R432.  Health, Family Health and Preparedness, Licensing.
R432-2.  General Licensing Provisions.
R432-2-1.  Legal Authority.
	This rule is adopted pursuant to Title 26, Chapter 21.

R432-2-2.  Purpose.
	The purpose of this rule is to define the standards that health care facilities and agencies must follow in order to obtain a license.  No person or governmental unit acting severally or jointly with any other person, or governmental unit shall establish, conduct, or maintain a health facility in this state without first obtaining a license from the Department.  Section 26-21-8.

R432-2-3.  Exempt Facilities.
	The provisions of Section 26-21-7 apply for exempt facilities.

R432-2-4.  Distinct Part.
	Licensed health care facilities that wish to offer services outside the scope of their license or services regulated by another licensing rule, with the exception of federally recognized Swing Bed Units, shall submit for Department review a program narrative defining the levels of service to be offered and the specific patient population to be served.  If the program is determined to require a license, the facility must meet the definition of a distinct part entity and all applicable codes and standards and obtain a separate license.

R432-2-5.  Requirements for a Satellite Service Operation.
	(1)  A "satellite operation" is a health care treatment service that:
	(a)  is administered by a parent facility within the scope of the parent facility's current license,
	(b)  is located further than 250 yards from the licensed facility or other areas determined by the department to be a part of the provider's campus,
	(c)  does not qualify for licensing under Section 26-21-2, and
	(d)  is approved by the Department for inclusion under the parent facility's license and identified as a remote service.
	(2)  A licensed health care facility that wishes to offer a satellite operation shall submit for Department review a program narrative and one set of construction drawings.  The program narrative shall define at least the following:
	(a)  location of the remote facility (street address);
	(b)  capacity of the remote facility;
	(c)  license category of the parent facility;
	(d)  service to be provided at the remote facility (must be a service authorized under the parent facility license);
	(e)  ancillary administrative and support services to be provided at the remote facility; and
	(f)  International Building Code occupancy classification of the remote facility physical structure.
	(3)  Upon receipt of the satellite service program narrative and construction drawings, the Department shall make a determination of the applicable licensing requirements including the need for licensing the service.  The Department shall verify at least the following items:
	(a)  There is only a single health care treatment service provided at the remote site and that it falls within the scope of the parent facility license;
	(b)  The remote facility physical structure complies with all construction codes appropriate for the service provided;
	(c)  All necessary administrative and support services for the specified treatment service are available, on a continuous basis during the hours of operation, to insure the health, safety, and welfare of the clients.
	(4)  If a facility qualifies as a single satellite service treatment center the Department shall issue a separate license identifying the facility as a "satellite service" of the licensed parent facility.  This license shall be subject to all requirements set forth in R432-2 of the Health Facility Rules.
	(5)  A parent facility that wishes to offer more than one health care service at the same remote site shall either obtain a satellite service license for each service offered as described above or obtain a license for the remote complex as a free-standing health care facility.
	(6)  A satellite facility is not permitted within the confines of another licensed health care facility.
	(7)  A licensed hospital is limited to one emergency department satellite location.  If a healthcare corporation owns and operates more than one hospital in the State of Utah;
	(a)  it may have up to two emergency department satellite locations associated with a licensed hospital; and
	(b)  the health care corporation's total number of emergency department satellite locations may not exceed the total number of licensed hospitals it owns and operates in the State of Utah.

R432-2-6.  Requirements for a Branch Location.
	(1)  A "Branch Location" is a licensed Home Health, Personal Care or Hospice agency location which:
	(a)  is administered by a parent agency within the scope of the parent agency's current license;
	(b)  is located no further than 150 miles from the licensed parent agency or within a designated geographical service area as determined by the Department; and
	(c)  is approved by the Department as a branch location under the parent agency's license.
	(2)  An applicant for a branch location license shall submit a narrative of the program for Department review.  The narrative shall include the following:
	(a)  street address of the parent and branch;
	(b)  license category of the parent agency;
	(c)  service(s) to be provided at the branch location, which must be a service authorized under the parent agency license; and
	(d)  ancillary administrative and support services to be provided at the branch location.
	(3)  Upon receipt of the branch location program narrative, the Department shall make a determination of the applicable licensing requirements including the need for licensing the service.  The Department shall verify at least the following items:
	(a)  the service provided at the remote site falls within the scope of the parent agency license; and
	(b)  all necessary administrative and support services are available, on a continuous basis during the hours of operation, to insure the health, safety, and welfare of the clients.
	(4)  If a location qualifies as a branch location the Department shall issue a separate license identifying the agency as a "Branch Location" of the licensed parent agency.  This license shall be subject to all requirements set forth in R432-2 of the Health Facility Rules.

R432-2-7.  Applications for License Actions.
	(1)  An applicant for a license shall file a Request for Agency Action/License Application with the Utah Department of Health on a form furnished by the Department.
	(2)  Each applicant shall comply with all zoning, fire, safety, sanitation, building and licensing laws, regulations, ordinances, and codes of the city and county in which the facility or agency is located.  The applicant shall obtain the following clearances and submit them as part of the completed application to the licensing agency:
	(a)  A certificate of fire clearance from the State Fire Marshal or designated local fire authority certifying compliance with local and state fire codes is required with initial and renewal application, change of ownership, and at any time new construction or substantial remodeling has occurred.
	(b)  A satisfactory Food Services Sanitation Clearance report by a local Health Department is required for facilities providing food service at initial application and upon a change of ownership.
	(c)  Certificate of Occupancy from the local building official at initial application, change of location and at the time of any new construction or substantial remodeling.
	(3)  As used in this section, an "owner" is any person or entity:
	(a)  ultimately responsible for operating a health care facility; or
	(b)  legally responsible for decisions and liabilities in a business management sense or that bears the final responsibility for operating decisions made in the capacity of a governing body.
	(4)  The applicant shall submit contact information for the ownership of the legal entity including the names, email addresses and mailing addresses.
	(5)  The applicant shall provide the following written assurances on all individuals listed in R432-2-7(4):
	(a)  None of the persons has been convicted of a felony;
	(b)  None of the persons has been found in violation of any local, state, or federal law which arises from or is otherwise related to the individual's relationship to a health care facility; and
	(c)  None of the persons who has currently or within the five years prior to the date of application had previous interest in a licensed health care facility that has been any of the following:
	(i)  subject of a patient care receivership action;
	(ii)  closed as a result of a settlement agreement resulting from a decertification action or a license revocation;
	(iii)  involuntarily terminated from participation in either Medicaid or Medicare programs; or
	(iv)  convicted of patient abuse, neglect or exploitation where the facts of the case prove that the licensee failed to provide adequate protection or services for the person to prevent such abuse.

R432-2-8.  License Fee.
	In accordance with Subsection 26-21-6(1)(d), the applicant shall submit a license fee with the completed application form.  A current fee schedule is available from the Bureau of Health Facility Licensing upon request.  Any late fees is assessed according to the fee schedule.

R432-2-9.  Additional Information.
	The Department may require additional information or review other documents to determine compliance with licensing rules. These include:
	(1)  architectural plans and a description of the functional program.
	(2)  policies and procedures manuals.
	(3)  verification of individual licenses, registrations or certification required by the Utah Department of Commerce.
	(4)  data reports including the submission of the annual report at the Departments request.
	(5)  documentation that sufficient assets are available to provide services: staff, utilities, food supplies, and laundry for at least a two month period of time.

R432-2-10.  Initial License Issuance or Denial.
	(1)  The Department shall render a decision on an initial license application within 60 days of receipt of a completed application packet.
	(2)  Upon verification of compliance with licensing requirements the Department shall issue a provisional license.
	(3)  The Department shall issue a written notice of agency decision under the procedures for adjudicative proceedings (R432-30) denying a license if the facility is not in compliance with the applicable laws, rules, or regulations.  The notice shall state the reasons for denial.
	(4)  An applicant who is denied licensing may reapply for initial licensing as a new applicant and shall be required to initiate a new request for agency action as described in R432-2-7.
	(5)  The Department shall assess an administrative fee on all denied license applications.  This fee shall be subtracted from any fees submitted as part of the application packet and a refund for the balance returned to the applicant.

R432-2-11.  License Contents and Provisions.
	(1)  The license shall document the following:
	(a)  the name of the health facility,
	(b)  licensee,
	(c)  type of facility,
	(d)  approved licensed capacity including identification of operational and secure unit beds,
	(e)  street address of the facility,
	(f)  issue and expiration date of license,
	(g)  construction variance information, and
	(h)  license number.
	(2)  The license is not assignable or transferable.
	(3)  Each license is the property of the Department. The licensee shall return the license within five days following closure of a health care facility or upon the request of the Department.
	(4)  The licensee shall post the license on the licensed premises in a place readily visible and accessible to the public.

R432-2-12.  Expiration and Renewal.
	(1)  Each standard license shall expire at midnight on the day designated on the license as the expiration date, unless the license is revoked or extended under subsection (2) or (4) by the Department.
	(2)  If a facility is operating under a conditional license for a period extending beyond the expiration date of the current license, the Department shall establish a new expiration date.
	(3)  The licensee shall submit a Request for Agency Action/License Application form, applicable fees, clearances, and the annual report for the previous calendar year (if required by the Department under R432-2-9) 15 days before the current license expires.
	(4)  A license shall expire on the date specified on the license unless the licensee requests and is granted an extension from the Department.
	(5)  The Department shall renew a standard license upon verification that the licensee and facility are in compliance with all applicable license rules.
	(6)  Facilities no longer providing patient care or client services may not have their license renewed.

R432-2-13.  New License Required.
	(1)  A prospective licensee shall submit a Request for Agency Action/License Application, fees, and required documentation for a new license at least 30 days before any of the following proposed or anticipated changes occur:
	(a)  occupancy of a new facility;
	(b)  change of ownership; or
	(c)  change in license category.
	(2)  Before the Department may issue a change of ownership license, the prospective licensee shall provide documentation that:
	(a)  all patient care records, personnel records, staffing schedules, quality assurance committee minutes, in-service program records, and other documents required by applicable rules remain in the facility and have been transferred to the custody of the new licensee.
	(b)  the existing policy and procedures manual or a new manual has been adopted by the facility governing body before change of ownership occurs.
	(c)  new contracts for professional or other services not provided directly by the facility have been secured.
	(d)  new transfer agreements have been drafted and signed.
	(e)  written documentation exists of clear ownership or lease of the facility by the new owner.
	(f)  the licensee shall provide the new owner with a written accounting, prepared by an independent certified public accountant, of all patient funds being transferred, and obtain a written receipt for those funds from the new owner.
	(g)  Nursing Care and Small Health Care Facilities shall provide a certificate from the Division of Medicaid and Health Financing's Bureau of Financial Services noting the current owner has no outstanding monies owed to the division.
	(3)  A prospective licensee is responsible for all uncorrected rule violations and deficiencies including any current plan of correction submitted by the previous licensee unless a revised plan of correction, approved by the Department, is submitted by the prospective licensee before the change of ownership becomes effective.
	(4)  If a license is issued to the new owner the previous licensee shall return his license to the Department within five days of the new owner's receipt of the license.
	(5)  Upon verification that the facility is in compliance with all applicable licensing rules, the Department shall issue a new license effective the date compliance is determined as required by R432-2-9.

R432-2-14.  Change in Licensing Status.
	(1)  A licensee shall submit a Request for Agency Action/License Application to amend or modify the license status at least 30 days before any of the following proposed or anticipated changes:
	(a)  increase or decrease of licensed capacity;
	(b)  change in name of facility;
	(c)  occupancy of a replacement facility;
	(d)  change of license classification; or
	(e)  change in administrator.
	(2)  An increase of licensed capacity may incur an additional license fee if the increase exceeds the maximum number of units in the fee category division of the existing license.  This fee shall be the difference in license fee for the existing and proposed capacity according to the license fee schedule.
	(3)  Upon verification that the licensee and facility are in compliance with all applicable licensing rules, the Department shall issue an amended or modified license effective the date that the Department determines that the licensee is in compliance.

R432-2-15.  Facility Ceases Operation.
	(1)  A licensee that voluntarily ceases operation shall complete the following:
	(a)  notify the Department and the patients or their next of kin at least 30 days before the effective date of closure.
	(b)  make provision for the safe keeping of records.
	(c)  return all patients' monies and valuables at the time of discharge.
	(d)  The licensee must return the license to the Department within five days after the facility ceases operation.
	(2)  If the Department revokes a facility's license or if it issues an emergency closure order, the licensee shall document for Department review the following:
	(a)  the location and date of discharge for all residents,
	(b)  the date that notice was provided to all residents and responsible parties to ensure an orderly discharge and assistance with placement; and
	(c)  the date and time that the facility complied with the closure order.

R432-2-16.  Provisional License.
	(1)  A provisional license is an initial license issued to an applicant for a probationary period of six months.
	(2)  In granting a provisional license, the Department shall determine that the facility has the potential to provide services and be in full compliance with licensing rules during the six month period.
	(3)  A provisional license is nonrenewable.  The Department may issue a provisional license for no longer than six months.
	(4)  If the licensee fails to meet terms and conditions of licensing before the expiration date of the provisional license, the license shall automatically expire.

R432-2-17.  Conditional License.
	(1)  A conditional license is a remedial license issued to a licensee if there is a determination of substandard quality of care, immediate jeopardy or a pattern of violations which would result in a ban on admissions at the facility or if the licensee is found to have:
	(a)  a Class I violation or a Class II violation that remains uncorrected after the specified time for correction;
	(b)  more than three cited repeat Class I or II violations from the previous survey; or
	(c)  fails to fully comply with administrative requirements for licensing.
	(2)  A standard license is revoked by the issuance of a conditional license.
	(3)  The Department may not issue a conditional license after the expiration of a provisional license.
	(4)  In granting a conditional license, the Department shall be assured that the lack of full compliance does not harm the health, safety, and welfare of the patients.
	(5)  The Department shall establish the period of time for the conditional license based on an assessment of the nature of the existing violations and facts available at the time of the decision.
	(6)  The Department shall set conditions whereby the licensee must comply with an accepted plan of correction.
	(7)  If the licensee fails to meet the conditions before the expiration date of the conditional license, the license shall automatically expire.

R432-2-18.  Standard License.
	(1)  A standard license is a license issued to a licensee if:
	(a)  the licensee meets the conditions attached to a provisional or conditional license;
	(b)  the licensee corrects the identified rule violations; or
	(c)  the licensee completes all licensing renewal requirements as per R432-2-12.

R432-2-19.  Variances.
	(1)  A health facility may submit a request for agency action to obtain a variance from state rules at any time.
	(a)  An applicant requesting a variance shall file a Request for Agency Action/Variance Application with the Utah Department of Health on forms furnished by the Department.
	(b)  The Department may require additional information from the facility before acting on the request.
	(c)  The Department shall act upon each request for variance in writing within 60 days of receipt of a completed request.
	(2)  A variance may be renewable or non-renewable. The licensee shall maintain a copy of the approved variance on file in the facility and make the copy available to all interested parties upon request.
	(a)  The Department shall file the request and variance with the license application.
	(b)  The terms of a requested variance may be modified upon agreement between the Department and the facility.
	(c)  The Department may impose conditions on the granting of a variance as it determines necessary to protect the health and safety of the residents or patients.
	(d)  The Department may limit the duration of any variance.
	(3)  The Department shall issue a written notice of agency decision denying a variance upon determination that the variance is not justified.
	(4)  The Department may revoke a variance if:
	(a)  The variance adversely affects the health, safety, or welfare of the residents.
	(b)  The facility fails to comply with the conditions of the variance as granted.
	(c)  The licensee notifies the Department in writing that it wishes to relinquish the variance and be subject to the rule previously varied.
	(d)  There is a change in the statute, regulations or rules.

R432-2-20.  Change In Ownership.
	(1)  As used in this section, an "owner" is any person or entity:
	(a)  ultimately responsible for operating a health care facility; or
	(b)  legally responsible for decisions and liabilities in a business management sense or that bears the final responsibility for operating decisions made in the capacity of a governing body.
	(2)  The owner of the health care facility does not need to own the real property or building where the facility operates.
	(3)  A property owner is also an owner of the facility if he:
	(a)  retains the right or participates in the operation or business decisions of the enterprise;
	(b)  has engaged the services of a management company to operate the facility; or
	(c)  takes over the operation of the facility.
	(4)  A licensed provider whose ownership or controlling ownership interest has changed must submit a Request for Agency Action/License Application and fees to the department 30 days prior to the proposed change
	(5)  Changes in ownership that require action under subsection (4) include any arrangement that:
	(a)  transfers the business enterprise or assets to another person or firm, with or without the transfer of any real property rights;
	(b)  removes, adds, or substitutes an owner or part owner; or
	(c)  in the case of an incorporated owner:
	(i)  is a merger with another corporation if the board of directors of the surviving corporation differs by 20 percent or more from the board of the original licensee; or
	(ii)  creates a separate corporation, including a wholly owned subsidiary, if the board of directors of the separate corporation differs by 20 percent or more from the board of the original licensee.
	(6)  A person or entity that contracts with an owner to manage the enterprise, subject to the owner's general approval of operating decisions it makes is not an owner, unless the parties have agreed that the managing entity is also an owner.
	(7)  A transfer between departments of government agencies for management of a government-owned health care facility is not a change of ownership under this section.

KEY:  health care facilities
Date of Enactment or Last Substantive Amendment:  August 27, 2018
Notice of Continuation:  January 29, 2018
Authorizing, and Implemented or Interpreted Law:  26-21-9; 26-21-11; 26-21-12; 26-21-13