Section 518.1150 Initial Licensure Application

Section 518

Section 518.1150  Initial Licensure

Application

a)          Any person acting individually, or jointly with other

persons, who proposes to build, own, establish or operate a freestanding

emergency center shall submit application information in writing on forms

provided by the Department.

b)          An application for a new facility shall be accompanied by a

permit as required by the Illinois Health Facilities Planning Act.

c)          Each application shall be accompanied by a non-refundable

license application fee of $2000.

d)          The application shall contain the following information:

1)         The name, address and telephone number of the applicant if the

applicant is an individual; if the applicant is a firm, partnership or

association, the name, address and telephone number of every member of the

firm, partnership or association; if the applicant is a unit of local

government, the name, address and telephone number of its chief executive

officer.

2)         If the applicant is a corporation, it shall submit:

A)        A list of the title, name and address of each of its

corporation officers; and

B)        A list of the name and address of each of its shareholders

holding more than 7.5% of the shares.

3)         The name of the person or persons under whose management or

supervision the facility will be conducted.

4)         The location of the facility, including the facility name,

telephone number, exact address, and proof that the freestanding emergency

center is not a part of a Resource or Associate Hospital's physical plant.

5)         Information regarding any conviction of the applicant, or, if

the applicant is a firm, partnership or association, of any if its members, or,

if the applicant is a corporation, of any of its officers or directors, or of

the person designated to manage or supervise the facility, of a felony or of

two or more misdemeanors involving moral turpitude in the last five years

hysical plant.

5)         Information regarding any conviction of the applicant, or, if

the applicant is a firm, partnership or association, of any if its members, or,

if the applicant is a corporation, of any of its officers or directors, or of

the person designated to manage or supervise the facility, of a felony or of

two or more misdemeanors involving moral turpitude in the last five years.

6)         Proof of ownership or control by an Associate or Resource

Hospital.

7)         The number of procedure rooms and observation/treatment rooms.

8)         A statement assuring compliance

with all State and federal

patient rights provisions, including, but not limited to, the Emergency Medical

Treatment Act

and the federal Emergency Medical Treatment and Active

Labor Act

(Section 32.5(a)(8) of the Act).

9)         The name, address, telephone number, education, experience,

credentials and any professional licensure or certification of the following

persons:

A)        Administrator;

B)        Medical

Director; and

C)        Nurse

Manager.

10)         A list of the medical staff, including name and license number.

11)         A list of all staff personnel, including name, position and

any professional licensure or certification.

12)         A detailed description of the services to be provided by the

facility.

13)         Schematic architectural plans.

e)         Each application shall document that at least one board

certified emergency physician is present at the FEC 24 hours per day.

f)         The Department will review the application form and other

information required by this Section to determine whether the application meets

the requirements of this Section prior to reviewing building plans and

specifications and conducting a survey of the physical plant.

g)         The Department will issue a license if, after application and

survey, it finds the applicant meets the requirements of the Act and this Part

the application form and other

information required by this Section to determine whether the application meets

the requirements of this Section prior to reviewing building plans and

specifications and conducting a survey of the physical plant.

g)         The Department will issue a license if, after application and

survey, it finds the applicant meets the requirements of the Act and this Part.

h)         The FEC license shall be prominently displayed in an area

accessible to the public.

i)          Ownership Change or Discontinuation

1)         The license is not transferable.  The license is issued to a

specific licensee and for a specific location.  The license and the valid

current renewal certificate immediately become void and shall be returned to

the Department when the facility is sold or leased; when operation is

discontinued; when operation is moved to a new location; when the licensee (if

an individual) dies; when the licensee (if a corporation or partnership)

dissolves or terminates; or when the licensee (whatever the entity) ceases to

exist.

2)         A license issued to a corporation shall be null, void and of

no further effect upon the dissolution of the corporation.  If the corporation

is subsequently reinstated, a new license shall be obtained.

3)         Before any change of ownership, dissolution or closure, the

facility shall follow the notification and process requirements of the Health

Facilities Planning Board.

j)          Each FEC shall notify the Department, in writing, of any

changes in:

1)         Facility

name;

2)         Business

telephone contact information; and

3)         Administrator

and/or Nurse Manager.

k)         Any freestanding emergency center may voluntarily relinquish

its license prior to the expiration date by notifying the Department in

writing.  The notification shall include the anticipated date of termination,

which shall not be less than 30 days nor more than 90 days from the date of

notification

s

telephone contact information; and

3)         Administrator

and/or Nurse Manager.

k)         Any freestanding emergency center may voluntarily relinquish

its license prior to the expiration date by notifying the Department in

writing.  The notification shall include the anticipated date of termination,

which shall not be less than 30 days nor more than 90 days from the date of

notification.  The notification shall describe the procedures taken by the

freestanding emergency center to advise pre-hospital providers, hospitals and

the EMS Medical Director.