477 Neb. Admin. Code, ch. 27, § 010

Current through September 17, 2024

Section 477-27-010 - KATIE BECKETT

The Katie Beckett program provides Medicaid coverage to children age 18 or younger with severe disabilities who live in their parent's household, but who otherwise would require hospitalization or institutionalization due to their high level of health care needs.

010.01ELIGIBILITY REQUIREMENTS. In order to receive Katie Beckett Medicaid, a child must meet all of the following:

(A) Not be eligible for the Supplemental Security Income (SSI) program or eligible for Medicaid based on parental income;

(B) Be age 18 or younger;

(C) Reside at home with a parent or legal guardian;

(D) Be certified by the Department's Central Office designee as having hospital level of care needs; and

(E) Not incur in-home service costs to be funded by Medicaid that would exceed the costs Medicaid would pay if the child were in a hospital setting.

010.02INCOME AND RESOURCES. Parental income and resources are not deemed for a child determined eligible for Katie Beckett Medicaid. Financial eligibility is based solely upon any income or resources belonging to the child.

010.03REFERRALS. Medicaid accepts referrals for Katie Beckett eligibility determinations in the following situations:

(A) It is anticipated that a child will be discharged from a hospital to the child's home and the child is not currently eligible for Medicaid;

(B) Notice has been received from SSI that a child's benefits are being discontinued;

(C) The medical need of a child currently eligible for Home and Community-Based Waiver has been determined to have increased beyond the level applicable to the waiver program; or

(D) A child is not financially eligible for Medicaid based on family income.

010.04HOSPITAL LEVEL OF CARE. Hospital level of care means that a child requires an extensive array of health care services throughout the day. This level of care may only be provided by highly skilled medical professionals in amounts normally available in a hospital but not in a skilled nursing facility. Lack of these services would be expected to result in hospitalization of the child.

010.04(A)CERTIFICATION OF HOSPITAL LEVEL OF CARE. Department certification for hospital level of care will be provided based upon the following criteria:

(i) A child needs frequent and complex medical care, as defined below, that requires the use of equipment to prevent life-threatening situations;

(ii) A child's complex skilled medical interventions are expected to persist for a specific duration of time; and

(iii) A child's overall health condition must require continuous assessment of a medical condition to prevent a life-threatening situation.

010.04(B)FREQUENT AND COMPLEX MEDICAL CARE. A child must need frequent and complex skilled medical interventions that require the use of medical equipment to prevent life-threatening situations. Tasks which are provided only when necessary and are not continuously required do not meet the criteria for frequent and complex medical care. Site Care is not considered skilled medical task for the purpose of these requirements. The child's health status must require both of the following:

(i) Provision of skilled medical assessment and interventions multiple times every 24-hour period; and

(ii) At least one of the following complex skilled medical interventions:

(a) Tracheostomy care requiring regular bronchial tree suctioning;

(b) Tracheostomy care with a dependency on a ventilator, for which the average use must be equal to or greater than 10 hours per day;

(c) Intravenous (IV) therapy involving central lines, including peripherally inserted central catheters (PICCs), for daily fluids or parenteral nutrition, for which the average use must be equal to or greater than ten hours per day; or

(d) Oxygen use that includes only skilled tasks requiring daily continuous oxygen, daily continuous assessments with titrations according to oxygen saturation levels, and daily bronchial tree suctioning.

010.04(C)DURATION. To meet hospital level of care, a child's qualifying frequent and complex medical care need must be expected to be required for at least six months.

010.05DISABILITY AND CARE LEVEL REVIEW. The Department will review a child's Katie Beckett Medicaid eligibility on an annual basis.

477 Neb. Admin. Code, ch. 27, § 010

Adopted effective 9/28/2021