471 NAC 20-002. DEFINITIONS

002. DEFINITIONS. The following definitions apply: 002.01 ADULT DAY TREATMENT PSYCHIATRIC SERVICES. Psychiatric day treatment is a service in a continuum of care designed to prevent hospitalization or to facilitate the movement of the acute psychiatric beneficiary to a status in which the beneficiary is capable of functioning within the community with less frequent contact with the psychiatric health care provider. 002.02 ADULT INPATIENT HOSPITAL PSYCHIATRIC SERVICES. Inpatient hospital psychiatric services for beneficiaries 21 and over are medically necessary psychiatric services provided to an inpatient. 002.03 ADULT SUBACUTE INPATIENT HOSPITAL PSYCHIATRIC SERVICES. Subacute inpatient hospital psychiatric services for beneficiaries 21 and over are medically necessary short-term psychiatric services provided to a beneficiary. 002.04 ANNUAL SUPERVISION OF NEBRASKA MEDICAID ELIGIBLE BENEFICIARIES. Annual supervision includes a review of a beneficiary’s treatment plan and progress notes, specific case discussion, and assessment of the beneficiary. This review should be completed annually or as often as is medically necessary. 002.05 BEHAVIORAL HEALTH OUTCOMES. Behavioral health outcomes mean improving adaptive ability, preventing relapse or decompensation, stabilization in an emergency situation, or resolving symptoms. 002.06 Family Assessment. A comprehensive family assessment must be completed during the initiation of services. This must be completed by a mental health professional with training and experience in family systems. 002.07 Family Psychotherapy. A treatment session requiring professional expertise between the beneficiary, the nuclear family, the extended family, or both, and the appropriate mental health professional. These services must focus on the family as a system and include a comprehensive family assessment. The specific objective of treatment must be to alter the family system to increase the functional level of the identified beneficiary. This therapy must be provided with the appropriate family members and the identified beneficiary. The focus of the services must be on systems within the family unit. Therapists of families with more than one provider must communicate with and coordinate services with any other provider for the family or individual family members. Coordination of services is required as part of the overall treatment plan and is not billable as a separate service. Duplicate or co-therapist services will not be reimbursed. The beneficiary must be eligible for Nebraska Medicaid and have an acceptable primary psychiatric diagnosis. Crisis outpatient family therapy is an immediate, short-term treatment service provided to a family with urgent psychotherapy needs. 002.08 FUNCTIONAL FAMILY THERAPY (FFT). Functional family therapy (FFT) is family therapy targeted at youth. Functional family therapy (FFT) provides clinical assessment and treatment for the beneficiary and their family to improve communication, problem solving, and conflict management in order to reduce problematic behavior of the beneficiary. 002.09 GEOGRAPHICALLY DEPRIVED AREAS. A geographically deprived area is an area where a psychiatrist is not available in the community, or within a reasonable driving distance of the community, to provide services. 002.10 Group Psychotherapy. A treatment session, requiring professional expertise, between the beneficiary and the appropriate mental health professional in the context of a group setting of at least three and not more than 12 beneficiaries. Group psychotherapy must provide active treatment for a primary psychiatric diagnosis. Nebraska Medicaid does not cover groups that are primarily supportive or educational in nature or the services of a co-therapist. 002.11 Individual Psychotherapy. A treatment session between the beneficiary and the appropriate mental health professional for an acceptable primary psychiatric diagnosis. No additional reimbursement is made for medication checks performed by a physician in the course of individual psychotherapy. Crisis outpatient individual therapy is an immediate, short-term treatment service provided to a beneficiary with urgent psychotherapy needs. 002.12 Inpatient Hospital Services for BENEFICIARIES Age 65 or Older in AN Institution for Mental Disease (IMD). Services provided under the direction of a psychiatrist for the care and treatment of beneficiaries age 65 and older in an institution for mental disease that meets the requirements of federal regulations. 002.13 Inspection of Care Team. The Department's inspection of care team, consisting of a psychiatrist knowledgeable about mental institutions, a qualified registered nurse (RN), and other appropriate personnel as necessary who conduct inspection of care reviews under federal regulations and this chapter. 002.14 Institution for Mental Disease (IMD). An institution for mental disease (IMD) is defined as an entity that primarily provides inpatient treatment for beneficiaries with mental diseases and is credentialed according to federal regulations. 002.15 Interdisciplinary Team. The interdisciplinary team is responsible for developing each beneficiary's individual plan of care. The team must include a board-eligible or board-certified psychiatrist. The team must also include at least two of the following: (A) A licensed mental health practitioner (LMHP); (B) A registered nurse (RN) with specialized training or one year's experience in treating individuals with mental illness; (C) An occupational therapist (OT) who is licensed, if required by state law, and who has specialized training or one year's experience in treating mentally ill individuals; or (D) A licensed psychologist. 002.16 MEDICAL NECESSITY. Medically necessary services are services provided at an appropriate level of care which are based on documented clinical evaluations including a comprehensive diagnostic workup and supervising practitioner-ordered treatment. 002.17 Medical Review Organization. A review body contracted by Nebraska Medicaid, responsible for pre-admission certification and concurrent and retrospective reviews of care. 002.18 OPIOID TREATMENT PROGRAM (OTP). An opioid treatment program (OTP) offers community-based outpatient addiction treatment for beneficiaries diagnosed with an opioid use disorder (OUD) and meeting level of care criteria. Opioid treatment programs (OTP) administer medications approved by the Food and Drug Administration (FDA) to treat opioid use disorder (OUD) and the alleviation of the adverse medical, psychological, or physical effects of opioid addiction. 002.19 OUTPATIENT. An outpatient is defined as a person who has not been admitted as an inpatient but is registered on the hospital records as an outpatient and receives services, rather than supplies alone. 002.20 Services of Psychiatric Resident Physicians. Psychiatric resident physicians may only provide psychotherapy services and medication checks when these services are directly supervised by the attending psychiatrist. The resident's supervising psychiatrist must sign Nebraska Medicaid approved treatment planning document for services provided by the resident physician. The resident physician will not supervise services of allied health therapists, licensed mental health practitioners (LMHP), or qualified registered nurses (RNs). Resident physician services must be billed using the appropriate Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) procedure codes. 002.21 SUPERVISION. Supervision by the supervising practitioner is defined as the critical oversight of a treatment activity or course of action.