006.01 Introduction and Legal Basis Treatment group home 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 the need for this level of care has been identified as part of an Initial Diagnostic Interview. Treatment group homes are non-hospital based treatment services that are community-based, family-centered, and culturally competent.
Treatment group home services for children and adolescents covered by Medicaid include treatment group home services for children age 20 and younger who are eligible for Medicaid. The policy in this section also covers children age 18 or younger who are wards of the Department.
Treatment group home services must be recommended by a licensed practitioner of the healing arts who is able to diagnose and treat major mental illness within his/her scope of practice for reduction of physical or mental disability, to restore a recipient to a better level of functioning, and to facilitate discharge to a less restrictive level of care.
006.02 Treatment Group Home Services for Children The Department's philosophy is that all care provided to clients must be provided at the least restrictive and most appropriate level of care. Care must be developmentally appropriate, family-centered, culturally competent and community based. It must directly involve the immediate family in all phases of treatment and discharge planning. Family may include biological, step, foster, or adoptive parents, sibling or half sibling, and extended family members as appropriate.
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.
Care must involve a representative from the appropriate home community service providers. This may include such areas as education, social services, law enforcement, religion, medical, and mental health professionals. NMAP will cover more restrictive levels of care only when all other resources have been explored and deemed to be inappropriate. If hospital-based inpatient care is deemed appropriate, see 471 NAC 32-008. If psychiatric residential treatment services are deemed appropriate, see 471 NAC 32-007.
To ensure a less institutional setting, each location where children are housed can serve no more than 2 units of up to 20 beds. Facilities may have up to two crisis intervention beds per unit (see 32-003 Treatment Crisis Intervention) and the facility must provide a home-like atmosphere.
006.03 Standards for Participation for Treatment Group Home Services 32-006.03AProvider Agreement: A provider of treatment group home services shall complete Form MC-19 or MC-20, "Medical Assistance Provider Agreement," and submit the completed form to the Department for approval. The Department is the sole determiner of which facilities are approved for participation in this program. The facility will be advised in writing when its participation is approved. The provider shall submit the following with Form MC-19 or MC-20:
1. A written overview of the program's philosophy and objectives of treating children and youth including: a. A complete description of how the family-centered requirement will be met, including a complete description of any home-based family therapy services;b. A complete description of how the community-based requirement will be met;c. A description of each available service;d. A list of treatment modalities available and the capacity for individualized treatment planning;e. A statement of the qualification, education, and experience of each staff member providing treatment and the therapy service each provides;f. A schedule covering the total number of hours that the program operates;g. The Department approved cost reporting document; andh. The target population.2. Facility/Program Changes: A treatment group home facility shall report to the HHS Resource Development and Support Unit and to the Division of Medicaid and Long-Term Care any major change in its program and/or facilities, before the change is made. The HHS Resource Development and Support Unit will determine whether the license must be modified or reissued. Any change in the capacity of a licensed facility requires that a license be reissued showing the number of youth who can be cared for under the new plan. The Division of Medicaid and Long-Term Care will determine if the facility maintains appropriate therapeutic programming for NMAP reimbursement.3. Confirmation that the staffing standards in 471 NAC 32-006.03E are met.4. Current licensure as a child caring agency. If the child caring agency license is denied or revoked, this requirement is not met; therefore, the provider is not eligible for participation. 32-006.03BPlace of Service: Treatment group home services may be provided in the following locations when the requirements in this section have been met: 1. A community-based facility in operation prior to 7-1-94, as a treatment group facility. (These facilities may apply for an exception to the unit/bed maximum. The Department is the sole determiner of eligibility for this exception.)2. A residential type community-based treatment facility appropriately licensed by the Nebraska Department of Health and Human Services, Division of Public Health; or3. A hospital that is licensed as a hospital by the Nebraska Department of Health and Human Services, Division of Public Health, is accredited by the Joint Commission on Accreditation of Health-Care Organizations (JCAHO) or the American Osteopathic Association (AOA), meets the requirements for participation in Medicare, and has a utilization review plan applicable to all Medicaid clients in effect. 32-006.03B1Facility and Program Requirements: In order to be approved as a provider of Treatment Group Home Services, the program must insure that the following requirements are met: 1. Adequate access to recreational facilities for both indoor and outdoor activities, commensurate with the size and scope of the program. (This may be provided on-site or through contract);2. Separation of the treatment group home program from inpatient hospital operations, including laboratory, radiology, surgery, patient rooms, dining areas, patient lounges, etc.;3. The doors to the unit and to the outside may be locked from the outside to allow for safety, but they must be unlocked or easily unlocked from the inside;4. Kitchen and laundry facilities easily accessible to the unit;5. Staff offices must be located on the unit;6. Secure storage for medications and clinical charts must be on the unit;7. A general living or lounge area must be on the unit;8. A home-like atmosphere;9. Program is staffed by awake personnel 24 hours per day; and10. Other requirements as listed in this chapter. 32-006.03CLicensure: The treatment group home facility must - 1. Be in compliance with all applicable federal, state, and local laws;2. Meet the program and operational definitions and criteria contained in the Nebraska Department of Health and Human Services Manual;3. Meet the definition of a treatment group home facility as stated in this section;4. Maintain documentation in each client's treatment record that provides a full and complete picture of the nature and quality of all services provided (see 471 NAC 32-006.07);5. Have the capacity to meet the needs of the individual Medicaid client either through employment of or contracts with appropriate staff;6. Be licensed under the minimum regulations for child caring agencies if not a hospital-based facility. If the child caring agency license is denied or revoked, this requirement is not met; therefore, the provider is not eligible for participation. (See 474 NAC 6-005, Licensing Group Homes and Child Caring and Placing Agencies.) 32-006.03DAccreditation: The licensed treatment group home must have -1. Be accredited by JCAHO, CARF, COA or AOA; or2. Include a copy of the accreditation certificate with the initial and updated enrollment materials and forward a copy of all survey visit reports and provider responses. Facilities accredited by these accrediting bodies are eligible to receive reimbursement for treatment and maintenance (room and board) costs and must maintain accreditation in order to qualify as a treatment group home provider. Treatment and maintenance costs are reimbursed as a per diem rate. See NMAP Fee Schedule, (Appendix 471-000-532).
Interpretive Note: Agencies that have applied for accreditation may be enrolled on a provisional status and receive reimbursement for treatment services only.
32-006.03EStaffing Standards for Participation: A treatment group home for children shall meet the following standards to participate in NMAP:1. The facility's staff must include - a. An executive director who has sufficient background and experience to administer a treatment program;b. A program director who meets the requirements of a clinical staff person in 471 NAC 32-001.04 and is acting within his/her scope of practice, with two years of professional experience in the treatment of children and adolescents with mental illnesses or emotional disturbances;c. Clinical staff professionals (who meet the requirements of a clinical staff person in 471 NAC 32-001.04) who provide family assessments and psychotherapy, including face-to-face individual, family, and group therapy, who are supervised by a licensed practitioner of the healing arts who is able to diagnose and treat major mental illness within his/her scope of practice;d. Child care staff who are age 21 or older and have specialized training and experience sufficient to equip them for their duties and are under the supervision of the program director. 67% of child care staff must have a bachelor's degree or four years of experience in the human services field;e. Supervisory staff will meet the standards outlined in 471 NAC 32-001.04 and have four years experience in a related field;f. Training must be approved by the Department and must meet the minimum standards for pre-service and on-going training in licensing requirements;g. A supervising practitioner who is a licensed practitioner of the healing arts who is able to diagnose and treat major mental illness within his/her scope of practice;h. Each facility shall show by employment records or on a contractual basis the ability to provide the needed services as indicated by the scope of the program, including necessary medical/psychiatric evaluations, and access to emergency care. The clinical services of a psychologist, psychiatrist, and physician may be obtained on a consultation basis; andi. Educators, when on-site education is provided. Services must be provided in accordance with applicable state and federal laws. NMAP does not make payment for educational services (see 471 NAC 32- 006.05J);2. Volunteer services may be used to augment and assist other staff in carrying out program or treatment plans. Volunteers who work directly with youth must receive orientation training regarding the program, staff, and children of the center and the functions that volunteers can perform. However, the services performed by a volunteer cannot be substituted for necessary medical/psychiatric and therapeutic patient/staff ratios;3. Staff must be mentally and physically capable of performing assigned duties and demonstrate basic professional competencies as required by the job description. Every staff member shall have an annual physical examination and obtain a statement that no medical condition exists that may interfere with his/her ability to perform assigned duties. This is addressed in policy governing licensure regulations. All applicable state, federal, and local laws must be followed;4. All program personnel having access to clients, including full-time, part-time, paid, volunteer, or contract, must be checked through the Central Registry, Adult Protective Services Registry, and the motor vehicle records. A criminal check must also be done through a law enforcement agency. A person whose name appears on any of the above registers because of behavior or activities that might be dangerous to clients must not have access to clients;5. The ratio of professional staff to children is dependent on the needs of the children and commensurate with the size and scope of the program, however - a. The minimum ratio of Master's level therapists providing direct face-to-face therapy services to children and families must be 1:12;b. The supervising practitioner must be available to spend approximately 45 minutes per month or more often as clinically necessary, per client, in the facility as a minimum. This includes face-to-face time with the client, treatment plan reviews, and supervision;c. There must be sufficient supervising practitioner consultation hours on a regular basis to meet the requirements for active treatment. Youth at this level of care must be assessed by the supervising practitioner a minimum of once a month, or more frequently if medically necessary;6. The ratio of child care staff to children during prime time hours is dependent on the needs of the children and the requirements of the individualized treatment plans. The ratio of staff to children must be commensurate with the size and scope of the program; however, minimum ratio is 1:6. This may be increased depending on the intensity of the program and the children's needs;7. The ratio of child care awake staff during sleeping and non-prime hours is dependent on the needs of the children and must be commensurate with the size and scope of the program; however, the minimum ratio is 1:8. This may be increased depending on the intensity of the program and the individual child's needs.8. The facility must be able to call back child care staff to provide staff and client safety in crisis situations.9. If the facility has a level program that requires intense observation for admissions, the direct care staff to youth ratio will need to be more intense during that observation period.10. Access to emergency services such as additional supervision and physician psychologist services must be available on a 24-hour basis.32-006.03FService Standards for Participation for Treatment Group Home Facilities: Treatment group home facilities shall - 1. Make every effort to keep the child in contact, where appropriate and possible, with the child's family and relatives, when reunification/reconciliation is the plan and maintain documentation of these activities;2. Directly involve the immediate family in all phases of treatment and discharge planning. Family may include biological, step, foster, or adoptive parents, sibling or half sibling, and extended family members as appropriate. For wards of the Department, the case manager must be included in all phases of assessment, treatment planning, evaluation of services, and discharge/after care arrangements;3. Provide a total of 21 hours of scheduled treatment interventions each week. These must include, but are not limited to: a. Group psychotherapy by a practitioner operating within their scope of practice;b. Individual therapy by a practitioner operating within their scope of practice;c. Family intervention (one hour per week minimum); andd. Other approved group or individual therapeutic activities.4. Provide or arrange for face-to-face family therapy a minimum of twice a month. Depending on the child's needs, this may include reunification/reconciliation therapy and may also include biological, step, foster or adoptive families, psychological parents, and/or extended family (this is included in the 21 hours per week);5. Provide the following mandatory services - a.Clinically Necessary Nursing Services: Medical services directed by a Qualified Registered Nurse who evaluates the particular medical nursing needs of each client and provides for the medical care and treatment that is indicated on the Department approved treatment planning document approved by the supervising practitioner.b.Clinically Necessary Psychological Diagnostic Services: Testing and evaluation services must reasonably be expected to contribute to the diagnosis and plan of care established for the individual client. Testing and evaluation services may be performed by a licensed psychologist acting within his/her scope of practice. Clinical necessity must be documented by the program supervising practitioner. Reimbursement for psychological diagnostic services is included in the per diem.c.Clinically Necessary Pharmaceutical Services: If medications are dispensed by the program, pharmacy services must be provided under the supervision of a registered pharmacy consultant; or the program may contract for these services through an outside licensed/certified facility. All medications must be stored in a special locked storage space and administered only by a physician, registered nurse, licensed practical nurse, or by a staff person approved by the Nebraska Department of Health and Human Services, Division of Public Health as a Medication Aide.d.Clinically Necessary Dietary Services: The meal services provided must be supervised by a registered dietitian, based on the client's individualized diet needs. Programs may contract for these services through an outside licensed certified facility.e. Transition and discharge planning must meet the requirements of 471 NAC 32-001.07A.6.Optional Services: The program must provide two of the following optional services. The client must have a need for the services, the supervising practitioner must order the services, and the services must be a part of the client's treatment plan. The therapies must be restorative in nature, not prescribed for conditions that have plateaued or cannot be significantly improved by the therapy, or which would be considered maintenance therapy: a. Services provided or supervised by a licensed or certified therapist may be provided under the supervision of a qualified consultant or the program may contract for these services from a licensed/certified professional as listed below: (1) Recreational Therapy;(3) Occupational Therapy;(4) Vocational Skills Therapy;(5) Self-Care Services: Services supervised by a staff person who is oriented toward activities of daily living and personal hygiene. This includes toileting, bathing, grooming, etc.b. Psychoeducational Services: Therapeutic psychoeducational services may be provided as part of a total program. Therapeutic psychoeducational services must be provided by teachers specially trained to work with child and adolescent experiencing mental health or substance abuse problems. These services may meet some strictly educational requirements, but must also include the therapeutic component. Professionals providing these services must be appropriately licensed and certified for the scope of practice.c. Social Work Services by a Bachelor's Level Social Worker: Case management social services to assist with personal, family, and adjustment problems which may interfere with effective use of treatment;d. Crisis Intervention (may be provided in the client's home);e. Social Skills Building;g. Substance abuse prevention, intervention, or treatment by an appropriately licensed alcohol and drug counselor.7. Provide appropriate conferences involving the client's interdisciplinary treatment team, the parents, the referring agency, and the child, to review the case status and progress at least every month. This does not substitute for documentation requirements. The need for conferences with interested parties is indicated by the individual child's circumstances and needs. For wards of the Department, this need will be jointly determined with the Department case manager;8. Provide a multi-disciplinary team progress report to the referring agency, the parents, and the legal guardian every month for the purpose of service coordination. This progress report must include a summary of the work done, the progress made by each multi-disciplinary team area, since the last report; plus treatment plans for the next reporting period. For wards of the Department, monthly reports must be provided to the Division of Children and Family Services case manager. The documentation from the Monthly Treatment Plan review may serve this purpose.9. The services of specialists in the fields of medicine, psychiatry, clinical psychology, and education must be used as needed. The costs of these services must be included in the total cost of care and cannot be billed separately.10. Allow for more than one type of activity to be scheduled at one time allowing for specialized and individualized treatment planning32-006.03GAnnual Update Renewal: The treatment group home shall submit the following information with the provider application and agreement, and update/renewal the information annually to coincide with submission of the cost report: 1. A written overview of the program's philosophy and objectives of treating children and youth including: a. A complete description of how the family-centered requirement will be met, including a complete description of any home-based family therapy services;b. A complete description of how the community-based requirement will be met;c. A description of each available service;d. A list of treatment modalities available and the capacity for individualized treatment planning;e. A statement of the qualification, education, and experience of each staff member providing treatment and the therapy service each provides;f. A schedule covering the total number of hours that the program operates;h. The target population.2. Confirmation that the staffing standards are met;3. A copy of child caring agency licensure certificate; and4. A copy of accreditation from JCAHO, CARF, COA, or AOA. The Division of Medicaid and Long-Term Care or its designee may request this information on an intermittent basis and the provider must comply by promptly supplying the requested information.
006.04 Covered Services NMAP limits payment for treatment group home services to those services for medically necessary primary psychiatric diagnoses. NMAP covers treatment group home services when the services are medically necessary and provide active treatment.
32-006.04APre-Admission Authorization: For treatment group home services to be covered by NMAP, the admission must be recommended by a licensed practitioner of the healing arts who is able to diagnose and treat major mental illness within their scope of practice through a pre-treatment assessment as outlined in 471 NAC 32-001.01 and prior authorized through the Division of Medicaid and Long-Term Care or its designee. Consent for treatment for wards of the Department must be obtained from the case manager or supervisor.32-006.04BGuidelines for Use of the Treatment Group Home Services for Children: A youth must have a diagnostic condition listed in the current diagnostic and statistics manual of the American Psychiatric Association (excluding V-codes and developmental disorders) for this level of care. NMAP applies the following general guidelines to determine when treatment group home services for children are clinically necessary for a client: 1. The child/youth requires 24-hour awake supervision;2. Utilization of treatment group home care is appropriate for individualized treatment and is expected to improve the client's condition to facilitate moving the client to a less restrictive placement;3. The child/youth's problem behaviors are persistent, may be unpredictable, and may jeopardize the health or safety of the client and/or others, but can be managed with this moderate level of structure;4. The child/youth's daily functioning is moderately impaired in such areas as family relationships, education, daily living skills, community, health, etc.;5. The child/youth has a history of previous problems due to ongoing inappropriate behaviors or psychiatric symptoms; or6. Less restrictive treatment approaches have not been successful (see 42 CFR 441.152 ) or are deemed inappropriate by the supervising practitioner or treatment in a more restrictive setting has helped stabilize the client's behavior or psychiatric symptoms and they are ready to transition to a less restrictive level of care. 32-006.04CTherapeutic Passes for Clients Involved in Treatment Group Home Services: Therapeutic passes are an essential part of the treatment for client/families involved in treatment group home services. Documentation of the client's continued need for treatment group home services must follow overnight therapeutic passes. Therapeutic passes must be indicated in the treatment plan as they become appropriate. NMAP reimburses for only 60 therapeutic pass days per client per year. This includes all treatment services in which the client is involved during the year. Therapeutic leave days are counted by the entity reimbursing for the care. Because the NMAP fee-for-service program reimburses for therapeutic leave days on a post-service basis and because providers have one year to bill for services, the Department cannot guarantee that an accurate account of the therapeutic leave days that have been used.
32-006.04DVacations: If a treatment group home program takes the clients on a "vacation," NMAP will reimburse for those days under the following conditions - 1. The trip is prior authorized by the Division of Medicaid and Long-Term Care or its designee;2. There is a clear statement of goals and objectives for the client's participation in the trip;3. At least 50% of the scheduled treatment interventions must occur during the "vacation";4. A clinical staff person must accompany the "vacation" trip; and5. The "vacation" must be included in the treatment program. NMAP will reimburse for up to seven "vacation" days per year for clients in treatment group home services.
006.05 Additional Requirements 32-006.05AWork Experience: When a treatment group home has a work program, it must - 1. Provide work experience that is appropriate to the developmental age and abilities of the child;2. Differentiate between the chores that children are expected to perform as their share in the process of living together, specific work assignments available to children as a means of earning money, and jobs performed in or out of the center to gain vocational training;3. Give children some choice in their work experiences and offer change from routine duties to provide a variety of experiences;4. Not interfere with the child's time for school, study periods, play, chores, sleep, normal community activities, visits with the child's family, or individual, group, or family therapy; Clients may not be solely responsible for any major phase of the center's operation or maintenance, such as cooking, laundering, housekeeping, farming, or repairing;
5. Comply with all state and federal labor laws. 32-006.05BSolicitation of Funds: A treatment group home may not use a child for advertising, soliciting funds, or in any way that may cause harm or embarrassment to the child or the child's family. Written consent of the parent or guardian must be obtained before the treatment group home uses a child's picture, person, or name in any form of written, visual, or verbal communication. Before obtaining consent, the treatment group home shall advise the parent or guardian of the purpose for which it intends to use the child's picture, person, or name, and of the times and places when and where this use would occur. Photos of the Department state wards cannot be used for these purposes.32-006.05CSpecial Treatment Procedures: Special treatment procedures in treatment group homes are limited to physical restraint. Locked time out (LTO), mechanical restraints, and pressure point tactics are not allowed. For wards of the Department, the case manager must approve use of physical restraints and must be informed within 24 hours each time they are used. Guardians and parents of non-wards must give informed consent and be informed of the use of physical restraints. Facilities must meet the following standards regarding physical restraints:
1. De-escalation techniques must be taught to staff and used appropriately before the initiation of physical restraints;2. Physical restraints may be used only when a youth's behavior presents a danger to self or others, or to prevent serious disruption to the therapeutic environment; and3. The youth's treatment plan must address the use of physical restraints and have a clear plan to decrease the behavior requiring physical restraints. These standards must be reflected in all aspects of the treatment program. Attempts to de-escalate, the use of restraints, and subsequent processing must be documented in the clinical record.
32-006.05DMedical Care: The center shall ensure that the following medical care is provided for each child: 1. Each child must receive a medical examination immediately before or at the time of admission;2. Each child must have current immunizations as required by the Nebraska Department of Health and Human Services;3. The treatment group home shall arrange with a physician and a psychiatrist for the medical and psychiatric care of the clients;4. Each child must have a medical examination/HEALTH CHECK (EPSDT) screen annually as allowed in 471 NAC 33-000 ff.;5. The treatment group home shall inform staff members of what medical care, including first aid, may be given by staff without specific physician orders. Staff must be instructed on how to obtain further medical care and how to handle emergency cases. The center shall ensure that - a. Staff members on duty must have satisfactorily completed current first aid and cardiopulmonary resuscitation training and have on file at the treatment group home a certificate of satisfactory completion as required by licensure regulations of the Department of Health and Human Services, Division of Public Health;b. Each staff member must be able to recognize the common symptoms of illnesses in children and to note any marked physical defects of children; andc. A sterile clinical thermometer, a complete first aid kit, and clearly posted emergency phone numbers must be available, according to licensure regulations of the Department of Health and Human Services. 32-006.05EHospital Admissions: The treatment group home shall make arrangements for the emergency admission of children from the center in case of serious illness, emergency, or psychiatric crisis. For wards of the Department, the case manager or the case manager's supervisor must give permission for admission. In the event that a client does require hospitalization while in a treatment group home, NMAP will reimburse the treatment program for up to 15 days per hospitalization. This reimbursement is only available if the treatment placement is not used by another client.
32-006.05FHospitalization or Death Reports: The treatment group home shall report any accident or illness requiring hospitalization to the parents or guardian immediately. The-treatment group home shall immediately report any death to the parents or guardian, the Department, a law enforcement agency, and the county coroner. If the child is a Department ward, see 390 NAC 11-002.01D.32-006.05GDental Care: Each child must have an annual dental examination. If a child has not had a dental exam in the twelve months before admission, an examination must occur within 90 days following admission. See 471 NAC 6-000 and 33-000 and 474 NAC 6-005.26F.32-006.05HGeneral Health: The treatment group home shall ensure the following: 1. Each child must have enough sleep for the child's age and physical and emotional condition at regular and reasonable hours, and under conditions conducive to rest. While children are asleep, at least one staff member must be within hearing distance;2. Children must be encouraged and helped to keep themselves clean;3. Bathing and toilet facilities must be properly maintained and kept clean;4. Each child must have a toothbrush, comb, an adequate supply of towels and washcloths, and personal toilet articles;5. Menus must provide for a varied diet that meets a child's daily nutritional requirements;6. Each child must have clothing for the child's exclusive use. The clothing must be comfortable and appropriate for the current weather conditions; and7. The treatment group home must provide safe, age-appropriate equipment for indoor and outdoor play. See 471 NAC 33-000.
32-006.05JEducation: Educational services, when required by law, must be available. Education services must only be one aspect of the treatment plan, not the primary reason for admission or treatment. Educational services are not eligible for payment by the Department.32-006.05KReligious Education: Children must be provided with an opportunity to receive instruction in their religion. No child may be required to attend religious services or to receive religious instructions if the child chooses not to attend the services or receive instruction.32-006.05LDiscipline: Discipline must be therapeutic and remedial rather than punitive. Corporal punishment, verbal abuse, and derogatory remarks about the child, the child's family, religion, or cultural background are prohibited. A child may not be slapped, punched, spanked, shaken, pinched, or struck with an object by any staff of the center. Only staff members of the treatment group home may discipline children (see 474 NAC 6-005.26K).32-006.05MTransition and Discharge Planning: Whenever a child or adolescent is transferred from one setting to another, transition and discharge planning must be performed and be documented, beginning at the time of admission (see 471 NAC 32-001.07A and 474 NAC 6-005.27H ). Facilities must meet the following standards regarding transition and discharge planning:
1. Transition and discharge planning must be based on the multidisciplinary treatment plan designed to achieve the client's transition into and discharge from treatment group home treatment status to a less restrictive level of care at the earliest possible time;2. Transition and discharge planning must address the client's need for ongoing treatment to maintain treatment gains, continuing education and support for normal physical and mental development following discharge;3. Discharge planning must include identification of and clear transition into developmentally appropriate services needed following discharge;4. The treatment group home treatment facility shall arrange for prompt transfer of appropriate records and information to ensure continuity of care during transition into and following the client's discharge;5. A written transition and discharge summary must be provided as part of the medical record; and6. The child's parents (and the caseworker if the child is a ward) must be included in all phases of transition and discharge planning. This participation must be clearly documented in the client's record. 32-006.05NNotification of Runaway Children: See 390 NAC 7-001.05.32-006.05PInterstate Compact on the Placement of Children: The center shall comply with the interstate compact on the placement of children. (See 474 NAC 6-005.)32-006.05QMedications: The treatment group home may possess a limited quantity of nonprescription medications and administer them under the supervision of designated staff. The treatment group home must follow all applicable regulations through the Department of Health and Human Services, Division of Public Health for storing and administering medications. The treatment group home shall have written policies governing the use of psychotropic medications. Parents and the guardian of a client who receives psychotropic medication must be informed of the benefits, risks, side effects, and potential effects of medications. A parent and legal guardian's written informed consent for use of the medication must be obtained before giving the medication and filed in the client's record. If the client is a state ward, informed consent must be given by the Department case manager.
A child's medication regime must be reviewed by the prescribing physician at least every seven days for the first 30 days following the initiation of a new medication and at least every 30 days thereafter.
006.06 Individualized Treatment The requirements of 42 CFR 441, Subpart D, must be met. To be covered by NMAP, services must include -
1.Program philosophy: Treatment Group Home facilities must provide family-centered, community-based, developmentally appropriate services under the direction of a supervising practitioner. a. These services must be able to meet the special needs of families with emotionally disturbed children. Families must be involved in all phases of treatment and discharge planning. For wards of the Department, the Department case manager must also be involved in all phases of treatment and discharge planning.b. The program intensity must be such that direct care staff, the youth in treatment, and/or the youth's family have access to professional staff on an "as needed" basis, determined by the child's condition.2.Active treatment, which must be - a. Treatment provided under a multi-disciplinary treatment plan reviewed and approved by the supervising practitioner. This plan will be developed by a multi-disciplinary team of professional staff members. The treatment plan must be for a primary psychiatric diagnosis and must be based on a thorough evaluation of the client's restorative needs and the client's potential. The initial treatment plan must be developed within 14 days of the client's admission. The treatment plan must be reviewed at least every 30 days by the multi-disciplinary team, the parents and/or the parents' advocate, the referring agency and the child. The goals and objectives documented on the treatment plan must reflect the recommendations included in the Pre-treatment Assessment and the integration of input from the supervising practitioner and the therapist. The treatment interventions provided must reflect these recommendations, goals, and objectives. Evaluation of the treatment plan by the therapist and the supervising practitioner should reflect the client's response to the treatment interventions based on the recommendations, goals and objectives.
b. In compliance with 471 NAC 32-001.07, Treatment Planning; andc. In compliance with 471 NAC 32-001.06, Active Treatment.3.Medically necessary services, which must be an appropriate level of care based on the documented pre-treatment assessment (see 471 NAC 32-001.01) including an Initial diagnostic interview by the supervising practitioner either prior to admission or immediately following admission.006.07 Documentation in the Client's Clinical Record The treatment group home must maintain accurate records indicating the degree and intensity of the treatment provided to clients who receive services in the treatment group home facility. For treatment group home services, clinical records must stress the clinical components of the care, including history of findings and treatment provided for the condition for which the client is in the facility. The record must include the requirements stated in 471 NAC 32-001.05, and -
1. The identification data, including the client's legal status (i.e., voluntary admission, Board of Mental Health commitment, court mandated);2. A provisional or admitting diagnosis which is determined for every patient at the time of admission and includes the diagnoses of intercurrent diseases as well as the diagnoses;3. The statements of others regarding the client's problems and needs, as well as the client's statement of their problems and needs;4. The pre-treatment assessment (see 471 NAC 32-001.01), including a medical/psychiatric history, which contains a record of the initial diagnostic interview and notes the onset of illness, the circumstances leading to admission, attitudes, behavior, estimate of intellectual functioning, memory functioning, orientation, and an inventory of the client's strengths in a descriptive, not interpretative, fashion;5. Complete psychological evaluation when indicated;6. Complete neurological examination, when indicated;7. A social history sufficient to provide data on the client's relevant past history, present situation, social support system, community resource contacts, and other information relevant to good treatment, and transition and discharge planning.8. A thorough family assessment;9. Reports of consultations, electroencephalograms, dental records, and special studies;10. The treatment received by the client, which is documented in a manner and with a frequency to ensure that all active therapeutic efforts, such as individual, group, and family psychotherapy, drug therapy, milieu therapy, occupational therapy, recreational therapy, nursing care, and other therapeutic interventions, are included;11. Progress notes must be recorded by all professional staff and, when appropriate, others significantly involved in active treatment modalities, following each contact. The frequency is determined by the individual treatment plan and the condition of the client. Progress notes must contain a concise assessment of the client's progress and recommendations for revising the treatment plan as indicated by the client's condition. Child care workers must maintain 24-hour documentation of a client's whereabouts and activities.12. The transition plan and discharge summary, including a summary of the client's and family's treatment, recommendations for appropriate services concerning follow-up, and a brief summary of the client's condition on discharge.13. The psychiatric diagnosis contained in the final diagnosis written in the terminology of the American Psychiatric Association's Diagnostic and Statistical Manual; and14. The client's response to therapeutic leave days recommended by the supervising practitioner under the treatment plan. The client's, family's, or guardian's response to time spent outside the facility must be entered in the client's clinical record. All documents from the client's clinical record submitted to the Department must contain sufficient information for identification (i.e., client's name, date of service, provider's name).
006.08 Utilization Review All facilities must provide utilization review.
006.09 Documentation for Claims The following documentation is required for all claims for treatment group home services. This requirement may be waived at the Department's discretion. The facility will be notified in writing if that occurs:
1. Initial diagnostic interview;3. Orders by the supervising practitioner; and4. Progress notes for all disciplines. All claims are subject to utilization review by the Department prior to payment.
32-006.09AException: Additional documentation from the client's clinical record may be requested by the Department prior to considering authorization of payment.006.10 Procedure Code and Description for Treatment Group Home Services HCPCS/CPT codes used by NMAP are listed in the Nebraska Medicaid Practitioner Fee Schedule at 471-000-532.
006.11 Costs Not Included in the Treatment Group Home Per Diem The mandatory and optional services are considered to be part of the per diem for treatment services. The following charges can be reimbursed separately from the treatment group home per diem when the services are necessary, part of the client's overall treatment plan, and in compliance with NMAP policy:
1. Direct client services performed by the supervising practitioner;2. Prescription medications (including injectable medications);3. Direct client services performed by a physician other than the supervising practitioner; and4. Treatment services for a physical injury or illness provided by other professionals. If the client is enrolled with another managed care vendor for medical-surgical services, it may be necessary to pursue prior authorization or referral with that entity.
006.12 Inspections of Care The Department's inspection of care team may conduct inspection of care reviews for Treatment Group Home Services. See 471 NAC 32-001.08 and 471 NAC 32-001.09.
471 Neb. Admin. Code, ch. 32, § 006