Intermediate Care Facilities for the Mentally Retarded
Requirements for Licensure

ho wishes to operate an Intermediate Care Facility for the Mentally Retarded must obtain a license prior to operating. All application materials for a license must be submitted to:

Health and Human Services Regulation and Licensure
Licensing & Regulatory Affairs - ICF/MR
PO Box 94986
Lincoln, NE 68509-4986

Initial License

The initial license process occurs in two stages:

The first stage consists of the applicants submission of affirmative evidence of the ability to comply with the operational and physical plant standards contained in 175 Nebraska Administrative Code (NAC) 17, Sections 006 and 007.

Initial License – The initial license application may be submitted to the department on the application form provided or an application constructed by the applicant. The application must include the information contained in 175 NAC 17, section 003.01B, which is completing the application form and submitting the additional information listed below:

• 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;
• Copy of the registration as a foreign corporation filed with the Nebraska Secretary of State, if applicant is a foreign corporation;
• Schematic plans;
• For new construction, construction plans completed in accordance with the Engineers and Architects Regulation Act, Neb. Rev. Stat. §§ 81-3401 to 81-3455. Construction plans and description must include the following:

1. Project name; description of the project with quantity and floor area information on bed, bathing, toileting, dining, and activity locations, and building systems; street address; and contact person;
2. Site plan, floor plans, elevations, wall and building sections, construction details, plumbing and electrical diagrams, and construction component schedules;
3. Complete list of names, titles, and telephone numbers of other authorities reviewing or inspecting the construction;
4. 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
5. Certification, if any, from a licensed architect or engineer that the construction plan and any revisions thereof meet the requirements of 175 NAC 17, Section 007;

• Copies of zoning approval from the relevant jurisdiction;
• Occupancy certificate issued by the State Fire Marshal or delegated authority; and
• Required licensure fee specified in 175 NAC 17, Section 004.09.

The second stage consists of the Department’s review upon receipt of the completed application  and may include an onsite inspection. The Department determines whether the applicant meets the standards contained in 175 NAC 17 and the Health Care Facility Licensure Act. An ICF/MR facility can not operate until the license has been issued.

Licensure Renewal

Intermediate Care Facilities for the Mentally Retarded licenses expire on March 31 of each year.

Renewal process: Notice of renewal is sent to the licensee’s preferred mailing address not later than 30 days prior to the expiration date. To renew a license you must submit:

1. Completed written application, ( 175 Nebraska Administrative Code (NAC) 17, Section 003.02A).
2. Required licensure fee specified in 175 NAC 17, Section 004.09.
3. 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;
4. Current fire certificate. Occupancy certificate issued by the State Fire Marshal or delegated authority.

Final notice: Renewals not postmarked or received by the Department on April 1 will be sent a final notice. If a renewal is not received by May 1 the license will be placed in lapsed status. (See 175 NAC 17, section 003.02B). During lapsed status the facility may not operate until the license has been reinstated.

Refusal to renew: The Department can refuse to renew a license. (See 175 NAC 17 section 008).

Forms

Initial Licensure Application