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Children’s Level of Care

Children’s Level of Care. 480 NAC 5-002. Client Eligibility Criteria. Be eligible for the Nebraska Medical Assistance Program (NMAP); Have participated in an assessment with a services coordinator; Meet the Nursing Facility (NF) level of care criteria (471 NAC 12-000);

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Children’s Level of Care

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  1. Children’s Level of Care 480 NAC 5-002

  2. Client Eligibility Criteria • Be eligible for the Nebraska Medical Assistance Program (NMAP); • Have participated in an assessment with a services coordinator; • Meet the Nursing Facility (NF) level of care criteria (471 NAC 12-000); • Have care needs which could be met through waiver services at a cost that does not exceed the cap; and • Have received an explanation of NF services and waiver services and elected to receive waiver services.

  3. Determination of Strengths, Priorities and Resources

  4. The Services Coordinator shall: • 14 days • Begin to develop the plan of services and supports • Early Intervention Exception • IFSP is the assessment

  5. Gathering Functional Information • Activities of Daily Living • Cognition • Environment • Medical/Health Status • Support Network • Transition

  6. Behavior General Hygiene Feeding/Eating Movement Site Hearing Communication Toileting Activities of Daily Living

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

  8. General Hygiene • Bathing • Dressing • Grooming

  9. Feeding/Eating • The ability to take nourishment

  10. Movement • Mobility • Transferring

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

  12. Hearing • The ability to perceive sound

  13. Communication • The ability to make oneself understood

  14. Toileting • The ability to get to and from the toilet, commode, bedpan, or urinal

  15. Cognition • The ability to remember, reason, understand, and use judgment.

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

  17. Medical/Health Status • Any medical or health condition that impacts the child's ability to function independently.

  18. Support Network • The ability and capacity of extended family, friends, and community resources to provide informal and formal supports

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

  20. Review • Activities of Daily Living • Cognition • Environment • Medical/Health Status • Support Network • Transition

  21. Route Functional Information • HHS Central Office for a NF level of care determination • The Pediatric Nurse Consultant Reviews and makes determinations

  22. To be Eligible for Waiver Services • A child must have care needs which could otherwise require services to be provided in a Nursing Facility (N.F.)

  23. Children ages 3-17 • One medical treatment/therapy • Highly dependent in Activities of Daily Living (ADLs) • Medium dependent + highly dependent in other considerations

  24. Children 0-3 • Have at least one medical treatment/therapy

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