Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 31 - SERVICES IN AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES (ICF/DD) › Section 471-31-003 - PROVIDER REQUIREMENTS

Current through June 17, 2024
003.01
GENERAL PROVIDER REQUIREMENTS.
To participate in the
  Nebraska Medical Assistance Program (Medicaid), providers of intermediate care
  facility for Individuals with developmental disabilities (ICF/DD) services must
  comply with ail applicable participation requirements codified in 471 NAC 2 and
  3. In the event which provider participation requirements in 471 NAC 2 and 3
  conflict with requirements outlined in this chapter, the individual provider
  participation requirements in this chapter govern.
003.02
SPECIFIC PROVIDER
  REQUIREMENTS.
To participate in Medicaid, an intermediate care
  facility for individuals with developmental disabilities (ICF/DD) must:
(1) Meet all related requirements for
  participation in Medicaid as required by state and federal law and
  regulation;
(2) Be certified as a
  Title XIX intermediate care facility for individuals with intellectual
  disabilities (ICF/IID) per federal regulations and licensed as an intermediate
  care facility for individuals with developmental disabilities (ICF/DD) by the
  Nebraska Department of Health and Human Services, Division of Public Health or,
  for an out-of-state facility, by that state's survey agency;
(3) Provide licensed nurses sufficient to
  care for clients' health needs, as defined in
  42 CFR
  483.460(c) and
  (d);
(4) Provide active treatment as defined in
  this chapter, and
  42 CFR
  483.440-
  483.450;
  and
(5) Have a current Medicaid
  provider agreement with the Department of Health and Human Services, Division
  of Medicaid and Long-Term Care.
003.02(A)
AGENCY
  COOPERATION.
AH intermediate care facility for individuals with
  developmental disabilities (ICF/DD) facilities must provide staff of the
  federal Department of Health and Human Services, and Medicaid with the data,
  forms, and cooperation necessary to admit, plan for, evaluate the needs of, and
  make determinations on the appropriate care level for each individual eligible
  for Medicaid as required by federal and state Medicaid regulations.
003.02(B)
FREEDOM OF
  CHOICE.
Each intermediate care facility for individuals with
  developmental disabilities (ICF/DD) must ensure that any client may exercise
  their freedom of choice in obtaining Medicaid-covered services from any
  provider qualified to perform the services.
003.02(C)
ROOM AND BED
  ASSIGNMENTS.
The facility must ensure any changes made in the
  client's room or bed assignment is documented in the client's individual
  program plan (IPP). This record must show the dates and reasons for all changes
  in accordance with 42 CFR 442.404.
003.02(D)
DISCHARGE.
The intermediate care facility for individuals with developmental disabilities
  (ICF/DD) must ensure any client identified to permanently move from the
  facility is discharged according to requirements in this section, if the client
  moves to a separately licensed and certified intermediate care facility for
  individuals with developmental disabilities (ICF/DD), the same discharge
  requirements must be followed. The client must be admitted to the receiving
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD).
003.02(D)(i)
DISCHARGE
  PLANNING.
The intermediate care facility for individuals with
  developmental disabilities (ICF/DD) must include discharge planning procedures
  for ail Nebraska Medicaid clients in the individual program plan (IPP). The
  discharge planning procedures must be reviewed and updated (if needed) by the
  client's interdisciplinary team (IDT) at least annually. The procedures must
  include:
(1) Which intermediate care facility
  for individuals with developmental disabilities (ICF/DD) staff person is
  responsible for discharge planning; and
(2) The interdisciplinary team (IDT)'s
  determination of the level of care the client needs or may need upon discharge,
  including programming, medical, nutritional, psychological or psychiatric, and
  supervision needs.
003.02(D)(ii)
DISCHARGE TO
  ALTERNATIVE SETTING.
If it is determined that a client does not
  meet level of care requirements and the client's health and habilitative needs
  could more appropriately be met in another setting, the facility must follow
  the steps as outlined in this chapter.
003.02(D)(iii)
DISCHARGE
  PROCESS.
When a client is to be discharged, the intermediate care
  facility for individuals with developmental disabilities (ICF/DD) facility must
  ensure:
(a) The following is documented in the
  client's individual program plan (IPP):
(i)
  Notification of the discharge to the client as well as to the family or legal
  representative:
(ii) The
  justification for the discharge:
(iii) The type of service or level of care
  the client is being discharged to;
(iv) The date the client is discharged;
  and
(v) The discharge plan which
  must include activities to ensure the client is adequately prepared for the
  discharge and the receiving facility is provided current information related to
  the client's social and programming history, current developmental skills and
  skill deficits, current training needs, and medical, nursing and nutritional
  status:
(b) Ail adaptive
  equipment and supplies specifically purchased for the client move with the
  client: and
(c) Medicaid is
  notified of the discharge within 10 days of discharge, to include the type of
  service setting the client was discharged to.
003.02(D)(iii)(1)
NOTICE.
Should the client's interdisciplinary team
  (IDT) decide to discharge the client without plans to admit to another service
  provider, the facility must notify the Department of Health and Human Services'
  Developmental Disabilities Division, Service Coordination (DDD SC) within two
  working days of the interdisciplinary team (IDT)'s decision in order to aid the
  client and their legal representative to secure alternative
  services.
003.02(D)(iv)
CLIENT DEATH.
Within 10 days after a client has
  expired, the intermediate care facility for individuals with developmental
  disabilities (ICF/DD) must notify Medicaid of the date of death.