Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 32 - CHILDREN'S MENTAL HEALTH AND SUBSTANCE USE TREATMENT SERVICES › Section 471-32-005 - Treatment Foster Care Services

Current through June 17, 2024
Treatment foster care services are available to clients age 20 or
	 younger when the client has participated in a HEALTH CHECK (EPSDT) screen, the
	 treatment is clinically necessary, and an Initial Diagnostic Interview
	 documents the need for continued care of this level. Treatment foster care
	 occurs in a foster home when specially trained foster parents are available at
	 all times to provide consistent behavior management programs, therapeutic
	 interventions, and render services under the direction of a supervising
	 practitioner. Treatment foster care services must be community-based, family
	 focused, culturally competent, and developmentally appropriate. Treatment is
	 provided within a family environment with services that focus on improving the
	 client/family's adjustment emotionally, behaviorally, socially, and
	 educationally. To be eligible to receive treatment in a treatment foster care
	 program, the client must participate in a HEALTH CHECK (EPSDT).
Providers must encourage family members to be involved in the
	 assessment of the client, the development of the treatment plan, and all
	 aspects of the client's treatment unless prohibited by the client, through
	 legal action, or because of federal confidentiality laws.
Providers must be available to schedule meetings and sessions in a
	 flexible manner to accommodate and work with a family's schedule. This includes
	 the ability to schedule sessions at a variety of times including weekends or
	 evenings.
The provider must document their attempts to involve the family in
	 treatment plan development and treatment plan reviews. A variety of
	 communication means should be considered. These may include, but should not be
	 limited to, including the family via conference telephone calls, using
	 registered letters to notify the family of meetings, and scheduling meetings in
	 the evening and on weekends.
005.01
  Definitions
The following definitions and descriptions apply to treatment foster
	 care services:
Agency Staff
: Treatment foster care requires
	 agency staff who are qualified, trained, and supported to implement the
	 treatment model. Some treatment foster care initiatives have been undertaken in
	 which one or a few staff with duties in other program areas assume
	 responsibility for additional treatment foster care cases. Such arrangements
	 tend to dilute the time, resources, and support available to the TFC Specialist
	 and to the intensity and focus of the services provided. This does not
	 constitute a true program of treatment foster care. A treatment foster care
	 program must have an adequate number of staff to provide administration and
	 direct services. See 471 NAC 32-001.04 for further staff requirements.
Children and Adolescents
: Treatment foster
	 care serves clients age 20 or younger whose special needs cannot be met in
	 their own families and who require out-of-home care. In addition to providing
	 treatment for specific problems or conditions, treatment foster care seeks to
	 promote a permanent family living arrangement for the children and youth it
	 serves.
Family Treatment
: Treatment foster care
	 programs also serve the families of the children and adolescents in their care.
	 Treatment foster care programs seek to involve children and families in
	 treatment-planning and decision making as members of the treatment team. They
	 provide family services to children and their families when return home is
	 planned, and actively seek to support and enhance children's relationships with
	 their parents, siblings, and other family members throughout the period of
	 placement regardless of the permanency goal unless such efforts are expressly
	 and legally prohibited.
TFC Program
: A program of treatment foster
	 care is a coherent, integrated constellation of services specifically designed
	 to provide treatment within the foster home setting. The term program implies a
	 discreet organizational entity with clearly stated purposes and means of
	 achieving them which are logically described and justified within the framework
	 of a consistent treatment philosophy. As a program, treatment foster care is
	 agency lead and team oriented.
Treatment
: Treatment is the coordinated and
	 planned provision of services and use of procedures designed to produce a
	 planned outcome in a person's behavior, attitude, or general condition based on
	 a thorough assessment of possible contributing factors. Treatment typically
	 involves the teaching of adaptive, pro-social skills and responses which equip
	 young persons and their families with the means to deal effectively with
	 conditions or situations which have created the need for treatment. The term
	 treatment presumes stated, measurable goals based on professional assessment, a
	 set of written procedures for achieving them, and a process for assessing these
	 results. Treatment accountability requires that goals and objectives be time
	 limited and outcomes systematically monitored.
Treatment Foster Family
: The treatment foster
	 family is viewed as the primary treatment setting, with treatment parents
	 trained and supported to implement the in-home portion of the treatment plan
	 and promote the goals of permanency planning for children in their care. The
	 treatment foster parents provide the main behavioral intervention and are
	 available at all times. (At least one TFC parent per home must be considered a
	 professional TFC parent whose time is dedicated to the TFC program.) While
	 their role is essential to the model, treatment parents do not carry primary or
	 exclusive responsibility for the design of treatment plans. This is a team
	 function carried out under the clinical direction of qualified program
	 staff.
005.02 Standards of
  Participation for Service Providers
The Nebraska Medical Assistance Program does not pay for care that is
	 chronic or custodial. An agency that provides treatment foster care services
	 shall meet the following standards for participation to ensure that payment is
	 made only for active treatment:
1. The
  agency shall meet the standards in 471 NAC
  32-001 and 471 NAC 32-005;
2. The treatment foster homes shall meet the
  minimum regulations for foster homes caring for children and be licensed
  through the Department (see 474 NAC
  6-003) or approved by the placing
  agency;
3. The agency providing
  treatment foster care must be licensed as a Child Placing Agency (see 474 NAC
  6-005);
4. The agency's records
  must be sufficient to permit the Department to determine the degree and
  intensity of treatment services furnished to the client/family;
5. The agency shall meet staffing
  requirements the Department finds necessary to carry out an active treatment
  program;
6. The program is designed
  to meet the developmental needs of persons age 20 and younger;
7. The program must provide for both planned
  and unplanned respite care services; and
8. The place of service must be the treatment
  foster family home.
32-005.02A
Provider Agreement
: A provider of treatment foster
  care (TFC) services shall complete a provider agreement, Form MC-19 or Form
  MC-20, "Medical Assistance Provider Agreement," and submit the completed form
  along with a program plan to the Department for approval. The provider
  application and agreement must be renewed annually to coincide with the
  submittal of the cost report (see 471 NAC 32-005.09).
An outline of the information required in a program plan is available
	 from the Division of Medicaid and Long-Term Care.
If an agency providing treatment foster care is licensed, certified, or
	 accredited through another agency (Department of Health and Human Services,
	 Division of Public Health, Joint Commission on Accreditation of Health Care
	 Organizations (JCAHO), etc.), the provider shall maintain this and provide a
	 current copy for verification.
Agencies providing treatment foster care must be appropriately licensed
	 by the Department of Health and Human Services, Division of Public
	 Health.
32-005.02B
Annual Renewal/Update
: The program will submit
  information with the provider agreement (see 471 NAC
  32-005.02A) and
  update the information annually and whenever requested by the Division of
  Medicaid and Long-Term Care.