471 NAC 32-003. GENERAL REQUIREMENTS

003. GENERAL REQUIREMENTS. 003.01 ELIGIBILITY. A beneficiary is eligible for mental health or substance use treatment services, or both, set forth in this chapter when: (A) The beneficiary has a diagnosis of a mental health or substance use disorder; (B) The mental health or substance use disorder results in functional impairment that substantially interferes with or limits the beneficiary’s role or functioning within their family, school, or community. Coexisting conditions must be carefully evaluated in order to identify the functional impairments resulting from the mental health or substance use disorder diagnosis and those resulting from the coexisting condition. In the evaluation of coexisting conditions, evidence of the conditions will not automatically result in denial of eligibility; and (C) The services meet medical necessity criteria. 003.02 FAMILY COMPONENT. Unless otherwise prohibited, providers must involve the family in assessment, treatment planning, updating of the treatment plan, therapy and transition, and discharge planning. Providers must schedule meetings and sessions in a flexible manner to accommodate a family’s schedule, including weekends and evenings. Family involvement, or lack thereof, must be documented in the clinical record. Parental or caregiver involvement in treatment is essential and evidence-based practices, which include parents or caregivers in therapy are the expectation for treatment. 003.03 CULTURAL COMPETENCE. Providers must be culturally competent. This includes awareness, acceptance, and respect of differences and continuing self-assessment regarding culture. 003.04 INITIAL DIAGNOSTIC INTERVIEW. The initial diagnostic interview is required prior to initiation of treatment services and must include a history, mental status, and a disposition and may include communication with family or other sources. If circumstances require, family members, guardians, or other supports may be interviewed to supplement the interview of the beneficiary. Except that beneficiaries receiving acute inpatient hospital services, crisis services, or substance use disorder services subject to the requirements of this chapter are not required to receive an initial diagnostic interview before services are initiated. 003.04(A) PROVIDER AGREEMENT. Providers of the acute services must facilitate or perform the initial diagnostic interview. Providers of crisis intervention services must facilitate the referral to or provide the initial diagnostic interview if it has not already occurred. For providers of substance use disorder services, if a co-occurring mental health condition is known or suspected, the clinician will refer the beneficiary for an initial diagnostic interview. 003.05 PRACTITIONERS REQUIRING SUPERVISION. A practitioner who is not eligible to practice independently and who provides mental health or substance use treatment services, or both, must be supervised by a supervising practitioner. A supervising practitioner must be a: (A)Provisionally licensed mental health practitioner (LMHP); (B)Registered nurse (RN); (C)Provisionally licensed psychologist; or (D)Provisional licensed alcohol and drug counselor (LADC). 003.05(i) SUPERVISING PRACTITIONER. A supervising practitioner must be: (1)A licensed physician who has a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine degree ( D.O.) and has completed a psychiatric residency or similar training program and preferably is board certified in psychiatry or addiction medicine, for any level of mental health or substance use services; (2)A licensed psychologist who has a Doctor of Philosophy (Ph.D) or Doctor of Psychology degree ( Psy.D.) for any level of mental health or substance use services except psychiatric residential treatment facility (PRTF); (3)A licensed independent mental health practitioner (LIMHP) for outpatient services, intensive outpatient, and community treatment aide (CTA) services only; and (4) A licensed advanced practice registered nurse (APRN) who has proof of a current certification from an approved certification program in a psychiatric or mental health specialty for any level of mental health or substance use services except psychiatric residential treatment facility (PRTF). 003.05(ii) RESPONSIBILITIES OF A SUPERVISING PRACTITIONER. A supervising practitioner must : (1)Approve and supervise the beneficiary’s assessment and treatment plan. This requires facilitation of an assessment in order to develop, approve, and supervise the beneficiary’s assessment and treatment plan; (2)Direct patient care by reviewing and approving beneficiary specific treatment plans and progress notes within the timelines specified for each level of care, not to exceed 90 days; and (3)Assure treatment provided meets standards of care. 003.05(iii) REIMBURSEMENT FOR SUPERVISION. Assessments and other services provided by the supervising practitioner, directly to the beneficiary, are reimbursable. Supervision is not reimbursable either by the supervising practitioner or the practitioner who is being supervised. 003.06 PROVIDER ENROLLMENT. All providers of mental health and substance use treatment services must submit a completed medical assistance provider agreement to Nebraska Medicaid for approval. A separate application must be submitted for each particular mental health and substance use treatment service. 003.06(A) NEBRASKA HEALTH CONNECTION ENROLLMENT. In order to be reimbursed for providing services to beneficiaries in Nebraska Health Connection, providers must be credentialed by and under contract with the Nebraska Medicaid managed care behavioral health contractor. 003.07 ACTIVE TREATMENT. Treatment must be provided in an interactive environment with the beneficiary present, and must be focused on reducing or controlling the beneficiary's mental health and substance use disorder symptoms that cause functional impairments and promoting the beneficiary's movement to less restrictive treatment in the most time efficient manner consistent with sound clinical practice. 003.08 TREATMENT PLANS. The treatment plan must include transition and discharge planning and must be amended as needed as treatment progresses. The treatment plan must: (A)Be individualized to the beneficiary; (B)Include the specific symptoms or skills to be addressed; (C)Provide clear and realistic goals; (D)Include treatment objectives services, strategies, and methods of intervention to be implemented; (E)Describe the methods for evaluating both the beneficiary's progress and the performance of the practitioner facilitating the intervention; and (F)Estimate the length of time or number of sessions necessary to complete the treatment goals. 003.09 TRANSITION AND DISCHARGE PLANNING. Providers must begin and document transition and discharge planning at the time of admission or onset of treatment and continue to update the documentation throughout the treatment episode. 003.10 COORDINATION OF CARE. Providers must coordinate services for beneficiaries who receive services from more than one mental health and substance use provider . 003.11 CLINICAL RECORDS. Each provider must maintain a legible clinical record for each beneficiary that includes a complete record of all the treatment services rendered. The clinical record must contain documentation sufficient to justify reimbursement and must allow an individual not familiar with the beneficiary to evaluate the course of treatment. Failure to have sufficient documentation to justify the level of reimbursement may result in recoupment of payments made for services lacking the documentation. 003.11(A) PROGRESS NOTES. Progress notes must identify the beneficiary name, the name and title of the practitioner, and the date of service. The progress note must also identify the type of therapy, beginning and end date, and time of the service delivered. 003.11(B) RECORD RETENTION. Clinical records must be maintained for a minimum of seven years in a secure location. 003.11(C) CONFIDENTIALITY OF RECORDS. Each provider must ensure the confidentiality of clinical data in accordance with state and federal law. 003.12 LOCATION OF COMMUNITY BASED SERVICES. Community based mental health and substance use treatment services must be provided in the beneficiary’s home or a professional environment conducive to beneficiary confidentiality and privacy. 003.13 QUALITY ASSURANCE, UTILIZATION REVIEW AND INSPECTION OF CARE. Providers must fully cooperate with any reviews conducted by Nebraska Medicaid or a Nebraska Medicaid designee to determine the quality of care and services provided. Providers must have access to a copy of any final inspection of care report. 003.13(A) RESPONSE TO INSPECTION OF CARE REPORTS. Within 15 days following the receipt of the inspection of care report, the provider must respond in writing and submit a plan of correction for any identified findings and recommendations. The provider may request an extension of time to respond if needed. 003.14 PAYMENT. Payment for services must be based upon rates established by Nebraska Medicaid, as described further throughout this chapter, and may be increased or decreased based on legislative appropriations or budget directives from the Nebraska Legislature. Providers may be required to report their costs on an annual basis or as needed. 003.15 INSTITUTION FOR MENTAL DISEASE (IMD). Services provided to beneficiaries residing in an institution for mental disease (IMD) must not be reimbursable by Nebraska Medicaid except as provided in the regulations on psychiatric residential treatment facilities (PRTF).