Provider Duties and Responsibilities

To receive Medicaid payments, an Assisted Living Facility must be licensed as such and must be certified as a Medicaid Waiver Assisted Living Provider according to DHHS Rules and Regulations. In your role as a Medicaid Waiver Services Provider, you will:

• Ensure that there is a written Resident Service Agreement for each resident that was developed jointly with the resident, his/her Services Coordinator and the facility staff. Resident Service Agreements must include:
  • the resident's strengths, needs and desired outcomes;
  • the service components to be provided (when and by whom);
  • an up-to-date listing of medications and treatments and any special dietary requirements; and
  • a description of any limitations of the resident that keep him/her from participating in activities.
• Review and revise the Resident Service Agreement with the resident and his/her Services Coordinator at least annually but more often if services or medical information need to be added or changed. You also need to keep his/her Services Coordinator informed of changes in the resident's condition, transfers, et cetera.
• Submit copies of original and revised Resident Service Agreements to the resident and his/her Services Coordinator;
• Attend training provided by DHHS staff on billing procedures, service provision, et cetera;
• Provide a private living unit with bath (toilet and sink) for each resident receiving Waiver Services. If funding is received from the Nebraska Health Care Trust Fund, “bath” also includes a tub or shower. Inclusion of a tub and/or shower being required for the “bath” also applies to all new constructions;
• Only upon “special request” from the residents involved, provide a semiprivate living unit. The Services Coordinator must get written consent from the residents and document their preference by using a Client Consent for Multiple Occupancy/MILTC-21 (Appendix E ). Prior to providing a semiprivate room, you must have a properly completed and signed consent form on record; and
• If providing Medicaid Waiver Assisted Living Services within a nursing facility, have Waiver certification of separately located areas to include separate dining and common areas.

By signing the Service Provider Agreement and the Assisted Living Service Provider Addendum, you have agreed to:

• Participate as a member of the resident/family's team;
• Make available each service component required to meet residents' needs as noted in their Plan of Services and Supports and Resident Service Agreements;
• Report any suspected abuse or neglect to Adult Protective Services by calling the Adult Protective Services/Child Protective Services Hotline at 1-800-652-1999;
• Respect every resident's right to confidentiality;
• Respect and accept responsibility for each resident's safety and property;
• Certify that direct care staff have:
  1. training and/or experience in working with adults in a health care or social setting;
  2. knowledge of first aid and current cardiopulmonary resuscitation (CPR) certification;
  3. the ability to recognize distress and signs of illness in residents;
  4. knowledge of available medical resources; and
  5. access to information on each resident's physician and emergency medical contacts; and

• Keep the following information in each resident's file for a minimum of four years:
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  • The current Resident Service Agreement (no specific DHHS form required);
  • The current Plan of Services and Supports;
  • Phone numbers of emergency contacts and the resident's physician's name and telephone number;
  • Supporting documentation for provision of services for each resident served under the Waiver; and
  • Documentation determined necessary by DHHS to support the selection and provision of services included in the Plan of Services and Supports.

You have also agreed to:

• Bill only for days when services were authorized;
• Submit billing documents within 90 days after services are provided (see Section 6 for instructions to complete the required billing forms);
• Not provide services to any resident for whom a facility owner or administrator is his/her spouse;
• Keep the facility license and Waiver certification current;
• Reserve the right to discharge any resident whose personal care needs exceed, for more than a temporary period, a level beyond your facility's service capability;
• Work with the Services Coordinator to arrange for alternative services if it becomes necessary to discharge a resident;
• Report the death of any resident in accordance with the procedures of the “Home and Community-Based Services Waiver Death Review Committee.” This includes notifying Carol Lieske at 1-402-471-9190 no later than the next DHHS working day following the resident's death;
• Keep on file for a minimum of four years:
  • Copies of all Long Term Care Facility Turnaround Billing Documents/MC-4 (Appendix F ) and Long Term Care Facility Add-On Turnaround Billing Documents/MC-4 (Appendix G) submitted to DHHS for services you provided to the residents; and
  • Provider agreements with DHHS;
• To provide a homelike environment for each resident. If a Waiver resident has no access to essential furniture, the facility will provide, at a minimum, a bed, a nightstand or table and a chair; and
• To supply normal, daily personal hygiene items. This includes at a minimum but not limited to: soap; shampoo; facial tissue; dental hygiene products; and toilet paper.