3701-19-32. License application, amended license, and renewal procedures

(A) Application for license as a pediatric respite care program shall be made on forms prescribed and provided by the director shall include such information as the director requires, including the information prescribed by paragraph (C) of this rule, and shall be accompanied by a non-refundable license fee of six hundred dollars in the form of a check or money order payable to the 'Treasurer, State of Ohio."

(B) Any person or public agency seeking to be licensed to provide a pediatric respite care program shall submit an application for licensure at least sixty days prior to the requested date for the inspection required by paragraph (A) of rule 3701-19-34 of the Administrative Code.

(C) An application for a license to provide a pediatric respite care program shall include:

(1) The name, address, and business telephone number of the pediatric respite care program;

(2) The names and addresses of the persons having an ownership or control interest in the pediatric respite care program and other information pertaining to ownership or control of the program;

(3) The corporate name of the pediatric respite care program, if any, and the names, titles, addresses, and telephone numbers of its officers and statutory agent;

(4) A list of the services which are or will be provided by the pediatric respite care program either directly or indirectly through written contracts;

(5) If services are to be provided through contract, the identities of any contractors and the services they will provide;

(6) The number of pediatric respite care patient rooms in the pediatric respite care program facility; and

(7) Documentation of compliance with the building code standards required by paragraph (C) of rule 3701-19-48 of the Administrative Code.

(D) The applicant or an authorized representative shall sign an affidavit included in the application certifying that, to the best of his or her knowledge, the information in the application and any accompanying material is true and accurate. If a representative signs the affidavit, he or she shall include documentation that he or she is the applicant's authorized representative.

(E) An application for renewal of a license shall be made at least ninety days prior to the expiration of the license. The application shall be made and a renewal fee paid in accordance with paragraph (A) of this rule in the same manner as for an initial license. A pediatric respite care program shall submit documentation of continued compliance with the Ohio fire code required by paragraph (C) of rule 3701-19-48 of the Administrative Code, and a certificate of occupancy required by paragraph (C) of rule 3701-19-48 of the Administrative Code only if it is different than the one previously submitted to the director. The director shall renew the license if the program continues to meet the requirements of Chapter 3712. of the Revised Code and Chapters 3701-19 and 3701-13 of the Administrative Code. If the program does not meet the requirements, the director may deny renewal of the license, in accordance with Chapter 119. of the Revised Code.

(F) When reviewing a license application, the director may request, in writing, that an applicant furnish any additional information that the director determines to be necessary to assess compliance with Chapter 3712. of the Revised Code and this chapter. The applicant shall furnish any requested information within fourteen days after the mailing of the director's request.

(G) A pediatric respite care program operating in another state seeking to provide services to patients in Ohio shall establish an administrative office in Ohio and comply with the rules of Chapter 3701-19 of the Administrative Code in order to obtain a license. All pediatric respite patients' clinical records shall be maintained at the Ohio administrative office.

(H) Each licensed pediatric respite care program shall notify the director, in writing, of any of the following:

(1) Any change in any of the information specified in the license application under paragraphs (C)(1) to (C)(5) of this rule no later than fifteen days after the change;

(a) A change of ownership shall require the submission of a change of ownership application on forms prescribed and provided by the director; and

(b) A non-refundable fee of two hundred dollars in the form of a check or money order payable to the "Treasurer, State of Ohio."

(2) Any other change that would render the information submitted in the license application inaccurate at least twenty-one days prior to the effective date of the change; and

(3) Any intent to cease operation at least sixty days prior to ceasing operation. This notification shall include a plan for assuring continuity of care for the program's patients and their families after the program ceases operation. The plan shall include procedures for assuring continuity of care for all pediatric respite care patients that includes the folowing:

(a) Provision of written notice of the proposed closure of the program, at least sixty days prior to ceasing operation, to each patient or patient's family;

(b) Development of a written discharge plan to be placed in each patient's record to assist the person or public agency that will be responsible for care of the patient and the patient's family after the program ceases operation; and

(c) Obtaining from each patient or the patient's authorized representative written approval of any transfer to another licensed pediatric respite care program and written authorization to release pertinent clinical record information to such a program or another person or public agency that will assume responsibility for the patient's and family's care.

(I) Each licensed pediatric respite care program that seeks to increase or decrease the number of pediatric respite care patient rooms as reported under paragraph (C)(6) of this rule, shall apply for an amended license.

(1) Application for an amended license shall be made on forms prescribed and provided by the director, shall include such information as the director requires, and shall be accompanied by a non-refundable amended license fee in the form of a check or money order payable to the "Treasurer, State of Ohio" in the following amounts:

(a) A decrease in the number of patient rooms not involving a renovation, a fee of two hundred dollars;

(b) An increase in the number of patient rooms not involving a renovation, a fee of two hundred dollars; or

(c) An increase in the number of patient rooms involving a renovation, a fee of six hundred dollars.

(2) Any increase in the number of pediatric respite care patient rooms shall require an inspection in accordance with rule 3701-19-34 of the Administrative Code.

Five Year Review (FYR) Dates: 11/5/2018 and 11/05/2023
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.99, 3712.09, 3712.061, 3712.051, 3712.041
Prior Effective Dates: 12/26/2013

Prior History: (Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031, 3712.041, 3712.051, 3712.061, 3712.09, 3712.99)