The state health facility licensing authority shall submit to the commission the following data elements, in a record layout agreed upon with the commission, for each of the designated health facilities licensed by the authority.

1. A. facility ID;
2. B. current license number;
3. C. medicare provider certification number;
4. D. medicaid Title 19 number;
5. E. name of administrator;
6. F. name of facility;
7. G. telephone number of facility;
8. H. business address of facility;
9. I. mailing address;
10. J. facility type;
11. K. owner(s) of facility;
12. L. current license issuance date;
13. M. current license expiration date;
14. N. nursing facility capacity;
15. O. skilled nursing capacity;
16. P. dually certified beds;
17. Q. behavioral health or psychiatric beds;
18. R. swing bed capacity;
19. S. total licensed bed capacity; [and]

20. T. any additional data, consistent with the purpose of this rule, that is customarily collected by the authority in its ordinary course of operation, as specified by the commission with at least 90 days notice prior to the submission date.

    [1/1/99; Recompiled 10/31/01]