Current through September 17, 2024
Treatment foster care services are available to clients age
20 or younger when the client has participated in a HEALTH CHECK (EPSDT)
screen, the treatment is clinically necessary, and an Initial Diagnostic
Interview documents the need for continued care of this level. Treatment foster
care occurs in a foster home when specially trained foster parents are
available at all times to provide consistent behavior management programs,
therapeutic interventions, and render services under the direction of a
supervising practitioner. Treatment foster care services must be
community-based, family focused, culturally competent, and developmentally
appropriate. Treatment is provided within a family environment with services
that focus on improving the client/family's adjustment emotionally,
behaviorally, socially, and educationally. To be eligible to receive treatment
in a treatment foster care program, the client must participate in a HEALTH
CHECK (EPSDT).
Providers must encourage family members to be involved in the
assessment of the client, the development of the treatment plan, and all
aspects of the client's treatment unless prohibited by the client, through
legal action, or because of federal confidentiality laws.
Providers must be available to schedule meetings and sessions
in a flexible manner to accommodate and work with a family's schedule. This
includes the ability to schedule sessions at a variety of times including
weekends or evenings.
The provider must document their attempts to involve the
family in treatment plan development and treatment plan reviews. A variety of
communication means should be considered. These may include, but should not be
limited to, including the family via conference telephone calls, using
registered letters to notify the family of meetings, and scheduling meetings in
the evening and on weekends.
005.01
Definitions
The following definitions and descriptions apply to
treatment foster care services:
Agency Staff: Treatment foster care
requires agency staff who are qualified, trained, and supported to implement
the treatment model. Some treatment foster care initiatives have been
undertaken in which one or a few staff with duties in other program areas
assume responsibility for additional treatment foster care cases. Such
arrangements tend to dilute the time, resources, and support available to the
TFC Specialist and to the intensity and focus of the services provided. This
does not constitute a true program of treatment foster care. A treatment foster
care program must have an adequate number of staff to provide administration
and direct services. See 471 NAC 32-001.04 for further staff
requirements.
Children and Adolescents: Treatment
foster care serves clients age 20 or younger whose special needs cannot be met
in their own families and who require out-of-home care. In addition to
providing treatment for specific problems or conditions, treatment foster care
seeks to promote a permanent family living arrangement for the children and
youth it serves.
Family Treatment: Treatment foster
care programs also serve the families of the children and adolescents in their
care. Treatment foster care programs seek to involve children and families in
treatment-planning and decision making as members of the treatment team. They
provide family services to children and their families when return home is
planned, and actively seek to support and enhance children's relationships with
their parents, siblings, and other family members throughout the period of
placement regardless of the permanency goal unless such efforts are expressly
and legally prohibited.
TFC Program: A program of treatment
foster care is a coherent, integrated constellation of services specifically
designed to provide treatment within the foster home setting. The term program
implies a discreet organizational entity with clearly stated purposes and means
of achieving them which are logically described and justified within the
framework of a consistent treatment philosophy. As a program, treatment foster
care is agency lead and team oriented.
Treatment: Treatment is the
coordinated and planned provision of services and use of procedures designed to
produce a planned outcome in a person's behavior, attitude, or general
condition based on a thorough assessment of possible contributing factors.
Treatment typically involves the teaching of adaptive, pro-social skills and
responses which equip young persons and their families with the means to deal
effectively with conditions or situations which have created the need for
treatment. The term treatment presumes stated, measurable goals based on
professional assessment, a set of written procedures for achieving them, and a
process for assessing these results. Treatment accountability requires that
goals and objectives be time limited and outcomes systematically
monitored.
Treatment Foster Family: The
treatment foster family is viewed as the primary treatment setting, with
treatment parents trained and supported to implement the in-home portion of the
treatment plan and promote the goals of permanency planning for children in
their care. The treatment foster parents provide the main behavioral
intervention and are available at all times. (At least one TFC parent per home
must be considered a professional TFC parent whose time is dedicated to the TFC
program.) While their role is essential to the model, treatment parents do not
carry primary or exclusive responsibility for the design of treatment plans.
This is a team function carried out under the clinical direction of qualified
program staff.
005.02
Standards of Participation for Service Providers
The Nebraska Medical Assistance Program does not pay for
care that is chronic or custodial. An agency that provides treatment foster
care services shall meet the following standards for participation to ensure
that payment is made only for active treatment:
1. The agency shall meet the standards in 471
NAC
32-001 and 471 NAC 32-005;
2. The treatment foster homes shall meet the
minimum regulations for foster homes caring for children and be licensed
through the Department (see 474 NAC
6-003) or approved by the placing
agency;
3. The agency providing
treatment foster care must be licensed as a Child Placing Agency (see 474 NAC
6-005);
4. The agency's records
must be sufficient to permit the Department to determine the degree and
intensity of treatment services furnished to the client/family;
5. The agency shall meet staffing
requirements the Department finds necessary to carry out an active treatment
program;
6. The program is designed
to meet the developmental needs of persons age 20 and younger;
7. The program must provide for both planned
and unplanned respite care services; and
8. The place of service must be the treatment
foster family home.
32-005.02A
Provider Agreement: A provider of treatment foster
care (TFC) services shall complete a provider agreement, Form MC-19 or Form
MC-20, "Medical Assistance Provider Agreement," and submit the completed form
along with a program plan to the Department for approval. The provider
application and agreement must be renewed annually to coincide with the
submittal of the cost report (see 471 NAC 32-005.09).
An outline of the information required in a program plan is
available from the Division of Medicaid and Long-Term Care.
If an agency providing treatment foster care is licensed,
certified, or accredited through another agency (Department of Health and Human
Services, Division of Public Health, Joint Commission on Accreditation of
Health Care Organizations (JCAHO), etc.), the provider shall maintain this and
provide a current copy for verification.
Agencies providing treatment foster care must be
appropriately licensed by the Department of Health and Human Services, Division
of Public Health.
32-005.02B
Annual Renewal/Update: The program will submit
information with the provider agreement (see 471 NAC 32-005.02A) and update the
information annually and whenever requested by the Division of Medicaid and
Long-Term Care.
005.03 Guidelines for Use of the Treatment
Foster Care Services for Children
A youth must have a diagnostic condition listed in the
current diagnostic and statistics manual of the American Psychiatric
Association (excluding V-codes and developmental disorders) for this level of
care. NMAP applies the following general guidelines to determine when treatment
foster care services for children are clinically necessary for a client:
1. Utilization of treatment foster care is
appropriate for individualized treatment and is expected to improve the
client's condition to facilitate moving the client to a less restrictive
placement;
2. The child/youth's
problem behaviors are persistent but can be managed with this moderate level of
structure;
3. The child/youth's
daily functioning is moderately impaired in such areas as family relationships,
education, daily living skills, community, health, etc.;
4. The child/youth has a history of previous
problems due to ongoing inappropriate behaviors or psychiatric symptoms;
or
5. Less restrictive treatment
approaches have not been successful (see
42 CFR
441.152) or are deemed inappropriate by the
supervising practitioner or treatment in a more restrictive setting has helped
stabilize the client's behavior or psychiatric symptoms and they are ready to
transition to a less restrictive level of care.
005.04 Staffing Standards for Participation
32-005.04A
Staff
Members: The following staff positions must be included in a
treatment foster care program description. All staff must be operating within
the scope of practice guidelines established by the Nebraska Department of
Health and Human Services, Division of Public Health; alcohol and drug abuse
counselors are licensed by HHS.
32-005.04A1
TFC Supervisor: The role of the TFC supervisor is to
provide support and consultation to the treatment team and caseworker.
1. TFC supervisor responsibilities are -
a. TFC Specialist supervision: The TFC
supervisor will provide regular support and guidance to the caseworker through
regular supervisory meetings and informal contact as needed. This TFC
supervisor/specialist ratio must not exceed 1 to 6 and must be adjusted to
accommodate for variables such as the severity of clients served or by the
experience/qualifications of the casework staff.
b. Treatment planning: The TFC supervisor is
a member of the treatment team and shares the responsibilities of developing
the plan. S/he also evaluates progress reports and updates.
c. Crisis on-call: The TFC supervisor
provides coordination and backup to ensure that 24-hour on-call crisis
intervention services are available and delivered to treatment families and
client families.
d. Other: May
include but is not limited to any of the following:
(1) Case management;
(2) Case assessment;
(3) Parent support and
consultation;
(4) Clinical and
administrative supervision of staff;
(5) Treatment parent recruitment;
(6) Orientation;
(7) Training and selection;
(8) Youth intake and placement;
(9) Record keeping;
(10) Program evaluation;
2. TFC supervisor activities must
be performed by a clinical staff member as defined in 471 NAC 32-001.04 who is
acting within his/her scope of practice.
32-005.04A2
TFC
Specialist: The TFC specialist is the practical leader of the
treatment team and works in development of the treatment plan, supports and
consults with the treatment families, client families, and other members of the
treatment team. The TFC specialist also advocates for, coordinates, and links
treatment families and client families to other services available in the
community.
1. TFC specialist
responsibilities:
a. Treatment team:
(1) Under the direction of the supervising
practitioner and the TFC supervisor, the TFC specialist takes primary
day-to-day responsibility for leadership of the treatment team. The TFC
specialist organizes and manages all team meetings and team decision making.
The TFC specialist takes an active role in identifying goals and coordinating
treatment services provided to the youth.
(2) The TFC specialist provides information
and training to treatment team members who may not be familiar with the
treatment foster care model. The TFC specialist prepares these individuals to
work with treatment parents and client families in a manner which is supportive
of their roles. The TFC specialist also prepares them to work with the team in
a manner consistent with the treatment foster care practice and
values.
b. Treatment
planning: The TFC specialist takes primary responsibility for the preparation
of each client/family's written comprehensive treatment plan and the written
updates of the plan. The TFC specialist seeks to inform and involve other team
members in this process including treatment parents and the client
family.
c. Support/consultation to
treatment parents:
(1) The TFC specialist
will provide regular support and technical assistance to the treatment parents
in their implementation of the treatment plan and with regard to other
responsibilities they undertake. The fundamental components of technical
assistance will be the design or revision of in-home treatment strategies
including proactive goal setting and planning, the provision of ongoing
child-specific skills training, and problem solving during home
visits.
(2) Other types of
support/supervision include emotional support and relationship building, the
sharing of information and general training to enhance professional
development, assessment of the client's progress, observation/assessment of
family interactions and stress, and assessment of safety issues. The TFC
specialist will provide at least weekly contact by phone or in person with the
treatment parent of each client family on his/her caseload. The TFC specialist
will visit the treatment home to meet with at least one TFC parent no less than
twice per month, or more often as is necessary.
d. Caseload: The number of client/families
assigned to a TFC specialist is a function of: the size/density of the
geographic area, the array of job responsibilities assigned, and the difficulty
of the population served. The preferred maximum number of youth that may be
assigned to a single TFC specialist is ten (individuals or siblings strips).
(Flexibility within this standard is possible and will be considered on an
individual program basis.)
e.
Contact with client/family: The TFC specialist or other program staff shall
regularly spend time alone with the client/families to allow them opportunity
to communicate special concerns, to make direct assessment of their progress,
and to monitor for potential abuse. The face-to-face contact must occur
monthly, or more often based on the current needs of the client/family and the
treatment parents and applies on an individual client/family basis.
f. Support/consultation of the
client/families: The TFC specialist will seek support and enhance the client's
relationships with his/her family during his/her time in treatment foster care.
The TFC specialist will arrange and encourage regular contact and visitation as
specified in the treatment plan. The TFC specialist will seek to include the
client/family in treatment team meetings, treatment planning, and decision
making, and will keep them informed of the client's progress.
g. Community liaison and advocacy: The TFC
specialist will work with the treatment team to determine which community
resources will help meet the needs of the client/families to meet the
objectives of the treatment plan. The TFC specialist will advocate for and
coordinate these services while providing technical assistance to the community
agency.
h. Crisis on-call: The TFC
specialist will work with other professionals on the team to coordinate 24-hour
crisis coverage.
2. TFC
specialist activities must be performed by a clinical staff member as defined
in 471 NAC 32-001.04 who is acting within his/her scope of practice.
32-005.04A3
Other
Members of the Agency Staff: These are recommended parts of the
agency staff and several areas may be covered by one staff member:
1. Staff development and training;
2. Administrative support;
3. Consultants, including -
a. Psychiatrist;
b. Psychologist;
c. Educational;
d. Substance abuse;
e. Sexual abuse;
f. Family systems;
g. Recreation therapist; and
h. Legal; and
4. Respite care staff.
32-005.04A4
Supervising
Practitioner: The role of the supervising practitioner is to
support and supervise the treatment team in providing active treatment to the
client/family.
1. The supervising
practitioner must be a licensed practitioner of the healing arts who is able to
diagnose and treat major mental illness within his/her scope of practice and
must maintain this licensure in the state in which the program operates (see
471 NAC 32-001.04, Staffing Standards);
2. Supervising practitioner responsibilities:
a. Treatment team participation: The
supervising practitioner will provide regular support and guidance to the
treatment team through team meetings;
b. Treatment planning: The supervising
practitioner helps in the development of a comprehensive treatment plan based
on a thorough assessment for each client/family admitted to the program and
input provided by the multidisciplinary team. S/he also participates in ongoing
treatment planning and implementation for each client/family, as
appropriate;
c. Crisis on-call: The
supervising practitioner provides consultation for on-call staff and foster
parents. The supervising practitioner also helps coordinate emergency
psychiatric hospitalizations when necessary and works with or is the admitting
physician; and
d. Client contact:
The supervising practitioner will meet with the client/family as described in
the treatment plan to assess the client's needs and monitor progress toward
goals.
32-005.04B
Staff Training and
Support: All professional staff require preservice and ongoing
professional development relevant to the treatment foster care model and to
their individual job responsibilities. The staff training plan must be approved
by the Department.
32-005.04B1
Crisis On-Call: The program shall provide on-call
crisis intervention support to supplement that provided by the TFC supervisor
and specialist to allow for 24-hour coverage and to avoid staff
burnout.
32-005.04B2
Liability Insurance: Professional staff must be
covered by liability insurance.
32-005.04B3
Legal Advocacy and
Representation: The agency shall assist staff in obtaining legal
advocacy and representation should the need arise in connection with the proper
performance of their professional duties.
32-005.04B4
Respite
Care: The program shall provide for planned and unplanned respite
care for clients and treatment foster parents.
32-005.04C
Treatment
Parents: Treatment parents are members of the treatment team whose
primary responsibility is to implement the specific strategies of the treatment
plan. Their responsibilities also include providing parenting duties as
outlined in state and agency regulations concerning foster parents. A treatment
parent must be available 24 hours a day to respond to crisis or emergency
situations. This may preclude one of the foster parents from working outside of
the home. Treatment parents may not provide day care for children in their
home.
32-005.04C1
Treatment
Parent Responsibilities:
1.
Foster role: Treatment duties encompass the basic parenting duties typically
required of foster parents. These include, but are not limited to -
a. Nutrition;
b. Clothing;
c. Shelter and physical care;
d. Nurturance and acceptance;
e. Supervision; and
f. Transportation;
2. Treatment planning: The treatment parents
shall assist the team in development of treatment plans for the client/family
in their care. Treatment parents contribute vital input based upon their
observations of the client/family in the natural environment of the treatment
home;
3. Treatment implementation:
The treatment parents have the primary responsibility for implementing the
interventions identified in the treatment plan;
4. Treatment team meetings: The treatment
parents shall work cooperatively with other team members and will attend team
meetings, training sessions, and other meetings required by the program by the
child's treatment plan;
5. Record
keeping: The treatment parent shall systematically record information and
document activities as required by the agency and the standards under which it
operates. The treatment parent shall keep a systematic record of the
client/family's behavior and progress in targeted areas on a daily basis (or
more often as medically necessary);
6. Contact with child's family: The treatment
parent shall assist the client in maintaining contact with his/her family and
work actively to enhance and support these relationships as identified in the
treatment plan;
7. Permanency
planning assistance: The treatment parent shall assist with efforts specified
by the treatment team to meet the child's permanency planning goals. These must
include, but are not limited to -
a.
Emotional support;
b.
Advice;
c. Demonstration of
effective child behavior management and other therapeutic interventions to the
child's family; and
d. Support to
the child and family during the initial period of post-treatment foster care
placement.
8. Community
relations: The treatment parent shall develop and maintain positive working
relationships with service providers in the community such as schools,
departments of recreation, social service agencies, and mental health programs
and professionals;
9. Advocacy: The
treatment parent shall work with other members of the treatment team to
advocate on behalf of the child/family to achieve the goals identified in the
treatment plan. This includes obtaining educational, vocational, medical, and
other services needed to implement the treatment plan and to assure full access
to and provision of public services to which the child is legally entitled;
and
10. Notice of request for child
move: Unless a move is required to protect the health and safety of the child
or other treatment family members, the treatment parent shall provide at least
14 days' notice to program staff if requesting a child's removal from the home
so as to allow for a planful and minimally disruptive transition.
32-005.04C2
Treatment
Parent Selection: Treatment parents are selected in part on the
basis of their acceptance of the program's treatment philosophy and their
ability to practice or carry out this philosophy on a daily basis. They must be
willing to accept the intense level of involvement and supervision provided by
the treatment team in their treatment parenting functions and the impact of
that involvement on their family life. Treatment parents must be willing to
carry out all tasks specified in their treatment foster care program's job
description including working directly and in a supportive fashion with the
families of children placed in their care.
The program shall have a written policy explaining the
procedures and criteria for treatment parent selection.
32-005.04C3
Treatment Parent
Training: Treatment parent training must be a systematic, planned,
and documented process which includes competency-based skill training and is
not limited to the provision of information through didactic instruction.
Training must be consistent and with the program's treatment philosophy and
methods. It should prepare treatment parents to carry out their
responsibilities as agents to the treatment process. The Treatment Parent and
Respite Care staff training curriculum must be approved by the Department. The
training must include the following components:
1. Preservice training: Prior to the
placement of children in their homes, all treatment parents must complete the
following training requirements:
a. Basic:
Treatment parents must satisfactorily complete the preservice training required
of all foster parents; and
b.
Agency specific: 20 hours of agency specific primarily skill-based training
consistent with the agency's treatment methodology and the service needs of the
child.
2. In-service
training: Each treatment parent must have a written educational plan, developed
by the treatment foster care parent and their supervisors, on record which
describes the content and objectives of in-service training. All treatment
parents must complete a minimum of 12 hours of in-service training annually
based on the specific training needs identified in the development plan and
specific services treatment parents are required to provide. In-service
training must emphasize skill development as well as knowledge acquisition and
may include a variety of formats and procedures including in-home training
provided by agency casework staff.
Respite care staff must be trained appropriately, as defined
by the treatment program.
32-005.04C4
Treatment Parent
Support: Treatment foster care programs are obligated to provide
intensive support, technical assistance, and supervision to all treatment
parents. This must include specific management and supervision services in
addition to those listed below:
1. Information
disclosure: All information the treatment foster care program receives
concerning a client/family to be placed with a treatment family must be shared
with and explained to the prospective TFC family prior to placement. Treatment
parents have access to full disclosure of information concerning the child as
well as the responsibility to maintain agency standards of confidentiality
regarding such information. The information must include, but is not limited to
-
a. The child's strengths and
assets;
b. Potential problems and
needs; and
c. Initial intervention
strategies for addressing these areas.
2. Respite: Respite care must be available at
both planned and crisis times. The respite care provider must be trained
according to the standards set by the treatment foster care program. The
respite care providers must be informed of the client/family treatment plan and
supervised in their implementation of the specific in-home strategies. There is
no additional payment for respite care as this is a cost that must be included
in the annual cost report.
3. Other
support (the cost of these supports must be included in the cost report):
a. Counseling: During their tenure as
Treatment Families, treatment families must have access to counseling and
therapeutic services arranged by the treatment foster care program for personal
issues or problems caused or exacerbated by their work as treatment families.
These issues may include marital stress or abuse of their own children by a
client/family in their care.
b.
Peer support: The treatment foster care program shall facilitate the creation
of support networks for treatment foster families (these may include formal
groups, informal meetings, of "buddy" systems).
c. Financial support: The treatment foster
care program financial support to treatment parents must cover the cost of care
associated with their treatment responsibilities and special needs of the
client/family. The additional financial support given to treatment parents is
directly related to the special skills, functions, and responsibilities
required of them in fulfilling their roles as treatment parents. This is above
and beyond the payment covering room, board, and care costs.
d. Damages and liability: The treatment
foster care program shall have a written plan concerning compensation for
damages done to a treatment family's property by client/families placed in
their care. This plan must be provided as part of their preservice orientation.
The agency shall provide liability coverage or assist the treatment family in
obtaining it. Treatment foster parents are required to show documentation of
coverage for home/apartment, vehicle (if appropriate), property, and liability
insurance in addition to any coverage provided by or through the treatment
foster care program.
e. Legal
advocacy: The treatment foster care program shall assist treatment parents in
obtaining legal advocacy for matters associated with the proper performance of
their role as treatment parents.
005.05 Covered Services for
Treatment Foster Care
Payment for treatment foster care services under the
Nebraska Medical Assistance Program is limited to payment for necessary
treatment services for diagnosable conditions. NMAP shall pay for treatment
provided to ameliorate or correct the diagnosed condition. NMAP does not make
payment for care that is primarily chronic or custodial in nature.
32-005.05A
Coverage
Criteria: The Department covers treatment foster care services
when the following criteria are met. The services must be -
1.
Active Treatment,
which must be -
a. Treatment provided under a
Department approved treatment planning document developed by the
multidisciplinary treatment team based on a thorough evaluation of the client's
restorative needs and potentialities, including the developmental needs of
clients age 20 or younger. The multidisciplinary treatment team includes the
supervising practitioner, the TFC specialist, the TFC parent, and other staff
as necessary. The treatment plan must be retained in the client's record.
The treatment plan must be completed within 14 days of the
client's admission to treatment foster care. The goals and objectives
documented on the treatment plan must reflect the recommendations included in
the Pre-treatment Assessment and the integration of input from the supervising
practitioner and the therapist. The treatment interventions provided must
reflect these recommendations, goals, and objectives. Evaluation of the
treatment plan by the therapist and the supervising practitioner should reflect
the client's response to the treatment interventions based on the
recommendations, goals and objectives.
b. Reasonably expected to improve the
client's medical condition or to determine a diagnosis. The treatment must, at
a minimum, be designed to correct or ameliorate the client's symptoms to
facilitate the movement of the client to a less restrictive environment within
a reasonable period of time.
c.
Consistent with the requirements listed in 471 NAC 32-001.06.
2.
Necessary Treatment
Services, which must be an appropriate level of care based on
documented evaluations, including a comprehensive diagnostic work up and
team-ordered treatment.
3.
Generally limited to one treatment child per home, or one sibling strip of up
to two children. Programs may place more than one child or sibling strip of
more than two only after specific review by the treatment team and prior
authorization through the Division of Medicaid and Long-Term Care.
4.
Therapeutic passes for client
involved in TFC. Therapeutic passes are an essential part of the
treatment for client/families involved in treatment foster care. Documentation
of the client's continued need for treatment foster care must follow overnight
therapeutic passes. Therapeutic passes must be indicated in the treatment plan
as they become appropriate. NMAP reimburses for only 60 therapeutic pass days
per client, per year. This includes all treatment services in which the client
is involved during the year.
Therapeutic leave days are counted by the entity reimbursing
for the care. Because the NMAP fee-for-service program reimburses for
therapeutic leave days on a post-service basis and because providers have one
year to bill for services, the Department cannot guarantee that an accurate
account of the therapeutic leave days that have been used.
In the event that a client does require hospitalization while
in treatment foster care, NMAP will reimburse the treatment program for up to
15 days per hospitalization. This reimbursement is only available if the
treatment placement is not used by another client.
32-005.05B
Special Treatment
Procedures in Treatment Foster Care: If a child/adolescent needs
behavior management and containment beyond time outs or redirection, special
treatment procedures may be utilized. Special treatment procedures in treatment
foster care is limited to physical restraint. Mechanical restraints and
pressure point tactics are not allowed. Parents or legal guardian or the
Department case manager must approve use of this procedure through informed
consent and must be informed within 24 hours each time they are used.
Treatment Foster Care Programs must meet the following
standards regarding special treatment procedures:
1. De-escalation techniques must be taught to
staff and TFC parents and used appropriately before the initiation of special
treatment procedures;
2. Special
treatment procedures may be used only when a child/adolescent's behavior
presents a danger to self or others, or to prevent serious disruption to the
therapeutic environment; and
3. The
child/adolescent's treatment plan must address the use of special treatment
procedures and have a clear plan to decrease the behavior requiring physical
restraints.
These standards must be reflected in all aspects of the
treatment program. Attempts to de-escalate, the special treatment procedure and
subsequent processing must be documented in the clinical record and reviewed by
the supervising practitioner.
005.06 Intake Process
Treatment foster care services are available to clients age
20 or younger when the condition needing care has been identified during a
HEALTH CHECK (EPSDT) screen, the treatment is clinically necessary, the need
for this level of care has been identified in the Initial Diagnostic Interview
, and the client has a serious emotional disturbance as indicated by the
following:
1. The youth must have a
diagnosable condition under the current Diagnostics and Statistics Manual of
the American Psychiatric Association, and that condition is seen as primarily
responsible for the client's problems;
2. The condition must result in substantial
functional limitations in two or more of the following areas:
a. Self care at an appropriate developmental
level;
b. Perception and expressive
language;
c. Learning;
d. Self-direction, including behavioral
controls, decision-making judgment, and value systems; and
e. Capacity for living in a family
environment.
32-005.06A
Intake Criteria: The following criteria must be met
for a client's admission to a treatment foster care program:
1. The need for treatment foster care must be
identified on an Initial Diagnostic Interview, based on the following criteria:
a. The client must have sufficient need for
active treatment at the time of intake to justify the expenditure of the
client/family's and program's time, energy, and resources;
b. Of all reasonable options for active
treatment available to the client, active treatment in this program must be the
best choice for expecting reasonable improvement in the client's
condition;
2. The
proposed or revised treatment plan must be the most efficient and appropriate
use of the program to meet the client/family's particular needs;
3. The plan must address active and ongoing
involvement of the family in care provision; and
4. The program is designed to meet the needs
of clients age 20 and younger.
005.07 Preadmission Authorization and
Continued Stay Review
32-005.07A
Preadmission Authorization: For treatment foster care
services to be covered by NMAP, the need for admission to this level of care
must be precertified by a licensed practitioner of the healing arts who is able
to diagnose and treat major mental illness within his/her scope of practice
through an Initial Diagnostic Interview and prior authorized through the
Division of Medicaid and Long-Term Care.
32-005.07B
Prior
Authorization: Treatment Foster Care Services must be prior
authorized by the Division of Medicaid and Long-Term Care or its
designee.
32-005.07C
Continued Stay Review/Utilization Review: Each program
is responsible for establishing a utilization review plan and procedure. A site
visit by Medicaid and/or Health and Human Services staff for purpose of
utilization review may be required for further clarification and review for
payment (see 471 NAC 32-001.11).
005.08 Documentation
32-005.08A
Treatment
Plan: The treatment plan must be developed within the first 14
days after the client's admission to the program. The plan must be reviewed by
the multi-disciplinary team at least every 30 days thereafter.
The multi-disciplinary treatment team consists of the
treatment parent, the TFC specialist, the supervising practitioner, and other
persons as necessary (parents, Department case manager).
Copies of the treatment plan must be retained in the client's
record.
The treatment plan retained in the client's record must
include -
1. The client's
name;
2. The client's Medicaid
number;
3. An indication if the
client is a Department ward;
4.
Date of the HEALTH CHECK during which the condition was disclosed;
5. The name of the referring physician
(EPSDT);
6. The client's
gender;
7. The client's
age;
8. An indication if this is an
initial or updated document;
9. The
date of the initial diagnostic interview;
10. The date of the last report;
11. The date of this report;
12. Current active symptoms and/or functional
impairments;
13. Date of onset of
current acute condition;
14. An
indication of whether this service was court-ordered (a copy of the court order
must be attached);
15. An
indication of whether psychological testing and/or a substance abuse evaluation
has been completed (a copy of the results must be included);
16. Associated medical, legal, social,
educational, occupational, or other problems;
17. Consultations;
18. Diagnoses;
19. Progress or complications since last
report, including the client/family's participation in treatment;
20. Short term goals;
21. Long term goals;
22. Therapeutic interventions prescribed by
the treatment team (frequency and by whom) including:
a. Family therapy, training, and
visits;
b. Behavioral
management;
c. Individual
counseling; and
d. Group
counseling;
23.
Medication prescribed, physician monitoring medication, frequency, and
dose;
24. The estimated length of
stay at this level of care;
25.
Placement and discharge plan;
26.
Prognosis and brief explanation;
27. The provider's name; and
28. The provider's Medicaid number.
The treatment plan must be signed by the supervising
practitioner.
32-005.08B
Documentation in the
Client's Clinical Record: Each client/family's clinical record
must contain the following information:
1.
The treatment plan;
2. The team
progress notes, recorded chronologically. The frequency is determined by the
client's condition, but the progress notes must be recorded at least daily. The
progress notes must contain a concise assessment of the client/family's
progress and recommendations for revising the treatment plan, as indicated by
the client/family's condition, and discharge planning;
3. The program's utilization review
committee's abstract or summary;
4.
The discharge summary; and
5. Other
documentation as required in 471 NAC 32-001.05.
005.09 Procedure Codes and Descriptions for
Treatment Foster Care
HCPCS/CPT procedure codes used by NMAP are listed in the
Nebraska Medicaid Practitioner Fee Schedule at 471-000-532.
005.10 Costs Not Included in the Treatment
Foster Care Per Diem
The mandatory, family therapy and optional services are
considered to be part of the per diem for TFC. The following charges can be
reimbursed separately from the TFC per diem when the services are necessary,
part of the client's overall treatment plan, and in compliance with NMAP
policy:
1. Direct client services
performed by the supervising practitioner;
2. Prescription medications (including
injectable medications);
3. Direct
client services performed by a physician or psychologist other than the
supervising practitioner;
4.
Treatment services for a physical injury or illness provided by other
professionals; and
5. Other
necessary treatment interventions including individual or group therapy and day
treatment services.
If the client is enrolled with another managed care vendor
for medical-surgical services, it may be necessary to pursue prior
authorization or referral with that entity.
The TFC per diem does not include room and board
costs.
005.11
Services Not Covered
Payment is not available for treatment foster care for
clients -
1. Receiving services in an
out-of-state facility, except as outlined in 471 NAC 1004.04, Services Provided
Outside Nebraska;
2. Whose needs
are social or educational and may be met through a less structural
program;
3. Whose primary diagnosis
and functional impairment is so severe in nature and whose condition is not
stable enough to allow them to participate in and benefit from the program;
or
4. Whose behavior may be very
disruptive and/or harmful to themselves, other program participants, or staff
members.
005.12
Inspections of Care
The Department's inspection of care team may conduct
inspection of care reviews for Treatment Foster Care Services. Please refer to
471 NAC 32001.08 and 32-001.09.
