N.J. Admin. Code § 8:43B-2.2

Current through Register Vol. 56, No. 9, May 6, 2024

Section 8:43B-2.2 - Licensing of AFC sponsor agency

(a) An entity seeking to be licensed as an AFC sponsor agency shall submit to the Department:

1. A completed application using the application form designated LCS-9, which is available on the Department's forms page at http://www.nj.gov/health/forms, which contains the following information, as applicable:

i. The words "Application for a long-term care facility license";

ii. The type of application, date of application, date of check or money order, check or money order number, and amount of the check or money order;

iii. The official name of the facility and employer identification number (EIN) at which the person will practice as an AFC caregiver, site address, including the county and mailing address, including the county, if different, telephone number, email address, name, and license number of administrator, if applicable, emergency contact name, telephone number, and email address;

iv. The owner/corporate name (licensed operator) and EIN number, the DBA, if applicable, address, including the county, telephone and fax number, and email address;

v. The management company, if applicable, address, including the county, telephone and fax number, and email address, along with the name and title of a contact person of the facility at which the person will practice as an AFC caregiver;

vi. The official name of the facility (provider name) and EIN number and primary type of facility--either adult family caregiver or adult family care sponsor agency and the quantity of all beds/slots at the location;

vii. The type of ownership: for-profit or non-profit, and whether it is a corporation, proprietorship, limited liability corporation, partnership, limited partnership, religious affiliation, or other;

viii. The building ownership; whether wholly owned by a licensed operator identified at (a)1iv above or leased and, if leased, identify the owner of the building and submit a copy of the lease;

ix. The name, title, and address of the individual or current registered agent upon whom orders may be served (must be a New Jersey resident);

x. The name, title, address, Social Security number or EIN number, and the percentage of ownership of each and every owner, officer, partner, stockholder, or corporate officer of the facility, which must add up to 100 percent;

xi. The counties served by the facility;

xii. Whether any person identified in the application has ever had an interest, directly or indirectly, in any application for a health care facility in New Jersey or any other state, that was denied or revoked;

xiii. Whether any of the principals have ownership, management, or operational interest in any other licensed health care facility in New Jersey or any other state;

xiv. Whether any principals, owners, operators, or managers of the facility have ever been found guilty of a criminal or administrative charge of resident/patient fraud, abuse, and/or neglect and whether any of these have ever been indicted for the same charge;

xv. Whether any principals, owners, operators, or managers of the facility have ever been indicted for, or convicted of, a felony crime;

xvi. With regard to (a)1xii, xiii, xiv, and xv above, identify the individual by name and provide details; and

xvii. A certification, with the certifier's name, title, signature, and date that reads: "The applicant certifies that all information contained in this application and attachments is true and correct, to the best of his/her knowledge and belief, and that willful misrepresentation of these facts may make the applicant subject to civil penalties; that the application has been duly authorized by the governing body of the applicant; and that the facility has been and will be operated in accordance with applicable licensing requirements";

2. A copy of a contract with an AFC sponsor agency;

3. Documentation that evidences compliance with N.J.A.C. 8:43B-4.1, Qualifications of caregivers;

4. Payment verification from the caregiver's mortgagor or lessor documenting the applicant's payment history for the 12 months preceding the filing of the application and, if the caregiver has no mortgagor or lessor for the preceding 12 months, proof that the AFC caregiver owns the home;

5. Proof that all AFC caregivers are up to date with influenza, pneumococcal, and COVID-19 vaccines in accordance with the recommendations for healthcare providers, and the applicable initial and catch-up schedules, of the Advisory Committee on Immunization Practices (ACIP), subject to ACIP recommendations regarding contraindications, all of which are available at http://www.cdc.gov/vaccines/schedules/hcp/index.html;

6. A non-refundable filing fee of $ 200.00 for initial licensure as an AFC caregiver, and biennially thereafter, upon application for license renewal;

7. A $ 200.00 fee for Department inspection of the applicant's home that is to be used as an AFC home, and biennially thereafter upon application for license renewal, provided:

i. The Department shall not impose this fee more frequently than biennially, even if inspections occur more frequently;

ii. Failure to pay an inspection fee shall result in the denial of an initial license for new AFC caregivers and non-renewal of a license for existing AFC caregivers; and

iii. This fee is refundable if an application is denied prior to Department inspection of the premises at which the applicant would provide AFC caregiver services due to an applicant failing to meet the qualification standards at N.J.A.C. 8:43B-4.1 or being disqualified following a criminal record background check pursuant to N.J.A.C. 8:43B-3.

8. A non-refundable filing fee of $ 1,500 for initial licensure of an AFC sponsor agency, and biennially thereafter upon application for license renewal; and

9. A nonrefundable $ 200.00 fee for Department inspection of the AFC sponsor agency upon initial application for licensure, and biennially thereafter upon application for license renewal, provided:

i. This fee shall be imposed only every other year, even if inspections occur more frequently; and

ii. Failure to pay an inspection fee shall result in the denial of an initial license for new AFC sponsor agencies and non-renewal of a license for existing AFC sponsor agencies.

(b) An entity that is already functioning as an AFC sponsor agency as of March 6, 2023, shall have until June 4, 2023, to comply with the licensure requirement.

(c) No entity or other health care provider shall advertise or hold itself out as an AFC sponsor agency, unless the entity or provider is licensed by the Department as an AFC sponsor agency.

N.J. Admin. Code § 8:43B-2.2

Adopted by 55 N.J.R. 377(a), effective 3/6/2023