10A NCAC 14G .0102      APPLICATION

(a)  The terms defined in G.S. 90-405 shall have the same meaning in this Rule.

(b)  "Applicant" means a health care provider that submits an application to the Director of the Division of Health Service Regulation requesting an exemption from G.S. 90-406.

(c)  The application shall include the following information:

(1)           the name, mailing address, email address, and telephone number of the applicant;

(2)           a list of the designated health care services provided or to be provided by the applicant;

(3)           the name, mailing address, email address, and telephone number of the manager of the entity to which the applicant wants to make referrals;

(4)           a list of the owners of the entity to which the applicant wants to make referrals;

(5)           a list of the types of designated health care services provided or to be provided by the entity to which the applicant wants to make referrals;

(6)           evidence that there is a need for the proposed designated health care services in the county where the entity is or will be located;

(7)           evidence that alternative financing is not available from other sources to develop the entity to which the applicant wants to make referrals; and

(8)           a statement affirming that all health care providers located in the county where the entity is or will be located shall be offered access to the entity.

(d)  Applications shall be:

(1)           mailed to the Office of the Director, Division of Health Service Regulation, Department of Health and Human Services, 2701 Mail Service Center, Raleigh, NC 27699-2701; or

(2)           delivered in person to the Office of the Director, Division of Health Service Regulation, Department of Health and Human Services, 809 Ruggles Drive, Raleigh, NC 27603.

History Note:        Authority G.S. 90-408;

Eff. April 1, 1995;

Readopted Eff. November 1, 2019.