Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 480 - HOME AND COMMUNITY-BASED SERVICES
Chapter 2 - PROGRAM REVIEW AND ADMINISTRATION
Section 480-2-003 - ADMINISTRATION

Universal Citation: 480 NE Admin Rules and Regs ch 2 ยง 003

Current through September 17, 2024

003.01 APPLICABILITY. The provisions outlined in 480 NAC 2-000 apply to all services in Title 480 Chapters 2-000 to 6-000.

003.02 COST EFFECTIVENESS. The average cost of Waiver services funded by Medicaid must not exceed the average cost to Medicaid for nursing facility services. Medicaid Waiver services must be cost effective in two distinct ways:

(A) In any year that the Waiver is in effect, the average per capita expenditures under the Waiver cannot exceed 100 percent of the average per capita expenditures that would have been made under the Medicaid State plan for the specified level of care had the Waiver not been granted; and

(B) In any year that the Waiver is in effect, the actual total expenditures for Home and Community-Based Waiver and other Medicaid services, including the corresponding claim for Federal Financial Participation (FFP) in expenditures for the services provided to individuals under the Waiver, cannot exceed 100 percent of the amount that would be incurred in the absence of the Waiver by the State's Medicaid program for these individuals in the specified institutional setting.

003.03 STATEWIDE PROVISION OF SERVICES. Waiver services are provided statewide to eligible participants depending on Waiver capacity availability.

003.04 AVAILABLE WAIVER CAPACITY. If a statewide waiting list is required due to limited Waiver capacity, the Department may determine that an individual qualifies for a priority placement into an available Waiver opening. The Department retains sole discretion to determine the applicability of criteria and the need for prioritization. The next available opening is assigned based upon the following priority criteria:

(A) Needs in domains which define nursing facility level of care are so severe that the health and welfare of the participant are jeopardized, but the needs could safely be met with immediate Waiver services;

(B) Family or caregivers are in a crisis or high stress situation;

(C) No informal support network is available to meet identified needs;

(D) Inappropriate out-of-home placement is being planned;

(E) No other program is available to meet the needs identified in the referral;

(F) Support services are required to allow the participant to return home; or

(G) A participant with an identified Waiver service need of Assistive Technology Supports or Home and Vehicle Modifications lacks access to resources to meet these specific needs and Waiver eligibility is the only method of addressing the identified needs.

003.05 WAIVER PARTICIPATION. A participant may receive services from only one Nebraska Home and Community Based Services (HCBS) Medicaid Waiver at a time.

003.06 FUNCTIONAL STABILITY. When a participant's functioning has stabilized due to the provision of Waiver services, the participant's history of risk and initial assessment will be considered and documented in determining whether level of care eligibility continues to apply.

003.07 SERVICE NEEDS FOR CHILD PARTICIPANTS. Participants who are children will always have a legally responsible caregiver; and therefore, will have differences in service needs when compared to adult participants. Service needs such as (but not limited to) meal preparation, food, shelter, access to education, and transportation should be met by the legally responsible caregiver.

003.08 PARTICIPANT SAFETY, HEALTH, AND WELFARE. Medicaid Home and Community-Based Waiver services must ensure the participant's health and welfare, including the consideration of acceptable risk with respect to participant choice, and must prevent the provision of unnecessary or inappropriate services and supports. If, despite consideration of the full range and scope of services, the participant's safety, health or welfare is in jeopardy, Waiver services may not be provided. The participant will be presented with alternate service delivery options, which are available to maintain a safe plan. The participant will be afforded notice and hearing rights in accordance with this chapter.

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