Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 404 - DEVELOPMENTAL DISABILITIES SERVICES
Chapter 4 - CERTIFICATION REQUIREMENTS FOR CERTIFIED PROVIDERS OF SERVICES
Section 404-4-001 - CERTIFICATION OF PROVIDERS
Universal Citation: 404 NE Admin Rules and Regs ch 4 ยง 001
Current through March 20, 2024
All agency providers of services under the Developmental Disabilities Services Act must meet the certification and accreditation requirements established by the Department of Health and Human Services.
001.01 OVERVIEW OF CERTIFICATION PROCESS. To become a certified provider, the provider applicant must:
(1) Submit a complete
application;
(2) Be a United States
citizen or qualified alien under applicable federal and state law;
(3) Provide all additional information the
Department may require; and
(4)
Comply with all provider requirements in this chapter.
001.01(A)
APPLICATION. An applicant for certification as an
agency provider of developmental disabilities services must apply for
certification on the forms supplied by the Department. The applicant shall
provide the following:
(i) The legal name of
the applicant, address, and contact information;
(ii) The structure, such as partnership,
corporation, government, or limited liability company;
(iii) A list of names and addresses of all
persons with financial interest in the agency provider;
(iv) The preferred mailing address for
receipt of official notices from the Department;
(v) The applicant's federal employer
identification number;
(vi) The
signature of the person of authority applying to be a certified agency
provider;
(vii) A copy of the
registration as a foreign corporation filed with the Nebraska Secretary of
State, if applicable;
(viii)
Program description for provision of services that includes:
(1) A copy of the applicant's organizational
chart identifying authority over the agency and the organization of management
positions;
(2) The developmental
disabilities services to be provided;
(3) The address, including street and city,
and telephone number of each location for service delivery, including type of
service to be provided at each location and planned capacity at each
location;
(4) Copies of current
policies and procedures, as required by this chapter; and
(5) A list of all subcontractors and proposed
subcontracts that will provide services under this application; and
(ix) A disclosure of any criminal
history or listing on the Department's Central Abuse and Neglect registries or
the Nebraska State Patrol Sex Offender Registry for any management positions,
including owners, directors, and managers;
(x) At initial certification only,
documentation showing the provider maintains a $10, 000.00 minimum cash reserve
or business line of credit; and
(xi) A statement of intent to seek a risk
endorsement (if applicable).
001.01(B)
INITIAL
CERTIFICATION. For prospective providers, the Department will
issue an initial certification for a six month period upon approval of the
application. Before the expiration of initial certification, the Department
will conduct an on-site review to determine compliance.
001.01(B)(i) Initial certification may be
extended for up to six additional months when the provider has not been serving
a participant for at least 90 days before the initial certification
expires.
001.01(B)(ii) Following
on-site review, the Department will:
(1) Issue
a one or two year certification when the provider is found to be in compliance
with applicable regulations;
(2)
Extend initial certification on a one-time basis for up to six months when the
on-site review shows the provider is not in compliance with applicable
regulations, but there are no health or safety issues and the provider is
making satisfactory progress towards compliance; or
(3) Deny certification when the on-site
certification review shows the provider is not in compliance with applicable
regulations and has not made progress in doing so, or there are serious health
or safety issues identified.
001.01(C)
LENGTH OF
CERTIFICATION. Provider certification is contingent upon
compliance with applicable 404 NAC standards as required by the Department.
Agencies, organizations, or individuals seeking certification will receive a
two-year certification upon successful completion of the certification review.
If the outcomes of the certification review show significant or repeated
deficiencies, or if there is evidence that provider systems are not functioning
properly, the Department may issue a one-year certification.
001.01(D)
DENIAL OF
CERTIFICATION. The Department, in its discretion, may deny or
terminate a provider's certification for good cause, which includes but is not
limited to the following grounds:
(1)
Violations of any of the provisions of Nebraska Administrative Code (NAC)
Titles 172, 403, 404, 471, 480, 482 or other applicable law or regulation
governing services provided;
(2)
The provider or its owner is the respondent of a protection order;
(3) The provider or its owner committed a
crime:
(a) Against a child or vulnerable
adult;
(b) Involving the illegal
use, possession, or distribution of a controlled substance; or
(c) That, if repeated, could injure or harm
the Developmental Disabilities Services Waiver program or a developmental
disabilities services participant;
(4) A provider's owner or administrative
staff or management have been convicted of any of the crimes listed in this
chapter; or
(5) The provider or its
owner is listed as a perpetrator on the Nebraska Adult Protective Services
Central Registry or the Child Abuse and Neglect Central Registry in a
court-substantiated or agency-substantiated case, or is listed as a perpetrator
on any comparable registry in any other state.
The Department deems a crime to have been committed when a conviction, admission, or substantial evidence of commission exists. In exercising its discretion, the Department considers the severity of the crime(s), the applicability of the crime(s) to the service of the provider, and the amount of time that has passed since the commission of the crime.
001.01(D)(i) Failure to disclose
requested information on the application, or providing incomplete or incorrect
information on the application may result in the denial of a
certification.
001.01(E)
Provider certification will be denied or terminated when any person with a 5%
or greater direct or indirect ownership interest in the provider has been
convicted of a criminal offense related to that person's involvement with a
Medicare, Medicaid, or Title XXI program within the last ten years, unless the
Department determines that denial or termination of enrollment is not in the
best interest of the program.
001.02 EXTENSION OF CERTIFICATION. The Department may extend the certification for up to 60 calendar days, for good cause shown.
001.03 CERTIFICATION RENEWAL. Renewal applications must be submitted at least 90 calendar days prior to the expiration of the current certification. At any time, the Department may conduct an onsite review and request additional documentation.
001.03(A)
ON-SITE
CERTIFICATION REVIEW. Initial and renewal certifications will not
be issued until the Department has conducted an on-site certification review to
assess compliance.
001.03(B)
RENEWAL APPLICATION. The provider must submit a
complete renewal application which includes all requirements outlined in this
chapter.
001.04 RISK ENDORSEMENT. In addition to all other certification requirements in this chapter, a certified agency seeking risk endorsement must meet specific qualifications including the following:
(A) Full-time employment of a clinician who
is currently licensed in Nebraska as one of the following:
(i) Licensed Independent Mental Health
Practitioner (LIMHP);
(ii) Licensed
Clinical Psychologist; or
(iii)
Advanced Practice Registered Nurse (APRN);
(B) Two consecutive years operating as a
certified, licensed, or accredited agency provider of Medicaid 1915(c) Waiver
Home and Community-Based Services for individuals with developmental
disabilities in Nebraska or another state;
(C) In good standing with the certification,
licensing, or accrediting body in any and all states of operation;
and
(D) Any other requirements as
defined by and at the Department's discretion.
001.05 NOTIFICATION REQUIREMENTS. The provider must notify the Department, in writing, of any:
(1) Change of ownership or control
within 10 business days of the effective date;
(2) Change in director within 10 business
days of the effective date;
(3)
Addition of a new service option at least 30 calendar days prior to the
effective date;
(4) Termination of
a service option currently being provided to participants at least 60 calendar
days prior to the effective date;
(5) Addition of a new provider-operated or
controlled service setting at least 15 calendar days prior to opening;
(6) Change in contact information,
including physical business address, phone number, mailing address, and e-mail
address, within 10 business days of the effective date; and
(7) For any provider with a risk endorsement,
a change in clinician, change in clinician's employment status with the
provider, or change in clinician's license status, within 5 business days of
the effective date of the change.
001.05(A)
CHANGE IN
OWNERSHIP. A provider certification is issued only to the person
named in the application as the certified provider. When a change of ownership
occurs, the new owner must assume responsibility for correction of all
previously cited deficient practices from the acquired
provider.
001.06 CERTIFICATION AND SERVICE REVIEWS. The Department may, at any time, conduct unannounced on-site reviews. Providers must cooperate with site reviews and documentation requests.
001.06(A)
RESULTS OF CERTIFICATION OR SERVICE
REVIEWS. If the Department determines there are deficiencies or
discovers non-compliance, the provider may:
(i) Be required to provide a plan of
improvement;
(ii) Have a
disciplinary action imposed; or
(iii) Have its certification
terminated.
001.06(B)
PLAN OF IMPROVEMENT. If the Department determines that
a provider is in non-compliance with the provider requirements outlined in the
Medicaid provider agreement or applicable law or regulation, a plan of
improvement will be required from the provider. Within 20 days of receipt of
the Department's written findings of non-compliance, the provider must submit
an acceptable plan of improvement to address areas found to be out of
compliance. The plan of improvement must:
(i)
Be specific in identifying a planned action on how the areas found to be out of
compliance have been or will be corrected for the individual cases included in
the review and system wide within the provider organization;
(ii) Include an expected date for completion
of the plan of improvement that is timely, taking into consideration the nature
of the violation;
(iii) Identify a
means to prevent a recurrence;
(iv)
Identify who is responsible for implementing the plan of improvement and
ensuring all areas are corrected and compliance is maintained; and
(v) Be signed and dated by the director of
the provider or designee.
001.07 DISCIPLINARY ACTIONS. When a provider is out of compliance with the provider requirements outlined in the Medicaid provider agreement or applicable law or regulation, the Department may impose, in any order, one or more of the following types of disciplinary action:
001.07(A)
DIRECTED PLAN OF
IMPROVEMENT. The provider will be required to implement a directed
plan of improvement, within the specified period of time, developed by the
Department, containing specific actions and timeframes.
001.07(B)
DIRECTED IN-SERVICE
TRAINING. The provider will be required to train staff as required
by the Department. The provider is responsible for the required training and
the associated cost of the training.
001.07(C)
STATE
MONITORING. The provider will be required to submit to monitoring
by the Department or designee as a safeguard against further harm or injury to
participants or serious risk to the safety of the participants.
001.07(D)
PROBATION.
The provider will be placed on probation and be required to meet the terms and
conditions of the probation in order to continue to operate.
001.07(E)
SUSPENSION OF
SERVICES. The provider will be prohibited from:
(i) Accepting new participants;
(ii) Providing a specific service to any
participants;
(iii) Providing a
specific service at a specific site; or
(iv) Providing services as otherwise deemed
appropriate by the department.
001.07(F)
TERMINATION OF THE
PROVIDER CERTIFICATION. The provider's certification may be
terminated when:
(i) The provider's
non-compliance poses an immediate and serious threat to one or more
participant's health and safety;
(ii) The provider's conduct or practices are
detrimental to the health or safety of a participant or others;
(iii) The provider knowingly fails to report
abuse, neglect, or exploitations as required by applicable law;
(iv) The provider has established a pattern
of not maintaining compliance;
(v)
The provider has not corrected previously identified areas of
non-compliance;
(vi) The provider
has established a pattern of not using internal quality improvement
practices;
(vii) The provider
commits, permits, aids, or abets any unlawful act that would disqualify it from
enrollment as a provider;
(viii)
The provider failed to disclose information on the application or provided
incomplete or incorrect information on the application;
(ix) The provider has failed to submit an
acceptable plan of improvement; or
(x) The provider has failed to comply with
any previously imposed disciplinary action directed by the
Department.
001.07(G)
NOTICE OF DISCIPLINARY ACTION TO PROVIDER. Notice of
disciplinary action will be given to the provider in writing via mail or
email.
001.07(H)
IMMEDIATE AND SERIOUS THREATS TO HEALTH AND SAFETY.
When situations involving immediate and serious threat to one or more
participants' health and safety are identified, the provider:
(i) Upon discovery, must take immediate
action to remove the risk to the identified individual and implement corrective
measures to prevent further immediate and serious threat situations;
(ii) May have participants removed from its
services, if the provider fails to remove the risk to identified participants
and to implement corrective measures to prevent further immediate and serious
threat situations;
(iii) May have
its certification terminated unless the provider has eliminated the immediate
and serious threat and is able to maintain corrective actions;
(iv) Must submit written evidence of
correction or that the circumstances causing the immediate and serious threat
no longer exist and that safeguards are in place to ensure the health and
safety of participants; and
(v) May
be required to submit to monitoring by the Department, including revisits, to
verify compliance.
001.08 APPEAL RIGHTS. Any adverse action taken under Chapter 4 of this Title may be appealed to the Director of the Division of Developmental Disabilities by the person or entity against whom the action was taken.
001.08(A)
HEARING REQUEST
PROCEDURE. The person or entity appealing an adverse action under
Chapter 4 of this Title must submit a written hearing request to the Director
of the Division of Developmental Disabilities within 30 days of the date of the
action.
001.08(B)
HEARINGS. Appeal and hearing procedures are governed
by 465 NAC.
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