Now, we begin with Your Application . . .

"Bit by Bit
putting it together . . ."
                                                           - from "Sunday in the Park with George"

State Regulatory Forms (Note:  These vary from State to State.) 

1. Application for Facility License
2. Request to Establish Eligibility (specific to that State's program)
3. Participation  Agreement (in that State-specific program)
4. Disclaimer of Conflict of Interest
5. Provider Data (e.g., disclosures of other health care facilities owned)
6. Compliance with Civil Rights Laws on Nondiscrimination

Applicant Information

1. Sole Proprietor, Partnership, Limited Liability Company, Corporation?
2. Background:  History, Philosophy and Objectives, Company Goals, Board of Directors, Community Advisory Board, LLC/Corporate legal documents of formation and operation
3. Information on each member of the Board of Directors (and possibly the members of the Advisory Board)
4. Proof of financial capability:  balance sheet, bankbook and bank contact, statement of assets, etc. 

Site, Location and Control of Premises

• Lease or Deed of Trust (Note:  Some regulatory agencies may require both.)
• Maps identifying the County, community, official/unofficial designated service area, and immediate neighborhood
• Narrative Description of the service area and immediate neighborhood
• Community Resources (e.g., contacts, connections, of similar or related community services)
• Floor Plan
• Clearances:  Planning and Zoning, Building and Safety, Fire Safety, Fire Prevention
• Certificate of Occupancy

Management and Services

1. Organization Chart of the Center
2. Staff, especially the key -- often licensed -- personnel who are responsible for regulatory compliance
3. Contractors (subcontracted licensed professsionals) and the subcontract form
4. Job Descriptions (employees and contractors)
5. Written Agreements:  Meals, Transportation, Fire Safety, HVAC, Maintenance, Hospital Transfer, Biohazardous Waste Disposal, Linen Service, Trash Collection, Nurses Registry, Insurance, etc.
6. Policies and Procedures (a "small", preliminary version of the final, operating guidebook, covering specific subjects that the regulatory agencies may deem immediately required) 
7. Community Outreach Plan
8. Informational Material:  flyers, mailers, brochures, and other means of advertising and public relations

Fiscal Information

1. Financial Projections:  Cash Flow Forecast and Assumptions to Cash Flow Forecast
2. Operating Budget
3. Fee Schedule - distribution of sources of revenue; e.g., reimbursement from State program, private insurance and other third-party payors, private pay on a sliding scale

Are we having fun yet?

Sounds complicated doesn't it?  No cause for alarm.  We know how to do this. 
We have removed  as much of the pain as possible with our proven Gear Up! system:  Consistent, reliable, predictable.  As close to child's play as regulators will allow!

Rica Burton, Founder / CEO
ADHC Team Leader
ricaburton@choicepros.com