Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 15 - PERSONAL ASSISTANCE SERVICES › Section 471-15-004 - ELIGIBILITY AND AUTHORIZATION

Current through June 17, 2024
004.01
GENERAL SERVICE REQUIREMENTS.
004.01(A)
MEDICAL
  NECESSITY.
Medical necessity requirements outlined in 471 NAC 1
  apply to the provision of personal assistance services, and are hereby
  incorporated as if fully rewritten herein.
004.01(B)
ELIGIBILITY AND
  AUTHORIZATION.
004.01(B)(i)
ELIGIBILITY CRITERIA.
The Department must determine
  that a client meets all of the following eligibility criteria:
(1) Is a current Medicaid client;
(2) Needs personal assistance services to
  live in the community;
(a) But does not have
  needs that require more intensive services than those listed in this chapter
  due to an acute health care level;
(3) Is not receiving or eligible for personal
  assistance services or similar staff support based on their residence or place
  of employment;
(a)
EXCEPTION.
An individual residing in a licensed
  residential service program may only be eligible for personal assistance
  services under this regulation if it is needed to maintain competitive
  integrated employment if it would duplicate any services already received;
  and
(4) Lives in a
  residence that is not a hospital, nursing facility, intermediate care facility,
  prison, or other institution.
004.01(B)(ii)
ASSESSMENT AND
  SERVICE PLAN.
The client must participate in the development of
  the assessment and service plan by stating his or her service needs and
  preferences, and jointly determining the units of service needed. If the client
  is not cooperative in the process, the client is not eligible for services. The
  Department makes the final determination of units authorized.
004.01(B)(ii)(1)
EMPLOYER
  APPOINTMENT OF AGENT FORM.
Before authorization of a personal
  assistance service provider, the Department must obtain the client's signature
  on Internal Revenue Service Form FA-65, Employer Appointment of
  Agent.
004.01(B)(iii)
AUTHORIZATION.
004.01(B)(iii)(1)
PRIOR
  AUTHORIZATION.
Personal assistance services must be authorized
  before actual provision of the service, based on the assessment of need and
  development of the service plan.
004.01(B)(iii)(2)
AUTHORIZATION
  PERIOD.
Services must be authorized based on the client's service
  needs for a period not to exceed a maximum of one year from the service
  authorization begin date.
004.01(B)(iii)(2)(a)
AUTHORIZATION PERIOD OF PROVIDERS.
A provider of
  personal assistance services may only be authorized until the end date of the
  client's existing authorization for services.
004.01(B)(iii)(2)(b)
AUTHORIZATION OF MULTIPLE PROVIDERS.
The client must
  work with the Department to determine the maximum number of units each provider
  will be authorized to provide. It is the client's responsibility to determine
  the day-to-day schedule of each provider.
004.01(B)(iii)(3)
LIMITATION.
Personal assistance services are limited
  to a maximum of 40 hours per seven-day period. Only the Department, not the
  approved service provider, may increase the maximum number of units for which
  the client is eligible per week, within the 40-hour per seven-day maximum. Any
  services provided in excess of 40 hours per seven-day period must receive prior
  authorization from the Department.
004.01(B)(iii)(4)
RELATIONSHIP TO
  SERVICE PLAN.
Personal assistance services authorized must relate
  directly to the tasks needed to be performed by someone else and that are
  essential to remain in the home, as listed on the service plan.
004.01(B)(iv)
REVIEW OF
  SERVICE PLAN AND RE-AUTHORIZATION.
Personal assistance services
  may be re-authorized at the end of an authorization period, which is at least
  annually, based on continued eligibility and a review of the service plan. The
  Department will review the service plan together with the client a minimum of
  once every 12 months, or whenever the client's service needs
  change.