471 NAC 35-005. COMMUNITY SUPPORT

005. COMMUNITY SUPPORT. The following community support service requirements apply. 005.01 COMMUNITY SUPPORT. The community support program is designed to: (A)Provide and develop the necessary skills, services, and supports to enable beneficiaries to reside and participate in the community; (B) Improve the skills of daily living and quality of life; (C)Facilitate communication and coordination between rehabilitative mental health providers that serve the same beneficiary; and (D)Decrease the frequency and duration of hospitalization. 005.02 SERVICES PROVIDED IN COMMUNITY SUPPORT. Community support providers must provide beneficiary advocacy, ensure continuity of care, support beneficiaries in time of crisis, provide or procure skill training, ensure the acquisition of necessary resources, to assist beneficiaries with spend downs and other financial insurance coverage programs, and assist the beneficiary in achieving community and social integration. The community support program must provide a clear focus of accountability for meeting the beneficiary’s needs within the resources available in the community. The role or roles of the community support provider may vary based on beneficiary’s needs. Community support is a service in which the beneficiary’s contact occurs outside of program offices in community locations, frequently in the beneficiary’s private residence, consistent with the needs and desires of each beneficiary . 90-day treatment, rehabilitation, and recovery team meetings are not considered to be a community support service. The frequency of contact between the community support provider and the beneficiary is individualized and adjusted in accordance with the needs of the beneficiary. 005.03 INITIAL DIAGNOSTIC INTERVIEW. Prior to admission to a community support program, an initial diagnostic interview must be completed by an independently licensed practitioner, a psychiatrist, psychologist, or a licensed independent mental health practitioner (LIMHP). The purpose of this assessment is to determine or verify the presence of a severe and persistent mental illness which requires psychiatric rehabilitation services. The document must include the need of the specific rehabilitation services necessary to meet the treatment and recovery goals of the beneficiary. 005.04 SEPARATE AND DISTINCT SERVICE. Community support is a separate and distinct service, and will not be provided as a component of other rehabilitative psychiatric services or mental health outpatient services. Agencies that provide more than one level of rehabilitative psychiatric or mental health outpatient service must have staff dedicated to the community support program. These community support staff must not provide any other rehabilitative psychiatric or treatment service to the beneficiary. 005.04(A) PROGRAM COMPONENTS. The community support program must: (i)Facilitate communication and coordination among the rehabilitative mental health providers serving the beneficiary; (ii)Ensure that the beneficiary has a diagnosis of severe and persistent mental illness, as exhibited by the completion of an initial diagnostic interview, no more than 12 months prior to admission to a community support program. The initial diagnostic interview must identify the need for community support and outline the needed services and resources for the beneficiary; (iii)Ensure completion of a strength-based needs assessment which can include skills inventories, interviews, and other tools to develop treatment and rehabilitation plans, which must be completed within 30 days of admission by the rehabilitation team or team members; (iv)Ensure the completion of an individual treatment, rehabilitation, and recovery plan for each beneficiary served. The individual treatment, rehabilitation, and recovery plan must be completed within 30 days following the admission of the beneficiary and reviewed and updated every 90 days or as often as clinically necessary thereafter while receiving services. The individual treatment, rehabilitation, and recovery plan must be based on the results of comprehensive assessments and is developed with the beneficiary’s involvement and through an interdisciplinary team process. The individual treatment, rehabilitation, and recovery plan must include methods and interventions to address: activities of daily living, community living skills, budgeting, education, independent living skills, social skills, interpersonal skills, psychiatric emergency or relapse, medication management including recognition of signs of relapse and control of symptoms, mental health services, physical health care, vocational and educational resource acquisition, and other related areas as necessary for successful living in the community; (v)Ensure the individual treatment, rehabilitation, and recovery plan encompasses the supportive and rehabilitative interventions that will be directly provided by the community support program; (vi)Identify the provision of services and interventions identified in the individual treatment, rehabilitation, and recovery plan as the responsibility of other rehabilitative service providers; (vii)Develop and implement strategies to assist the beneficiary in becoming engaged and remaining engaged in medically necessary mental health treatment and psychiatric rehabilitation services; (viii)Provide service coordination and case management activities, including coordination or assistance in accessing medical, social, education, housing, transportation or other appropriate support services as well as linkage to other community services identified in the individual treatment, rehabilitation, and recovery plan; (ix)Facilitate communication between the treatment and rehabilitation providers and with the primary care physician, psychiatrist, or advanced practice registered nurse (APRN) serving the beneficiary; (x)Monitor beneficiary progress of the services being received and participate in the revision of the individual treatment, rehabilitation, and recovery plan as needed or at the request of the beneficiary; (xi)Provide contact as needed with other service provider, beneficiary family member, and other significant people in the beneficiary’s life to facilitate communication necessary to support the beneficiary in maintaining community living; (xii)Assist the beneficiary in the developing, evaluating, and updating a crisis and relapse prevention plan. This plan must be coordinated with any other rehabilitative service and include the beneficiary’s natural supports; (xiii)Provide therapeutic support and intervention to the client in time of crisis. If hospitalization is necessary, facilitate, in cooperation with the inpatient treatment provider, the beneficiary’s transition back into the community upon discharge; (xiv)Participate with and report to the treatment and rehabilitation team on the progress of the beneficiary in areas of medication compliance, relapse prevention, social skill acquisition, application, education, substance use disorder, and ability to sustain community living; (xv)Monitor medication compliance; and (xvi)Assist the beneficiary with all health insurance issues including share of cost eligibility issues. Ensure the beneficiary’s understanding of financial benefits and procedures to use those benefits . 005.04(B) ADMISSION CRITERIA. Community support services require a prior authorization by Nebraska Medicaid or its designee. To be eligible for community support services, the beneficiary must meet all of the criteria described in this chapter. . () 005.04(C) STAFFING REQUIREMENTS. Staff of rehabilitative programs that deliver rehabilitative services must either be licensed practitioners operating within their scope of practice or be skilled direct care staff that meet the following minimum standards: (i)Have demonstrated skills and competencies in working with people experiencing severe and persistent mental illness; (ii)Have completed a staff training curriculum for initial orientation and complete a continuing education curriculum at intervals as defined and prepared by the providing agency. This curriculum and periodic updates must be included in the program description submitted to Nebraska Medicaid; and (iii) Be trained in the principles of recovery. 00.0 005.04(D) CLINICAL STAFF. The community support program must have available a: (i) LICENSED CLINICAL SUPERVISOR. The clinical supervisor must qualify as a licensed practitioner and must participate in the individual treatment, rehabilitation, and recovery plan development and provide clinical supervision, consultation, and support. The licensed clinical supervisor will review the community support beneficiary’s clinical needs and progress toward their goals with the community support worker every 30 days. The review can be accomplished by the supervisor consulting with the community support worker on their assigned beneficiaries and providing clinical guidance or recommendations to better serve the beneficiary. (ii) OTHER CONSULTANTS. Consultation by licensed professionals for general medical, psychopharmacology, and psychological issues, as well as overall program design as necessary. These consultations must themselves meet the standards laid out in the appropriate sections of these regulations. 005.04(E) DIRECT CARE STAFF. The community support program must have community support staff who meet the following requirements: (i)Direct care staff must have a minimum level of experience or training that is satisfied by one of the following: (1) A bachelor’s degree or higher in psychology, sociology, or a related human services field; (2) Two years of coursework in a human service field; or (3) Two years of experience or training in a human service field, and two years of lived recovery experience, with demonstrated skills in the treatment of individuals with a behavioral health diagnosis; and (ii)Community support staff must receive monthly supervision by the community support clinical supervisor. 005.05 PROGRAM AVAILABILITY. The community support program must establish hours of service delivery that ensure program staff are accessible and responsive to the needs of the beneficiary. Scheduled services must include evening and weekend hours. The community support program must directly provide or otherwise demonstrate that each beneficiary has on-call access to a licensed mental health practitioner (LMHP) 24 hours per day . Access to a licensed mental health practitioner (LMHP) must be documented in the beneficiary's individual treatment, rehabilitation, and recovery plan. 005.06 CONTACTS. The frequency of contact between the beneficiary and the community support worker must be individualized and adjusted in accordance with the needs of the beneficiary. Community support providers must ensure that the amount of direct contact is sufficient to meet the beneficiary’s needs as identified in the individual treatment, rehabilitation, and recovery plan. Contacts may either be direct beneficiary contact or collateral contact. (A) DIRECT BENEFICIARY CONTACT. Direct beneficiary contacts are contacts with the beneficiary that focus on the development of skills, or the management of other activities or goals identified on the individual treatment, rehabilitation, and recovery plan. Contacts must occur in community settings and be medically necessary for the beneficiary’s recovery. Face-to-face contact must be individualized to the beneficiary’s recovery needs and must be identified in the beneficiary’s individual treatment, rehabilitation, and recovery plan . Contacts must be timed in units, with each unit being equivalent to a 15-minute period, with contacts being limited in duration with a maximum of 144 units per 180-day period. In situations of beneficiary absence or unavailability for a scheduled contact, providers must document the circumstances in which the scheduled contact did not occur and the program’s response to the lack of beneficiary’s availability to participate in the community support intervention. (B) COLLATERAL CONTACT. Collateral contacts must be documented in the beneficiary's clinical record and are considered an essential supportive component to the beneficiary's treatment, recovery, and rehabilitation plan but may not be billed as a separate service to Nebraska Medicaid. 005.07 CLINICAL DOCUMENTATION. Rehabilitative psychiatric service providers must maintain a clinical record that is confidential, complete, accurate, and contains up-to-date information relevant to the beneficiary’s care and services. The record must sufficiently document assessments; individual treatment, rehabilitation, and recovery plans and plan reviews; and important provider discussion. The clinical record must document beneficiary contacts describing the nature and extent of the services provided, such that a clinician unfamiliar with the service can identify the beneficiary’s service needs and services received. The documentation must reflect the rehabilitative services provided, be consistent with the goals in the treatment and recovery plan, and be based upon the comprehensive assessment. The absence of appropriate, legible, and complete records can result in the recoupment of previous payments for services. Providers must provide the clinical record in the English language, however, providers must accommodate beneficiaries of other cultures and language in order that the beneficiary can completely participate in and understand their treatment and recovery rehabilitation program. Each entry must identify the date, beginning and end time of the service, and the location of service. The individuals in attendance must be identified by name and relationship to the identified beneficiary and the name and title of the staff person providing the intervention and entering the information. 005.07(A) CLINICAL RECORDS. Clinical records must be maintained at the provider’s headquarters. Records must be kept in a locked file when not in use. For purposes of confidentiality, disclosure of treatment information is subject to all the provisions of applicable state and federal laws. The beneficiary’s clinical record must be available for review by the beneficiary, and their guardian with appropriate consent, unless there is a specific medically indicated reason to preclude this availability. The specific reason must be documented in the clinical record and reviewed periodically. 005.07(B) CLINICAL RECORD REQUIREMENTS. The clinical record must include, at a minimum: (i)Beneficiary identifying data, including demographic information and the beneficiary’s legal status; (ii)Assessment and evaluations; (1)initial diagnostic interview completed prior to admission; (2)Strength-based needs assessment; and (3)Other appropriate assessments; (iii)Treatment and recovery plan and updates to plans; (iv) Documentation of review of client rights with the beneficiary; (v) A chronological record of all services provided to the beneficiary. Each entry must include the staff member who performed the service received. Each entry includes the date the service was performed, the duration of the service, including the beginning and end time, the place of the service, and the staff member’s name and title and legible signature ; (vi)Documentation of the involvement of family and significant others; (vii)Documentation of treatment and recovery services and discharge planning; (viii)A chronological listing of the medications prescribed for the beneficiary, including dosages and schedule, and the beneficiary’s response to the medication; (ix)Documentation of coordination with other services and treatment providers; (x)Discharge summaries from previous levels of care; (xi)Discharge summary when appropriate; and (xii)Any clinical documentation requirements identified in the specific service. 005.08 PROVIDER PARTICIPATION. Providers must comply with all applicable provider participation requirements . The provider must sign an agreement at the time of enrollment that states the provider will submit initial and annual cost information to Nebraska Medicaid as a part of the enrollment. The cost information must be updated upon request. 005.08(A) LICENSURE REQUIREMENTS. Community support providers must be appropriately licensed when licensure is required to provide the service and the program must have acquired national accreditation in The Joint Commission , the Commission on Accreditation of Rehabilitation Facilities (CARF), or Council on Accreditation (COA) as a condition for enrollment as a participating provider. Accreditation must be maintained throughout the Nebraska Medicaid participation period. 005.09 BENEFICIARY RIGHTS POLICY. Individual staff and the treatment and recovery team must provide all services in a manner to support and maintain the beneficiary’s rights with a continuous focus on empowerment and movement toward recovery. Providers must have a written beneficiary rights and responsibilities policy and staff must review beneficiary rights, responsibilities, and grievance procedures with each new beneficiary at admission, at treatment and recovery plan review, and at the request of the beneficiary. This review must be documented in the clinical record. Substance use disorder and mental health treatment providers must comply with all state and federal beneficiary rights requirements. 005.09(A) BENEFICIARIES’ RIGHTS. Beneficiaries’ rights must be observed when providing mental health and substance use disorder services through Nebraska Medicaid. The beneficiary has the right to: (i)Be treated with respect and dignity regardless of state of mind or condition; (ii)Have privacy and confidentiality related to all aspects of care; (iii)Be protected from neglect; physical, emotional or verbal abuse; and exploitation of any kind; (vi)Be part of developing an individual treatment and recovery plan and decision-making regarding their treatment and rehabilitative services; (v)Refuse treatment or therapy unless ordered by a mental health board or court; (vi)Be free of any sexual exploitation or harassment; (vii)Voice complaints and file grievances without discrimination or reprisal and to have those complaints and grievances addressed; and (viii)Receive such forms, instructions, and assistance as needed to file a complaint or request a state fair hearing. 005.10 BILLING FOR COMMUNITY SUPPORT SERVICES. Community support services must be billed in 15-minute increments for a maximum of 144 units per 180 days.