Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 175 - HEALTH CARE FACILITIES AND SERVICES LICENSURE › Chapter 4 - ASSISTED LIVING FACILITIES › Section 175-4-003 - LICENSING REQUIREMENTS AND PROCEDURES

Current through June 17, 2024
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.