471 NAC 32-002. DEFINITIONS

002. DEFINITIONS. The following definitions apply. 002.01 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. 002.02 APPLIED BEHAVIOR ANALYSIS (ABA). Applied behavior analysis (ABA) is a type of therapy that uses behavior modification principles to treat functional impairments due to maladaptive behaviors in individuals with autism spectrum disorder (ASD) or developmental or intellectual disabilities. 002.03 CHILD PARENT PSYCHOTHERAPY. Child parent psychotherapy is an evidence-based service provided to children from birth to age five, who have experienced at least one traumatic event and, as a result, are experiencing behavior, attachment, or mental health problems, including post-traumatic stress disorder. 002.04 COMMUNITY TREATMENT AIDE SERVICES (CTA). Community treatment aide (CTA) services are supportive and psychoeducational interventions designed to assist the beneficiary and parents or primary caregivers to learn and rehearse the specific strategies and techniques that can decrease the severity of, or eliminate, symptoms and behaviors associated with the beneficiary’s mental illness that create significant impairments in functioning. 002.05 CRISIS OUTPATIENT. Crisis outpatient individual or family therapy is an immediate, short-term treatment service provided to a beneficiary with urgent psychotherapy needs. 002.06 FAMILY PSYCHOTHERAPY. Family psychotherapy is a treatment session in which an identified beneficiary and the beneficiary’s nuclear or extended family interact with a practitioner for the purpose of improving the functioning of the family system and decrease or eliminate the mental health symptoms experienced by the family. 002.07 FAMILY SUBSTANCE USE DISORDER COUNSELING. Family substance use disorder counseling is a treatment session between an identified beneficiary and the beneficiary’s nuclear or extended family and a licensed practitioner. 002.08 FUNCTIONAL FAMILY THERAPY (FFT). 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 GROUP PSYCHOTHERAPY. Group psychotherapy is a treatment session between a beneficiary and a licensed practitioner in the context of a group setting of three to 12 beneficiaries. 002.10 GROUP SUBSTANCE USE DISORDER COUNSELING. Group substance use disorder counseling is a counseling session during which a practitioner directs interactions between three to 12 beneficiaries who have a substance use disorder diagnosis for the purpose of all beneficiaries achieving abstinence from alcohol and drug use. 002.11 INDIVIDUAL PSYCHOTHERAPY. Individual psychotherapy is an active treatment session between a beneficiary and an appropriately licensed practitioner for the purpose of improving the mental health symptoms that are significantly impairing the beneficiary’s functioning in at least one life domain. 002.12 INDIVIDUAL SUBSTANCE USE DISORDER COUNSELING. Individual substance use disorder counseling is a counseling session between a beneficiary and a licensed practitioner for a primary substance use disorder. 002.13 INPATIENT HOSPITAL SERVICES FOR BENEFICIARIES AGE 20 OR YOUNGER IN INSTITUTIONS FOR MENTAL DISEASE (IMD). Services provided under the direction of a psychiatrist for the care and treatment of beneficiaries age 20 and younger in an institution for mental disease (IMD) that meets the requirements of federal regulations. 002.14 INSPECTION OF CARE TEAM. Nebraska Medicaid or designee's inspection of care team for institutions of mental disease (IMD), consisting of a psychiatrist knowledgeable about institutions for mental disease (IMD), a qualified registered nurse (RN), and other appropriate personnel as necessary who conduct inspection of care reviews under federal regulations and this regulations. 002.15 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. 002.16 INTERDISCIPLINARY TEAM. The team responsible for developing each beneficiary's individual plan of care. 002.17 MEDICAL NECESSITY. Medical necessity is defined as the need for treatment services which are necessary to diagnose, treat, cure, or prevent regression of significant functional impairments resulting from symptoms of a mental health or substance use disorder diagnosis. Treatment services must: (A) Be provided in the least restrictive level of care that is appropriate to meet the needs of the beneficiary; (B) Be supported by evidence that the treatment improves symptoms and functioning for the individual beneficiary’s mental health or substance use disorder diagnosis; (C) Be reasonably expected to improve the beneficiary’s condition or prevent further regression so that the services will no longer be necessary; and (D) Be required for reasons other than primarily for the convenience of the beneficiary or the provider. 002.18 MEDICAL REVIEW ORGANIZATION. A review body contracted by Nebraska Medicaid, responsible for pre-admission certification and concurrent and retrospective reviews of care. 002.19 MEDICATION MANAGEMENT. Medication management is the service provided by a physician, physician assistant (PA), or advanced practice registered nurse (APRN) focused on the monitoring and prescribing of psychopharmacologic agents. 002.20 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. If a beneficiary receives 24 or more hours of continuous outpatient care, that beneficiary is defined as an inpatient regardless of the hour of admission, whether they used a bed and whether they remained in the hospital past midnight or the census-taking hour, and all inpatient prior-authorization requirements apply. 002.21 PARENT CHILD INTERACTION THERAPY. Parent child interaction therapy is aservice provided to children age two to 12 that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. 002.22 PSYCHOLOGICAL TESTING. Psychological testing is the administration and interpretation of standardized tests used to assess a beneficiary’s psychological or cognitive functioning. It assists in gaining an understanding of a beneficiary’s diagnostic presentation and informs the appropriate course of treatment. 002.23 SELF-CARE SERVICES. Self-care services are services supervised by a registered nurse (RN) or occupational therapist (OT) who is oriented toward activities of daily living and personal hygiene. 002.24 SEX OFFENDER RISK ASSESSMENT. A sex offender risk assessment is a structured evaluation for the purpose of recommending whether sex offender specific treatment is necessary, the most appropriate intensity, frequency and type(s) of sex offender treatment and to recommend safety parameters, including the level of supervision and monitoring needed during treatment. 002.25 TREATMENT PLAN. The treatment plan is a written, comprehensive plan of care to address mental health and substance use disorder symptoms identified in the initial diagnostic interview.