Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 9 - HOME HEALTH AGENCIES AND SKILLED NURSING SERVICES
Section 471-9-004 - SERVICES REQUIREMENTS

(i) Necessary to a continuing medical treatment plan;

(ii) Prescribed by a licensed physician, nurse practitioner, physician assistant, or clinical nurse specialist; and

(iii) Recertified by the licensed physician, nurse practitioner, physician assistant, or clinical nurse specialist at least every 60 days.

(i) The client's name, address, Medicaid identification number, and date of birth;

(ii) The dates of the period covered, not exceeding 60 days;

(iii) The diagnosis;

(iv) The type and frequency of services;

(v) The equipment and supplies needed;

(vi) A brief, specific description of the client's needs and services provided;

(vii) Any other pertinent documentation that justifies the medical necessity of the services; and

(viii) The plan of care must include a signature or verbal authorization from the physician, nurse practitioner, physician assistant, or clinical nurse specialist at prior authorization submittal. Verbal authorizations must be signed within 30 days.

(1) A registered nurse (RN);

(2) A licensed practical nurse (LPN);

(3) A certified nurse midwife;

(4) A nurse practitioner;

(5) A physician assistant; or

(6) A clinical nurse specialist;

(1) A nurse aide; or

004.02(A) USE OF AUTHORIZED HOURS. A client who requires and is authorized to receive home health nursing services in the home setting may use their approved hours outside of the home during those hours when their normal life activities take them out of the home. The Department will not authorize any additional hours of nursing service beyond what would normally be authorized. If a client requests to receive nursing services to attend school or other activities outside the home, but does not need nursing services in the home, nursing services cannot be authorized.

004.02(B) HOME HEALTH AIDES. A home health aide may provide services to a client in the client's home to meet personal care needs resulting from the client's illness or disability. Skilled nursing visits are not a prerequisite for the provision of home health aide services. The services must be:

004.02(C) MEDICATIONS. Medicaid covers intravenous or intramuscular injections and intravenous feeding. Oral medications are covered only where the complexity of the medical condition (physical or psychological) and the number of drugs require a licensed nurse to monitor, detect, and evaluate side effects. The complexity of the medical condition must be documented and submitted with the plan of care.

004.02(D) ADDITIONAL SERVICES FOR DIABETIC CLIENTS. Medicaid covers blood sugar testing and foot care for blind or disabled diabetic clients who are unable to perform this task themselves and where there is no one else available to perform the tasks on the client's behalf.

004.02(E) DECUBITUS AND SKIN DISORDERS. Covered when specific physician, nurse practitioner, physician assistant, or clinical nurse specialist orders indicate that skilled care is necessary, or that skilled nursing care is necessary, requiring prescribed medications and treatment.

004.02(F) DRESSINGS. Medicaid covers application of dressings when aseptic technique and prescription medications are used.

004.02(G) COLOSTOMY, ILEOSTOMY, AND GASTROSTOMY. These services are covered during immediate postoperative time when maintenance care and control by the patient or family is being established. This includes the initial teaching. General maintenance care is not covered.

004.02(H) ENTEROSTOMAL THERAPY. Medicaid recognizes enterostomal therapy visits as a skilled nursing service.

004.02(I) ENEMAS AND REMOVAL OF IMPACTIONS. Medicaid covers enemas and removal of impactions when the complexity of the patient's condition establishes that the skills of a nurse are required.

004.02(J) BOWEL AND BLADDER TRAINING. The Department covers teaching skills and facts necessary to adhere to a specific formal regimen. General routine maintenance program or treating is not covered.

004.02(K) URETHRAL CATHETERS AND STERILE IRRIGATIONS. The Department covers insertions and changes when active urological problems are present or when client is unable to do physician-ordered irrigations. Routine catheter maintenance care is not covered.

004.02(L) CASTS. Casts are covered if the physician's order evidences more complexity than routine or general supportive care.

004.02(M) DRAW OR COLLECTION OF LABORATORY SPECIMENS. Medicaid covers the collection of specimens only if based on the client's medical condition home health services are medically necessary and appropriate services to be provided in the home.

004.02(N) OBSERVATION AND EVALUATION. Medicaid covers observation and evaluation requiring the furnishing of a skilled service for an unstable condition. An unstable condition is evidenced by the presence of one of the following conditions:

004.02(O) TEACHING AND TRAINING ACTIVITIES. Medicaid limits postpartum visits for teaching and training to two visits. The Department covers up to two visits of skilled nursing services for teaching or training purposes. The necessity of further visits must be justified by additional documentation evidencing extenuating circumstances that create the need beyond two visits. Medicaid covers skilled nursing visits for teaching or training that require the skills or knowledge of a nurse. The client must have a medical condition that has been diagnosed and treated by a physician, nurse practitioner, or clinical nurse specialist, and there must be a physician, nurse practitioner, physician assistant, or clinical nurse specialist order for the specific teaching and training. Visits are covered on an individual basis. The provider must maintain specific documentation of both the need for the teaching or training, and the teaching or training provided. Documentation must be submitted along with the plan of care. Teaching or training can occur in the following areas:

004.02(P) OCCUPATIONAL THERAPY, PHYSICAL THERAPY, AND SPEECH, HEARING, AND LANGUAGE THERAPY. Medicaid covers occupational therapy, physical therapy, and speech, hearing, and language therapy as a home health agency service only when the services meet the requirements in accordance with 471 NAC 14 and 23.

004.02(Q) DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND MEDICAL SUPPLIES (DMEPOS). Durable medical equipment, prosthetics, orthotics, and medical supplies provided by a home health agency or any skilled nursing services must meet all requirements outlined in 471 NAC 7. The Department covers medically necessary durable medical equipment, prosthetics, orthotics, and medical supplies (DMEPOS) which meets program guidelines when ordered by a physician, nurse practitioner, physician assistant, or clinical nurse specialist.

004.02(R) EXTENDED-HOUR NURSING SERVICES. Provision of extended-hour nursing services must be authorized by the Department or its designee. Extended-hour nursing services are authorized only when the client's care needs must be provided by skilled nursing personnel in the absence of the caregiver or parents. Clients are authorized 56 hours a week for a maximum of 12 hours a day in a 24 hour period.