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Viewing: CSU: Application Requirements, 01-327

Current Status: Active PolicyStat ID: 1605631

CSU: Application Requirements, 01-327

FULL IMPLEMENTATION DATE - July 1, 2015

APPLICABILITY

All State of Georgia Certified Crisis Stabilization Units, and any associated Crisis Service Center (CSCs) and/or Temporary Observation Services (Temp Obs).

POLICY

DBHDD certifies Crisis Stabilization Units (CSUs) in the state of Georgia. The following requirements described in this policy apply to any person, corporation or other entity applying for certification in order to operate a CSU.

DEFINITIONS

Initial certification means the certification granted pursuant to a provider’s original and first application to operate as a CSU/CSC or Temp Obs successfully approved by DBHDD.

New certification means the certification granted pursuant to a provider’s application for certification during a period of valid certification prompted by a change in ownership, or relocation to new premises.

Renewal certification means the certification granted pursuant to a provider’s application for continued certification to operate as a CSU following the expiration of an existing certification.

PROCEDURES

  1.  Initial Certification or New Certification Application Submission 
    1. A separate application for certification must be submitted for each proposed CSU location.
    2. An application for a certificate to provide CSU and any associated services/functions is submitted using Attachment A: Application for Initial or New CSU Certification.
    3. For each application, the applicant submits the following documents no later than ninety (90) calendar days prior to the projected opening date of the CSU:
      1. An accurate and complete application form;
      2. A working budget showing projected revenue and expenses for the first year of operation, including revenue plan;
      3. Documentation of working capital:
        1. Funds or a line of credit sufficient to cover at least 90 days of operating expenses if the applicant is a corporation, unincorporated organization or association, a sole proprietor or a partnership; or,
        2. Appropriate revenue if the applicant is a state or local governmental agency, board or commission.
      4. Documentation of authority to conduct business in the State of Georgia;
      5. A separate twenty-four hour staffing plan for each service/function (CSU, CSC and/or Temp Obs where applicable) which includes nurses and physicians;
      6. A floor plan with dimensions and with space and room function designations;
      7. Number of proposed CSU beds; and proposed capacity in Temp Obs were applicable;
      8. Photocopies of operating agreements with healthcare providers to provide care that is beyond the scope of the facility;
      9. A program description signed by the medical director that includes, admission and discharge criteria and procedures, including reasons for denial of admission, for both voluntary and involuntary individuals who do not meet admission criteria consistent with Medical Evaluation Guidelines and Exclusion Criteria for Admission to State Hospitals and Crisis Stabilization Units, 03-520;
      10. Proposed daily schedule of treatment and education options throughout twelve waking hours each day, to include treatment and educational opportunities responsive to the mental health, physical health and substance use disorder issues represented by individuals receiving services;
      11. Fire Safety Documentation:
        1. For new construction, additions, and renovation projects, written approval by the local building authority as well as well as a fire safety report (e.g., Fire Safety Inspection Report or a Certificate of Occupancy) in the jurisdiction in which the proposed CSU site is located, must be submitted before a certificate is issued;
        2. For buildings already constructed, a copy of a fire safety report indicating approval by the local fire authority for the jurisdiction in which the proposed CSU site is located, dated within the last twelve (12) months of the projected opening date must be submitted before a certificate is issued;
      12. Documentation of applicant agency’s accreditation as detailed in Accreditation and Standards Compliance Requirements for Providers of Behavioral Health Services, 01-103;
      13. Copy of Commercial General Liability or Comprehensive Liability Insurance Certificate;
      14. Organizational chart of the applicant agency;
      15. A signed and notarized U.S. Citizen/Qualified Alien Affidavit, with required documentation (see Appendix C of Attachment A), to be completed by the CEO of the CSU.
  2. Submission Requirements
    1. All supporting documentation required by this Policy are submitted simultaneously with the completed applications.
    2. Applications and supporting documentation must include a single hard copy of all elements, submitted in a 3-ring binder, appropriately labeled and tabbed for easy review. Documents must be submitted in the same order as listed on the application checklist.
    3. Completed packets with supporting documentation must be delivered via U.S. Postal Service or other recognized delivery services, such as UPS, Federal Express, DHL, etc., to the following address:

      Department of Behavioral Health and Developmental Disabilities
      Office of Provider Certification and Services Integrity
      Two Peachtree Street Suite 22.477
      Atlanta, Georgia 30303-3142  
    4. DELIVERIES BY THE APPLICANT, BY APPLICANT’S STAFF, OR BY PERSONS OTHER THAN THE U.S. POSTAL SERVICE OR RECOGNIZED DELIVERY SERVICES, WILL NOT BE ACCEPTED.
  3. Inspections
    1. DBHDD conducts announced or unannounced on-site reviews of all facilities and services to determine compliance with policy to operate a CSU, prior to a certificate being granted.
  4. Renewal Certification Application Submission
    1. At least 90 calendar days prior to the expiration date of a CSU certification, it is the responsibility of the CSU provider to complete and submit, and deposit with the U.S. Mail or with a recognized delivery service, the following:
      1. A complete Attachment B: Application for Renewal of CSU Certification
      2. A separate twenty-four (24) hour staffing plan for each service function (CSU, CSC and/or Temp Obs where applicable) which includes nurses and physicians.
      3. If expired or changed since the previous application on which the current certification is based, photocopies of current operating agreements with healthcare providers to provide care that is beyond the scope of the CSU.
      4. If changes have occurred since the previous application on which the current certification is based, a program description signed by the medical director that includes, consistent with DBHDD policy, admission and discharge criteria and procedures, including reasons for denial of admission, for both voluntary and involuntary individuals who do not meet admission criteria. A CSU under contract to operate a CSC and/or Temp Obs has a description of services which clearly states that the distinct, yet interrelated roles of the CSU, CSC and/or Temp/Obs as a program is designed as an alternative to and/or diversion from hospitalization.
      5. Fire Safety Documentation:
        1. A copy of a fire safety report indicating approval by the local fire authority for the jurisdiction in which the CSU is based dated within the last twelve (12) months of the renewal application date.
      6. Documentation of the most recent agency accreditation as per Accreditation and Standards Compliance Requirements for Providers of Behavioral Health Services, 01-103.
      7. Copy of a current Commercial General Liability or Comprehensive Liability Insurance Certificate.
      8. If changes have occurred since initial application, a current copy of organizational chart of the agency.
      9. If there has been a change in CEO, or if an affidavit has never been submitted by the current CEO, a signed and notarized U.S. Citizen/Qualified Alien Affidavit, with required documentation.
    2. The renewal application must be postmarked at least ninety (90) calendar days prior to the expiration date of the current certificate. If the CSU fails to submit the completed renewal application, DBHDD provides notice by certified mail advising that unless the renewal application and certification review is satisfactorily completed, the CSU is operating without a valid certificate and is subject to sanctions.
    3. Renewal applicants submit the application according to the instructions detailed in ‘Submission Requirements’ section above.

Legal References

 O.C.G.A. 37-1-29 

Related Policies

Accreditation and Standards Compliance Requirements for Providers of Behavioral Health Services, 01-103

Medical Evaluation Guidelines and Exclusion Criteria for Admission to State Hospitals and Crisis Stabilization Units, 03-520

CSU: General Certification Requirements, 01-326

CSU: Program Description, 01-329

CSU: Complaint Reporting and Incident Investigations Procedures, 01-346

Behavioral Health Certification and Operational Requirements for Certified Crisis Stabilization Units (CSUs), 01-325

Attachments:

Approval Signatures

Approver Date
Joetta Prost, Ph.D.: DBHDD Policy Director 6/22/2015
Robert Dorr: Division Director, Accountability & Compliance 6/22/2015
Cheryl Abernathy, Ph.D.: Behavioral Health Provider Certification Manager 6/19/2015
Joetta Prost, Ph.D.: DBHDD Policy Director 6/18/2015
Approver Date
Joetta Prost, Ph.D.: DBHDD Policy Director 6/22/2015
Robert Dorr: Division Director, Accountability & Compliance 6/22/2015
Cheryl Abernathy, Ph.D.: Behavioral Health Provider Certification Manager 6/19/2015
Joetta Prost, Ph.D.: DBHDD Policy Director 6/18/2015
Older Version Approval Signatures