Respite Care Service

Initial Licensure Requirements: Read Title 175 NAC 15​ 003.01

Stage 1: Submit to the Department a complete application as required at 175 NAC 15-003.01A and 15-003.01B.  For inpatient RCS facilities which meet the “new construction" definition at 15-002, see additional paperwork requirements on the Department's Facility Construction webpage.

Stage 2: Pass an onsite inspection as required at 175 NAC 15-005 and for inpatient RCS facilities, submit a Completion Certificate form completed by a Nebraska-licensed architect or engineer which documents compliance by the inpatient RCS facility with 175 NAC 15-007.

Please see the Inspections section of this page for initial inspection information.

Initial License Application

Renewal Licensure Requirements: Read Title 175 NAC 15-003.02

• 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 by 175 NAC 15-003.02A. 

• 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 15-004.08

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.

Renewal License Application please call (402) 471-4967 

Notifications

An applicant or licensee must notify the Department in writing, by mail, email, or fax as required at 175 NAC 15-004.05.

Additional General Requirements

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 RCS 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.

Change or Correction Request Form

The Department inspects the RCS prior to and following licensure to determine compliance with 175 NAC 15​​ 006 – Standards of Operations, Care and Treatment and for inpatient RCS facilities with 15-007 – Physical Plant Standards. The RCS may not operate without an active license issued by the Department. Inspection requirements are at 175 NAC 15-005.

Initial Licensing Inspections

An onsite inspection is scheduled with the applicant after the Department has received a complete initial licensure application as required at 175 NAC 15-003.01A and 15-003.01B, 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 licensure application or requesting the initial onsite licensure inspection, the applicant should be ready to operate, but not operating. The RCS licensee and Person in Charge must be prepared to demonstrate during the Department's onsite inspection how the RCS will comply with the requirements at 175 NAC 15-006 and for inpatient RCS facilities at 15-007. Compliance is demonstrated through the use of RCS-specific organizational charts, job descriptions, policies, procedures, forms, and similar items along with a physical inspection of the RCS for inpatient RCS 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 15-006 and for inpatient RCS facilities with 15-007.

Inspection Results: See 175 NAC 15-005