4-004.01 Separate License: An applicant must obtain a separate license for each type  of health care facility or health care service that the applicant seeks to operate. All buildings in which care and treatment is provided must comply with 175 NAC 4-006 and if applicable, 175 NAC 4-007. A single license may be issued for:


  1. An assisted-living facility operating in separate buildings or structures on the same premises under one management;
  2. An inpatient facility that provides services on an outpatient basis at multiple locations; or
  3. A health clinic operating satellite clinics on a intermittent basis within a portion of the total geographic area served by such health clinic and sharing administration with such


4-004.02 Single License Document: The Department may issue one license document that indicates the various types of health care facilities or health care services for which the entity is licensed.


4-004.03 Effective Date and Term of License: An assisted-living facility license expires on April 30 of each year.


4-004.04 License Not Transferable: A license is issued only for the premises and persons named in the application and is not transferable or assignable. Change of ownership (sale, whether of stock, title, or assets, lease, discontinuance of operations) or premises terminates the license. If there is a change of ownership and the assisted- living facility remains on the same premises, the inspection in 175 NAC 4-005 is not required. If there is a change of premises, the assisted-living facility must pass the inspection specified in 175 NAC 4-005.


4-004.05 Bed Capacity, Usage and Location:  The licensee must not put into use  more beds than the total number of beds for which the assisted-living facility is licensed. Changes in the use and location of beds may occur at any time without prior Departmental approval for licensure purposes. A licensee must not locate more residents in a resident room than the capacity for which the room was originally approved.

4-004.06 Change of Ownership or Premises: The licensee must notify the Department in writing ten days before an assisted-living facility is sold, leased, discontinued, or moved to new premises.

4-004.07 Notification: An applicant or licensee must notify the Department in writing by electronic mail, facsimile, or regular mail:

  1. At the time of licensure renewal, of any change in the location of beds;
  2. At least 30 working days prior to the date it wishes to increase the number of beds for which the assisted-living facility is licensed;
  3. To request a single license document;
  4. To request simultaneous facility or service licensure inspections for all types of licensure held or sought;
  5. If new construction is planned, and submit construction plans for Department approval prior to any new construction affecting resident care and treatment areas of the assisted-living facility. The Department may accept certification from an architect or engineer in lieu of Department review;
  6. Within 24 hours of any resident death that occurred due to suicide, a violent act, or the resident’s leaving the facility without staff knowledge when departure presented a threat to the safety of the resident or others;
  7. Within 24 hours if a facility has reason to believe that a resident death was due to abuse or neglect by staff;
  8. Within 24 hours of any facility fire requiring fire department response; or
  9. Within 24 hours of an accident or natural disaster resulting in damage to the physical plant and having a direct or immediate adverse effect on the health, safety, and security of residents. This must include a description of the well- being of the facility’s residents and the steps being taken to assure resident safety, well-being, and continuity of care and treatment. The notification may be made by telephone if the accident or natural disaster has affected the facility’s capacity to


4-004.08 Information Available to Public: The licensee must make available for public inspection upon request licenses, license record information, and inspection reports. This information may be displayed on the licensed premises.


4-004.09 Fees: The licensee must pay fees for licensure as set forth below:


  1. Initial and Renewal Licensure fees:
    1. 1 to 10 Beds $  950
    2. 11 to 20 Beds $1,450
    3. 21 to 50 Beds $1,650
    4. 51 or more Beds $1,950
  2. Duplicate original license: $10
  3. Refunds for denied applications:
    1. If the Department did not perform an inspection, the license fee is refunded except for an administrative fee of $25.
    2. If the Department performed an inspection, the license fee is not refunded.


4-004.10 Deemed Compliance


4-004.10A Accreditation: The Department may deem a licensee in compliance with 175 NAC 4-006 based on acceptance of accreditation as an assisted-living facility by a recognized independent accreditation body or public agency, which has standards that are at least as stringent as those of the State of Nebraska, as evidence that the assisted-living facility complies with rules and regulations adopted and promulgated under the Assisted-Living Facility Act.


4-004.10A1 A licensee must request the Department to deem its facility in compliance with 175 NAC 4-006 based on accreditation. The request must be:

  1. Made in writing;
  2. Submitted within   30    days of receipt of a report granting accreditation; and
  3. Accompanied by a copy of the accreditation

4-004.10A2 Upon receipt of the request and acceptance of accreditation, the Department will deem the facility in compliance with 175 NAC 4-006 and will provide written notification of the decision to the facility within ten working days of receipt of the request.


4-004.10A3 The Department will exclude an assisted-living facility that has been deemed in compliance with 175 NAC 4-006 from the random selection of up to 25% of assisted-living facilities for compliance inspections under 175 NAC 4-005.04A. The assisted-living facility may be selected for a compliance inspection under 175 NAC 4-005.04B.


4-004.10A4 To maintain deemed compliance, the licensee must maintain the accreditation on which the license was issued. If the accreditation is sanctioned, modified, terminated, or withdrawn, the licensee must, within 15 days of receipt of notification of an action, notify the Department in writing of the action and the cause for the action. If the cause for action indicates possible regulatory violation, the Department will inspect the assisted-living facility within 90 days of receipt of notice. The assisted-living facility may continue to operate unless the Department determines that the assisted- living facility no longer meets the requirements for licensure under the Assisted-Living Facility Act and Health Care Facilities Licensure Act. If the Department determines the facility no longer qualifies for deemed compliance, the facility is subject to inspections under 175 NAC 4-005.