Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 15 - PERSONAL ASSISTANCE SERVICES › Section 471-15-003 - PROVIDER REQUIREMENTS

Current through June 17, 2024
003.01
GENERAL PROVIDER REQUIREMENTS.
To participate in the
  Nebraska Medicaid program, providers of personal assistance services will
  comply with all applicable provider participation requirements codified in 471
  Nebraska Administrative Code (NAC) 1, 2, and 3.
003.02
SERVICE SPECIFIC PROVIDER
  REQUIREMENTS.
003.02(A)
PARTICIPATION STANDARDS.
All providers are Medicaid
  providers as defined under 471 NAC 2 and will meet the following standards:
(i) Follow all applicable Department policies
  and procedures including those found in NAC 465, 471, 473, 474 and 480. Bill
  only for services which are authorized and actually provided;
(ii) Accept payment as payment in full for
  the agreed upon service(s) unless the client has been assigned a portion of the
  cost by the Department. Provider will not charge clients any difference between
  the agreed upon rate and private pay rate;
(iii) Spouses or parents of minor children
  are not eligible to be providers;
(iv) Not engage in any activity that
  influences service approval or utilization if they are an employee of the
  Department or, the relative of a Department staff person.
(v) Retain all records related to provider
  enrollment and service provision, including financial records. Records will be
  maintained for retention periods in compliance with federal and state law, but
  no record will be destroyed prior to expiration of a six year retention
  period;
(vi) Allow federal, state,
  or local offices responsible for program administration or audit to review
  service records, in accordance with 45 CFR 74.20- 74.24; and 42 CFR 431.107.
  Inspections, reviews, and audits may be conducted on site;
(vii) A provider of personal assistance
  services is not an employee of the Department or of the State;
(viii) Any false claims including claims
  submitted electronically, statements, documents, or concealment of material
  fact may be prosecuted under applicable state or federal laws;
(ix) Respect every client's right to
  confidentiality and safeguard confidential information;
(x) Understand and accept responsibility for
  the client's safety and property;
(xi) Not transfer this agreement to any other
  entity or person;
(xii) Not use any
  federal funds received to influence agency or congressional staff;
(xiii) Not engage in or have an ongoing
  history of criminal activity that may be harmful or may endanger individuals
  for whom they provide services. This may include a substantiated listing as a
  perpetrator on the child and adult central registries of abuse and
  neglect;
(xiv) Agency providers
  agree to allow Department staff to review agency policies regarding hiring and
  reporting to ensure that appropriate procedures regarding abuse, neglect, and
  law violations are in place;
(xv)
  Have the knowledge, experience, and skills necessary to perform the tasks of
  patient care and Electronic Visit Verification (EVV);
(xvi) Be capable of recognizing signs of
  distress in client and know how to access available emergency resources if a
  crisis situation occurs;
(xvii)
  Report changes to appropriate Department staff;
(xviii) Report all incidents in which there
  is reasonable cause to believe a client has been subjected to abuse, neglect,
  or exploitation. All such incidents will be reported to law enforcement and the
  Department;
(xix) Be age 19 or
  older if an individual provider; or assure that agency staff who assume the
  following roles are age 19 or older: director, administrator, agency
  representative for signing legal documents, or provider of in-home client
  services;
(xx) Not be a recipient
  of personal assistance services or similar services; and
(xxi) Providers entering the client's home to
  provide services will not be accompanied in the client's home by any
  individuals, including the provider's minor children, whose presence is
  unnecessary to the provision of services to the client, or who are not
  authorized to provide services to the client. This does not apply when the
  provider shares a home with the client.