<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.21.07.05" title_num="10" subtitle_num="21" chapter_num="07" heading="Application Process.">
  <paragraph num="A.">
    <text>Consultation. If the Administration is the designated lead agency, an applicant for licensure for a TGH, before submitting an application, may request assistance from the designated licensure unit of the Department, the appropriate CSA director, or the Administration regarding the proper compilation of application materials and completion of the application.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Application. An applicant for licensure of a TGH shall:</text>
    <paragraph num="(1)">
      <text>Submit, to the Department's designated licensure unit, a signed, notarized application on the form approved by the Department with the requirement that all questions be answered and all required documents be attached;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Include in the application:</text>
      <paragraph num="(a)">
        <text>The applicant's:</text>
        <paragraph num="(i)">
          <text>Name;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Agency affiliation, if any; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Address;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Documentation:</text>
        <paragraph num="(i)">
          <text>Of the applicant's not-for-profit status; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>That the applicant has sufficient financial resources or that sufficient resources are available to the applicant for the establishment and operation of the residence;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>The following information about the property:</text>
        <paragraph num="(i)">
          <text>The street address of the location of the TGH or, if it has no street address, a description that adequately identifies the location of the property; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>If the applicant does not own the property, the name and address of the owner;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>The satisfactory fire, safety, and health inspection reports, not more than 1 year old, of the TGH that are required by the local jurisdiction;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Written material that describes how the applicant intends to comply with the requirements outlined in:</text>
        <paragraph num="(i)">
          <text>COMAR 14.31.05; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>This chapter;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>An explanation of the need for the TGH, including, if the jurisdiction in which the TGH is to be located is served by a CSA, a letter of intent that explains how the TGH meets a need identified in the Administration-approved CSA plan;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>When applicable, documentation that the TGH will collaborate with the CSA, as required under Regulation .07 of this chapter;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Documentation that the TGH:</text>
        <paragraph num="(i)">
          <text>Is near transportation facilities, or has a plan for the provision of transportation services based on the individual's need; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Meets, or on completion will meet, general zoning requirements regarding size, density, land use, and architectural guidelines that apply to the site; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(i)">
        <text>The applicant's program service plan, as outlined in §C of this regulation; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Forward a copy of the:</text>
      <paragraph num="(a)">
        <text>Application cover letter to the Administration; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Application to the:</text>
        <paragraph num="(i)">
          <text>CSA, if the jurisdiction in which the TGH is to be located is served by a CSA; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Administration, if the jurisdiction in which the TGH is to be located is not served by a CSA.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Program Service Plan (PSP). On the form approved by the Administration, as part of the application, a TGH shall submit a PSP that includes:</text>
    <paragraph num="(1)">
      <text>If appropriate, a copy of the articles of incorporation, organizational chart, bylaws, and list of the members, including officers, of the governing body;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Documentation that at least 1/3 of the members of either the governing body or an advisory committee includes representation of consumers, former consumers, or family members;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The proposed budget for the TGH;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A description of:</text>
      <paragraph num="(a)">
        <text>The number of children, as well as their age groups and other relevant characteristics, that the TGH expects to serve;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The geographic area to be served;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The goals, objectives, and expected outcomes of the program;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The plan for the provision of the following services:</text>
        <paragraph num="(i)">
          <text>Medical;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Dental;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Required education;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Social and recreational;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Nutritional; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Mental health treatment;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>The method for linkage with service providers and community resources, including, when applicable, written agreements with inpatient facilities and other providers of health, mental health, and social services; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>The methods by which quality, including risk management and utilization review, are assured; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>A list of staff positions, their job descriptions and educational and clinical training requirements, and staffing patterns, including an organizational chart detailing lines of authority and responsibility.</text>
    </paragraph>
  </paragraph>
</regulation>