Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 16 - Health Facilities › Subpart 1 - Health Facilities Licensure and Certification › Chapter 3 - MINIMUM STANDARDS FOR PEDIATRIC SKILLED NURSING FACILITIES › Subchapter 3 - Licensing › Rule 15-16-1-3.3.9 - Initial Licensure

Current through June 25, 2024
For initial licensure, an applicant shall be in
						compliance with all requirements, as outlined in these regulations, and must
						submit documents, included but not limited to, those outlined below:
1. A completed/signed application, on forms
					 as designated by MSDH. All information submitted on the application forms, or
					 by request for additional information, shall be accurate and current at the
					 time of filing;
2. A
					 non-refundable application/processing fee in an amount set by the Board and
					 made payable to the Mississippi State Department of Health, by business check,
					 money order, or by electronic means. The fee is non-refundable.
3. A Licensing Fee in an amount set by the
					 Board and made payable to the Mississippi State Department of Health by
					 business check, money order, or by electronic means. The fee is non-refundable.
4. Certificates/letters of
					 approval from the local zoning authority indicating that the location of the
					 Pediatric Skilled Nursing Facility conforms to local zoning ordinances, if
					 applicable;
5.
					 Certificates/letters of approval from the local/regional/state Fire Marshal
					 that the Pediatric Skilled Nursing Facility is in compliance with all
					 applicable fire safety standards;
6. Evidence that the Pediatric Skilled
					 Nursing Facility water and sewer systems have been approved by the Mississippi
					 State Department of Health;
7.
					 Copy of the Health Inspection report/approval from the MSDH, office of public
					 health.
8. Certificate of
					 Occupancy;
9. Clinical Laboratory
					 Improvement Amendments (CLIA) certificate or CLIA certificate of waiver.
10. Proof of general and
					 Professional Liability Insurance in the amount of at least $300,000.00
					 including Workman's Compensation Insurance;
11. Articles of Incorporation, Disclosure of
					 Ownership and Control Information;
12. Proof of financial viability/contingency
					 plan demonstrating evidence that the applicant processes assets sufficient to
					 establish and sustain all components of a Pediatric Skilled Nursing Facility to
					 meet the provisions as outlined in these regulations while operating and/or
					 during extraordinary circumstances including but not limited to audited
					 financial statements, an established line of credit issued from a federally
					 insured institution in the amount of at least $100,000.00, a projected twelve
					 (12) month statement of operations and a projected first twelve months
					 statement of cash flow. The requesting Pediatric Skilled Nursing Facility shall
					 provide evidence of the referenced above review in the form of a certified
					 affidavit or statement resultant of a review from an independent certified
					 public accountant firm.
13. That
					 the center is located within 20 miles or 30 minutes (whichever is greater) of
					 an Emergency Department that has capabilities to handle pediatric emergencies;
14. The name of the Pediatric
					 Skilled Nursing Facility's administrator, manager or supervisor, the name and
					 license number of the Medical Director and Director of Nursing along with proof
					 of available licensed and supportive personnel who will have responsibility for
					 any part of the care given to Pediatric Skilled Nursing Facility's clients; as
					 well as proof of ancillary support services such as dietary, housekeeping,
					 maintenance and other personnel either directly or contractually secured to
					 support the Pediatric Skilled Nursing Facility on a daily basis;
15. The names and titles of personnel who
					 have been affiliated, during the preceding five (5) years with any other
					 Pediatric Skilled Nursing Facility, through ownership or employment, and the
					 listing of names and addresses of the appropriate Pediatric Skilled Nursing
					 Facility for each. This information shall be provided for the applicant:
					 administrator, manager or supervisor, and all licensed nurses; and
16. Floor sketch or drawing of premises to be
					 licensed, letter of intent and functional plan.
17. Lead Testing Reports. The exterior
					 playground shall be soil tested for lead contamination; soil samples shall be
					 taken from a minimum of four remote locations around the playground and
					 submitted to a certified lead testing laboratory for analysis. If the building
					 was constructed before 1965, a lead hazard screen or lead-based paint risk
					 assessment shall be done by an individual or company certified as a Lead Risk
					 Assessor by the Mississippi Department of Environmental Quality (MDEQ).
18. Asbestos Testing Report. An
					 asbestos survey shall be performed on all existing structures to be converted
					 into a Pediatric Skilled Nursing Facility to assure compliance with Air
					 Emission Regulations for the Prevention, Abatement, and Control of Air
					 Contaminates-APC S-1-Section 8 (state regulation) and National Emission
					 Standards for Hazardous Air Pollutants (NESHAP) - 40CFR Part 62, Subpart M
					 (federal regulation).
Mississippi Code
						Annotated §
												43-13-117