Title:Initial Application Form (4 pages) About: This form is used for an organization not previously licensed by the Department to apply to provide behavioral health care services (substance abuse and/or mental health) to adults and substance abuse services to minors. This initial form needs to be submitted only once. The (twelve) licensed services can be chosen from the menu on page 2 (Part III Selected Services Information).
Title:Renewal or Add Services/Site Application Form (3 pages) About: This form is used by Behavioral Healthcare Organizations to: Renew an existing license, add a licensed service/program at an existing site, add a new site for licensed service delivery. Licenses are required to be renewed every two years. An Add Service or Site application may be submitted at any time.
Title:DDD License Renewal Application (3 page) About: This form is to be used to apply to renew an existing agency license or an existing facility license
Title:FEIN Addendum (1 page) About: The Department is required to obtain this information. It is to be submitted with each license renewal application. It is not required with an Add Service/Site application.
Title:Deeming Protocol - Licensing Rules and Regulations About: Deeming is understood to mean that compliance with accreditation standards is considered equivalent to compliance with the Department's designated licensing regulations. Deemed regulations are generally not the subject of review by the Department's survey team.
The Department grants the deemed status of designated licensing regulations to organizations that are certified by three national accreditation organizations: JCAHO, CARF and COA.
Organizations are required to apply, or re-apply, for deemed status with every biennial application.
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