Hospice Services

Initial Licensure Requirements – read Title 175 NAC 16-003.01​

• Stage 1: Submit to the Department a complete application. For inpatient hospice facilities which meet the “new construction" definition at 16-002, see additional paperwork requirements on the Department's Facility Construction webpage.
• Stage 2: Pass an onsite inspection as required at 175 NAC 16-005 and for inpatient hospice facilities submit a Completion Certificate form​ completed by a Nebraska-licensed architect or engineer which documents compliance by the inpatient hospice facility with 175 NAC 16-007.
    
  Please see the Inspections section of this page for initial inspection information.

Renewal Licensure Requirements – read Title 175 NAC 16-003.02

• Stage 1: Department mails to licensee a notice of expiration and renewal application.
• Stage 2: Licensee returns to the Department the renewal application with correct owner signatures, owner titles, dates, renewal fee, and additional items as required at 175 NAC 16-003.02A.
• Stage 3: Department mails to licensee an updated license card after a complete renewal application is received.

Fees – The licensee must pay fees for licensure and services as set forth at 175 NAC 16-004.10

Forms – The following form may be completed online but must be printed, signed, and mailed to our office. We require an original signature on all applications.

Initial License Application

Renewal Licensure Application: please call (402) 471-4967 

An applicant or licensee must notify the Department in writing, by mail, electronic mail, or facsimile as required at: 175 NAC 16-004.07

Additional General Requirements:

Change of premises (for inpatient hospice facilities) or ownership (for all hospices) – The sale, whether of stock, title, or assets, lease, or discontinuance of operations terminates the license. The licensee must notify the Department in writing 10 days before a hospice is sold, leased, discontinued, or moved to a new location. A license is issued only for the premises and persons named in the application and is not transferable or assignable.

Forms:

The following form may be completed online but must be printed, signed, and mailed to our office.

The Department inspects hospice services prior to and following licensure to determine compliance with 175 NAC 16-006​​ – Standards of Operations, Care and Treatment and for inpatient hospice facilities with 16-007 – Physical Plant Standards. The hospice service may not operate without an active license issued by the Department. Inspection requirements are at 175 NAC 16-005.

Initial Licensure Inspections:

An onsite inspection is scheduled with the applicant after the Department has received a complete initial license application and a written notification from the applicant with the date the applicant will be ready for the inspection. Unless the applicant requests a later date, the Department has 30 working days to conduct this initial onsite inspection after a complete application is received by the Department.

Prior to submitting an initial license application or requesting the initial onsite licensure inspection, the applicant should be ready to operate, but not operating. The hospice Administrator and back-up Administrator must be prepared to demonstrate during the Department's onsite inspection how the hospice will comply with the requirements at 175 NAC 16-006 and for inpatient hospice facilities at 16-007. Compliance is demonstrated through the use of hospice-specific organizational charts, job descriptions, policies, procedures, forms, and similar items along with a physical inspection of the hospice for inpatient hospice facilities prior to the applicant being issued a license by the Department.

Compliance Inspections:

Following initial licensure, the Department may conduct unannounced onsite inspections at any time the Department deems necessary to determine compliance with 175 NAC 16-006 and for inpatient hospice facilities with 16-007.

Inspection Results: See 175 NAC 16-005 

• Centers for Medicare and Medicaid Services (CMS) general enrollment
• CMS Hospice Survey & Certification

To request a hospice Medicare-certification initial enrollment paperwork packet, please call (402) 471-4967.

For Medicaid certification information see Nebraska State Medicaid webpage.​