1. (a) Providers that possess at least two licenses/certificates from at least two separate State licensing agencies and are seeking approval to integrate services for which they are licensed or certified may submit an application to the State licensing agency of the host site.
2. (b) Applications shall be submitted in a format prescribed for all applicants and reviewed by the State licensing agency that regulates the services to be added, in conjunction with the State licensing agency with authority for the host clinic, as appropriate.

3. (c) Applications shall include information needed to demonstrate that the provider is:

   1. (1) licensed or certified by the relevant State licensing agencies to provide services for which the provider is seeking to integrate;
   2. (2) in compliance with all applicable requirements of the relevant State licensing agencies;

   3. (3) in good standing at the time of application approval. A provider is in good standing if each clinic site for which the provider is licensed or certified to offer services:

      1. (i) is licensed by the Office of Mental Health and has a one year or greater time frame on operating certificate (Tier 3 providers are not eligible to participate); and/or
      2. (ii) is certified by the Office of Alcoholism and Substance Abuse Services and all of its programs have an operating certificate with partial or substantial compliance (two or three years); and/or
      3. (iii) has an operating certificate from the Department of Health and not currently under any enforcement actions;
   4. (4) in compliance with the physical plant requirements under this Part; and
   5. (5) a member of a health home designated by the Commissioner of Health pursuant to section 365-l of the Social Services Law.
4. (d) Applications may include but not be limited to requests for information regarding services to be added and the plan for implementation, staffing, operating expenses and revenues, and utilization of services as they relate to integrated care services as described in this Part.
5. (e) The applicant shall supply any additional documentation or information requested by the State licensing agency of the host site, in conjunction with the other State licensing agencies as appropriate, within a stated timeframe of such request, unless an extension is obtained. The granting of a request for an extension shall be at the discretion of such State licensing agency of the host site. Failure to provide the additional documentation or information within the time prescribed shall constitute an abandonment or withdrawal of the application without any further action from the State licensing agency.
6. (f) The affected State licensing agency shall approve or disapprove an application in writing.
7. (g) Applicants may appeal the denial of an application in accordance with the rules and regulations of the affected State licensing agency.

Application and approval process.