Section 471-9-003 - PROVIDER REQUIREMENTS003.01GENERAL PROVIDER REQUIREMENTS. Providers of home health services must comply with all applicable provider participation requirements codified in 471 Nebraska Administrative Code (NAC) 2 and 3. In the event that participation requirements in 471 NAC 2 or 3 conflict with requirements outlined in this chapter, the participation requirements in this chapter will govern.003.02SPECIFIC PROVIDER REQUIREMENTS.003.02(A)PLAN OF CARE AND TREATMENT RECORD. The home health agency must maintain a clinical record that includes the plan of care signed by the attending physician, nurse practitioner, physician assistant, or clinical nurse specialist responsible for the client's care. The attending physician, nurse practitioner, physician assistant, or clinical nurse specialist and home health agency personnel must review the total plan of care and treatment record at least every 60 days. The home health agency must maintain these records on all Medicaid clients and make them readily available upon the Department's request.003.02(B)COST REPORTS. The home health agency must provide a cost report upon a request made by the Department.003.02(C)LICENSING. Providers of nursing services must be licensed by the Department of Health and Human Services Division of Public Health or by the appropriate licensing agency of the state in which they practice, as an individual registered nurse (RN) or licensed practical nurse (LPN).003.02(D)PROVIDER DOCUMENTATION. The nurse must maintain records to document services provided and the time worked for which payment is claimed. These records must be available to the Department upon request. Records must be retained for no fewer than six years for audit purposes. Records must include: (i) Current, signed physician, nurse practitioner, physician assistant, or clinical nurse specialist orders for the care provided;(ii) Assessment of the client's health status;(iv) Nurse's notes documenting the care provided; and(v) Time sheets documenting the date and times that care was provided.003.03SPECIFIC PROVIDER REQUIREMENTS FOR PRIVATE-DUTY NURSE.003.03(A)CLIENT RECORDS. The private-duty nurse must maintain a medical record in the client's home or current living arrangement which includes the Form MS-81: Certification and Plan of Care For Private-Duty Nursing.003.03(B)MULTIPLE REGISTERED NURSE (RN) AND LICENSED PRACTICAL NURSE (LPN) PROVIDERS. When more than one registered nurse (RN) or licensed practical nurse (LPN) is providing skilled nursing services for a client, the providers and client must determine which registered nurse (RN) or licensed practical nurse (LPN) will be the coordinator of services. The coordinator must complete the Form MS-81: Certification and Plan of Care For Private-Duty Nursing, obtaining physician, nurse practitioner, physician assistant, or clinical nurse specialist orders, obtaining authorization for providing services, and making copies available to the other providers.003.03(D)PROVIDER REQUIREMENTS. To participate in the Medicaid program, the provider must:(i) Be a participant in the home health and nursing services program;(ii) Be licensed to provide home health care by the Department of Health and Human Services Division of Public Health;(iii) Assume full responsibility of the professional management of the client's home health care; (iv) Maintain certification;(v) Develop the plan of care as identified by client;(vi) Follow all applicable regulations put in place by the Department;(vii) Comply with the requirements of 471 NAC 1; and(viii) Be a participant in the Medicare home health program.471 Neb. Admin. Code, ch. 9, § 003
Amended effective 3/17/2020Amended effective 5/5/2024