175 Neb. Admin. Code, ch. 7, § 003 - LICENSING REQUIREMENTS AND PROCEDURES

Any person intending to establish, operate, or maintain a health clinic must first obtain a license from the Department. A facility must not hold itself out as a health clinic or as providing health care services unless licensed under the Health Care Facility Licensure Act. An applicant for an initial or renewal license must demonstrate that the health clinic meets the care, treatment, operational and physical plant standards contained in 175 NAC 7.

003.01 Initial License

The initial license process occurs in two stages. The first stage consists of the applicant's submission of affirmative evidence of the ability to comply with the operational and physical plant standards contained in 175 NAC 7-006 and 7-007. The application is not complete until the Department receives documents specified in 175 NAC 7-003.01.

The second stage consists of the Department's review of the completed application together with an inspection of the health clinic. The Department determines whether or not the applicant for an initial license meets the standards contained in 175 NAC 7 and the Health Care Facility Licensure Act.

7-003.01A Applicant Responsibilities: An applicant for an initial health clinic license must:

1. Intend to provide health clinic services as defined;

2. Comply with the applicable codes, guidelines, and standards specified in 175 NAC 7-007;

3. Submit a written application to the Department as provided in 175 NAC 7-003.01B;

4. Receive approval in writing, from the Department, of schematic plan and, if new construction, of construction plans; and

5. Notify the Department at least 30 working days prior to planned patient occupancy.

7-003.01B Application Requirements: The applicant may construct an application or obtain an application form from the Department. The application must include:

1. Full name of the health clinic to be licensed, street and mailing address, telephone number and facsimile number, if any;

2. Type of health clinic to be licensed;

3. Name of the administrator;

4. Name and address(es) of the health clinic owner(s);

5. Ownership type;

6. Mailing address(es) for 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 health clinic. 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 health clinic. 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 7;

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. 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 health clinic to be licensed, if the applicant is a governmental unit;

13. Copy of the registration as a foreign corporation filed with the Nebraska Secretary of State, if applicant is a foreign corporation;

14. Schematic plans;

15. For new construction, construction plans completed in accordance with the Engineers and Architects Regulation Act, Neb. Rev. Stat. §§ 813401 to 81-3455. An applicant may construct a project description and/or certification document, or obtain a form from the Department. Construction plans must include the following:

a. Project name, description of the project with quantity and floor area information on bed, care, treatment, and toileting locations, building systems, medical equipment, street address, and contact person;

b. Site plan, floor plans, elevations, wall and building sections, construction details, plumbing and electrical diagrams, construction component schedules;

c. Complete list of names, titles, and telephone numbers of other authorities reviewing or inspecting the construction;

d. Upon Department request, any additional information that may be required for review, such as structural and mechanical calculations, electrical system calculations, and product and equipment information; and

e. Certification, if any, from a licensed architect or engineer that the schematic plans, construction plans, and any revisions thereof meet the requirements of 175 NAC 7-007;

16. Planned occupancy date;

17. Copies of zoning approval from the relevant jurisdiction;

18. Occupancy certificates issued by the State Fire Marshal or delegated authority; and

19. Required licensure fee specified in 175 NAC 7-004.09.

7-003.01C Department Responsibilities: The Department will:

1. Review the application for completeness;

2. Provide notification to the applicant of any information needed to complete the application;

3. Confirm, either by Department review or by accepting certification from an architect or engineer, that the schematic plans and, if new construction, the construction plans meet the standards of 175 NAC 7007;

4. Upon receipt of the requested information, conduct an on-site inspection in accordance with 175 NAC 7-005 prior to the issuance of a health clinic license; and

5. Issue or deny a license based on the results of the initial inspection.

7-003.01D Denial of License: See 175 NAC 7-008.01 and 7-008.02 for grounds and procedures for the Department's denial of an initial license.

003.02 Renewal Licenses

7-003.02A 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 health clinic to be licensed, street and mailing address, telephone number, and facsimile number, if any;

2. Type of health clinic to be licensed;

3. Name of the administrator;

4. Name and address(es) of the health clinic or service owner(s);

5. Ownership type;

6. Mailing address(es) for 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 health clinic. 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 health clinic. 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 7;

10. Applicant's federal employer identification number, if 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 patient admissions in the past year;

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 health clinic 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; and

15. Required licensure fee as specified in 175 NAC 7-004.09.

7-003.02B 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 health clinic.

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. That upon failure to receive the renewal fee and completed renewal application, the license will be lapsed.

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

7-003.02C Refusal to Renew: See 175 NAC 7-008.01 and 7-008.02 for grounds and procedures for the Department's refusal to renew a license.

003.03 Reinstatement from Lapsed Status

A health clinic 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 7-004.09. The application must conform to the requirements specified in 175 NAC 7-003.02.

7-003.03A The Department will review the application for completeness and will decide if an onsite inspection is needed to determine compliance with the operation, care, treatment, and physical plant requirements of 175 NAC 7-006 and 7-007. 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 health clinic has provided care or treatment from the site under a license that is different from the lapsed license.

7-003.03B When the Department decides that a reinstatement inspection is warranted, it will conduct the inspection in accordance with 175 NAC 7-005.

7-003.03C When the Department decides that a reinstatement inspection is not warranted, it will reinstate the license.

7-003.03D Refusal to Reinstate: See 175 NAC 7-008.01 and 7-008.02 for grounds and procedures for the Department's refusal to reinstate a lapsed license.

Notes

175 Neb. Admin. Code, ch. 7, § 003