175 Neb. Admin. Code, ch. 4, § 003 - LICENSING REQUIREMENTS AND PROCEDURES

Any person intending to establish, operate, or maintain an assisted-living facility must first obtain a license from the Department. A facility must not hold itself out as an assisted-living facility or as providing health care services unless licensed under the Assisted-Living Facility Act and the Health Care Facility Licensure Act. An applicant for an initial or renewal license must demonstrate that the assisted-living facility meets the care, treatment, and operational and physical plant standards contained in 175 NAC 4.

003.01 Initial License

003.02 Renewal Licenses

4-003.02A Licensee Responsibilities: Licensees must submit a written application to the Department. The licensee may construct an application or obtain an application form from the Department. The licensure application must include:

1. Full name of the assisted-living facility to be licensed, street and mailing address, telephone and facsimile number, if any;

2. Type of assisted-living facility to be licensed;

3. Name of the administrator;

4. Name and address of the assisted-living facility owner(s);

5. Ownership type;

6. Mailing address for the owner(s);

7. The preferred mailing address for the receipt of official notices from the Department;

8. List of names and addresses of all persons in control of the assisted-living facility. The list must include all individual owners, partners, limited liability company members, parent companies, if any, and members of boards of directors owning or managing the operations and any other persons with financial interests or investments in the assisted-living facility. In the case of publicly held corporations, the individual owners listed must include any stockholders who own 5% or more of the company's stock;

9. The legal name of the individual or business organization (government, corporation, partnership, limited liability company or other type) to whom the license should be issued and a statement that the individual or organization accepts the legal responsibility for compliance with these regulations;

10. Applicant's federal employer identification number, if not an individual;

11. Applicant's social security number if the applicant is an individual. To ensure social security numbers are not part of public records and are used only for administrative purposes, applicants may submit social security numbers in a separate document;

12. Number of beds;

13. Signature(s) of:

a. The owner, if the applicant is an individual or partnership;

b. Two of its members, if the applicant is a limited liability company;

c. Two of its officers, if the applicant is a corporation; or

d. The head of the governmental unit having jurisdiction over the assisted-living facility to be licensed, if the applicant is a governmental unit;

14. Occupancy certificates issued by the State Fire Marshal or delegated authority dated within the 18 months prior to the license expiration date;

15. Required licensure fee specified in 175 NAC 4-004.09; and

16. If applicable, the disclosure information required by Neb. Rev. Stat. §§ 71-516.01 to 71-516.04, the Alzheimer's Special Care Disclosure Act. The following information must be submitted:

a. The Alzheimer's special care unit's written statement of its overall philosophy and mission which reflects the needs of residents afflicted with Alzheimer's disease, dementia, or a related disorder;

b. The process and criteria for placement in, transfer to, or discharge from the unit;

c. The process used for assessment and establishment of the plan of care and its implementation, including the method by which the plan of care evolves and is responsible to changes in condition;

d. Staff training and continuing education practices;

e. The physical environment and design features appropriate to support the functioning of cognitively impaired adult residents;

f. The frequency and types of resident activities;

g. The involvement of families and the availability of family support programs; and

h. The costs of care and any additional fees.

4-003.02B Department Responsibilities: The Department will:

1. Send a notice of expiration and an application for renewal to the licensee's preferred mailing address not later than 30 days prior to the expiration date. The licensure renewal notice specifies:

a. Date of expiration;

b. Fee for renewal;

c. License number; and

d. Name and address of the assisted-living facility.

2. Issue a renewal when it determines that the licensee has submitted a completed application;

3. Send to each licensee that fails to renew its license a second notice, which is the final notice and specifies that:

a. The licensee failed to pay the renewal fee or submit an application or both;

b. The license has expired;

c. The Department will suspend action for 30 days following the date of expiration;

d. Upon receipt of the renewal fee and completed renewal application, the Department will issue the renewal license; and

e. Upon failure to receive the renewal fee and completed renewal application, the license will be lapsed.

4. Place the assisted-living facility license on lapsed status for nonpayment of fees if the licensee fails to renew the license. During this time, the assisted-living facility may not operate. The license remains in lapsed status until it is reinstated.

4-003.02C Refusal to Renew: See 175 NAC 4-008.01 and 4-008.02 for grounds and procedures for the Department's refusal to renew a license.

003.03 Reinstatement from Lapsed Status

An assisted-living facility requesting reinstatement of its lapsed license must submit to the Department an application for reinstatement and pay the required licensure fee specified in 175 NAC 4-004.09. The application must conform to the requirements specified in 175 NAC 4-003.02.

4-003.03A The Department will review the application for completeness and decide if an onsite inspection is needed to determine compliance with the operation, care, treatment, and physical plant requirements of 175 NAC 4-006 and 4-007. The decision is based on the following factors:

1. The length of time that has transpired from the date the license was placed on lapsed status to the date of the reinstatement application; and

2. Whether the assisted-living facility has provided care from the site under a license that is different from the lapsed license.

4-003.03B When the Department decides that a reinstatement inspection is warranted, it will conduct the inspection in accordance with 175 NAC 4-005.

4-003.03C When the Department decides that a reinstatement inspection is not warranted, it will reinstate the license.

4-003.03D Refusal to Reinstate: See 175 NAC 4-008.01 and 4-008.02 for grounds and procedures for the Department's refusal to reinstate a lapsed license.

Notes

175 Neb. Admin. Code, ch. 4, § 003