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 471-20-008 - Inpatient Hospital Services for Clients 65 and Over in Institutions for Mental Disease (IMD's)

Current through June 17, 2024
008.01
Legal Basis
The Nebraska Medical Assistance Program (NMAP) covers IMD services,
	 for clients 65 and over, under
	 42
	 CFR 431.620(b),
	 435.1009;
	 440.140;
	 440.160;
	 Part 441, Subparts C and D; Part 447, Subparts B and C; Part 456, Subparts D
	 and I; and Part 482. The Department provides IMD services under the Family
	 Policy Act, Sections 43-532 through 534,
Reissue Revised Statute of
	 Nebraska, 1943
.
008.02
Definition of an
  IMD
42 CFR
	 435.1009 defines an IMD as "an institution
	 that is primarily engaged in providing diagnosis, treatment or care of persons
	 with mental diseases, including medical attention, nursing care and related
	 services. Whether an institution is an institution for mental diseases is
	 determined by its overall character as that of a facility established and
	 maintained primarily for the care and treatment of individuals with mental
	 diseases, whether or not it is licensed as such. An institution for the
	 mentally retarded is not an institution for mental diseases." This is limited
	 to free-standing facilities which are not excluded units of acute care
	 hospitals.
008.03
Standards for Participation
To participate in the NMAP, the IMD must -
1. Be in conformity with all applicable
  federal, state, and local laws;
2.
  Be licensed as a hospital by the Nebraska Department of Health and Human
  Services, Division of Public Health or the licensing agency in the state where
  the IMD is located;
3. Be certified
  as meeting the conditions of participation for hospitals in 42 CFR Part
  482;
4. Be accredited by the Joint
  Commission of Accreditation of Healthcare Organizations (JCAHO) or the American
  Osteopathic Association (AOA), and submit a copy of the most recent
  accreditation survey with Form MC-20;
5. Meet the definition of an IMD as stated in
  471 NAC 20-008.02 (above);
6. Meet
  the program and operational definitions and criteria contained in the Nebraska
  Department of Health and Human Services Manual;
7. Meet the current JCAHO or AOA standards of
  care; and
8. Meet all requirements
  in 471 NAC
  20-001 except active treatment.
20-008.03A
Provider
  Agreement
: The provider shall complete Form MC-20 and submit the
  form, along with a copy of its current JCAHO or AOA accreditation survey,
  program, policies, and procedures to the Department to enroll in NMAP as a
  provider. If approved, the Department notifies the IMD of its provider
  number.
20-008.03B
Annual Update
: With the annual cost report, the
  provider shall submit a copy of all program information, their most recent
  license and accreditation certificates, and any other information specifically
  requested by the Department. Claims will not be paid if this has not been
  received and approved. This information must be submitted with a new copy of
  Form MC-20.
20-008.03C
Monthly Reports
: The IMD shall submit a monthly report
  to the Division of Medicaid and Long-Term Care. The report must contain -
1. The names of all Medicaid clients admitted
  or discharged during the month; and
2. The date of each Medicaid client's
  admission or discharge.
The report must be submitted by the 15th of the following month.
20-008.03D
Record Requirements
: The regional center (or the local
  office for a client in a private facility) shall enter the Form MC-9H document
  number in Form Locator 63 on each Form CMS-1450 or standard electronic Health
  Care Claim: Institutional transaction that is submitted to the Department.
Transfer to another IMD or readmission constitutes a new admission for
	 the receiving facility.
20-008.03D1
An Individual Who Applies For NMAP While in the IMD
:
  For an individual who applies for NMAP while in the IMD, the certification must
  be -
1. Made by the team that develops the
  individual plan of care (see 471 NAC 20-008.10);
2. Cover any period before application for
  which claims are made.
When Medicaid eligibility is determined, authorization for previous and
	 continued care must be obtained from the Department contracted peer review
	 organization or management designee.