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must obtain a license from the department under 7 AAC 12.610 and this section if the individual or entity seeks to

(1) conduct, maintain, or operate a hospice agency;

(2) participate in conducting, maintaining, or operating a hospice agency; or

(3) represent that the individual or entity will provide hospice services. (b) A hospice agency may have more than one office that is either a branch office or a subunit of the parent agency. Each parent agency and each branch office or subunit must be assigned a distinctive name. For purposes of this section,

(1) a branch office is located in the same service area as the parent agency and shares administration, supervision, and service with the parent agency on a daily basis; a branch office is not required to be separately licensed under this chapter; and

(2) a subunit is located outside the service area where the parent agency is located, and does not share administration, supervision, and services with the parent agency on a daily basis; a subunit must be separately licensed under this chapter. (c) The completed application submitted to the department must contain

(1) the applicant’s name and address;

(2) the location of the hospice agency and each of its subunits and branch offices;

(3) identification of each person administratively responsible for the hospice program, including each person’s name, address, telephone number, and affiliation, if any, with a licensed home health agency, hospital, or other health care facility;

(4) identification of the proposed service area;

(5) a list of hospice services directly provided by the hospice agency;

(6) a list of any hospice services to be provided through a contractual agreement, including each provider’s name, address, and telephone number; and

(7) any additional information specified by the department as necessary to determine that the applicant is a hospice agency. (d) The department will grant, deny, suspend, or revoke a license in accordance with AS 47.32 and this chapter. (Eff. 5/24/2007, Register 182) Statutory Authority: Authority: AS 47.32.010 AS 47.32.020 AS 47.32.030