Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 404 - DEVELOPMENTAL DISABILITIES SERVICES
Chapter 4 - CERTIFICATION REQUIREMENTS FOR CERTIFIED PROVIDERS OF SERVICES
Section 404-4-002 - ADMINISTRATION STANDARDS
Universal Citation: 404 NE Admin Rules and Regs ch 4 ยง 002
Current through September 17, 2024
All agency providers of services under the Developmental Disabilities Services Act must meet the administration standards and requirements in this section.
002.01 MEDICAID PROVIDERS. All providers must be an enrolled Medicaid provider pursuant to applicable laws and regulations relating to the Nebraska Medical Assistance Program.
002.02 DIRECTOR. Each provider must have a director who is responsible for overall management and compliance of the requirements in this Title, establish policies and procedures as specified in this chapter and ensure compliance with applicable laws and regulations.
002.03 PROVIDER POLICIES AND PROCEDURES. The provider must establish and implement written policies and procedures that:
(1) Describe the provider's operation and how
systems are set up to meet participants' needs;
(2) Comply with all applicable regulations
and laws governing providers;
(3)
Are available to staff; and
(4) Are
reviewed at least annually and revised if needed.
002.03(A)
PROCEDURAL REQUIREMENTS
REGARDING RIGHTS. The provider must establish procedures that:
(i) Specify participant rights and
responsibilities and this specification does not conflict with Title 404
NAC;
(ii) Inform each participant
served, and if applicable, the participant's parent if a minor, or the
participant's legal representative, of the participant's rights and
responsibilities;
(1) The information must be
given at the time of entry to services, at the participant's annual individual
support plan (ISP) review, and when significant changes occur; and
(2) The information must be provided in a
manner that is easily understood, given verbally and in writing, in the native
language of the participant, or through other modes of communication necessary
for understanding;
(iii)
Require the provision of supports to participants receiving services in
exercising their rights;
(iv) Do
not treat participants' rights as privileges; and
(v) Prohibit retaliation against
participants' services and supports due to the participant, family members, or
legal representatives advocating on behalf of the participant served. This
includes initiating a complaint with outside
agencies.
002.04 PSYCHOTROPIC MEDICATION. Psychotropic medications administered by the certified agency provider must:
(1) Only be given as
prescribed by the participant's treating medical professional acting within his
or her scope of practice;
(2) Be
reviewed by the individual support planning team to determine if the benefits
outweigh the risks and potential side effects;
(3) Be supported by evidence that a less
restrictive and more positive technique has been systematically tried and shown
to be ineffective, and that administration of the medications is part of the
participant's person-centered plan as demonstrated by supporting data and
outcome measures;
(4) Be reviewed
by the rights review committee, unless all of the following are clearly
documented:
(a) The psychotropic medication
and dosage;
(b) The diagnosis for
which the medication has been prescribed;
(c) The justification or reason for the
medication; and
(d) Changes in the
medication prescribed or dosage, if any;
(5) Be reviewed annually by the prescribing
physician and semi-annually by the individual support planning team;
(6) Not be used as a way to deal with
under-staffing; ineffective, inappropriate, or other nonfunctional programs or
environments;
(7) Also have a
positive behavioral supports plan established and in place to address problem
behavior when it occurs; and
(8) Be
monitored and documented on an ongoing basis by the provider to provide the
individual support planning team and physician sufficient information
regarding:
(a) The effectiveness of and any
side effects experienced from the medication;
(b) Frequency and severity of symptoms;
and
(c) The effectiveness of the
positive behavioral supports plan.
002.04(A)
BEHAVIORAL SUPPORT
PLAN. No positive behavioral support plan is required when an
individual is prescribed a medication that has the effect of behavior
modification, but is prescribed for other reasons, as documented by a
physician.
002.05 RIGHTS REVIEW COMMITTEE. The provider must establish a rights review committee to review any situation requiring an emergency safety intervention, the use of certain psychotropic medications, any restrictive measure, and any situation where violation of a participant's rights occurred.
002.05(A)
MEMBERSHIP OF THE
RIGHTS REVIEW COMMITTEE. At least half of the committee members
must be participants, family, or other interested persons who are not provider
staff. The provider must appoint members of the committee that:
(i) Are free from conflict of interest;
and
(ii) Will ensure the
confidentiality of information related to participants
served.
002.05(B)
RECUSAL OF RIGHTS REVIEW COMMITTEE MEMBER. If the
person responsible for approving the participant's program or any staff who
provides direct services serve as a member of a rights review committee, he or
she must recuse him or herself from participation in rights review committee
proceedings pertaining to such participant.
002.05(C)
MEETINGS.
The committee must meet, at a minimum, semi-annually. The review may include
obtaining additional information and gathering input from the affected
participant and his or her legal representative, if applicable, to make
recommendations to the provider.
002.05(D)
SUB-COMMITTEES. The rights review committee may
utilize sub-committees to complete its work. The sub-committee must document
its activities and submit that documentation to the rights review committee, as
evidenced in the rights review committee's meeting minutes.
002.05(E)
INTERIM APPROVAL OF
RESTRICTIVE MEASURES. Interim approvals of restrictive measures
are allowed in circumstances that require immediate attention. The interim
approval may be done by a documented designee of the rights review committee,
who must be a current member of the rights review committee and can be an
employee of the certified provider but must be free from conflict of interest.
The meeting minutes must document final approval by the rights review committee
at its next meeting.
002.05(F)
ALLEGATIONS OF ABUSE OR NEGLECT. The rights review
committee must evaluate all known allegations and investigations of abuse or
neglect for any violation of a participant's rights.
002.06 PARTICIPANTS' PERSONAL FUNDS AND PROPERTY. The provider shall have written policies and procedures to protect the participant's funds and property. The provider must:
(1) Have a policy to address who is
responsible for replacement or compensation when a participant's personal items
are damaged or missing;
(2) Not use
the participant's funds and personal property as a reward or
punishment;
(3) Not assess the
participant's funds and personal property as payment for damages unless
approved by the individual support planning team, and written consent is
received from the participant to make the restitution;
(4) Not use the participant's funds and
personal property to purchase inventory or services for the provider;
and
(5) Not allow the participant's
funds and personal property to be used by provider staff or subcontractors for
their personal use.
002.06(A)
SUPPORT IN MANAGING FINANCIAL RESOURCES. When a
participant does not have the skills necessary to manage his or her financial
resources, the provider may, with the informed choice of the participant, offer
services and supports that temporarily transfers some of the control of
handling the participant's financial resources to the provider.
002.06(A)(i)
TRANSFER OF
CONTROL. The transfer of control of a participant's financial
resources:
(1) Must not be for a convenience
of staff, or as a substitute for habilitation;
(2) Must be temporary;
(3) Must be based on the choice of the
participant and the extent to which the participant can participate;
and
(4) Must not be transferred to
another entity and the participant must not be charged for the
service.
002.06(A)(ii)
DOCUMENTATION REQUIREMENTS. The participant's
individual support planning team must determine and document in the individual
support plan (ISP) the following regarding the temporary transfer of control of
a participant's finances to the provider:
(1)
The extent in which the participant can participate in management of his or her
financial resources;
(2) The
participant's informed choice; and
(3) The rationale for the transfer of
control.
002.06(B)
PROVIDER MANAGEMENT OF
PARTICIPANTS' FINANCES. If the provider is responsible for
handling participants' funds:
(i) The provider
must maintain a financial record for each participant that includes:
(1) Documentation of all cash funds, savings,
and checking accounts, deposits, and withdrawals; and
(2) An individual ledger which provides a
record of all funds received and disbursed and the current
balance;
(ii) The
provider must provide account balances and records of transactions to each
participant at least quarterly, unless otherwise requested;
(iii) Before the provider allows a
non-routine expenditure exceeding $150, the participant must review and prior
authorize it, as well as notify the participant's individual support planning
team;
(iv) The provider must have
policies and procedures that outline how financial errors, overdrafts, late
fees, and missing money will be handled when the provider is responsible for
managing participants' funds. The policies and procedures must include that:
(1) The provider is responsible for service
charges and fees assessed due to staff errors;
(2) The provider must replace missing money
promptly if missing money is due to staff error; and
(3) The provider is responsible for taking
steps to correct a participant's credit history when it is affected by provider
staff actions in managing the participant's finances; and
(v) When the provider is maintaining
participants' personal funds in a common trust, a separate accounting is
maintained for each participant or for the participant's interest in a common
trust fund.
002.07 ENTRY TO SERVICE. Prior to accepting a participant into services, the provider must:
(A) Gather and review referral
information regarding the participant, to the greatest extent possible, to make
an informed determination as to whether the agency is capable of providing
services to meet the participant's needs;
(B) Consider the safety of all participants
in the decision to accept new participants to service or the location for the
services;
(C) Consider whether the
provider has the capacity, commitment, and resources necessary to provide
supports to the participant for the long term. The provider must not admit a
participant to services if it cannot reasonably assure that it has the ability
to meet the participant's needs; and
(D) Participate in the transition process for
a participant from one provider to another, whether the provider is ending
services or beginning to provide services.
002.08 TERMINATION OF SERVICES. A provider may terminate services to a participant when the provider has determined that it can no longer effectively and appropriately serve the participant due to a lack of resources, skills, or capacity. Written notification outlining the reasons for termination of services must be given to the participant no less than 60 unless the participant is served under a risk endorsement, in which case written notification outlining the reason for termination of services must be given to the participant no less than 90 calendar days prior to the final day of services.
002.08(A)
TRANSITION
PLAN. If a provider or participant elects to terminate services,
prior to terminating services, the provider must develop a transition plan in
conjunction with the participant's individual support planning team. If another
provider has been identified to serve the participant, that provider must be
invited to the transition meeting. The individual support plan (ISP) must
include:
(i) A primary focus on the
participant's needs and preferences;
(ii) Timelines for the transition;
and
(iii) Supports and strategies
that are needed for the new and current provider that meet the needs of the
participant during and after the transition from one provider to
another.
002.08(B)
ADDITIONAL TIME. If additional time is needed to
transition the participant from one provider to another, the provider
terminating services may be required to provide services for up to an
additional 10 calendar days.
002.09 ACCESS TO RECORDS. The provider must provide access to or copies of all records or other documents relating to the operation of the provider, and all participants served by the provider, to the Department upon request.
002.10 PARTICIPANT RECORD KEEPING. The provider must maintain participant records that:
(A) Designate staff responsible for the
maintenance of the individual's records;
(B) Develop and implement a systematic
organization of records to ensure permanency, accuracy, completeness, and easy
retrieval of information;
(C) Have
a method to access the records by staff and other relevant persons as needed.
The provider must ensure that current and applicable records relating to the
participant are readily available to staff when providing services to
participants. If there are changes in ownership, all participant records must
be transferred to the current owner. Before dissolution of any provider agency,
the administrator must notify the Department in writing of the location and
storage of participant records;
(D)
Govern access to, duplication, dissemination, and release of information from
the participant's record;
(i) The provider
must ensure written consent is obtained from the participant or the
participant's legal representative for the release of information specific to
the participant, including release of photographs to persons not authorized
under law to receive them. The consent must identify the specific information
to be released and the time period the consent is in effect, except that no
written consent to release or access information is necessary for Department
representatives to review the records; and
(ii) The provider must specify the method and
frequency for obtaining authorizations for medical treatment and
consents.
002.11 INCIDENT REPORTING. The provider must report incidents using the electronic system approved and used by the Department. The provider must implement a system for handling and reporting incidents that includes:
(A) Identification of incidents that require
completion of an incident report to the Department that includes:
(i) Situations that adversely affect the
physical or emotional well-being of a participant served;
(ii) Alleged or suspected cases of abuse,
neglect, exploitation, or mistreatment; and
(iii) Emergency safety situations that
require the use of emergency safety interventions;
(B) Recording the essential facts of the
incident, including the results of the incident and any actions which might
have prevented the incident;
(C) An
action plan that includes the provider's immediate effort to address the
situation and prevent recurrence;
(D) Timelines to ensure prompt reporting of
incidents as appropriate, including reporting to:
(i) Provider management;
(ii) The individual who receives services
involved in the incident;
(iii)
Family member or legal representative as appropriate;
(iv) Child and Adult Abuse and Neglect in the
Department; and
(v) Law
enforcement;
(E)
Reporting requirements including:
(i) A
verbal report to the Department upon becoming aware of the incident;
(ii) A written report using the Department
approved format within 24 hours of the verbal report;
(iii) A written summary submitted to the
Department of the provider's investigation and action taken within 14 calendar
days; and
(iv) An aggregate report
of incidents must be submitted to the Department on a quarterly basis. Each
report must be received by the Department no later than 30 calendar days after
the last day of the previous quarter. The reports must include a compilation,
analysis, and interpretation of data, and include evidentiary examples to
evaluate performance that result in a reduction in the number of incidents over
time; and
(F) A process
to review and analyze information from incident reports to identify trends and
problematic practices which may be occurring and take appropriate corrective
actions to address problematic practices identified.
Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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