reglab/statecodes huggingface dataset:
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 3 - ADMINISTRATIVE APPEAL PROCEDURES FOR APPLICANTS, FOOD VENDORS AND LOCAL AGENCIES PARTICIPATING IN SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL NUTRITION PROGRAM (CSFP) IN THE STATE OF NEBRASKA › Section 181-3-004 - NOTIFICATION OF ADVERSE ACTION

Current through June 17, 2024
Notification of Adverse Action shall include the following
	 information:
004.01
WRITTEN NOTICE - INITIAL APPLICATION DENIAL.
Whenever
  an application to be a vendor or local agency is denied, the Department shall
  provide the applicant with a written notice of the denial or adverse action
  that meets the requirements of
  7 CFR
  246.18 as of the effective date of this
  chapter.
004.02
WRITTEN
  NOTICE - ADVERSE ACTION.
Whenever adverse action is taken against
  a participating vendor or local agency, the Department shall provide the vendor
  or local agency with a written notice of the adverse action that meets the
  requirements of
  7 CFR
  246.18 as of the effective date of this
  chapter.
004.03
ADVERSE
  ACTION - FINALITY.
The decision to take adverse action is final
  according to the following.
004.03A
INITIAL APPLICATION DENIED.
The decision to deny an
  initial application by an applicant to participate in the Program is effective
  for a vendor on the date of receipt of the notice. A denial of a local agency
  application is effective immediately. An applicant may request a hearing on the
  denial within 15 days of the date of the notice.
004.03B
PARTICIPATING VENDOR OR
  AGENCY.
The decision to take adverse action against a
  participating vendor shall become final 15 days after the date of the notice
  and the decision to take adverse action against a local agency shall become
  final sixty (60 day) days after the date of the notice unless the vendor or
  local agency, within the applicable period, files a request for hearing with
  the Department.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 3 - ADMINISTRATIVE APPEAL PROCEDURES FOR APPLICANTS, FOOD VENDORS AND LOCAL AGENCIES PARTICIPATING IN SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL NUTRITION PROGRAM (CSFP) IN THE STATE OF NEBRASKA › Section 181-3-005 - HEARING PROCEDURE

Current through June 17, 2024
The procedure for hearings is described below:
005.01
CONDUCT.
All
  hearings shall be conducted in accordance with the 184 Nebraska Administrative
  Code (NAC) 1.
005.02
DECISION.
On the basis of the evidence at the hearing,
  the determination to take adverse action shall be affirmed, modified, or set
  aside. A copy of the decision setting forth the bases of the decision, shall be
  sent by either registered or certified mail to the vendor or local agency
  within 90 days from the date the Department receives the request for a hearing
  from a vendor and within 60 days from the date the Department receives the
  request for a hearing from a local agency. The decision shall become final
  thirty (30) days after a copy thereof is mailed unless the vendor, or local
  agency seeks judicial review within such thirty day period in accordance with
  the Administrative Procedure Act, Neb. Rev. Stat. §§
									84-901
  to
  84-920.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 3 - ADMINISTRATIVE APPEAL PROCEDURES FOR APPLICANTS, FOOD VENDORS AND LOCAL AGENCIES PARTICIPATING IN SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL NUTRITION PROGRAM (CSFP) IN THE STATE OF NEBRASKA › Section 181-3-006 - CONTINUING RESPONSIBILITIES

Current through June 17, 2024
Appealing an adverse action does not relieve a local agency or a vendor
	 permitted to continue in the Special Supplemental Food Program for Women,
	 Infants and Children (WIC Program) or the Commodity Supplemental Food Program
	 (CSFP) while its appeal is in process, from the responsibility of continued
	 compliance with the terms of any written agreement or contract with the local
	 agency or the Department.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations implement Nebraska Revised Statute (Neb. Rev. Stat.)
	 §§
									71-2225
	 to
	 71-2230.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-002 - DEFINITIONS

Current through June 17, 2024
Definitions in 7 Code of Federal Regulations (CFR) Part 246 and Part
	 247 and the following definitions apply to this chapter.
002.01
ADVERSE ACTION.
Any action by the local agency or the Department which results in
  a) a claim against the participant for repayments of the cash value of
  improperly issued benefits, b) the denial of participation in the program to an
  applicant, or c) the participant's disqualification from the program.
002.02
PROGRAM.
The Special Supplemental Nutrition Program for Women, Infants and
  Children or the Commodity Supplemental Food Program.
002.03
REQUEST FOR
  HEARING.
Any clear expression, either verbal or written, by the
  applicant or participant, the applicant or participant's parent, caretaker, or
  other representative that he or she desires an opportunity to present his or
  her case to the Department or other higher authority.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-003 - RIGHT OF FAIR HEARING

Current through June 17, 2024
The Department shall grant the right of fair hearing whenever an
	 applicant or a participant is the subject of an adverse action by a local
	 agency.
003.01
NOTICE OF
  APPEAL RIGHTS.
The local agency taking the adverse action shall
  inform each applicant or participant in writing of the adverse action and
  include the information required by
  7 CFR
  246.9 or
  247.33 as
  applicable. In the event a participant is disqualified or a claim is made for
  cash repayment, notification of such action shall be given at least (15) days
  before the effective date of the adverse action. In the event of dual
  participation in more than one program, the adverse action is effective
  immediately.
003.02
REQUEST FOR HEARING.
The local agency shall not limit
  or interfere with the applicant or participant's freedom to request a hearing.
003.02(A)
REQUEST
  SUBMISSION.
The request for a fair hearing shall be submitted to
  the local agency and then transmitted to the Department or may be submitted
  directly to the Department. The Local Program Director is responsible for
  sending the request to the Department.
003.02(B)
REQUEST
  FORMAT.
The request for hearing shall be signed by the applicant,
  the participant, or the applicant or participant's parent, caretaker, or other
  representative, and shall contain sufficient information to identify the
  applicant or participant and the adverse action regarding for which the request
  is being made. No particular written form shall be required. The local agency
  or the Department shall put the request for a hearing in writing, if
  necessary.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-004 - NOTIFICATION OF ADVERSE ACTION.

Current through June 17, 2024
The local agency taking the adverse action shall inform each applicant
	 or participant in writing of the adverse action and include the information
	 required by 7 CFR Part
	 246.9 or
	 247.33 as applicable.
004.01
INITIAL APPLICATION OR
  DENIAL.
The written notice of adverse action shall include the
  cause or causes for such action, the effective date of the action, and
  applicant's appeal rights as set forth in this chapter. Such notification shall
  be provided by the agency taking the adverse action.
004.02
ADVERSE
  ACTION.
Whenever adverse action is taken against a participant
  disqualifying him or her from the program, such participant shall be provided
  with 15 days advance written notice of the adverse action, the cause or causes
  for such action, the effective date of the action, and the participant's right
  to request a hearing as described in this chapter. If a claim is pursued
  against a participant seeking repayment of the cash value of improperly issued
  benefits, such participant shall be provided with the information stated above
  and, in addition, the reason(s) for the claim, and the value of the improperly
  issued benefits which must be paid. Such notification shall be provided by the
  agency taking the adverse action.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-005 - TIME LIMIT FOR REQUEST

Current through June 17, 2024
Adverse actions shall follow appropriate timelines as described
	 below.
005.01
PERIOD FOR
  REQUESTING A HEARING.
An applicant or participant who has been
  notified of adverse action may request a fair hearing before the Department as
  provided in 7 CFR Part
  246.9 or
  247.33 as applicable.
005.02
DENIAL OR DISMISSAL OF
  REQUEST.
The Department shall not deny or dismiss a request for a
  fair hearing except as provided in 7 CFR Part
  246.9 or
  247.33 as applicable.
005.03
CONTINUATION OF
  BENEFITS.
A participant who appeals a disqualification notice
  before the disqualification takes effect shall continue to receive program
  benefits until the hearing official reaches a decision or the certification
  period expires, whichever occurs first. A participant whose certification
  period has expired or who becomes categorically ineligible may not receive
  benefits after the certification period has ended. An applicant either at
  initial certification or whose certification has expired or has become
  categorically ineligible during the certification period may not receive
  benefits during the hearing process.
005.04
TIMING OF NOTICE AND
  HEARING.
The Department shall set the date, time, and place of the
  hearing within seven (7) calendar days after it receives a request for a fair
  hearing.
005.04(A)
NOTICE.
The Department shall send the notice of
  hearing to the applicant or participant to ensure receipt no later than ten
  (10) calendar days before the hearing, using certified or registered
  mail.
005.04(B)
HEARING.
A hearing shall be held within twenty-one
  (21) calendar days of receipt of the request for a fair hearing, unless the
  appellant requests a continuance or the hearing officer orders a continuance,
  as provided in this chapter.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-006 - RESCHEDULING OPPORTUNITY

Current through June 17, 2024
An applicant or participant shall be provided with one opportunity to
	 reschedule the hearing date upon specific written request submitted to the
	 Department. The hearing date may also be rescheduled at the order of the
	 hearing official or officer. Any continued hearing shall be held within
	 thirty-one (31) calendar days of the request for hearing, unless good cause is
	 demonstrated for not holding the hearing within such period of
	 time.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-007 - RIGHTS OF APPLICANT OR PARTICIPANT

Current through June 17, 2024
The Department shall specifically provide the appellant or
	 representative an opportunity to examine the documents and record appeal, prior
	 to and during the hearing. Appellants or representatives shall also have the
	 opportunity to be represented or assisted by a person other than the
	 participant or applicant as follows:
(A) Be represented by legal counsel, which
  means any person licensed to practice law in Nebraska;
(B) Be assisted by other persons, such as a
  relative or friend, except that such other person may not provide legal advice,
  serve as an advocate or spokesperson, question witnesses or otherwise assume
  duties customarily performed by persons engaged in the practice of
  law;
(C) Bring witnesses;
(D) Advance arguments without
  undue interference;
(E) Question or
  refute any testimony or evidence, including an opportunity to confront and
  cross-examine adverse witnesses; and
(F) Submit evidence to establish all
  pertinent facts and circumstances in the case.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-008 - HEARING DECISIONS

Current through June 17, 2024
On the basis of the evidence presented at the hearing, the
	 determination to take adverse action shall be affirmed, modified, or set aside.
	 A copy of the decision setting forth the findings of fact and reasons upon
	 which the decision is based shall be sent by either registered or certified
	 mail to the applicant or participant at his or her last address of record
	 within forty-five (45) days of the receipt of the request for a hearing. This
	 decision shall become final thirty (30 days) after the copy is mailed unless
	 the applicant or participant appeals within such thirty day period in
	 accordance with the Administrative Procedure Act, Neb. Rev. Stat. §§
									84-901
	 to
	 84-920.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 4 - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC PROGRAM) AND THE COMMODITY SUPPLEMENTAL FOOD PROGRAM (CSFP) FAIR HEARING PROCEDURES › Section 181-4-009 - POST DECISION BENEFITS

Current through June 17, 2024
Benefits to the applicant or participant shall be handled as
	 follows:
009.01
DECISIONS
  FOR APPLICANT OR PARTICIPANT.
If the decision is in favor of the
  applicant or participant and benefits were denied or discontinued, benefits
  shall begin immediately.
009.02
DISQUALIFICATION
. If the decision concerns
  disqualification and is in favor of the agency, the local agency shall
  terminate continued benefits, as indicated in the decision, as soon as
  administratively feasible.
009.03
REPAYMENT OF BENEFITS
. If the decision regarding
  repayment of benefits by the participant is in favor of the agency, the local
  agency or the Department shall resume efforts to collect the claim, even during
  the pendency of judicial review.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 6 - CANCER DRUG REPOSITORY PROGRAM › Section 181-6-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations apply to the Cancer Drug Repository Program Act
	 pursuant to Nebraska Revised Statutes (Neb. Rev. Stats.) §§
									71-2422
	 to
	 71-2430.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 6 - CANCER DRUG REPOSITORY PROGRAM › Section 181-6-002 - DEFINITIONS

Current through June 17, 2024
Definitions set out in Neb. Rev. Stats. §§
									71-404
	 to
	 71-431, Neb.
	 Rev. Stat. §
									38-2841,
	 and Neb. Rev. Stat. §
									71-2423
	 apply to this chapter.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 6 - CANCER DRUG REPOSITORY PROGRAM › Section 181-6-003 - DONATING CANCER DRUGS

Current through June 17, 2024
Any person or entity who wishes to donate cancer drugs to the program
	 must contact a participant to obtain a form on which they must specify the
	 cancer drug to be donated. The form must include:
(A) Name of the cancer drug;
(B) Quantity of the cancer drug;
(C) The name of the person to whom the cancer
  drug was originally prescribed;
(D)
  The relationship between the person or entity donating the cancer drugs and the
  person to whom the cancer drug was prescribed;
(E) Signature of the person donating the
  cancer drug; and
(F) Date the form
  was signed.
003.01
ACCEPTABLE CANCER DRUGS.
Acceptable drugs for
  dispensing or distribution under the program include those listed by category
  in Neb. Rev. Stat. §
									71-2426
  and includes the following: any cancer drug that does not require
  refrigeration, freezing, or other special temperature requirements beyond
  controlled room temperature.
003.02
UNACCEPTABLE CANCER DRUGS.
Cancer drugs that are not
  acceptable for dispensing or distribution under the program are those set out
  in Neb. Rev. Stat. §§
									71-2426,
  any cancer drug that requires refrigeration, freezing, or other special
  temperature requirements beyond controlled room temperature because the safety
  of the cancer drug can no longer be ensured, or any cancer drug that is a
  controlled substance because federal law prohibits their
  return.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 6 - CANCER DRUG REPOSITORY PROGRAM › Section 181-6-004 - DISPENSING AND DISTRIBUTION REQUIREMENTS

Current through June 17, 2024
Only those licensees who are authorized to dispense as set out in Neb.
	 Rev. Stat. §
									38-2850
	 may dispense cancer drugs.
004.01
AUTHORIZED TO DISPENSE.
The following persons are
  authorized pursuant to Neb. Rev. Stat. §
									38-2850
  to dispense drugs:
(A) Licensed physicians who
  do not charge a handling fee for the cancer drugs;
(B) Licensed physicians who charge a handling
  fee for the cancer drugs and who hold a valid dispensing practitioner pharmacy
  license; and
(C) Licensed
  pharmacists.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 6 - CANCER DRUG REPOSITORY PROGRAM › Section 181-6-005 - PARTICIPANT REGISTRY

Current through June 17, 2024
Any licensee listed in 181 Nebraska Administrative Code (NAC)
	 6-004 that wants to participate in the
	 program must provide the Department with the information set out in Neb. Rev.
	 Stat. §
									71-2430. It
	 is the responsibility of a participant to notify the Department of any change
	 in the required information or when the participant no longer wishes to
	 participate in the program
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 7 - IMMUNOSUPPRESSANT DRUG REPOSITORY PROGRAM › Section 181-7-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations implement the Immunosuppressant Drug Repository
	 Program under Nebraska Revised Statutes (Neb. Rev. Stat.) §§
									71-2436
	 to
	 71-2443 of
	 the Immunosuppressant Drug Repository Program Act, and the Uniform
	 Credentialing Act.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 7 - IMMUNOSUPPRESSANT DRUG REPOSITORY PROGRAM › Section 181-7-003 - DONATING IMMUNOSUPPRESSANT DRUGS

Current through June 17, 2024
Any person or entity who wishes to donate immunosuppressant drugs to
	 the program must contact a participant to obtain a form on which they must
	 specify the immunosuppressant drug to be donated. The form must include:
(A) Name of the immunosuppressant
  drug;
(B) Quantity of the
  immunosuppressant drug;
(C) The
  name of the person to whom the immunosuppressant drug was originally
  prescribed;
(D) The relationship
  between the person or entity donating the immunosuppressant drug and the person
  to whom the immunosuppressant drug was prescribed;
(E) Signature of the person donating the
  immunosuppressant drug; and
(F)
  Date the form was signed.
003.01
ACCEPTABLE IMMUNOSUPPRESSANT DRUGS.
Acceptable drugs
  for dispensing or distribution under the program include those listed by
  category in Neb. Rev. Stat. §
									71-2440
  and includes any immunosuppressant drug that does not require refrigeration,
  freezing, or other special temperature requirements beyond controlled room
  temperature.
003.02
UNACCEPTABLE IMMUNOSUPPRESSANT DRUGS.
Unacceptable
  drugs for dispensing or distribution under the program include those listed by
  category in Neb. Rev. Stat. §
									71-2440
  and the following:
(A) An immunosuppressant
  drug that requires refrigeration, freezing, or other special temperature
  requirements beyond controlled room temperature because the effectiveness and
  safety of the immunosuppressant drug cannot be ensured; or
(B) Controlled substances because Federal Law
  prohibits their return.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 7 - IMMUNOSUPPRESSANT DRUG REPOSITORY PROGRAM › Section 181-7-004 - DISPENSING AND DISTRIBUTION OF IMMUNOSUPPRESSANT DRUGS

Current through June 17, 2024
Only those licensees who are authorized to dispense as set out in Neb.
	 Rev. Stat. §
									38-2850
	 may dispense immunosuppressant drugs.
004.01
DISPENSING AND
  DISTRIBUTION REQUIREMENTS.
Participants must meet the requirements
  set out in Neb. Rev. Stat. §
									71-2441
  and these regulations.
004.01(A)
AUTHORIZED TO DISPENSE.
The following persons are authorized
  pursuant to Neb. Rev. Stat. §
										38-2850
  to dispense drugs:
(i) Licensed physicians who
  do not charge for the drugs;
(ii)
  Licensed physicians who hold a valid dispensing practitioner pharmacy license;
  and
(iii) Licensed
  pharmacists.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 7 - IMMUNOSUPPRESSANT DRUG REPOSITORY PROGRAM › Section 181-7-005 - COMPLIANCE INSPECTIONS

Current through June 17, 2024
Each participant has the responsibility to be in compliance, and to
	 remain in compliance, with the regulations set out in this chapter. For the
	 purpose of assuring initial and continued compliance, the Department will
	 conduct inspections of participants. Participats must allow such inspections
	 which includes allowing access to and the copying of records
005.01
RESULTS OF
  INSPECTIONS.
Notifications will be made in writing to the
  participant.
005.01(A)
NOTIFICATION OF IMMINENT DANGER.
If notified that the
  violations would create an imminent danger of death or serious physical harm or
  immediate adverse effect to the safety or security of the immunosuppressant
  drugs, the participant must cease participation in the program
  immediately.
005.01(B)
NOTIFICATION OF NON-IMMINENT DANGER.
If notified that
  the violations do not create an imminent danger of death or serious physical
  harm to the patients of the participant and no direct or immediate adverse
  effect to the safety or security of the immunosuppressant drugs, the
  participant must correct any deficiencies noted in the inspection within 30
  days after receiving the inspection results.
005.01(C)
CORRECTIVE
  ACTION.
Participants that are not fully in compliance with these
  regulations within 30 days after receiving the inspection results will no
  longer be allowed to participate in the program.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations govern the use of nonsurgical pharmaceutical gender
	 altering treatments under the Let Them Grow Act, Nebraska Revised Statutes
	 (Neb. Rev. Stat.) §§
									71-7301 to
	 71-7307.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
This regulation governs the use of nonsurgical pharmaceutical gender
	 altering treatments under the Let Them Grow Act, Nebraska Revised Statutes
	 (Neb. Rev. Stat.) §§
									71-7301 to
	 71-7307.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-002 - DEFINITIONS

Current through June 17, 2024
Definitions are set out in the Let Them Grow Act, and this
	 chapter.
002.01
GENDER
  DYSPHORIA.
A marked incongruence between a person's experienced or
  expressed gender and the biological sex at birth for at least six months as
  manifested by the criteria set out in in the Diagnostic and Statistical Manual
  of Mental Disorders. Fifth Edition, Text-Revisions as published in March
  2022.
002.02
GENDER
  NONCONFORMITY.
For purposes of this chapter, gender nonconformity
  is a pattern of sexual identity different from the biological sex at birth
  expressed through observable behaviors as determined by a credentialed health
  care practitioner or mental health care practitioner.
002.03
LONG-LASTING AND INTENSE
  PATTERN OF GENDER NONCONFORMITY OR GENDER DYSPHORIA.
A pattern of
  gender nonconformity being observed or treated for more than six continuous
  months or a diagnosis of gender dysphoria.
002.04
PRESCRIBED
  MEDICATIONS.
For the purposes of this chapter, prescribed
  medications mean puberty blocking drugs or cross-sex hormones for the treatment
  of gender nonconformity or gender dysphoria.
002.05
TANNER SCALE OF
  PUBERTY.
Also known as Sexual Maturity Rating is an objective
  classification system used to determine the development and sequence of
  secondary sex characteristics of children during puberty.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-002 - DEFINITIONS

Current through June 17, 2024
Definitions are set out in the Let Them Grow Act, and this
	 chapter.
002.01
GENDER
  DYSPHORIA.
A marked incongruence between a person's experienced or
  expressed gender and the biological sex at birth for at least six months as
  manifested by the criteria set out in in the Diagnostic and Statistical Manual
  of Mental Disorders, Fifth Edition, Text-Revisions as published in March
  2022.
002.02
GENDER
  NONCONFORMITY.
For purposes of this chapter, gender nonconformity
  is a pattern of sexual identity different from the biological sex at birth
  expressed through observable behaviors as determined by a credentialed health
  care practitioner or mental health care practitioner.
002.03
LONG-LASTING AND INTENSE
  PATTERN OF GENDER NONCONFORMITY OR GENDER DYSPHORIA.
A pattern of
  gender nonconformity being observed or treated for more than six continuous
  months or a diagnosis of gender dysphoria.
002.04
PRESCRIBED
  MEDICATIONS.
For the purposes of this chapter, prescribed
  medications mean puberty blocking drugs or cross-sex hormones for the treatment
  of gender nonconformity or gender dysphoria.
002.05
TANNER SCALE OF
  PUBERTY.
Also known as Sexual Maturity Rating is an objective
  classification system used to determine the development and sequence of
  secondary sex characteristics of children during puberty.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-003 - PUBERTY BLOCKING DRUGS

Current through June 17, 2024
Prior to prescribing, dispensing, or administering puberty blocking
	 drugs for the treatment of gender nonconformity or gender dysphoria to a
	 patient who has not reached the age of majority, the prescribing practitioner
	 must meet the following:
(A) Obtain
  three hours of Category 1 Continuing Competency Education for prescribing drugs
  for the purpose of treating gender nonconformity or gender dysphoria within the
  most recent biennial renewal period;
(B) Determine or document:
(i) That gender nonconformity or gender
  dysphoria is driving the patient's distress and not other mental or physical
  health conditions, that there is no reasonable expectation of natural
  resolution of gender nonconformity, and that there has been a long-lasting and
  intense pattern of gender nonconformity or gender dysphoria which began or
  worsened at the start of puberty;
(ii) The severity of other mental or physical
  health conditions is being properly addressed and treated, and will not
  negatively impact treatment;
(iii)
  Puberty blocking treatment is not likely to negatively impact, or exacerbate
  other mental or physical health conditions;
(iv) The patient has received at least 40
  contact hours of therapeutic treatment as required by this chapter;
(v) The patient has at least six consecutive
  months of living primarily as the preferred gender;
(vi) For individuals not suffering from
  gender dysphoria or for whom a clinical diagnosis of gender dysphoria is not
  available, that without puberty blocking treatment the patient will experience
  harm;
(vii) Tanner stage of puberty
  development and if puberty blockers would be effective; and
(viii) The appropriate supports are in place
  for the patient including appropriate social, and familial supports prior to
  initiating puberty blocking treatment;
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-004 - CONTACT HOURS OF THERAPEUTIC TREATMENT

Current through June 17, 2024
A patient who has not reached the age of majority must receive a
	 minimum of 40 gender-identity-focused contact hours of therapeutic treatment
	 prior to receiving prescribed medications subject to the following
	 restrictions:
(A) The following may
  count toward the contact hours:
(i) An initial
  assessment of up to four consecutive hours; and
(ii) Following an initial assessment, up to
  two hours per week;
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-005 - ONGOING CONTACT HOURS OF THERAPEUTIC TREATMENT

Current through June 17, 2024
A patient who has not reached the age of majority must receive at least
	 one therapeutic contact hour every 90 days while puberty blocking drugs or
	 cross-sex hormones are being administered to evaluate ongoing effects on the
	 patient's mental health.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-006 - ATTESTATION REQUIREMENTS FOR PRACTITIONERS

Current through June 17, 2024
006.01
PRESCRIBING
  PRACTITIONER.
If the prescribing practitioner provided all or some
  of the contact hours of therapeutic treatment required by this chapter, the
  prescribing practitioner must sign an attestation as part of the documentation
  required by this chapter.
006.02
NON-PRESCRIBING PRACTITIONER.
For contact hours of
  therapeutic treatment required by this chapter not provided by the prescribing
  practitioner, the prescribing practitioner must obtain an attestation from the
  other practitioner or practitioners as part of the documentation required by
  this chapter.
006.03
INITIAL 40 HOUR ATTESTATION REQUIREMENTS.
The initial
  40 gender-identity-focused contact hours attestation must include at least the
  following:
(A) Name of patient;
(B) Patient date of birth;
(C) Statement from the practitioner providing
  therapy detailing their training and experience with gender-identify-focused
  issues;
(D) Number of all contact
  hours of therapeutic treatment spent with the patient;
(E) Detailing the duration and frequency of
  those contact hours of therapeutic treatment;
(F) The duration and frequency of gender nonconformity;
(G) Any diagnosis of gender
  dysphoria;
(H) Any other
  co-occurring psychiatric diagnosis as required in this chapter;
(I) Appropriate support or referrals for the
  patient;
(J) Patient level of
  engagement in the therapy;
(K)
  Parental or legal guardian consent to therapy and their level of engagement in
  the therapy, or the consent of the patient, if the patient is an emancipated
  minor;
(L) Any other relevant
  information regarding the patient; and
(M) When the patient is an unemancipated
  minor, the ability of the patient to assent to therapy.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-006 - ATTESTATION REQUIREMENTS FOR PRACTITIONERS

Current through June 17, 2024
006.01
PRESCRIBING
  PRACTITIONER.
If the prescribing practitioner provided all or some
  of the contact hours of therapeutic treatment required by this chapter, the
  prescribing practitioner must sign an attestation as part of the documentation
  required by this chapter.
006.02
NON-PRESCRIBING PRACTITIONER.
For contact hours of
  therapeutic treatment required by this chapter not provided by the prescribing
  practitioner, the prescribing practitioner must obtain an attestation from the
  other practitioner or practitioners as part of the documentation required by
  this chapter.
006.03
INITIAL 40 HOUR ATTESTATION REQUIREMENTS.
The initial
  40 gender-identity-focused contact hours attestation must include at least the
  following:
(A) Name of patient;
(B) Patient date of birth;
(C) Statement from the practitioner providing
  therapy detailing their training and experience with gender-identify-focused
  issues;
(D) Number of all contact
  hours of therapeutic treatment spent with the patient;
(E) Detailing the duration and frequency of
  those contact hours of therapeutic treatment;
(F) The duration and frequency of gender
  nonconformity;
(G) Any diagnosis of
  gender dysphoria;
(H) Any other
  co-occurring psychiatric diagnosis as required in this chapter;
(I) Appropriate support or referrals for the
  patient;
(J) Patient level of
  engagement in the therapy;
(K)
  Parental or legal guardian consent to therapy and their level of engagement in
  the therapy, or the consent of the patient, if the patient is an emancipated
  minor;
(L) Any other relevant
  information regarding the patient; and
(M) When the patient is an unemancipated
  minor, the ability of the patient to assent to therapy.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-007 - PATIENT INFORMED CONSENT FOR PUBERTY BLOCKING TREATMENT

Current through June 17, 2024
A patient consent form must be obtained by the prescribing practitioner
	 and include the following, in addition to information otherwise required in a
	 consent form:
(A) Discussion of
  appropriateness of care has taken place;
(B) All the known side effects of puberty
  blockers, the risks associated with taking them and the risks associated with
  discontinuing the treatment including, but not limited to, long-term effects on
  bone density, brain development, impact on fertility, sexual side effects
  including, but not limited to, loss of sexual gratification, and effects upon
  physical growth and development;
(C)
  List of alternatives to treatment including, but not limited to, social,
  behavioral, and physical alternatives, and that these alternatives have been
  discussed with the patient and parent or legal guardian or the patient, if the
  patient is an emancipated minor;
(D)
  Signed consent of a parent or legal guardian or the signed consent of the
  patient, if the patient is an emancipated minor;
(E) When the patient is an unemancipated
  minor, patient assent to treatment; and
(F) Whether the medication is being
  prescribed for off-label use or otherwise not approved by the Food and Drug
  Administration.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-007 - PATIENT INFORMED CONSENT FOR PUBERTY BLOCKING TREATMENT

Current through June 17, 2024
A patient consent form must be obtained by the prescribing practitioner
	 and include the following, in addition to information otherwise required in a
	 consent form:
(A) Discussion of
  appropriateness of care has taken place;
(B) All the known side effects of puberty
  blockers, the risks associated with taking them and the risks associated with
  discontinuing the treatment including, but not limited to, long-term effects on
  bone density, brain development, impact on fertility, sexual side effects
  including, but not limited to, loss of sexual gratification, and effects upon
  physical growth and development;
(C) List of alternatives to treatment
  including, but not limited to, social, behavioral, and physical alternatives,
  and that these alternatives have been discussed with the patient and parent or
  legal guardian or the patient, if the patient is an emancipated
  minor;
(D) Signed consent of a
  parent or legal guardian or the signed consent of the patient, if the patient
  is an emancipated minor;
(E) When
  the patient is an unemancipated minor, patient assent to treatment;
  and
(F) Whether the medication is
  being prescribed for off-label use or otherwise not approved by the Food and
  Drug Administration.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-008 - PUBERTY BLOCKING DRUG PRESCRIPTIONS

Current through June 17, 2024
The following restrictions apply for a patient who has not reached the
	 age of majority in addition to all other applicable laws relating to the
	 administration, prescribing, delivery, sale, or use of puberty blocking
	 drugs:
(A) Prescriptions must identify
  the drugs being prescribed are for the treatment of gender nonconformity or
  gender dysphoria;
(B) Prescribed
  medications picked up from a pharmacy are required to be picked up by the
  patient's parent, legal guardian, or the patient if the patient is an
  emancipated minor;
(C) Injectable
  prescribed medications must be administered in the prescribing practitioner's
  office by staff who are properly credentialed to administer drugs by
  injection;
(D) The prescribing
  practitioner must document no adverse effects on the patient's mental health
  during the course of treatment and that continued treatment is still medically
  appropriate as required by the chapter; and
(E) The prescribing practitioner must
  document the ongoing contact hours of therapeutic treatment as required by this
  chapter.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-008 - PUBERTY BLOCKING DRUG PRESCRIPTIONS

Current through June 17, 2024
The following restrictions apply for a patient who has not reached the
	 age of majority in addition to all other applicable laws relating to the
	 administration, prescribing, delivery, sale, or use of puberty blocking
	 drugs:
(A) Prescriptions must identify
  the drugs being prescribed are for the treatment of gender nonconformity or
  gender dysphoria;
(B) Prescriptions
  must identify the patient's parent or legal guardian or if the patient is an
  emancipated minor;
(C) Prescribed
  medications picked up from a pharmacy are required to be picked up by the
  patient's parent, legal guardian, or the patient if the patient is an
  emancipated minor;
(D) Injectable
  prescribed medications must be administered either in the prescribing
  practitioner's office or in the office of the patient's primary care provider,
  by staff who are properly credentialed to administer drugs by
  injection;
(E) The prescribing
  practitioner must document no adverse effects on the patient's mental health
  during the course of treatment and that continued treatment is still medically
  appropriate as required by the chapter; and
(F) The prescribing practitioner must
  document the ongoing contact hours of therapeutic treatment as required by this
  chapter.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-009 - PUBERTY BLOCKING DRUGS WAITING PERIOD

Current through June 17, 2024
A minimum waiting period of seven calendar days is required between the
	 time the prescribing practitioner obtains informed patient consent and the time
	 the puberty-blocking drugs are prescribed, administered, or delivered to a
	 patient who has not reached the age of majority.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-009 - PHARMACIST REQUIREMENTS

Current through June 17, 2024
A pharmacist dispensing puberty blocking drugs, as defined in the Let
	 Them Grow Act, to a patient under the age of 19 shall comply with the following
	 restrictions:
(A) Prescribed
  medications picked up from a pharmacy are required to be picked up by the
  patient's parent, legal guardian, or the patient if the patient is an
  emancipated minor;
(B) Unless the
  individual taking receipt of the dispensed medications is personally and
  positively known to the pharmacist and or dispensing practitioner, the
  individual shall display a valid driver's or operator's license, a state
  identification card, or military identification card, an alien registration
  card, or a passport as proof of identification; and
(C) Prescription drugs that are otherwise
  lawful to be sent by home delivery, must be delivered to the address of
  patient's parent or legal guardian, or the patient's address if the patient is
  an emancipated minor.
009.01
EXEMPTIONS.
The additional requirements of this
  subsection shall not apply if the pharmacist documents that the patient began
  receiving the prescribed medication prior to October 1, 2023, that the
  medication is not being prescribed for the treatment of gender nonconformity or
  gender dysphoria, or that the patient has reached the age of 19. A pharmacist
  is not required to determine that the prescribing practitioner has complied
  with the additional requirements of this chapter prior to dispensing prescribed
  medications, as defined in this chapter, to a patient under the age of
  19.
009.02
PHARMACIST
  AUTHORITY.
This chapter does not otherwise limit or expand the
  scope of practice of a pharmacist. Prescriptions must continue to meet all
  other state and federal statutes, rules, and regulations.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-010 - USE OF CROSS-SEX HORMONES

Current through June 17, 2024
Prior to prescribing, dispensing, or administering cross-sex hormones
	 for the treatment of gender nonconformity or gender dysphoria, prescribing
	 practitioners must meet the following:
(A) Obtain three hours of Category 1
  Continuing Competency Education for prescribing drugs for the purpose of
  treating gender nonconformity or gender dysphoria within the most recent
  biennial renewal period;
(B)
  Determine or document:
(i) Puberty blocking
  treatment, if occurring, has been successful at reducing patient distress and
  discomfort;
(ii) That gender
  nonconformity or gender dysphoria is driving the patient's distress and not
  other mental or physical health conditions, that there is no reasonable
  expectation of natural resolution of gender nonconformity, and that there has
  been a long-lasting and intense pattern of gender nonconformity or gender
  dysphoria which began or worsened at the start of puberty;
(iii) There is an expectation of increased
  distress if puberty blocking treatment is terminated or cross-sex hormone
  treatment is not initiated;
(iv)
  Cross-sex hormones would be effective and are not likely to negatively impact,
  or exacerbate other mental or physical health conditions;
(v) The patient has received at least 40
  contact hours of therapeutic treatment as required by this chapter;
(vi) The patient has at least six consecutive
  months of living primarily as the preferred gender and has continued living
  primarily as the preferred gender;
(vii) For individuals not suffering from
  gender dysphoria or for whom a clinical diagnosis of gender dysphoria is not
  available, documentation that without cross-sex hormone treatment the patient
  will experience harm; and
(viii) The
  appropriate supports are in place for the patient including appropriate social,
  and familial support prior to initiating cross-sex hormone treatment;
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-010 - PUBERTY BLOCKING DRUGS WAITING PERIOD

Current through June 17, 2024
A minimum waiting period of seven calendar days is required between the
	 time the prescribing practitioner obtains informed patient consent and the time
	 the puberty-blocking drugs are prescribed, administered, or delivered to a
	 patient who has not reached the age of majority.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 181 - SPECIAL HEALTH PROGRAMS › Chapter 8 - NONSURGICAL PHARMACEUTICAL GENDER ALTERING TREATMENTS › Section 181-8-011 - PATIENT INFORMED CONSENT FOR CROSS-SEX HORMONE TREATMENT

Current through June 17, 2024
A patient consent form must be obtained by the prescribing practitioner
	 and include the following, in addition to information otherwise required in a
	 consent form:
(A) Discussion of
  appropriateness of care has taken place;
(B) All the known side effects of cross-sex
  hormone, the risks associated with taking them and the risks associated with
  discontinuing the treatment including, but not limited to. long-term effects on
  cardiovascular and cerebrovascular systems, metabolic disorders, increased risk
  of cancer, bone density, brain development, impact on fertility, sexual side
  effects including, but not limited to, loss of sexual gratification, and
  effects upon physical growth and development;
(C) List of alternatives to treatment
  including, but not limited to. social, behavioral, and physical alternatives,
  and that these alternatives have been discussed with the patient and parent or
  legal guardian or the patient, if the patient is an emancipated
  minor;
(D) Signed consent of a
  parent or legal guardian or the signed consent of the patient, if the patient
  is an emancipated minor;
(E) When
  the patient is an unemancipated minor, patient assent to treatment:
  and
(F) Whether the medication is
  being prescribed for off-label use or otherwise not approved by the Food and
  Drug Administration.