New Jersey Administrative Code › Title 8 - HEALTH › Chapter 43J - STANDARDS FOR LICENSURE OF PEDIATRIC MEDICAL DAY CARE FACILITIES › Subchapter 2 - LICENSURE PROCEDURES › Section 8:43J-2.8 - Licensure renewal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department shall
				issue to the facility a renewal application form pursuant to (c) below and a
				licensure fee request form requiring submission of the information in (c) and the
				renewal fee 30 days prior to the expiration of the facility license unless the
				Department has suspended or revoked the license.
(b) The Department shall not issue a renewed
				license until the Department receives a completed renewal application and the
				appropriate licensure renewal fee.
(c) A
				facility desiring to renew its license shall submit the following, on a licensure
				renewal application form that the Department provides pursuant to (a) above:
1. The name under which the facility has been
				operating;
2. The street address of the
				facility;
3. The number of
				slots;
4. The name and address of the
				applicant seeking renewal;
5. The type
				of business organization;
6.
				Identification of the ownership of the physical plant.
i. If the physical plant is to be leased, a signed
				copy of the lease;
7.
				Identification of any management company that will be operating the facility,
				including the entity's name and address and the name, title and telephone number of
				a contact person;
8. Identification of
				100 percent of the proposed owners, including the names and addresses of all
				principals (that is, individuals and/or entities with a 10 percent or more
				interest);
9. Whether any person
				mentioned in the renewal application has ever had any interest in any application
				for a health care facility, in New Jersey or any other state, which was denied or
				revoked.
i. If yes, indicate whom and the
				details;
10. Whether any of
				the principals have an ownership, management or operational interest in a licensed
				health care facility in New Jersey or any other state.
i. If yes, indicate whom and provide a list of the
				licensed health care facilities;
11. Whether any person mentioned in the renewal
				application is related to any person who now operates or has operated a health care
				facility in New Jersey or any other state.
i. If
				yes, indicate whom, the relationship, and provide a list of the licensed health care
				facilities;
12. Whether any
				principals, owners, operators or managers of the facility have ever been found
				guilty of a criminal or administrative charge of fraud, abuse and/or neglect of a
				resident, a participant and/or a patient.
i. If
				yes, indicate whom and provide details;
13. Whether any principals, owners, operators or
				managers of the facility have ever been indicted for or convicted of a felony crime.
i. If yes, indicate whom and provide
				details;
14. The name and
				address of an agent in the State of New Jersey for service of process; and
15. A certification, signed by the applicant that
				states:
i. All the information submitted is true
				and correct, to the best of the applicant's knowledge and belief, and that willful
				misrepresentation of these facts may make the applicant subject to civil
				penalties;
ii. The application has been
				duly authorized by the governing body of the applicant; and
iii. The facility has been operated in accordance
				with applicable licensing requirements.