Applications must be signed by:

1. The owner, if the applicant is an individual or partnership,
2. Two of its members, if the applicant is a limited liability company,
3. Two of its officers, if the applicant is a corporation,
4. The head of the governmental unit having jurisdiction over the facility to be licensed, if the applicant is a governmental unit.


List the names and addresses of all persons in control of the facility (do not include social security numbers or date of birth), including:

• individual owners,
• partners,
• limited liability members,
• parent companies, if any,
• members of boards of directors owning or managing the operations,
• any other persons with financial interests or investments in the facility,
• For publicly held corporations, list the stockholders who own 5% or more of the company’s stock.


The legal name of a business is the name under which the business conducts its operations. The legal name of the individual is the name that identifies a person for legal, administrative and other official purposes.  Example: Licensee Name (as listed with the Secretary of State) dba Facility Name.


​An Administrator must hold a current Nebraska Nursing Home Administrator license.


A schematic is a simple floor plan showing room numbers and the number of beds in each room and the type of beds in each room (example: Medicare, Medicaid, License-Only).


​This is a worksheet used to find the highest number of beds a facility can have based on their physical plant. The worksheet must be completed for all new facilities and any facility wanting to increase their number of beds. The bed capacity is based on the size of resident rooms, the number of bathing and toilet fixtures, and the size of the dining and activity rooms.  


Provide documents that explain the additional care provided. Include:
1. A written statement of the Alzheimer's special care unit's philosophy and mission. It should reflect the needs of residents with Alzheimer’s, dementia, or related disorders.
2. The process and criteria for placement in, transfer to, or discharge from the unit
3. The process used to assess and establish the plan of care, including how the plan responds and changes in response to changing conditions 
4. Staff training and continuing education practices
5. The physical environment and design features appropriate to support the functioning of cognitively impaired adult residents
6. The frequency and types of activities for residents
7. How families are involved and the available family support programs
8. Costs of care and any other fees.


​A generic email address should:

• Be accessed by more than one person at your facility
• Not change with personnel changes 
• NOT use a person’s name in the email address

An example would be or


The Department may deem a licensee in compliance with 175 NAC 12-006 based on its accreditation as a skilled nursing facility, nursing facility, or intermediate care facility by the:

1. Joint Commission on Accreditation of Health Organizations;
2. Commission on Accreditation of Rehabilitation facilities; or
3. Medicare or Medicaid certification program.

Bed change rules:
• 30-day written notifice is required to change bed locations. 
• Written notifice is required 45 days prior to the first day of a cost-reporting quarter to raise or lower the number of beds. 
• A change in the number of beds must take place on the first day of a cost reporting quarter. A change of location of beds can take place on any day. 
• For all changes, submit a letter explaining specific changes and the effective date. Also submit a current and a proposed schematic showing room numbers and the type and number of beds in each room.