(a)

1. (1) Applicants for licensure of a Level II assisted living facility shall obtain the necessary forms for initial licensure or to request relicensure of the facility after a change of ownership (see subsection (g) of this section and 20 CAR § 411-208) from the Department of Human Services.
2. (2) The issuance of an application form shall not be construed to be a guarantee that the completed application will be acceptable, or that the department will issue a license.

(c)

1. (1) Applicants for initial licensure, or relicensure after a change in ownership, shall pay in advance a license fee of ten dollars ($10.00) per bed to the department.
2. (2) Such fee shall be refunded to the applicant in the event a license is not issued.
3. (3) An application fee of two hundred fifty dollars ($250) shall also accompany every application which shall be nonrefundable.

(d)

1. (1) Annual licensure fees shall be tendered with each application for a new long-term care facility license and annually thereafter by the anniversary of the date the department issued the long-term care facility license.
2. (2) The annual licensure fees consist of a two-hundred-fifty-dollar annual fee plus ten dollars ($10.00) per bed.

(g) As a part of the application process, and in addition to all other applicable requirements, facility operators must provide:

1. (1) Information on the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility;
2. (2) Information on the owner or owners of the building or other structures that will be used in the operation of the facility;
3. (3) Information on all other facilities owned, operated, or managed by the applicant or applicants;
4. (4) Information on all other facilities owned, operated, or managed by the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility; and
5. (5) Affirmative evidence of the ability to comply with standards and rules as may be lawfully prescribed.

(h) The applicant or licensee must furnish the following information:

1. (1) The identity of each person having, directly or indirectly, an ownership interest of five percent (5%) or more in the facility;
2. (2) The complete name and address of the assisted living facility for which license is requested and such additional information as the department may require including, but not limited to, affirmative evidence of ability to comply with standards and rules as are lawfully prescribed hereunder;
3. (3) In case such facility is organized as a corporation, the identity of each officer and director of the corporation, together with a certificate of good standing from the Secretary of State;
4. (4) In case such facility is organized as a partnership, the identity of each partner and a copy of the partnership agreement;
5. (5) A statement from an authorized representative of the facility acknowledging that the facility is responsible for any funds that are handled for the residents by the facility or its staff, including personal allowance funds, together with an acknowledgement that the failure to make restitution within ten (10) working days for lost or stolen funds will result in the nonrenewal of licensure or other sanctions;
6. (6) A copy of any required contract agreement for the provision of services meeting specifications in 20 CAR § 411-303; and

7. (7)

   1. (A) A copy of the floor plan of the assisted living facility.
   2. (B) If the assisted living facility will be a part of another facility under a different license, the distinct part of the facility that will be used for assisted living shall be identified.

(i)

1. (1)

   1. (A) A Level II assisted living facility may apply for and be granted a license to operate as a Level I-only facility.
   2. (B) The facility shall, prior to the issuance of the license, provide a written plan to the department setting forth:

(i) The means by which alternative placement for individuals who receive, or meet the medical eligibility for, nursing home level of care, will be made; and

1. (ii) The date of transfer to alternative placement for each resident that receives, or meets the medical eligibility for, nursing home level of care.

2. (2)

   1. (A) The department shall evaluate all written plans and will grant the license as a Level I-only facility only upon determination, in the sole discretion of the Office of Long-Term Care, that the proposed plan meets the best interest of residents.
   2. (B) The facility shall comply with all requirements of 20 CAR § 411-805 regarding transfer of residents.
   3. (C) A facility desiring to change its licensure status to a Level I from a Level II shall meet all requirements for and shall make application without additional fee, in accordance with new licensure applications.