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

2. Client Eligibility Criteria 1. Be eligible for the Nebraska Medical Assistance Program (NMAP); 2. Have participated in an assessment with a services coordinator; 3. Meet the Nursing Facility (NF) level of care criteria (471 NAC 12-000); 4. Have care needs which could be met through waiver services at a cost that does not exceed the cap; and 5. 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 14 days Begin to develop the plan of services and supports Begin to develop the plan of services and supports Early Intervention Exception Early Intervention Exception –IFSP is the assessment

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

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

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

9. Feeding/Eating The ability to take nourishment The ability to take nourishment

10. Movement Mobility Mobility Transferring Transferring

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

12. Hearing The ability to perceive sound The ability to perceive sound

13. Communication The ability to make oneself understood The ability to make oneself understood

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

15. Cognition The ability to remember, reason, understand, and use judgment. 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. 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. 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 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. 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 Activities of Daily Living Cognition Cognition Environment Environment Medical/Health Status Medical/Health Status Support Network Support Network Transition Transition

21. Route Functional Information HHS Central Office for a NF level of care determination HHS Central Office for a NF level of care determination The Pediatric Nurse The Pediatric Nurse Consultant Consultant Reviews and Reviews and makes determinations 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.) 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 One medical treatment/therapy Highly dependent in Activities of Daily Living (ADLs) Highly dependent in Activities of Daily Living (ADLs) Medium dependent + highly dependent in other considerations Medium dependent + highly dependent in other considerations

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