474 Neb. Admin. Code, ch. 1, § 014

Current through September 17, 2024

Section 474-1-014 - SERVICE PROVIDERS

This section contains definitions, requirements and standards used in evaluating and approving providers who wish to enroll and provide services through this Program.

014.01DEFINITIONS. The following definitions apply:

014.01(A)PROVIDER IDENTIFICATION NUMBER. A nine-digit Federal Identification number or a nine-digit Social Security number following by two-digit suffix code.

014.01(B)SERVICE PROVIDER ENROLLMENT FORM. A document whereby the provider indicates willingness to participate in the program and provide services to recipients. The enrollment form describes the services to be provided, the agreed upon unit(s) and the unit rate(s) for the each provider. The provider's responsibilities are stated in the enrollment form.

014.01(C)SUBCONTRACTING. When a service provider pays someone other than a provider's employee to provide the contracted service .

014.01(D)TWO-DIGIT SUFFIX CODE. Two identifying numbers attached to the Federal Identification number of providers who share the same Federal Identification number due to affiliation with a larger agency.

014.02FACE-TO-FACE INTERVIEW. A face-to-face interview is required of each potential provider.

014.03FAILURE TO MEET STANDARDS. If the potential provider does not meet standards at the time of the initial visit or face-to-face interview, but is able to correct the deficiency within 30 days, the enrollment process will continue when proof of compliance with standards is received.

014.04CONFLICT OF INTEREST. No employee of the Department may be approved as a service provider if the employee is in a position to influence the employee's own approval or utilization.

014.05RECIPIENT RELATIVE AS PROVIDER. A relative provider may not be a legally responsible relative or legal dependent of the recipient. A non-legally responsible relative of a recipient may be a provider if it is documented that the relative provider is held to the same provider requirements as non-relative providers.

014.06SERVICE PROVIDER ENROLLMENTS. The following policies govern service provider enrollments:

(A) The provider must obtain any necessary registration or child care license before being enrolled as a provider;

(B) Each provider must be properly enrolled before services can be authorized for purchase;

(C) The Department must evaluate the need for service provider in the area; if capacity is not met, additional providers will not be enrolled;

(D) Enrollments are effective up to 12 months, are never back-dated, and must be signed by the provider on or before the effective date;

(E) Changes in the service provider services or terms require a new enrollment. Address changes which do not affect the service location do not require a new enrollment but an amendment must be completed showing the provider's new address;

(F) Notice of any changes in services, units or unit rates proposed by either the provider or the service agency must be given as soon as possible; and

(G) Service provider enrollments must be approved by the Department.

014.07PROVIDER EVALUATION. As part of the provider approval process, the Department conducts an evaluation consisting of the following:

(1) A face-to-face interview with each potential provider at least annually;

(2) Annual visits to each facility in which services are provided to recipients outside of recipients' homes; and

(3) Assessment of the quality of service provision at least once during the enrollment period by observing service delivery, visiting the service facility, interviewing the provider, or interviewing a recipient served by the provider.

14.07(A)SECONDARY AGREEMENTS. Site visits are not required for facilities with secondary agreements. The service provider shall ensure that providers with secondary agreements meet all standards and requirements.

014.08RATE NEGOTIATION AND ESTABLISHMENT. For all services, the rate negotiated must:

(A) Be usual and customary or less for similar services in the community;

(B) Not exceed amounts reasonable and necessary to ensure the quality of service;

(C) Not exceed the rate charged to non-social services clients for comparable service; and

(D) Not exceed the service's maximums unless approved by the Department.

014.09SERVICE PROVIDER ENROLLMENT RENEWAL. The provider will undergo evaluation at time of renewal before the expiration of the enrollment term and any time there is reason to believe the provider is not fulfilling the provider's responsibilities.

014.10PROVIDER TERMINATIONS. Either the Department or the provider may terminate an enrollment by giving at least 30 days advance written notice. The 30-day requirement may be waived in case of emergencies such as illness, death, injury or fire. A written notice will be sent to the provider when the Department terminates a provider enrollment. Written notice to the provider is not required when the provider or potential provider voluntarily withdraws an application to enroll.

14.10(A)IMMEDIATE TERMINATIONS. The Department may terminate this agreement immediately if determined necessary to protect the health or safety of the recipient, or if the provider has provides false information to the Department or otherwise breached the agreement.

014.11PROVIDER STANDARDS. The following standards apply to all providers:

(1) The proposed service must meet the service definitions and must be purchasable;

(2) The Department need not enroll a potential provider if the proposed service is sufficiently available ;

(3) All service providers must have a Federal Identification number or Social Security number whichever is appropriate before being approved for enrollment ;

(4) The provider must not be the parent of the minor child receiving services nor the legal guardian, spouse, or minor child of the recipient;

(5) The provider must not have a history of chronic incorrect or inaccurate billings whether intentional or unintentional for services that have been provided or have a criminal history of financial mismanagement; and

(6) The provider must not engage in or have an ongoing history of criminal activity that may be harmful or endanger individuals served by the potential provider. This may include a substantiated listing as a perpetrator on the child or adult Central Registries of abuse or neglect, a criminal conviction for a crime endangering the life, well-being or safety of the victim or a member of the public or a crime involving fraud or theft of property or services.

014.11(A)PROVIDER AGENCIES. If the provider is an agency, the agency must review its policies regarding hiring and reporting to ensure appropriate procedures regarding abuse, neglect and other criminal violations are in place to protect recipients of services. The Department may require background checks on the agency employees when enrolling or reviewing an agency provider.

014.11(B)PROVIDERS. To participate as a provider or as an employee of a provider agency, the Department may conduct the following background checks:

(1) A search of the following registries, repositories, or databases in the State of Nebraska plus each State where the individual has resided during the preceding two years;

(a) State criminal registry or repository;

(b) State sex offender registry; and

(c) Child and Adult Abuse and Neglect Central Registry; and

(2) Providers transporting vulnerable adults or persons under age 19, must comply with the requirements of Neb. Rev. Stat. § 81-6,120 and undergo the necessary national criminal history background checks.

014.11(B)(i)ADDITIONAL CRIMES. Provider enrollment will be revoked or application denied when the provider has a conviction or pending charges for a crime including crimes against a child or vulnerable adult, crimes involving intentional bodily harm, crimes involving the illegal use of a controlled substance, or crimes involving moral turpitude.

014.11(C)DEPARTMENT DISCRETION. The Department has discretion to not approve a potential provider and terminate a current provider based upon the provider's failure to meet standards, the results of the criminal history check or the provider's failure to cooperate with the process

014.12ENROLLMENT FORMS. Before furnishing any service, each provider shall sign an enrollment form agreeing to provide services in compliance with the enrollment form terms.

014.13PROVIDER AGE QUALIFICATIONS. Service providers must be at least 19 years old.

474 Neb. Admin. Code, ch. 1, § 014

Adopted effective 6/26/2022