gold_ball.gif (1008 bytes) Hospice Services Home Page
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gold_ball.gif (1008 bytes) Initial License
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Hospice Services
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 PDF File 175 Nebraska Administrative Code (NAC) 16, Section 006.

Initial License - The initial license application may be submitted to the department on the application form provided or an application may be constructed by the applicant.  The application must include the information contained in 175 NAC 16, Section 003.01B. Complete the application form and submit the additional information listed below:

  • List of names and addresses of all persons in control of the service. 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 service. 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;
  • Required licensure fee specified in 175 NAC 16, Section 004.10.

Initial Licensure for Inpatient Hospice Facilities: For Addendum to Initial Licensure Application, click here.

Initial Licensure Requirements for *New Construction (and/or additions) For Inpatient Hospice Facilities: For Addendum to Initial Licensure, click here.

*New Construction includes an addition to existing building which will affect patient care or treatment areas of the hospice inpatient facility.

The second stage, consists of the Department’s review, of the completed application, and may include an onsite inspection. The Department determines whether the applicant meets the standards contained in the PDF File Health Care Facility Licensure Act and PDF File 175 NAC 16, Section 003.01.

A Hospice can not operate until the license has been issued.

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