15 Neb. Admin. Code, ch. 3, § 004

Current through September 17, 2024

Section 15-3-004 - PLAN OF OPERATION

Each Plan of Operation for a Care Management Unit must provide the following information:

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

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

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

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

(C) Coordinating the delivery of a continuum of services;

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

(E) Person centered.

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

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

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

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

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

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

004.09ANNUAL BUDGET. An annual budget of income and expenses for the Care Management Unit that coincides with the state fiscal year and must include units of services to be provided, and details of costs of a casework time unit as explained in Section 8 of these rules and regulations and the Act.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(iv) Define who provides each service;

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

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

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

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

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

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

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

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

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

004.17UNIFORM DATA COLLECTION. Each Plan of Operation must provide for use of the Aging Designated Service Reporting System as defined in Section 1 of these rules and regulations and which must be provided by the State Unit on Aging to the Care Management Unit upon Certification.

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

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

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

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

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

15 Neb. Admin. Code, ch. 3, § 004

Amended effective 9/21/2020