Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 31 - SERVICES IN AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES (ICF/DD)
Section 471-31-002 - DEFINITIONS

Universal Citation: 471 NE Admin Rules and Regs ch 31 ยง 002

Current through March 20, 2024

The following definitions apply:

002.01 ACTIVE TREATMENT. A continuous treatment plan which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services, and related services that meet the requirements of 42 Code of Federal Regulations (CFR) 483.440(a).

002.02 ADMISSION DATE. The date the facility determines to admit the client to the facility. The determination must occur within 24 hours of the client's arrival at the facility.

002.03 ALTERNATE LEVELS OF CARE. Non-institutional living arrangements providing less care than a nursing facility (NF) or an intermediate care facility for individuals with developmental disabilities (ICF/DD)) and more care than independent living, such as adult family home, domiciliary facility, residential care facility, group home, center for the developmentally disabled, or other community living situations.

002.04 BED HOLDING. Per diem payment made to an intermediate care facility for individuals with developmental disabilities (ICF/DD) to hold a bed when a client is hospitalized or on therapeutic leave.

002.05 BENEFIT FROM ACTIVE TREATMENT. Demonstrable progress in reducing barriers to less restrictive alternatives.

002.06 CLIENT. An individual who has been determined eligible for the Nebraska Medicaid Program.

002.07 COMMUNITY-BASED DEVELOPMENTAL DISABILITY SERVICES. An array of specialized services, including vocational, pre-vocational, residential, and service coordination, provided outside an institutional setting.

002.08 COMPREHENSIVE FUNCTIONAL ASSESSMENT. A report or a series of reports synthesizing the results of relevant evaluations of the client's abilities and deficits to determine needs. These reports, or assessments, must be made in the following areas: developmental skills, behavioral skills, social skills, health and nutritional status, and other assessments based on the client's needs.

002.09 DEVELOPMENTAL DISABILITY (DP) Developmental disability means a severe, chronic disability, including an intellectual disability, other than mental illness, which:

(1) Is attributable to a mental or physical impairment unless the impairment is solely attributable to a severe emotional disturbance or persistent mental illness:

(2) Is manifested before the age of twenty-two years;

(3) Is likely to continue indefinitely;

(4) Results in substantial functional limitations in one of each of the following areas of adaptive functioning:
(i) Conceptual skills, including language, literacy, money, time, number concepts, and self-direction: nil Social skills, including interpersonal skills, social responsibility, self-esteem, gullibility, wariness, social problem solving, and the ability to follow laws and rules and to avoid being victimized: and

(ii) Practical skills, including activities of daily living, personal care, occupational skills, healthcare, mobility, and the capacity for independent living; and

(iii) Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance which are of lifelong or extended duration and are individually planned and coordinated.

002.09(A) INDIVIDUALS NINE AND YOUNGER. An individual from birth through the age of nine years inclusive, who has a substantial developmental delay or specific congenital or acquired condition, may be considered to have a developmental disability without meeting three or more of the major life activities described in subdivision of this section if the individual, without services and support, has a high probability of meeting those criteria later in life.

002.10 DISCHARGE PLAN. A plan developed by the client's interdisciplinary team (IDT) at the time of admission as part of the individual program plan (IPP). reviewed quarterly and revised as needed, which identifies:

(A) The rationale for the client's current level of care;

(B) The types of services the client would require in a less restrictive alternative: and

(C) A summary of alternatives explored for the client through the Department of Health and Human Services Developmental Disabilities Division, Service Coordination (DDD SC) over the past year as in 42 CFR 456.380.

002.11 DUAL DIAGNOSIS. An individual diagnosed with a developmental disability or related condition along with a mental illness disorder.

002.12 HABILITATIVE TRAINING. Training in new skills and behaviors necessary to facilitate independent functioning.

002.13 INDEPENDENT QIDP (QUALIFIED INTELLECTUAL DISABILITY PROFESSIONAL) ASSESSMENT. A functional evaluation to determine the client's present skills with recommendations for training, services, and level of care.

002.14 INDIVIDUAL PROGRAM PLAN (IPP). A document or documents developed by the interdisciplinary team (IDT) which includes services and supports needed by the client

002.15 INDIVIDUALIZED EDUCATIONAL PLAN (lEP). A written statement for a child with a verified disability that specifies the special education and related services necessary to assure that child a free and appropriate education. The development of the individualized educational plan (lEP) is the responsibility of the school district in which the child is receiving educational services.

002.16 INPATIENT DAYS. The number of days of care covered for inpatient intermediate care facility for individuals with developmental disabilities (ICF/DD) services is always in units of full days. A day begins at midnight and ends 24 hours later. The midnight-to-midnight method is to be used in counting days of care for Medicaid reporting purposes, even if the intermediate care facility for individuals with developmental disabilities (ICF/DD) uses a different definition of a day for statistical or other purposes.

002.16(A) PART OF DAY. Except for death on the day of admission, a part of a day on the day of discharge or death is not counted as a day. If inpatient admission and death occur on the same day, the day is considered a day of admission and counted as one inpatient day.

002.17 INTELLECTUAL DISABILITY (ID). An individual with significantly sub-average, general intellectual functioning existing concurrently with deficits in adaptive behavior. An intelligence Quotient of seventy or below on a reliably administered intelligence quotient test is presumptive evidence of intellectual disability.

002.18 INTERDISCIPLINARY TEAM (IDT). A group of persons representing the professions, disciplines, or service areas which are relevant to identifying the client's needs, and coordinating and designing training programs and services to meet these needs. Team membership varies according to individual needs, but must always include a qualified intellectual disability professional (QIDP) and a person(s) responsible to assure the client's rights are protected. The interdisciplinary team (IDT) must include the client and the client's legal representative(s).

002.19 INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES (ICF/DD). A facility where shelter, food, and active treatment are provided for a period of more than twenty-four consecutive hours to four or more persons residing at such facility who have an Intellectual Disability or related condition.

002.20 LEAST RESTRICTIVE ALTERNATIVE. The most appropriate living environment which meets the client's needs in the most normalizing manner.

002.21 LEVEL OF CARE (LOG). A category of living arrangement. Levels of care funded by Medicaid include nursing facility (NF), intermediate care facility for individuals with developmental disabilities (lCF/DD), acute hospital, and institution for mental disease (IMP).

002.22 MAINTENANCE THERAPY. Therapy to maintain the client at their current level and to prevent loss or deterioration of present abilities.

002.23 MEDICAL CARE PLAN. A plan developed by the physician when the physician determines the client requires 24-hour nursing care or the client suffers from an acute illness requiring 24-hour nursing care.

002.24 MENTAL ILLNESS. A mental disorder according to the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

002.25 NEED LEVEL. A classification system which identifies clients as high need, moderate need, or low need, which is:

(A) Based on the amount of staff time required to meet the client's needs; and

(B) Determined by intermediate care facility for individuals with developmental disabilities (ICF/DD) staff.

002.26 NURSING FACILITY (NF). A facility, or a distinct part of a facility, as defined in, and operating in, accordance with 471 Nebraska Administrative Code (NAC) 12.

002.27 PHYSICIAN'S CERTIFICATION. Physician's determination specifying the type of services the client requires.

002.28 PLAN OF CARE. A plan to provide care and interventions to a person according to that person's needs,

002.29 PRE-ADMISSION EVALUATION. An interdisciplinary process to determine:

(1) Specific needs of the client;

(2) The least restrictive alternative which meets the client's needs;

(3) Availability of the least restrictive alternative:

(4) The intermediate care facility for individuals with developmental disabilities (ICF/DD)'s ability to meet the client's needs; and

(5) If admitted, a written plan of services for the first 30 days.

002.29(A) ADMISSION DECISION. This process results in the intermediate care facility for individuals with developmental disabilities (ICF/DD)'s decision on admitting the client.

002.30 POST-ADMISSION EVALUATION. The initial Individual program plan developed and implemented by the interdisciplinary team within 30 days of the client's admission to the facility. The post-admission evaluation is based on the results and recommendations of the functional assessments completed during the client's initial 30 days residing at the facility.

002.31 PRIOR AUTHORIZATION. Determination of necessity for intermediate care facility for individuals with developmental disabilities (ICF/DD) level of care and authorization for payment.

002.33 QUALIFIED INTELLECTUAL DISABILITIES PROFESSIONAL (QIDP). A member of the clients interdisciplinary team who is responsible for coordinating and monitoring the clients active treatment program. The qualified intellectual disabilities professional (QIDP) must meet the federal Qualifications found at 42 CFR 483.430(a) through 483.430(a)(2)(iii) and 42 CFR 483.430(b)(5) through 483.430(b)(5)(x).

002.34 RELATED CONDITION. A severe, chronic disability which meets the following conditions:

(A) it is attributable to:
(i) Cerebral palsy or epilepsy; or

(ii) Any other condition, other than mental illness, found to be closely related to intellectual disability because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with intellectual disability, and requires treatment or services similar to those required for these persons;

(B) It is manifested before the person reaches age 22;

(C) It is likely to continue indefinitely;

(D) In the case of a child under three years of age, results in at least one developmental

(E) In the case of a person three years of age or older, results in substantial functional limitations in three or more of the following areas of major life activity:
(i) Self-care:

(ii) Understanding and use of language:

(iii) Learning;

(iv) Mobility;

(v) Self-direction; or

(vi) Capacity for independent living; and

(F) Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services which are life-long or of an extended duration and are individually planned and coordinated.

002.35 SUBSTANTIAL FUNCTIONAL LIMITATION. A demonstrated interference in the capacity or ability to perform activities appropriate given the individual's stage of development.

002.36 THERAPEUTIC LEAVE. Therapeutically indicated overnight home visits with relatives and friends or visits to participate in therapeutic or habilitative programs.

002.37 UTILIZATION REVIEW, Review of Medicaid-eligible clients residing in intermediate care facility for individuals with developmental disabilities (ICF/DD) facilities to determine the client's need for intermediate care facility for individuals with developmental disabilities (ICF/DD) level of care.

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