Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 175 - HEALTH CARE FACILITIES AND SERVICES LICENSURE › Chapter 12 - SKILLED NURSING FACILITIES, NURSING FACILITIES, AND INTERMEDIATE CARE FACILITIES › Section 175-12-003 - LICENSING REQUIREMENTS AND PROCEDURES

Current through June 17, 2024
Any person intending to establish, operate, or maintain a
				  skilled nursing facility, nursing facility, or intermediate care facility must
				  first obtain a license from the Department. A facility must not hold itself out
				  as a skilled nursing facility, nursing facility, or intermediate care facility
				  or as providing skilled nursing, nursing or intermediate care nursing services
				  unless licensed under the Health Care Facility Licensure Act. An applicant for
				  an initial or renewal license must demonstrate that the facility meets the
				  care, treatment, operational, and physical plant standards contained in 175 NAC
				  12.
003.01 Initial License
003.02 Renewal Licenses
12-003.02A
Licensee
				Responsibilities:
The licensee must submit a written application
				to the Department. The licensee may construct an application or obtain an
				application form from the Department. The application must include:
1. Full name of the facility to be licensed,
				street and mailing address, telephone number, and facsimile number, if
				any;
2. Type of facility to be
				licensed;
3. Name of the
				administrator;
4. Name(s) and
				address(es) of the facility owner(s);
5. Ownership type;
6. Mailing address(es) of the
				owner(s);
7. Preferred mailing
				address for receipt of official notices from the Department;
8. List of names and addresses of all persons
				in control of the facility. The list must include all individual owners,
				partners, limited liability company members, parent companies, and members of
				boards of directors owning or managing the operations and any other persons
				with financial interests or investments in the 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. 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
				175 NAC 12;
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 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 12-004.10; and
16. If applicable, the disclosure information
				required by 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.