Source: https://www.jointcommission.org/state_recognition/state_recognition_details.aspx?ps=100&s=NE
Timestamp: 2018-03-18 23:19:05
Document Index: 540427584

Matched Legal Cases: ['§ 004', '§ 004', '§ 001', '§ 006', '§ 009', 'art 482', '§ 002', '§ 007', '§ 004', '§ 004', '§ 004', '§ 004', '§ 004']

Sunday 6:19 CST, March 18, 2018
State Reference: 92 NE ADC Ch. 72, APPENDIX A
Setting/Service: Vocational Rehabilitation Facilities and Services Providers
To determine whether a facility, service, program, or provider meets minimum standards, program staff consider such factors as: their past performance in achieving results or employment outcomes and the quality of results or employment outcomes achieved, licensure, accreditation, certification, or registration from state authorities; accreditation or certification from nationally recognized accrediting organizations; education, training, and experience of personnel; and, compliance with the American With Disabilities Act and Section 504 of the Rehabilitation Act.
State Reference: Stroke System of Care Act
Setting/Service: Comprehensive Stroke Certification, Primary Stroke Certification, Acute Stroke Ready Certification
Sec. 4. The department shall designate hospitals as comprehensive stroke centers, primary stroke centers, and acute stroke-ready hospitals based on certification from the American Heart Association, the Joint Commission on Accreditation of Healthcare Organizations, or another nationally recognized, guidelines-based organization that provides certification for stroke care, as such certification existed on the effective date of this act. The department shall compile and maintain a list of such hospitals and post the list on the department’s web site. Before June 1 of each year, the department shall send the list to the physician medical director of each emergency medical service licensed pursuant to the Emergency Medical Services Practice Act.
Sec. 6. Beginning on January 1, 2017, a hospital that does not have certification described under section 4 of this act shall have a predetermined plan for the triage and transfer of acute stroke patients and shall file the plan annually with the department.
State Reference: 175 NE ADC Ch. 9, § 004
9-004.09 Deemed Compliance 9-004.09A Accreditation or Certification: The Department may deem an applicant or licensee in compliance with 175 NAC 9-006 based on its accreditation or certification as a hospital by the:
1. Joint Commission on Accreditation of Healthcare Organizations;
2. American Osteopathic Association;
3. Commission on Accreditation of Rehabilitation Facilities; or
4. Medicare or Medicaid certification program.
9-004.09A1 The applicant or licensee must request the Department to deem its facility in compliance with 175 NAC 9-006 based on accreditation or certification. The request must be:
1. Made in writing;
2. Submitted within 30 days of receipt of a report granting accreditation or certification; and
3. Accompanied by a copy of the accreditation or certification report.
State Reference: 175 NAC 19-004.09
Setting/Service: Mental Health Centers
19-004.09 Accreditation or Certification: The Department must deem applicants or licensees in compliance with 175 NAC 19-006 based on its accreditation by the: 1. Joint Commission on Accreditation of Healthcare Organizations; 2. Commission on Accreditation of Rehabilitation Facilities; or 3. Council on Accreditation for Children and Family Services. 19-004.09A The applicant or licensee must request the Department to deem its facility in compliance with 175 NAC 19-006 based upon its accreditation. The request must be: 1. In writing; 2. Submitted within 30 days of receipt of a report granting accreditation; and 3. Accompanied by a copy of the accreditation report. 19-004.09B Upon receipt of the request, the Department must deem the facility in compliance with 175 NAC 19-006 and must provide written notification of its decision to the facility within 10 working days of the receipt of the request. 19-004.09C The licensee must maintain the accreditation on which its license was issued. If the accreditation has been sanctioned, modified, terminated or withdrawn, the licensee must notify the Department within 15 days of receipt of notification of the action. After giving the notice, the facility may continue to operate unless the Department determines that the facility no longer meets the requirements for licensure under the Health Care Facility Licensure Act.
State Reference: 206 NAC 5-001
Setting/Service: Behavioral Health Services
Type of Recognition: Requirements for Providers Contracting with RBHAs (Regional Behavioral Health Authorities)
5-001 Accreditation: To receive funds administered by the Division for service delivery, providers must submit the following: 1. Current copy of the required licenses issued by the Department or the applicable local licensing authorities of competent jurisdiction which apply to the program; 2. Documentation on the type of organization seeking approval (such as governmental, private non-profit) to operate the program(s); and 3. Accreditation appropriate to the organization's mission by The Joint Commission (TJC), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation (COA), or other nationally recognized accreditation organization(s) approved by the Director. Documentation of accreditation must include: a. A complete copy of the most recent official accreditation report; b. Documentation of the most recent official award of accreditation; and c. A complete copy of the plan of correction submitted in response to the official accreditation report, if applicable. 5-001.01 Exceptions: The requirements of 5-001 do not apply to the following: 1. Substance abuse prevention funds; or 2. When a nationally recognized accreditation organization appropriate to the organization’s mission cannot be identified.
State Reference: 175 NE ADC Ch. 7, § 004
Setting/Service: Health clinics, Ambulatory surgical centers, Providers of hemodialysis services, or Providers of labor and delivery services
7-004.08A Accreditation or Certification: The Department may deem an applicant or licensee in compliance with 175 NAC 7-006 based on its accreditation or certification as a health clinic, ambulatory surgical center, provider of hemodialysis services, or provider of labor and delivery services by the:
2. Accreditation Association of Ambulatory Health Care; or
3. Medicare or Medicaid certification program.
Agency: Health and Human Services System
State Reference: 204 NE ADC Ch. 5, § 001
Setting/Service: Community-Based Mental Health Programs
001.03 PROGRAM CERTIFICATION PROCEDURES.
001.03B3 Accreditation appropriate to the organization's mission by the Joint Commission on Accreditation of Healthcare Organizations (hereafter referred to as JCAHO), the Commission on Accreditation of Rehabilitation Facilities (hereafter referred to as CARF), or other nationally recognized accreditation organization(s) approved by the Director.
State Reference: 471 NE ADC Ch. 32, § 006
Setting/Service: Mental Health and Substance Abuse Treatment Group Home for Children and Adolescents
Type of Recognition: Medicaid
32-006.03D Accreditation:
The licensed treatment group home must have -
1. Be accredited by JCAHO, CARF, COA or AOA;
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.
State Reference: 471 NE ADC Ch. 32, § 009
Setting/Service: Inpatient Mental Health Services for Clients 20 and Younger in Institutions for Mental Disease (IMD's)
32-009.04 Standards for Participation:
To participate in the NMAP, the IMD must -
1. Be in conformity with all applicable federal, state, and local laws;
2. Be licensed as a hospital by the Nebraska Department of Health and Human Services, Division of Public Health or the licensing agency in the state where the IMD is located;
3. Be certified as meeting the conditions of participation for hospitals in 42 CFR Part 482;
4. Be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the American Osteopathic Association (AOA), and submit a copy of the most recent accreditation survey with Form MC-20;
5. Meet the definition of an IMD as stated in 471 NAC 32-009.02 (above);
6. Meet the program and operational definitions and criteria contained in the Nebraska Department of Health and Human Services Manual;
7. Meet the current JCAHO or AOA standards of care;
8. Meet all requirements in 471 NAC 32-001 and 471 NAC 32-008. 32-009.04A Provider Agreement: The provider shall complete Form MC-20 and submit the form, along with a copy of its current JCAHO or AOA accreditation survey, program, policies, and procedures to the Department to enroll in NMAP as a provider. If approved, the Department notifies the IMD of its provider number.
State Reference: 471 NE ADC Ch. 32, § 002
Setting/Service: Outpatient Substance Abuse and Mental Health Treatment Services for Children and Adolescents
32-002.02A Location of Services:
Outpatient mental health and substance abuse services by qualified staff may be provided in -
1. A licensed and certified hospital which provides psychiatric or substance abuse services and which -
a. Is maintained for the care and treatment of patients with primary mental health and/or substance disorders;
b. Is licensed or formally approved as a hospital by the Nebraska Department of Health and Human Services, Division of Public Health or if the hospital is located in another state, the officially designated authority for standard - setting in that state;
c. Is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or by the AOA;
d. Has licensed and certified psychiatric and/or substance abuse beds;
e. Meets the requirements for participation in Medicare for psychiatric hospitals;
f. Has in effect a utilization review plan applicable to all Medicaid clients;
State Reference: 471 NE ADC Ch. 32, § 007
Setting/Service: Residential Treatment Services for Children and Adolescents
32-007.03D Accreditation:
The residential treatment center must have -
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. If the most recent survey required a plan of corrections, the plan must also be submitted; or Agencies accredited through these accrediting bodies are eligible for NMAP reimbursement of treatment and maintenance (room and board) costs and must maintain accreditation in order to qualify as a residential treatment services 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 with one of these entities may be enrolled on a provisional status and receive reimbursement for treatment only
State Reference: 175 NE ADC Ch. 5, § 004
Setting/Service: Adult Day Services
5-004.09 Deemed Compliance
5-004.09A Accreditation: The Department may deem an applicant or licensee in compliance with 175 NAC 5-006 based on its accreditation as an Adult Day Service by the:
2. Commission on Accreditation of Rehabilitation Facilities.
State Reference: 175 NE ADC Ch. 18, § 004
Setting/Service: Substance Abuse Treatment Centers
18-004.09 Accreditation: The Department must deem applicants or licensees in compliance with 175 NAC 18-006 based on its accreditation by the:
2. Commission on Accreditation of Rehabilitation Facilities;
3. Council on Accreditation for Children and Family Services.
Program: Critical Access Hospitals
Setting/Service: All Hospitals
9-004.09 Deemed Compliance 9-004.09A Accreditation or Certification:
The Department may deem an applicant or licensee in compliance with 175 NAC 9-006 based on its accreditation or certification as a hospital by the:
State Reference: 175 NE ADC Ch. 16, § 004
Setting/Service: Hospice
The Department may deem an applicant or licensee in compliance with 175 NAC 16-006 based on its accreditation as a hospice by the:
1. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO);
2. The Community Health Accreditation program (CHAP); or
3. The Medicare or Medicaid certification program.
An applicant or licensee must request the Department to deem its hospice in compliance with 175 NAC 16-006 based upon its accreditation. The request must be:
2. Submitted within 30 days of receipt of a report granting accreditation; and
3. Accompanied by a copy of the accreditation report.
To maintain deemed compliance, the licensee must maintain the accreditation on which its license was issued. If the accreditation has been sanctioned, modified, terminated or withdrawn, the licensee must notify the Department within 15 days of receipt of notification of the action. After notifying the Department, the hospice may continue to operate unless the Department determines that the hospice no longer meets the requirements for licensure under the Health Care Facility Licensure Act. If the Department determines the hospice no longer qualifies for deemed compliance, the hospice is subject to inspections under 175 NAC 16-005.
State Reference: 175 NE ADC Ch. 14, § 004
The Department may deem an applicant or licensee in compliance with 175 NAC 14-006 based on its accreditation as a home health agency by the:
1. Joint Commission on Accreditation of Healthcare Organizations (JCAHO);
2. Community Health Accreditation program (CHAP);
3. Accreditation Commission for Healthcare; or
State Reference: 175 NE ADC Ch. 12, § 004
Setting/Service: Skilled Nursing Facilities, Nursing Facilities, and Intermediate Care Facilities
12-004.09 Deemed Compliance 12-004.09A Accreditation or Certification:
The Department may deem an applicant or licensee in compliance with 175 NAC 12-006 based on its accreditation as a skilled nursing facility, nursing facility, or intermediate care facility by the:
1. Joint Commission on Accreditation of Health Organizations;
12-004.09A1 The applicant or licensee must request the Department to deem its facility in compliance with 175 NAC 12-006 based upon accreditation or certification. The request must be:
1. Submitted in writing within 30 days of receipt of a report granting accreditation or certification;
2. Accompanied by a copy of the accreditation or certification report.
Agency: Multi-Payer Patient-Centered Medical Home Pilot
State Reference: N/A
Setting/Service: Primary Care Medical Home (PCMH)
Multi-Payer Patient-Centered Medical Home Pilot
In January 2014, Nebraska’s major commercial insurers and Medicaid managed care plans voluntarily launched a two-year multi-payer medical home pilot. The pilot aims to align participation requirements and measures across participating payers and practices, and requires payers to contract with an average of ten practices per pilot year. The pilot participation agreement describes expectations for participating payers and practices. Representatives of the following individuals and groups signed the pilot participation agreement:
Nebraska State Senators Mike Gloor and John Wightman
Nebraska Chapter of the American Academy of Pediatrics
In Nebraska, a medical home is defined as a health care delivery model in which a patient establishes an ongoing relationship with a physician in a physician-directed team, to provide comprehensive, accessible, and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality, safety, access, and health outcomes in a cost effective manner. For further information, see the Medical Home Pilot Program Act (LB 396).
The Nebraska developed two tiers of recognition. Tier 1 practices were required to meet 29 standards in five “core competencies,” with eight additional standards required to meet Tier 2 recognition standards.
Payers participating in the pilot are not required to use certification or recognition standards. The pilot participation agreement specifies that if participating insurers do require practices be certified or recognized as medical homes, they will accept NCQA PCMH recognition, Joint Commission PCMH certification, URAC achievement, or Nebraska Medicaid PCMH Pilot Program standards.
Payers participating in the pilot are not required to use certification or recognition standards.
The pilot participation agreement specifies that if participating insurers do require practices be certified or recognized as medical homes, they will accept NCQA PCMH recognition, Joint Commission PCMH certification, URAC achievement, or Nebraska Medicaid PCMH Pilot Program standards.