reglab/statecodes huggingface dataset:
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 46 - RATES FOR HOSPITAL SERVICES › Section 471-46-018 - LOWER LEVELS OF CARE

Current through June 17, 2024
When the Department determines that a client no longer requires
	 inpatient services but requires skilled nursing care and there are no skilled
	 nursing beds available when the determination is made, the Department will pay
	 only for authorized medically necessary skilled nursing care provided in an
	 acute care hospital at a rate equal to the average rate per patient day paid by
	 the Department to skilled nursing facilities during the previous calendar year.
	 When a Medicaid patient no longer requires inpatient hospital services and has
	 requested nursing home admission and is waiting for completion of the
	 pre-admission screening process, the Department may pay for the pre-admission
	 screening process days the client remains in the hospital before the
	 pre-admission screening process is completed at a rate equal to the average
	 rate per patient day paid by the Department to skilled nursing facilities
	 during the previous calendar year. The hospital shall request prior
	 authorization from the Medicaid Division before the pre-admission screening
	 process days are provided. The Medicaid Division will send the authorization to
	 the hospital. The hospital shall bill for class of care 81 and enter the prior
	 authorization document number from Form MC-9 on Form HCFA-1450 (UB-92). The
	 claim for the pre-admission screening process days must be separate from the
	 claim for the inpatient days paid at the acute rate. The pre-admission
	 screening process days will be disallowed as acute care days and Medicaid will
	 pay the average rate per patient day paid by the Department to skilled nursing
	 facilities during the previous calendar year for the pre-admission screening
	 process day. Pre-admission screening process days will not be considered in
	 computing the hospital's prospective rate.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 46 - RATES FOR HOSPITAL SERVICES › Section 471-46-019 - ACCESS TO RECORDS

Current through June 17, 2024
Hospitals shall make all records relating to the care of Medicaid
	 patients and any and all other cost information available to the Department,
	 its designated representatives or agents, or representatives of the federal
	 Department of Health and Human Services, upon reasonable notice during regular
	 business hours. Hospitals shall allow authorized representatives of the
	 Department of Health and Human Services Finance and Support, the federal
	 Department of Health and Human Services, and state and federal fraud and abuse
	 units to review and audit the hospital's data processing procedures and
	 supportive software documentation involved in the production of
	 computer-encoded claims submitted to the Department. The hospital shall allow
	 the authorized representatives access for the purpose of audit and review at
	 any reasonable time during normal working hours upon written notice by the
	 Department at least one working day before the review and
	 audit.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 46 - RATES FOR HOSPITAL SERVICES › Section 471-46-020 - AUDITS

Current through June 17, 2024
The Department periodically performs or receives cost report audits to
	 monitor the accuracy of data used to set rates. Audits may be performed by the
	 hospital's Medicare intermediary, the Department, or an independent public
	 accounting firm, licensed to do business in Nebraska and retained by the
	 Department. Audits will be performed as determined appropriate by the
	 Department.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 46 - RATES FOR HOSPITAL SERVICES › Section 471-46-021 - PROVIDER APPEALS

Current through June 17, 2024
A hospital may submit additional evidence and request prompt
	 administrative review of its prospective rate within 90 days of the rate
	 notification date according to the procedures in 471 NAC 2. A hospital may also
	 request an adjustment to its rate.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 46 - RATES FOR HOSPITAL SERVICES › Section 471-46-022 - REQUEST FOR RATE ADJUSTMENTS

Current through June 17, 2024
Requests for rate adjustments are subject to the rules contained in
	 this section.
022.01
REQUESTS.
Hospitals may submit a request to the
  Department for an adjustment to their rates for the following:
(A) An error in the calculation of the rate.
  Hospitals may submit a request for adjustment to their rate if the rate-setting
  methodology or principles of reimbursement established under the State Plan
  were incorrectly applied, or if incorrect data or erroneous calculations were
  used in the establishment of the hospital's rate;
(B) Extraordinary circumstances. Hospitals
  may submit a request for adjustment to their rate for extraordinary
  circumstances that are not faced by other Nebraska hospitals in the provision
  of hospital services. Extraordinary circumstances are limited to circumstances
  occurring since the base year that are not addressed by the reimbursement
  methodology. Extraordinary circumstances are limited to:
(i) Changes in routine and ancillary costs,
  which are limited to:
(1) Intern and resident
  related medical education costs; and
(2) Establishment of a subspecialty care
  unit.
(ii) Extraordinary
  capital-related costs. Adjustment for capital-related costs will be limited to
  no more than a five percent increase.
(C) Catastrophic circumstances. Hospitals may
  submit a request for adjustment to their rate if they incur allowable costs as
  a consequence of a natural or other catastrophe. The following circumstances
  must be met to be considered a catastrophic circumstance:
(i) One-time occurrence;
(ii) Less than twelve-month
  duration;
(iii) Could not have been
  reasonably predicted;
(iv) Not of
  an insurable nature;
(v) Not
  covered by federal or state disaster relief; and
(vi) Not a result of malpractice or
  negligence.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 1 - INTRODUCTION › Section 472-1-001 - Legal Basis

Current through June 17, 2024
The Nebraska Department of Social Services administers the Disabled
	 Persons and Family Support Program (DPF Support) based upon Sections
	 68-1501
	 through 1521,
Reissue Revised Statutes of Nebraska,
	 1943
. The program is designed to encourage -
1. Employable disabled people who live
  independently to remain or become employed;
2. Families living with disabled family
  members to preserve the family unit; and
3. Disabled adults who reside in an
  independent living situation to maintain their maximum level of
  independence.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 1 - INTRODUCTION › Section 472-1-003 - Definitions

Current through June 17, 2024
Disability
: Disability for this program is a
	 medically determinable, severe, chronic condition which -
1. Is attributable to mental and/or physical
  impairments;
2. Is likely to
  continue indefinitely;
3.
  Demonstrates a need for long-term, individually planned and coordinated care,
  treatment, vocational rehabilitation, or other services; and
4. Results in substantial functional
  limitations in two or more of the following areas of major life activity -
a. Self-care;
b. Receptive and expressive
  language;
c. Learning;
d. Mobility;
e. Self-direction;
f. Capacity for independent living;
g. Work skills or work tolerance;
  and
h. Economic sufficiency.
Eligible Persons
: The Department determines
	 eligibility for those families and individuals who meet all guidelines and
	 -
1. Whose needs assessment indicates
  appropriateness for the program; and
2. Demonstrate that the support requested is
  the most cost-effective form of care.
Employment
: Employment is defined as earning
	 wages at least equal to the amount considered substantial gainful activity by
	 the Social Security Administration.
Family Size
: For income eligibility purposes,
	 the family includes one or more adults (age 19 or older) and children, if any,
	 related by blood, marriage, or adoption who reside in the same household. An
	 unborn child may be included if pregnancy is verified by a physician's
	 statement. Related adults other than spouses and unrelated adults who reside
	 together are separate families.
Independent Living Situation
: Means residing
	 alone, with another person who does not provide care, or with a caregiver who
	 is not related by blood, marriage, or adoption in a house or apartment.
	 Unlicensed board and room homes, foster homes, adult family homes, facilities
	 licensed by the Department of Health (e.g., domicilary facilities, centers for
	 the developmentally disabled, intermediate care facilities), and other medical
	 facilities are not considered independent for this program.
Support Programs
: Other support programs
	 include all forms of local, state, or federal assistance, grants-in-aid,
	 educational programs, insurance benefits, and support provided by public or
	 private funds for disabled persons or their families.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 1 - INTRODUCTION › Section 472-1-004 - Fraud

Current through June 17, 2024
Any person who knowingly provides false information or knowingly
	 withholds pertinent information to obtain or attempt to obtain support under
	 this program may be prosecuted for fraud in a court of law and, if found
	 guilty, punished accordingly.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 2 - APPLICATION AND ELIGIBILITY › Section 472-2-001 - Clients Served

Current through June 17, 2024
001.01 Employed Disabled Clients
To be eligible for the DPF Support Program, employed disabled people
	 shall -
1. Reside with intent to
  remain in Nebraska;
2. Be currently
  employed or be able to become employed with the support of this
  program;
3. Require support to
  remain in an independent living situation;
4. Have insufficient income to cover
  disability-related support expenses necessary to remain independent;
  and
5. Meet the criteria for need
  (see 472 NAC
  2-003).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 2 - APPLICATION AND ELIGIBILITY › Section 472-2-002 - Application Process

Current through June 17, 2024
002.01 Request
Any individual may request an application for himself/ herself or as
	 representative for another person. All applications will be provided through
	 Central Office and may be requested directly from Central Office or through a
	 local office of the Department of Social Services.
002.02 Local Office Activities
Local offices shall accept all requests for DPF Support applications
	 and forward to the Department's Central Office staff.
Local office staff shall assist potential clients to complete the
	 application, as requested.
002.03 Central Office Responsibilities
Central Office staff shall -
1. Mail an application to each person
  requesting one;
2. Answer questions
  to facilitate application;
3.
  Evaluate each completed application to determine eligibility;
4. Notify each applicant in writing when a
  decision is reached; and
5.
  Maintain a waiting list of eligible applicants, as appropriate.
6. Provide the opportunity for a fair hearing
  (see 472 nAc
  4-004); and
7. Provide information and referral to any
  applicant whose request for assistance under this program is denied.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 2 - APPLICATION AND ELIGIBILITY › Section 472-2-003 - Needs Assessment

Current through June 17, 2024
003.01 Medical Need
Each applicant shall submit Form DPF-2, "Disabled Persons and Family
	 Support Disability Report," or other medical report containing similar
	 information with Form DPF-1 to verify that s/he meets the program definition of
	 disability. The medical information supplied must support the applicant's
	 request for assistance.
003.02 Alternate Support Programs
The assistance provided by the DPF Support Program is supplemental to
	 any other support program for which the applicant is eligible. The
	 applicant
shall -
1. Submit current
  program plans if currently receiving support from a service program, as
  requested;
2. Describe any support
  received in the past from any service program;
3. Report any instance when an application
  for service was denied;
4. Apply to
  all appropriate resources not previously explored; and
5. Accept any appropriate support offered
  through another program.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 2 - APPLICATION AND ELIGIBILITY › Section 472-2-005 - Support Services

Current through June 17, 2024
The Department may authorize support for disability-related expenses.
	 Examples include, but are not limited to -
1. Architectural modification of a home to
  remove barriers;
2. Attendant
  care;
3. Disability-related
  counseling or training;
4. Expenses
  incurred during evaluation or treatment;
5. Home health care;
6. Housekeeping services for disabled
  adults;
7. Payments for health
  services;
8. Purchase or lease of
  special equipment;
9. Respite care;
  and
10. Transportation.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 2 - APPLICATION AND ELIGIBILITY › Section 472-2-006 - Maximum Support

Current through June 17, 2024
The support provided through this program must not exceed $300 per
	 family or disabled person per month, averaged over the number of months in the
	 eligibility period. The Department shall determine the maximum monthly
	 expenditure for each case based on need and available funds. This maximum does
	 not prohibit the use of other resources to meet total support
	 costs.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 2 - APPLICATION AND ELIGIBILITY › Section 472-2-007 - Method of Provision

Current through June 17, 2024
Support may be provided directly to -
1. The family or disabled person;
  or
2. Qualified programs and
  services.
(See 472 NAC
	 4-002.)
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 2 - APPLICATION AND ELIGIBILITY › Section 472-2-008 - Forms and Instructions

Current through June 17, 2024
The following forms are used in the DPF Support Program:
1. Form DPF-3, "Service and Device
  Application (multi-agency form)" ( 472-000-1); and
2. Form DPF-2, "Disabled Persons and Family
  Support Disability Report" ( 472-000-2).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 3 - DPF SUPPORT PROVIDERS › Section 472-3-001 - Locating Providers

Current through June 17, 2024
Clients shall locate their own providers. The Department may refer
	 eligible clients to community resources with expertise in the appropriate
	 area.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 3 - DPF SUPPORT PROVIDERS › Section 472-3-002 - Contracts

Current through June 17, 2024
Clients may be required to contract with the approved provider(s) they
	 will be using. Form DPF-3, "Disabled Persons and Family Support Provider
	 Contract," may be used. The client shall submit a copy of the signed contract
	 to the Department before Department funds may be paid to that
	 provider.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 3 - DPF SUPPORT PROVIDERS › Section 472-3-003 - Provider Approval

Current through June 17, 2024
To be approved by the Department as a provider under this program, each
	 provider shall meet any applicable local, state, and federal laws and
	 regulations.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 4 - AUTHORIZING SUPPORT › Section 472-4-001 - Notices

Current through June 17, 2024
Based on eligibility factors, the needs assessment, and available
	 funds, the Department shall select clients for the DPF Support Program. Central
	 Office staff shall notify each applicant in writing when s/he has been
	 determined -
1. Eligible to
  participate in the program. The notice identifies the type(s) of support for
  which the individual/family is eligible;
2. Eligible for participation, but placed on
  a waiting list due to insufficient funds; or
3. Ineligible for participation.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 4 - AUTHORIZING SUPPORT › Section 472-4-002 - Payments

Current through June 17, 2024
The Department and the disabled person or family shall agree whether
	 support payments should be provided directly to the client or family or as
	 vendor payments to qualified providers.
002.01
Payment to the
  Client
If payments are to be made directly to the family or disabled person,
	 s/he shall sign and submit an itemized bill or receipt, signed also by the
	 provider, showing the amount(s) owed or paid to the approved
	 provider(s).
The amount billed by the client must be consistent with the
	 corresponding contract submitted to the Department, if one was required.
	 Regardless of the total disability-related expenses, the Department's payment
	 must not exceed the maximum dollar amount allowed the client.
Note
: DPF Support payments made directly to
	 the client might be considered as income by other assistance
	 programs.
002.02
Payment to the Provider
If payments are made directly to qualified programs and services, the
	 provider shall submit an itemized statement which -
1. Describes the support provided;
2. Includes the dates of service;
  and
3. Is signed by the client.
The amount billed by the provider must be consistent with the contract
	 submitted to the Department. Regardless of the total disability-related
	 expenses, the Department's payment shall not exceed the maximum dollar amount
	 allowed the client.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 4 - AUTHORIZING SUPPORT › Section 472-4-003 - Eligibilitv Periods

Current through June 17, 2024
The Department shall establish eligibility periods for participants
	 with ongoing needs. (See also 472 NAC
	 2-003 for non-employed clients who do
	 not reside with caregiver relatives.)
003.01 Reporting Changes
Each disabled person or head of a family receiving support under this
	 program shall immediately report any change in income, need, or provider to the
	 Department.
003.02 Notice of
  Adverse Action
The Department shall provide written notice to the client at least ten
	 calendar days in advance of the effective date if support is to be reduced or
	 terminated before the current authorization period ends.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 472 - THE DISABLED PERSONS AND FAMILY SUPPORT PROGRAM › Chapter 4 - AUTHORIZING SUPPORT › Section 472-4-004 - Right to Appeal

Current through June 17, 2024
Any disabled person or family who is denied support or whose support is
	 to be reduced or terminated under this program may appeal by requesting a fair
	 hearing in writing within 90 days of the date of the written notice or alleged
	 inaction. This request must
1. Include
  a short summary of the Department's action being appealed; and
2. Describe the reason for the appeal;
  and
3. Be sent to the Director of
  the Nebraska Department of Social Services.
The Department shall handle the appeal and fair hearing according to
	 the policies in 465 NAC
	 2-006.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 1 - GENERAL PROVISIONS › Section 473-1-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
Nebraska Revised Statute (Neb. Rev. Stat.) §
									68-1206
	 authorizes the Nebraska Department of Health and Human Services, hereinafter
	 "the Department," to administer a program providing social services to eligible
	 individuals. This Title governs the program services offered to elderly adults
	 and disabled adults.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 1 - GENERAL PROVISIONS › Section 473-1-002 - DEFINITIONS

Current through June 17, 2024
The following definitions apply:
002.01
ADVERSE
  ACTION.
The Department's determination that the services provided
  to a recipient will be reduced or terminated.
002.02
ADULT.
An
  individual age 19 or older.
002.03
EMANCIPATED MINOR.
A child age 18 or younger is
  considered emancipated if the individual has:
(A) Married; or
(B) Moved away from the parent's or legal
  guardian's home and is self-supporting.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 1 - GENERAL PROVISIONS › Section 473-1-003 - APPEAL RIGHTS

Current through June 17, 2024
Applicants and recipients have the right to appeal for a fair hearing
	 on the following matters:
(A) A
  determination that the applicant is not eligible to receive program
  services;
(B) Denial of
  services;
(C) Termination or
  reduction of services; or
(D)
  Inaction on the application.
003.01
EXCEPTION.
Applicants or recipients are not entitled
  to a fair hearing when state or federal law requires automatic case adjustments
  for classes of clients unless the reason for an individual appeal is incorrect
  eligibility determination.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-001 - APPLICATION FOR SERVICES

Current through June 17, 2024
Anyone may contact the Department by telephone, in writing, or in
	 person to obtain information, explore eligibility, or to apply for services.
	 Individuals may apply for themselves or as an authorized representative of
	 another person.
001.01
APPLICATION PROCESS.
Applicants must apply for
  services using a form approved by the Department. Applications must be signed
  and complete. Applications may be submitted in person, by mail, by fax, or by
  electronic submission. Applicants who require assistance with the application
  may ask the Department for assistance. Incomplete or unsigned applications may
  be denied.
001.02
INTERVIEWS.
An interview is required at initial
  eligibility determination. Interviews may be conducted face-to-face or
  telephonically. The Department determines if a face-to-face interview is
  necessary. If a face-to-face interview cannot be conducted at a local office,
  the Department will consider an interview at a mutually agreeable alternate
  location. The interview must be attended at least one of the following:
(A) An adult applicant;
(B) The applicant's legal guardian or
  conservator; or
(C) An adult
  representing the applicant.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-002 - ELIGIBILTY

Current through June 17, 2024
To be eligible the applicant must meet the following eligibility
	 rules:
002.01
RESIDENCY,
  CITIZENSHIP, AND ALIEN STATUS.
Only Nebraska residents are
  eligible for program services. Applicants and recipients must be United States
  citizens or qualified aliens as defined in Nebraska§ Revised Statute (Neb.
  Rev. Stat.) §
									4-111
  and sign an attestation form verifying lawful presence in the United States.
  The Department must be able to verify the recipient's status.
002.02
ELIGIBILITY BASED ON
  FAMILY SIZE.
The Department considers an applicant's family size
  in determining eligibility for services. A family is a unit consisting of one
  or more adults and any children related by blood, marriage, or adoption who
  reside in the same household. An unborn is included if proof of pregnancy is
  provided. Foster children may be included when determining the size of the
  foster family. The following are considered separate families:
(A) Unmarried adults who reside
  together;
(B) Children living with
  non-legally responsible relatives;
(C) Emancipated minors;
(D) Minor parents; and
(E) Biological parents or usual caretakers
  with a child in substitute care and children, if any, residing in the
  home.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-003 - NEEDS ELIGIBILITY

Current through June 17, 2024
Social services are authorized based on the applicant or recipient's
	 income eligibility and needs and are not provided based on demand. Need for a
	 particular service implies that the provision of that service will assist the
	 applicant, recipient, or the family members toward achieving one of the five
	 program goals:
(A) Achieving or
  maintaining economic self-support to prevent, reduce, or eliminate
  dependency;
(B) Achieving or
  maintaining self-sufficiency, including reduction or prevention of
  dependency;
(C) Preventing or
  remedying neglect, abuse, or exploitation of children and adults unable to
  protect their own interests, or preserving, rehabilitating, or reuniting
  families;
(D) Preventing or
  reducing inappropriate institutional care by providing for community-based
  care, home-based care, or other forms of less intensive care; or
(E) Securing referral or admission for
  institutional care when other forms of care are not appropriate.
003.01
NEEDS
  CRITERIA.
The applicant or recipient has no defined service need
  when:
(A) The applicant or recipient is able
  to perform or provide for the identified service needs in 473 NAC 4;
(B) The applicant or recipient has family
  members or caregivers who have the responsibility or capability to meet
  identified service needs;
(C) The
  applicant or recipient has other relatives, friends, or interested individuals
  who will provide needed identified services at no cost to the applicant or
  recipient or to the family;
(D) The
  applicant or recipient has access to financial resources which may be used to
  meet the needs;
(E) The applicant
  or recipient is residing in an institution except when transitioning from the
  institution or short-term care; or
(F) The applicant or recipient does not meet
  the requirements specified for each service.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-004 - VERIFICATION

Current through June 17, 2024
To determine initial or ongoing eligibility, the Department may need to
	 verify information provided by the applicant or recipient. The applicant or
	 recipient must cooperate with the verification process. Failure to cooperate
	 with verification may result in services being denied or reduced, termination
	 from the program, or establishment of an overpayment.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-005 - AUTHORIZATION

Current through June 17, 2024
The service provider is responsible for providing the service
	 authorized on the service authorization and in the provider agreement. Each
	 provider from whom service is purchased must receive authorization before
	 providing the service.
005.01
AUTHORIZATION FOR IN-HOME SERVICES.
If an individual
  in-home service provider is authorized, the applicant or recipient must execute
  necessary documents to appoint the Department as agent for state and federal
  employment taxes and other withholding taxes.
005.02
TERMINATING AUTHORIZED
  SERVICES.
When a service authorization is terminated before the
  end of the authorization period, the affected provider will be
  notified.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-006 - DUTY TO CONTACT THE DEPARTMENT

Current through June 17, 2024
The recipient or the authorized representative must contact the
	 Department when
(A) There has been a
  change in the recipient's situation such as a change in address, change in
  income, change in family composition, change in health, or change in need for
  services; or
(B) The recipient is
  dissatisfied or experiencing problems with the service delivery.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-007 - NOTICE OF AGENCY ACTION

Current through June 17, 2024
The Department will mail the applicant or recipient a notification of
	 agency action when
(A) An applicant is
  determined ineligible for program services;
(B) A recipient is found ineligible at the
  time of verification or redetermination;
(C) A requested service is denied or provided
  services are to be reduced or terminated;
(D) A provider has met standards to be
  approved as a provider; or .
(E)
  When a recipient's provider is disapproved or will not be reapproved.
007.01
ADVANCE
  NOTICE.
When a provided service is to be reduced or terminated,
  the Department provides written notice to the recipient at least ten calendar
  days before the adverse action is effective.
007.02
ADEQUATE
  NOTICE.
If the Department has verified possible recipient fraud, a
  notice of termination or reduction is sent to the recipient no later than the
  action's effective date.
007.03
SERVICE CONTINUATION DURING APPEAL.
In cases where
  advance notice has been given, the recipient may appeal. If the appeal is
  requested in writing within ten days following the date the Department's notice
  was mailed, the adverse action will not be carried out until a fair hearing
  decision is made. In situations where only adequate notice is required, service
  is not continued pending a hearing decision.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-008 - SOCIAL SERVICE EXCEPTION

Current through June 17, 2024
In limited circumstances, the Department may grant waivers of the
	 requirements when necessary to:
(A)
  Meet extraordinary needs of individuals eligible for services; or
(B) Obtain providers for eligible applicants
  or recipients.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-009 - TIME-LIMITED SERVICE EXCEPTIONS

Current through June 17, 2024
Approval for extension beyond the initial six month authorization
	 period for the sole purpose of ongoing advocacy or follow-up will not be
	 granted. The following services are time limited:
(A) Services provided in conjunction with
  Adult Protective Services;
(B)
  Adult Day Services; and
(C)
  Homemaker.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-010 - ASSIGNMENT OF PAYEE, GUARDIANSHIP, OR CONSERVATOR STATUS

Current through June 17, 2024
No employee of the Department may serve as a guardian or conservator
	 for any recipient for whom the employee:
(A) Determines eligibility;
(B) Authorizes service provision;
(C) Provides direct services; or
(D) Has any other professional relationship
  which may be considered a conflict of interest.
010.01
SERVICE WORKER AS
  PROTECTIVE PAYEE.
A Department employee may act as a protective
  payee for a recipient only if the employee does not determine eligibility for a
  categorical program for the recipient. All other community resources must be
  explored before a services worker may accept the payee assignment.
010.02
PROVIDER AS PROTECTIVE
  PAYEE.
The Department must approve before a service provider who
  contracts with the Department may act as protective payee for a recipient
  served by the service provider.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 2 - APPLICATION AND ELIGIBLITY › Section 473-2-011 - ELIGIBILITY REDETERMINATION

Current through June 17, 2024
Eligibility redeterminations must be conducted at least once every
	 twelve months. More frequent redeterminations may be necessary whenever the
	 Department learns of a change in the recipient's circumstances or possible
	 change in need for services. An interview may be necessary as part of the
	 redetermination process.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-001 - INTRODUCTION

Current through June 17, 2024
This Chapter contains definitions, requirements, and standards used in
	 evaluating and approving social service providers who wish to enroll and
	 provider services through this Program.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-002 - DEFINITIONS

Current through June 17, 2024
The following definitions apply:
002.01
INDIVIDUAL PROVIDER.
A provider who has no employees and will not normally subcontract
  any service(s) for which they are requesting approval to provide. Individual
  providers are independent contractors and not employees of the Department or
  the State of Nebraska. For the purpose of the Federal Insurance Contribution
  Act withholding for Social Security and Medicare taxes, the provider is
  considered an employee of the recipient.
002.02
PROVIDER IDENTIFICATION
  NUMBER:
A nine-digit Federal Identification number or a nine-digit
  Social Security number followed by a two-digit suffix code.
002.03
PROVIDER ENROLLMENT FORM.
A document whereby the provider indicates willingness to
  participate in the program and provide services to recipients. The enrollment
  form describes the services to be provided as well as the agreed upon units and
  unit rates for the each provider. The provider's responsibilities are stated in
  the enrollment form.
002.04
SUBCONTRACTING.
When a service provider pays someone
  other than a provider's employee to provide the contracted service .
002.05
TWO-DIGIT SUFFIX
  CODE.
Two identifying numbers attached to the Federal
  Identification Number of providers who share the same Federal Identification
  Number due to affiliation with a larger agency.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-003 - FACE-TO-FACE INTERVIEW

Current through June 17, 2024
A face-to-face interview is required of each potential provider.
003.01
FAILURE TO MEET
  STANDARDS.
If the potential provider does not meet standards at
  the time of the initial visit or face-to-face interview, but is able to correct
  the deficiency within 30 days, the enrollment process will continue when proof
  of compliance with standards is received.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-004 - CONFLICT OF INTEREST

Current through June 17, 2024
No employee of the Department may be approved as a service provider if
	 the employee is in a position to influence the employee's own approval or
	 utilization.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-005 - RECIPIENT'S RELATIVE AS PROVIDER

Current through June 17, 2024
A relative provider may not be a legally responsible relative or legal
	 dependent of the recipient. A non-legally responsible relative of a recipient
	 may be a provider if it is documented that the relative provider is held to the
	 same provider requirements as non-relative providers.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-006 - SERVICE PROVIDER ENROLLMENTS

Current through June 17, 2024
The following requirements govern service provider enrollments:
(A) Each provider must be properly enrolled
  before services can be authorized for purchase;
(B) The Department must evaluate and approve
  or disapprove all service providers seeking enrollment;
(C) Enrollments are effective up to 12
  months, are never back-dated, and must be signed by the provider on or before
  the effective date;
(D) Changes in
  the services of a provider or terms require a new enrollment form. Address
  changes which do not affect the service location do not require a new
  enrollment form but an amendment must be completed showing the provider's new
  address;
(E) Notice of any changes
  in services, units or unit rates proposed by either the provider or the service
  agency must be given as soon as possible; and
(F) Service provider enrollments must be
  approved by the Department.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-007 - PROVIDER EVALUATION

Current through June 17, 2024
As part of the provider approval process, the Department conducts an
	 evaluation consisting of the following:
(A) A face-to-face interview with each
  potential provider at least annually;
(B) Annual visits to each facility in which
  services are provided to recipients outside of recipients' homes; and
(C) Assessment of the quality of service
  provision at least once during the enrollment period by observing service
  delivery, visiting the service facility, interviewing the provider, or
  interviewing a recipient served by the provider.
007.01
PROVIDER
  COMPLIANCE.
If the provider does not meet standards at the time of
  the initial visit or interview, but is willing to correct the deficiency within
  30 days, the evaluation process will continue when proof of compliance is
  received.
007.02
SUBCONTRACTORS.
Site visits are not required for
  subcontracted facilities. The service provider shall ensure that subcontractors
  meet all standards and requirements.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-009 - SERVICE PROVIDER ENROLLMENT RENEWAL

Current through June 17, 2024
The provider will undergo an evaluation at the time of renewal before
	 the expiration of the enrollment term and any time there is reason to believe
	 the provider is not fulfilling the provider's responsibilities. The Department
	 may require providers and provider employees to undergo updated background
	 checks as part of the renewal process.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-010 - PROVIDER TERMINATIONS

Current through June 17, 2024
Either the Department or the provider may terminate an enrollment by
	 giving at least 30 days advance written notice. The 30-day requirement may be
	 waived in case of emergencies such as illness, death, injury, or fire. A
	 written notice will be sent to the provider when the Department terminates a
	 provider enrollment. Written notice to the provider is not required when the
	 provider or potential provider voluntarily withdraws an application to
	 enroll.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-011 - PROVIDER STANDARDS

Current through June 17, 2024
The following standards apply to all providers:
(A) The proposed service must meet the
  service definitions;
(B) The
  Department need not enroll a potential provider if the proposed service is
  sufficiently available. The Department has discretion to determine if adequate
  services are available;
(C) All
  service providers must have a Federal Identification number or Social Security
  number whichever is appropriate before being approved for enrollment;
(D) The provider must not be the parent of
  the minor child receiving services nor the legal guardian, spouse, or minor
  child of the recipient;
(E) The
  provider must not have a history of chronic incorrect or inaccurate billings
  whether intentional or unintentional for services that have been provided or
  have a criminal history of financial mismanagement; and
(F) The provider must not engage in or have
  an ongoing history of criminal activity that may be harmful or may endanger
  individuals for whom the provider serves. This may include a substantiated
  listing as a perpetrator on the child or adult Central Registries of abuse or
  neglect; a criminal conviction for a crime endangering the life, well-being, or
  safety of the victim or a member of the public; or a crime involving fraud or
  theft of property or services. The following criminal violations will
  disqualify a provider from enrollment:
(i)
  Child pornography;
(ii) Child
  sexual abuse;
(iii) Driving under
  the influence. For providers of non-transportation services, two or more
  driving under the influence citations or convictions have occurred within the
  last five years;
(iv) Domestic
  violence;
(v) Shoplifting after age
  19 within the last three years;
(vi) Felony fraud within the last 10
  years;
(vii) Misdemeanor fraud
  within the last five years;
(viii)
  Termination of provider status for cause from any Department program within the
  last 10 years;
(ix) Possession of
  any controlled substance within the last five years;
(x) Possession of a controlled substance with
  intent to deliver within the last five years;
(xi) Felony or misdemeanor assault without a
  weapon in the last 10 years;
(xii)
  Felony or misdemeanor assault with a weapon in the last 15 years;
(xiii) Prostitution or solicitation of
  prostitution within the last five years;
(xiv) Felony or misdemeanor robbery or
  burglary within the last 10 years;
(xv) Rape or sexual assault;
(xvi) Homicide; or
(xvii) Other pending criminal charges or
  convictions are evaluated using the general guidelines of this Chapter and
  weighted to similar offenses included on this list.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 3 - SOCIAL SERVICE PROVIDERS › Section 473-3-014 - SOCIAL SECURITY TAX WITHHOLDING

Current through June 17, 2024
In some situations, the Department withholds Social Security taxes
	 from provider payments. Individual in-home service providers of adult day care,
	 homemaker services, and chore service providers who are not affiliated with an
	 agency or who are not self-employed are considered employees of the recipient
	 from whom they provide services. For in-home service providers who are not
	 affiliated with an agency, the Department acts on behalf of those recipients to
	 withhold mandatory Social Security taxes and pay the recipient's matching tax
	 share to the Internal Revenue Service.
014.01
EARNINGS TAXED FOR SOCIAL
  SECURITY.
Providers are subject to Social Security tax payment for
  each calendar quarter in which they are paid $
  50.00 or more for services provided
  to one recipient. The $
  50.00 is for one recipient, not a
  total received for two or more recipients. The Department withholds the tax
  from all payments to providers. If a provider's earnings do not reach $
  50.00 per quarter, the amount
  withhold for that quarter is refunded.
014.02
SELF-EMPLOYED
  PROVIDERS.
Individuals who file Social Security taxes on their own
  behalf are considered self-employed. They are identified by a Federal
  Identification number rather than a Social Security number.
014.03
SOCIAL SECURITY TAX
  RATES.
The Department remits to the Internal Revenue Service an
  amount equal to the current Social Security tax rate for specified in-home
  services. Half of this amount is withheld from the provider as the employee's
  share; the other half is provided by the Department on behalf of the recipient
  employer.
014.04.
OTHER
  TAXES.
The Department does not withhold federal or state income
  tax or federal unemployment tax from any provider payment.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 473 - SOCIAL SERVICES FOR THE AGED AND DISABLED › Chapter 4 - DEFINED SERVICES › Section 473-4-001 - CHORE SERVICE

Current through June 17, 2024
This section contains material which governs:
(A) The authorization and provision of chore
  services; and
(B) The evaluation
  and approval of chore service providers.
001.01
CHORE SERVICE
  NEED.
Chore service is not provided based on the demand of the
  recipient. Any person receiving social services must have a defined need for
  service in order to meet eligibility requirements. Need implies that the
  provision of that services will assist the client to advance toward the
  achievement of program goals.
001.02.
AVAILABLE CHORE
  SERVICES.
The available chore services are those which could
  normally be performed by the applicant or recipient, but the applicant or
  recipient is presently unable to perform as determined during the service needs
  assessment process.
001.02(A)
CLEANING.
Cleaning services include light
  housecleaning that is required in order to maintain the individual in a safe
  and sanitary environment. Cleaning includes only vacuuming, sweeping, mopping,
  dusting, trash removal, cleaning and sanitizing of the kitchen and bathroom,
  cleaning and clearing the refrigerator of old and spoiled foods, and cleaning
  the stove and oven as appropriate. It does not include window washing,
  furniture moving, cleaning closets or drawers, any exterior cleaning or
  maintenance, or other non-essential tasks.
001.02(A)(i)
ESSENTIAL
  TASKS.
For essential tasks, the recipient shall provide necessary
  supplies.
001.02(A)(ii)
EXCPETION.
An exception will be considered for an
  Adult Protective Services recipient whose home requires major one-time
  cleaning.