N.J. Admin. Code § 8:42C-2.4

Current through Register Vol. 56, No. 11, June 3, 2024

Section 8:42C-2.4 - Licensure application

(a) Subject to the maximum fee caps at N.J.S.A. 26:2H-12, an applicant shall submit to the Department:

1. A nonrefundable fee of $ 2,000 for the filing of an application for licensure of a hospice and $ 2,000 for the annual renewal of the license;

2. A nonrefundable fee of $ 150.00 for the filing of an application for licensure of each branch office of the hospice and $ 150.00 for the annual renewal of each branch office license; and

3. A nonrefundable fee of $ 1,500, plus $ 15.00 per each bed to be licensed for the filing of an application, to add an inpatient hospice care unit to a hospice license and for the annual renewal of an inpatient hospice care unit.

(b) All applicants must demonstrate character and competence, the ability to provide quality of care commensurate with applicable licensure standards and an acceptable track record of past and current compliance with in- and out-of-State licensure requirements for new licenses, as applicable, and Federal requirements, as applicable, including, but not limited to, the following:

1. The performance of the applicant in meeting its obligations under any previously approved New Jersey certificate of need, where applicable, including full compliance with all conditions of approval, if applicable; and

2. The capacity to provide quality of care, which meets or surpasses the requirements contained in applicable licensure standards pertinent to the proposed facility and/or service, as set forth below:

i. Applicants shall demonstrate a satisfactory record of compliance in accordance with this section with licensure standards in existing health care facilities, which are owned, operated or managed, in whole or in part, by the applicant, according to the provisions in (i) below. In addition to demonstrating compliance with in-State licensure provisions, applicants shall also include reports issued by licensing agencies in other states, where applicable;

ii. Applicants shall include narrative descriptions of staffing patterns, policies and protocols addressing delivery of nursing, medical, pharmacy, dietary, and other services affecting quality of care to patients; and

iii. Applicants shall include documentation of compliance with the standards of accreditation of nationally-recognized professional bodies.

(c) The Department shall examine and evaluate the licensure track record of each applicant for the period beginning 12 months preceding the submission of the application and extending to the date on which a determination is made to either approve or deny the license, for the purpose of determining the capacity of an applicant to operate a health care facility in a safe and effective manner, in accordance with State and Federal requirements. An application for a license shall be denied where an applicant has not demonstrated such capacity, as evidenced by continuing violations or a pattern of violations of State licensure standards or Federal conditions of participation standards or by existence of a criminal conviction or a plea of guilty to a charge of fraud, patient or resident abuse or neglect, or crime of violence or moral turpitude. An application may also be denied where an applicant has violated any State licensing or Federal certification standards in connection with an inappropriate discharge or denial of admission of a patient. An applicant, for purposes of this section, includes any person who was or is an owner or principal of a licensed health care facility, excluding individuals or entities who are limited partners with no managerial control or authority over the operation of the facility and who have an ownership interest of 10 percent or less in a corporation which is the applicant and who also do not serve as officers or directors of the applicant corporation.

(d) An applicant for a new license, which operates or manages licensed or Federally certified health care facilities in other states shall have performed an evaluation of each facility's compliance with State and Federal licensing and certification requirements during the 12 months preceding application submission, and extending to the date on which a determination is made to either approve or deny the license.

1. This information shall be submitted on the letterhead of the state agency responsible for health facility inspection, monitoring and enforcement of State and Federal requirements.

2. The following information shall be included:

i. Written notice that the subject facilities have been in substantial compliance with licensing and/or certification requirements during the 12 months immediately preceding application submission; and

ii. In instances in which substantial compliance has not been achieved, a description of the deficiency or deficiencies and a description of penalties and other enforcement action imposed by the state agency and/or imposed by, or recommended to the Centers for Medicare and Medicaid Services.

(e) An applicant for a license who was cited for any State licensure or Federal certification deficiency during the period identified in (c) and (d) above, which presented a serious risk to the life, safety or quality of care of the facility's patients or residents, shall be denied, except in cases where the applicant has owned/operated the facility for less than 12 months and the deficiencies occurred during the tenure of the previous owner/operator.

1. A serious risk to life, safety or quality of care of patients or residents includes, but is not limited to, any deficiency in State licensure or Federal conditions of participation requirements (42 CFR 488.400) resulting in:

i. An action by a State or Federal agency to ban, curtail or temporarily suspend admissions to a facility or to suspend or revoke a facility's license; or

ii. A termination, or exclusion from Medicaid or Medicare participation, including denial of payment for new admissions, imposed by the Department or by the Centers for Medicare and Medicaid Services, as a result of noncompliance with Medicaid or Medicare conditions of participation.

(f) In any facility, the existence of a track record violation during the period identified in (c) and (d) above shall create a rebuttable presumption, which may be overcome as set forth below, that the applicant is unable to meet or surpass licensure standards of the State of New Jersey.

1. Those applicants with track record violations, which would result in denial of the application shall submit with their application any evidence tending to show that the track record violations do not presage operational difficulties and quality of care violations at the facility, which is the subject of the application or in any other licensed facility in New Jersey, which is operated or managed by the applicant.

2. If after review of the application and the evidence submitted to rebut a negative track record, the Commissioner denies the application, the applicant may request a hearing, which will be held in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., and 52:14F-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1.1.

i. At the Commissioner's discretion, the hearing shall be conducted by the Commissioner or transferred to the Office of Administrative Law.

ii. The purpose of the hearing is to provide the applicant with the opportunity to present additional evidence in conjunction with evidence already included with the initial application, for the purpose of demonstrating the applicant's operational history and capacity to deliver quality of care to patients or residents, which meets or surpasses licensure standards of the State of New Jersey to the satisfaction of the Commissioner.

iii. The conclusion of that process with either a decision by the Commissioner or the Commissioner's acceptance or denial of an initial decision by an administrative law judge shall constitute a final agency decision.

(g) The criteria for denial of an application specified in (c) through (e) above shall also result in denial of a new license if the criteria are found to have been true of the lower number of five facilities or five percent of out-of-State facilities operated or managed by the applicant, within the 12 months preceding submission of the application and extending to the date on which a determination is made to either approve or deny the license and with respect to any service which is similar or related to the proposed service.

(h) In addition to the provisions of (c) through (e) above, and notwithstanding any express or implied limitations contained therein, the Commissioner may deny any application where he or she determines that the actions of the applicant at any facility operated or managed by the applicant constitute a threat to the life, safety, or quality of care of the patients or residents. In exercising his or her discretion under this subsection, the Commissioner shall consider the following:

i. The scope and severity of the threat;

ii. The frequency of occurrence;

iii. The presence or absence of attempts at remedial action by the applicant;

iv. The existence of any citations, penalties, warnings, or other enforcement actions by any governmental entity pertinent to the condition giving rise to the threat;

v. The similarity between the service within which the threat arose and the service which is the subject of the application; and

vi. Any other factor which the Commissioner deems to be relevant to assessment of risk presented to patients or residents.

(i) For the purposes of this section, hospice care shall be considered similar or related to the ambulatory care and other category, which includes primary care, home health care, family planning, drug counseling, abortion, ambulatory surgery, and outpatient rehabilitation.

(j) Licensees shall incur and pay the following inspection fees at initial licensure, and biennially thereafter upon renewal, in addition to the applicable licensure or renewal fee:

1. Hospice $ 1,000

2. Inpatient hospice care unit (each site) $ 1,500

(k) Failure to pay applicable inspection fees incurred pursuant to (j) above shall result in non-renewal of the license for existing facilities and the ineligibility of the licensee for initial licensure of new facilities.

1. Licensees shall incur inspection fees no more or less frequently than every other year, even if inspections occur more or less frequently than every other year.

N.J. Admin. Code § 8:42C-2.4

Amended by R.2010 d.106, effective 6/21/2010.
See: 42 N.J.R. 25(a), 42 N.J.R. 1192(b).
Rewrote the section.
Amended by R.2018 d.050, effective 1/16/2018.
See: 49 N.J.R. 232(a), 50 N.J.R. 522(a).
Rewrote (a); deleted former (j); and added new (j) and (k).