404 Neb. Admin. Code, ch. 4, § 001

Current through September 17, 2024

Section 404-4-001 - CERTIFICATION OF PROVIDERS

All agency providers of services under the Developmental Disabilities Services Act must meet the certification and accreditation requirements established by the Department of Health and Human Services.

001.01OVERVIEW OF CERTIFICATION PROCESS. To become a certified provider, the provider applicant must:

(1) Submit a complete application;

(2) Be a United States citizen or qualified alien under applicable federal and state law;

(3) Provide all additional information the Department may require; and

(4) Comply with all provider requirements in this chapter.

001.01(A)APPLICATION. An applicant for certification as an agency provider of developmental disabilities services must apply for certification on the forms supplied by the Department. The applicant shall provide the following:

(i) The legal name of the applicant, address, and contact information;

(ii) The structure, such as partnership, corporation, government, or limited liability company;

(iii) A list of names and addresses of all persons with financial interest in the agency provider;

(iv) The preferred mailing address for receipt of official notices from the Department;

(v) The applicant's federal employer identification number;

(vi) The signature of the person of authority applying to be a certified agency provider;

(vii) A copy of the registration as a foreign corporation filed with the Nebraska Secretary of State, if applicable;

(viii) Program description for provision of services that includes:

(1) A copy of the applicant's organizational chart identifying authority over the agency and the organization of management positions;

(2) The developmental disabilities services to be provided;

(3) The address, including street and city, and telephone number of each location for service delivery, including type of service to be provided at each location and planned capacity at each location;

(4) Copies of current policies and procedures, as required by this chapter; and

(5) A list of all subcontractors and proposed subcontracts that will provide services under this application; and

(ix) A disclosure of any criminal history or listing on the Department's Central Abuse and Neglect registries or the Nebraska State Patrol Sex Offender Registry for any management positions, including owners, directors, and managers;

(x) At initial certification only, documentation showing the provider maintains a $10,000.00 minimum cash reserve or business line of credit; and

(xi) A statement of intent to seek a risk endorsement (if applicable).

001.01(B)INITIAL CERTIFICATION. For prospective providers, the Department will issue an initial certification for a six month period upon approval of the application. Before the expiration of initial certification, the Department will conduct an on-site review to determine compliance.

001.01(B)(i)EXTENSIONS. Initial certification may be extended for up to six additional months when the provider has not been serving a participant for at least 90 days before the initial certification expires.

001.01(B)(ii)REVIEW. Following on-site review, the Department will:

(1) Issue a one or two year certification when the provider is found to be in compliance with applicable regulations;

(2) Extend initial certification on a one-time basis for up to six months when the on-site review shows the provider is not in compliance with applicable regulations, but there are no health or safety issues and the provider is making satisfactory progress towards compliance; or

(3) Deny certification when the on-site certification review shows the provider is not in compliance with applicable regulations and has not made progress in doing so, or there are serious health or safety issues identified.

001.01(C)LENGTH OF CERTIFICATION. Provider certification is contingent upon compliance with applicable 404 NAC standards as required by the Department. Agencies, organizations, or individuals seeking certification will receive a two-year certification upon successful completion of the certification review. If the outcomes of the certification review show significant or repeated deficiencies, or if there is evidence that provider systems are not functioning properly, the Department may issue a one-year certification.

001.01(D)DENIAL OF CERTIFICATION. The Department, in its discretion, may deny or terminate a provider's certification for good cause, which includes but is not limited to the following grounds:

(1) Violations of any of the provisions of Nebraska Administrative Code (NAC) Titles 172, 403, 404, 471, 480, 482 or other applicable law or regulation governing services provided;

(2) The provider or its owner is the respondent of a protection order;

(3) The provider or its owner committed a crime:

(a) Against a child or vulnerable adult;

(b) Involving the illegal use, possession, or distribution of a controlled substance; or

(c) That, if repeated, could injure or harm the Developmental Disabilities Services Waiver program or a developmental disabilities services participant;

(4) A provider's owner or administrative staff or management have been convicted of any of the crimes listed in this chapter; or

(5) The provider or its owner is listed as a perpetrator on the Nebraska Adult Protective Services Central Registry or the Child Abuse and Neglect Central Registry in a court-substantiated or agency-substantiated case or is listed as a perpetrator on any comparable registry in any other state.

001.01(D)(i)COMMISSION OF CRIMES. The Department deems a crime to have been committed when a conviction, admission, or substantial evidence of commission exists. In exercising its discretion, the Department considers the severity of the crime(s), the applicability of the crime(s) to the service of the provider, and the amount of time that has passed since the commission of the crime.

001.01(D)(ii)FAILURE TO DISCLOSE. Failure to disclose requested information on the application or providing incomplete or incorrect information on the application may result in the denial of a certification.

001.01(E)CONDITIONS FOR DENIAL OR TERMINATION. Provider certification will be denied or terminated when any person with a 5% or greater direct or indirect ownership interest in the provider has been convicted of a criminal offense related to that person's involvement with a Medicare, Medicaid, or Title XXI program within the last ten years, unless the Department determines that denial or termination of enrollment is not in the best interest of the program.

001.02EXTENSION OF CERTIFICATION. The Department may extend the certification for up to 60 calendar days, for good cause shown.

001.03CERTIFICATION RENEWAL. Renewal applications must be submitted at least 90 calendar days prior to the expiration of the current certification. At any time, the Department may conduct an onsite review and request additional documentation.

001.03(A)ON-SITE CERTIFICATION REVIEW. Initial and renewal certifications will not be issued until the Department has conducted an on-site certification review to assess compliance.

001.03(B)RENEWAL APPLICATION. The provider must submit a complete renewal application which includes all requirements outlined in this chapter.

001.04RISK ENDORSEMENT. In addition to all other certification requirements in this chapter, a certified agency seeking risk endorsement must meet specific qualifications including the following:

(A) Full-time employment of a clinician who is currently licensed in Nebraska as one of the following:

(i) Licensed Independent Mental Health Practitioner (LIMHP);

(ii) Licensed Clinical Psychologist; or

(iii) Advanced Practice Registered Nurse (APRN);

(B) Two consecutive years operating as a certified, licensed, or accredited agency provider of Medicaid 1915(c) Waiver Home and Community-Based Services for individuals with developmental disabilities in Nebraska or another state;

(C) In good standing with the certification, licensing, or accrediting body in any and all states of operation; and

(D) Any other requirements as defined by and at the Department's discretion.

001.05NOTIFICATION REQUIREMENTS. The provider must notify the Department, in writing, of any:

(1) Change of ownership or control within 10 business days of the effective date;

(2) Change in director within 10 business days of the effective date;

(3) Addition of a new service option at least 30 calendar days prior to the effective date;

(4) Termination of a service option currently being provided to participants at least 60 calendar days prior to the effective date;

(5) Addition of a new provider-operated or controlled service setting at least 15 calendar days prior to opening;

(6) Change in contact information, including physical business address, phone number, mailing address, and e-mail address, within 10 business days of the effective date; and

(7) For any provider with a risk endorsement, a change in clinician, change in clinician's employment status with the provider, or change in clinician's license status, within 5 business days of the effective date of the change.

001.05(A)CHANGE IN OWNERSHIP. A provider certification is issued only to the person named in the application as the certified provider. When a change of ownership occurs, the new owner must assume responsibility for correction of all previously cited deficient practices from the acquired provider.

001.06CERTIFICATION AND SERVICE REVIEWS. The Department may, at any time, conduct unannounced on-site reviews. Providers must cooperate with site reviews and documentation requests.

001.06(A)RESULTS OF CERTIFICATION OR SERVICE REVIEWS. If the Department determines there are deficiencies or discovers non-compliance, the provider may:

(i) Be required to provide a plan of improvement;

(ii) Have a disciplinary action imposed; or

(iii) Have its certification terminated.

001.06(B)PLAN OF IMPROVEMENT. If the Department determines that a provider is in non-compliance with the provider requirements outlined in the Medicaid provider agreement or applicable law or regulation, a plan of improvement will be required from the provider. Within 20 days of receipt of the Department's written findings of non-compliance, the provider must submit an acceptable plan of improvement to address areas found to be out of compliance. The plan of improvement must:

(i) Be specific in identifying a planned action on how the areas found to be out of compliance have been or will be corrected for the individual cases included in the review and system wide within the provider organization;

(ii) Include an expected date for completion of the plan of improvement that is timely, taking into consideration the nature of the violation;

(iii) Identify a means to prevent a recurrence;

(iv) Identify who is responsible for implementing the plan of improvement and ensuring all areas are corrected and compliance is maintained; and

(v) Be signed and dated by the director of the provider or designee.

001.07DISCIPLINARY ACTIONS. When a provider is out of compliance with the provider requirements outlined in the Medicaid provider agreement or applicable law or regulation, the Department may impose, in any order, one or more of the following types of disciplinary action.

001.07(A)DIRECTED PLAN OF IMPROVEMENT. The provider will be required to implement a directed plan of improvement, within the specified period of time, developed by the Department, containing specific actions and timeframes.

001.07(B)DIRECTED IN-SERVICE TRAINING. The provider will be required to train staff as required by the Department. The provider is responsible for the required training and the associated cost of the training.

001.07(C)STATE MONITORING. The provider will be required to submit to monitoring by the Department or designee as a safeguard against further harm or injury to participants or serious risk to the safety of the participants.

001.07(D)PROBATION. The provider will be placed on probation and be required to meet the terms and conditions of the probation in order to continue to operate.

001.07(E)SUSPENSION OF SERVICES. The provider will be prohibited from:

(i) Accepting new participants;

(ii) Providing a specific service to any participants;

(iii) Providing a specific service at a specific site; or

(iv) Providing services as otherwise deemed appropriate by the department.

001.07(F)TERMINATION OF THE PROVIDER CERTIFICATION. The provider's certification may be terminated when:

(i) The provider's non-compliance poses an immediate and serious threat to one or more participant's health and safety;

(ii) The provider's conduct or practices are detrimental to the health or safety of a participant or others;

(iii) The provider knowingly fails to report abuse, neglect, or exploitations as required by applicable law;

(iv) The provider has established a pattern of not maintaining compliance;

(v) The provider has not corrected previously identified areas of non-compliance;

(vi) The provider has established a pattern of not using internal quality improvement practices;

(vii) The provider commits, permits, aids, or abets any unlawful act that would disqualify it from enrollment as a provider;

(viii) The provider failed to disclose information on the application or provided incomplete or incorrect information on the application;

(ix) The provider has failed to submit an acceptable plan of improvement; or

(x) The provider has failed to comply with any previously imposed disciplinary action directed by the Department.

001.07(G)NOTICE OF DISCIPLINARY ACTION TO PROVIDER. Notice of disciplinary action will be given to the provider in writing via mail or email.

001.07(H)IMMEDIATE AND SERIOUS THREATS TO HEALTH AND SAFETY. When situations involving immediate and serious threat to one or more participants' health and safety are identified, the provider:

(i) Upon discovery, must take immediate action to remove the risk to the identified individual and implement corrective measures to prevent further immediate and serious threat situations;

(ii) May have participants removed from its services, if the provider fails to remove the risk to identified participants and to implement corrective measures to prevent further immediate and serious threat situations;

(iii) May have its certification terminated unless the provider has eliminated the immediate and serious threat and is able to maintain corrective actions;

(iv) Must submit written evidence of correction or that the circumstances causing the immediate and serious threat no longer exist and that safeguards are in place to ensure the health and safety of participants; and

(v) May be required to submit to monitoring by the Department, including revisits, to verify compliance.

001.08APPEAL RIGHTS. Any adverse action taken under Chapter 4 of this Title may be appealed to the Director of the Division of Developmental Disabilities by the person or entity against whom the action was taken.

001.08(A)HEARING REQUEST PROCEDURE. The person or entity appealing an adverse action under Chapter 4 of this Title must submit a written hearing request to the Director of the Division of Developmental Disabilities within 30 days of the date of the action.

001.08(B)HEARINGS. Appeal and hearing procedures are governed by 465 NAC.

404 Neb. Admin. Code, ch. 4, § 001

Amended effective 11/19/2022

Amended effective 9/17/2024