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 471-31-003 - PROVIDER REQUIREMENTS
Universal Citation: 471 NE Admin Rules and Regs ch 31 ยง 003
Current through September 17, 2024
003.01 GENERAL PROVIDER REQUIREMENTS. To participate in the Nebraska Medical Assistance Program (Medicaid), providers of intermediate care facility for Individuals with developmental disabilities (ICF/DD) services must comply with ail applicable participation requirements codified in 471 NAC 2 and 3. In the event which provider participation requirements in 471 NAC 2 and 3 conflict with requirements outlined in this chapter, the individual provider participation requirements in this chapter govern.
003.02 SPECIFIC PROVIDER REQUIREMENTS. To participate in Medicaid, an intermediate care facility for individuals with developmental disabilities (ICF/DD) must:
(1) Meet all related requirements for
participation in Medicaid as required by state and federal law and
regulation;
(2) Be certified as a
Title XIX intermediate care facility for individuals with intellectual
disabilities (ICF/IID) per federal regulations and licensed as an intermediate
care facility for individuals with developmental disabilities (ICF/DD) by the
Nebraska Department of Health and Human Services, Division of Public Health or,
for an out-of-state facility, by that state's survey agency;
(3) Provide licensed nurses sufficient to
care for clients' health needs, as defined in
42 CFR
483.460(c) and
(d);
(4) Provide active treatment as defined in
this chapter, and
42 CFR
483.440-
483.450;
and
(5) Have a current Medicaid
provider agreement with the Department of Health and Human Services, Division
of Medicaid and Long-Term Care.
003.02(A)
AGENCY
COOPERATION. AH intermediate care facility for individuals with
developmental disabilities (ICF/DD) facilities must provide staff of the
federal Department of Health and Human Services, and Medicaid with the data,
forms, and cooperation necessary to admit, plan for, evaluate the needs of, and
make determinations on the appropriate care level for each individual eligible
for Medicaid as required by federal and state Medicaid regulations.
003.02(B)
FREEDOM OF
CHOICE. Each intermediate care facility for individuals with
developmental disabilities (ICF/DD) must ensure that any client may exercise
their freedom of choice in obtaining Medicaid-covered services from any
provider qualified to perform the services.
003.02(C)
ROOM AND BED
ASSIGNMENTS. The facility must ensure any changes made in the
client's room or bed assignment is documented in the client's individual
program plan (IPP). This record must show the dates and reasons for all changes
in accordance with 42 CFR 442.404.
003.02(D)
DISCHARGE.
The intermediate care facility for individuals with developmental disabilities
(ICF/DD) must ensure any client identified to permanently move from the
facility is discharged according to requirements in this section, if the client
moves to a separately licensed and certified intermediate care facility for
individuals with developmental disabilities (ICF/DD), the same discharge
requirements must be followed. The client must be admitted to the receiving
intermediate care facility for individuals with developmental disabilities
(ICF/DD).
003.02(D)(i)
DISCHARGE
PLANNING. The intermediate care facility for individuals with
developmental disabilities (ICF/DD) must include discharge planning procedures
for ail Nebraska Medicaid clients in the individual program plan (IPP). The
discharge planning procedures must be reviewed and updated (if needed) by the
client's interdisciplinary team (IDT) at least annually. The procedures must
include:
(1) Which intermediate care facility
for individuals with developmental disabilities (ICF/DD) staff person is
responsible for discharge planning; and
(2) The interdisciplinary team (IDT)'s
determination of the level of care the client needs or may need upon discharge,
including programming, medical, nutritional, psychological or psychiatric, and
supervision needs.
003.02(D)(ii)
DISCHARGE TO
ALTERNATIVE SETTING. If it is determined that a client does not
meet level of care requirements and the client's health and habilitative needs
could more appropriately be met in another setting, the facility must follow
the steps as outlined in this chapter.
003.02(D)(iii)
DISCHARGE
PROCESS. When a client is to be discharged, the intermediate care
facility for individuals with developmental disabilities (ICF/DD) facility must
ensure:
(a) The following is documented in the
client's individual program plan (IPP):
(i)
Notification of the discharge to the client as well as to the family or legal
representative:
(ii) The
justification for the discharge:
(iii) The type of service or level of care
the client is being discharged to;
(iv) The date the client is discharged;
and
(v) The discharge plan which
must include activities to ensure the client is adequately prepared for the
discharge and the receiving facility is provided current information related to
the client's social and programming history, current developmental skills and
skill deficits, current training needs, and medical, nursing and nutritional
status:
(b) Ail adaptive
equipment and supplies specifically purchased for the client move with the
client: and
(c) Medicaid is
notified of the discharge within 10 days of discharge, to include the type of
service setting the client was discharged to.
003.02(D)(iii)(1)
NOTICE. Should the client's interdisciplinary team
(IDT) decide to discharge the client without plans to admit to another service
provider, the facility must notify the Department of Health and Human Services'
Developmental Disabilities Division, Service Coordination (DDD SC) within two
working days of the interdisciplinary team (IDT)'s decision in order to aid the
client and their legal representative to secure alternative
services.
003.02(D)(iv)
CLIENT DEATH. Within 10 days after a client has
expired, the intermediate care facility for individuals with developmental
disabilities (ICF/DD) must notify Medicaid of the date of death.
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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