Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 35 - REHABILITATIVE PSYCHIATRIC SERVICES › Section 471-35-004 - Covered Services

Current through June 17, 2024
Medicaid covers the following rehabilitative psychiatric services under
	 the rules and regulations of this chapter.
1. Community Support;
2. Day Rehabilitation;
3. Psychiatric Residential rehabilitation.
For the purposes of meeting the requirements of 471 NAC
	 35-002, programs certified by the
	 Department of Health and Human Services under 204 NAC 5 (effective date
	 December 19, 1994) as Residential Support and/or Service Coordination providers
	 shall be considered to be certified as Community Support providers.
004.01 Community Support
The Community Support program is designed to:
1. Provide/develop the necessary services and
  supports to enable clients to reside in the community;
2. Maximize the client's community
  participation, community and daily living skills, and quality of
  life;
3. Facilitate communication
  and coordination between mental health rehabilitation providers that serve the
  same client; and
4. Decrease the
  frequency and duration of hospitalization.
Community support shall provide client advocacy, ensures- continuity of
	 care, supports clients in time of crisis, provide/procure skill training,
	 ensures- the acquisition of necessary resources, to assist clients with spend
	 downs and other financial insurance coverage programs and assists- the client
	 in achieving community/social integration. The community support program shall
	 provide a clear focus of accountability for meeting the client's needs within
	 the resources available in the community. The role(s) of the community support
	 provider may vary based on client's needs. Community support is a service in
	 which the client's contact occurs outside the program offices in community
	 locations consistent with the individual client choice/need. Community support
	 is frequently provided in the home and is not facility or office-based.
	 Ninety-day treatment, rehabilitation and recovery team meetings are not
	 considered to be a community support service. The frequency of contact between
	 the community support provider and the client is individualized and adjusted in
	 accordance with the needs of the client.
Prior to admission to a community support program, a client shall have
	 a comprehensive Pretreatment Assessment. The Initial Diagnostic Interview (Part
	 II of the PTA) shall be completed by an independently licensed practitioner
	 (psychiatrist, psychologist, or LIMHP). The purpose of this assessment is to
	 determine/verify the presence of a severe and persistent mental illness which
	 requires psychiatric rehabilitation services. The document must include the
	 need of the specific rehabilitation services necessary to meet the treatment
	 and recovery goals of the client.
Community Support is a separate and distinct service, and may not be
	 provided as a component of other Rehabilitative Psychiatric Services or Mental
	 Health Outpatient Services. Agencies that provide more than one level of
	 rehabilitative psychiatric or Mental Health Outpatient service shall have staff
	 dedicated to the Community Support program. These Community Support staff shall
	 not provide any other rehabilitative psychiatric or treatment service to the
	 client.
35-004.01A
Program
  Components
: The Community Support program shall -
1. Facilitate communication and coordination
  among the mental health rehabilitation providers serving the client;
2. Ensure that if a Pretreatment Assessment
  was completed 12 months or more prior to admission, the licensed mental health
  practitioner shall review and update the Biopsychosocial Assessment (Part I of
  the Pretreatment Assessment) within 30 days of admission of the client into the
  program. The assessments shall identify needed services and resources for each
  client;
3. Ensure completion of a
  strength-based needs assessment which may include skills inventories,
  interviews and other tools to develop treatment and rehabilitation plans which
  must be completed within 30 days of admission by the rehabilitation team or
  team members.
4. Ensure the
  completion of an Individual Treatment, Rehabilitation, and Recovery Plan for
  each client served. The Individual Treatment, Rehabilitation, and Recovery Plan
  shall be completed within 30 days following the admission of the client and
  reviewed and updated every 90 days or as often as clinically necessary
  thereafter while receiving services. The Individual Treatment, Rehabilitation,
  and Recovery Plan shall be based on the results of comprehensive assessments
  and is developed with the client's involvement and through an interdisciplinary
  team process. The Individual Treatment, Rehabilitation, and Recovery Plan shall
  include methods and interventions to address: activities of daily living,
  community living skills, budgeting, education, independent living skills,
  social skills, interpersonal skills, psychiatric emergency/relapse, medication
  management including recognition of signs of relapse and control of symptoms,
  mental health services, physical health care, vocational/educational: services,
  resource acquisition, and other related areas as necessary for successful
  living in the community.
5. Ensure
  the Individual Treatment, Rehabilitation, and Recovery Plan that encompasses
  the supportive/rehabilitative interventions that will be directly provided by
  the Community Support Program;
6.
  Identify the provision of services/interventions identified in the Individual
  Treatment, Rehabilitation, and Recovery Plan as the responsibility of other
  rehabilitative service providers;
7. Develop and implement strategies to assist
  the client in becoming engaged and remaining engaged in medically necessary
  mental health treatment and psychiatric rehabilitation services;
8. Provide service coordination and case
  management activities, including coordination or assistance in accessing
  medical, social, education, housing, transportation or other appropriate
  support services as well as linkage to other community services identified in
  the Individual Treatment, Rehabilitation, and Recovery Plan.
9. Facilitate communication between the
  treatment and rehabilitation providers and with the primary care
  physician/psychiatrist serving the client.
10. Monitor client progress of the services
  being received and participate in the revision of the Individual Treatment,
  Rehabilitation, and Recovery Plan as needed or at the request of the
  client;
11. Provide contact as
  needed with other service provider(s), client family member(s), and/or other
  significant people in the client's life to facilitate communication necessary
  to support the individual in maintaining community living;
12. Assist the client in the developing,
  evaluating and updating a crisis and relapse prevention plan. This plan shall
  be coordinated with any other rehabilitative service and include the client's
  natural supports. Provide therapeutic support and intervention to the client in
  time of crisis. If hospitalization is necessary, facilitate, in cooperation
  with the inpatient treatment provider, the client's transition back into the
  community upon discharge.-;
13.
  Participate with and report to the treatment/rehabilitation team on the
  progress of the client in areas of medication compliance, relapse prevention,
  social skill acquisition, application, education, substance abuse, and ability
  to sustain community living.
14.
  Monitor medication compliance; and
15. Assist the client with all health
  insurance issues including Share of Cost eligibility issues. Ensures client
  understanding of financial benefits and procedures to use those benefits such
  as Medicaid spend downs, AABD, SSI and SSA, etc.
35-004.01B
Admission and
  Discharge Criteria for Community Support Services
35-004.01C
Admission
  Criteria
: Community Support Services shall be prior authorized by
  the Division of Medicaid and Long-Term Care or its designee. To be eligible for
  Community Support Services, the client shall meet all of the criteria described
  in 471 NAC 35-001.01 and the Community Support specific criteria identified by
  this prior authorization process.
35-004.01D
Staffing
  Requirements
: Rehabilitative programs shall provide staff to
  deliver rehabilitative psychiatric services and staff may be either licensed
  practitioners operating within their scope of practice or skilled direct care
  staff that shall meet the following minimum standards:
1. Have demonstrated skills and competencies
  in working with people experiencing severe and persistent mental
  illness;
2. Have completed a staff
  training curriculum for initial orientation and completes a continuing
  education curriculum at intervals as defined and prepared by the providing
  agency. This curriculum and periodic updates shall be included in the program
  description submitted to the Division of Medicaid and Long-Term Care;
3. Licensed staff provide services as
  identified within their scope of practice; and
4. All staff are trained in the principles of
  recovery.
35-004.01E
Clinical Staff
: The Community Support program shall
  have available a:
1.
Licensed
  Clinical Supervisor
: The clinical supervisor shall qualify as a
  licensed practitioner and shall participate in the Individual Treatment,
  Rehabilitation, and Recovery Plan development and provide clinical supervision,
  consultation, and support. The Licensed Clinical Supervisor will review
  community support client's clinical needs and progress toward their goals with
  the community support worker every 30 days. The review should be completed
  preferably face-to-face. The review may be accomplished by the supervisor
  consulting with the community support worker on their assigned clients and
  providing clinical guidance or recommendations to better serve the
  client.
2.
Other
  Consultants
: Consultation by licensed professionals for general
  medical, psychopharmacology, and psychological issues, as well, as overall
  program design and shall be available and accessed as necessary.
35-004.01F
Direct Care
  Staff
: The Community Support program shall have Community Support
  staff who:
1. Direct Care staff having a
  bachelor's degree in psychology, sociology or related human services field or
  two years of course work in the human services field and two years of
  experience/training in the human services field or two years of lived recovery
  experience is acceptable. All community support workers shall be trained in
  rehabilitation and recovery principles and shall have demonstrated skills and
  competency. Each staff shall have demonstrated skills and competency in
  treatment with individuals with mental health diagnosis.
Direct care staff employed by an agency before the effective date of
	 these regulations will be considered to meet staffing requirements when the
	 provider submits documentation identifying the name, address and the provider
	 number, service provided, names of direct care staff employed before the
	 effective date of the these regulations, and their date of hire. Documentation
	 shall be submitted to Medicaid within 30 days following the effective date of
	 these regulations. Staff hired on or after the effective date of these
	 regulations shall meet the specified requirements identified in the above
	 paragraph;
2. Receive
  monthly supervision by the Community Support Clinical Supervisor.