Section 471-31-003 - PROVIDER REQUIREMENTS003.01GENERAL PROVIDER REQUIREMENTS. To participate in the Nebraska Medical Assistance Program (Medicaid), providers of intermediate care facility for Individuals with developmental disabilities (ICF/DD) services must comply with ail applicable participation requirements codified in 471 NAC 2 and 3. In the event which provider participation requirements in 471 NAC 2 and 3 conflict with requirements outlined in this chapter, the individual provider participation requirements in this chapter govern.003.02SPECIFIC PROVIDER REQUIREMENTS. To participate in Medicaid, an intermediate care facility for individuals with developmental disabilities (ICF/DD) must: (1) Meet all related requirements for participation in Medicaid as required by state and federal law and regulation;(2) Be certified as a Title XIX intermediate care facility for individuals with intellectual disabilities (ICF/IID) per federal regulations and licensed as an intermediate care facility for individuals with developmental disabilities (ICF/DD) by the Nebraska Department of Health and Human Services, Division of Public Health or, for an out-of-state facility, by that state's survey agency;(3) Provide licensed nurses sufficient to care for clients' health needs, as defined in 42 CFR 483.460(c) and (d);(4) Provide active treatment as defined in this chapter, and 42 CFR 483.440- 483.450; and(5) Have a current Medicaid provider agreement with the Department of Health and Human Services, Division of Medicaid and Long-Term Care. 003.02(A)AGENCY COOPERATION. AH intermediate care facility for individuals with developmental disabilities (ICF/DD) facilities must provide staff of the federal Department of Health and Human Services, and Medicaid with the data, forms, and cooperation necessary to admit, plan for, evaluate the needs of, and make determinations on the appropriate care level for each individual eligible for Medicaid as required by federal and state Medicaid regulations.003.02(B)FREEDOM OF CHOICE. Each intermediate care facility for individuals with developmental disabilities (ICF/DD) must ensure that any client may exercise their freedom of choice in obtaining Medicaid-covered services from any provider qualified to perform the services.003.02(C)ROOM AND BED ASSIGNMENTS. The facility must ensure any changes made in the client's room or bed assignment is documented in the client's individual program plan (IPP). This record must show the dates and reasons for all changes in accordance with 42 CFR 442.404.003.02(D)DISCHARGE. The intermediate care facility for individuals with developmental disabilities (ICF/DD) must ensure any client identified to permanently move from the facility is discharged according to requirements in this section, if the client moves to a separately licensed and certified intermediate care facility for individuals with developmental disabilities (ICF/DD), the same discharge requirements must be followed. The client must be admitted to the receiving intermediate care facility for individuals with developmental disabilities (ICF/DD). 003.02(D)(i)DISCHARGE PLANNING. The intermediate care facility for individuals with developmental disabilities (ICF/DD) must include discharge planning procedures for ail Nebraska Medicaid clients in the individual program plan (IPP). The discharge planning procedures must be reviewed and updated (if needed) by the client's interdisciplinary team (IDT) at least annually. The procedures must include: (1) Which intermediate care facility for individuals with developmental disabilities (ICF/DD) staff person is responsible for discharge planning; and(2) The interdisciplinary team (IDT)'s determination of the level of care the client needs or may need upon discharge, including programming, medical, nutritional, psychological or psychiatric, and supervision needs.003.02(D)(ii)DISCHARGE TO ALTERNATIVE SETTING. If it is determined that a client does not meet level of care requirements and the client's health and habilitative needs could more appropriately be met in another setting, the facility must follow the steps as outlined in this chapter. 003.02(D)(iii)DISCHARGE PROCESS. When a client is to be discharged, the intermediate care facility for individuals with developmental disabilities (ICF/DD) facility must ensure:(a) The following is documented in the client's individual program plan (IPP): (i) Notification of the discharge to the client as well as to the family or legal representative:(ii) The justification for the discharge:(iii) The type of service or level of care the client is being discharged to;(iv) The date the client is discharged; and(v) The discharge plan which must include activities to ensure the client is adequately prepared for the discharge and the receiving facility is provided current information related to the client's social and programming history, current developmental skills and skill deficits, current training needs, and medical, nursing and nutritional status:(b) Ail adaptive equipment and supplies specifically purchased for the client move with the client: and(c) Medicaid is notified of the discharge within 10 days of discharge, to include the type of service setting the client was discharged to.003.02(D)(iii)(1)NOTICE. Should the client's interdisciplinary team (IDT) decide to discharge the client without plans to admit to another service provider, the facility must notify the Department of Health and Human Services' Developmental Disabilities Division, Service Coordination (DDD SC) within two working days of the interdisciplinary team (IDT)'s decision in order to aid the client and their legal representative to secure alternative services.003.02(D)(iv)CLIENT DEATH. Within 10 days after a client has expired, the intermediate care facility for individuals with developmental disabilities (ICF/DD) must notify Medicaid of the date of death.471 Neb. Admin. Code, ch. 31, § 003
Amended effective 10/20/2015.Amended effective 12/26/2021