403 Neb. Admin. Code, ch. 2, § 008

Current through May 7, 2024

Section 403-2-008 - FUNDING

008.01OBJECTIVE ASSESSMENT PROCESS (OAP). The funding for a participant is determined using the Objective Assessment Process (OAP) involving information from an assessment of the participant's physical, cognitive, and emotional functioning.

008.01(A)OBJECTIVE ASSESSMENT. The assessment must include a comprehensive assessment of the participant's:

(i) Activities of daily living (ADL);

(ii) Problematic Behaviors;

(iii) Community Living; and

(iv) Behavioral and health factors.

008.01(B)DATA. Scoring data from the assessment are entered into a formula to determine the funding amount for day services or residential services.

008.01(C)BUDGET. An individual budget amount is assigned for each participant based on each participant's assessed needs. Assessments are completed to determine individual budget amounts for participants.

008.02EXCEPTION FUNDING. When the Individual Support Plan (ISP) team identifies an individual's needs cannot be safely met through their Individual Budget Amount (IBA), the team can request additional funds with an exception. The amount of exception funding is for the cost of additional services to meet the participant's behavioral or medical needs. Exception funding is short-term. If increased needs are likely to be long-term, a new Inventory for Client and Agency Planning (ICAP) may be completed, instead of considering exception funding.

008.02(A)EXCEPTION REQUEST APPROVAL. When an exception request is approved:

(i) The participant's Service Coordinator shall distribute the Request for Exception to the Individual Budget Amount (IBA) form, which includes an explanation of the decision and any recommendations made by the Division of Developmental Disabilities (DDD), to the Individual Support Plan (ISP) team. This includes the duration of the approval, the approved rate, and expectations for the provider;

(ii) The Division of Developmental Disabilities (DDD) shall send a notice of the decision to the participant; and

(iii) After the Division of Developmental Disabilities (DDD) makes the exception decision, the Individual Support Plan (ISP) team shall meet to discuss the decision and any recommendations.

008.02(B)EXCEPTION REQUEST DENIAL. When an exception request is denied:

(i) The Service Coordinator shall provide the Individual Support Plan (ISP) team "A Request for Exception to the IBA" form, which includes an explanation of the decision and any recommendations made by Division of Developmental Disabilities (DDD);

(ii) The Division of Developmental Disabilities (DDD) shall send a notice of decision, with appeal information, to the participant; and

(iii) The ISP team shall meet to discuss the explanation of the decision and any recommendations made by the Division of Developmental Disabilities (DDD) clinical team.

403 Neb. Admin. Code, ch. 2, § 008

Amended effective 5/7/2024