10-144-118 Me. Code R. § 3.B

Current through 2024-51, December 18, 2024

Section 144-118-3.B - Application Procedure

3.B.1. Filing of Application

Any person desiring a license to operate an ICF/MR shall, prior to the commencement of such operation, file an application containing the information required in this section with the Department. Application on behalf of a corporation, association, or government unit shall be made by any two officers thereof or by its managing agency and by any general partner of a partnership. All applicants shall submit satisfactory evidence of their ability to comply with the minimum standards of Chapter 405 of Title 22 M.R.S.A., and all rules and regulations adopted thereunder. Such application shall be on a form approved by the Department.

3.B.2. Contents of Application

a. The name or address by which the ICF/MR is to be legally known and the name under which it will be doing business;

b. The address and telephone number of the premises which are to constitute the location of the ICF/MR, together with a description of all structures and buildings forming a part thereof, and the name of the owner or owners of the premises; and

c. The full name and address of each person having a direct or indirect ownership interest of ten percent (10%) or more in such ICF/MR. Additionally, in case the ICF/MR is organized as a corporation, the full name and address of each officer and director of the corporation; and if the ICF/MR is organized as a partnership, the full name and address of each partner;

d. The name, home address, home telephone number, e-mail address and office telephone number of the individual designated by the applicant as the administrator of the facility.

3.B.3. Statement by Commissioner of the Department of Public Safety

Each applicant shall provide to the Department a written statement signed by an authorized representative of the Department of Public Safety or the proper municipal official designated in Title 25 M.R.S.A., Chapters 311 to 321, to make fire safety inspections, so that the ICF/MR and premises comply with said Chapters.

3.B.4. Fees

Each application for a license must be accompanied by a non-refundable fee of $10.00 for each bed contained within the facility. Licenses issued must be renewed annually upon payment of a like fee and determination of compliance with state and federal statutes and regulations. Any license re-issued as a result of a change of administrator, change in bed complement, change of ownership or modification to a temporary or a conditional status will be issued upon payment of a $25.00 fee.

3.B.5. Additional Information

Each applicant shall provide to the Department any information the Department may require to determine the suitability for licensure and conformity with state and federal statutes and regulations.

10-144 C.M.R. ch. 118, § 3.B