Current through September 17, 2024
006.01 Introduction and Legal Basis
Treatment group home 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 the need for this level of
care has been identified as part of an Initial Diagnostic Interview. Treatment
group homes are non-hospital based treatment services that are community-based,
family-centered, and culturally competent.
Treatment group home services for children and adolescents
covered by Medicaid include treatment group home services for children age 20
and younger who are eligible for Medicaid. The policy in this section also
covers children age 18 or younger who are wards of the Department.
Treatment group home services must be recommended by a
licensed practitioner of the healing arts who is able to diagnose and treat
major mental illness within his/her scope of practice for reduction of physical
or mental disability, to restore a recipient to a better level of functioning,
and to facilitate discharge to a less restrictive level of
care.
006.02 Treatment Group
Home Services for Children
The Department's philosophy is that all care provided to
clients must be provided at the least restrictive and most appropriate level of
care. Care must be developmentally appropriate, family-centered, culturally
competent and community based. It must directly involve the immediate family in
all phases of treatment and discharge planning. Family may include biological,
step, foster, or adoptive parents, sibling or half sibling, and extended family
members as appropriate.
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.
Care must involve a representative from the appropriate home
community service providers. This may include such areas as education, social
services, law enforcement, religion, medical, and mental health professionals.
NMAP will cover more restrictive levels of care only when all other resources
have been explored and deemed to be inappropriate. If hospital-based inpatient
care is deemed appropriate, see 471 NAC
32-008. If psychiatric residential
treatment services are deemed appropriate, see 471 NAC
32-007.
To ensure a less institutional setting, each location where
children are housed can serve no more than 2 units of up to 20 beds. Facilities
may have up to two crisis intervention beds per unit (see
32-003 Treatment Crisis Intervention)
and the facility must provide a home-like atmosphere.
006.03 Standards for Participation for
Treatment Group Home Services
32-006.03A
Provider Agreement: A provider of treatment group home
services shall complete Form MC-19 or MC-20, "Medical Assistance Provider
Agreement," and submit the completed form to the Department for approval. The
Department is the sole determiner of which facilities are approved for
participation in this program. The facility will be advised in writing when its
participation is approved.
The provider shall submit the following with Form MC-19 or
MC-20:
1. A written overview of the
program's philosophy and objectives of treating children and youth including:
a. A complete description of how the
family-centered requirement will be met, including a complete description of
any home-based family therapy services;
b. A complete description of how the
community-based requirement will be met;
c. A description of each available
service;
d. A list of treatment
modalities available and the capacity for individualized treatment
planning;
e. A statement of the
qualification, education, and experience of each staff member providing
treatment and the therapy service each provides;
f. A schedule covering the total number of
hours that the program operates;
g.
The Department approved cost reporting document; and
h. The target population.
2. Facility/Program Changes: A
treatment group home facility shall report to the HHS Resource Development and
Support Unit and to the Division of Medicaid and Long-Term Care any major
change in its program and/or facilities, before the change is made. The HHS
Resource Development and Support Unit will determine whether the license must
be modified or reissued. Any change in the capacity of a licensed facility
requires that a license be reissued showing the number of youth who can be
cared for under the new plan. The Division of Medicaid and Long-Term Care will
determine if the facility maintains appropriate therapeutic programming for
NMAP reimbursement.
3. Confirmation
that the staffing standards in 471 NAC 32-006.03E are met.
4. Current licensure as a child caring
agency. If the child caring agency license is denied or revoked, this
requirement is not met; therefore, the provider is not eligible for
participation.
32-006.03B
Place of
Service: Treatment group home services may be provided in the
following locations when the requirements in this section have been met:
1. A community-based facility in operation
prior to 7-1-94, as a treatment group facility. (These facilities may apply for
an exception to the unit/bed maximum. The Department is the sole determiner of
eligibility for this exception.)
2.
A residential type community-based treatment facility appropriately licensed by
the Nebraska Department of Health and Human Services, Division of Public
Health; or
3. A hospital that is
licensed as a hospital by the Nebraska Department of Health and Human Services,
Division of Public Health, is accredited by the Joint Commission on
Accreditation of Health-Care Organizations (JCAHO) or the American Osteopathic
Association (AOA), meets the requirements for participation in Medicare, and
has a utilization review plan applicable to all Medicaid clients in effect.
32-006.03B1
Facility and Program
Requirements: In order to be approved as a provider of Treatment
Group Home Services, the program must insure that the following requirements
are met:
1. Adequate access to recreational
facilities for both indoor and outdoor activities, commensurate with the size
and scope of the program. (This may be provided on-site or through
contract);
2. Separation of the
treatment group home program from inpatient hospital operations, including
laboratory, radiology, surgery, patient rooms, dining areas, patient lounges,
etc.;
3. The doors to the unit and
to the outside may be locked from the outside to allow for safety, but they
must be unlocked or easily unlocked from the inside;
4. Kitchen and laundry facilities easily
accessible to the unit;
5. Staff
offices must be located on the unit;
6. Secure storage for medications and
clinical charts must be on the unit;
7. A general living or lounge area must be on
the unit;
8. A home-like
atmosphere;
9. Program is staffed
by awake personnel 24 hours per day; and
10. Other requirements as listed in this
chapter.
32-006.03C
Licensure: The treatment group home facility must -
1. Be in compliance with all applicable
federal, state, and local laws;
2.
Meet the program and operational definitions and criteria contained in the
Nebraska Department of Health and Human Services Manual;
3. Meet the definition of a treatment group
home facility as stated in this section;
4. Maintain documentation in each client's
treatment record that provides a full and complete picture of the nature and
quality of all services provided (see 471 NAC 32-006.07);
5. Have the capacity to meet the needs of the
individual Medicaid client either through employment of or contracts with
appropriate staff;
6. Be licensed
under the minimum regulations for child caring agencies if not a hospital-based
facility. If the child caring agency license is denied or revoked, this
requirement is not met; therefore, the provider is not eligible for
participation. (See 474 NAC 6-005, Licensing Group Homes and Child Caring and
Placing Agencies.)
32-006.03D
Accreditation: The licensed treatment group home must
have -
1. Be accredited by JCAHO, CARF, COA or
AOA; or
2. Include a copy of the
accreditation certificate with the initial and updated enrollment materials and
forward a copy of all survey visit reports and provider responses.
Facilities accredited by these accrediting bodies are
eligible to receive reimbursement for treatment and maintenance (room and
board) costs and must maintain accreditation in order to qualify as a treatment
group home provider. Treatment and maintenance costs are reimbursed as a per
diem rate. See NMAP Fee Schedule, (Appendix 471-000-532).
Interpretive Note: Agencies that have applied for
accreditation may be enrolled on a provisional status and receive reimbursement
for treatment services only.
32-006.03E
Staffing Standards for
Participation: A treatment group home for children shall meet the
following standards to participate in NMAP:
1.
The facility's staff must include -
a. An
executive director who has sufficient background and experience to administer a
treatment program;
b. A program
director who meets the requirements of a clinical staff person in 471 NAC
32-001.04 and is acting within his/her scope of practice, with two years of
professional experience in the treatment of children and adolescents with
mental illnesses or emotional disturbances;
c. Clinical staff professionals (who meet the
requirements of a clinical staff person in 471 NAC 32-001.04) who provide
family assessments and psychotherapy, including face-to-face individual,
family, and group therapy, who are supervised by a licensed practitioner of the
healing arts who is able to diagnose and treat major mental illness within
his/her scope of practice;
d. Child
care staff who are age 21 or older and have specialized training and experience
sufficient to equip them for their duties and are under the supervision of the
program director. 67% of child care staff must have a bachelor's degree
or four years of experience in the human services
field;
e. Supervisory staff will
meet the standards outlined in 471 NAC 32-001.04 and have four years experience
in a related field;
f. Training
must be approved by the Department and must meet the minimum standards for
pre-service and on-going training in licensing requirements;
g. A supervising practitioner who is a
licensed practitioner of the healing arts who is able to diagnose and treat
major mental illness within his/her scope of practice;
h. Each facility shall show by employment
records or on a contractual basis the ability to provide the needed services as
indicated by the scope of the program, including necessary medical/psychiatric
evaluations, and access to emergency care. The clinical services of a
psychologist, psychiatrist, and physician may be obtained on a consultation
basis; and
i. Educators, when
on-site education is provided. Services must be provided in accordance with
applicable state and federal laws. NMAP does not make payment for educational
services (see 471 NAC 32- 006.05J);
2. Volunteer services may be used to augment
and assist other staff in carrying out program or treatment plans. Volunteers
who work directly with youth must receive orientation training regarding the
program, staff, and children of the center and the functions that volunteers
can perform. However, the services performed by a volunteer cannot be
substituted for necessary medical/psychiatric and therapeutic patient/staff
ratios;
3. Staff must be mentally
and physically capable of performing assigned duties and demonstrate basic
professional competencies as required by the job description. Every staff
member shall have an annual physical examination and obtain a statement that no
medical condition exists that may interfere with his/her ability to perform
assigned duties. This is addressed in policy governing licensure regulations.
All applicable state, federal, and local laws must be followed;
4. All program personnel having access to
clients, including full-time, part-time, paid, volunteer, or contract, must be
checked through the Central Registry, Adult Protective Services Registry, and
the motor vehicle records. A criminal check must also be done through a law
enforcement agency. A person whose name appears on any of the above registers
because of behavior or activities that might be dangerous to clients must not
have access to clients;
5. The
ratio of professional staff to children is dependent on the needs of the
children and commensurate with the size and scope of the program, however -
a. The minimum ratio of Master's level
therapists providing direct face-to-face therapy services to children and
families must be 1:12;
b. The
supervising practitioner must be available to spend approximately 45 minutes
per month or more often as clinically necessary, per client, in the facility as
a minimum. This includes face-to-face time with the client, treatment plan
reviews, and supervision;
c. There
must be sufficient supervising practitioner consultation hours on a regular
basis to meet the requirements for active treatment. Youth at this level of
care must be assessed by the supervising practitioner a minimum of once a
month, or more frequently if medically necessary;
6. The ratio of child care staff to children
during prime time hours is dependent on the needs of the children and the
requirements of the individualized treatment plans. The ratio of staff to
children must be commensurate with the size and scope of the program; however,
minimum ratio is 1:6. This may be increased depending on the intensity of the
program and the children's needs;
7. The ratio of child care awake staff during
sleeping and non-prime hours is dependent on the needs of the children and must
be commensurate with the size and scope of the program; however, the minimum
ratio is 1:8. This may be increased depending on the intensity of the program
and the individual child's needs.
8. The facility must be able to call back
child care staff to provide staff and client safety in crisis
situations.
9. If the facility has
a level program that requires intense observation for admissions, the direct
care staff to youth ratio will need to be more intense during that observation
period.
10. Access to emergency
services such as additional supervision and physician psychologist services
must be available on a 24-hour basis.
32-006.03F
Service Standards for
Participation for Treatment Group Home Facilities: Treatment group
home facilities shall -
1. Make every effort
to keep the child in contact, where appropriate and possible, with the child's
family and relatives, when reunification/reconciliation is the plan and
maintain documentation of these activities;
2. Directly involve the immediate family in
all phases of treatment and discharge planning. Family may include biological,
step, foster, or adoptive parents, sibling or half sibling, and extended family
members as appropriate. For wards of the Department, the case manager must be
included in all phases of assessment, treatment planning, evaluation of
services, and discharge/after care arrangements;
3. Provide a total of 21 hours of scheduled
treatment interventions each week. These must include, but are not limited to:
a. Group psychotherapy by a practitioner
operating within their scope of practice;
b. Individual therapy by a practitioner
operating within their scope of practice;
c. Family intervention (one hour per week
minimum); and
d. Other approved
group or individual therapeutic activities.
4. Provide or arrange for face-to-face family
therapy a minimum of twice a month. Depending on the child's needs, this may
include reunification/reconciliation therapy and may also include biological,
step, foster or adoptive families, psychological parents, and/or extended
family (this is included in the 21 hours per week);
5. Provide the following mandatory services -
a.
Clinically Necessary Nursing
Services: Medical services directed by a Qualified Registered
Nurse who evaluates the particular medical nursing needs of each client and
provides for the medical care and treatment that is indicated on the Department
approved treatment planning document approved by the supervising
practitioner.
b.
Clinically Necessary Psychological Diagnostic
Services: Testing and evaluation services must reasonably be
expected to contribute to the diagnosis and plan of care established for the
individual client. Testing and evaluation services may be performed by a
licensed psychologist acting within his/her scope of practice. Clinical
necessity must be documented by the program supervising practitioner.
Reimbursement for psychological diagnostic services is included in the per
diem.
c.
Clinically
Necessary Pharmaceutical Services: If medications are dispensed by
the program, pharmacy services must be provided under the supervision of a
registered pharmacy consultant; or the program may contract for these services
through an outside licensed/certified facility. All medications must be stored
in a special locked storage space and administered only by a physician,
registered nurse, licensed practical nurse, or by a staff person approved by
the Nebraska Department of Health and Human Services, Division of Public Health
as a Medication Aide.
d.
Clinically Necessary Dietary Services: The meal
services provided must be supervised by a registered dietitian, based on the
client's individualized diet needs. Programs may contract for these services
through an outside licensed certified facility.
e. Transition and discharge planning must
meet the requirements of 471 NAC 32-001.07A.
6.
Optional
Services: The program must provide two of the following optional
services. The client must have a need for the services, the supervising
practitioner must order the services, and the services must be a part of the
client's treatment plan. The therapies must be restorative in nature, not
prescribed for conditions that have plateaued or cannot be significantly
improved by the therapy, or which would be considered maintenance therapy:
a. Services provided or supervised by a
licensed or certified therapist may be provided under the supervision of a
qualified consultant or the program may contract for these services from a
licensed/certified professional as listed below:
(1) Recreational Therapy;
(2) Speech Therapy;
(3) Occupational Therapy;
(4) Vocational Skills Therapy;
(5) Self-Care Services: Services supervised
by a staff person who is oriented toward activities of daily living and
personal hygiene. This includes toileting, bathing, grooming, etc.
b. Psychoeducational Services:
Therapeutic psychoeducational services may be provided as part of a total
program. Therapeutic psychoeducational services must be provided by teachers
specially trained to work with child and adolescent experiencing mental health
or substance abuse problems. These services may meet some strictly educational
requirements, but must also include the therapeutic component. Professionals
providing these services must be appropriately licensed and certified for the
scope of practice.
c. Social Work
Services by a Bachelor's Level Social Worker: Case management social services
to assist with personal, family, and adjustment problems which may interfere
with effective use of treatment;
d.
Crisis Intervention (may be provided in the client's home);
e. Social Skills Building;
f. Life Survival Skills;
g. Substance abuse prevention, intervention,
or treatment by an appropriately licensed alcohol and drug counselor.
7. Provide appropriate conferences
involving the client's interdisciplinary treatment team, the parents, the
referring agency, and the child, to review the case status and progress at
least every month. This does not substitute for documentation requirements. The
need for conferences with interested parties is indicated by the individual
child's circumstances and needs. For wards of the Department, this need will be
jointly determined with the Department case manager;
8. Provide a multi-disciplinary team progress
report to the referring agency, the parents, and the legal guardian every month
for the purpose of service coordination. This progress report must include a
summary of the work done, the progress made by each multi-disciplinary team
area, since the last report; plus treatment plans for the next reporting
period. For wards of the Department, monthly reports must be provided to the
Division of Children and Family Services case manager. The documentation from
the Monthly Treatment Plan review may serve this purpose.
9. The services of specialists in the fields
of medicine, psychiatry, clinical psychology, and education must be used as
needed. The costs of these services must be included in the total cost of care
and cannot be billed separately.
10. Allow for more than one type of activity
to be scheduled at one time allowing for specialized and individualized
treatment planning
32-006.03G
Annual Update
Renewal: The treatment group home shall submit the following
information with the provider application and agreement, and update/renewal the
information annually to coincide with submission of the cost report:
1. A written overview of the program's
philosophy and objectives of treating children and youth including:
a. A complete description of how the
family-centered requirement will be met, including a complete description of
any home-based family therapy services;
b. A complete description of how the
community-based requirement will be met;
c. A description of each available
service;
d. A list of treatment
modalities available and the capacity for individualized treatment
planning;
e. A statement of the
qualification, education, and experience of each staff member providing
treatment and the therapy service each provides;
f. A schedule covering the total number of
hours that the program operates;
g.
The cost report; and
h. The target
population.
2.
Confirmation that the staffing standards are met;
3. A copy of child caring agency licensure
certificate; and
4. A copy of
accreditation from JCAHO, CARF, COA, or AOA.
The Division of Medicaid and Long-Term Care or its designee
may request this information on an intermittent basis and the provider must
comply by promptly supplying the requested information.
006.04 Covered Services
NMAP limits payment for treatment group home services to
those services for medically necessary primary psychiatric diagnoses. NMAP
covers treatment group home services when the services are medically necessary
and provide active treatment.
32-006.04A
Pre-Admission
Authorization: For treatment group home services to be covered by
NMAP, the admission must be recommended by a licensed practitioner of the
healing arts who is able to diagnose and treat major mental illness within
their scope of practice through a pre-treatment assessment as outlined in 471
NAC 32-001.01 and prior authorized through the Division of Medicaid and
Long-Term Care or its designee. Consent for treatment for wards of the
Department must be obtained from the case manager or supervisor.
32-006.04B
Guidelines for Use of
the Treatment Group Home 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 group home services for children are
clinically necessary for a client:
1. The
child/youth requires 24-hour awake supervision;
2. Utilization of treatment group home 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;
3. The child/youth's
problem behaviors are persistent, may be unpredictable, and may jeopardize the
health or safety of the client and/or others, but can
be managed with this moderate level of structure;
4. The child/youth's daily functioning is
moderately impaired in such areas as family relationships, education, daily
living skills, community, health, etc.;
5. The child/youth has a history of previous
problems due to ongoing inappropriate behaviors or psychiatric symptoms;
or
6. 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.
32-006.04C
Therapeutic Passes for
Clients Involved in Treatment Group Home Services: Therapeutic
passes are an essential part of the treatment for client/families involved in
treatment group home services. Documentation of the client's continued need for
treatment group home services 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.
32-006.04D
Vacations: If a treatment group home program takes the
clients on a "vacation," NMAP will reimburse for those days under the following
conditions -
1. The trip is prior authorized
by the Division of Medicaid and Long-Term Care or its designee;
2. There is a clear statement of goals and
objectives for the client's participation in the trip;
3. At least 50% of the scheduled treatment
interventions must occur during the "vacation";
4. A clinical staff person must accompany the
"vacation" trip; and
5. The
"vacation" must be included in the treatment program.
NMAP will reimburse for up to seven "vacation" days per year
for clients in treatment group home services.
006.05 Additional Requirements
32-006.05A
Work
Experience: When a treatment group home has a work program, it
must -
1. Provide work experience that is
appropriate to the developmental age and abilities of the child;
2. Differentiate between the chores that
children are expected to perform as their share in the process of living
together, specific work assignments available to children as a means of earning
money, and jobs performed in or out of the center to gain vocational
training;
3. Give children some
choice in their work experiences and offer change from routine duties to
provide a variety of experiences;
4. Not interfere with the child's time for
school, study periods, play, chores, sleep, normal community activities, visits
with the child's family, or individual, group, or family therapy;
Clients may not be solely responsible for any major phase of
the center's operation or maintenance, such as cooking, laundering,
housekeeping, farming, or repairing;
5. Comply with all state and federal labor
laws.
32-006.05B
Solicitation of Funds: A treatment group home may not
use a child for advertising, soliciting funds, or in any way that may cause
harm or embarrassment to the child or the child's family. Written consent of
the parent or guardian must be obtained before the treatment group home uses a
child's picture, person, or name in any form of written, visual, or verbal
communication. Before obtaining consent, the treatment group home shall advise
the parent or guardian of the purpose for which it intends to use the child's
picture, person, or name, and of the times and places when and where this use
would occur. Photos of the Department state wards cannot be used for these
purposes.
32-006.05C
Special Treatment Procedures: Special treatment
procedures in treatment group homes are limited to physical restraint. Locked
time out (LTO), mechanical restraints, and pressure point tactics are not
allowed. For wards of the Department, the case manager must approve use of
physical restraints and must be informed within 24 hours each time they are
used. Guardians and parents of non-wards must give informed consent and be
informed of the use of physical restraints.
Facilities must meet the following standards regarding
physical restraints:
1. De-escalation
techniques must be taught to staff and used appropriately before the initiation
of physical restraints;
2. Physical
restraints may be used only when a youth's behavior presents a danger to self
or others, or to prevent serious disruption to the therapeutic environment;
and
3. The youth's treatment plan
must address the use of physical restraints 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 use of restraints, and
subsequent processing must be documented in the clinical record.
32-006.05D
Medical Care: The center shall ensure that the
following medical care is provided for each child:
1. Each child must receive a medical
examination immediately before or at the time of admission;
2. Each child must have current immunizations
as required by the Nebraska Department of Health and Human Services;
3. The treatment group home shall arrange
with a physician and a psychiatrist for the medical and psychiatric care of the
clients;
4. Each child must have a
medical examination/HEALTH CHECK (EPSDT) screen annually as allowed in 471 NAC
33-000 ff.;
5. The treatment group
home shall inform staff members of what medical care, including first aid, may
be given by staff without specific physician orders. Staff must be instructed
on how to obtain further medical care and how to handle emergency cases. The
center shall ensure that -
a. Staff members
on duty must have satisfactorily completed current first aid and
cardiopulmonary resuscitation training and have on file at the treatment group
home a certificate of satisfactory completion as required by licensure
regulations of the Department of Health and Human Services, Division of Public
Health;
b. Each staff member must
be able to recognize the common symptoms of illnesses in children and to note
any marked physical defects of children; and
c. A sterile clinical thermometer, a complete
first aid kit, and clearly posted emergency phone numbers must be available,
according to licensure regulations of the Department of Health and Human
Services.
32-006.05E
Hospital
Admissions: The treatment group home shall make arrangements for
the emergency admission of children from the center in case of serious illness,
emergency, or psychiatric crisis. For wards of the Department, the case manager
or the case manager's supervisor must give permission for admission.
In the event that a client does require hospitalization while
in a treatment group home, 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.
32-006.05F
Hospitalization or
Death Reports: The treatment group home shall report any accident
or illness requiring hospitalization to the parents or guardian immediately.
The-treatment group home shall immediately report any death to the parents or
guardian, the Department, a law enforcement agency, and the county coroner. If
the child is a Department ward, see 390 NAC 11-002.01D.
32-006.05G
Dental
Care: Each child must have an annual dental examination. If a
child has not had a dental exam in the twelve months before admission, an
examination must occur within 90 days following admission. See 471 NAC 6-000
and 33-000 and 474 NAC 6-005.26F.
32-006.05H
General
Health: The treatment group home shall ensure the following:
1. Each child must have enough sleep for the
child's age and physical and emotional condition at regular and reasonable
hours, and under conditions conducive to rest. While children are asleep, at
least one staff member must be within hearing distance;
2. Children must be encouraged and helped to
keep themselves clean;
3. Bathing
and toilet facilities must be properly maintained and kept clean;
4. Each child must have a toothbrush, comb,
an adequate supply of towels and washcloths, and personal toilet
articles;
5. Menus must provide for
a varied diet that meets a child's daily nutritional requirements;
6. Each child must have clothing for the
child's exclusive use. The clothing must be comfortable and appropriate for the
current weather conditions; and
7.
The treatment group home must provide safe, age-appropriate equipment for
indoor and outdoor play.
See 471 NAC 33-000.
32-006.05J
Education: Educational services, when required by law,
must be available. Education services must only be one aspect of the treatment
plan, not the primary reason for admission or treatment. Educational services
are not eligible for payment by the Department.
32-006.05K
Religious
Education: Children must be provided with an opportunity to
receive instruction in their religion. No child may be required to attend
religious services or to receive religious instructions if the child chooses
not to attend the services or receive instruction.
32-006.05L
Discipline: Discipline must be therapeutic and
remedial rather than punitive. Corporal punishment, verbal abuse, and
derogatory remarks about the child, the child's family, religion, or cultural
background are prohibited. A child may not be slapped, punched, spanked,
shaken, pinched, or struck with an object by any staff of the center. Only
staff members of the treatment group home may discipline children (see 474 NAC
6-005.26K).
32-006.05M
Transition and Discharge Planning: Whenever a child or
adolescent is transferred from one setting to another, transition and discharge
planning must be performed and be documented, beginning at the time of
admission (see 471 NAC 32-001.07A and 474 NAC 6-005.27H).
Facilities must meet the following standards regarding
transition and discharge planning:
1.
Transition and discharge planning must be based on the multidisciplinary
treatment plan designed to achieve the client's transition into and discharge
from treatment group home treatment status to a less restrictive level of care
at the earliest possible time;
2.
Transition and discharge planning must address the client's need for ongoing
treatment to maintain treatment gains, continuing education and support for
normal physical and mental development following discharge;
3. Discharge planning must include
identification of and clear transition into developmentally appropriate
services needed following discharge;
4. The treatment group home treatment
facility shall arrange for prompt transfer of appropriate records and
information to ensure continuity of care during transition into and following
the client's discharge;
5. A
written transition and discharge summary must be provided as part of the
medical record; and
6. The child's
parents (and the caseworker if the child is a ward) must be included in all
phases of transition and discharge planning. This participation must be clearly
documented in the client's record.
32-006.05N
Notification of
Runaway Children: See 390 NAC 7-001.05.
32-006.05P
Interstate Compact on
the Placement of Children: The center shall comply with the
interstate compact on the placement of children. (See 474 NAC 6-005.)
32-006.05Q
Medications: The treatment group home may possess a
limited quantity of nonprescription medications and administer them under the
supervision of designated staff. The treatment group home must follow all
applicable regulations through the Department of Health and Human Services,
Division of Public Health for storing and administering medications.
The treatment group home shall have written policies
governing the use of psychotropic medications. Parents and the guardian of a
client who receives psychotropic medication must be informed of the benefits,
risks, side effects, and potential effects of medications. A parent and legal
guardian's written informed consent for use of the medication must be obtained
before giving the medication and filed in the client's record. If the client is
a state ward, informed consent must be given by the Department case
manager.
A child's medication regime must be reviewed by the
prescribing physician at least every seven days for the first 30 days following
the initiation of a new medication and at least every 30 days
thereafter.
006.06 Individualized Treatment
The requirements of 42 CFR 441, Subpart D, must be met. To
be covered by NMAP, services must include -
1.
Program
philosophy: Treatment Group Home facilities must provide
family-centered, community-based, developmentally appropriate services under
the direction of a supervising practitioner.
a. These services must be able to meet the
special needs of families with emotionally disturbed children. Families must be
involved in all phases of treatment and discharge planning. For wards of the
Department, the Department case manager must also be involved in all phases of
treatment and discharge planning.
b. The program intensity must be such that
direct care staff, the youth in treatment, and/or the youth's family have
access to professional staff on an "as needed" basis, determined by the child's
condition.
2.
Active treatment, which must be -
a. Treatment provided under a
multi-disciplinary treatment plan reviewed and approved by the supervising
practitioner. This plan will be developed by a multi-disciplinary team of
professional staff members. The treatment plan must be for a primary
psychiatric diagnosis and must be based on a thorough evaluation of the
client's restorative needs and the client's potential. The initial treatment
plan must be developed within 14 days of the client's admission. The treatment
plan must be reviewed at least every 30 days by the multi-disciplinary team,
the parents and/or the parents' advocate, the referring agency and the child.
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. In compliance with 471 NAC
32-001.07, Treatment Planning; and
c. In compliance with 471 NAC 32-001.06,
Active Treatment.
3.
Medically necessary services, which must be an
appropriate level of care based on the documented pre-treatment assessment (see
471 NAC 32-001.01) including an Initial diagnostic interview by the supervising
practitioner either prior to admission or immediately following
admission.
006.07
Documentation in the Client's Clinical Record
The treatment group home must maintain accurate records
indicating the degree and intensity of the treatment provided to clients who
receive services in the treatment group home facility. For treatment group home
services, clinical records must stress the clinical components of the care,
including history of findings and treatment provided for the condition for
which the client is in the facility. The record must include the requirements
stated in 471 NAC 32-001.05, and -
1.
The identification data, including the client's legal status (i.e., voluntary
admission, Board of Mental Health commitment, court mandated);
2. A provisional or admitting diagnosis which
is determined for every patient at the time of admission and includes the
diagnoses of intercurrent diseases as well as the diagnoses;
3. The statements of others regarding the
client's problems and needs, as well as the client's statement of their
problems and needs;
4. The
pre-treatment assessment (see 471 NAC 32-001.01), including a
medical/psychiatric history, which contains a record of the initial diagnostic
interview and notes the onset of illness, the circumstances leading to
admission, attitudes, behavior, estimate of intellectual functioning, memory
functioning, orientation, and an inventory of the client's strengths in a
descriptive, not interpretative, fashion;
5. Complete psychological evaluation when
indicated;
6. Complete neurological
examination, when indicated;
7. A
social history sufficient to provide data on the client's relevant past
history, present situation, social support system, community resource contacts,
and other information relevant to good treatment, and transition and discharge
planning.
8. A thorough family
assessment;
9. Reports of
consultations, electroencephalograms, dental records, and special
studies;
10. The treatment received
by the client, which is documented in a manner and with a frequency to ensure
that all active therapeutic efforts, such as individual, group, and family
psychotherapy, drug therapy, milieu therapy, occupational therapy, recreational
therapy, nursing care, and other therapeutic interventions, are
included;
11. Progress notes must
be recorded by all professional staff and, when appropriate, others
significantly involved in active treatment modalities, following each contact.
The frequency is determined by the individual treatment plan and the condition
of the client. Progress notes must contain a concise assessment of the client's
progress and recommendations for revising the treatment plan as indicated by
the client's condition. Child care workers must maintain 24-hour documentation
of a client's whereabouts and activities.
12. The transition plan and discharge
summary, including a summary of the client's and family's treatment,
recommendations for appropriate services concerning follow-up, and a brief
summary of the client's condition on discharge.
13. The psychiatric diagnosis contained in
the final diagnosis written in the terminology of the American Psychiatric
Association's Diagnostic and Statistical Manual; and
14. The client's response to therapeutic
leave days recommended by the supervising practitioner under the treatment
plan. The client's, family's, or guardian's response to time spent outside the
facility must be entered in the client's clinical record.
All documents from the client's clinical record submitted to
the Department must contain sufficient information for identification (i.e.,
client's name, date of service, provider's name).
006.08 Utilization Review
All facilities must provide utilization
review.
006.09 Documentation
for Claims
The following documentation is required for all claims for
treatment group home services. This requirement may be waived at the
Department's discretion. The facility will be notified in writing if that
occurs:
1. Initial diagnostic
interview;
2. The treatment
plan;
3. Orders by the supervising
practitioner; and
4. Progress notes
for all disciplines.
All claims are subject to utilization review by the
Department prior to payment.
32-006.09A
Exception: Additional documentation from the client's
clinical record may be requested by the Department prior to considering
authorization of payment.
006.10 Procedure Code and Description for
Treatment Group Home Services
HCPCS/CPT codes used by NMAP are listed in the Nebraska
Medicaid Practitioner Fee Schedule at 471-000-532.
006.11 Costs Not Included in the Treatment
Group Home Per Diem
The mandatory and optional services are considered to be
part of the per diem for treatment services. The following charges can be
reimbursed separately from the treatment group home 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 other than the supervising
practitioner; and
4. Treatment
services for a physical injury or illness provided by other professionals.
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.
006.12 Inspections of Care
The Department's inspection of care team may conduct
inspection of care reviews for Treatment Group Home Services. See 471 NAC
32-001.08 and 471 NAC 32-001.09.
