471 Neb. Admin. Code, ch. 36, § 003 - PROVIDER STANDARDS

003.01 Standards for Providing Services

The hospice provider must deliver services in accordance with the following standards:

1. The needs, preferences, cultural diversity, values and expectations of client/caregiver are reflected in all aspects of service delivery;

2. All service provision is done in a manner that is empowering to the client/caregiver;

3. The client/caregiver feels safe and confident that their right to privacy is protected; and

4. The client/caregiver is treated with dignity and respect at all times.

003.02 Hospice Provider Requirements

To participate in the Medicaid program, the hospice provider shall:

1. Be a participant in the Medicare hospice program;

2. Be licensed to provide hospice care by the Department of Health and Human Services Division of Public Health;

3. Assume full responsibility for the professional management of the client's hospice care;

4. Maintain certification by a physician that the client is terminally ill with a life expectancy of six months or less based on the physician's or medical director's clinical judgement regarding the normal course of the client's illness;

5. Maintain the signed election statement in its files;

6. Develop the plan of care and interventions based on the assessment of the needs and choices identified by client/caregiver. All service provision must be consistent with the plan of care;

7. Provide "on call" services 24 hours a day, seven days a week;

8. Follow all applicable Nebraska Health and Human Services System regulations;

9. Bill only for services authorized and actually provided;

10. Comply with the requirements of 471 NAC 3 for the submission of claims for payment;

11. Retain financial and statistical records for four years from date of service provision to support and document claims;

12. Accept Medicaid payment as payment in full from the Department of Health and Human Services Finance and Support plus the client's share of cost;

13. Allow federal and state offices responsible for program administration or audit to review service and financial records. Inspections, reviews and audits may be conducted on site;

14. Operate a drug free work place;

15. Allow the Department of Health and Human Services staff to review agency policies regarding hiring and reporting to ensure that appropriate procedures regarding abuse, neglect, and law violations are in place;

16. Agree and assure that any suspected abuse or neglect will be reported to law enforcement and/or appropriate Department staff;

17. Not discriminate against any employee, applicant for employment, or program participant or applicant because of race, age, color, religion, sex, handicap, or national origin, in accordance with 45 CFR Parts 80, 84, 90; and 41 CFR Part 60;

18. Agree and understand that any false claims (including claims submitted electronically), statements, documents, or concealment of material facts may be prosecuted under applicable state or federal laws ( 42 CFR 455.18 ); and

19. Respect every client's right to confidentiality and safeguard confidential information.

003.03 Provider Agreement and Enrollment

The hospice provider must complete and submit Form MC-19, "Medical Assistance Provider Agreement." When the client resides in a facility, a copy of the hospice provider's contract with the facility must be attached.

Notes

471 Neb. Admin. Code, ch. 36, § 003