Section 479-8-007 - RETROACTIVE ADOPTION ASSISTANCE AGREEMENTSAll retroactive Adoption Assistance Agreements will be Nebraska Adoption Assistance Agreements. To be eligible for a retroactive Adoption Assistance Agreement all provisions of this section must be met.
007.01ELIGIBILITY OF CHILD. A child who has already been adopted may be eligible for a retroactive Adoption Assistance Agreement if the following conditions are met: (1) The child was in the custody of the Department at the time the adoption was finalized;(2) The child is a citizen of the United States or a qualified alien as defined in the Personal Responsibility and Work Opportunity Act of 1996 and the Department has documentation to confirm the child's citizenship or qualified alien status;(3) The Adoptive Parent(s) contacted the Department and made a written request for an Adoption Assistance Agreement within three (3) years from the date the adoption was finalized;(4) The child has been diagnosed with a physical or mental illness or condition that predates the adoption and the Department did not inform the adopting parents of such condition prior to the adoption, including when the Department did not have knowledge of the child's illness or condition prior to the adoption; and(5) The Department has been provided documentation from a Medical or Mental Health Professional that the child's illness or condition predated the adoption, is of such nature as to require medical, psychological, or psychiatric treatment and is more extensive than ordinary childhood illness. 007.01(A)REQUIRED DOCUMENTATION. The following documentation from a Medical or Mental Health Professional is required in order to meet the eligibility requirements of this section:(i) The child's diagnosis;(ii) The prognosis and treatment recommendations for the diagnosed illness or condition;(iii) The length of anticipated treatment; and(iv) Written confirmation that the illness or condition predated the adoption and is more extensive than ordinary childhood illness.007.02RETROACTIVE ADOPTION ASSISTANCE AGREEMENT PROVISIONS. A retroactive Adoption Assistance Agreement may include one or more of the following: (1) An adoption assistance payment negotiated between the Department and the Adoptive Parent(s) in accordance with the Department's established rate determination tool. In no case may the amount of the adoption assistance payment exceed the foster care maintenance payment which would have been paid by the Department if the child with respect to whom the adoption assistance payment is made had been in a foster family home;(2) Special services payments made for a specific service or item related to the child's needs for a specified period of time. No special services payments will be included if other resources or programs are available to assist with the services;(3) Non-recurring adoption expenses, including but not limited to: (a) Legal fees directly related to the adoption of the child; and(b) Funeral assistance if the child being adopted is diagnosed by a medical professional as being terminally ill and the life expectancy of the child is less than 20 years old; or(4) Reimbursement for or payment of medically necessary medical, psychological, or psychiatric treatment costs for the care of the eligible child which are the result of the child's diagnosed illness or condition that predated the adoption. 007.02(A)PAYMENT OF TREATMENT COSTS. When treatment costs are included as a provision in the retroactive Adoption Assistance Agreement the provisions of this section apply. 007.02(A)(i)HEALTH INSURANCE. The family's health insurance will be billed before the Department will pay treatment costs. If the child is Medicaid eligible, Medicaid benefits must be exhausted before payment of treatment costs will be paid under the Adoption Assistance Agreement.007.02(A)(ii)EFFECTIVE DATE. A child whose retroactive Adoption Assistance Agreement includes payment of treatment costs, will be eligible for payment of treatment costs that are incurred beginning on the date the written request for adoption assistance is received by the Department.007.02(A)(iii)MEDICALLY NECESSARY. For the treatment to be considered medically necessary, the treatment services must be recommended in writing by a Medical or Mental Health Professional no more than 90 days prior to the start of the treatment services. Treatment services must be provided in a manner consistent with the Medicaid laws of the state in which the treatment is provided. 007.02(A)(iii)(1)RESIDENTIAL TREATMENT FACILITIES. For treatment costs in a residential treatment center or a psychiatric residential treatment facility to be considered medically necessary, the following provisions must be met: (a) The residential treatment center or psychiatric residential treatment facility must be licensed or approved for therapeutic or psychiatric care by the Division of Public Health of the Nebraska Department of Health and Human Services or the equivalent state agency or department in the state where the treatment facility is located;(b) The residential treatment service is anticipated to result in progress which will enable the child to return to the family or community;(c) Less restrictive care or treatment alternatives are not appropriate or available or have declined to provide treatment for the child; and(d) The family must continue to support the child during treatment, including planning for the child's reintegration into the family home.007.02(A)(iv)PARTICIPATION IN SERVICES. When the Department is paying for treatment services, the child's family must participate in the child's treatment services when it is recommended in the child's treatment plan.007.02(A)(v)PAYMENTS ISSUED TO PROVIDER. Payment for the child's treatment services will be made directly to the service provider. In the event a provider will not accept payment from the Department, the Department may reimburse the family directly when proof of payment to the service provider is received by the Department.479 Neb. Admin. Code, ch. 8, § 007
Adopted effective 9/4/2021