1. A. A licensee shall submit a request for approval of a modification of a health care institution when planning to make:

   1. 1. An addition or removal of an authorized service;
   2. 2. An addition or removal of a colocator;
   3. 3. A change in a health care institution’s licensed capacity, licensed occupancy, respite capacity, or the number of dialysis stations;
   4. 4. A change in the physical plant, including facilities or equipment, that costs more than $300,000; or

   5. 5. A change in the building where a health care institution is located that affects compliance with:

      1. a. Applicable physical plant codes and standards incorporated by reference in R9-10-104.01, or
      2. b. Physical plant requirements in the specific Article in this Chapter applicable to the health care institution.
2. B. A licensee of a health care institution that is required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in R9-10-104.01 shall submit an application, according to R9-10-104(A), for a modification of the health care institution described in subsections (A)(3) through (5).

3. C. A licensee of a health care institution shall submit an application for a modification of the health care institution in a Department-provided format that contains:

   1. 1. The following information in a Department-provided format:

      1. a. The health care institution’s name, mailing address, email address, and license number;

      2. b. A narrative description of the modification, including as applicable:

         1. i. The services the licensee is requesting be added or removed as an authorized service;
         2. ii. The name and license number of an associated licensed provider being added or removed as a colocator;
         3. iii. The name and professional license number of an exempt health care provider being added or removed as a colocator;
         4. iv. If an associated licensed provider or exempt health care provider is being added as a colocator, the proposed scope of services;
         5. v. The current and proposed licensed capacity, licensed occupancy, respite capacity, and number of dialysis stations;
         6. vi. The change being made in the physical plant; and
         7. vii. The change being made that affects compliance with applicable physical plant codes and standards incorporated by reference in R9-10-104.01; and
      3. c. The name and email address of the health care institution’s administrator’s or individual representing the health care institution as designated in according to A.R.S. § 36-422 and the dated signature of the administrator or individual; and

   2. 2. Documentation that demonstrates that the requested modification complies with applicable requirements in this Chapter, including as applicable:

      1. a. A floor plan showing the location of each colocator’s proposed treatment area and the areas of the collaborating outpatient treatment center’s premises shared with a colocator;

      2. b. For a change in the licensed capacity, licensed occupancy, respite capacity, or number of dialysis stations or a modification of the physical plant:

         1. i. A floor plan showing, for each story of the facility affected by the modification, the room layout, room usage, each door and each window, plumbing fixtures, each exit, and the location of each fire protection device; or
         2. ii. For a health care institution or part of the health care institution that is required to comply with the physical plant codes and standards incorporated by reference in R9-10-104.01 or the building, documentation of the Department’s approval of the health care institution’s architectural plans and specifications in R9-10-104(D); and
      3. c. Any other documentation to support the requested modification; and
   3. 3. If applicable, a copy of the written agreement the associated licensed provider or exempt health care provider has with the collaborating outpatient treatment center.
4. D. The Department shall approve or deny a request for a modification described in subsection (C) according to R9-10-108.
5. E. A licensee shall not implement a modification described in subsection (C) until an approval or amended license is issued by the Department.
6. F. A licensee shall submit the applicable fee according to R9-10-106.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Section R9-10-110 renumbered to Section R9-10-111; new Section R9-10-110 made by exempt rulemaking at 20 A.A.R. 1409, pursuant to Laws 2013, Ch. 10, § 13; effective July 1, 2014 (Supp. 14-2). Amended by final rulemaking at 25 A.A.R. 1583, effective October 1, 2019 (Supp. 19-3). Amended by final expedited rulemaking, at 25 A.A.R. 3481 with an immediate effective date of November 5, 2019 (Supp. 19-4). Amended by final rulemaking at 31 A.A.R. 2457 (July 25, 2025), effective August 30, 2025 (Supp. 25-3).