification, comply with R9-25-1307(A);

b. A national verification organization assessing the health care institution's meeting the applicable standards specified in R9-25-1308 and Table 13.1, comply with R9-25-1307(B); or

c. The Department assessing the health care institution's meeting the applicable standards specified in R9-25-1308 and Table 13.1, assess compliance with applicable requirements in A.R.S. Title 36, Chapter 21.1 and this Article according to R9-25-1307(E) or (G).

D. The Department shall consider an application withdrawn if an owner:

1. Fails to submit to the Department all of the information or items listed in a notice of missing items within 60 calendar days after the date on the notice of missing items, unless the Department and the owner agree to an extension of this time; or

2. Submits a written request withdrawing the application.

E. If an owner submits an application for renewal of designation for a health care institution according to subsection (A) before the expiration date of the current designation, the designation of the health care institution remains in effect until the:

1. Department has determined whether or not to issue a renewal of the designation, or

2. Application is withdrawn.

Ariz. Admin. Code § R9-25-1303

New Section made by final rulemaking 11 A.A.R. 4363, effective October 6, 2005 (Supp. 05-4). Section expired under A.R.S. 41-1056(E) at 18 A.A.R. 2153, effective June 30, 2012 (12-3). Amended and renumbered from R9-6-1304 by final rulemaking at 23 A.A.R. 2656, effective 1/1/2018.