Neb. Admin. Code tit. 473 — Social Services for the Aged and Disabled

Chapter 1 General Provisions

Neb. Admin. Code tit. 473, ch. 1 General Provisions {#sec-473-nac-1 omnilex-key=us-ne-regs-official--title-473--473 NAC 1}

001. SCOPE AND AUTHORITY . Nebraska Revised Statute (Neb. Rev. Stat.) § 68-1206 authorizes the Nebraska Department of Health and Human Services, hereinafter “the Department,” to administer a program providing social services to eligible individuals. This Title governs the program services offered to elderly adults and disabled adults.

002. DEFINITIONS . The following definitions apply:

002.01 ADVERSE ACTION. The Department’s determination that the services provided to a recipient will be reduced or terminated.

002.02 ADULT. An individual age 19 or older.

002.03 EMANCIPATED MINOR. A child age 18 or younger is considered emancipated if the individual has:

(A) Married; or

(B) Moved away from the parent’s or legal guardian’s home and is self-supporting.

002.04 LEGALLY RESPONSIBLE INDIVIDUAL. A parent or legal guardian of a minor child or an individual’s spouse.

003. APPEAL RIGHTS . Applicants and recipients have the right to appeal for a fair hearing on the following matters:

(A) A determination that the applicant is not eligible to receive program services;

(B) Denial of services;

(D) Inaction on the application.

003.01 EXCEPTION. Applicants or recipients are not entitled to a fair hearing when state or federal law requires automatic case adjustments for classes of clients unless the reason for an individual appeal is incorrect eligibility determination.

History

Effective 2021-07-13

Chapter 2 Application and Eligibility

Neb. Admin. Code tit. 473, ch. 2 Application and Eligibility {#sec-473-nac-2 omnilex-key=us-ne-regs-official--title-473--473 NAC 2}

001. APPLICATION FOR SERVICES . Anyone may contact the Department by telephone, in writing, or in person to obtain information, explore eligibility, or to apply for services. Individuals may apply for themselves or as an authorized representative of another person.

001.01 APPLICATION PROCESS. Applicants must apply for services using a form approved by the Department. Applications must be signed and complete. Applications may be submitted in person, by mail, by fax, or by electronic submission. Applicants who require assistance with the application may ask the Department for assistance. Incomplete or unsigned applications may be denied.

001.02 INTERVIEWS. An interview is required at initial eligibility determination. Interviews may be conducted face-to-face or telephonically. The Department determines if a face-to-face interview is necessary. If a face-to-face interview cannot be conducted at a local office, the Department will consider an interview at a mutually agreeable alternate location. The interview must be attended by at least one of the following:

(A) An adult applicant;

(B) The applicant’s legal guardian or conservator; or

001.03 FAILURE TO COOPERATE. If an applicant fails to keep appointments, fails to contact the Department when requested, or fails to provide requested information, then the application may be denied.

002. ELIGIBILITY . To be eligible the applicant must meet the following eligibility rules:

002.01 RESIDENCY, CITIZENSHIP, AND ALIEN STATUS. Only Nebraska residents are eligible for program services. Applicants and recipients must be United States citizens or qualified aliens as defined in Nebraska Revised Statute (Neb. Rev. Stat.) § 4-111 and sign an attestation form verifying lawful presence in the United States. The Department must be able to verify the recipient’s status.

002.02 ELIGIBILITY BASED ON FAMILY SIZE. The Department considers an applicant’s family size in determining eligibility for services. A family is a unit consisting of one or more adults and any children related by blood, marriage, or adoption who reside in the same household. An unborn is included if proof of pregnancy is provided. Foster children may be included when determining the size of the foster family. The following are considered separate families:

(A) Unmarried adults who reside together;

(B) Children living with non-legally responsible relatives;

(D) Minor parents; and

(E) Biological parents or usual caretakers with a child in substitute care and children, if any, residing in the home.

002.03 CATEGORIES OF ELIGIBILITY FOR ADULTS. Individuals must meet one of the categories noted below to be eligible:

002.03(A) CURRENT SUPPLEMENTAL SECURITY INCOME OR STATE SUPPLEMENTAL. Applicants who currently receive assistance through the Title XVI Supplemental Security Income Program, the Supplemental Security Income Extended Benefits Program, or the Nebraska State Supplemental Program are eligible as current aged, current blind, or current disabled.

002.03(B) LOW INCOME. This section discusses categories of eligible low income applicants who are either Aged, Blind or Disabled.

002.03(B)(i) LOW INCOME AND AGED. An individual age 60 or older whose family income is within income guidelines of this chapter.

002.03(B)(ii) LOW INCOME AND BLIND. An individual age 19 through 59 who has a visual impairment, who meets the definition for low income disabled and whose family income is within the income guidelines of this chapter.

002.03(B)(iii) LOW INCOME AND DISABLED. An individual eligible as low income and disabled must have a family income which is within the income guidelines of this chapter and a physical or mental impairment which substantially prevents the applicant from engaging in useful occupations within the individual’s competence. The impairment must be verifiable by medical findings of:

(1) Physical impairment includes loss or defects of the extremities, malfunctioning of the organs of the body or physiological disturbances with structural damages; or

(2) Mental impairment includes conditions characterized by a marked and consistent failure to adjust to the emotional, social, or individual demands of living which require that the individual have assistance in essential activities of daily living.

002.03(C) WITHOUT REGARD TO INCOME. An individual who is not eligible as a current recipient or as low income but who is actively working with Adult Protective Services is eligible without regard to income on a time-limited basis.

002.04 MAXIMUM ALLOWABLE INCOME. For an applicant to be determined eligible as low income and aged, low income and blind, or low income and disabled, the applicant’s income must not exceed the maximum allowable monthly income for an individual or for a family of two or more. As of January 1, 2021, the current base level income is $1,216 per month for an individual or $1,362 for a family of two or more. A cost of living adjustment to the base level income is calculated each fall when the new cost of living adjustment is released by the Social Security Administration. If the applicant’s income is verified as equal to or less than this amount, the applicant is income-eligible for the various services outlined in this title.

002.04(A) SOURCES OF INCOME. All sources of income not excluded in this Title are counted as income.

002.04(B) INCOME EXCLUSIONS. The following sources of income are not considered when determining eligibility:

(i) Money received from participation in the Foster Grandparent Program authorized by the ACTION Program;

(ii) Money awarded by the Indian Claims Commission or the Court of Claims;

(iii) Alaska Native Claims Settlement Act payments to the extent the payments are exempt from taxation under section 21(a) of the Act;

(iv) Money received from the sale of property such as stocks, bonds, a house or a car unless the person was engaged in the business of selling the property in which case the net proceeds would be counted as income from self-employment;

(v) Withdrawals of bank deposits;

(vi) Tax refunds;

(vii) Gifts;

(viii) Earned Income Credits and Advanced Earned Income Credits;

(ix) Lump sum inheritances or insurance payments;

(x)Capital gains;

(xi) The value of the allotment of benefits under the Supplemental Nutrition Assistance Program;

(xii) The value of United States Department of Agriculture donated foods;

(xiii) The value of supplemented food assistance under the Child Nutrition Act of 1966 and the special food service program for children under the National School Lunch Act, as amended;

(xiv) Any payment received under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970;

(xv) Earnings of a child age 18 or younger who is a full-time student or a part-time student who is not employed full-time. Summer earnings of a child age 18 or younger are excluded if the child plans to return to school in the fall;

(xvi) Loans;

(xvii) Any grant to a student for educational purposes;

(xviii) Work study for an undergraduate student;

(xix) Home produce used for household consumption;

(xx) Earnings received by a youth age 18 or younger under a Job Training Partnership Act Program;

(xxi) Workforce Innovation and Opportunity Act allowance paid for supportive services such as transportation, meals, special tools, and clothing;

(xxii) Volunteers In Service to America living allowances and stipends;

(xxiii) Reimbursement from the Senior Companion Program;

(xxiv) Low Income Home Energy Assistance Program funds;

(xxv) Housing assistance provided by Housing and Urban Development or by a local housing program;

(xxvi) Assistance received under the Disaster Relief Act of 1974 or under a federal law because of a presidentially declared major disaster;

(xxvii) Payments to a client participating in training or school attendance subsidized by Vocational Rehabilitation within the Nebraska Department of Education;

(xxviii) Payments made by the Veterans Administration under the Veterans Education and Employment Assistance Act for education expenses of a veteran; and

(xxix) Payments made by an absent parent to a child care provider, landlord or mortgage holder on behalf of the applicant or recipient.

002.04(C) TYPES OF INCOME. The following types of income are considered when determining eligibility:

002.04(C)(i) IRREGULAR INCOME. Irregular income is income, earned or unearned, which varies in amount from month to month or which is received at irregular intervals. This may be due to irregular employment, but even when an individual works regularly, the income may be irregular because of factors such as seasonal increases or decreases in employment and earnings such as day labor or sales work on a commission basis. The Department averages three consecutive months of irregular income, if available, to project future income unless there has been a significant change. Small, irregular earnings which are not computable or predictable are not considered.

002.04(C)(ii) IN-KIND INCOME. In-kind income is any non-monetary consideration received by a client in place of income for services provided or as a payment of an obligation.

002.04(C)(iii) LUMP SUM INCOME. Lump sum income is money received on a one-time basis. The lump sum amount is divided by six months and the result is added to the gross monthly income to determine eligibility. If that amount exceeds the income maximum, the applicant is ineligible for that six month period.

002.04(C)(iv) EARNED INCOME. Earned income is money received from wages, tips, salary, commissions, self-employment, or items of need received in lieu of wages.

002.04(C)(v) UNEARNED INCOME. The Program considers unearned income in determining eligibility. Unearned income includes but is not limited to:

(1) Social Security benefits;

(2) Railroad retirement benefits;

(3) Child support;

(4) Unemployment compensation; and.

(5) Returns from savings or investments.

002.04(C)(vi) TREATMENT OF PAYMENT BY ABSENT PARENT. When an absent parent makes a payment for child care, rent, or mortgage payment whether court-ordered, or through an informal arrangement, the payment is:

(1) Treated as income if paid to the client; or

(2) Excluded if paid to the provider, a lender, or the landlord.

003. NEEDS ELIGIBILITY . Social services are authorized based on the applicant or recipient’s income eligibility and needs and are not provided based on demand. Need for a particular service implies that the provision of that service will assist the applicant, recipient, or the family members toward achieving one of the five program goals:

(A) Achieving or maintaining economic self-support to prevent, reduce, or eliminate dependency;

(B) Achieving or maintaining self-sufficiency, including reduction or prevention of dependency;

(C) Preventing or remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests, or preserving, rehabilitating, or reuniting families;

(D) Preventing or reducing inappropriate institutional care by providing for community-based care, home-based care, or other forms of less intensive care; or

(E) Securing referral or admission for institutional care when other forms of care are not appropriate.

003.01 NEEDS CRITERIA. The applicant or recipient has no defined service need when:

(A) The applicant or recipient is able to perform or provide for the identified service needs in 473 NAC 4;

(B) The applicant or recipient has family members or caregivers who have the responsibility or capability to meet identified service needs;

(C) The applicant or recipient has other relatives, friends, or interested individuals who will provide needed identified services at no cost to the applicant or recipient or to the family;

(D) The applicant or recipient has access to financial resources which may be used to meet the needs;

(E) The applicant or recipient is residing in an institution except when transitioning from the institution or short-term care; or

(F) The applicant or recipient does not meet the requirements specified for each service.

004. VERIFICATION . To determine initial or ongoing eligibility, the Department may need to verify information provided by the applicant or recipient. The applicant or recipient must cooperate with the verification process. Failure to cooperate with verification may result in services being denied or reduced, termination from the program, or establishment of an overpayment.

005. AUTHORIZATION . The service provider is responsible for providing the service authorized on the service authorization and in the provider agreement. Each provider from whom service is purchased must receive authorization before providing the service.

005.01 AUTHORIZATION FOR IN-HOME SERVICES. If an individual in-home service provider is authorized, the applicant or recipient must execute necessary documents to appoint the Department as agent for state and federal employment taxes and other withholding taxes.

005.02 TERMINATING AUTHORIZED SERVICES. When a service authorization is terminated before the end of the authorization period, the affected provider will be notified.

006. DUTY TO CONTACT THE DEPARTMENT . The recipient or the authorized representative must contact the Department when

(A) There has been a change in the recipient’s situation such as a change in address, change in income, change in family composition, change in health, or change in need for services; or

(B) The recipient is dissatisfied or experiencing problems with the service delivery.

007. NOTICE OF AGENCY ACTION . The Department will mail the applicant or recipient a notification of agency action when

(A) An applicant is determined ineligible for program services;

(B) A recipient is found ineligible at the time of verification or redetermination;

(D) A provider has met standards to be approved as a provider; or

(E) When a recipient’s provider is disapproved or will not be reapproved.

007.01 ADVANCE NOTICE. When a provided service is to be reduced or terminated, the Department provides written notice to the recipient at least ten calendar days before the adverse action is effective.

007.02 ADEQUATE NOTICE. If the Department has verified possible recipient fraud, a notice of termination or reduction is sent to the recipient no later than the action's effective date.

007.03 SERVICE CONTINUATION DURING APPEAL. In cases where advance notice has been given, the recipient may appeal. If the appeal is requested in writing within ten days following the date the Department’s notice was mailed, the adverse action will not be carried out until a fair hearing decision is made. In situations where only adequate notice is required, service is not continued pending a hearing decision.

008. SOCIAL SERVICE EXCEPTION . In limited circumstances, the Department may grant waivers of the requirements when necessary to:

(A) Meet extraordinary needs of individuals eligible for services; or

(B) Obtain providers for eligible applicants or recipients.

009. TIME-LIMITED SERVICE EXCEPTIONS . Approval for extension beyond the initial six month authorization period for the sole purpose of ongoing advocacy or follow-up will not be granted. The following services are time limited:

(A) Services provided in conjunction with Adult Protective Services;

(B) Adult Day Services; and

010. ASSIGNMENT OF PAYEE, GUARDIANSHIP, OR CONSERVATOR STATUS . No employee of the Department may serve as a guardian or conservator for any recipient for whom the employee:

(A) Determines eligibility;

(B) Authorizes service provision;

(D) Has any other professional relationship which may be considered a conflict of interest.

010.01 SERVICE WORKER AS PROTECTIVE PAYEE. A Department employee may act as a protective payee for a recipient only if the employee does not determine eligibility for a categorical program for the recipient. All other community resources must be explored before a services worker may accept the payee assignment.

010.02 PROVIDER AS PROTECTIVE PAYEE. The Department must approve before a service provider who contracts with the Department may act as protective payee for a recipient served by the service provider.

011. ELIGIBILITY REDETERMINATION . Eligibility redeterminations must be conducted at least once every twelve months. More frequent redeterminations may be necessary whenever the Department learns of a change in the recipient’s circumstances or possible change in need for services. An interview may be necessary as part of the redetermination process.

History

Effective 2021-07-13

001. INTRODUCTION . This Chapter contains definitions, requirements, and standards used in evaluating and approving social service providers who wish to enroll and provide services through this Program.

002. DEFINITIONS . The following definitions apply:

002.01 INDIVIDUAL PROVIDER. A provider who has no employees and will not normally subcontract any service(s) for which they are requesting approval to provide. Individual providers are independent contractors and not employees of the Department or the State of Nebraska. For the purpose of the Federal Insurance Contribution Act withholding for Social Security and Medicare taxes, the provider is considered an employee of the recipient.

002.02 PROVIDER IDENTIFICATION NUMBER. A nine-digit Federal Identification number or a nine-digit Social Security number followed by a two-digit suffix code.

002.03 PROVIDER ENROLLMENT FORM. A document whereby the provider indicates willingness to participate in the program and provide services to recipients. The enrollment form describes the services to be provided as well as the agreed upon units and unit rates for each provider. The provider’s responsibilities are stated in the enrollment form.

002.04 SUBCONTRACTING. When a service provider pays someone other than a provider’s employee to provide the contracted service.

002.05 TWO-DIGIT SUFFIX CODE. Two identifying numbers attached to the Federal Identification Number of providers who share the same Federal Identification Number due to affiliation with a larger agency.

003. FACE-TO-FACE INTERVIEW . A face-to-face interview is required of each potential provider.

003.01 FAILURE TO MEET STANDARDS. If the potential provider does not meet standards at the time of the initial visit or face-to-face interview, but is able to correct the deficiency within 30 days, the enrollment process will continue when proof of compliance with standards is received.

004. CONFLICT OF INTEREST . No employee of the Department may be approved as a service provider if the employee is in a position to influence the employee’s own approval or utilization.

005. RECIPIENT’S RELATIVE AS PROVIDER . A relative provider may not be a legally responsible relative or legal dependent of the recipient. A non-legally responsible relative of a recipient may be a provider if it is documented that the relative provider is held to the same provider requirements as non-relative providers.

006. SERVICE PROVIDER ENROLLMENTS . The following requirements govern service provider enrollments:

(A) Each provider must be properly enrolled before services can be authorized for purchase;

(B) The Department must evaluate and approve or disapprove all service providers seeking enrollment;

(C) Enrollments are effective up to 12 months, are never back-dated, and must be signed by the provider on or before the effective date;

(D) Changes in the services of a provider or terms require a new enrollment form. Address changes which do not affect the service location do not require a new enrollment form but an amendment must be completed showing the provider’s new address;

(E) Notice of any changes in services, units or unit rates proposed by either the provider or the service agency must be given as soon as possible; and

(F) Service provider enrollments must be approved by the Department.

007. PROVIDER EVALUATION . As part of the provider approval process, the Department conducts an evaluation consisting of the following:

(A) A face-to-face interview with each potential provider at least annually;

(B) Annual visits to each facility in which services are provided to recipients outside of recipients’ homes; and

(C) Assessment of the quality of service provision at least once during the enrollment period by observing service delivery, visiting the service facility, interviewing the provider, or interviewing a recipient served by the provider.

007.01 PROVIDER COMPLIANCE. If the provider does not meet standards at the time of the initial visit or interview, but is willing to correct the deficiency within 30 days, the evaluation process will continue when proof of compliance is received.

007.02 SUBCONTRACTORS. Site visits are not required for subcontracted facilities. The service provider shall ensure that subcontractors meet all standards and requirements.

008. SERVICE PROVIDER RATES . The service provider’s approved rates must not exceed the Department’s approved maximums without prior Department approval.

009. SERVICE PROVIDER ENROLLMENT RENEWAL . The provider will undergo an evaluation at the time of renewal before the expiration of the enrollment term and any time there is reason to believe the provider is not fulfilling the provider’s responsibilities. The Department may require providers and provider employees to undergo updated background checks as part of the renewal process.

010. PROVIDER TERMINATIONS . Either the Department or the provider may terminate an enrollment by giving at least 30 days advance written notice. The 30-day requirement may be waived in case of emergencies such as illness, death, injury, or fire. A written notice will be sent to the provider when the Department terminates a provider enrollment. Written notice to the provider is not required when the provider or potential provider voluntarily withdraws an application to enroll.

011. PROVIDER STANDARDS . The following standards apply to all providers:

(A) The proposed service must meet the service definitions;

(B) The Department need not enroll a potential provider if the proposed service is sufficiently available. The Department has discretion to determine if adequate services are available;

(C) All service providers must have a Federal Identification number or Social Security number whichever is appropriate before being approved for enrollment;

(D) The provider must not be the parent of the minor child receiving services nor the legal guardian, spouse, or minor child of the recipient;

(E) The provider must not have a history of chronic incorrect or inaccurate billings whether intentional or unintentional for services that have been provided or have a criminal history of financial mismanagement; and

(F) The provider must not engage in or have an ongoing history of criminal activity that may be harmful or may endanger individuals for whom the provider serves. This may include a substantiated listing as a perpetrator on the child or adult Central Registries of abuse or neglect; a criminal conviction for a crime endangering the life, well-being, or safety of the victim or a member of the public; or a crime involving fraud or theft of property or services. The following criminal violations will disqualify a provider from enrollment:

(i) Child pornography;

(ii) Child sexual abuse;

(iii) Driving under the influence. For providers of non-transportation services, two or more driving under the influence citations or convictions have occurred within the last five years;

(iv) Domestic violence;

(v) Shoplifting after age 19 within the last three years;

(vi) Felony fraud within the last 10 years;

(vii) Misdemeanor fraud within the last five years;

(viii) Termination of provider status for cause from any Department program within the last 10 years;

(ix) Possession of any controlled substance within the last five years;

(x) Possession of a controlled substance with intent to deliver within the last five years;

(xi) Felony or misdemeanor assault without a weapon in the last 10 years;

(xii) Felony or misdemeanor assault with a weapon in the last 15 years;

(xiii) Prostitution or solicitation of prostitution within the last five years;

(xiv) Felony or misdemeanor robbery or burglary within the last 10 years;

(xv) Rape or sexual assault;

(xvi) Homicide; or

(xvii) Other pending criminal charges or convictions are evaluated using the general guidelines of this Chapter and weighted to similar offenses included on this list.

011.01 PROVIDER AGENCIES. If the provider is an agency, the provider agency must review its policies regarding hiring and reporting to ensure appropriate procedures regarding abuse, neglect and other criminal violations are in place to protect recipients of services.

011.02 INDIVIDUAL PROVIDERS. If the provider is an individual, the Department will check the Abuse and Neglect Central Registries to determine if any substantiated reports of abuse or neglect by the provider exist. If the provider provides services in the provider’s home, the Department will check the Abuse and Neglect Central Registries to determine if any substantiated reports of abuse or neglect by household members exist. If a report of abuse or neglect has been substantiated, the Department will not contract with the provider. If a report of abuse or neglect concerning a current provider or a household member as perpetrator is substantiated, the provider will be immediately terminated.

012. ENROLLMENT FORMS . Before furnishing any service, each provider shall sign an enrollment form agreeing to provide services in compliance with the enrollment form terms.

013. PROVIDER AGE QUALIFICATIONS . Service providers must be at least 19 years old.

014. SOCIAL SECURITY TAX WITHHOLDING . In some situations, the Department withholds Social Security taxes from provider payments. Individual in-home service providers of adult day care, homemaker services, and chore service providers who are not affiliated with an agency or who are not self-employed are considered employees of the recipient from whom they provide services. For in-home service providers who are not affiliated with an agency, the Department acts on behalf of those recipients to withhold mandatory Social Security taxes and pay the recipient’s matching tax share to the Internal Revenue Service.

014.01 EARNINGS TAXED FOR SOCIAL SECURITY. Providers are subject to Social Security tax payment for each calendar quarter in which they are paid $50.00 or more for services provided to one recipient. The $50.00 is for one recipient, not a total received for two or more recipients. The Department withholds the tax from all payments to providers. If a provider’s earnings do not reach $50.00 per quarter, the amount withhold for that quarter is refunded.

014.02 SELF-EMPLOYED PROVIDERS. Individuals who file Social Security taxes on their own behalf are considered self-employed. They are identified by a Federal Identification number rather than a Social Security number.

014.03 SOCIAL SECURITY TAX RATES. The Department remits to the Internal Revenue Service an amount equal to the current Social Security tax rate for specified in-home services. Half of this amount is withheld from the provider as the employee’s share; the other half is provided by the Department on behalf of the recipient employer.

014.04 OTHER TAXES. The Department does not withhold federal or state income tax or federal unemployment tax from any provider payment.

History

Effective 2021-07-13

Chapter 4 Defined Services

Neb. Admin. Code tit. 473, ch. 4 Defined Services {#sec-473-nac-4 omnilex-key=us-ne-regs-official--title-473--473 NAC 4}

001. CHORE SERVICE . This section contains material which governs:

(A) The authorization and provision of chore services; and

(B) The evaluation and approval of chore service providers.

001.01 CHORE SERVICE NEED. Chore service is not provided based on the demand of the recipient. Any person receiving social services must have a defined need for service in order to meet eligibility requirements. Need implies that the provision of that services will assist the client to advance toward the achievement of program goals.

001.02 AVAILABLE CHORE SERVICES. The available chore services are those which could normally be performed by the applicant or recipient, but the applicant or recipient is presently unable to perform as determined during the service needs assessment process.

001.02(A) CLEANING. Cleaning services include light housecleaning that is required in order to maintain the individual in a safe and sanitary environment. Cleaning includes only vacuuming, sweeping, mopping, dusting, trash removal, cleaning and sanitizing of the kitchen and bathroom, cleaning and clearing the refrigerator of old and spoiled foods, and cleaning the stove and oven as appropriate. It does not include window washing, furniture moving, cleaning closets or drawers, any exterior cleaning or maintenance, or other non-essential tasks.

001.02(A)(i) ESSENTIAL TASKS. For essential tasks, the recipient shall provide necessary supplies.

001.02(A)(ii) EXCPETION. An exception will be considered for an Adult Protective Services recipient whose home requires major one-time cleaning.

001.02(B) ESSENTIAL SHOPPING. Essential shopping includes obtaining food, clothing, housing, or personal care items a maximum of one time per week.

001.02(C) FOOD PREPARATION. Food preparation includes preparing meals necessary for and related clean-up to maintain the recipient's independence. The recipient must provide necessary meal preparation supplies.

001.02(D) LAUNDRY SERVICE. Laundry service includes washing, drying, folding, and storing laundry in the individual's home, or utilizing laundromat services on behalf of the individual. The soap and machine use fees are provided by the recipient.

001.02(E) PERSONAL CARE. Personal care consists of only bathing, dressing, shaving, and shampooing.

001.03 INDIVIDUALS SERVED. Chore services are only for those individuals who are age 19 or older who are either:

(A) Current Supplemental Security Income or State Supplemental recipients; or

(B) Low income aged or disabled persons.

001.04 CONDITIONS OF PROVISION. Services are provided as follows:

001.04(A) LIMITS BASED ON LIVING ARRANGEMENTS. Based upon the service needs assessment process, essential shopping and medical escort components of the chore services can only be authorized for individuals residing in relatives' homes, board and room homes, adult family homes, residential care facilities, domiciliary facilities, or centers for the developmentally disabled.

001.04(B) SPECIAL GRANT CIRCUMSTANCES. The laundry or shopping components of chore services cannot be authorized if those needs are included as a Special Requirement in the Assistance to the Aged, Blind or Disabled State Supplemental grant.

001.04(C) PERSONAL CARE. The personal care component of chore services cannot be authorized if the recipient is eligible for Medicaid and is receiving personal care through Home Health Services or Personal Assistance Services.

001.05 LIMITS FOR ADULT PROTECTIVE SERVICES WITHOUT REGARD TO INCOME RECIPIENTS. Based upon the service needs assessment, chore services are authorized for recipients eligible without regard to income for a maximum of 31 days in situations of abuse or neglect of an individual age 18 or older.

001.06 MAXIMUM RATES. The rate for chore services matches the federal minimum wage. Periodic increases or decreases may be made to the chore services rate in a percentage amount corresponding with legislative appropriations or budget directives from the Nebraska Legislature which result in general Medicaid service provider increases or decreases.

001.07 FREQUENCY. The frequency of service is by the hour.

001.08 MAXIMUM ALLOWABLE UNITS. The maximum allowable units is 65 hours per month or 15 hours per week for chore services.

001.09 LIMIT EXCEPTIONS. Requests to increase the number of maximum units provided will not be granted unless the request is related to an active Adult Protective Services case.

001.10 HEALTH AND SAFETY STANDARDS. Each chore service provider must:

(A) Be free of communicable disease, physically capable of providing service, and willing to provide a physician's verification statement, if required;

(B) Have knowledge of basic first aid skills and of available emergency medical resources, if providing full-time or live-in housekeeping or personal care; and

001.10(A) SKILL AND CAPABILITY STANDARDS. The provider has training or home experience in carrying out chore services comparable to those which will be authorized.

001.10(B) EQUIPMENT AND SUPPLIES STANDARDS. The chore service provider provides any equipment necessary to perform authorized tasks or duties, if the recipient does not provide them. This cost may not be authorized for service reimbursement, but is considered in setting the provider's rate. The recipient provides household supplies.

002. ADULT DAY SERVICES . This section contains material governing adult day services as follows:

(A) The authorization and provision of adult day services; and

(B) The evaluation of adult day services.

002.01 DAY SERVICES DEFINITIONS. The following definitions apply to adult day services:

002.01(A) ADULT DAY SERVICES, HOME OR CENTER. A program of structured and monitored social, manual, physical, and intellectual services or activities provided for a minimum of three hours per day. These services are provided in a supervised setting in either a day services home or a center outside a recipient’s own home. Adult day services is directed toward adults who do not require 24 hour institutional care and yet, because of physical or mental impairment or social isolation, require services in a group setting.

002.01(A)(i) ADULT DAY SERVICES CENTER. A facility meeting established standard that provides supervision and activities for four or more adults away from the recipient’s home.

002.01(A)(ii) ADULT DAY SERVICES HOME. A facility meeting established standard that provides supervision and activities for fewer than four adults away from the recipient’s home.

002.01(B) IN-HOME ADULT DAY SERVICES. Supervision or services provided in an individual’s home that enables the recipient’s caretaker who also lives in the home, to participate in employment or training. The services may include part-time chore and homemaker activities.

002.02 INDIVIDUALS SERVED. Adult day services are authorized only for those individuals who are 19 or older who are:

(A) Current Supplemental Security Income or State Supplemental recipients; or

(B) Low income aged or disabled persons.

002.03 NEED. Eligible recipients must need adult day services to increase or maintain social and emotional wellbeing through opportunities for intellectual, physical, manual, and social activities.

002.03(A) GOALS. Adult day services are necessary for the applicant or recipient to:

(i) Avoid unnecessary institutionalization or to delay institutionalization;

(ii) Facilitate community readjustment after institutionalization;

(iii) Improve level of functioning;

(iv) Alleviate deteriorating effects of isolation and self-neglect; or

(v) Aid in the transition from one living arrangement to another, such as a more independent living arrangement.

002.03(B) RELEVANT FACTORS. The Department considers the following when determining the recipient’s need for adult day services:

(i) The individual's residential situation in terms of support available through a group or family setting;

(ii) What the individual has previously done with their time that adult day services are now being considered, or what other service arrangements existed;

(iii) What other supportive community resources are available to the individual which may not make the provision of adult day services an urgent need; and

(iv) The individual's employment or training status. If the individual is employed or in a vocational or training program for part of the day, the need for adult day services would be questionable as the individual would already be on the path toward goal achievement.

002.03(C) IN-HOME DAYCARE NEED. In assessing the need for in-home day care, the applicant or recipient must demonstrate:

(i) The individual cannot remain alone. Documentation may be requested from the individual's medical provider for verification;

(ii) The individual's usual caretaker will be participating in employment or training;

(iii) The service required is of a non-medical supervisory nature; and

(iv) No other resources, including volunteers or community resources, are available to meet the individual’s needs.

002.04 LIMITS FOR ADULT PROTECTIVE SERVICES INDIVIDUALS WITHOUT REGARD TO INCOME. Based upon the service needs assessment process, the Department may authorize adult day service for recipients eligible without regard to income for a maximum of 31 days in situations of abuse or neglect for an individual age 18 or older.

002.05 MAXIMUM RATES AND ALLOWABLE UNITS. The following criteria applies to authorization standards for adult day services:

002.05(A) RATES. The statewide rate is established utilizing the total federal funding appropriation to Nebraska for adult day care services and the total state funding for adult day care services divided by the projected total of the adult day care service days provided on an annual basis. The projected number of days to be provided is derived from the Department’s historical data. Periodic increases or decreases may be made to the adult day care service rate in a percentage amount corresponding with legislative appropriations or budget directives from the Nebraska Legislature which result in general Medicaid service provider increases or decreases.

002.05(B) FREQUENCY. The frequency of services is by the hour or by the day. A day is defined as six or more hours per day.

002.05(C) MAXIMUM ALLOWABLE UNITS. Adult day services shall be authorized up to five days per week for the first six months. After the initial six months, adult day services may be authorized up to three days per week. If the recipient needs more days, an exception request must be submitted to the Department. A statement from the recipient’s mental health provider or guardian, will be required.

002.06 ADULT DAY SERVICE PROVIDER STANDARDS. The following standards are applicable to adult day service providers:

002.06(A) PROVIDER SKILLS. Personnel who provide adult day services are required to be trained, or have home or work experience in performing day service duties. Personnel must:

(i) Practice courtesy, patience, and understanding with recipients;

(ii) Be sensitive to the special needs of elderly and disabled recipients for personal attention and assistance; and

(iii) Be able to recognize distress or signs of illness in recipients.

002.06(B) PROVIDER KNOWLEDGE. Personnel who provide adult day services must have practical knowledge of:

(i) Basic first aid procedures and available emergency medical resources;

(ii) Procedures to follow in case of a recipient's sudden illness or an accident;

(iii) Reasonable safety precautions to exercise when dealing with recipients and their property;

(iv) Each recipient's address, telephone number, and means of transportation; and

(v) Procedures to follow when problems and grievances need to be discussed.

002.06(C) PROVIDER HEALTH. All personnel of adult day service facilities must be:

(i) Physically capable of completing assignments; and

(ii) Free of communicable disease and willing to provide a physician's verifying statement, requested by the Department.

002.07 PROGRAM STANDARDS FOR CENTERS. Providers offering adult day service centers to program recipients must meet the following standards:

002.07(A) ACTIVITY GUIDELINES. Adult day services center staff will ensure:

(1) Activities are available to all recipients;

(2) Each recipient is encouraged to participate, but free to decline;

(3) The program is geared to the recipient’s abilities and interests;

(4) The program provides intellectual and physical stimulation while preserving the dignity of the recipient; and

(5) The program meets the financial responsibility for any activities or field trips available as part of the Adult Day Care Services Program.

002.07(A)(i) ACTIVITY TYPES. Adult day services center staff will offer the following activities:

(1) Intellectual activities for exploring subjects of interest to the recipient population;

(2) Manual activities such as hobbies and home arts and crafts;

(3) Physical activities which stress physical fitness, either individually or as group programs; and

(4) Social activities involving groups. Adult day care services staff must be present with recipients at all times during the provision of any adult day service activity.

002.07(A)(ii) ACTIVITY EQUIPMENT. Adult day services center staff will provide:

(1) Furniture, equipment, supplies, and materials for recipient’s use;

(2) Magazines, books, games, and recreational materials for recipient’s use; and

(3) Quiet areas for reading and resting.

002.07(B) MEALS. If the recipient is in the facility more than four hours per day and the adult day services program provides a meal, the meal must include one third of an adult's daily nutritional requirement. If the program does not provide a meal and requires recipients to bring their own food, a meal cost must be deducted from the program's daily rate of Title XX reimbursement.

002.07(C) FACILITIES. Adult day services center staff and facilities must:

(i) Comply with fire prevention regulations, health and sanitation regulations, and zoning codes and regulations;

(ii) Maintain lavatory and toilet facilities that are available, accessible, and in working order;

(iii) Have adequate space, proper ventilation, and means of adequate temperature control for the number of individuals served;

(iv) Maintain facilities which are safe and free from hazards and barriers; and

(v) Contact the Department if:

(1) The adult day services program is to be provided in a facility licensed by the Department; or

(2) The program intends to provide medical services.

002.07(D) RECORDS MAINTENANCE. Adult day services staff are required to maintain the following records:

(i) Recipient’s charts documenting individualized adult day services goals, activities in which the recipient participates, and all individual problem areas and the progress made through service provision. Progress notes should be recorded at least every three months;

(ii) Recipients’ physicians, pertinent medical information and phone numbers of emergency contacts;

(iii) Signed consents for release of information about recipients;

(iv) Recipient attendance, services received, and method of payment;

(v) Program costs; and

(vi) Program admissions and program discharges.

003. HOME-DELIVERED AND CONGREGATE MEALS SERVICE . This section contains material which governs:

(A) The authorization and provision of home delivered and congregate meals; and

(B) The evaluation and approval of meal providers.

003.01 MEALS SERVICE NEED. Meals service is not provided based on the demand of the recipient. Any individual receiving meals service must have a defined need for the service in order to meet eligibility requirements. Need for a service implies that the provision of that service will assist the recipient in achieving program goals.

003.02 MEALS SERVICE DEFINITIONS. The following definitions apply:

003.02(A) CONGREGATE MEALS. Meals prepared and served at a dining facility outside of the recipient's residence.

003.02(B) HOME-DELIVERED MEALS. Meals that are prepared outside of the recipient's residence and delivered to their residence. The residence must be an independent living arrangement.

003.02(C) MEAL. A variety of properly prepared foods containing one-third of the minimum daily nutritional requirements for adults.

003.03 RECIPIENTS SERVED. Home-delivered or congregate meals service may be authorized for those individuals age 19 or older who are:

(A) Current Supplemental Security Income State Supplemental recipients; or

(B) Low income aged or disabled persons.

003.04 NEED FOR SERVICE. Eligible recipients must meet at least one of the following criteria:

(A) Be unable to prepare adequate meals within their own residences. This inability may be due to:

(i) Physical or mental impairment or disabilities;

(ii) Chronic illness;

(iii) Inability to obtain food products because of distance to the source;

(iv) Lack of cooking facilities; or

(v) Lack of motivation. Lack of motivation is characterized by emotional or physical deterioration which seriously endangers the recipient’s ability to remain in an individual living situation;

(B) Have no other person living in their homes who are able and willing to obtain, prepare, and serve adequate meals in the home; or

(C) Not living in a congregate facility where meal service is the responsibility of the facility and the cost of meals is included in the payment rate.

003.05 LIMITS FOR ADULT PROTECTIVE SERVICES WITHOUT REGARD TO INCOME RECIPIENTS. Recipients eligible without regard to income may be eligible for a maximum of 31 days in situations of abuse or neglect for an individual age 18 or older.

003.06 MAXIMUM RATES AND ALLOWABLE UNITS. The following guidelines of rate and allowable units are applicable to meal services:

003.06(A) RATES. The statewide rate is established utilizing the total federal funding appropriation to the State of Nebraska for meals services and the total state funding for meals services divided by the projected total of the congregate and delivered meals to be produced on an annual basis. The projected number of meals to be produced is derived from data provided by the state Area Agency on Aging organizations. Periodic increases or decreases may be made to the meal service rate in a percentage amount corresponding with legislative appropriations or budget directives from the Nebraska Legislature which result in general Medicaid service provider increases or decreases.

003.06(B) FREQUENCY. The frequency of service is per occurrence.

003.06(C) MAXIMUM ALLOWABLE UNITS. One congregate or home-delivered meal per day can be authorized.

003.07 MEAL SERVICE EXCEPTIONS. The following criteria are considered when agreements are entered into with meals service providers:

(A) Actual service cost in the provision of meal service is not a basis for granting a rate increase;

(B) Special rates will not be granted to providers who prepare meals catering to the various dietary requirements of their recipients. Providers are required to prepare meals for special diets; and

003.08 HEALTH AND SAFETY STANDARDS. Food preparation and serving facilities and areas are required to conform to all established local, state, or federal fire prevention, sanitation, zoning, and facility maintenance standards. Food preparation and serving personnel must meet the following criteria:

(1) Be in good health and free from contagious disease;

(2) Skilled and instructed in sanitary food handling, preparation, and serving practices;

(3) Courteous, understanding, and helpful when seating or serving aged or mentally impaired or disabled recipients;

(4) Knowledgeable of basic first aid; and

(5) Aware of available resources for medical emergencies and for transportation.

003.08(A) HOME-DELIVERED MEAL STANDARDS. Home-delivered meal providers must:

(i) Deliver meals to recipients on an established schedule;

(ii) Be knowledgeable of basic first aid; and

(iii) Transport and deliver meals using utensils and equipment which are sanitary and maintain proper food temperatures. Thermos type containers and disposable or sterilizable serving dishes must be used.

003.08(B) CONGREGATE MEAL STANDARDS. Providers serving meals in a congregate setting must ensure the facility is:

(i) Accessible to adult recipients and free from architectural barriers to aged or handicapped individuals; and

(ii) Maintained at a comfortable temperature, properly ventilated, and have sufficient space.

003.09 MENU AND MEAL REQUIREMENTS. The meals and menu must:

(A) Reflect the general dietary needs of aged or disabled people as well as the specific dietary needs of the recipients served;

(B) Be prepared one week in advance on a weekly menu plan form and kept available for inspection by service unit staff at any time; and

004. HOMEMAKER SERVICE FOR ADULTS . This section contains material which governs:

(1) The authorization and provision of homemaker; and

(2) The evaluation and approval of homemaker providers.

004.01 HOMEMAKER DEFINITION FOR ADULTS. Homemaker services is not provided based on the demand of the recipient. The instruction provided by the homemaker must maintain or strengthen the recipient's capacity to function in the most independent living situation possible.

004.02 HOMEMAKER TASKS. Recipients approved for homemaker services receive assistance with the following tasks:

(A) Organization of household activities and time management;

(B) Management, maintenance, arrangement, cleaning, and care of home appliances, equipment, eating utensils, furniture, and supplies;

(D) Management, supervision, training, and proper care of infants, children, or incapacitated family members;

(E) Obtaining and properly caring for clothing, household supplies, and sundry needs of self or family;

(F) Maintenance of sanitation within the home;

(G) Maintenance of personal hygiene and health practices for self and family members, if applicable;

(H) Obtaining any necessary medical care and treatment;

(I) Management and proper use of income and resources; and

(J) Maintaining proper relationships and communication with family members.

004.03 RECIPIENTS SERVED. Eligible recipients include:

(A) Current Supplemental Security Income State Supplemental recipients; or

(B) Low income aged or disabled persons.

004.04 HOMEMAKER NEED. Eligible recipients must:

(A) Have an identified service need; and

(B) Be unable to maintain safe and adequate homemaking practices within their own living facilities. This inability may be caused by:

(i) A change in living situation within the past 12 months;

(ii) Recent death of or other separation from the usual homemaker;

(iii) Adjustment to a recent medical condition; or

(iv) A household crisis.

004.05 LIVING ARRANGEMENT. Applicants and recipients living in a congregate facility are not eligible for homemaker service if the facility:

(A) Is responsible to provide either homemaker service; and

(B) Includes the cost of homemaker service in its rate.

004.06 LIMITS FOR ADULT PROTECTIVE SERVICES WITHOUT REGARD TO INCOME RECIPIENTS. Based upon the service needs assessment, the homemaker services can be authorized for recipients eligible without regard to income for a maximum of 31 days in situations of abuse or neglect for an individual age 18 or older.

004.07 MAXIMUM RATES AND ALLOWABLE UNITS. The following guidelines of rate and allowable units are applicable to homemaker services:

(A) RATES. Homemaker rate of pay matches the federal minimum wage. Periodic increases or decreases may be made to the homemaker service rate in a percentage amount corresponding with legislative appropriations or budget directives from the Nebraska Legislature which result in general Medicaid service provider increases or decreases.

(B) FREQUENCY. The frequency of service is by the hour.

(D) TIME LIMIT. Maximum of six months. Services beyond six months must receive approval from the Department.

004.08 HOMEMAKER PROVIDER REQUIREMENTS. Homemakers participating as providers must:

(A) Have experience in performing homemaker tasks;

(B) Be free of communicable disease, have the physical capability to provide service, and be willing to provide a physician's verification statement if requested;

(D) Demonstrate acceptance of, respect for, and a positive attitude toward other people, especially those who are aged or disabled;

(E) Exhibit emotional maturity in assuming responsibility, maintaining schedules, and adapting to new situations; and

(F) Possess the necessary skills to demonstrate, complete and instruct individuals to adopt proper activities to overcome identified deficiencies.

005. TRANSPORTATION SERVICES . Transportation service is transporting an eligible recipient to and from allowable community resources when the recipient has no other transportation. Service may be provided by an individual, exempt provider, or by common carrier.

005.01 TRANSPORTATION DEFINITIONS. The following definitions apply to Transportation services:

005.01(A) COMMON CARRIER. Common carrier means any person who transports passengers by motor vehicle for hire and is licensed as such with the Public Service Commission.

005.01(B) ESCORT SERVICES. Escort Services means an attendant or caregiver accompanying a minor or person who is physically, mentally, or developmentally disabled and unable to travel or wait without assistance or supervision.

005.01(C) EXEMPT PROVIDER. An exempt provider means the carriers are exempted from Public Service Commission licensure by law including those that:

(i) Transport for hire persons who are aged and their spouses and dependents under a contract with a municipality or county;

(ii) Are owned and operated by a nonprofit organization which has been exempted from the payment of federal income taxes as provided by Section 501(c)(4), Internal Revenue Code, and transporting solely those persons over age 60, their spouses and dependents, or persons experiencing disabilities;

(iii) Are operated by a municipality or county as authorized by law in the transportation of persons who are aged;

(iv) Are operated by a governmental subdivision or a qualified public purpose organization having motor vehicles with a seating capacity of 20 or less and are engaged in the transportation of passengers in the state;

(v) Are operated by a governmental subdivision or a qualified public purpose organization having motor vehicles with a seating capacity of 20 or less and are engaged in the transportation of passengers in the state;

(vi) Are engaged in the transportation of passengers and are operated by a transit authority created under and acting pursuant to the laws of the State of Nebraska; and

(vii) Provide escort services under contract with the Department or with any agency organized under the Nebraska Community Aging Services Act.

005.01(D) INDIVIDUAL PROVIDER. An individual provider is a person who is not in the business of providing transportation for hire for example, a friend, neighbor or non-legally responsible relative.

005.01(E) MEDICAL ESCORT. A medical escort is an attendant or caregiver accompanying a minor or persons who are physically, mentally, or developmentally disabled and unable to travel or wait without assistance or supervision to receive a Nebraska Medicaid coverable service.

005.01(F) NEBRASKA MEDICAID COVERED SERVICE. This is a medical service that could be covered by the Nebraska Medical Assistance Program as specified in Nebraska Administrative Code Title 471.

005.01(G) TARIFF. Tariff is the geographic and rate parameters of operation assigned to a particular carrier by the Public Service Commission.

005.02 NEED FOR SERVICE. Transportation services are not provided based on the demand of the recipient. Need for a service implies that the provision of that service will assist the recipient in achieving program outcomes. Eligible recipients are required to have the following conditions:

(1) Have no access to a working licensed vehicle or a valid driver’s license;

(2) Be unable to drive due to physical or cognitive limitation;

(3) Be unable to secure transportation from relatives, friends, or other organizations at no cost; or

(4) Require transportation to receive a Nebraska Medicaid covered service. Transportations services cannot be authorized if the recipient is eligible for Medicaid.

005.02(A) RESIDENTS OF NURSING FACILITIES OR IMMEDIATE CARE FACILITIES FOR DEVELOPMENTAL DISABILITIES. Residents of nursing facilities or immediate care facilities for development disabilities are not eligible to receive transportation through the Social Services for the Aged and Disabled Program, except for discharge transportation. All other transportation is the responsibility of the facility. Transportation, including moving the individual’s household goods or personal property, may not be authorized for these recipients.

005.02(B) MEDICAL ESCORT SERVICES. The following conditions must be met for a recipient to be eligible for escort services:

(i) Be physically or mentally unable to travel alone or wait alone to obtain a Medicaid coverable service;

(ii) Require assistance with personal care; or

(iii) Require supervision; and

(iv) Must not be currently Medicaid eligible.

005.03 NON-MEDICAL TRANSPORTATION. The services are authorized for the following needs:

(A) APPLYING FOR BENEFITS AND SERVICES:

(i) Public assistance

(ii) Social Security; or

(iii) Veteran’s benefits; or

(B) SHOPPING FOR FOOD AND ESSENTIAL ITEMS:

(i) Shop for food;

(ii) Receive commodities or food pantry services;

(iii) Obtain clothing or personal care items;

(iv) Obtain legal services, receive legal counsel from legal aid societies, private attorneys, county attorneys and other professional legal sources; or

(v) Allow the recipient to obtain financial services and to take care of financial matters; or

(C) SECURING HOUSING. A recipient may be approved to locate, secure or retain adequate housing or independent living arrangement. Transportation may be provided for a recipient to return home from a hospital or nursing home; or

(D) RECEIVE SOCIAL SERVICES FOR THE AGED AND DISABLED. Transportation to allow the transporting of a recipient to and from congregate meals and adult day services; or

(E) ARRANGE EDUCATION OR TRAINING. The recipient may make arrangements for participation in a formal educational or employment skill training program directed toward a self-support goal; or

(F) SECURE EMPLOYMENT. The recipient is allowed transportation to locate, apply for or secure paid employment or training leading to paid employment, but they are not allowed transportation to and from employment.

005.04 TRANSPORTATION SERVICE PROVIDER STANDARDS. The Department approves provider agreements with common carriers, exempt providers, escort providers, and individual providers. To be approved, providers must meet all general provider standards in addition to the service specific standards. Annual reviews for provider agreements are required to renew the agreement. The provider must continue to meet all provider standards and service specific standards.

005.04(A) COMMON CARRIER STANDARDS. Public Service Commission certifies common carriers. Taxis and van companies are certified by the Public Service Commission as common carriers.

005.04(B) EXEMPT PROVIDER STANDARDS. Exempt providers must ensure that their employees meet the individual provider standards.

005.04(C) ESCORT PROVIDER STANDARDS. The provider must:

(1) Be an individual aged 19 or older;

(2) Have training or experience in working with persons who are aged or who have a disability;

(3) Have training or experience in providing personal assistance;

(4) Agree to have his or her driving records reviewed, if the escort will drive;

(5) Maintain information on specific needs of each recipient served; and

(6) Report all changes observed to the recipient’s services coordinator.

005.04(C)(i) The escort provider who personally drives the recipient must also meet all individual provider standards. The escort provider is required to complete the individual transportation provider self-certification.

005.04(C)(ii) If the recipient requires an escort and the escort will not drive, sufficient transportation units for both the recipient and the escort are authorized with another suitable transportation option.

005.04(D) INDIVIDUAL PROVIDER STANDARDS. Provider agreements with individual providers by Neb. Rev. Stat. § 75-303.03 can be authorized only if the driver and vehicle standards are met at all times when the individual is providing transportation for a client.

005.04(D)(i) DRIVER STANDARDS. The individual provider requirements include:

(1) Have been chosen by the recipient or the usual caregiver to provide transportation;

(2) Be age 19 or older;

(3) Possess a current and valid driver’s license;

(4) Have no more than three points assessed against their Nebraska driver’s license, or meet a comparable standard in the state where they are licensed to drive;

(5) Currently have no limitations that would interfere with safe driving;

(6) Personally drive their own vehicle to transport the recipient;

(7) Use seat belts and child passenger restraint devices as required by law;

(8) Not smoke while transporting the recipient;

(9) Not transport the recipient while under the influence of alcohol or any drug that impairs the ability to drive safely;

(10) Not provide transportation if they have a communicable disease which poses a threat to the health and well-being of the recipient;

(11) Have and maintain the minimum automobile liability and medical insurance coverage as required by law; and

(12) Report disqualification from any Department program for intentional program violation.

005.04(D)(ii) VEHICLE STANDARDS. The individual provider’s vehicle requirements are:

(1) Currently licensed and registered as required by law;

(2) Kept at all times in proper physical and mechanical conditions;

(3) Equipped with operable seat belts, turn signals, lights, and horn;

(4) Equipped with proper child passenger restraint devices as required by law when transporting children; and

(5) Equipped to provide comfortable temperature and ventilation conditions.

005.04(D)(iii) REGISTRY CHECKS. The following registries are checked:

(a) Adult Protective Services Central Registry;

(b) Central Register of Child Protection Cases; and

005.04(D)(iii)(1) If the potential provider does not reside in Nebraska, or has resided in Nebraska for less than one year, the Department must check registries in the state of residence or previous residence.

005.04(D)(iii)(2) The Department will not approve a provider agreement with the potential individual provider if a report of abuse or neglect concerning the individual provider has been determined to be Court Substantiated or Department Substantiated on the Adult Protective Services Central Registry or Court Substantiated, Court Pending, or Inconclusive on the Central Registry of Child Protection Cases.

005.04(D)(iii)(3) The Department will not approve a provider agreement with a potential individual provider if the individual’s name appears on the Nebraska State Patrol Sex Offender Registry.

005.04(D)(iv) CRIMINAL BACKGROUND CHECKS. The Department is required to:

(a) Obtain a criminal history statement from the potential individual provider; and

(b) Perform a criminal history check of the potential individual provider.

005.04(D)(iv)(1) GENERAL CRIMINAL HISTORY. The Department must not approve a provider agreement with a potential individual provider if a history of convictions for misdemeanor or felony actions that endanger the health and safety of any client is indicated. This includes crimes against a child or vulnerable adult, crimes involving intentional bodily harm, crimes involving the illegal use of a controlled substance, and crimes involving moral turpitude on the part of the potential provider, or any major traffic violations.

005.04(D)(iv)(2) SPECIFIC CRIMINAL HISTORY. A provider agreement will be denied or terminated when conviction has occurred in the following areas:

(a) Child pornography;

(b) Child or adult abuse;

(d) Domestic assault;

(e) Shoplifting after age 19 and within the last three years;

(f) Felony fraud within the last 10 years;

(g) Misdemeanor fraud within the last five years;

(h) Termination of provider status for cause from any Department program within the last 10 years;

(i) Possession of any controlled substance within the last five years;

(j) Possession of a controlled substance with intent to deliver within the last 10 years;

(k) Felony or misdemeanor assault without a weapon in the last 10 years;

(l) Felony or misdemeanor assault with a weapon in the last 15 years;

(m) Prostitution or solicitation of prostitution within the last five years;

(n) Felony or misdemeanor robbery or burglary within the last 10 years;

(o) Rape or sexual assault; or

(p) Homicide.

005.04(D)(iv)(3) Pending charges are reviewed by the Department to determine whether the recipient’s safety is in jeopardy. Other convictions are weighted to similar offenses included in the aforementioned list.

005.04(D)(v) INDIVIDUAL PROVIDER APPROVAL PROCESS. A copy of the individual’s current driver’s license, insurance card, and vehicle registration is required. The provider must complete and sign the provider self-certification and the provider agreement. In addition to having no more than three points assessed against their driver’s license, each provider’s past eight-year driving history must be considered. If a license has been suspended or revoked, the provider must not be approved for eight years from the date of suspension or revocation.

005.04(D)(v)(1) RENEWAL. The provider self-certification and the provider agreement is renewed annually. The registry checks and criminal history checks will be completed for each renewal. Department staff must obtain a copy of the individual’s current driver’s license, insurance card, and vehicle registration. No provider agreement with a provider whose name appears on the registries, or whose criminal history check indicates any convictions, will be renewed.

005.04(D)(v)(2) TERMINATION. The provider agreement will be terminated if the individual provider is found to be in violation of any of the regulatory standards. Any provider agreement with a provider whose name appears on the registries or whose criminal history check indicates any convictions will be terminated.

005.05 AUTHORIZATION PROCEDURES. Before authorizing transportation or escort services, the use of family, neighbors, friends, or community agencies that will provide this service without charge, whenever possible, will be explored.

005.05(A) NON-MEDICAL TRANSPORTATION. For areas where exempt providers are available, or the recipient has chosen to use an individual provider, the recipient will not be allowed to use common carriers unless the exempt, or individual provider, cannot provide the service.

005.05(A)(i) AUTHORIZATION OF EXEMPT PROVIDERS. The Department will approve a provider agreement with, and authorize services for a provider who is exempt from Public Service Commission licensure as appropriate to meet a recipient's needs. The availability of a common carrier does not limit the use of an exempt provider.

005.05(A)(ii) MEDICAL ESCORT. The following is the criteria to determine when to authorize an hourly rate for medical escort services:

(a) The escort is not a legally responsible member of the recipient’s family;

(b) The recipient is not able to secure an escort at no cost; and

005.05(A)(ii)(1) UTILIZATION OF EXEMPT PROVIDERS AS THE DRIVER. When transportation is provided by an exempt provider, the cost of the escort’s transportation is authorized only if there is an extra charge for the escort’s transportation, such as with air fares, rural transit system, or city bus systems.

005.05(A)(ii)(2) UTILIZATION OF COMMON CARRIER. When transportation is provided by common carrier provider, the provider may not charge an extra cost for transporting the escort.

005.05(A)(ii)(3) UTILIZATION OF INDIVIDUAL PROVIDERS AS THE DRIVER. When transportation is provided to a recipient and an escort by an individual provider, the provider will not be paid an additional amount for transporting the escort.

005.05(B) INDIVIDUAL PROVIDERS. An individual can be authorized as the provider if the following criteria are met:

(i) The recipient has chosen the individual provider;

(ii) The individual will personally drive the vehicle; and

(iii) The individual meets provider standards.

005.06 TRANSPORTATION SERVICES RATES, FREQUENCY, AND MAXIMUM ALLOWABLE UNITS. The following regulations apply to transportation services:

005.06(A) CONDITIONS FOR PAYMENT. The Department will pay for transportation services only:

(i) When the recipient is actually in the vehicle; and

(ii) Using the most direct and logical route from the recipient’s residence to the service location.

005.06(B) UPPER LIMITS. The Department establishes transportation rates according to the following limits:

005.06(B)(i) COMMON CARRIERS. Neb. Rev. Stat. § 75-303.02 limits the distance rates for common carriers at a rate no greater than three times the state employee mileage rate. The maximum reimbursement rate does not apply when the carrier:

(1) Transports the recipient wholly within the corporate limits of the city or village where the transportation of the recipient originated; or

(2) Transports a disabled person as defined by the federal Americans with Disabilities Act of 1990 in a vehicle that is compliant with the regulations for the transportation of the disabled person.

005.06(B)(ii) TAXIS. Taxi rates may be no greater than 95% of published rates.

005.06(B)(iii) EXEMPT PROVIDERS. The Department will establish rates for exempt providers.

005.06(B)(iv) ESCORT PROVIDERS. The mileage rate for escort providers must not exceed the state employee mileage rate unless the escort is a certified carrier. The hourly rate is set by the Department.

005.06(B)(v) INDIVIDUAL PROVIDERS. As provided in Neb. Rev. Stat. § 75-303.03, the Department will reimburse the individual provider for costs incurred in transportation at a rate no greater than that paid for reimbursement of state employees under Neb. Rev. Stat. § 81-1176.

005.06(C) FREQUENCY. The frequency for medical and non-medical transportation is by miles or trip. The frequency for medical escort services is by:

(i) The hour(s) and miles; or

(ii) The hours and trip.

005.06(D) MAXIMUM ALLOWABLE UNITS. Transportation units must be authorized based on the recipient’s need not to exceed the following limits:

(i) Non-medical Transportation:

(1) 50 miles per one way trip;

(2) One round trip per week for shopping for food and essential items;

(3) Two round trips per month for necessary business; or

(4) One round trip per day for congregate meals.

(ii) Medical Transportation: Based on needed treatment and care.

History

Effective 2021-07-13

Chapter 5 Adult Family Homes

Neb. Admin. Code tit. 473, ch. 5 Adult Family Homes {#sec-473-nac-5 omnilex-key=us-ne-regs-official--title-473--473 NAC 5}

001. INTRODUCTION TO ADULT FAMILY HOMES . This section contains material which relates to:

(A) Recruitment, evaluation, and approval of adult family homes; and

(B) Providing case management services for all adult family home guests.

001.01 DEFINITIONS. The following definitions apply:

001.01(A) ADULT FAMILY HOME. An adult family home is a residential living unit certified by the Department to provide full-time residence and minimal supervision and guidance to not more than three guests age 19 or older. Service includes room and board with meals, standard furnishings, equipment, household supplies, laundry service, and facilities to ensure client comfort.

001.01(B) ADULT FAMILY HOME GUEST. An adult family home guest is a resident, age 19 or older, whose needs are most appropriately met in an adult family home.

001.01(C) ADULT FAMILY HOME SPONSOR. An adult family home sponsor is an adult, age 19 or older, who manages and provides caretaker responsibilities in an adult family home. The sponsor accepts responsibility for maintaining the facility and meeting the needs of the guests.

001.01(D) SUPERVISION. Each sponsor defines supervision for his or her home by indicating acceptable guest conditions on the adult family home application.

001.02 SELF-ADMINISTRATION OF MEDICATION. An adult who requires an occasional reminder to take medications is appropriate for adult family home care.

001.03 COMPLAINTS OF SUSPECTED ABUSE OR NEGLECT OCCURRING IN ADULT FAMILY HOMES. All complaints of adult abuse or neglect occurring in an adult family home must be reported.

001.04 ADULT FAMILY HOME SPONSOR RESPONSIBILITIES. Each adult family home sponsor must:

(A) Accept guests only through the direction of, or in cooperation with, local service unit staff;

(B) Comply with the provisions of Title VI of the Civil Rights Act of 1964 and its amendments;

(C) Agree to share required information with, and follow the directions and suggestions of, agency representatives regarding the guest's functioning;

(D) Allow agency staff to visit the adult family home at any reasonable time;

(E) Arrange for substitute supervision in the home, like when the sponsor is absent because of illness or a death in the family. The sponsor shall notify and receive prior approval from the local unit before arranging substitute supervision. The sponsor shall accept responsibility for reimbursing any substitute care provided;

(F) Arrange for guest’s access to the home in the event of a guest's illness;

(G) Maintain a record of important information about each guest including the name and telephone number of the guest's doctor, clinic, hospital and pharmacy preference, and the guest’s medication schedule;

(H) Report any changes in the sponsor's address, family members, telephone number or number of guests to the Department’s resource development coordinator before the change occurs;

(I) Contact the Internal Revenue Service to determine if additional information is necessary such as whether income from adult family home care must need to be considered for tax purposes; and

(J) Contact their insurance agent when looking for a policy to protect them from liability in the event a guest is injured.

001.05 FINANCIAL ARRANGEMENTS FOR ADULT FAMILY HOME CARE. Guests who are recipients of benefits from the Department may be paying for adult family home care with public assistance funds. These funds are unrestricted and there is no stipulation as to how the money is spent. The Department suggests that the amount be reserved for the recipient's personal needs. Therefore, the reimbursement each adult family home receives is negotiated between the sponsor and the guest, or their legal representative.

001.05(A) Sponsors may assist guests in money management, but may not act as guardians, conservators, representative payees, or have power of attorney for any of their guests, unless related to the guest.

001.06 ANNUAL CERTIFICATION. Adult family homes are re-evaluated annually and before the expiration of the certification. Another medical examination may be required if it is determined to be necessary during the re-evaluation.

001.07 CHANGE OF ADULT FAMILY HOME ADDRESS. When an adult family home sponsor changes his or her address, an evaluation of the new home is required. The evaluation must be completed before the move, or within five days after the move, to continue the sponsor’s certification.

001.08 INCREASE IN THE NUMBER OF GUESTS. When an adult family home sponsor wants to increase the number of guests for whom they are certified, an evaluation of the sponsor's ability to handle additional guests, and whether there is adequate space available in the home, is completed.

001.09 TERMINATION OF APPROVAL. When an adult family home sponsor, or home, is in violation of adult family home regulations, the adult family home sponsor is allowed the opportunity to correct the violation within a reasonable time, not to exceed 30 days. If the violation has not been corrected within that time, the adult family home certificate is terminated.

001.10 STANDARDS FOR ADULT FAMILY HOME APPROVAL. Adult family homes and sponsors must meet the following standards:

001.10(A) ADULT FAMILY HOME SPONSORS. All adult family home sponsors must:

(i) Be physically and mentally capable of assuming the responsibilities and functions involved in adult family care;

(ii) Be capable of exercising good judgment in supervising adults and in cooperating with the local service office;

(iii) Conform with all local, state, and federal fire, sanitation, and zoning standards;

(iv) Arrange for any inspection required by the resource developer;

(v) Accept responsibility and potential liability for guest safety and property security; and,

(vi) Not have engaged in, or have an ongoing history of, criminal activity that is harmful or may endanger individuals for whom they provide an adult family home living arrangement. This also applies to other adult household members, and must include a substantiated listing as a perpetrator on the child and adult Central Registries of abuse and neglect.

001.10(B) ADULT FAMILY HOME ENVIRONMENTAL REQUIREMENTS. The following list applies to the environmental requirements for adult family homes:

001.10(B)(i) BEDROOMS. The adult family home sponsor must furnish each guest with a private or semi-private bedroom having:

(1) A minimum of 80 square feet per occupant in a single room;

(2) A minimum of 60 square feet per occupant in a double room;

(3) A single or double bed for each guest with a mattress and box spring in good condition;

(4) At least three feet between beds at all points;

(5) Adequate and convenient room, closet, and drawer space and clean, adequate bedding that must be changed at least weekly;

(6) Adequate provision for the guest's privacy. Guests of opposite sexes must not be required to share a bedroom; and

(7) A first floor location for any guest when another location might be unsafe.

001.10(B)(ii) BATHROOMS. Bath, lavatory, and toilet facilities are required to be easily accessible and available to residents. Adequate amounts of bar soap, toilet tissue, and facial tissue must be provided.

001.10(B)(iii) COMMON AREAS. A well-lighted, well-ventilated, and heated living room is required to be available for the use of guests and their visitors for social and recreational purposes.

001.10(C) FIRE SAFETY REQUIREMENTS. All homes must meet existing state and local fire prevention standards. The adult family home sponsor must ensure that the adult family home is in sufficient repair so there is no fire hazard. Smoke detection devises, in good working order, are required.

001.10(C)(i) FIRE EVACUATION PLAN. Adult family home sponsors must develop a written fire evacuation plan which is routinely explained to and practiced with the guests. If the basement has no outdoor exit, the guests' physical limitations and the sponsor's evacuation plan must be evaluated before approving the home. A fire inspection to determine the appropriateness of having basement bedrooms for guests' use is required.

001.10(D) SANITATION REQUIREMENTS. Adult family home sponsors must carry out accepted sanitation practices, provide necessary household cleaning supplies, and meet state and local health standards.

001.10(E) MEAL PREPARATION. The adult family home sponsor must observe adequate nutrition standards and food handling sanitation practices in preparing and serving meals, with three meals a day being available for guests.

001.10(F) LAUNDRY FACILITIES. Adult family home sponsors must provide laundry services for their guests, using either facilities in the home or commercial laundry facilities. The sponsor is not responsible for dry cleaning costs.

History

Effective 2021-07-13

Neb. Admin. Code tit. 473 — Social Services for the Aged and Disabled

Chapter 1 General Provisions

Neb. Admin. Code tit. 473, ch. 1 General Provisions {#sec-473-nac-1 omnilex-key=us-ne-regs-official--title-473--473 NAC 1}

Chapter 2 Application and Eligibility

Neb. Admin. Code tit. 473, ch. 2 Application and Eligibility {#sec-473-nac-2 omnilex-key=us-ne-regs-official--title-473--473 NAC 2}

Chapter 3 Social Service Providers

Neb. Admin. Code tit. 473, ch. 3 Social Service Providers {#sec-473-nac-3 omnilex-key=us-ne-regs-official--title-473--473 NAC 3}

Chapter 4 Defined Services

Neb. Admin. Code tit. 473, ch. 4 Defined Services {#sec-473-nac-4 omnilex-key=us-ne-regs-official--title-473--473 NAC 4}

Chapter 5 Adult Family Homes

Neb. Admin. Code tit. 473, ch. 5 Adult Family Homes {#sec-473-nac-5 omnilex-key=us-ne-regs-official--title-473--473 NAC 5}

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