Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 15 - PERSONAL ASSISTANCE SERVICES
Section 471-15-006 - CLIENT RIGHTS AND RESPONSIBILITIES

Universal Citation: 471 NE Admin Rules and Regs ch 15 ยง 006

Current through September 17, 2024

006.01 CLIENT RIGHTS. Clients, or if the clients not able to exercise these rights, a designated, responsible party who is able to perform these functions for the client, who are found to be eligible for personal assistance services have the right to:

(A) Identify their service needs;

(B) Determine their preferred approved provider, which may include selecting from a Medicaid enrolled list of providers;

(C) Identify a possible provider who meets the minimum qualifications as described in this chapter;

(D) Direct their personal assistance services;

(E) Receive services according to the service plan, free from risk of harm or exploitation, including physical and verbal abuse, theft and misuse of household belongings, personal funds, prescriptions or other medical supplies; and

(F) Dismiss a provider if not satisfied with the provision of services.

006.02 CLIENT RESPONSIBILITIES. Clients receiving personal assistance services must:

(A) Disclose necessary medical information to the personal assistance service provider to ensure the safety of both the client and provider;

(B) Notify the Department of any changes in their medical condition or service needs;

(C) Schedule provider(s) within the parameters of the Service Authorization Notice;

(D) Notify the Department if the provider is not performing the tasks for which they are authorized;

(E) Notify the Department of any harm or exploitation by the provider, including physical and verbal abuse, theft and misuse of household belongings, personal funds, prescriptions or other medical supplies;

(F) Validate service delivery in a manner that includes, but is not limited to, the date and location of service delivery, arrival and departure times of provider, and verification of service delivery by both the provider and client, or their authorized representative;

(G) Sign the Internal Revenue Service Form FA-65, "Employer Appointment of Agent";

(H) Be at home or other designated location when the provider arrives to carry out scheduled authorized tasks;

(I) Ensure that the provider is free from risk of harm while performing the authorized tasks;

(J) Follow the terms of the service plan ;

(K) Formulate a back-up plan for provision of services, including the selection of an approved back-up personal assistance services provider, in case of provider emergency; and if a provider emergency arises, initiate the back-up plan for provision of services; and

(L) Direct their personal assistance services.

006.03 CLIENT NOTIFICATION. The Department will send written notice of denial, reduction, or termination of services to the client. Notice to clients must contain: a clear statement of the action to be taken; a clear statement of the reason for the action; a specific regulation citation which supports the action; and a complete statement of the client's right to appeal.

006.03(A) NOTICE OF REDUCTION OR TERMINATION OF SERVICES. Notice of reduction or termination of services must be mailed at least ten calendar days before the effective date of action. Refer to NAC Title 465 for additional computation excluding the day of the event, last day of the period, and holidays and weekend mailings.
006.03(A)(i) EXCEPTION. If the termination of personal assistance services is because of loss of Medicaid eligibility, the effective date of the termination must match the effective date of the termination of Medicaid eligibility.

006.03(B) CHANGES TO AUTHORIZATION. The Department will notify the client in writing of any change in the authorized service, including:
(i) Change in service tasks to be provided;

(ii) Change in authorized units;

(iii) Change in approved provider; or

(iv) Change in authorization period.

006.03(C) DENIAL AND TERMINATION REASONS. The Department will provide notice of denying or terminating eligibility for the following reasons:
(i) The client has no personal assistance service need;

(ii) The client's needs are being met by another source;

(iii) The client has not supplied needed information to complete the eligibility process;

(iv) The client fails to meet the specified eligibility criteria in this chapter;

(v) The Department and the client cannot agree on the s pecific component(s) of the service plan, including services to be provided, and number of units to be authorized;

(vi) The client voluntarily closes their personal assistance services case;

(vii) The client moves out of Nebraska;

(viii) The client dies;

(ix) The Department loses contact with the client and their whereabouts are unknown;

(x) The client has not made themselves available to the provider(s) at scheduled times by being home or at other designated locations, three or more times in a 30-day period;

(xi) The client or household member has demonstrated violence toward the provider(s);

(xii) The client has provided an unsafe and dangerous environment in which the provider(s) has been expected to work;

(xiii) An authorization period is ending and the client has not acted upon the Department's written notice of the need for re-authorization; or

(xiv) The client fails to comply with any of the client responsibilities in this chapter.

006.03(D) ADVANCE NOTICE NOT REQUIRED. Ten-day notice, in accordance with 15-006.03 and 477 NAC 9, is not required in the following situations:
(i) The Department has factual information confirming the death of a client;

(ii) The Department receives a clear written statement signed by a client that they no longer wish to receive services;

(iii) The client has been admitted to a nursing facility, intermediate care facility for persons with developmental disabilities, or institution for mental disease;

(iv) The client's whereabouts are unknown; or

(v) The client has been accepted for Medicaid services by another state.

006.04 CLIENT APPEALS OF ADVERSE ACTIONS. Persons who request, apply for, or receive services may appeal any adverse action or inaction of the Department in accordance with NAC Title 465.

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