Therapeutic Group Homes (TGH) Initial Licensure Requirements

Initial License Application Checklist for Providers

Initial Licensing Application Packet shall include:

1.  completed license application form

2.  non-refundable licensing fee: the Payment Procedure has changed please follow the link for instructions.

3.  copy of approval letter of the architectural facility plans for the TGH from Office of State Fire Marshal

4.  copy of the health inspection report with approval of occupancy from the Office of Public Health

5.  copy of statewide criminal background checks, including sex offender registry status, on all individual owners with a 5% or more ownership interest in the TGH, and on all managing employees

6.  proof of financial viability, comprised of the following:
a.  line of credit issued from a federally insured, licensed lending institution in the amount of at least $50,000.00
b.  general and professional liability insurance of at least $300,000.00; and
c.  worker's compensation insurance;

7.  an organizational chart and names, including positiontitles, of key administrative personnel and governing body; and

8.  a floor sketch or drawing of the premises to be licensed

9.  a letter of intent as to the types of services or specializations that will be provided by the TGH (i.e. sexually offending behaviors);

10. Disclosure of Ownership form