Department Responsibilities

As a partner with the Nebraska Department of Health and Human Services, your facility provides residents with the best possible selection of services. DHHS Services Coordinators or those of agencies contracting with DHHS to provide Services Coordination and Resource Developers can help you address the needs of your residents and assist you and your staff in your efforts to receive payments for those services. DHHS takes the responsibility to:

• Contract with you annually to ensure that all applicable Federal, State and local laws and regulations are met;
• Provide you with a detailed, written description which clearly defines the parameters of service delivery including:
  • the amount and frequency of service provision;
  • specific service components authorized; and
  • any applicable time limitations;
• Process payments for services listed on Long Term Care Facility Turnaround Billing Documents and Long Term Care Facility Add-On Turnaround Billing Documents.

To be eligible for support through the Aged and Disabled Medicaid Waiver, a potential client must meet the following general criteria:

1. Be eligible for the Nebraska Medical Assistance Program (NMAP/Medicaid);
2. Have participated in an assessment with a Services Coordinator;
3. Have care needs, which would otherwise require services to be provided in a Nursing Facility (NF). Medicaid criteria for admission to a nursing facility is found in Title 471, Chapter 12 of the Nebraska Administrative Code (471 NAC 12-000);
4. Have received an explanation of NF and waiver services and elected to receive waiver services; and
5. Work with the Services Coordinator to develop an individualized, outcome-based, cost-effective service plan.

Services Coordinators collect information on each individual seeking waiver services to determine the functional abilities and care needs of that individual.

• Information may be gathered from a variety of sources (e.g. the individual, family, care providers, physicians, facility staff, case files, medical charts) using observation, documentation review and/or interviews until sufficient information is obtained to determine the individual's current functioning in each area.
• Persons who require assistance, supervision, or care in at least one of the following four categories meet the level of care criteria for Nursing Facility of Aged and Disabled Home and Community-Based Medicaid Waiver services:
  1. Limitations in three or more Activities of Daily Living AND medical treatment or observation;
  2. Limitations in three or more Activities of Daily Living AND one or more Risk factor;
  3. Limitations in three or more Activities of Daily Living AND one or more Cognition factor; OR
  4. Limitations in one or more Activities of Daily Living AND one or more Cognition factor AND one or more Risk factor.
• For those clients that meet NF level of care, the Services Coordinator shall then determine if the client meets priority criteria.

If the potential client does not meet the NF level of care criteria, the Services Coordinator shall inform the referral source of this decision and provide notice to the potential client/guardian. The Services Coordinator shall also provide appropriate information and referral. Notices to clients must contain:

1. A clear statement of the action to be taken;
2. A clear statement of the reason for the action;
3. A specific policy reference which supports such action; and
4. A complete statement of the client's rights to appeal.