Children’s Level of Children’s Level of CareCare

480 NAC 5-002480 NAC 5-002

Client Eligibility CriteriaClient Eligibility Criteria

1.1. Be eligible for the Nebraska Medical Assistance Be eligible for the Nebraska Medical Assistance Program (NMAP); Program (NMAP);

2.2. Have participated in an assessment with a services Have participated in an assessment with a services coordinator; coordinator;

3.3. Meet the Nursing Facility (NF) level of care criteria Meet the Nursing Facility (NF) level of care criteria (471 NAC 12-000); (471 NAC 12-000);

4.4. Have care needs which could be met through waiver Have care needs which could be met through waiver services at a cost that does not exceed the cap; and services at a cost that does not exceed the cap; and

5.5. Have received an explanation of NF services and Have received an explanation of NF services and waiver services and elected to receive waiver waiver services and elected to receive waiver services. services.

Determination of Strengths, Determination of Strengths, Priorities and ResourcesPriorities and Resources

The Services Coordinator The Services Coordinator shall:shall:

14 days14 days

Begin to develop the plan of services Begin to develop the plan of services and supportsand supports

Early Intervention ExceptionEarly Intervention Exception– IFSP is the assessmentIFSP is the assessment

Gathering Functional Gathering Functional InformationInformation

Activities of Daily Activities of Daily LivingLiving

CognitionCognition

EnvironmentEnvironment

Medical/Health StatusMedical/Health Status

Support NetworkSupport Network

TransitionTransition

Activities of Daily LivingActivities of Daily Living

BehaviorBehavior

General HygieneGeneral Hygiene

Feeding/EatingFeeding/Eating

MovementMovement

SiteSite

HearingHearing

CommunicationCommunication

ToiletingToileting

BehaviorBehavior

Behavior: The ability to exhibit Behavior: The ability to exhibit actions that are developmentally and actions that are developmentally and socially appropriate in the areas of socially appropriate in the areas of independence, maturation, learning, independence, maturation, learning, and social responsibility. and social responsibility.

General HygieneGeneral Hygiene

BathingBathing

DressingDressing

GroomingGrooming

Feeding/EatingFeeding/Eating

The ability to take The ability to take nourishmentnourishment

MovementMovement

MobilityMobility

TransferringTransferring

SightSight

The ability to The ability to visualize or see, visualize or see, especially one’s especially one’s environment.environment.

HearingHearing

The ability to The ability to perceive soundperceive sound

CommunicationCommunication

The ability to The ability to make oneself make oneself understoodunderstood

ToiletingToileting

The ability to The ability to get to and get to and from the toilet, from the toilet, commode, commode, bedpan, or bedpan, or urinalurinal

CognitionCognition

The ability to The ability to remember, reason, remember, reason, understand, and understand, and use judgment. use judgment.

EnvironmentEnvironment

The ability to The ability to function in function in his/her living his/her living situation, situation, including health, including health, housing, and housing, and accessibility. accessibility.

Medical/Health StatusMedical/Health Status

Any medical or Any medical or health health condition that condition that impacts the impacts the child's ability child's ability to function to function independently. independently.

Support NetworkSupport Network

The ability and The ability and capacity of capacity of extended family, extended family, friends, and friends, and community community resources to resources to provide informal provide informal and formal and formal supportssupports

TransitionTransition

The availability of a The availability of a coordinated set of coordinated set of activities designed to activities designed to promote independence promote independence and movement and movement through services and through services and developmental stages. developmental stages.

ReviewReview

Activities of Daily LivingActivities of Daily Living

CognitionCognition

EnvironmentEnvironment

Medical/Health StatusMedical/Health Status

Support NetworkSupport Network

TransitionTransition

Route Functional Route Functional InformationInformation

HHS Central Office for a NF level of HHS Central Office for a NF level of care determinationcare determination

The Pediatric NurseThe Pediatric Nurse

Consultant Consultant

Reviews and Reviews and

makes determinationsmakes determinations

To be Eligible for Waiver To be Eligible for Waiver ServicesServices

A child must have care needs A child must have care needs which could otherwise require which could otherwise require services to be provided in a services to be provided in a Nursing Facility (N.F.)Nursing Facility (N.F.)

Children ages 3-17Children ages 3-17

One medical treatment/therapyOne medical treatment/therapy

Highly dependent in Activities of Highly dependent in Activities of Daily Living (ADLs)Daily Living (ADLs)

Medium dependent + highly Medium dependent + highly dependent in other considerationsdependent in other considerations

Children 0-3Children 0-3

Have at least one medical Have at least one medical treatment/therapytreatment/therapy