Neb. Admin. Code tit. 206 — Behavioral Health Services

Chapter 1 Scope and Definitions

Neb. Admin. Code tit. 206, ch. 1 Scope and Definitions {#sec-206-nac-1 omnilex-key=us-ne-regs-official--title-206--206 NAC 1}

001. SCOPE AND LEGAL AUTHORITY . This title governs the administration of Nebraska’s Public Behavioral Health System. These regulations are authorized by and implement the Nebraska Behavioral Health Services Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 71-801 to 71-831.

002. DEFINITIONS . For purposes of this Title, the definitions in Neb. Rev. Stat. § 71-804 and the following apply.

002.01 ACTIVITIES OF DAILY LIVING. Activities that allow individuals to live successfully in non-institutional settings. Development of daily living skills involves an organized service which provides skill building needed by the consumer in such areas as personal hygiene, self-care, interpersonal skills, self-direction, meal preparation and nutrition, as well as, other related areas required to successfully live independently in the community. This may also be referred to as “basic daily living skills”.

002.02 ADULT WITH SEVERE AND PERSISTENT MENTAL ILLNESS. An individual who:

(A) Is age 19 and older;

(B) Has a primary diagnosis of schizophrenia, major affective disorder, or other major mental illness under the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Developmental disorders or psychoactive substance use disorders may be included if they co-occur with the primary mental illnesses listed above;

(C) Is at significant risk of continuing in a pattern of either institutionalization or living in a severely dysfunctional way if needed mental health services are not provided, and this pattern has existed for 12 months or longer or is likely to endure for 12 months or longer; and

(D) Has a degree of limitation that seriously interferes with the individual's ability to function independently in an appropriate and effective manner, as demonstrated by functional impairments which substantially interferes with or limits at least two of three areas:

(i) Vocation or education;

(ii) Social skills; or

(iii) Activities of daily living.

002.03 ASSESSMENT. The process that a provider completes with each consumer to gather information and documentation needed to identify the individual’s status, strengths, preferences, and needs in order to develop a service plan.

002.04 CONSUMER. An individual or family member of an individual with lived experience with a mental illness or substance use disorder.

002.05 CONFLICT OF INTEREST. A conflict of interest is when an organizational matter to be acted upon confers a personal benefit, financial or otherwise, direct or indirect, to a member of the Regional Governing Board, an employee, a volunteer, a student, a consultant, or person related by kinship, or personal or professional association.

002.06 CO-OCCURRING DISORDER. The coexistence of both a mental health and substance use disorder.

002.07 DOCUMENTATION. The written, dated, and where applicable, signed evidence to substantiate performance as part of an organized system of official records.

002.08 FUNCTIONAL IMPAIRMENT. Serious limitations an individual has which substantially interfere with or limit functioning in major life activities, as determined through an assessment by qualified personnel. In adults, it is the degree of limitation that seriously interferes with the individual’s ability to function independently in an appropriate and effective manner in any of the functional areas of vocational and educational, social skills, or activities of daily living.

002.09 FUNCTIONAL LIMITATIONS IN ACTIVITIES OF DAILY LIVING. Functional limitations in activities of daily living are an inability to consistently perform the range of practical daily living tasks required for basic adult functioning in the community in any of the following areas:

(A) Grooming, hygiene, washing of clothes, and meeting nutritional needs;

(B) Care of personal business affairs;

(C) Transportation and care of residence;

(D) Procurement of medical, legal, or housing services; or

(E) Recognition and avoidance of common dangers or hazards to self and possessions.

002.10 FUNCTIONAL LIMITATIONS IN SOCIAL SKILLS. Limitations that consist of:

(A) Repeated inappropriate or inadequate social behavior or an ability to behave appropriately or adequately except with extensive or consistent support or coaching or only in special contexts or situation;

(B) The ability to participate in adult activities only with extensive support or coaching and when involvement is mostly limited to special activities established for persons with behavioral health diagnoses; or

(C) A history of dangerousness to self or others.

002.11 FUNCTIONAL LIMITATIONS IN VOCATION AND EDUCATION. Limitations that consist of:

(A) An inability to be consistently employed or an ability to be employed only with extensive supports, except that a person who can work but is regularly unemployed because of acute episodes of mental illness is considered vocationally impaired;

(B) Deterioration or decompensation resulting in an inability to establish or pursue educational goals within a normal time frame or without extensive supports; or

(C) An inability to consistently and independently carry out home management tasks, including household meal preparation, washing clothes, budgeting, or child care tasks and responsibilities.

002.12 MILITARYSERVICE. Full-time duty in the active military service of the United States, a National Guard call to active service for more than 30 consecutive days, or active service as a commissioned officer of the Public Health Service or the National Oceanic and Atmospheric Administration. Military service may also include any period during which a servicemember is absent from duty on account of sickness, wounds, leave, or other lawful cause. (From the Servicemembers Civil Relief Act, 50 U.S.C. App. 501 et seq., as it existed in 2016.)

002.13 NATIONAL ACCREDITATION. The standards set by The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation, or other nationally recognized accreditation organization approved by the Director.

002.14 PERSON-CENTERED CARE. Services and supports designed around the needs, preferences and strengths of an individual.

002.15 PROVIDER. An organization or individual that has contracted with one of the Regional Behavioral Health Authorities or the Division to provide publicly-funded behavioral health services to consumers.

002.16 PSYCHOLOGICAL TRAUMA. Trauma from events or experiences that confront the person directly or as a witness to an event or experience where there exists an immediate perceived threat of death, extreme human suffering, severe bodily harm or injury, coercive exploitation or harassment, or sexual violation.

002.17 RECOVERY. A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

002.18 REGIONAL BEHAVIORAL HEALTH AUTHORITY. The regional administrative entity responsibility for each behavioral health region.

002.19 REGIONAL BEHAVIORAL HEALTH AUTHORITY NETWORK. Providers who have contracted with a Regional Behavioral Health Authority to form a network to provide behavioral health services in that Region.

002.20 TRAUMA-INFORMED SERVICES. Services that are informed about, and sensitive to, trauma-related issues present in survivors; but they need not be specifically designed to treat symptoms or syndromes related to sexual or physical abuse or other trauma. Trauma-informed services are designed to include a basic understanding of how trauma impacts the life of an individual seeking services.

002.21 TREATMENT. Recovery-oriented and person-centered clinical evaluations or interventions provided to consumers to ameliorate disability or discomfort or reduce signs and symptoms of a behavioral health diagnosis.

History

• Effective 2021-06-27

Chapter 2 Administration

Neb. Admin. Code tit. 206, ch. 2 Administration {#sec-206-nac-2 omnilex-key=us-ne-regs-official--title-206--206 NAC 2}

001. CONTRACTS . The Division will contract for the delivery of behavioral health programs and services.

001.01 SUBMISSION OF REPORTS AND OTHER DOCUMENTS. The Division has the authority to request that all contractors provide reports, evaluations, plans, and any other documents as deemed necessary by the Division for monitoring and accountability.

001.02 INSPECTIONS. The Division has the authority to inspect all programmatic and fiscal records of each all contractors, which must allow access for on-site monitoring by authorized representatives of the Division.

002. ALTERNATIVE COMPLIANCE . The Division has the discretion to authorize alternative methods of compliance with any standards or compliance procedures specified in these regulations, as deemed appropriate to further the development and implementation of recovery-oriented and person-centered community-based behavioral health services.

002.01 REQUESTING ALTERNATIVE COMPLIANCE. To apply for alternative compliance with a regulation, a provider must submit a written request to the Division. This request must include:

(A) The citation of the specific regulation for which alternative compliance is being requested;

(B) Reasons for the request for alternative compliance;

(C) If appropriate, activities or performance criteria to replace the requirement of the regulation and the date the provider is expected to attain compliance;

(D) The signature of the organization’s program director or individual provider;

(E) Authorization from the provider's governing body, if applicable, to request alternative compliance;

(F) Approval by the regional governing board when the provider is under contract with the Regional Behavioral Health Authority; and

(G) Documentation of how alternative compliance with the regulation would enhance quality, accessibility, public safety, and cost effectiveness.

002.02 DIVISION DETERMINATION. The Division will make a determination to grant the request for alternative compliance when the provider's proposal:

(A) Is consistent with the intent of the specified regulation;

(B) Conforms to good and customary administrative management and programmatic practices;

(C) Protects the rights, health, and safety of the consumers;

(D) Does not relieve the provider of the responsibility to comply with other pertinent regulatory requirements; and

(E) Contains documentation of how alternative compliance with the regulation would enhance quality, accessibility, public safety, and cost effectiveness.

002.03 DIVISION DECISION. The Division will review the request and issue a decision and send a copy to the regional governing board when the provider is under contract with the Regional Behavioral Health Authority. When alternative compliance is granted:

(A) It will be for a specified time period not to exceed the end of the program certification;

(B) A provider must receive the written decision from the Division before implementing alternative compliance; and

(C) A provider must meet all the conditions prescribed by the Division in granting alternative compliance. Failure to comply with the specified conditions voids the authorization for alternative compliance.

002.04 APPEAL. A provider aggrieved by a decision to deny a request for alternative compliance may appeal to the Director.

003. INFORMAL DISPUTE RESOLUTION AND ADMINISTRATIVE APPEALS . A client, guardian, or provider has the right to appeal a service authorization denial after all available appeals through the service authorization appeals process have been exhausted.

003.01 COMMENCEMENT OF APPEAL PROCESS. A client, guardian, or provider may begin the appeal process by either:

(A) Requesting an informal dispute resolution in writing within 14 calendar days following the service authorization denial; or

(B) Requesting a formal administrative appeal in writing within 30 calendar days following the service authorization denial.

003.02 INFORMAL DISPUTE RESOLUTION SUSPENSION OF TIME PERIOD. If a client, guardian, or provider requests an informal dispute resolution, the 30-day period to request a formal appeal will be suspended, beginning on the day the Division receives the request for informal dispute resolution until the day the Division notifies the client, guardian, or provider of the outcome of the informal dispute resolution. Following the informal dispute resolution process, if the client, guardian, or provider still wishes to dispute the Division’s decision, the client, guardian, or provider may request a formal appeal until the expiration of the 30-day period as calculated above.

003.03 INFORMAL DISPUTE RESOLUTION. Upon receiving a request for an informal dispute resolution, the Division will schedule a meeting between the client, guardian, or provider and the appropriate Department staff. An informal dispute resolution may be held in person, by video, or by telephone. The Division’s Chief Clinical Officer or designee serves as the decision-maker for the informal dispute resolution process, and will issue a written decision.

003.04 ADMINISTRATIVE APPEAL. Administrative appeals are conducted in accordance with the Administrative Procedure Act, Neb. Rev. Stat. §§ 84-901 to 84-920.

History

• Effective 2021-06-27

Chapter 3 Contracting Requirements for Regional Behavioral Health Authorities

Neb. Admin. Code tit. 206, ch. 3 Contracting Requirements for Regional Behavioral Health Authorities {#sec-206-nac-3 omnilex-key=us-ne-regs-official--title-206--206 NAC 3}

001. ADMINISTRATION AND MANAGEMENT . The Division provides funding and oversight of six local Regional Behavioral Health Authorities for the provision of publically funded community mental health and substance use disorder services.

001.01 REGIONAL ADVISORY COMMITTEE. Pursuant to Neb. Rev. Stat. §71-808, each Regional Behavioral Health Authority must establish and utilize a Regional Advisory Committee for the purpose of advising the Regional Behavioral Health Authority on needs and matters relating to community behavioral health services provided in the Region.

001.01(A) COMMITTEE MEMBERSHIP. The Regional Advisory Committee membership must be consistent with Neb. Rev. Stat. § 71-808.

001.01(B) COMMITTEE PROCEDURES. Procedures must be established to prevent a conflict of interest for members of the committee who may benefit financially or programmatically from their participation.

001.01(C) MEMBERSHIP LIST. Each Regional Behavioral Health Authority must submit an annual updated list of the names, addresses, and phone numbers of the officers and members of the Regional Advisory Committee to the Division by July 1.

001.01(D) MEETINGS. The Regional Advisory Committee must meet quarterly per year at a minimum.

001.01(E) ADVICE PROCEDURES. The Regional Behavioral Health Authority must develop procedures for soliciting advice from the Regional Advisory Committee, including procedures for input into the regional planning process, budget development and approval, contracting, evaluation, and other related areas.

001.01(F) DOCUMENTATION. The Regional Behavioral Health Authority must document the input received from the Regional Advisory Committee.

001.02 MATCHING FUNDS. The Regional Behavioral Health Authority must certify in writing to the Division, in a manner specified by the Division, that the required matching funds have been allocated as required by Neb. Rev. Stat. § 71-808.

001.02(A) FUND CERTIFICATION. The Regional Behavioral Health Authority must certify that required match funds in each Region have been appropriated for expenditure during the fiscal year for which the match has been allocated.

001.02(B) FUND EXPENDITURE. The match dollars must be expended for community behavioral health services and for the operation of the Regional Behavioral Health Authority as reported in the Regional Budget Plan, or as amended, if applicable.

001.02(C) ANNUAL AUDIT. The amounts of match dollars certified to the Division by the Regional Behavioral Health Authority and expended during the fiscal year must appear in the annual audit of the Regional Behavioral Health Authority.

001.03 ANNUAL REPORT. The Regional Behavioral Health Authority must annually submit to the Division a report summarizing the actual expenditure of funds and revenues received from all sources, in a manner specified by the Division.

001.04 DOCUMENTATION. The Regional Behavioral Health Authority must provide reports, evaluations, plans, and any other documents as deemed necessary by the Division for monitoring and accountability.

001.05 GRANT PROPOSAL. In making any grant application to the federal government, the Regional Behavioral Health Authority must submit the proposal to the Division for review and comment before formal submission to the federal agency.

001.06 INSPECTION AND MONITORING. The Regional Behavioral Health Authority must permit inspection of all contracts, subcontracts, programmatic records, service records, and fiscal records by the Division. The Regional Behavioral Health Authority must allow access for on-site monitoring by authorized representatives of the Division.

001.07 COORDINATION. The Regional Behavioral Health Authority must facilitate the coordination of community behavioral health providers with other providers and individuals to carry out the Regional Budget Plan.

001.08 RECORD RETENTION. The Regional Behavioral Health Authority must maintain contracts, subcontracts, programmatic records, service records, and fiscal records for at least five years following the end of the contract period or until resolution of any audit questions, whichever is later.

002. ANNUAL REGIONAL BUDGET PLAN . Pursuant to Neb. Rev. Stat. §71-809 the Regional Behavioral Health Authority must annually submit to the Division a Regional Budget Plan in a format specified by the Division that is consistent with the state plan.

002.01 ANNUAL BUDGET PLAN REQUIREMENTS. The Annual Regional Budget Plan must include, but is not limited to:

(A) A proposed budget that projects expenses and the allocation of funds for the recovery-oriented and person-centered community-based services to be offered in the Region; and

(B) A projection of all other revenues from all sources for each community behavioral health provider and the Regional Behavioral Health Authority in a manner specified by the Division.

003. CONTRACTING . The Regional Behavioral Health Authority is responsible for contracting for the publicly funded behavioral health services for consumers within its designated Region, consistent with the approved Regional Budget Plan. Contracting must meet the following requirements.

003.01 REGION SERVICES AND CONTRACTS. The Regional Behavioral Health Authority must comply with Neb. Rev. Stat. § 71-809 for all services provided or services contracted through the Region.

003.02 REQUESTS FOR PROPOSAL. The Regional Behavioral Health Authority must publicize and distribute a request for proposal that has been approved by the Division, with the exception of services funded by time-limited discretionary grants. Approved requests for proposal must be released with adequate public notice before notification of an award to ensure an open and fair competitive process. Each Regional Behavioral Health Authority is expected to make reasonable efforts to contact all potentially eligible bidders.

003.03 REQUESTS FOR PROPOSAL CONTENTS. Requests for proposals for services must at a minimum contain:

(A) A clear description of the process by which consumers are directly and actively involved in the development, implementation, and evaluation of the services to be provided;

(B) A clear description of the services to be provided;

(C) A clear description of the minimum qualifications for prospective bidders;

(D) Accurate data related to the service;

(E) The process to be used to determine the award; and

(F) The process for appeal.

003.04 DETERMINATION OF AWARD. The determination of an award for a contract must meet the following minimum criteria:

(A) Each proposal received must be recorded and evaluated according to the published criteria in the request; and

(B) Upon notice of award to the successful bidder, all proposals must be open to public inspection.

003.05 AWARD AND MANAGEMENT OF CONTRACTS. Each Regional Behavioral Health Authority is solely responsible for awarding and managing contracts resulting from the request for proposal process.

003.06 DIVISION APPROVAL. The Regional Behavioral Health Authority must receive approval from the Division before entering into contracts with any provider providing behavioral health services funded in whole or in part by the Division. The Division’s approval of the Regional Budget Plan and funding allocation may serve as the written approval for the purposes of this requirement.

003.07 PROVIDER CONTRACTS. The contract between the Regional Behavioral Health Authority and the provider must stipulate that the provider must adhere to the regulations and contract requirements of the Division.

003.08 PROVIDER ENROLLMENT. The Regional Behavioral Health Authority is responsible for enrolling contracted providers in their network. The Regional Behavioral Health Authority shall develop policies and procedures for determining eligibility for enrollment. At a minimum, the enrollment must include:

(A) A demonstration of capacity to provide behavioral health services based upon verification of:

(i) Compliance with all applicable state standards and licensure requirements for program, facilities, and staff members;

(ii) Professional licenses and endorsements;

(iii) All applicable insurance coverage; and

(iv) Fiscal viability, including fiscal and budgetary systems that provide appropriate accounting for and spending of contracted funds;

(B) A verified demonstration of compliance with state or national accreditation standards;

(C) Documented completion of an on-site visit for all contracted providers before enrollment and service provision to any consumer receiving services funded by the Division. This on-site visit must include the following minimum areas:

(i) Verification of compliance with this chapter; and

(ii) Verification that the clinical record keeping practices conform with the provider’s plan submitted and meet the minimum requirements this title; and

(D) Primary source verification of all information used to meet the criteria.

003.09 PERFORMANCE REVIEW. Contract renewal is determined through a performance review that at a minimum includes:

(A) Continued compliance;

(B) A review of data demonstrating the operation of the service outlined in the current contract;

(C) Consumer satisfaction;

(D) Compliance with information reporting to the Division;

(E) On-site visit;

(F) Completion of all provider enrollment forms and reports specified by the Division; and

(G) Documentation of inclusion of consumers in development, implementation, and evaluation of services.

004. CONFLICT OF INTEREST . The Regional Behavioral Health Authority must have policies and procedures that guard against a conflict of interest between the Regional Behavioral Health Authority, a current or prospective provider, or any individual member of either organization.

004.01 POLICIES AND PROCEDURES. The Regional Behavioral Health Authority must have policies and procedures that, at a minimum, ensure no person covered under the Regional Behavioral Health Authority, a current or prospective provider, or any individual member of either organization:

(A) Is the recipient of gifts or gratuities, with financial value or otherwise, from individuals or organizations doing business with the Regional Behavioral Health Authority or a provider;

(B) Misuses confidential information;

(C) Uses the organization's personnel, resources, property, or funds for personal financial gain;

(D) Employs persons related by kinship or personal or professional association without prior written approval from the Regional Behavioral Health Authority; or

(E) Uses or attempts to use any official position to secure unwarranted privileges or exemptions for themselves or others.

004.02 REPORTING OF CONFLICTS OF INTEREST. The Regional Behavioral Health Authority must have policies and procedures that address any conflict of interest between the Regional Behavioral Health Authority in its role as administrator and any provider including the Regional Behavioral Health Authority in its role as a provider and detail the method to identifying, reporting, and resolving potential conflicts of interest. All disclosures, reports, and resolutions must be in writing and be available for review by the Division.

005. DISASTER PLANNING . The Regional Behavioral Health Authority must have the capacity to respond to the psychosocial needs of people affected by a disaster within the Region's assigned geographic area, consistent with the state disaster plan. The Regional Behavioral Health Authority must have a written plan prepared to meet the disaster-generated psychosocial needs for the people residing within the Region.

005.01 DISASTER RESPONSE PLAN. The Regional Behavioral Health Authority disaster response plan must reflect coordination of its disaster preparations and response with the other emergency responders in the Region's assigned geographic area.

005.02 PERSONNEL. The Regional Behavioral Health Authority must work in cooperation with the local emergency management organization and the Division to organize, recruit, and train qualified behavioral health staff to respond in times of disaster. The behavioral health personnel designated to serve as part of the disaster response team must have received training to develop skills for providing psychosocial support after disaster.

006. INABILITY TO PAY . A provider funded in whole or in part under a contract with the Division must not deny or suspend services to persons residing in Nebraska because of an inability to pay scheduled fees, including preadmission deposits, co-payments, or other payments required from the consumer.

History

• Effective 2021-06-27

Chapter 4 Requirements for Providers Contracting with Regional Behavioral Health Authorities

Neb. Admin. Code tit. 206, ch. 4 Requirements for Providers Contracting with Regional Behavioral Health Authorities {#sec-206-nac-4 omnilex-key=us-ne-regs-official--title-206--206 NAC 4}

001. ACCREDITATION . To receive funds administered by the Division for service delivery, providers must submit:

(A) A current copy of the required licenses issued by the Department or the applicable local licensing authorities of competent jurisdiction which apply to the program;

(B) Documentation on the type of provider seeking approval to operate the programs; and

(C) National accreditation appropriate to the provider’s mission approved by the Director. Documentation of national accreditation must include:

(i) A complete copy of the most recent official accreditation report;

(ii) Documentation of the most recent official award of accreditation; and

(iii) A complete copy of the plan of correction submitted in response to the official accreditation report, if applicable.

001.01 EXCEPTIONS. The national accreditation requirements do not apply:

(A) To substance abuse prevention funds;

(B) To individual practitioners or small groups of individual practitioners providing outpatient services; or

(C) When a nationally recognized accreditation organization appropriate to the provider’s mission cannot be identified.

002. ACCREDITATION DEVELOPMENT PLAN . Those providers that do not have documentation of official award of national accreditation approved by the Director must submit an accreditation development plan for progressively bringing the provider into national accreditation status during a period not to exceed two years from approval. During the time a provider is working toward national accreditation under an accreditation development plan, the provider must meet the standards for behavioral health services. The accreditation development plan must demonstrate a systematic approach toward achieving national accreditation and must include:

(A) Policies and procedures to be followed during the accreditation development plan period including policies and procedures for protecting the life, safety, and rights of consumers served;

(B) A quality improvement program which follows the standards set by the national accreditation body which is being sought by the provider;

(C) A separate written plan submitted to the Division for accomplishing the national accreditation. The plan must include: the type of national accreditation being sought that is appropriate to the provider’s mission and includes goals; measurable objectives; target dates; contact information for the person responsible; and deadlines for making application for national accreditation and for scheduling the national accreditation survey; and

(D) A report on the results of a self-administered survey following the standards set by the national accreditation body which is being sought by the provider.

002.01 PROGRESS REPORTS. The provider must submit to the Region a semi-annual written progress report on the implementation of the accreditation development plan.

002.02 ANNUAL REVISIONS. The provider must revise the accreditation development plan on an annual basis to reflect its present situation.

002.03 ACCREDITATION MONITORING. The Region must monitor the provider’s progress until accreditation is granted.

003. TERMINATION OF PROCESS . The falsification of documents or information by the provider or individual to the Department is grounds to immediately terminate the provider application process or the existing provider approval.

History

• Effective 2021-06-27

Chapter 5 Consumer Eligibility

Neb. Admin. Code tit. 206, ch. 5 Consumer Eligibility {#sec-206-nac-5 omnilex-key=us-ne-regs-official--title-206--206 NAC 5}

001. TRAUMA-INFORMED SERVICES . Providers must consistently screen for trauma symptoms and history of traumatic events; provide ongoing review of trauma symptoms and problems related to that trauma; and offer services that are recovery-oriented and trauma-informed.

002. CONSUMER ELIGIBILITY AND PAYMENT FOR SERVICES . The Division will reimburse the Regional Behavioral Health Authorities for behavioral health services for consumers who are in Nebraska voluntarily and intend to make Nebraska his or her home and who meet:

(A) The clinical eligibility criteria for the services specified in the contract;

(B) The financial eligibility criteria as specified in the Region’s Financial Eligibility Policy and Financial Eligibility Fee Schedule. For the fiscal year July 1, 2012 through June 30, 2013, the Financial Eligibility Policy is based on the 2012 United States Department of Health and Human Services Federal Poverty Guidelines. For future fiscal years, the Financial Eligibility Policy and Financial Eligibility Fee Schedule will be adjusted based on changes to the annual United States Federal Poverty Guidelines and will not be specified in the regulations; and

(C) Lawful presence requirements set forth in Neb. Rev. Stat. §§ 4-108 to 4-114.

002.01 FINANCIAL ASSESSMENT OF ELIGIBILITY. The assessment of a consumer’s financial eligibility is an ongoing process. The consumer’s financial eligibility status must be re-assessed annually or when known changes occur that increase or decrease the co-payment obligations of the consumer.

002.02 REFUSAL TO PROVIDE FINANCIAL INFORMATION. Consumers who refuse to provide financial information shall be charged the full cost of services. The provider may not bill the Division for any service for which the consumer is responsible due to the failure of the consumer to provide financial information or attest to the financial information.

002.03 POLICIES AND FEE SCHEDULES. Regional Behavioral Health Authority’s Financial Eligibility Policy and Financial Eligibility Fee Schedule shall be adopted pursuant to Neb. Rev. Stat. § 71-809. The Financial Eligibility Policy and Financial Eligibility Fee Schedule shall be approved by the Division.

002.04 REIMBURSEMENT. For a consumer who meets the clinical eligibility, financial eligibility, and lawful presence criteria, the Regional Behavioral Health Authority will be reimbursed:

(A) At the rate set by the Division for services provided which are pre-authorized;

(B) The Region-determined rate of reimbursement for allowable uncompensated expenses for services provided; and

(C) Not more than the actual cost of the service less any co-payment and third party payment received for the service.

002.05 PAYOR OF LAST RESORT. The Division reserves the right to be the payer of last resort for consumers who meet the Division’s clinical criteria for an identified level of care and who are without the financial resources to pay for care. The Division will not reimburse:

(A) For Medicaid reimbursable services provided to Medicaid consumers. If the consumer has accrued personal needs allowance and created savings that disqualify him or her from a benefit such as Medicaid, the full cost of the service must be assessed to the consumer until he or she qualifies for the Medicaid benefit.

(B) For any portion of services required to be paid by a Medicaid recipient to meet a share of cost obligation.

(C) For services eligible for, or covered under, other health insurance benefits that were:

(i) Denied by an insurance company due to provider error, insufficient documentation, or lack of medical necessity;

(ii) That were not submitted to the insurance company in accordance with the policy; or

(iii) That were not submitted to the insurance company at the request of the consumer.

(D) For any service in which the consumer is deemed eligible to pay the cost of the service.

002.06 DETERMINATION OF FINANCIAL ELIGIBILITY. To determine if a consumer meets financial eligibility on the Financial Eligibility Policy and Financial Eligibility Fee Schedule:

(A) Complete the eligibility worksheet to determine the adjusted monthly income. To determine the adjusted monthly income:

(i) Add up wages, alimony, tips or other money received for a good or service in the past 12 month period. Divide this number by 12 to determine the taxable monthly income of the consumer.

(ii) Determine the monthly amount for housing, utilities, transportation, or daycare paid by the consumer. Actual cost claimed cannot exceed the maximum amounts listed on the worksheet for each item. Total the amounts listed for housing, utilities, transportation, and daycare to determine total allowable liabilities.

(iii) Subtract the total allowable liabilities from the taxable monthly income to determine the adjusted monthly income amount to be used to determine eligibility for funded services.

(B) Locate the adjusted monthly income amount on the appropriate fee schedule;

(i) The Financial Eligibility Fee Schedule is used for consumers who do not meet the requirements for the hardship or emergency access fee schedules.

(ii) Hardship fee schedule is used for:

(1) Consumers who meet criteria for severe and persistent mental illness; or

(2) Consumers who meet criteria for serious emotional disorder in youth 19 or under; or

(3) Medical bills or medical debt in excess of 10% of the taxable annual income.

(iii) Emergency access fee schedule is used for:

(1) Consumers receiving assistance from crisis response team, emergency community support, housing related assistance; or

(2) The hospital diversion services where consumers stay less than 24 hours.

(C) Locate the total number of family members dependent on the taxable income; and

(D) Only those consumers who fall within the shaded areas on the fee schedules are eligible for services funded by the Division.

002.07 CO-PAYMENT. In addition to payments made by the Division, the Regional Behavioral Health Authority may assess consumers a co-payment fee based upon the Financial Eligibility Fee Schedule. To determine the maximum co-payment:

(A) Locate the adjusted monthly income amount on the appropriate schedule.

(B) Locate the total number of family members dependent on the taxable income.

(C) Locate the box in which the column and row intersect is the maximum co-payment fee to be charged to the consumer for each appointment or unit of service.

002.08 RESIDENTIAL LEVELS OF CARE. Residential levels of care will receive payment based on the Division’s established rates. In addition to room and board fees, co-payment fees may also be assessed. The room and board fee may not be in excess of actual costs incurred for these services by the provider. All co-payments charged must be in compliance with the Region’s Financial Eligibility Policy and Financial Eligibility Fee Schedule.

002.09 SUBSTANCE USE DISORDER EDUCATION AND DIVERSION. Fees and co-payments for substance use disorder education and diversion services are determined by the Region or other providers and are not subject to the provisions of the Region’s Financial Eligibility Policy and Financial Eligibility Fee Schedule.

002.10 ELIGIBILITY VERIFICATION. The Division or the Regional Behavioral Health Authority may request from the provider verification of a consumer’s eligibility for service.

History

• Effective 2021-06-27

Chapter 6 Mental Health Board Training

Neb. Admin. Code tit. 206, ch. 6 Mental Health Board Training {#sec-206-nac-6 omnilex-key=us-ne-regs-official--title-206--206 NAC 6}

001. AUTHORITY . These regulations govern training of mental health board members and alternate members pursuant to Neb. Rev. Stat. § 71-916.

002. REQUIREMENT FOR TRAINING . All mental health board members and alternate members must attend and satisfactorily complete the mental health board training at least once every four years.

003. TRAINING . If the member or alternate member completes training through video or audio media or other self-study courses, the member must provide proof of completion of the training to the Department by affidavit or other method as determined by the Department.

History

• Effective 2021-06-27

Chapter 7 Peer Support

Neb. Admin. Code tit. 206, ch. 7 Peer Support {#sec-206-nac-7 omnilex-key=us-ne-regs-official--title-206--206 NAC 7}

001. CERTIFICATION . To obtain a certificate to provide peer support in Nebraska, an individual must submit a completed application and provide documentation of meeting the certification requirements.

001.01 APPLICATION. All applicants must submit a completed application, including all required supporting documentation utilizing the Department’s approved application form. The following information is required:

(A) Legal name and any other names by which the applicant is known;

(B) Mailing address;

(C) Social Security Number or Alien Registration Number, if the applicant has both, both need to be reported;

(D) Date and place of birth; and

(E) Phone number and email address.

001.02 REQUIREMENTS AND DOCUMENTATION. To obtain certification as a peer support specialist, an individual must submit a complete application. All applicants must meet the minimum requirements for certification and submit documentary proof of same.

001.02(A) AGE. An applicant must be at least 19 years old.

001.02(B) CITIZENSHIP OR LAWFUL PRESENCE. Applicants must submit documentation that he or she meets the requirements set out in Neb. Rev. Stat. §§ 4-108 through 4-111.

001.02(C) EDUCATION. Applicants for a certification must provide:

(i) Documentation of a minimum of a high school diploma or General Equivalency Degree as recognized by a state Department of Education; and

(ii) Certificate of completion or equivalent documentation of completion of peer support core curriculum training course approved by the Department within 12 months prior to the date of the application that includes:

(1) The name and address of the training program;

(2) Applicant’s name;

(3) Category of training;

(4) Hours of training;

(5) Date training completed; and

(6) The signature of the training instructor for a total of 60 hours, a minimum of 40 hours must be live interactive peer support training.

001.02(D) EXAMINATION. Applicants are required to take and pass the Peer Recovery Examination or its successor administered by the International Certification & Reciprocity Consortium or its successor. The passing score is the score established by International Certification & Reciprocity Consortium or its successor.

001.02(E) LIVED EXPERIENCE. The applicant must provide an attestation that the applicant is a self-disclosed current or previous individual who receives or has received behavioral health services, or is a parent, legal guardian, or primary caretaker of an individual who receives or has received behavioral health services.

001.02(F) CODE OF ETHICS. The applicant must attest to receiving the State of Nebraska Certified Peer Support Specialist Code of Ethics.

001.02(G) RECOVERY. The applicant must have been in recovery for a minimum of one year.

001.02(H) RELEASES. The applicant must sign all appropriate releases for a Child and Adult Abuse and Neglect Central Registry check and sign a release to allow his or her name to be placed on the Department’s website as a Certified Peer Support Specialist.

001.02(I) CONVICTION INFORMATION. If the applicant has ever been convicted of a felony or misdemeanor in Nebraska or in another jurisdiction, submit:

(i) A copy of the court record related to all misdemeanor and felony convictions that includes the statement of all charges and final disposition, if the conviction(s) occurred in a state other than Nebraska;

(ii) An explanation of the events leading to the conviction and a summary of actions that the applicant has taken to address the behaviors or actions related to the conviction; and

(iii) A letter from the applicant’s probation officer addressing the terms and current status of the probation, if the applicant is currently on probation.

001.02(J) DRUG OR ALCOHOL RELATED CONVICTIONS. To aid in the evaluation of drug or alcohol related convictions, an applicant may submit evaluations and discharge summaries where drug or alcohol treatment was obtained or required. Evaluations and discharge summaries may be submitted by the provider directly to the Department.

001.02(K) OTHER PROFESSIONAL CERTFICATION OR LICENSURE. If disciplinary action was taken against any of the applicant’s current or past certifications or licenses by Nebraska or another jurisdiction, the applicant must submit an official copy of the disciplinary action, including charges, sanctions, and disposition.

001.03 GRANDFATHER. All applicants must submit a completed application, including all required supporting documentation, utilizing the Department’s approved application form. Applicants seeking grandfathering must provide a current Peer Support and Wellness Specialist or Certified Peer Support Specialist certificate from the Department.

001.03(A) TRAINING. Applicants do not have to take the required training if the applicant has:

(i) Been employed or volunteered a minimum of 500 hours in the 12 months prior to the effective date of this chapter as a peer support specialist. The applicant must provide an attestation from the applicant’s employer or supervising volunteer coordinator containing:

(1) The dates of employment or volunteer work;

(2) The name of the employer or organization where volunteer work was performed;

(3) The job title; and

(4) The job description or volunteer duties indicating direct work with consumers.

001.03(B) EXAMINATION. Applicants do not have to take the required examination if the applicant has already passed the examination.

001.03(C) APPLICATION SUBMISSION. Applications for grandfathering must be submitted within 90 days after the effective date of this chapter.

001.03(D) CONTINUING EDUCATION. If an applicant is grandfathered, the applicant has until August 31, 2021 to complete continuing education hours.

001.04 RECIPROCITY. All applicants seeking reciprocity must submit a completed application, a valid reciprocal level certification from another jurisdiction or valid national certification, and all required supporting documentation, utilizing the Department’s approved application form. Applicants seeking reciprocity do not have to take the required training.

001.04(A) EXAMINATION. Applicants seeking reciprocity do not have to take the required examination if the applicant has passed the International Certification & Reciprocity Consortium or its successor’s examination.

001.04(B) CONTINUING EDUCATION. If an applicant is granted reciprocity, the applicant has until August 31st of odd numbered years to complete continuing education hours.

002. RENEWAL AND CONTINUING EDUCATION . All certificates issued by the Department pursuant to these regulations expire on September 1st of each odd numbered year.

002.01 RENEWAL INFORMATION. The certificate holder must submit a completed renewal application, prior to the expiration date, utilizing the Department’s approved renewal application form. The certificate holder must provide:

(A) Legal name and any other names by which the certificate holder is known;

(B) Mailing address;

(C) Social Security Number or Alien Registration Number, if the certificate holder has both, both need to be reported;

(D) Telephone number and E-mail address; and

(E) An attestation to the completion of at least 20 hours of continuing education per certification period in the 13 designated peer support domains. Of the 20 hours, six hours must be in ethics. Continuing education must be completed during the renewal period for which credit is sought. Credit will not be received for the same continuing education program more than once per biennial renewal period.

002.02 WAIVER OF CONTINUING EDUCATION REQUIREMENTS. The continuing education requirements are waived for:

(A) Certificate holders who were certified within the 12 month period immediately prior to the renewal date.

(i) This does not apply to certificate holders who received their certificate by meeting the grandfathering requirements.

(B) Certificate holders actively engaged in military service. The Department may conduct an audit of military status. The certificate holder selected for audit must provide documentation of active military service within 30 days.

002.03 AUDIT OF CONTINUING EDUCATION REQUIREMENTS. Each certificate holder is responsible for retaining documentation of completion and credit from continuing education classes. A certificate holder selected for audit by the Department must provide documentation of completion and credit for the continuing education hours attested to on the renewal application.

002.03(A) AUDIT DOCUMENTATION. When selected for an audit, the credential holder must provide documentation of completion of continuing education hours attested to on the certification renewal form within 30 days from the date of the letter requesting the documents.

002.03(B) INSUFFICIENT DOCUMENTATION. Continuing education classes for which sufficient documentation of completion is not produced will not be included in the calculation of the total number of continuing education hours earned.

002.03(C) FAILURE TO COMPLY. Failure to comply with the audit or failure to meet the continuing education requirements will result in expiration of the certificate.

003. DENIAL AND DISCIPLINARY ACTION . A certificate may be denied, refused renewal, or have other disciplinary measures taken against it on any of the following grounds:

(A) Not respecting the privacy and confidentiality of private information shared by people utilizing peer support services and disclosing confidential information except as permitted by law;

(B) Engaging in a romantic or sexual relationship with the people utilizing peer support where the certificate holder is employed or providing peer support services to anyone with whom the certificate holder had romantic or sexual relationship with in the past;

(C) Using clients of peer support services for improper financial gain or putting the client at risk of exploitation or harm;

(D) Intimidating, threatening, harassing, using undue influence, physical force or verbal abuse, or making unwarranted promises of benefits to any individual that utilizes peer support services;

(E) Abuse of a substance or a substance use disorder, not in remission, related to alcohol, drugs, controlled substances or any mind-altering substance;

(F) Practice as a Certified Peer Support Specialist while his or her ability to practice is impaired by alcohol, drugs, controlled substances, or any mind-altering substances or mental health disorder with serious functional impairments;

(G) Misrepresentation of information provided in procuring or attempting to procure certification;

(H) Practice as a Certified Peer Support Specialist fraudulently, beyond its authorized scope, with gross incompetence or gross negligence, or in a pattern of incompetence or negligent conduct. Use of any letters, words, or terms on stationery, in advertisements, or otherwise indicating that such person is entitled to practice a profession for which the individual is not certified or credentialed;

(I) Failure to keep and maintain adequate records of treatment or service;

(J) Having any certification denied, refused renewal, limited, suspended, revoked, or disciplined in any manner by another jurisdiction;

(K) Failure to maintain the requirements necessary to obtain certification;

(L) Cheating on or attempting to subvert the credentialing examination;

(M) Commission of any act of sexual abuse, misconduct, or exploitation related to the practice of the Certified Peer Support Specialists;

(N) Failure to follow procedures and policies of the certificate holder’s employer to ensure safety of the client;

(O) Failure to meet the requirements of certification;

(P) Convicted of a felony or misdemeanor in Nebraska or in another jurisdiction; or

(Q) A current entry on a Child and Adult Abuse and Neglect Central Registry or Sex Offender Registry or equivalent registry in Nebraska or another jurisdiction.

003.01 DISCIPLINARY ACTION. Disciplinary action against a certificate can include:

(A) Censure or reprimand;

(B) Probation;

(C) Temporary suspension; or

(D) Revocation of certificate.

004. MANDATORY REPORTING . A certificate holder shall, within 30 days of an occurrence described in this section, report to the Department:

(A) Loss of employment due to alleged incompetence, negligence, unethical or unprofessional conduct, or impairment by alcohol, drugs, controlled substances or any mind-altering substance and an explanation of the events that led to the loss of employment;

(B) Conviction of a felony or misdemeanor in Nebraska or another jurisdiction and provide required documentation; or

(C) An entry on a Child and Adult Abuse and Neglect Central Registry or Sex Offender Registry or equivalent registry in Nebraska or another jurisdiction and an explanation of the incident.

005. PEER SUPPORT CORE CURRICULUM TRAINING COURSE APPROVAL . To receive approval of a peer support core curriculum training course that is required for applicants, the following is required to be submitted to the Department:

(A) Name, qualifications of the instructor submitting peer support core curriculum for approval, and instructors who will be assisting in providing education and support to the class. One instructor must be a Nebraska Certified Peer Support Specialist in good standing;

(B) An attestation that the trainer to trainee ratio will be a minimum of one instructor per ten students;

(C) Curriculum including course competencies and amount of hours spent in each course competency for a total of 60 hours of total course work with a minimum of 40 hours of live, interactive training. All 60 hours must meet the competencies specified within the following 13 domains including a minimum of 10 hours in ethics:

(i) Engages peers in collaborative and caring relationships;

(ii) Support;

(iii) Shares lived experiences of recovery;

(iv) Personalized peer support;

(v) Supports recovery planning;

(vi) Links to resources, services, and supports;

(vii) Provides information about skills related to health, wellness, and recovery;

(viii) Helps peers to manage crises;

(ix) Values communication;

(x) Supports collaboration and teamwork;

(xi) Promotes leadership and advocacy;

(xii) Promotes growth and development; and

(xiii) Ethics;

(D) Means of delivering the curriculum;

(E) Handouts, worksheets, and video links utilized;

(F) Interactive exercises that will aid in the facilitation of understanding key competencies;

(G) Competency measurements utilized to ensure an understanding of key competencies; and

(H) Signature and telephone number of the instructor or representative of the training entity.

005.01 REPORT CHANGES. Any change in structure, instructor, or to the curriculum must be submitted to the Department for approval 30 days prior to implementing the proposed change.

005.02 LENGTH OF APPROVAL. Approval of the peer support core curriculum training course is effective for three years from the initial date of approval.

005.03 AUDIT. All approved peer support core curriculum training courses are subject to audit by the Department.

005.03(A) AUDIT DOCUMENTATION. Documentation requested by the Department for an audit must be provided within 30 days of the request. Failure to provide documentation requested during an audit will result in revocation of approval of curriculum and course work.

005.04 DENIAL OR REVOCATION OF CURRICULUM. Certification of curriculum and course work will be denied or have approval revoked if:

(A) There has been fraud or misrepresentation of information provided to the Department; or

(B) The course curriculum does not meet the criteria.

006. NON-ENGLISH DOCUMENTS . Any documents written in a language other than English must be translated. An individual may not translate his or her own non-English documents. For the translation to be considered, it must contain:

(A) The original English translation;

(B) A certification containing the original notarized signature of the translator or certification statement, attesting that the translator is:

(i) Fluent in English;

(ii) Fluent in the language of the original non-English document;

(iii) Competent to render the translation; and

(iv) That the translation is a complete and accurate rendition of the original language; and

(C) Include a copy of the original non-English document.

007. APPEAL . A decision made by the Department pursuant to this chapter may be contested according to Neb. Rev. Stat. § 84-917.

History

• Effective 2021-06-27