The Administration shall designate a provider who applies to be an OHCDS if the provider entity: Submits an application on a form approved by the Administration; Is licensed by the Administration to provide one of the following services: Community supported living arrangements; Family and individual support services; Day services; Supported employment services; Residential services; and Other services as applicable; Is a Medicaid enrolled provider and renders at least one Medicaid Service directly; and Meets the requirements of this chapter.