Neb. Admin. Code tit. 15 — Aging Services

Chapter 1 Definitions

Neb. Admin. Code tit. 15, ch. 1 Definitions {#sec-15-nac-1 omnilex-key=us-ne-regs-official--title-15--15 NAC 1}

001 SCOPE AND AUTHORITY . These rules and regulations provide definitions for the Nebraska Community Aging Services Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 81-2201 to 81-2236, §§ 81-2273 to 81-2283, § 81-2210, and §§ 68-1107 to 68-1117 consistent with the Older Americans Act of 1965 (OAA).

002. DEFINITIONS . For purposes of this title, the following definitions apply:

002.01 ACT. The Act is the Nebraska Community Aging Services Act.

002.02 ANNUAL BUDGET. The annual budget is a document identifying fiscal year expenditures based on services to be provided in the Planning and Service Area, and corresponding service unit projections.

002.03 ASSESSMENT. An assessment is a comprehensive appraisal of individuals by making orderly and purposeful observations, conducting interviews, and recording the results of those observations and interviews on a standardized assessment document issued by the Department.

002.04 AUTHORITY AND CAPACITY. The authority and capacity is the power and right of an Area Agency on Aging to enforce, administer, and implement laws, rules, and regulations and programs for which it is responsible.

002.05 CARE MANAGEMENT. Care management is assisting a client to identify and utilize services needed to ensure that the client is receiving, when reasonably possible, the level of care that best matches his or her level of need.

002.06 CARE MANAGEMENT FEE SCALE. The Care Management fee scale is the document issued annually by the State Unit on Aging, using the Federal Poverty Level, for Area Agencies on Aging to determine the client fee for Care Management services based on family income. Defined as follows:

(A) Family income is the total income the individual and spouse (if any) receives annually;

(B) Income is money received as profit from fees (net income after business expenses, before taxes) from a person's own business, professional practice, partnership, or farm;

(C) Income includes but is not limited to, regular payments such as social security, income from public assistance or welfare, interest, dividends, pensions, net rents, alimony, child support, or allotments;

(D) Income includes wages, salary, commission, bonuses, or tips from all jobs (before deductions from taxes), including sick leave pay; and

(E) For the purposes of this Title, family means an individual and his or her spouse.

002.07 CARE MANAGEMENT UNIT (CMU). The Care Management Unit is the organization which is created by, or which is contracting with, an Area Agency on Aging, or the public or private entity contracting with the Department, to provide Care Management program services as defined in the Act and this Title.

002.08 CERTIFIED CARE MANAGEMENT UNIT. Certified Care Management Unit is a Care Management Unit that has been found by the Department to meet the standards for certification under the Act.

002.09 CLIENT. Client is an eligible individual receiving services authorized by the Older Americans Act of 1965, or 15 Nebraska Administrative Code (NAC) services, also known as a participant.

002.10 CONTINUUM OF CARE. Continuum of care is a range of services designed to ensure that persons are receiving, when reasonably possible, the level of care that best matches their level of need.

002.11 CONTRIBUTION. A contribution is a donation of money, or anything of value, that is voluntarily given by an eligible individual to a service provider to be used toward the cost of the program or service received by the individual from the service provider.

002.12 DESIGNATION. Designation is the authorization granted by the Department to an entity to act as the Area Agency on Aging for a given Planning and Service Area.

002.13 DIRECT CARE PROGRAM. A direct care program is any program of an Area Agency on Aging, except the Care Management program, providing services to older eligible individuals.

002.14 ELIGIBLE INDIVIDUAL. Eligible individual is a person who resides in Nebraska and is either 60 years of age or older, or a caregiver, and meets program eligibility criteria within this Title.

002.15 ENVIRONMENTAL NEEDS. Environmental needs are factors required to maintain an individual in an appropriate and safe living arrangement.

002.16 FUNCTIONAL NEEDS. Functional needs are factors that affect an individual's ability to perform the activities of daily living and the instrumental activities of daily living.

002.17 GRANT. Grant is an award of financial assistance in the form of money, or of property in lieu of money, by the Department. See also Subawards.

002.18 GRANTEE. Grantee is any legal entity to which a grant is awarded and which is accountable to the Department for the use of the grant. The grantee includes the entire legal entity even if only a particular component of the entity is designated in the grant.

002.19 GRANTING AGENCY. Granting agency is the Department.

002.20 GRANT OR SUBAWARD AMENDMENT. Grant or subaward amendment is a change by an Area Agency on Aging that would:

(A) Alter the program scope, planned objectives, or the manner in which services are delivered;

(B) Provide financial assistance or payments to any entity not authorized by the original grant or contract; or,

(C) Alter the approved budget of the original grant or contract, except as authorized in directives issued by the Department.

002.21 INDIVIDUAL APPROVAL OR CLIENT APPROVAL. Individual approval or client approval is confirmation given after full disclosure, on a form by the eligible individual or the client, or their legal representative.

002.22 LONG-TERM CARE (LTC). Long-term care is caring for people who have unmet psycho-social, environmental, or functional needs and who need assistance in meeting these needs for a period of at least three months.

002.23 LONG-TERM CARE PLAN. Long-term Care Plan is a document prepared with a client by the Care Management Unit in compliance with 15 NAC 3.

002.24 LONG-TERM CARE PLANNING. Long-term care planning is the process used to prepare a Long-Term Care Plan.

002.25 MEAL. Meal is food served as the morning, mid-day, or evening meal. The meal must meet Older Americans Act of 1965, state, and local law requirements.

002.26 NUTRITION SCREENING. Nutrition screening is the completion of a nutrition screening checklist by eligible individuals to determine if they are at nutritional risk.

002.27 NUTRITION SERVICES INCENTIVE PROGRAM (NSIP). Nutrition Services Incentive Program provides funds that are distributed by the State Unit on Aging to the Area Agencies on Aging based on a ratio of the number of meals served the prior year to the total number of meals served throughout the state. Nutrition Services Incentive Program funds are primarily received in cash, however the State may choose to receive food commodities, cash, or a combination of both.

002.28 OLDER INDIVIDUALS, OLDER NEBRASKANS, OLDER POPULATION. Older individuals, older Nebraskans, and older population are persons who are 60 years of age or older.

002.29 PLAN OF OPERATION. Plan of Operation is a plan prepared in compliance with 15 NAC 3.

002.30 PERSON-CENTERED. Person-centered is as defined in Code of Federal Regulations (CFR) Title 42, Sec. 441.540.

002.31 POTENTIALLY HAZARDOUS FOODS. Potentially hazardous foods are foods that require time control, temperature control, or both, for safety to limit pathogenic microorganism growth or toxin formation.

002.32 PSYCHO-SOCIAL NEEDS. Psycho-social needs are basic needs which include, but are not limited to, social participation, orientation, understanding, and a sense of well-being.

002.33 REGISTERED DIETITIAN. Registered dietitian is a person registered by the Commission on Dietetic Registration.

002.34 REQUEST FOR PROPOSAL (RFP). Request for proposal is a document containing criteria which is used to solicit applications for a contract or subgrant from potential service providers.

002.35 SERVICE PROVIDER. Service provider is any entity that is obligated under law, subaward, or contract to provide community aging services to eligible individuals, in any Planning and Service Area.

002.36 SIGNIFICANT CHANGES IN HEALTH OR FUNCTIONAL STATUS. Significant changes in health or functional status are changes in a Care Management program client’s health or abilities that requires admission to a hospital or a skilled nursing facility for inpatient care, or an increase in in-home services.

002.37 STATE PLAN. State Plan is a document developed, approved, and submitted to the Governor, and the Administration on Aging, a division of the Administration for Community Living, for the purposes of administering grant funds allocated to the state under the Older Americans Act of 1965. The State Plan must meet federal requirements outlined in the Older Americans Act of 1965, Title I, Sections, 306, 307, and 705.

002.38 SUBAWARD. Subaward is a document awarding financial assistance in the form of money, or of property in lieu of money, by the Department. See also Grant.

002.39 TAKE HOME MEAL. Take home meal is any meal sold at full price at a meal site, for eligible or ineligible individuals, who wish to take meals from the site.

002.40 TITLE III-C. Title III-C is as defined in Title III-C of the Older Americans Act of 1965.

History

Effective 2020-09-21

Chapter 2 Designation, Area Plan, and Budget

Neb. Admin. Code tit. 15, ch. 2 Designation, Area Plan, and Budget {#sec-15-nac-2 omnilex-key=us-ne-regs-official--title-15--15 NAC 2}

001. SCOPE AND AUTHORITY . These rules and regulations implement Nebraska Revised Statute (Neb. Rev. Stat.) §§ 81-2201 to 81-2227 (the Act) and the Older Americans Act of 1965 (OAA).

002. DEFINITIONS . Definitions are located in this Title, Chapter 1.

003. DESIGNATION AND CONTINUED DESIGNATION . A proposed Area Agency on Aging must comply with applicable legal requirements to be designated, and an existing Area Agency on Aging must continue to comply with applicable legal requirements to continue to be designated, according to the Act and the Older Americans Act of 1965 (OAA).

003.01 AUTHORITY. A proposed Area Agency on Aging must demonstrate its authority to be designated to the State Unit on Aging, which includes providing to the State Unit on Aging copies of the following documents:

(A) An Interlocal Cooperation Act agreement signed by the chief elected officials of participating counties within its Planning and Service Area;

(B) Authority to accept and utilize funds for aging services as specified by the Act, this Title, and the Older Americans Act of 1965;

(C) Authority to develop and implement policies and procedures for administration, services and program development, program records, data collection, and planning. Policies and procedures, including the following, are to be in writing and on file:

(i) A statement that the Agency is an Equal Opportunity Employer with an Affirmative Action Plan;

(ii) By-laws for the Governing Unit;

(iii) By-laws for an Advisory Committee;

(iv) Use of property;

(v) Confidentiality and storage of confidential material; and

(vi) Personnel policies which include: job descriptions for each Area Agency employee, code of ethics, leave, travel, discipline, performance evaluation, hiring and termination, grievance procedures, and accounting and financial management;

(D) Collected and evaluated views of units of general purpose local government gathered in public hearing in the Planning and Service Area prior to seeking designation;

(E) Evidence that the views of older persons have been considered and evidence of support from older persons in the Planning and Service Area;

(F) Evidence of support from Units of General Purpose Local Government and human service agencies and community organizations in the Planning and Service Area; and

(G) Authority to be an advocate for older persons in the Planning and Service Area.

003.02 CAPACITY REVIEW. A proposed Area Agency on Aging must demonstrate its capacity to be designated to the State Unit on Aging, which includes providing to the State Unit on Aging documents demonstrating its capacity to carry out the following:

(A) The planning, organizing, staffing, directing, and supervision of a comprehensive and coordinated program of services for older Nebraskans;

(B) Monitoring, evaluating and commenting on policies, programs, hearings, and community actions which affect older persons;

(D) Representing the interest of older persons;

(E) Conducting activities in support of the Department's Long-Term Care Ombudsman and Legal Services program as required by the Older Americans Act of 1965;

(F) Coordinating planning with other agencies and organizations to promote programs and opportunities which benefit older persons;

(G) Providing technical assistance to providers of services and to multipurpose senior centers in the Planning and Service Area;

(H) Establishing effective and efficient procedures for the coordination between the programs assisted by the Department and other programs available to older Nebraskans; and

(I) Carrying out the intention of the Act and these rules and regulations and the Older Americans Act of 1965, and its rules and regulations.

003.03 PUBLIC HEARING. A proposed Area Agency on Aging must conduct a public hearing to consider the views of units of general purpose local governments in its planning and service area.

003.04 PROPOSAL AND SUPPORT. A proposed Area Agency on Aging must obtain within its planning and service area the support of the chief elected officials of the units of general purpose local governments formed under the Interlocal Cooperation Act (Neb. Rev. Stat. §§ 13-801 – 13-827).

003.05 ON-SITE ASSESSMENT. A proposed or designated Area Agency on Aging must allow the State Unit on Aging to conduct assessments, including on-site assessments, which may include an evaluation of the proposed or designated Area Agency on Aging’s performance in carrying out responsibilities and functions, an evaluation of goals and objectives under any approved plan or budget, onsite visits, client interviews, a review of performance and fiscal reports, and a review of any plan.

004. WITHDRAWAL OF DESIGNATION

004.01 REASONS FOR WITHDRAWAL. The Department may revoke an Area Agency on Aging’s designation, and may accordingly withhold all or a portion of a grant award, for any of the following reasons:

(A) Voluntarily withdrawal;

(B) Adverse change in authority or capacity to perform;

(D) Failure to implement an approved plan or budget;

(E) Refusal to serve older persons in the planning and service area with a program of services as outlined in an approved plan or budget;

(F) Misappropriation of funds;

(G) Failure to obtain approval, in advance, for any proposed amendment to an approved plan or budget;

(H) Failure to meet the conditions of the subaward from the State Unit on Aging; or

(I) Failure to comply with applicable law, including the Act, this Title, or the Older Americans Act of 1965.

004.02 RECONSIDERATION. If its proposed designation is denied, a proposed Area Agency on Aging may submit a request for reconsideration within 30 days of the date that the State Unit on Aging issued its denial, which shall include sufficient reasons why designation should occur and supporting documentation.

If an existing designation is revoked, an Area Agency on Aging may submit a request for reconsideration within 30 days of the date that the State Unit on Aging issued its revocation, which shall include sufficient reasons why designation should not be revoked, supporting documentation, and a proposed plan of corrective action that indicates an understanding and acknowledgment of the reason(s) for the designation revocation, describes the steps to be taken to remedy the reason(s), indicates the expected outcome(s) for each proposed remediation step, and describes the time frame to which the Area Aging on Aging would expect to be held to remedy the reason(s) for the designation revocation, if the State Unit on Aging were to reconsider revocation and accept the proposed corrective action plan. The Area Agency on Aging must not implement a proposed plan prior to the granting of its request for reconsideration and approval of the proposed corrective plan by the State Unit on Aging.

004.03 FAILURE OF SECOND CHANCE. If an Area Agency on Aging fails to comply with a corrective action plan that was approved by the State Unit on Aging, the Area Agency on Aging will have its designation revoked by the State Unit on Aging.

004.04 APPEAL PROCESS. A decision by the Department to deny or revoke designation may be appealed in writing to the director of the State Unit on Aging within 10 days of the date the denial or revocation notice was sent. Appeal and hearing procedures are governed by the Administrative Procedures Act, Neb. Rev. Stat. Sec. 84-917 and 465 NAC 6.

005. GOVERNANCE

005.01 SUFFICIENT STAFFING. An Area Agency on Aging must provide for the employment of sufficient staff to carry out its approved plan and budget.

005.02 PLAN AND BUDGET APPROVAL. An Area Agency on Aging must submit a budget to the State Unit on Aging no later than May 1 of each year.

005.03 THIRD-PARTY SERVICES APPROVAL. An Area Agency on Aging must approve appropriate subawards, contracts and agreements that are necessary to carry out its functions

005.04 ADVISORY COUNCIL CONSULTATION. An Area Agency on Aging must establish and consult with an area advisory council on needs, services and policies affecting older persons in the area.

005.05 ADVISORY COUNCIL BYLAWS. The advisory council must establish bylaws specifying its role and function, number and selection of members, and term of membership and frequency of meetings. The council must meet at least quarterly.

005.06 COMPOSITION OF COUNCIL. The advisory council may include a representative of developmental disability organizations within the planning and service area. The council must include individuals and representatives of community organizations to enhance the leadership role of the Area Agency on Aging in developing community-based systems of services. The advisory council must be made up of:

(A) More than 50 percent older persons, including minority individuals who are participants or who are eligible to participate in programs under this Title;

(B) Representatives of older persons;

(D) Representatives of supportive services providers’ organizations;

(E) Persons with leadership experience in the private and voluntary sectors;

(F) Local elected officials; and

(G) The general public.

006. AREA PLAN . An Area Agency on Aging must submit to the State Unit on Aging for approval an Area Plan that covers a period of two, three, or four years (as indicated by the State Unit on Aging) from the date of approval. The Area Plan, which must outline a comprehensive and coordinated program of community aging services for older persons within the planning and service area, must be in compliance with applicable law, including the Act, this Title, and with the Older Americans Act of 1965. A proposed Area Plan must include the following items:

(A) A statement of mission;

(B) A narrative and statement of goals and objectives, including a time frame and plan for implementation;

(C) A statement indicating an intent to comply with applicable law, including the Act, this Title, and with the Older Americans Act of 1965;

(D) A statement describing how the Area Agency on Aging develops, administers and supports the comprehensive coordinated program of community aging services in its Planning and Service Area;

(E) A statement describing how the Area Agency on Aging monitors and evaluates the activities of service providers;

(F) A statement describing how the Area Agency on Aging provides technical assistance to service providers;

(G) Procedures to evaluate compliance with the Area Plan and budget;

(H) Documentation to substantiate the following items:

(i) The program is administered in accordance with applicable law and the approved Area Plan;

(ii) Policies, procedures and methods that are necessary for the proper and efficient administration of the Area Plan exist in writing and are followed;

(iii) Uniform administrative requirements and cost principles are in compliance with the relevant provisions of applicable law;

(iv) Sufficient internal control and accounting procedures are maintained in accordance with generally accepted accounting principles (GAAP) to ensure proper disbursement of and accounting for funds under the approved plan. Fiscal records must be maintained for three years from the date of final payment, except records that fall under the provisions of the Health Insurance Portability and Accountability Act (HIPAA) must be maintained for six full years from the date of final payment. (Health Insurance Portability and Accountability Act [HIPAA] procedures must be compliant with Code of Federal Regulations (CFR) 45 Sec.160, Sec.162, and Sec.164.) Records must identify adequately the source and application of funds for grant or subaward support activities;

(v) Providers of service under the Area Plan operate fully in conformance with all applicable federal, state, and local fire, health, safety and sanitation and other standards prescribed in law or regulations. The Area Agency on Aging requires that when the state or local public jurisdictions require licensure for the provision of services, agencies providing the services must be licensed;

(vi) Standards and procedures that are necessary to meet the requirements provided in Neb. Rev. Stat. § 81-2214.02, regarding safeguarding confidential information exist in writing and are followed;

(vii) The Area Agency on Aging furnishes reports and evaluations to the State Unit on Aging as requested and as required by law;

(viii) Each program funded through the Area Agency on Aging operates its program or activity in a manner accessible to persons with disabilities;

(ix) Benefits and services available under the Area Plan are provided in a non-discriminatory manner;

(x) A third-party blanket liability coverage is in force, reasonably sufficient to cover an accident on project premises;

(xi) A statement acknowledging responsibility for: the subgranting and subcontract of Area Agency on Aging funds, the fiscal accountability for these funds, the meeting of all state requirements and the avoidance of any conflicts of interest arising from any grants, contracts, subgrants, or subcontracts under the plan; and

(xii) A statement that the Area Agency on Aging has a copy of the Interlocal Cooperation Agreement and bylaws under which it operates, maintains it, and that is available on request.

006.01 DISASTERS. An Area Agency on Aging must have a current plan for services, a copy of which is available on request, to the elderly during disasters, including, but not limited to, a tornado (high winds), chemical event , nuclear event, flood, and blizzard. The plan must show the coordination with Civil Defense and Red Cross and its pyramid alert system, including notification of the Department's disaster coordinator.

006.02 PROVIDING SERVICES. An Area Agency on Aging must submit in its plan a description or explanation, or both, of:

(A) A reasonable and objective method for determining the needs of all eligible residents of all geographic areas in the Planning and Service Area for allocating resources to meet those needs;

(B) A reasonable and objective method for establishing priorities for service and how the methods are in compliance with the Act;

(C) A method to ensure that Older Americans Act of 1965 and Community Aging Services Act funds are used to serve only those individuals and groups eligible under these Acts and their rules and regulations;

(D) How the plan addresses the needs of older individuals with the greatest economic need and the greatest social need;

(E) A plan to coordinate and utilize as much as possible the services and resources of other appropriate public and private agencies and organizations; and

(F) A plan that provides that in the operations and programs conducted by the Area Agency on Aging or service providers, any contributions received are to be collected in a manner which provides the client maximum confidentiality.

006.03 COMMUNITY FOCAL POINT. An Area Agency on Aging must designate at least one community focal point within the boundaries of each participating county in its planning and service area.

006.04 COMMUNITY FOCAL POINT LIST. An Area Agency on Aging must maintain an accurate listing of the community focal points, must provide the Department with the listing, and must update that listing as needed.

006.05 AVAILABILITY OF DOCUMENTS. An Area Agency on Aging must make available in its offices during ordinary business hours its Area Plan and budget, all periodic reports, and all policies governing the administration of the program in the area, for review by interested persons.

006.06 CONFIDENTIALITY OF RECORDS AND INFORMATION. An Area Agency on Aging must include written policies and procedures in its plan governing the confidentiality and information of all clients. No client record or information of sensitive or confidential nature is to be disclosed or released to any other party except with the written consent of the client, unless the disclosure is required by applicable law.

006.07 CONTRIBUTION FOR SERVICES. An Area Agency on Agency must include policies and procedures in its plan to ensure that those using services funded in whole, or in part, with Older Americans Act of 1965 funds are provided a free and voluntary opportunity to contribute to the cost of the services and ensure that their privacy is protected with respect to their contribution. Policies and procedures must include, but not be limited to:

(A) A means of providing contributions with anonymity;

(B) The availability of envelopes for confidential contributions for services provided in the home; and

(C) Written listings of total costs of services, suggested contributions, and cost-sharing fee schedules presented in a manner not to be mistaken for a bill or invoice for services rendered.

006.08 EXPANSION. An Area Agency on Aging must include policies and procedures in its plan for expansion of activities in the planning and service area, including services or programs, or both, in unreached areas and new or expanded services or programs, or both, in areas currently receiving services.

006.09 REDUCTION. An Area Agency on Aging must include policies and procedures in its plan for reducing services in the planning and service area if federal, state, or local funding sources are decreased or are no longer adequate to continue the current level of activity.

006.10 ELIGIBILITY. An Area Agency on Aging must describe procedures in its plan for determining eligibility for receiving federal and state funded services. Determination must take into account:

(A) For congregate activities, the area's community and older citizens' needs, resources, and standards and the recommendations of the area advisory council; and

(B) For individual services, an assessment of an individual's or family's circumstances and the development of a service plan.

006.11 USE OF SENIOR AND MULTI-PURPOSE CENTERS. An Area Agency on Aging must follow any requirements regarding the length of time a senior center must be used as an aging service center when funds granted by the State Unit on Aging are used in its acquisition, renovation, or construction, pursuant to the Older Americans Act of 1965, Section 312.

006.12 AMENDMENTS TO AREA PLANS AND BUDGETS. Any request for approval of an amendment must be accompanied by:

(A) Reason(s) for the requested change;

(B) Proposed amended budget;

(D) Any pages of the Area Plan or budget, or both, that are altered as a result of the proposed change(s); and

(E) Records of public hearings on any changes which are substantial or which adjust scope or direction.

006.13 PLAN DEFICIENCIES. An Area Agency on Aging must revise the proposed Area Plan if the State Unit on Aging finds that the proposed plan fails to comply with the Act, this Title, or the Older Americans Act of 1965, or its rules and regulations.

006.14 NOTICE OF REVISION. The Notice of Revision states the items to be revised.

006.15 PLAN RESUBMISSION. The Area Agency on Aging must resubmit the revised Area Plan to the Department within 45 days from the postmark of the Notice of Revision.

006.16 NON-COMPLIANCE. Failure to have an approved, or conditionally approved, Area Plan constitutes non-compliance with the Act and these rules and regulations and will require withdrawal of designation.

006.17 NEW OR REVISED PLAN. Ninety days prior to the expiration of an Area Plan, the Area Agency on Aging must submit a new or revised Area Plan to cover the next two, three, or four year period. Prior to submission of a new Area Plan, the Area Agency must:

(A) Hold at least one public hearing within its Planning and Service Area to gather comments on the proposed Area Plan;

(B) Make available draft copies of the Area Plan to service providers and other agencies and local governments in the Planning and Service Area for comment;

(C) Revise draft Area Plan responding to comments of the public, service providers, and other agencies and local governments, insofar as they are consistent with the Act and this Title; and

(D) Obtain approval of the Area Plan by the Governing Unit of the Area Agency on Aging.

007. ANNUAL BUDGET . Each Area Agency on Aging must submit to the Department for approval an annual budget. The budget must detail how the Area Agency on Aging implements goals and objectives during the ensuing fiscal year. The annual budget must:

(A) Tie service definitions between service unit projections and budgets;

(B) Provide cost itemization of equipment with cumulative cost of $5,000 or more and expenditures involving renovation, construction, and data processing equipment;

(D) Identify all subgrantees and contractors who receive Older Americans Act of 1965 funds, including dollar amounts for each; and

(E) Provide an indication of planned expansion or reduction activities.

007.01 DEPARTMENT REVIEW. The Department will review the annual budget prior to approval. The review will include, but not be limited to:

(A) A review of Area Agency objectives and their relationships to the Area Plan and budget;

(B) A review of the last assessment of the Area Agency on Aging including progress made on any deficiencies found during that assessment;

(D) Targeting of resources to socially and economically needy, low-income minority, rural older persons and Native Americans;

(E) A match of no less than 25% of the approved Area Plan and budget from local sources; and

(F) Compliance with the Act, these Rules and Regulations and the Older Americans Act of 1965, and its rules and regulations.

007.02 SUBAWARD ISSUANCE. The Governing Unit of the Area Agency on Aging must accept the subaward or grant before the annual budget is effective, once approved and issued by the Department. Acceptance of the subaward or grant is accomplished by the return of an executed subaward or grant.

007.03 NOTICE OF REVISION. An Area Agency on Aging will receive a notice of revision, which states the items to be revised, if, after review, the Department determines revisions to the submitted annual budget are required to be in compliance with the Act, this Title, the Older Americans Act of 1965, or its rules and regulations.

007.04 RESUBMISSION. An Area Agency on Aging must resubmit a revised annual budget within 15 days from the postmark of the rejection by the Department of the annual budget.

007.05 DEPARTMENT OPTIONS. If the Department does not approve an annual budget before the start of a new fiscal year, the Department may do any of the following:

(A) Issue a subaward or grant providing conditional approval, setting the conditions and date for compliance; or

(B) Approve the continued operation by the Area Agency on Aging under the previously approved Area Plan or budget, or both until a revised annual budget is approved, but in no case for more than 180 days.

007.06 AMENDMENTS OF ANNUAL BUDGET. Before an Area Agency on Aging can implement its budget, the Area Agency on Aging must obtain the approval of the budget from the Department. Failure to apply for an amendment of the annual budget, or to receive approval for an amendment, constitutes non-compliance and is cause for withdrawal of designation. Any request for approval of amendment must be accompanied by:

(A) Reason for the requested change;

(B) Proposed amended budget;

(D) Any pages of the Area Plan and budget that are altered as a result of the changes; and

(E) Records of public hearings on any changes which are substantial or with a change in scope or direction.

008. REPORTING REQUIREMENTS . Each Area Agency on Aging must submit required program and financial reports to comply with state requirements and federal requirements in 45 CFR Part 74 and 2 CFR 200, respectively.

008.01 SERVICE REPORTING SYSTEM. Each Area Agency on Aging must use the Aging designated Service Reporting System. Service units, activities, and reports must be entered or submitted by the Area Agency on Aging by due dates set by the Department.

008.02 THIRD PARTY REPORTING. Each Area Agency on Aging must obtain and report necessary information from those sub-recipients and service providers with whom they have subawards or contracts.

008.03 AUDITS. Each Area Agency on Aging must obtain and file with the Department an audit report in compliance with the Office of Management and Budget (OMB) CFR 200 Part F. The audit must be conducted in accordance with generally accepted auditing standards.

009. GRANTS AND REIMBURSEMENT . Each Area Agency on Aging is reimbursed, through a subaward, up to 75 percent of the actual cost of providing activities and services as described in its approved Area Plan and budget that are eligible for funding under Neb. Rev. Stat. Sec. 81-2222.

009.01 SOURCES. The reimbursements are made from:

(A) State funds appropriated to the Department under the Act; and

(B) Federal funds allocated to the Department, including funds allocated under the Older Americans Act of 1965.

009.02 INSUFFICIENT FUNDING. If appropriated state or federal funds are insufficient to finance the approved budget for each Area Agency on Aging, the reimbursement to each Agency is proportionately reduced.

009.03 EXCEEDING APPROVED BUDGET. If an Area Agency on Aging chooses to exceed the approved budget, the Department cannot reimburse costs in excess of the approved budget.

009.04 REIMBURSEMENT QUALIFICATION. To qualify for reimbursement, an Area Agency on Aging must provide no less than 25 percent of the approved budget from local sources, which must include but not be limited to:

(A) Local public tax dollars, federal revenue sharing trust funds and local government in-kind donations in the form of rent, building space, utilities, utility repair, paving, sewer fees, equipment, labor materials, and supplies, provided they are program related; and

(B) Local "other" donations in the form of cash, labor, materials, supplies, acceptable safe food, transportation services, furniture, equipment, provided they are program related.

History

Effective 2020-09-21

Chapter 3 Care Management Units

Neb. Admin. Code tit. 15, ch. 3 Care Management Units {#sec-15-nac-3 omnilex-key=us-ne-regs-official--title-15--15 NAC 3}

001. SCOPE AND AUTHORITY . These rules and regulations implement Nebraska Revised Statute (Neb. Rev. Stat.) §§ 81-2229 - 81-2235, the Act, which directs the establishment of a statewide system of Care Management Units through the Area Agencies on Aging.

002. DEFINITIONS . Care Management definitions are located in this Title, Chapter 1.

003. CERTIFICATION PROCEDURES . The Plan of Operation must comply with this Title for Care Management Units, and include all the elements specified in Section 4 below.

003.01 PLAN OF OPERATION SUBMISSION. The Care Management Unit must submit the Plan of Operation to the State Unit on Aging, as prescribed by the Department.

003.02 MULTIPLE CERTIFICATIONS. An Area Agency on Aging may create more than one certified Care Management Unit to serve its Planning and Service Area by submitting a Plan of Operation for each Care Management Unit for which it plans to provide and supervise or subaward.

004. PLAN OF OPERATION . Each Plan of Operation for a Care Management Unit must provide the following information:

004.01 REQUIREMENTS. A statement of the philosophy and goals and objectives of the Care Management Unit. The goals and objectives must include a timetable for making care management services available in an entire Planning and Service Area of an Area Agency on Aging.

004.02 APPROACH OF CARE MANAGEMENT UNIT. The statement of philosophy must detail the approach to be used by the Care Management Unit is:

(A) Involving all support systems of a client, including family members, neighbors, or friends;

(B) Utilizing all available care resources including community-based services and institutionalization;

(D) Assuring that persons are receiving, when reasonably possible, the level of care that best matches their level of need; and

(E) Person centered.

004.03 CITIZEN INPUT. A statement of the procedures to receive input from local citizens in the formulation and implementation of the Plan of Operation, and the procedures to be used to inform eligible individuals on a regular schedule and in a comprehensive manner about Care Management Unit services.

004.04 PROGRAM EVALUATION. A statement of methods to evaluate the attainment of program goals and objectives for the Care Management Unit, and how the evaluation findings are documented and resolved.

004.05 SEPARATE OPERATION. A written representation that the Care Management Unit is operated separately from Direct Care Programs of an Area Agency on Aging.

004.06 INTERDISCIPLINARY APPROACH. The Care Management Unit's Plan of Operation must outline procedures for utilizing an interdisciplinary approach to care management.

004.07 SERVICE PRIORITY. A statement of criteria to be used to determine the priority of service to eligible clients in the event funds are insufficient to meet all the client needs of a Care Management Unit.

004.08 GRIEVANCE PROCEDURE. A statement detailing the grievance procedure available to clients of the Care Management Unit and the process to be used to resolve client complaints.

004.09 ANNUAL BUDGET. An annual budget of income and expenses for the Care Management Unit that coincides with the state fiscal year and must include units of services to be provided, and details of costs of a casework time unit as explained in Section 11 of these rules and regulations and the Act.

004.10 RECORDING OF SERVICES. The Care Management Unit must have a procedure approved by the State Unit on Aging in its Plan of Operation for recording on a timesheet or other document the actual casework time units and Care Management Unit services provided each client.

004.11 OPERATIONS PROCEDURES. Each Plan of Operation must provide written policies and procedures for the administrative and programmatic operation of the Care Management Unit based upon the following minimum standards.

004.11(A) PERSONNEL POLICIES AND PROCEDURES. The Care Management Unit must have a job description for each position as well as written personnel policies and procedures for hiring and selection, compensation, evaluation, disciplinary action and grievance, and supervision and training of employees, contractors, volunteers, students, and interns. The personnel policies and procedures must include:

(i) An Equal Opportunity Policy that includes nondiscrimination on the basis of race, disability, color, sex, affiliation or age, and an Affirmative Action statement;

(ii) An organization chart which identifies the responsibility of each position in the Care Management Unit; and

(iii) A policy that Care Management services for clients as outlined in this Title of these rules and regulations are the exclusive responsibility of the Care Management Unit Supervisor or care manager; except that a supervisor or care manager may delegate to staff of the Care Management Unit assistance with the performance of the services of referral, coordination of the Long-Term Care Plan, assessment and monitoring of the delivery of services to clients if supervision is provided by the supervisor or care manager.

004.11(B) DESIGNATION OF SUPERVISOR. The designation of a Care Management Unit Supervisor responsible to implement the Plan of Operation and to supervise the activities of the Care Management Unit.

004.11(C) QUALIFICATIONS. The Care Management Unit Supervisor and care managers must have the following minimum qualifications:

(i) A current Nebraska license as a registered nurse, or baccalaureate or graduate degree in the human services field, or certification as a social worker or master social worker under the Mental Health Practice Act;

(ii) At least an equivalency of two years of related, professional experience; paid or unpaid; (employment; college internships; volunteering at philanthropic, community and social organizations) in long-term care, gerontology or community health. Candidates will receive credit for all qualified experience; and

(iii) In addition, a Care Management Unit Supervisor shall have at least an equivalency of two years of related, professional supervisory or management experience.

004.11(D) ORGANIZATION. Each Plan of Operation must provide information about the organization of the Care Management Unit as follows:

(i) An organizational chart which shows that the Care Management Unit is operated separately from any Area Agency on Aging Direct Care Programs or from any Direct Care programs of another provider of a Care Management Unit;

(ii) An organizational chart showing the line of authority between the Care Management Unit and the Area Agency on Aging or other public or private entity operating the unit;

(iii) A description of the process that the Care Management Unit uses to monitor sub grantees;

(iv) Each Care Management Unit must maintain accounting records as necessary for presentation of financial statements in accordance with generally accepted accounting principles; and

(v) Each Care Management Unit must obtain and file with the State Unit on Aging an annual audit report in compliance with the Office of Management and Budget (OMB) Code of Federal Regulations (CFR) 200 Part F. The audit must be conducted in accordance with generally accepted auditing standards resulting in an opinion of the financial statements.

004.11(E) CLIENT RIGHTS. The Care Management Unit must have written policies and procedures on client rights, and those rights must be given to the client prior to the assessment. Written policies and procedures must include as a minimum the following:

(i) Each client has the right to accept or reject care management services;

(ii) Each client has the right to be consulted in the development and to approve or disapprove his or her Long-Term Care Plan;

(iii) Each client has the right to choose available services and providers of services;

(iv) Each client has the right to receive care management services without regard to race, color, sex, national origin, religion, or disability;

(v) Each client has the right to be informed of the name of the care manager responsible for their case;

(vi) Each client has the right to receive a description of available care management services, fees charged, and billing mechanisms;

(vii) Each client has the right to have access to his or her care management service file and record unless access is restricted by applicable law or a state or federal regulation; and

(viii) Each client has the right to register complaints and the right to file grievances without discrimination or reprisal from the Care Management Unit.

004.11(F) CONFIDENTIALITY. The Care Management Unit must have written policies and procedures which govern confidentiality of case records and information including the following:

(i) Procedures for maintaining confidentiality in releasing information to other agencies or professionals and in obtaining information from outside agencies or professionals. Forms for the release and receipt of client information must be part of the policies and procedures;

(ii) Methods and procedures used to secure and to control access to records;

(iii) Procedures to be followed by the Care Management Unit and contractors when participating in Long-Term Care Plan conferences or consultations involving outside agencies or professionals;

(iv) Procedures to put all release forms and other documents legally approving the release of information in the client file or record;

(v) Procedures for maintaining confidentiality of case records in use and in storage, including computerized case data; and

(vi) Procedures must be compliant with CFR 45 Sec.160, Sec.162, Sec.164, and all applicable law.

004.12 CLIENT FILES. Each Plan of Operation must include policies and procedures for establishment of client files and records which includes all documents relating to the client.

004.12(A) REVIEW OF CLIENT FILES. The Care Management Unit must permit the State Unit on Aging to inspect and review client files and records to evaluate performance and achievement of the Care Management Unit and to verify and audit the services provided and information published by the Care Management Unit.

004.13 TRAINING. Each Plan of Operation must include a training plan including at a minimum:

(A) An orientation training for employees, contractors, volunteers, students or interns commensurate with their responsibilities in the Care Management Unit;

(B) Required participation by the Care Management Unit in training provided by the State Unit on Aging; and

(C) A schedule for in-service training, which must include, but not be limited to, policies and procedures of the Care Management Unit, and techniques, methods, and research on Care Management.

004.14 STANDARDIZED LONG-TERM CARE ASSESSMENT DOCUMENT. Each Plan of Operation must provide for the use of the standardized long-term care assessment document, as prescribed by the Department.

004.14(A) TRAINING. Each care manager must be trained by the Care Management Unit Supervisor prior to using the assessment document.

004.14(B) ASSESSMENT COMPLETION. This assessment document is to be completed in its entirety and to be used with the initial assessment and development of the Long-Term Care Plan as well as with subsequent annual reassessments and reviews of the Long-Term Care Plan.

004.15 LONG-TERM CARE PLAN. Each Plan of Operation must have written policies and procedures concerning Long-Term Care Plan development.

004.15(A) REQUIREMENTS. Each Long-Term Care Plan must outline procedures for utilizing an interdisciplinary, person centered, approach to care management which involves input from a variety of professionals, agencies, which may be already involved with the client, and support systems which may be available to the client.

004.15(B) SERVICES NOT UTILIZED. Services which are needed but not available must be recorded in the Long-Term Care Plan, as well as those rejected by the client.

004.15(C) REQUIREMENTS. As a minimum, the Long-Term Care Plan must:

(i) Establish individual goals and objectives agreed to by the client;

(ii) Establish a time frame for implementation of the Long-Term Care Plan;

(iii) Define the services which are needed, including any equipment or supplies;

(iv) Define who provides each service;

(v) Specify the availability of services, supplies and equipment;

(vi) Specify the costs and methods of service delivery; and

(vii) Provide for reassessment upon change in client status.

004.15(D) MONITORING. The purpose of periodic monitoring is to reasonably ensure the continued appropriateness and effectiveness of the services being delivered as outlined in the Long-Term Care Plan.

004.15(E) REVIEW. The review of the client's Long-Term Care Plan is to determine its continued appropriateness and must occur at least annually and upon significant change in client status.

004.15(F) ON-GOING CONSULTATION. There must be ongoing consultation, including the regular exchange of ideas and comments between the client and the Care Management Unit.

004.15(F)(i) CLIENT CONTACT. The Care Management Unit must have ongoing contact with each client to ensure that their service needs are being met. This includes a minimum of quarterly client contact with at least two face-to-face visits per year, one of which is to complete an annual client reassessment using the State Unit on Aging’s standardized assessment document, and review and update to the Plan of Care.

004.15(F)(ii) CLIENT CONTACT AFTER SIGNIFICANT CHANGE. Client contact, for purposes of reassessment and updating the Plan of Care, must also be made within 10 calendar days of notification of client returning to non-institutional setting of choice for continued Care Management services, after a significant change in health or functional status.

004.16 ACCESSIBILITY OF SERVICES. Each Plan of Operation must provide for development of a comprehensive directory of available public and private resources that documents Continuum of Care services, including both formal and informal community-based services and institutions for use in referral activities of the Care Management Unit.

004.17 UNIFORM DATA COLLECTION. Each Plan of Operation must provide for use of the Aging Designated Service Reporting System as defined in these regulations and which must be provided by the State Unit on Aging to the Care Management Unit upon Certification.

004.17(A) DATA ENTRY. Each Care Management Unit must have access to a compatible computer in order to use the Aging Designated Service Reporting System and is responsible for data entry and verification for quarterly and annual reports.

004.18 PERIODIC REVIEW. The Care Management Unit must cooperate fully during periodic reviews, including on-site assessments, for the purpose of evaluating compliance with the Act and this Title to retain Certification.

004.18(A) ACCESS TO FILES AND RECORDS. In conducting a periodic review, the Care Management Unit must provide access to the State Unit on Aging to files and records of the Care Management Unit as well as the files and records of the provider or contractor of a Care Management Unit.

004.19 AMENDMENT OF THE PLAN OF OPERATION. A certified Care Management Unit must not change its Plan of Operation or its practice under the Plan unless the Area Agency on Aging’s proposed amendment submission has been approved by the State Unit on Aging.

004.20 DURATION OF CERTIFICATION. Approval of a Plan of Operation and Certification of Care Management Unit is valid for four years from the date granted unless revoked by the State Unit on Aging at an earlier date.

005. DENIAL OF PLAN OF OPERATION AND CERTIFICATION OF A CARE MANAGEMENT UNIT . The State Unit on Aging may deny certification for any or all of the following reasons:

(A) Failure of the Area Agency on Aging to submit a complete Plan of Operation as outlined in these rules and regulations;

(B) Failure of the Area Agency on Aging to provide a Plan of Operation reasonably calculated to achieve the intent of the Act;

(C) Failure of the Area Agency on Aging to provide in the initial Plan of Operation a reasonable time frame for providing the opportunity for care management services to all eligible individuals within the Planning and Service Area of an Area Agency on Aging; or

(D) The Area Agency on Aging putting into effect any change to the Plan of Operation without prior approval from the State Unit on Aging.

005.01 PLAN OF OPERATION RESUBMISSION. The Area Agency on Aging may submit a revised Plan of Operation within 30 days of the date that the State Unit on Aging mails or otherwise notifies the Area Agency on Aging of the denial of certification.

006. APPEAL PROCESS . A decision by the Department to revoke or deny Certification of a Care Management Unit may be appealed by the Area Agency on Aging by filing a notice of appeal with the Director of the Department within 10 days after postmark of notice by the Department. The appeal follows the procedures of the Administrative Procedures Act, Neb. Rev. Stat. Sec. 84-917.

007. REAPPLICATION FOR CERTIFICATION . If the State Unit on Aging has not yet certified another agency as the Care Management Unit for the geographic area for which a provider has had its certification revoked or denied, the provider may reapply for certification 90 days after the date of the revocation or denial of certification. Revocation becomes final after all appeals under the Administrative Procedures act have expired.

008. REVOCATION OF CERTIFICATION . The State Unit on Aging may revoke Certification of a Care Management Unit at any time for any of the following reasons:

(A) There is a change in ownership of the company or organization operating a Care Management Unit without the prior approval of the State Unit on Aging;

(B) The Care Management Unit clients are being inadequately served; or that the resources allocated to the Care Management Unit by the State Unit on Aging or any other state or federal source are being used in violation of the Act or of these rules and regulations;

(D) The Care Management Unit fails to provide services to all eligible persons in the Planning and Service Area of the Area Agency on Aging as required by the Act, these rules and regulations and the Plan of Operation;

(E) The Care Management Unit is not a separate operation from a Direct Care Program of the Area Agency on Aging;

(F) The Care Management Unit fails to obtain approval from the State Unit on Aging for a change in its Plan of Operation; or

(G) The Care Management Unit is in violation of any of these rules and regulations, the Act, or any other applicable law.

008.01 SERVING CLIENTS DURING APPEAL. During an appeal of a revocation of Certification, a Care Management Unit may continue to serve existing clients. New clients cannot be accepted without prior approval of the State Unit on Aging.

008.01(A) SUSPENSION OF PAYMENTS. A Care Management Unit will not receive reimbursement payments for any time period its certification as a Care Management Unit is suspended or revoked. Suspension of reimbursement payments will continue during the pendency of any appeal of the suspension of reimbursement payments. To the extent that a suspension is not ultimately upheld in an appeal process, reimbursement payments otherwise due for the time period at issue will be paid.

009. RECERTIFICATION . A Care Management Unit that seeks recertification must submit an application for recertification to the State Unit on Aging at least 90 calendar days prior to the expiration of each certification period.

009.01 APPLICATION FOR RECERTIFICATION. The Area Agency on Aging must submit an application for recertification on the form issued by the State Unit on Aging, as prescribed by the Department.

009.02 REVIEW OF APPLICATION FOR RECERTIFICATION. An application for recertification will be reviewed on the basis of the results of periodic reviews and onsite inspections, including but not limited to a review of files and records and visits with clients and cooperating agencies to determine compliance with these rules and regulations and the Plan of Operation.

009.03 CERTIFICATION EXPIRATION. Failure to file for recertification results in Certification expiration at the end of the current Certification period.

009.04 APPROVAL OR DENIAL OF RECERTIFICATION. The basis for approval or denial of recertification is set forth in Section 005, Subsections A – D, and Section 008, Subsections A - G of this section of this Title, and is based upon the results of the review conducted in Subsection 2 of this section and an evaluation of the performance of the Care Management Unit in meeting its goals and objectives outlined in its approved Plan of Operation.

009.05 APPEAL PROCEDURES. In case of a denial, appeal procedures are set forth in Section 6.

010. FEE SCALE . Each Care Management Unit must use the fee scale as prescribed by the Department.

010.01 POVERTY INDEX. The State Unit on Aging adopts as its poverty index the poverty income guidelines issued by the U.S. Department of Health and Human Services.

010.02 FEE FOR SERVICES. The Care Management Unit shall inform the individual of the fee for services prior to the delivery of services. Monthly statements of the services rendered and prior balance receivable, charges at full fee, sliding fee scale adjustments, payments received and ending balance receivable shall be sent to each client.

010.03 PAYMENT OF FEE. A client whose family income is below 300% of the poverty level in the index issued by the Department must pay from 0 to 90 percent of the fee for the Care Management Unit services based on the fee scale as prescribed by the Department.

011. REIMBURSEMENT . The Department may reimburse a Care Management Unit for costs not required to be paid for by the client and not paid through other sources.

011.01 REIMBURSABLE SERVICES. A casework time unit is one hour of reimbursable service by a Care Management Unit for a client. The reimbursable services are consultation, assessment, Care Plan development and coordination, referral of a client to other agencies and services, and Care Plan review and monitoring.

011.02 VALUE OF TIME UNITS. The value of a casework time unit is calculated by dividing all expenses by the number of actual casework time units to be delivered by a Care Management Unit during the fiscal year as approved by the State Unit on Aging in the budget for the Care Management Unit.

011.03 REIMBURSABLE TIME. The reimbursable amount of a casework time unit is based upon the difference between actual value of a casework time unit less fees required to be paid for by the client, payment from Medicaid and other third-party payers, and other sources of income to the Care Management Unit as specified in the Act.

011.04 MAXIMUM REIMBURSABLE AMOUNT. The maximum reimbursable dollar amount per casework time unit follows the fee schedule as prescribed by the Department, however, the maximum reimbursement must not exceed the cost of an actual casework time unit minus costs required to be paid for by the client or through other reimbursement specified in the Act.

011.05 REIMBURSEMENT LIMIT. The State Unit on Aging provides reimbursement only up to the limit of funds appropriated to the State Unit on Aging under the Act and may not exceed the approved budget and projected actual casework time units in a Care Management Unit's Plan of Operation.

011.06 VERIFICATION OF SERVICES DELIVERED. In requesting reimbursement, the Care Management Unit grants authority to the State Unit on Aging to verify the service delivered to the client by inspecting individual client files and records which must be maintained in the client files and records which must be maintained in the Care Management Unit office, to verify costs allocated to the casework time unit, and to verify total income from an individual or client and from other sources.

011.06(A) NON REIMBURSABLE UNITS OR COSTS. A Care Management Unit may seek reimbursement from the State Unit on Aging for otherwise allowable costs, except for costs required to be paid by the client or those that are paid by another person or entity.

History

Effective 2020-09-21

Chapter 4 Nebraska Aging Nutrition Services

Neb. Admin. Code tit. 15, ch. 4 Nebraska Aging Nutrition Services {#sec-15-nac-4 omnilex-key=us-ne-regs-official--title-15--15 NAC 4}

001. SCOPE AND AUTHORITY . These rules and regulations implement Nebraska Revised Statute (Neb. Rev. Stat.) §§ 81-2201 to 81-2227 (the Act) and the Older Americans Act of 1965 (OAA), Title III-A and Title III-C.

002. DEFINITIONS . Nutrition definitions are located in this Title, Chapter 1.

003. GENERAL AREA AGENCY ON AGING REQUIREMENTS

003.01 REQUIREMENTS. An Area Agency on Aging nutrition program must:

(A) Provide meal services at locations and according to the frequency as prescribed by the State Unit on Aging and the Older Americans Act of 1965, Title III-C;

(B) Comply with all applicable law, including the United States Department of Labor - Occupational Safety and Health Administration rules;

(C) Provide Nutritional Education approved by a Registered Dietitian or by a publicly recognized nutrition organization as prescribed by the Department. Nutrition education must be delivered to individuals at both congregate sites and through home delivered meal programs at least one time per year;

(D) Self-monitor all meal sites within each service area at least annually and as otherwise appropriate; and

(E) Have appropriate arrangements in place for emergency and disaster relief.

(F) Nutrition counseling can only be provided by a Registered Dietitian in good standing. A Medical Nutrition Therapy License is required if a client’s nutritional status is medically assessed, treated, and monitored. If permitted and available, compliant distance programs may be used for Nutrition Counseling for individuals who cannot attend face-to-face sessions. Procedures must be compliant with Code of Federal Regulations (CFR) 45 Sec.160, Sec.162, Sec.164, and all applicable law.

003.02 OTHER ENTITIES. With the written permission of the State Unit on Aging, an Area Agency on Aging may delegate the provision of meals to another entity, and the provisions of this chapter and all applicable law would apply to that entity; though, that Area Agency on Aging would remain responsible for compliance with its agreements with the State Unit on Aging and with applicable law, including this chapter.

004. REIMBUREMENT REQUIREMENTS FOR MEALS

004.01 REQUIREMENTS. An Area Agency on Aging is eligible for reimbursement at the cost of one meal served per present eligible individual per meal time. Meal costs are determined by each Area Agency on Aging. Costs must be allowable, reasonable, and allocable and must be compliant with CFR 200 Subpart E, the Nebraska Community Services Act, as prescribed by the Department, and all applicable law.

005. NON-DUPLICATION OF SERVICES

005.01 REQUIREMENTS. An Area Agency on Aging must not duplicate services between or among the Nutrition Services Incentive Program and Title III-C with Medicaid Waiver, Title VI, Title XX, or other governmental sources. An Area Agency on Aging must properly record all eligible and non-eligible individual meals in its reimbursement report to the State Unit on Aging.

006. NUTRITION SERVICES INCENTIVE PROGRAM

006.01 REIMBURSEMENT. Nutrition Services Incentive Program funds can only reimburse an Area Agency on Aging for meals that:

(A) Are served to eligible individuals;

(B) Are served to the spouses of participating eligible individuals and volunteers of any age who are involved directly with the meal service; and

006.02 PROCUREMENT. Nutrition Services Incentive Program funds can only be used to reimburse an Area Agency on Aging for the purchase of food.

007. MEAL SITE OPERATIONS

007.01 OPERATIONS. An Area Agency on Aging operating a meal site must:

(A) Ensure the meal site building and location are:

(i) Compliant with local building and safety codes, the Americans with Disabilities Act and all applicable law;

(ii) Equipped with cleaning solutions and equipment for general cleaning and sanitation;

(iii) Accessible and have connections to proper waste disposal, potable drinking water, electricity and the means to access services for equipment repair and building maintenance; and

(iv) Maintaining meal preparation, cooking, storage, dining and restroom areas to be clean and free from pests and debris;

(B) Ensure meal preparation equipment is safe, in proper working condition, holds temperatures, is sanitary for use, and staff records and monitors temperature and chemical levels; and

(i) Where exits are located;

(ii) Posted dining menus;

(iii) Cost sharing information for full price and suggested contributions; and

(iv) Signage encouraging individuals to not take home potentially hazardous foods.

008. FOOD SAFTY AND REGULATIONS

008.01 FOOD SAFETY TRAINING. An Area Agency on Aging operating a meal site must utilize the food safety training program as specified by the Nebraska State Unit on Aging, the Nebraska Food Code, the Food and Drug Administration’s Food Code, local food codes, and all applicable law.

008.02 FOODBORNE ILLNESS. An Area Agencies on Aging operating a meal site must report any outbreak of suspected foodborne illness to local health departments and the State Unit on Aging.

009. CONGREGATE MEAL SITES

009.01 PROCEDURES. Each Area Agency on Aging operating a meal site must:

(A) Institute and maintain appropriate procedures for collecting feedback from individuals about the services received; and

(B) Ensure the provision of a meal to an eligible individual who has failed to make a reservation, when sufficient food is available.

009.02 OPERATIONS. Each congregate meal site operated by an Area Agency on Aging must:

(A) Have an appropriate person designated to be responsible for the day-to-day activities at each site, and physically be on-site during meal time;

(B) Have operational restrooms with toiletries, lighting, and ventilation that meet the requirements of local building codes and all applicable law; and

(C) Have equipment, including tables and chairs, which are sturdy and appropriate for older individuals who may be frail, disabled, or have limited mobility. Tables must be arranged to ensure ease of access and encourage socialization.

010. CONGREGATE MEAL ELIGIBLE INDIVIDUALS AND OPERATIONS

010.01 REQUIREMENTS. Each Area Agency on Aging operating a congregate meal site must:

(A) Give each eligible individual who receives a meal the opportunity to contribute to the cost of the meal;

(B) Develop a suggested contribution and consider the income ranges of the older individuals in the community and the Area Agency on Aging’s other sources of income;

(C) Post a conspicuous sign near the contribution box at each congregate meal site that indicates the suggested contribution for participating eligible individuals and that this amount is a required contribution from participating non-eligible individuals;

(D) The spouse of an eligible older adult congregate meal individual can also participate in the congregate meal program;

(E) An eligible individual cannot be denied participation because of failure or inability to contribute;

(F) Ensure that the amount of an eligible individual's contribution, if any, is kept confidential; and

(G) Establish written procedures that include at least weekly deposits and dual control of financial transactions to protect contributions and fees from loss, mishandling, and theft. Procedures must be kept on file on-site when feasible and at the providers office when not feasible; and

(H) Use all income received in contributions to increase the number of meals served.

011. POTENTIALLY HAZARDOUS FOODS

011.01 ALLOWANCE AND PROCEDURES. Each Area Agency on Aging operating a meal site must allow individuals to take away foods that are not potentially hazardous. Centers should have a visible sign that discourages the removal of potentially hazardous foods located at the meal site. Potentially hazardous foods are defined by the Nebraska Food Code.

012. SUGGESTED CONTRIBUTION BOX SPECIFICATIONS

012.01 MEAL SITES. Each Area Agency on Aging operating a meal site must protect each suggested contribution box with a barrier that shields an individual’s declaration or non-declaration from other individuals.

013. TAKE HOME MEALS AND FULL PRICE

013.01 PROVISIONS. An individual who wishes to take a meal from the meal site is able to do so by paying full price. Meals that are paid for at full price are exempt from sales tax per the Nebraska Sales and Use Tax Regulations. The Area Agency on Aging must provide written instructions, when feasible, in the language of the majority of the individuals, for proper handling and re-heating of the meals sold.

014. HOME DELIVERED MEAL PROGRAM

014.01 OPERATIONS. Each Area Agency on Aging operating a home-delivered meal program must:

(A) Complete an initial determination of eligibility in person or by telephone;

(B) Complete a written assessment, including nutrition-related supportive services, within two weeks of the individual’s first meal service and referrals made as necessary;

(C) Provide reassessment of need, determined by the Area Agency on Aging, annually or with a change in individual status;

(D) Establish a waiting list for home-delivered meals when the provider(s) are unable to provide meals to all eligible individuals;

(E) Provide contribution statements to individuals that clearly state that the amount is a suggested contribution. The statements must not include the words bill, requested, required, or other language implying that it is not voluntary;

(F) Provide home-delivered meals only to persons 60 years of age or older, except a spouse of a homebound eligible individual, regardless of age, is eligible to receive a home-delivered meal if the provision of the collateral meal supports maintaining the person at home; and except an individual with a disability, regardless of age, who resides at home with an eligible individual and is dependent on the eligible individual for care is eligible to receive a home-delivered meal; and

(G) Prioritize the provision of home-delivered meals to eligible individuals with the greatest economic and social need, persons who are homebound due to illness, incapacitating disability or who are otherwise isolated. Preference must also be given to low-income older adults, including low-income minority older adults, older adults with limited English proficiency and older adults residing in rural areas;

(H) Provide home-delivered meals to eligible individuals at nutritional risk who have physical, emotional, or behavioral conditions that would make their service at a congregate nutrition site inappropriate;

(I) Provide home-delivered meals directly to the individual recipient of the meal;

(J) While delivering home-delivered meals, inform individuals at the residence about any apparent health, fire or safety hazards noticed in the home;

(K) Provide home-delivered meals at the appropriate temperatures in accordance with the Nebraska Food Code and any other applicable law. More than one meal may be delivered for consumption each day for different meal times, if proper storage and heating facilities are available in the home and the individual is able to consume the second meal either alone or with available assistance;

(L) Utilize equipment that maintains the safe and sanitary handling of food items during packaging and transport

(M) Provide home-delivered meals in packages or containers that are easily opened by eligible individuals; and

(N) Provide written instructions, and when feasible, in the language of the majority of the individuals at the residence, for proper handling and reheating of the meals.

015. NUTRITION RISK SCREENING AND ASSESSMENT TOOLS

015.01 REQUIREMENTS. Area Agencies on Aging must utilize a tool, questions, or both to conduct nutrition risk screenings and assessments, as prescribed by the State Unit on Aging.

016. REQUIRED FORMS

016.01 REQUIREMENTS. Area Agency on Aging must utilize any required forms from the State Unit on Aging that are identified in program instructions, information memorandums, and applicable communications.

History

Effective 2020-09-21

Chapter 5 Senior Volunteer Program

Neb. Admin. Code tit. 15, ch. 5 Senior Volunteer Program {#sec-15-nac-5 omnilex-key=us-ne-regs-official--title-15--15 NAC 5}

001. SCOPE AND AUTHORITY . These regulations govern the Senior Volunteer Program. The regulations are authorized by and implement the Nebraska Senior Volunteer Program Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 81-2273 to 81-2283, and § 81-2210.

002. DEFINITIONS . Senior Volunteer definitions are located in this Title, Chapter 1.

003. SENIOR VOLUNTEERS

003.01 ELIGIBILITY CRITERIA. An individual must meet the statutory requirement to serve as a senior volunteer.

003.01(A) AGE. An individual must be age 60 or older.

003.01(B) NON-DISCRIMINATION. Recruitment, selection and eligibility may not be restricted on the basis of education, experience, citizenship, race, color, creed, belief, sex, national origin, disability, sexual orientation, or political affiliation.

003.01(C) BACKGROUND CHECKS. Background checks must meet requirements as set forth by the State Unit on Aging.

003.02 SENIOR VOLUNTEER BENEFITS. Senior volunteers may receive:

(A) Transportation expenses to and from their residences and place where services are to be rendered;

(B) One free meal when reasonably available during each day that services are rendered;

(D) Accident, personal liability, and excess auto insurance coverage while volunteering.

003.03 SENIOR VOLUNTEER ASSIGNMENTS. Assignments and activities may involve person-to-person relationships with the individuals served or include service to the volunteer station. Appropriate activities may include but are not limited to: personal care, nutrition duties, social or recreational activities, home management, information and advocacy, respite care, service senior center meals, and home delivered meals.

004. SERVICE PROVIDER

004.01 SERVICE PROVIDER ELIGIBILITY. Public agencies and private non-profit organizations that have the capacity to accept and the capability to administer these grants are eligible.

004.02 SERVICE PROVIDER RESPONSIBILITY. The service provider is responsible for all programmatic and fiscal aspects of the project. The service provider must:

(A) Designate a project director who is directly responsible to the sponsor for the management of the project;

(B) Provide for the recruitment, assignment, supervision, and support of volunteers. Special efforts must be made to recruit and assign persons from minority groups, people with disabilities, and hard-to-reach individuals;

(D) Provide the volunteers with accident, personal liability, and excess auto liability insurance as provided below:

(i) Provide a Certificate of Insurance to the State Unit on Aging to ensure while volunteering, senior volunteers are included under the service provider’s insurance policies; and

(ii) Adhere to the State Unit on Aging’s subaward requirements related to General Insurance, Commercial General Liability and Commercial Automobile Liability insurance provisions and maintenance of the required amounts of insurance;

(E) Provide for recognition of the volunteers and their activities;

(F) Establish grievance and appeal procedures for volunteers following the guidance provided by the State Unit on Aging;

(G) Maintain project records in accordance with generally accepted accounting principles and provide for accurate and timely preparation and submission of reports required by the State Unit on Aging;

(H) Provide training prior to the start of service and quarterly thereafter;

(I) Provide or arrange for direct benefits as described in 003.02 of 15 Nebraska Administrative Code (NAC) 5;

(J) Ensure that liability insurance is maintained for owned, non-owned, or hired vehicles used in the project;

(K) Develop a transportation plan for the project based on lowest cost transportation modes; and

(L) Conduct an annual appraisal of the volunteers’ performance using forms prescribed by the State Unit on Aging and an annual review of volunteers’ driver’s record and liability insurance.

005. PROJECT DEVELOPMENT

005.01 GRANT APPLICATION. The State Unit on Aging may solicit project proposals. Any eligible organization may file an application for a grant. Any grant application is not guaranteed to be funded.

005.02 GRANT REVIEW AND AWARD PROCESS

005.02(A) GRANT SELECTION. Grant applicants whose proposals provide the best potential for serving the purpose of this program may be awarded available funds.

005.02(B) FUNDING LEVEL. Individual project grants of up to a maximum of $25,000 are awarded annually and are subject to appropriations and other funding available.

005.02(C) LOCAL MATCH. Local match may be in the form of cash or in-kind resources. Local match must be equal to or greater than 10% of the amount of the grant.

005.03 MONITORING AND REPORTS. Grantees are subject to monitoring of program activity funded through these grants. Grantees must submit quarterly program reports to the State Unit on Aging describing the number of volunteers, hours of service, persons served, and training provided. Reporting format and content requirements are prescribed by the State Unit on Aging.

History

Effective 2020-09-21

Chapter 6 Long-Term Care Ombudsman Program

Neb. Admin. Code tit. 15, ch. 6 Long-Term Care Ombudsman Program {#sec-15-nac-6 omnilex-key=us-ne-regs-official--title-15--15 NAC 6}

001. SCOPE AND AUTHORITY . These rules and regulations implement Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 81-2237 to 81-2264, which directs the establishment of a statewide long-term care ombudsman program and meet the requirements of (1) Older Americans Act of 1965, 42 United States Code (U.S.C.) Sections 3058f-3058h, as amended; (2) 42 Code of Federal Regulations (CFR) Sections 483.10 through 483.13; (3) 45 CFR Parts 1321 and 1324; and (4) The Nebraska Nursing Home Act, Rev. Statutes of Nebraska, Article 60, Section 71-6019.

002. DEFINITIONS

002.01 ADULT PROTECTIVE SERVICES. As defined in §§ 28-352.

002.02 AGENCY. Any entity seeking designation or redesignation by the Department to operate and administer a local long-term care ombudsman program in accordance with Neb. Rev. Stat. §§ 81-2237 to 81-2264 and with these rules and regulations.

002.03 CONFLICT OF INTEREST. As defined in Section 712 of the Older Americans Act of 1965, as amended.

002.04 DEPARTMENT. As defined in §§ 81-2239.

002.05 DIRECTOR. The Director of the Nebraska State Unit on Aging.

002.06 LOCAL LONG-TERM CARE OMBUDSMAN. As defined in §§ 81-2242.

002.07 LOCAL LONG-TERM CARE OMBUDSMAN PROGRAM. As defined in §§ 81-2242.

002.08 LONG-TERM CARE FACILITY. As defined in §§ 81-2243 and Neb. Rev. Stat. § 71-2017.01.

002.09 OFFICE. As defined in §§ 81-2244.

002.10 OLDER AMERICANS ACT. As defined in §§ 81-2245.

002.11 OMBUDSMAN ADVOCATE. As defined in §§ 81-2247.

002.12 REPRESENTATIVE OF THE OFFICE. As defined in §§ 81-2247.01.

002.13 RESIDENT REPRESENTATIVE. As defined in §§ 81-2247.03 and 45 CFR 1324.1(3)(4).

002.14 STATE LONG-TERM CARE OMBUDSMAN. As defined in §§ 81-2248, and in accordance with the Older Americans Act of 1965, 42 U.S.C. Sections 3058f-3058h, as amended; 42 CFR Sections 483.10 through 483.13, Neb. Rev. Stat. §§ 81-2237 to 81-2264 and these rules and regulations.

003. DESIGNATION PROCEDURES . A proposed Plan of Operation must be submitted by the agency to the Office to provide the services of a local long-term care ombudsman program within a planning and service area as described in Neb. Rev. Stat. § 81-2213(6).

003.01 PLAN OF OPERATION. The proposed Plan of Operation must comply with the Act and these rules and regulations.

003.02 DENIAL. The Office may deny designation of a proposed Plan of Operation for any or all of the following reasons:

(A) Failure to submit a complete Plan of Operation as outlined in these rules and regulations;

(B) Failure to provide a Plan of Operation which is in conformance with the Act; or

(C) Failure to provide in the initial Plan of Operation a reasonable time frame for providing local long-term care ombudsman services.

003.03 PROVISIONAL DESIGNATION. The Office may provisionally designate a local long-term care ombudsman program for no more than 90 days provided:

(A) The local long-term care ombudsman program has complied substantially with the requirements of Neb. Rev. Stat. §§ 81-2237 to 81-3364 and these rules and regulations;

(B) There is a strong likelihood that the sponsoring agency will be able to correct any areas of non-compliance within 60 days; and

(C) No person has been or is likely to be placed in a position where his or her life, livelihood, health, or property is placed in jeopardy by the continued operation of the local long-term care ombudsman program during the period the local long-term care ombudsman program is provisionally certified.

004. APPROVAL AND DESIGNATION . Approval of a Plan of Operation and designation of a local long-term care ombudsman program is valid for two years from October 1 and ending on September 30, unless revoked by the Office at an earlier date or the Office specifies a different date.

005. REVOCATION OF DESIGNATION . The Office may revoke designation at any time for one or more of the following reasons:

(A) There is a change in status or ownership of the agency operating a local long-term care ombudsman program without prior approval of the Office;

(B) The resources allocated to the local long-term care ombudsman program by the Office or any other state or federal source are being used in violation of the Act, the Older Americans Act of 1965, as amended and its rules and regulations;

(D) The local long-term care ombudsman program fails to obtain approval from the Office for a change in its Plan of Operation in accordance with this chapter;

(E) Failure to disclose or resolve any individual or organizational conflict of interest; or

(F) The local long-term care ombudsman program is in violation of any of the Older Americans Act of 1965, as amended, and its rules and regulations.

006. REDESIGNATION . Any application for redesignation must be submitted by the agency to the Office 60 calendar days prior to the expiration of each two-year designation period. Failure to file for redesignation will cause designation to expire at the end of the two-year designation period.

006.01 APPLICATION. Any application for redesignation must be submitted by the agency according to the designation process as outlined in this title.

006.02 NOTICE. Notice of approval or denial of redesignation will be issued by the Office prior to the expiration of the current designation period.

006.03 DESIGNATION PERIOD. The new designation period will begin on October 1, unless otherwise provided.

007. PLAN OF OPERATION . An Agency Plan of Operation for a local long-term care ombudsman program, must provide the following information:

(A) A description of the area to be served within a planning and service area. No local program will include within its service area any facility being served by another designated program;

(B) A statement of philosophy and goals and objectives of the program;

(D) A statement of methods to evaluate the attainment of program goals and objectives for the program;

(E) If more than one local long-term care ombudsman program is to be established in the planning and service area, a statement detailing how the programs will coordinate services and avoid duplication of effort;

(F) An annual budget of income and expenses for the program coincident with the state fiscal year;

(G) A statement of procedures that ensure the program must comply with all requirements of the Office, including training of all representatives of the Office, confidentiality of records and reporting;

(H) A statement of procedures that ensure that no person will investigate any complaint filed with the Office unless such person is certified by the Office; and

(I) A statement of procedures that ensure the program has the ability to pursue appropriate remedies to resolve complaints, including but not limited to:

(i) Representing residents in administrative hearings and appeals before state and federal agencies, including the Nebraska Department of Health and Human Services and the United States Department of Health and Human Services;

(ii) Making referrals and recommending specific courses of action, referring situations to public and private agencies, such as the Nebraska Department of Health and Human Services Adult Protective Services Program, Legal Services Corporations, county attorneys' offices, the Nebraska Attorney General's office, state and federal courts and other agencies; and

(J) Serving as an agent for residents in negotiations with long-term care facilities, public and private agencies, family members, and other individuals and agencies to the extent permitted by state and federal law.

007.01 MINIMUM STANDARDS. Written policies and procedures for the administrative and programmatic operation of the program must be based upon the following minimum standards:

(A) The program must have a job description for each position, as well as written personnel policies and procedures for hiring and selection, compensation, evaluation, disciplinary action and grievance and supervision and training of employees, contractors, volunteers, students and interns. The personnel policies and procedures must include:

(i) The following minimum requirements qualifications for individuals serving in the capacity of local long-term care ombudsman or ombudsman advocates for the State or local long-term care ombudsman programs:

(1) An understanding of long-term care issues;

(2) Experience in the fields of aging and health care;

(3) Worked with and been involved in volunteer programs;

(4) Good verbal, listening and writing skills;

(5) Commitment to serve a minimum of three hours per week in the performance of their duties facility;

(6) No known conflict of interest which would interfere with their objective performance as an ombudsman advocate;

(7) Not been employed by or affiliated with a long-term care facility within the previous 12 months;

(8) Understanding of, and agreement to follow, the ombudsman rules of confidentiality;

(9) Agreement to follow the policies and procedures of the State and local long term care ombudsman program and accept the direction of the Ombudsman Advocate Coordinator;

(10) Compliance with the Office's reporting needs to collect and analyze data relating to complaints and conditions in long-term care facilities; and

(11) Certification by the Office of the Long-Term Care Ombudsman;

(B) An Equal Opportunity Policy that includes nondiscrimination on the basis of race, disability, color, sex, affiliation, or age and an Affirmative Action statement;

(D) Means to ensure that no individual or organizational conflict of interest exists in accordance with 45 CFR 1324.21; and

(E) A local long-term care ombudsman program staff must include at least one individual available to conduct ombudsman advocate activities, manage the program on a day-to-day basis and coordinate and supervise ombudsman advocates and adequate support staff.

007.02 FISCAL ACCOUNTABILITY. An agency must maintain accounting records as necessary for preparation of financial statements in accordance with generally accepted accounting principles.

007.03 COMPLAINT INVESTIGATION AND RESOLUTION. A local program will investigate and resolve to the best of its ability all complaints received by or on behalf of individuals who reside in long-term care facilities.

007.03(A) INDIVIDUAL INTEREST. The Office and designated local programs will represent the interests and wishes of individuals who are residents of long-term care facilities, even if they are contrary to the interests and wishes of any person who files a complaint with the Office or local program on behalf of such individuals.

007.04 ACCESS TO RESIDENT MEDICAL RECORDS. The Office and local programs must obtain the consent of the resident in order to have access to the medical and personal records retained by the facility of any individual who is a resident, or client of a long-term care facility. The Health Insurance Portability and Accountability Act of 1996 does not preclude release by covered entities of resident private health information or other resident identifying information to the Office and local programs, including but not limited to residents’ medical social or other records, a list of resident names and room numbers, or information collected in the course of a State or Federal survey or inspection process.

007.04(A) CONSENT. If consent is given by a resident of a long-term facility to allow a representative of the Office access to medical and personal records retained by a long term care facility, such consent must be in writing, including through the use of auxiliary aids and services, unless:

(i) The resident is unable or unwilling to consent in writing, but is willing and able to give oral consent, in which case consent may be granted orally by the resident;

(ii) The resident is under legal guardianship or conservatorship that provides the guardian or conservator with the authority to approve review of records. In such case the representative of the Office must obtain the permission of the guardian or conservator for review of the records in the same manner as required if the resident was not under conservatorship or guardianship; or

(iii) The consent of the legal guardian or conservator will not be required if:

(1) The existence of the legal guardianship or conservatorship is unknown to the Office or the facility;

(2) The legal guardian or conservator cannot be reached within five working days;

(3) The subject of the complaint is the guardian or the conservator; or

(4) In case of an emergency.

007.04(B) REASONABLE CAUSE. If the resident is unable to express written or oral consent and in order to investigate a complaint, the resident representative refuses to consent to the access, a representative of the Office has reasonable cause to believe that the resident representative is not acting in the best interests of the resident the Office will have access to the medical and personal records of the resident without prior consent.

007.04(C) PERMANENT FILE. If authorized in writing by the resident, legal guardian or conservator of the resident, or any other person having legal authority to inspect records, such authorization will be made a part of the permanent file of the resident.

008. CERTIFICATION OF OMBUDSMAN ADVOCATES . To receive certification, local long-term care ombudsman programs must meet the following requirements:

(A) Successful completion of 20 hours of classroom training covering topics as listed in Revised Statute § 81-2253;

(B) Successful completion of a three-month probationary period determined through an evaluation of the ombudsman advocate's performance of duties and responsibilities in accordance with these rules and regulations and an on-site evaluation at the ombudsman advocate's assigned facility; and

(C) Demonstration of the ability to perform duties and display competence in advocating for residents of long-term care facilities as determined by the State Long-Term Care Ombudsman.

009. RECERTIFICATION OF OMBUDSMAN ADVOCATES . Ombudsman advocates must be recertified biennially, after having met the following requirements:

(A) Completion of 12 hours of additional classroom training provided by the Office; and

(B) Evaluation of performance of duties and responsibilities in accordance with these rules and regulations and the policies and procedures of the local program.

010. DECERTIFICATION OF OMBUDSMAN ADVOCATES . Cause for decertification of an ombudsman advocate may include the following:

(A) Any conduct which adversely affects the performance of his or her duties as ombudsman advocate, or which adversely affects the sponsoring agency's ability to provide services under the Act or these regulations;

(B) Disclosure of information relating to any complaints or investigations made pursuant to the Act that identifies complainants, patients, residents, or clients to any individual or agency unless such disclosure is:

(i) Authorized in writing by the complainant, resident or resident representative or the legal guardian or legal representative of such individual;

(ii) Necessary for the provision of services to the patient, resident or client and the patient, resident or client is unable to express written or oral consent; or

(iii) Made pursuant to court order;

(C) Failure to comply with the policies and procedures of the local long-term care program or these rules and regulations; or

(D) Having a conflict of interest as described in this Chapter that has not been resolved or has not been disclosed by the ombudsman advocate to the state long-term care ombudsman.

010.01 DECERTIFICATION PROCESS. The process of decertification is:

(A) The local long-term care ombudsman will investigate and document the reasons for pursuing the decertification process;

(B) Upon determination that valid reason exists to decertify an ombudsman advocate, the local long-term care ombudsman program will recommend to the Office that the ombudsman advocate be decertified;

(D) The Office will send a letter to the ombudsman advocate stating that decertification has been requested by the local long-term care ombudsman program, has been approved by the Office and the reasons for such action; and

(E) The Office, in consultation with the local long-term care ombudsman program, may temporarily suspend an ombudsman advocate pending completion of the investigation and appeal of the decision.

History

Effective 2020-09-21

Neb. Admin. Code tit. 15 — Aging Services

Chapter 1 Definitions

Neb. Admin. Code tit. 15, ch. 1 Definitions {#sec-15-nac-1 omnilex-key=us-ne-regs-official--title-15--15 NAC 1}

Chapter 2 Designation, Area Plan, and Budget

Neb. Admin. Code tit. 15, ch. 2 Designation, Area Plan, and Budget {#sec-15-nac-2 omnilex-key=us-ne-regs-official--title-15--15 NAC 2}

Chapter 3 Care Management Units

Neb. Admin. Code tit. 15, ch. 3 Care Management Units {#sec-15-nac-3 omnilex-key=us-ne-regs-official--title-15--15 NAC 3}

Chapter 4 Nebraska Aging Nutrition Services

Neb. Admin. Code tit. 15, ch. 4 Nebraska Aging Nutrition Services {#sec-15-nac-4 omnilex-key=us-ne-regs-official--title-15--15 NAC 4}

Chapter 5 Senior Volunteer Program

Neb. Admin. Code tit. 15, ch. 5 Senior Volunteer Program {#sec-15-nac-5 omnilex-key=us-ne-regs-official--title-15--15 NAC 5}

Chapter 6 Long-Term Care Ombudsman Program

Neb. Admin. Code tit. 15, ch. 6 Long-Term Care Ombudsman Program {#sec-15-nac-6 omnilex-key=us-ne-regs-official--title-15--15 NAC 6}

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