Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 20 - PSYCHIATRIC SERVICES FOR INDIVIDUALS AGE 21 AND OLDER › Section 471-20-001 - General Requirements for Psychiatric Services

Current through June 17, 2024
Effective July 1, 1995, the requirements of this chapter apply to all
	 psychiatric services for individuals age 21 and older provided under the
	 Nebraska Medical Assistance Program (NMAP).
Mental health and substance abuse services (MH/SA) are provided as a
	 managed care benefit for all Nebraska Medicaid Managed Care (NMMCP) clients.
	 The benefit includes the Client Assistance Program (CAP). Clients may access
	 five services annually with any CAP-enrolled provider without prior
	 authorization. All other MH/SA services must be prior authorized.
001.01
Philosophy of
  Care
The Department's philosophy is that all care provided to clients must
	 be provided at the least restrictive and most appropriate level of care. More
	 restrictive levels of care will be used only when all other resources have been
	 explored and deemed to be inappropriate.
001.02
Non-Discrimination
The Department believes that each person, regardless of race, color,
	 sex, age, religion, national origin, disability, sexual orientation, or marital
	 status possesses inherent worth and value. The Department expects services to
	 be provided in a way that shows respect and support for such diversity.
	 Providers must be aware of the issues which may arise and ask for consultation
	 or make referrals as needed.
001.03
Family of Origin
  Component
Care must address family concerns and, whenever possible, involve the
	 family in treatment planning, therapy, and transition/discharge planning.
	 Family may include biological, step, foster, or adoptive parents; siblings or
	 half siblings; and Sreextended family members, as appropriate. Family
	 involvement, or lack thereof, must be documented in the clinical record. For
	 adults who choose not to have family members involved or for whom the treating
	 professional deems family involvement inappropriate or harmful, that
	 information must be documented in the medical record.
Providers must encourage family members to be involved in the
	 assessment of the client, the development of the treatment plan, and all
	 aspects of the client's treatment unless prohibited by the client, through
	 legal action, or because of federal confidentiality laws.
Providers must be available to schedule meetings and sessions in a
	 flexible manner to accommodate and work with a family's schedule. This includes
	 the ability to schedule sessions at a variety of times including weekends or
	 evenings.
The provider must document their attempts to involve the family in
	 treatment plan development and treatment plan reviews. A variety of
	 communication means should be considered. These may include, but should not be
	 limited to, including the family via conference telephone calls, using
	 registered letters to notify the family of meetings, and scheduling meetings in
	 the evening and on weekends.
001.04
Community-Based
  Care
Care must be community-based and, when appropriate, must involve a
	 representative from the client's community support system. This may include
	 areas such as education, social services, law enforcement, religion, medical,
	 and other mental health or substance abuse professionals. Community involvement
	 must be documented in the clinical record. This documentation must include any
	 lack of cooperation or resistance from the community support
	 system.
001.05
Developmentally Appropriate Care
Care must address the client's biological, psychological, and social
	 development. Therapeutic interventions must be congruent with the findings of
	 the developmental level of the client, based on comprehensive psychiatric and
	 psychological assessments.
001.06
Culturally Competent
  Care
Providers of psychiatric services for individuals age 20 and over must
	 be culturally competent. This includes awareness, acceptance, and respect of
	 differences and continuing self-assessment regarding culture. Cultural
	 competence also includes careful attention to the dynamics of differences and
	 how they affect interactions, assumptions, and the delivery of services.
	 Providers also demonstrate cultural competence through continuous expansion of
	 cultural knowledge and resources through training, readings, etc., and by
	 providing a variety of adaptations to service models in order to meet the needs
	 of different cultural populations.
Culturally competent providers hire unbiased employees, seek advice and
	 consultation from the minority community, and actively decide whether or not
	 they are capable of providing services to clients from other cultures. They
	 provide support for staff to become comfortable working in cross-cultural
	 situations and understand the interplay between policy and practice and are
	 committed to policies that enhance services to diverse
	 clientele.
001.07
Dually Diagnosed Clients
The treatment provider shall incorporate the needs of the "dually
	 diagnosed" client and provide active treatment for clients with concurrent or
	 secondary complicating problems. The "dually diagnosed" clients may have
	 problems such as substance abuse, eating disorder symptoms, developmental
	 delays, or mental retardation. Dual diagnosis treatment is the simultaneous and
	 integrated treatment of coexisting disorders.
001.08
Coordinated
  Services
If a client is receiving services from more than one psychiatric
	 provider, the providers must assure coordination of all services. That
	 coordination must be documented in the client's medical record. Coordination of
	 services is required as part of the overall treatment plan must be covered in
	 one unified treatment plan, and is not billable as a separate
	 service.
001.09
Provider Enrollment
20-001.09A
Provider
  Agreement
: A provider of psychiatric services for individuals age
  21 and over shall complete Form MC-19 or Form MC-20, "Medical Assistance
  Provider Agreement," and submit the completed form to the Department for
  approval. Specific requirements for each type of care are listed in the
  respective subpart. The provider must meet all of these standards in order to
  be enrolled with NMAP. The Department is the sole determiner of which providers
  are approved for participation in this program. The provider will be advised in
  writing when their participation is approved. (A separate application must be
  submitted for each particular service and each service will be approved
  separately.)
Refer to the
Standards for Participation
section in each subpart.
20-001.09B
Provider Enrollment
  Status
: The provider enrollment process allows for three types of
  provider enrollment status based on information from the provider and other
  sources. The Department shall notify the provider of the status assigned. The
  types of provider enrollment are -
1.
  Provisional status: A provider who has recently established services within
  this chapter or who is new to the NMAP will be enrolled with a provisional
  status. After a minimum of one year of services, the Department may choose to
  grant ongoing status to the provider.
a.
  Grounds for terminating a provider agreement are further defined in 471 NAC
  2-002.03, "Reasons for Sanctions."
b. Providers may appeal the decision to
  terminate a provider enrollment. The appeal process is described in 471 NAC
  2-003, "Provider Hearings."
2. Ongoing status: A provider may
  establish ongoing status after a minimum of one year of service within the
  Medicaid guidelines.
3.
  Probationary status: A provider may be placed on probationary status when there
  are deficiencies in meeting Medicaid guidelines or there are other concerns
  about the provider's program or practices. While on probationary status, a
  provider may be required to work with Medicaid staff to develop a corrective
  action plan. This plan shall be submitted to Medicaid staff for approval.
a. Grounds for terminating a provider
  agreement are further defined in 471 NAC 2-002.03, "Reasons for
  Sanctions."
b. Providers may appeal
  the decision to place a provider on probationary status. The appeal process is
  described in 471 NAC
  2-003, "Provider Hearings."
c. The probationary status will be evaluated
  by Medicaid staff on a frequency based on the situation. At these evaluations,
  a provider's enrollment may be terminated, placed on further probation, or
  returned to ongoing status. Providers may appeal these decisions as described
  in 471 NAC
  2-003, "Provider Hearings."
d. If the deficiencies are not causing
  immediate jeopardy or compromising the safety of the clients, then the facility
  can continue to participate in Medicaid. A prohibition of new admissions may
  occur if -
(1) There are allegations of abuse
  or neglect under investigation in relation to the program or its
  staff;
(2) The quality of treatment
  is significantly compromised by the deficiencies; or
(3) The provider is violating any laws,
  regulations, or code of ethics governing their program.
20-001.09C
Updates
: The provider shall send to the Department an
  update of the services provided in its facility and the current list of staff
  each year during the anniversary quarter of the provider's enrollment in
  Nebraska Medicaid as a provider of psychiatric services for individuals age 21
  and over. This information shall also be sent to the Department if a provider
  makes changes in how they provide a service. These changes and updates must be
  indicated on Form MC-19 or Form MC-20, "Medical Assistance Provider
  Agreement."