CONNECT MW Manual 08142008

CONNECT Manual for the Medicaid Aged and Disabled
Waiver
Let’s Get Started and Getting in to the CONNECT System .................................. 5
Helpful Hints ......................................................................................................... 9
General Security Information .............................................................................. 10
Adding a Client to CONNECT ............................................................................. 11
When the Client is Already in CONNECT .................................................12
When the Client is Not Already in CONNECT ..........................................14
Emergency Contact ..................................................................................17
Selecting a Client Sponsor .......................................................................17
Transferring the Client to a Different Sponsor/Services Coordinator ........18
Add an Authorized Representative to Client’s General information ..........19
Edit a Client’s General Information ...........................................................20
Adding an AD Waiver Case ................................................................................ 23
Adding, Completing and Viewing a HHS-6 Notice .............................................. 34
Adding a HHS-6 Notice ............................................................................34
Finalizing and Printing the HHS-6.............................................................36
Viewing a HHS-6 ......................................................................................38
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Adding and Completing the Level of Care and Functional Criteria ..................... 39
Children’s Level of Care................................................................................ 39
Adult/Aged Level of Care .............................................................................. 46
Adding, Editing, and Finalizing Narratives .......................................................... 54
Adding an AD Waiver Worksheet ....................................................................... 59
Adding Medicaid Non-Waiver Services to a Worksheet ...........................60
Adding Medicaid Waiver Services to a Worksheet ...................................61
To View of Print a Client’s Worksheet ......................................................62
Adding, Viewing, or Printing a Client’s Service Needs Page............................... 64
Adding and Completing a Local Level Complaint Form ...................................... 67
Adding and Completing a Local Level Incident Form.......................................... 72
Adding and Editing Waiver Assisted Living Providers ........................................ 77
Adding a Waiver Assisted Living Provider ................................................77
Ending a Waiver Assisted Living Provider ................................................80
Adding, Editing, or Viewing Assisted Living Authorizations................................. 82
Adding an Assisted Living Authorization...................................................82
Editing a Waiver Assisted Living Authorization.........................................84
Closing or Denying a Waiver Case ..................................................................... 88
Transferring Cases and Clients .......................................................................... 91
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Transferring a Case to a Different Services Coordinator Within Your
Agency ..................................................................................................... 91
Transferring an Entire Caseload to a One of More Services Coordinators

Within Your Agency ......................................................................................91
Transferring A Case to a Services Coordinator at Another Agency..............92
Receiving a Case Transferred from Another Agency ...................................92
Billing for Services Coordination ......................................................................... 94
Billing Roles..............................................................................................95
MW Billing Process...................................................................................96
SC Billing ..................................................................................................97
Supervisor Review and Submission ........................................................99
Quality Assurance Supervisory File Review ..................................................... 103
Accessing the QA File Review Form ......................................................103
Completing the QA File Review Form ....................................................105
Finalizing the QA File Review.................................................................109
E-mailing Central Office..........................................................................109
Printer Friendly Options..........................................................................110
CONNECT Reports........................................................................................... 112
Writing Reports.......................................................................................117
Technical Information........................................................................................ 124
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There will come a time when you think everything
is finished. That will be the beginning.
-Louis L’Amour
CONNECT (Coordinating Options in Nebraska’s Network Through Effective

Communication and Technology) is a Nebraska Department Health and Human
Services (DHHS) internet based computer program designed for several State
programs. Much of the information Aged and Disabled Medicaid Waiver staff
gather through their work is entered in to CONNECT. The information entered in
the system is utilized for numerous activities such as; tracking, authorizations,
notification, data, quality assurance, and payment to contracted services
coordination agencies for services coordination.
CONNECT is an evolving system. Enhancements will be developed so that

Services Coordinators’ (SC) needs are met as well as better data gathered.
For questions regarding information in this manual please contact the HHS State
Unit on Aging (SUA) program coordinator at (402) 471-8091.
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Let’s Get Started!
The purpose of this manual is to provide instruction on how to navigate through
and use the CONNECT system for your work. You will learn how to input
information needed for the Aged and Disabled Medicaid Waiver (MW) services
coordination work as well as how to create and submit billing for your work.
The directions in this manual were written with the intent for users (you!) to read
the manual while following along on the computer. The instructions are
accompanied by visuals to not only assist you in learning but to also provide you
pictures of what you should be seeing on your computer while following the
manual.
For questions, problems or deletion requests related to CONNECT please

contact your designated Health and Human Services System staff in the central
office.
Getting in to the CONNECT System

Before you can access CONNECT your agency’s security administrator will need
to request access for you by submitting the “Security Access Information Form”
and “NHHSS External Access Confidentiality Statement” to the HHS State Unit
on Aging, Early Development, or HCBS Waivers Services Unit contact. Once
you have been given a log on ID and password you will be able to log in to
CONNECT.
You’ll access CONNECT through the internet by typing in the following

address of https://my.ne.gov here and then press enter.
**Through out this document the pictures of computer pages or screens only contain
the top portion of what you will actually see on your computer. To save space the
whole page or screen was not cut and pasted in to this document.
After typing in the above address and pressing enter the following MyNebraska Portal
page should appear.
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From the MyNebraska Portal page you may find it helpful to click on <Favorites>
to add the address as a bookmark or create a shortcut to your desktop for future
use. You can create a shortcut by either using the mouse to click, hold, and drag
the icon that you see by the address (the right before the http) to the
computer desktop or you can right click your mouse and select “Create Shortcut”
from the list that appears. A shortcut should then appear on the desktop and you
may double click on it to access CONNECT.
2) On the MyNebraska Portal page type in your User ID and password. The first
time you log on you will likely be asked security questions so you will need to
reply to those in order to proceed. The password you are first given is temporary
so you will need to change it the first time you log on. After typing in your User
ID and Password then press the “Enter” key or click on <Login>
Once you have logged on you should see a page similar to the below.
The list on the left of this page is telling you the options you may chose. Clicking
on “My Applications” will take you to a page where you can access CONNECT.
If you want or need to change your password you would click on “Change
Password” and get a pop up box where you can enter a new password.
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After clicking on “My Applications” you should see a page similar to the below.
*Note: The page that you will see will not have all the same options shown in
blue below but you should at least have CONNECT showing up as an option to
click on.
3) After clicking on CONNECT you should see a screen similar to below. This is
the main menu for the CONNECT program and may contain important messages
regarding updates or problems with the CONNECT program.
Some of the things you do from this main menu include, search for or add clients
through the <Client Tracking> button, pull up your caseload (or your staffs if you
are an aide or a supervisor) by clicking on the <Cases> button, or view clients
assigned to them by clicking on the <Client> button. Supervisors and some
others will also have access to <Reports>, which will take them to the Dashboard
software which will be discussed later in the Reports section.
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If you click on the <Cases> tab you would see a screen similar to the below
listing the clients assigned to you (if you are a supervisor or aide you can look at
a specific SC’s caseload by selecting the SC’s name from the drop down list),
along with other case related information.
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Helpful Hints
Never use your browser’s back arrow to exit a page.
Never use the refresh button. Using the back arrow or the refresh needs to be
avoided as it can cause duplicate entries on the system.
Never Double Click the on the

buttons.
This will cause the client information to be submitted again. The client will be
listed twice.
Click on < Home> or to return to the CONNECT main

menu page.
In the top right hand corner of each screen you will have a “map” of where you
are that looks like the following:
You are Here: Home > Client Search > View Waiver Case Action.
The title on the right tells you the name of the page you are on and the preceding
information tells you where you were previously. As seen above, this is letting
you know that you are now viewing a Wavier case. You may click on those in
blue, e.g. if you click on <Client Search>, it will take you to the Client Search
window or if you click <Home> it will take you to the CONNECT Home Page (if
you have entered information that needs to be saved/submitted make sure you
click on <Submit> before you leave that page to avoid losing the information).
Any time there is a drop down list you can either click on the uor type in the first
letter of the selection you want (if you are familiar with the options listed). If there
is more than one option starting with the same letter you can keeping typing that
letter to scroll through the options until you come across the selection you want.
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For questions or problems with CONNECT you or your supervisor are unable to
resolve (with the exception of technical issues such as your password expired,
system not working, etc. – for those issues call the Help Desk at 471-9069 in
Lincoln or 800-722-1715 outside of Lincoln) please contact your designated
central office staff by phone or email; EDN and DHHS staff and the Independent
Living Centers contact the HCBS Waiver Services Unit contact and Area
Agencies on Aging contact Jodie Gibson at (402) 471-8091.
General Security Information

CONNECT is an internet-based Government Computer System and contains
information which is confidential and legally privileged. It is intended only for use
of the individuals or entities legally authorized and all information therein should
be held in the strictest confidence. Additionally, any disclosure, copying, printing,
distribution or the taking of any action in reliance on the contents of this
information, other than that which is pertinent to work assigned and authorized by
the Nebraska Department of Health and Human Services System (DHHS) is
strictly prohibited.
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Adding a Client to CONNECT
The first thing that should be done before adding any client and case
information in CONNECT is 1) to check to make sure the person does not
already exist in CONNECT. Checking CONNECT before adding a client or a
case for a client is important so that a duplicate entry is avoided. From the
home page for CONNECT you will need to first click on <Client Tracking>.
You should then be taken to a screen similar to the following.
2) You will search by SSN and last name by typing in the information here (you
should always have a SSN since checking Medicaid eligibility is a requirement.
Should you not have the SSN you can enter the last name and check the “No
SSN” box and then click on <Search>. After clicking on search you with either
get “Your search returned zero results” or a list of names should be returned if
the same or similar name or a SSN match is found.
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When the Client is Already in CONNECT
If you find information to match your client, click on the name in the list to go to
that client’s information.
Once you’ve clicked on the name you should be taken to a screen similar to the
above (this screen contains demographic information on the client). By looking
at the blue bar towards the top of the screen you can tell what other programs
the client has been involved with through CONNECT. The <DPFS>, <EDN>,
<MHCP>, and <Respite> tabs are not highlighted and have “add” at the end,
which tells you this person has not had a case under those programs. The
<Waiver> and <SCO> tab are highlighted and do not have the add option for this
person, which tells you they had or currently have a case under those programs.
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*If your client is already in CONNECT the client may still be actively involved with
another program. The “owner” of the client in CONNECT is the only person who
can change the demographic information. It’s also important to let the Services
Coordinator of another open program know if you are opening or closing a case
as it may impact the eligibility for other programs on CONNECT. To know who
the “owner” of the client is in CONNECT please see the following hierarchy:
1 Early Development Network

Services Coordinator Reminder: Once a case
is transitioned, you must
remember to transfer the
2 HHSS A&D Waiver Client’s demographic case
Services Coordinator
3 Medically Handicapped Children’s

Program
4
Centers for Independent Living
4 Services Coordinator
5 Area Agencies on Aging

Services Coordinators
Disabled Persons and Family

6 Support Services Coordinator
Reminder: If another 7 Respite Services Coordinator

Services Coordinator is
working with the
client/family and is not the
“owner” and has information
on address change for
example, they must let the
Service Coordinator who
“owns” the Client
information know so they
can make the changes
If you “own” the client then you will need to check the previously entered
demographic information. If you need to make changes or assign the client to
yourself then you will need to click on the <Edit Client> tab in the blue bar
towards the top of the page, make the needed corrections and then click on
13
<Submit> at the bottom of the page (see page 20 for Editing a Client’s General
Information).
When the Client is Not Already in CONNECT
If your search returned no results or if none of the results match your client then
you will click on <Add> to enter your client in CONNECT.
Once you have clicked <Add>, the following screen should appear. You will
need to enter the demographic information on your client (this will be some or all
of the information from the DSS-14AD Part A). You can go from field to field (the
blank spaces) by using your tab key. See below for additional information on
completing the demographic information.
*Note: CONNECT information needs to be completely filled out as the

information is used for reporting and quality assurance purposes. While all items
marked with an asterisk * are mandatory for the computer system to let you
proceed, you have a responsibility to complete all information to be in compliance
in utilizing the CONNECT system.
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The “First” and “Last” name fields will be pre-populated from the information you
entered when searching. Verify the spelling and make any changes as
necessary. Be sure to spell the name correctly so that you and other staff can
locate the person and to avoid a duplicate entry under a different spelling.
At “Address 1”, type-in individual’s address of residence, including street or rural

route number. Use “Address 2” line, if necessary. This can be used to type in
the name of the Assisted Living Facility if applicable. If not, leave blank.
At “City”, type-in individual’s city of residence (usually the post office city.)
At “State”, select the individual’s state of residence. Note: If you don’t click on
“State”, it will default to “Nebraska.”
At “Zip”, type-in 5-digit zip code, tab, and enter zip’s next 4-digits, if known.
Tab through “Home Phone”, “Work Phone”, “Mobile Phone” and “Fax”, typing-
in the phone numbers if applicable.
Documenting the Race and Ethnicity
The Office of Management and Budget (OBM) announced revisions to the

standards for classification of Federal data on race and ethnicity. The five
minimum race categories are: American Indian or Alaska Native; Asian; Black or
African American; Native Hawaiian or Other Pacific Islander; and White. There
are two minimum categories for ethnicity: Hispanic or Latino; and Not Hispanic or
Latino. Hispanics and Latinos may be of any race.
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Definitions:
--American Indian or Alaska Native. A person having origins in any of
the original peoples of North and South America (including Central
America), and who maintains tribal affiliation or community attachment.
--Asian. A person having origins in any of the original peoples of the Far
East, Southeast Asia or the Indian subcontinent including for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
--Black or African American. A person having origins in any of the black

racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in
addition to “Black or African American.”
--Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South

or Central American, or other Spanish culture or origin, regardless of race.
--Native Hawaiian or Other Pacific Islander. A person having origins in

any of the original peoples of Hawaii, Guam, Samoa, or other Pacific
Islands.
--White. A person having origins in any of the original peoples of Europe,

the Middle East or North Africa.
The “SSN” field will be pre-populated from the information you entered when
searching. Verify the SSN is correct and make changes if necessary
At “DOB” date of birth, enter the DOB using the mmddyyyy format.
At “DOD”, if individual has died, type in the date of death, using the same format
as you did in DOB above.
At “Gender”, select the appropriate option.
At “Notes” type-in any further information that may be useful to you, other
services coordinators or resource developers, with the latest note on top. At the
beginning of the note type-in the date and at the end type-in your name.
At “Medicaid Eligible?” select “Yes” or “No”. If Yes, tab to “Medicaid ID” and
type-in individual’s Medicaid number (make sure you type in the correct Medicaid
number rather than just guessing and putting in the individual’s SSN and 01 as
16
this Medicaid number will be used for other tasks completed in CONNECT, such
as assisted living authorizations).
Emergency Contact
If the emergency contact is the same as the authorized representative skip the
Emergency Contact section (when you enter the authorized representative
information in a later step the information will automatically populate in to the
Emergency Contact section).
Complete the rest of the information for the client first and then additional
information will be provided later on how to add the Authorized Rep. (see Add an
Authorized Representative to Client’s General Information section following
Selecting a Client Sponsor).
Selecting a Client Sponsor
If the client is unsponsored and needs to be assigned the page should appear as
below. To sponsor the client click <here> to make the change. You will
automatically be selected as the sponsor. If you are a supervisor or support staff
entering client information on the system you will need to follow the instructions
below for transferring the client in order to change the SC from yourself to the
correct person at your agency.
If you are the “owner” of the client and need to edit the client information make
any changes needed, such as correcting or updating the address, telephone, etc.
If you are finished editing the client’s information click on <Submit> (if not, tab
back to where you need to enter additional information).
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If you did not complete a mandatory field or entered data incorrectly you will
receive a message in a red box telling you what you need to correct. If you have
to correct information you may need to select the Service Coordinator again as
that selection will not be retained if it is the first time submitted. Once you have
made any needed corrections click on <Submit>.
Transferring the Client to a Different Sponsor/Services Coordinator
If you need to transfer the client to another Services Coordinator in your agency
or unsponsor the client then click on the appropriate option available towards the
bottom of the screen. If you no longer have an open case on a client you may
choose to unsponsor the client so the name doesn’t continue to show up in your
client list. However, if you are still the SC assigned to the waiver case the case
will still show on your case list.
If you selected the option to transfer the client the following should appear (as
long as any narratives for the case are finalized as discussed later in the
narratives section).
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Type the last name of the services coordinator who is to be the sponsor for the
client and click <Search>. When the search results are returned click on
<Select> by the correct services coordinator’s name. You may get a list if there
is more than one services coordinator with the same name or if the search
produced no results you likely misspelled the name or you were not set up as a
supervisor or aide for the person you are trying to select (if support staff or
supervisors are unable to select appropriate staff from their office then they were
likely not set up correctly and the supervisor will need to let their central office
computer security staff know).
Add an Authorized Representative to Client’s General Information
Complete this section if the client has an authorized representative. From the
<View Client> you will click on <Add> by the Authorized Representative section.
19
After you’ve clicked on <Add> you should see a screen similar to the
following.
At “*Authorized Rep Type” select the type that best describes the individual’s
authorized representative’s role (e.g. spouse, parent, guardian).
At “*First”, type-in rep’s first name; tab to “Middle”, type-in middle initial (if no
middle initial, leave blank); then tab to “*Last”, and type-in last name.
If the Authorized Representative is also the Emergency Contact person then click
on the appropriate box. This action will copy the information back to the
Emergency Contact screen. If the Authorized Rep. has the same address as the
client check the box. If the Authorized Representative has the same phone
number as the client check that box as well.
If the Authorized Representative did not have the same address or phone
number then enter that information in the Address and Phone section.
Make sure the information you have entered is correct, and click on
<Submit>.
Edit a Client’s General Information
On the CONNECT home screen, click on <Cases> or <Clients>. If you click on
<Cases> you will only pull up those clients that have a MW case (as well as SCO
cases if you do SC for that program as well). If you click on <Clients> the list will
pull up any clients you sponsor. If you are working with a client who has another
program case open on CONNECT and based on the hierarchy the client is
“owned” by another Services Coordinator then that client’s name may not appear
in your list under <Clients> (but will under <Cases>) and you will not be able to
edit the client information.
20
If you are a supervisor or support staff you may need to pull up a client or case
list for Services Coordinators you supervise or support. You can pull up a client
or case list for another staff by selecting their name from the drop down list and
clicking on <Submit>. If the SC names you support or supervise do not appear
the supervisor will need to let their central office CONNECT contact person
know.
Click on the name of the client whose information you want to view or edit and
that will take you to that person’s information similar to the below (you can also
get to this same place by clicking on <Client Tracking> from the CONNECT
home page, then do a name search for the client you wish to view or edit, then
from results of the name search click on the underlined name of the client you
wish to edit). Once you are familiar with CONNECT and have cases on the
system you can also click on the waiver case link to edit the case information.
On the “View Client Information” page click on <Edit Client> to change client
information (only if you are the sponsor for the client, see chart on page 13).
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If the <Edit Client> button is not an option (it’s in gray and does not become
underlined if you hover the arrow over it) then the client is either “owned” by
another SC, is unsponsored and will need to be assigned a sponsor, or the client
is currently sponsored by someone you are not associated with in the CONNECT
system so you do not have the authority to make changes.
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Adding a Waiver Case
All waiver cases are to be entered on CONNECT. Whether your client was
already in CONNECT or you’ve just added the person you will then click on
<Waiver -add> or <Waiver> from the View Client Information screen (if the client
has never had a waiver case in CONNECT it will say <Waiver -add> here, if the
client already has a current or past waiver cases it will say <Waiver>, so in this
example you can tell the client has a current or past waiver case already on
CONNECT).
If you clicked on <Waiver – add> you should see a screen similar to the
following, which is where you will begin.
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If you clicked on <Waiver> you should see a screen similar to the below (since
there was already at least one Waiver case the screen below opens up directly to
the most recently entered waiver case).
In order to avoid duplicate entries you should always click <Other Waiver Case
Actions>, if enabled, to make sure the referral you wish to put on is not already
on the system or that there is not already a current open waiver case (if you
create a duplicate you will experience problems with billings and quality
assurance and the only potential way to delete a duplicate case is for the
supervisor to contact their central office contact for CONNECT). In the example
shown above Other Case Actions is in grey, meaning it’s not enabled and no
other waiver case is on CONNECT for this client. If there are other waiver cases
on the system then clicking on <Other Waiver Case Actions> would bring you to
a screen similar to the following.
If you see information listed matching your current referral you will need to click
on <View> by the referral to access what’s already on CONNECT rather than
create a duplicate referral. If the referral is already on the system then you will
be updating, editing, or completing the existing information to finish adding
information to the waiver case. If the list does not contain information for your
current waiver case then click on <Add New Referral>.
Once you have clicked on either <Add New Referral>, <Waiver – add>, or
<View> (to look at one of multiple existing cases already on the system) you
should then have the following screen (if you clicked on <View> then at least
some of the information on the system will already be filled in).
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On this screen you will need to go through and enter information. The following
information tells you the type of information you need to enter.
The first section to fill in is Source Type of the referral.
At Source Type select the option which best describes the referral source.
The following are the choices available for Source Type and the correct choice
is to be selected based on the source of the referral which matches one of the
definitions below:
Adult Protective Services - referral from an Adult Protective Services staff
Area Agency on Aging – an Area Agencies on Aging (AAA) staff made the
referral (e.g. you are a SC at an AAA and you received a referral from a Senior
Center, or care management staff or another AAA)
Assisted Living Facility – staff from an assisted living made the referral
CAPTA (Protection and Safety) – CAPTA is an acronym for the Child Abuse
Prevention and Treatment Act. Select this option only if you received the referral
on a child birth to 3 involved with Child Protective Services.
Child Care – a referral from a child care provider
Child Protective Services (non-CAPTA) - referral from CPS (Child Protective

Services) unless the CAPTA definition above applies
Community Agency – referral from a community agency (not an Area Agency on

Aging or Independent Living Center)
Developmental Tips/NICU Follow-up – a referral has been received through the

TIPS program upon the child’s discharge from the hospital after a NICU stay.
Early Development Network – referral came from the Early Development

Network
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Head Start – referral from a Head Start program
Health and Human Services – a referral from staff from any Health and Human
Services office unless the staff meets any of the other options, e.g. legal
guardian, Child Protective Services worker , Newborn Hearing Screening
program, parent, other services coordinator, etc.
Health Care Provider – a referral from any health care provider other than a
hospital, nursing facility, or physician
Hospital – referral from hospital staff, not from the Developmental TIPS program
Independent Living Center - referral from an Independent Living Center, includes

the League of Human Dignity and Center for Independent Living
Legal Guardian – referral from a legal guardian other than the parent of a minor
child (select Parent for referrals from a parent of a minor child)
Newborn Hearing Screening – referral from the Newborn Hearing Screening

program staff at DHHS
Nursing Facility – referral from nursing facility staff
Other– this is only to be used when no other category applies and should not be
used as an “easy” answer as referral information should be gathered on each
referral
Other Services Coordinator – referral from a services coordinator other than

yourself when no other option for source type applies
Parent – referral from a parent, unless the parent is the legal guardian of an adult
Physician – referral from a doctor or staff from a doctor’s office
Relative – referral from a relative unless the relative is the parent of a minor child
or the relative is the legal guardian
Respite Network Coordinator – referral from staff with a respite program
School – referral from school staff
Self – client self-referral (this should likely never be used for a child under 19)
Services Coordination (self) – the referral is from you as a services coordinator

(e.g. you worked with the client already through your agency in another capacity
and have now referred the client to waiver)
26
Social Security Admin. (SSI/DCP) – referral from staff at a Social Security
Administration office
Transfer case from another AAA-this source type is to be used when the client is
moving from another AAA service area and the case if transferring to the current
AAA agency
Transfer case from another DHHS agency- this source type is to be used when
the client is moving from another DHHS service area and the case if transferring
to the current DHHS agency
Transfer case from another ILC- this source type is to be used when the client is
moving from another ILC service area and the case if transferring to the current
ILC agency
Transfer case from DHHS- this is to be used when a client has turned 18 and the
case is transitioning from a DHHS Services Coordinator to an ILC Services
Coordinator
Transfer case from ILC- this is to be used when a client has turned 65 and the
case is transitioning from an ILC Services Coordinator to an AAA Services
Coordinator
Transfer from another state-this is to be used when the client has moved from
another state and was receiving waiver services through that state
WIC – referral from staff with a WIC (Women, Infants and Children) program
Then complete the remainder of the information regarding the referral source
(it’s suggested that you at least record the name and phone number of the
referral party should you need to contact them for additional information)
Then next area captures additional referral information and you must complete
each field, with the exception of Waiver While Waiting (only check YES for that if
it applies)
At Referral Date enter the appropriate date. Be sure to record the correct date,
using referral date rather than request date. If the Medicaid case is pending and
you receive a request for services on May 15, 2006 but you don’t actually contact
the client/family to schedule an assessment until May 18, 2006 then the referral
date to be entered on CONNECT is May 18, 2006.
27
At Priority select the option which best matches the priority for the referral.
The following are the choices available for Priority:
Assistive Technology Only – select this if the referral is only for assistive
technology, regardless if other priority codes also apply
Abuse or Neglect - select this if there is a substantiated report of abuse or

neglect and Adult Protective Services or Child Protective Services jointly
determine the applicant and his/her living situation can be appropriately
supported with waiver services
Existing – this is no longer to be selected as it was established for transferring

open/existing cases to CONNECT when CONNECT was first developed
High Functional Need – select this if the individual has 5 or more ADL limitations
and appropriate informal supports, plus it is not for an ATO case, a referral from
Senior Care Options, or a nursing facility transition case
Mod Need, no informal support – select this if the individual as 4 ADLs and no
informal supports (this would include those in assisted living or home) and it is
not for an ATO case, a referral from Senior Care Options, or a nursing facility
transition case
Moderate need, informal support – select this if the individual as 4 ADLs and
informal supports and it is not for an ATO case, a referral from Senior Care
Options, or a nursing facility transition case
NF Transition – select this for current nursing facility (NF) residents for whom
Nebraska Medicaid is paying for the NF services (this does not include short-
term, temporary, or rehabilitation admissions), even if the case is ATO or a
referral from Senior Care Options
None – select this if the individual did not meet NF LOC
Other – this shouldn’t be selected as an individual should meet one of the other
priorities listed
Senior Care Options – select this only if the applicant has been evaluated by
Senior Care Options and the applicant is age 65 or older, has specific, immediate
28
plans for nursing facility admission or is already in the facility, and will enter a
facility or stay at the facility if waiver services are not made available
Transfer – select this for existing waiver cases transferred from another AAA or
CIL
At Initial Level of Care Assessment Date type in the date in which the
Services Coordinator completed the Initial Functional Criteria or Child/Client’s
Level of Care Documentation for Nursing Facility Level of Care Determination
If the Initial Level of Care Assessment date is greater than 14 working days from
referral, it will become mandatory on CONNECT for you to enter a reason in the
Reason for Delay dropdown box.
At Waiver Type select one of the appropriate options as follows:
AD – if the case will be opened under an Aged and Disabled Waiver case, unless
the case is being opened under the Waiver While Waiting regulation
EDN – if the case will be opened under the Early Intervention Waiver only for
children 0-3 years of age
Waiver While Waiting – if the case will be opened under the Waiver While
Waiting regulation, in which case you will also need to mark the Waiver While
Waiting box
At Program Type select one of the following options which best matches the
program:
ATP – select this option if waiver case is for Assistive Technology Only (this
should match the priority selection for Assistive Technology Only)
None – select this if an Aged and Disabled waiver case will be opened and no
other options apply
Partial Vent – select this if the client uses partial ventilator assistance for the
Aged and Disabled Waiver
TBI – select this if the client will be receiving services through the Traumatic
Brain Injury Waiver
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Vent – select this if the client uses total ventilator assistance for the Aged and
Disabled Waiver
At Living Status select one of the following options which best matches the
current living situation:
Assisted Living – if the individual is currently residing in an assisted living facility
In Home – if the individual is currently living in a private residence, whether it be

an apartment or house and regardless of whether it is their home or the home of
a relative or friend (do not select this if it is anything other than a private
residence, such as a group home)
Other – select this if neither of the prior two options match the individuals
situation
At Prior Living Arrangement select the option below which best matches the
permanent living arrangement (e.g. if the client was short-term at a hospital or in
a nursing facility for respite then you would select the most recent permanent
living arrangement prior to the current non-permanent situation) of the client prior
to receiving waiver services:
Assisted Living – if the individual was already residing at an assisted living facility
(e.g. private pay conversion)
Home, parents/legal guardian – if the child under 18 was living with his/her
parent/legal guardian
Nursing Facility – if the individual was a long-term resident or planned to be long-

term (if at a nursing facility for a short-term/rehabilitative stay with plans to return
home then do not select this option)
Other – only select this option as a last resort when no other option matches
Own home, alone – if the individual resides in their own residence with no one
else
Own home, other relative – if the individual resides in their own residence and a
relative other than a spouse lives there as well
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Own home, spouse – if the individual resides in their own residence with his/her
spouse
Relative’s/Friend’s Home – if the individual is not in their own residence but

rather that of a relative or friend
At SC Agency select the name of the SC agency responding to the referral, the
employer/office for which you work.
The next line states that Diagnosis may be added after the case has been added.
Once you have entered all information and submitted the waiver case for
CONNECT then the diagnosis section will be enabled.
The next section is Waiver Eligibility Status

At Pending enter the date a case is put in pending status, if applicable (i.e.
determination of LOC has not been made or safe POSS has not been
established)
At Opened enter the start date for the waiver case. This date should never be
before the valid consent has been signed AND services should never be
authorized before this date.
At Review Date you have a couple options. You can either leave the field blank
and CONNECT will automatically enter a date a year from the LOC evaluation
date or you can manually enter the review date (if you manually enter a date you
will need to do so after the field has already been automatically filled in by
CONNECT, if you do so before that then CONNECT will override and replace the
date you manually entered). If you manually enter a date, enter the last day of
client’s eligibility period.
For Denied, see section Closing or Denying a Case on page 88.
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The next section is Medicaid Eligibility Status
At Pending, if the Medicaid case is pending, enter the date of application
(available from the HHS local office or NFOCUS). If/when the individuals
Medicaid is opened you will need to update CONNECT and enter the date in the
field for Opened.
At Opened enter the date the Medicaid eligibility started (not the date the
Medicaid eligibility worker determines eligibility but rather than date Medicaid
coverage begins).
The next section is Notes

At Notes you may enter information pertinent to the case that is not captured
elsewhere but will be helpful to you, your supervisor, another SC, or central office
staff. If you enter notes more than once put the most recent note on top and at
the beginning of the note type in the date and at the end type in your name.
The next section is Services Coordinator

At Name select the name of the services coordinator at your agency that will be
the services coordinator for the individual. You will either be able to select
yourself if you are a services coordinator and will be providing the services
coordinator or if you are a supervisor or support staff you will be able to select
any of the staff you support or supervise (if the appropriate staff do not appear in
the list please contact your central office contact as they will need to edit the
roles assigned for staff in CONNECT).
If you need to exit the case but have not completed entering information in to all
the fields you may click <Submit> to save what you’ve entered. You will be able
to come back to the waiver case at a later time and select <Edit Case> to finish
filling in the information.
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Once you have completed all information on CONNECT (additional instructions
for all required sections of CONNECT for AD Waiver follow), including making
the nursing facility level of care determination, click on <Submit and Create HHS-
6> to complete the HHS-6 notice if the client is being denied and a notice of
action is required per regulations (instructions for completing an HHS-6 are
included later).
After you have submitted the client’s case information you will then have the
ability to go back to add any diagnoses. To add diagnoses click on <Add> next
to Diagnosis.
The following screen should appear. Using your mouse and arrow, click on one
or more diagnosis you wish to include. To add more than one diagnosis hold the
“Ctrl” key on your keyboard until you’ve finished clicking on all those that apply.
Once completed click on <Submit>..
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Adding, Completing and Viewing a HHS-6 Notice
You will need to create and complete a HHS-6 any time required by regulations,
such as when you deny or terminate a Medicaid Waiver case or if you reduce
any waiver services already in place. You can also create an HHS-6 to notify a
client they are eligible for services and of their 12 month eligibility period.
*It is a requirement for any HHS-6 that you provide a regulatory citation in the
notice supporting the action.
CONNECT has the capacity to retain all HHS-6s that have been completed. You
cannot edit existing HHS-6s but you can review and print any HHS-6 created
after August 14, 2008, when the history of HHS-6s was added to the system.
Adding a HHS-6 Notice
In order to create a HHS-6 you need to be in the “Add Waiver Referral” or “Edit
Waiver Case Action” screen. From either of those pages you will have the option
to create an HHS’6 by scrolling to the bottom of the page and clicking on
After clicking on the <Submit & Create HHS-6> button you will see a screen
similar to the following.
The client information will be automatically populated in to the notice (see

above). If the client has a legal representative that should receive the notice as
well you will need to send them a copy of the notice sent to the client.
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To OPEN or RECERTIFY a Case. This option (above) on the HHS-6 can be
used if/when you open a Medicaid Waiver case (the regulations currently only
require a notice be submitted when a case or service is being denied or reduced
so sending a notice to inform a client a case is opening is not mandatory).
You will need to mark the box to indicate which section you are completing. In
the notes box you will need to provide a statement to indicate what action you
are taking. In the eligibility date area you will need to enter the date the waiver
case becomes effective and the date through which it will continue to be open.
The through date must be no longer than 12 months from the effective date.
Services are authorized through a different process (NFOCUS or the AL
authorization on CONNECT) so you would not complete this section related to
individual services.
“To REDUCE, or DISCONTINUE …”. This section needs to be completed if you

are closing an open waiver case (not denying a case), reducing services, or
discontinuing services. First mark the box to indicate this is the section you are
completing. In the next box type in what will be discontinued (e.g. “your Medicaid
Waiver eligibility”). Then select the appropriate action from the drop down list. In
the next fields you will need to enter the last day of the client’s eligibility. In the
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following box you will need to provide the reasoning for the action you are taking,
including a citation for the regulations that supports the action. Again, services
are authorized through a different process (NFOCUS or the AL authorization on
CONNECT) so you would not complete this section related to individual services.
“To DENY one…” will be used when the initial determination is to deny a client
waiver eligibility; this is not to be used for an individual who already has an open
waiver case. To complete this section you will need to mark the appropriate box
and after “The reason for this decision is” type in an explanation for the action
and cite the regulation to support the action.
There is also a box at the bottom of the form where you can provide additional
information to the client. DO NOT CLICK ON THE SUBMIT BUTTON YET!
Finalizing and Printing the HHS-6
It is required that every client be informed of their rights so the next time, once
you have completed filling in the appropriate information as previously discussed,
is to click on <Print “Your Rights” (pdf form)> to get a print out of “YOUR
RIGHTS”. You will need to include the print out of the client’s rights to mail to the
client along with the HHS-6.
36
Once the HHS-6 is finalized you do not have the ability to edit so review all the
information to confirm the HHS-6 is complete and accurate.
Once you have verified the information is accurate click on <Submit> towards the
bottom of the page. There are some mandatory fields, dependent upon which
action box you checked (e.g. if you checked deny then CONNECT requires that
you fill in the box for “The reason for this decision is”, if the field is blank when
you click on <Submit> then you will get an error message telling you what you
need to correct before to resubmitting).
Once your submission has been accepted a copy of the notice will pop up in a
separate screen as shown below. The final version will only show the sections
you have checked and the comments you provided. You will need to print the
HHS-6 to send to the client as it cannot be printed and mailed from the DHHS
central office as can be done on NFOCUS. You will print the form by either
clicking on the printer icon or clicking on “File” from the tool bar and then “Print”
from the drop down list (the same process for printing for a Microsoft program).
When you have finished printing the copies you need then close the window with
the HHS-6 by click on the “X”.
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Viewing Existing HHS-6 Notices
To view prior HHS-6 notices (any created on or after August 14, 2008) you will
need to click on <Select HHS-6> from the waiver case screen.
After clicking on <Select HHS-6> you should see a screen similar to the below.
If there are any prior HHS-6s created for the case (only those created after
8/14/08) they will show in the list. To view one of the HHS-6s from the list click
on the PDF icon.
38
Adding and Completing the Level of Care and
Functional Criteria
Children’s Level of Care
To create an initial Level of Care for a child, click on the <Add> button from the
<Select Level of Care> link on the case page. This will create a new LOC form.
To create a Level of Care Document for the annual review, choose the most
recent LOC from the <Select Level of Care> screen. Do not choose the most
current LOC and edit this form. You will lose the history of reviews.
The Current LOC document will come up. Next, click on the <Make New LOC>
button on the top of the document. This will pull up a new LOC with the previous
LOC information allowing you to edit the information for the current assessment
without re-entering all of the data.
Click on the button in “Section 1-Type of Waiver” and complete

this section. By clicking on “Section 1” you will be able to complete Sections 1,
39
3, and 7 on this page. Choose “Initial” from the drop down box for an initial
Level of Care determination. Choose “Review” for all annual reassessment
completed after the initial determination. Next, complete the Diagnosis notes
field by entering the primary diagnosis which medical personnel have determined
for the child/client and the secondary diagnosis. Complete the Cognitive Status
field if cognition impairment is indicated, by summarizing educational
documentation. Also complete the Recent Height and Recent Weight fields.
Finally, complete the Recommendation Date field. The Recommendation
Date is the date the Child/Client’s Level of Care Document is completed with the
family (the date the assessment to gather information is completed in-person with
the family). Click on the <Submit> button when finished.
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Section 4- Medical Treatment/Therapies
Complete this section for medical conditions/therapies present which require a

specific intervention to prevent a decline in health status in one or more of the
following 9 categories. If a child/client meets the criteria in one or more of these
categories, mark the checkbox next to the appropriate category. Next, complete
the summary section to indicate if the child/client does/does not meet the criteria
for this section. A child/client meeting one of the criteria in this section will qualify
as nursing facility level of care.
VENOUS ACCESS/CENTRAL LINE: Should be marked if the child/client has a

central line (for long-term use) that is being used for administration of daily
medications; IV fluids administration in the home; nutrients and/or for obtaining
blood specimens. Examples of Central lines are: broviacs, hickman, groshong
catheters, implanted ports (port-a-cath, infuse-a-port, mediport, norport,
groshong port); PICC lines (Peripheral Central Lines); if the central line requires
dressing changes, monitoring and flushing (to maintain patency) as prescribed by
a physician. The care of the central line may be done by a health care
professional or an unlicensed person(s) that has been certified and trained to
correctly handle this procedure. This section should not be marked if the Central
Line is in place as a safety measure (e.g., for prophylaxis) and that is not being
utilized for the administration of medications, IV fluid administration, nutrients
and/or blood specimens will be scored “NO.” E.g., child/client was utilizing
central line, but is no longer utilizing it – physician is keeping it in place just in
case something happens).
IV THERAPY INFUSION: Should be marked if the child/client has an

intravenous infusion for the administration of fluids to correct electrolyte
imbalance, medications or for hydration. The intravenous infusion includes
41
observation of the intravenous site for infiltration, dressing changes as needed
and monitoring the child/client’s input and output for dehydration or fluid
overload; or if the child/client has an intermittent Intravenous Infusion such as a
heparin lock which permits administration of periodic IV medications and solution
without continuous intravenous infusion. The heparin lock may be kept in place
for administration of long-term antibiotic therapy; or if the child/client has
“Piggyback” IV administration which is used to administer medication via the fluid
pathway of an established primary intravenous infusion line. Medication may be
given on an intermittent basis through the primary infusion line.
WOUND/SKIN CARE: Should be marked if he child/client has a wound/skin care

treatment plan established by a physician. Medical record must establish that a)
the physician or nurse has documented the presence of a wound; (b) a written
wound treatment plan has been developed; (c) progress notes indicating the
client’s response to treatment has been recorded by licensed nurses/or
physician, and the physician has documented periodic reassessment of the
status and treatment of the wound and determined the need for continued wound
care. Care of the skin/wound may be done by a health care professional or an
unlicensed person(s) that has been certified as being competent and has been
trained to correctly handle this procedure.
Example of some types of wound skin/care treatment(s) include:
a) Stage 3 and Stage 4 decubitus ulcers
b) Ostomies – gastrostomy, colostomy, ileostomy, uretorostomy,
cystostomy, tracheostomy, jejunostomy, ileostomy, tracheostomy
c) Central line dressing changes
d) Intravenous Infusion dressing changes
CATHETERIZATION/STERILE IRRIGATION: Should be marked if the

child/client has an indwelling catheter or needs intermittent catheterizations.
Intermittent catheterizations must be performed at least daily. This procedure is
being done by someone else other than child/client.
*Note: This section should not be marked if the child/client can self-catheterize
safely and has minimum history of urinary tract infections; if the child/client can
assemble supplies, and perform self-catheterization with little or minimum
physical assistance; or if the child/client can perform their own catheter care with
minimum or no physical assistance if an indwelling catheter is present.
DIALYSIS AT HOME (PERITONEAL): Should be marked if the child/client is

receiving Continuous Ambulatory Peritoneal Dialysis (CAPD) at home on a daily
basis.
TUBE FEEDING: Should be marked if the child/client is receiving foods, liquids

and/or medications through a nasogastric, orogastric tube, or by utilizing a g-
button, gastrostomy/jejunostomy tube that has been surgically inserted into the
stomach/jejunum through the abdominal wall for the administration of nutrients,
42
liquids, and medications. Nasogastric- and orogastric- tubes are usually short-
term; g-tubes/jejunostomy tubes and g-buttons are usually long-term. The
child/client must be receiving daily administration of foods, liquids and/or
medications by the tube, and the tube is being utilized as the primary source of
nutrition.
*Note: This section should not be marked if the child/client can manage their own
tube feedings with minimal or no physical assistance to set up equipment and
administer foods, nutrients, or medications through the tube; or if G-tube/button is
not used as the primary source of nutrition and oral intake is greater than 75% of
daily intake; nutritionist or physician has documented that child is receiving
adequate calories orally for weight gain; if the child/client is being weaned from a
feeding tube and is tolerating more than 75% of oral intake on a daily basis over
a trial period of three months; or if the child/client is only utilizing feeding tube
during an illness, but otherwise takes all foods orally. (Rationale: Most children
have significant decrease in oral intake during an acute phase of illness, and will
usually return to their regular daily caloric intake when they are feeling better.)
NASOPHARYNGEAL ASPIRATION AND THROAT SUCTIONING: Should be

marked if the child/client is receiving nasopharyngeal, tracheostomy or throat
suctioning and is being suctioned on at least a daily and frequent basis to
maintain patency of the airway, utilizing a suction machine with tubing, suction
catheters, and normal saline. Client may or may not be oxygenated. If
child/client is being oxygenated, the air is humidified.
*Note: This section should not be marked if the child/client is being suctioned by
bulb syringe only; or if the child/client is being suctioned less than daily.
UNSTABLE MEDICAL CONDITION REQUIRING CLINICAL MONITORING,

OBSERVATION AND INTERVENTION: This section should be marked if the
child/client is being clinically monitored. Clinical monitoring includes nursing
procedures emanating from the child/client’s diagnosis and medically unstable
condition and high risk condition(s). Examples of unstable medical condition
requiring clinical monitoring are active/terminal cancers receiving radiation and/or
chemotherapy or potent narcotics for pain management; post transplant with
complications; and Cerebrovascular Accident (CVA)/Stroke where the child/client
has severe ADL limitations (based on ADL criteria of Level of Care Document) as
a result of this injury. See LOC handout for further examples which may meet
this criteria.
*Note: This section should not be marked if he child/client has suffered a mild
stroke and has not lost ability to perform ADLs; or has shown significant
improvement and restoration to almost normal /normal level of functioning.
Child/client receiving OT/PT through the school system; if the child/client has no
treatment plan based on medical condition; or the child/client has suffered a
stroke in utero with minimal physical limitations and is functioning close to or at a
developmentally appropriate level (this includes corrected age for premature
43
children under age 2). Child may be receiving early intervention services that
include PT and/or OT and/or speech related to this condition or to another
existing condition.
NARCOTIC AND CONTROLLED SUBSTANCES: Should be marked if being

used for symptom control management including program designed by a
physician, registered nurse, for ongoing management of pain, nausea or other
disabling symptoms. The medical record must establish that a physician has
diagnosed a terminal illness/or need for ongoing pain management; medication
monitoring which require changes in dosages due to undesired side effects or
reactions. Care relative to these substances must require physician monitoring
through caregiver observations; a written symptom control treatment plan has
been developed; and the physician has documented periodic reassessment of
the status of the child/client’s medical condition as it relates to the symptom
control plan and made adjustments to the plan as necessary.
Click on the <Submit> button at the bottom of the page when complete.
Section 5-Activities of Daily Living

This section is Non-applicable for children 0-36 months
Mark the number which best represents the child/client’s functional ability in
Bathing, Dressing, Grooming, Eating, Transfers, Mobility, and Toileting.
44
Section 6- Other considerations
Mark the number that best represents the child/client’s other considerations in
Behavior (the ability to exhibit actions that are developmentally and socially
appropriate in the areas of independence, maturation, learning and social
responsibility, Communication (the ability to make oneself understood through
the use of words, sounds, signs, facial expressions, communication boards, or
other adaptive devices), Hearing (the ability to perceive sound, including by the
use of equipment such as hearing aids, cochlear implants, etc.), and Vision (the
ability to visualize or see, especially one's environment. This may include the
use of glasses, contacts, prisms, or other adaptive devices).
Services Coordinator after completion of the entire Level of Care Document will
route the Level of Care document, functional information gathered during the in-
person assessment and other documentation to HHS Central Office for a Nursing
Facility (NF) level of care determination.
Central Office staff will then complete the Section 8-Justification and
Certification section, after reviewing the functional information and will make the
Nursing Facility Level of Care Determination. Central Office staff will then notify
the Services Coordinator of the decision.
45
Adult/Aged Level of Care
The functional criteria form on CONNECT is the same or similar to the DSS-
14AD, Part B (depending on which version you use). Although you may have
filled in the hard copy DSS-14AD, Part B by hand you will need to completely and
accurately fill in the information on CONNECT as the CONNECT version of the
form is what will be viewed and/or evaluated by central office. The information
contained on CONNECT needs to justify the scores you selected as well as
support the LOC determination
To create an initial Level of Care for a child, click on the <Add> button from the
<Select Level of Care> link on the case page. This will create a new LOC form.
To create a Level of Care Document for the annual review, choose the most
recent LOC from the <Select Level of Care> screen. Do not choose the most
current LOC and edit this form. You will lose the history of reviews.
The Current LOC Document will come up. Next, click on the <Make a New
LOC> button on the top of the document. This will pull up a new LOC with the
previous LOC information allowing you to edit the information for the current
assessment without re-entering all of the data.
Each section on the Functional Criteria has an <Edit> button. Clicking on the
<Edit> button will pull up that section’s template on CONNECT and allow you to
enter information to complete the section.
46
The top portion contains information on the date and site of the evaluation and
the date of the LOC determination. You may chose to enter information in this
section now or you may chose to enter it at the end in the “Certification
Summary” section (those sections contain the same information and are linked
together so entering information in one section automatically populates the same
information in to the other section). To enter information in either of these two
sections you will need to click on the corresponding <Edit> button for the section.
Once you have clicked on <Edit> you should see a screen similar to the
following.
At Initial or Review select the appropriate option from the drop down list. At
Evaluation Location enter where you conducted the evaluation, e.g. office,
name of facility, or client’s home. At Evaluation Date enter the date you did the
evaluation. At Determination Date enter the date the LOC determination was
made. Click on <Submit> when you have completed this section to return to the
Adult Level of Care Document to select the next section to edit.
If the person is at a nursing facility under Medicaid payment and will be leaving
due to a waiver case opening then enter the last date of Medicaid payment to the
nursing facility (typically this will be the date of discharge). If the person is not at
a nursing facility under Medicaid payment do not enter a date.
Section 1- Activities of Daily Living
47
Complete this section for each ADL to document supporting information for the
score you select. In the description section you will need to, at a minimum,
briefly document what assistance is needed and why. The information should be
based on an individual’s needs rather than wants (someone wanting assistance
styling their hair as they like how a salon does it is not a deficit based on the
individual’s wants but would be a deficit if the client needs someone to style their
hair based on physical limitations which interfere with the individuals ability to do
it themselves). Provide enough information so a supervisor, central office staff,
or auditor reviewing the Functional Criteria on CONNECT will be able to
determine whether the client met LOC. Simply documenting “requires
assistance” is not acceptable.
Bathing should not be marked as a deficit unless the individual needs physical
assistance or supervision transferring in and/or out of the shower/tub or
cleansing all body parts and/or hair. Needing assistance with only scrubbing the
individuals back is not a bathing deficit. An individual going to the salon to get
their hair washed is not a bathing deficit unless the individual does so solely
because the individual is unable to wash their hair (e.g. if the person is able to
wash their hair but prefers the salon then there is no deficit for washing hair). If
the individual has assistive devices or equipment and can complete all bathing
tasks using the equipment, without the supervision or assistance of another
individual then the individual is independent with bathing. An example of
acceptable documentation is “needs assist of one in and out of tub due to partial
paralysis” – the description includes both what assistance is needed and why.
Dressing/Grooming should not be marked as a deficit unless the individual

needs physical assistance or supervision putting on and/or removing clothing
and/or to do routine daily personal hygiene. This should be marked as a deficit
if the individual needs assistance combing hair, brushing teeth, caring for
dentures, washing face and hands, and shaving. If the individual has assistive
devices or equipment and can complete all dressing and grooming tasks using
the equipment, without the supervision or assistance of another individual then
the individual is independent with dressing and grooming. There is not a deficit if
the individual needs help clipping nails as that is not a routine daily activity. If
the individual chooses to go to the salon to have their hair set when the individual
has the ability to do it themselves then it is not a grooming deficit. If a provider
assists with removing the individual’s clothing prior to bathing solely because of
convenience for the provider (the provider can do it quicker than the client) but
the client could do it on their own then it is not a deficit.
Mobility should not be marked as a deficit unless the individual needs

supervision or physical assistance to routinely move from place to place indoors
or outside. Examples of mobility deficits are if the individual needs supervision
using a walker (e.g. the person has dementia and needs supervision to prevent
them from wandering in to unsafe situations) or assistance to propel their
48
wheelchair. Needing assistance on uneven surfaces is not a deficit unless the
individual has to routinely encounter uneven surfaces. If the individual has
assistive devices or equipment and can complete all mobility tasks using the
equipment, without the supervision or assistance of another individual then the
individual is independent with mobility.
Continence should not be marked as a deficit unless the individual needs

supervision or physical assistance changing incontinence pads/briefs, cleansing,
and disposing of soiled articles; managing ostomy equipment; or self-
catheterizing. Do not record the same information under toileting. To mark both
continence and toileting the individual must need assistance with multiple tasks
related to continence and toileting to have a deficit with both ADL’s. It is not a
continence or toileting deficit if the individual is incontinent of bladder and/or
bowel if the individual can manage all related tasks independently.
Toileting should not be marked as a deficit unless the individual needs

supervision or physical assistance using the toilet, commode, bedpan, or urinal,
including transferring to and from the toilet, management of clothing and
cleansing.
Transferring should not be marked as a deficit unless the individual needs

routine supervision or physical assistance to move from one place to another,
including bed to chair and back and into and out of a vehicle. If the individual
only needs assistance in and out of a vehicle for occasional medical
appointments or shopping then it is not a deficit as it is not a routine task to meet
the condition as being an activity of daily living. If the individual has assistive
devices or equipment and can complete all mobility tasks using the equipment,
without the supervision or assistance of another individual then the individual is
independent with mobility.
After completing the description section you will select the button next to the
correct corresponding score (select by either using the tab key to get to the
correct “box” and then press the space bar or use your mouse to get the arrow to
the correct “box” and then right click with the mouse). Once you have entered all
information related to the ADL’s you will click on <Submit> at the end of the
section and you will be taken back to the Functional Criteria where you can
chose to edit the next section.
Section 2 – Risk Factors
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This section is to be completed to document any applicable risk factors. If no risk
factors are present, this section is not completed. Check each box for any
existing risk factors. It is required that you complete the comments area towards
the bottom to enter additional information to support any marked risk. A risk
should not be marked if the client is “at risk” or an intervention to address the risk
is not needed. Once all information is entered click on <Submit> and you will be
taken back to the Functional Criteria where you can edit additional sections.
Section 3 – Medical Treatment or Observation
Complete this section to document any applicable medical treatments or

observation. If no medical treatment or observations factors exist this section is
not completed. Check each box, in compliance with regulations, for each
applicable treatment or observation. Type in any notes in the “Comment” section
needed to explain or support items you’ve check. Once you have completed all
information for the section click on <Submit> to return to the Functional Criteria
page.
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Section 4 – Cognition
Complete this section to document any applicable cognition related issues.

Check each applicable box. It is required for documentation purposes that you
provide additional information in the “Description” sections to support or explain
any cognition related selections you marked. It is also a system requirement to
fill in information in the “Description” section because if you do not provide notes
in the description area an error message will show even though CONNECT will
allow the submission to go through.
Memory and Orientation are not to be marked as deficits unless there is a

dementia related diagnosis documented on CONNECT, a recent cognitive test
documented on CONNECT (such as the SLUMS, St. Louis University Mental
Status Exam) or another documented diagnosis impacting memory and/or
orientation and explained in the “Description” section. Solely checking “Memory”
without providing information such as a dementia diagnosis or other information
(e.g. the score from a mini-cognitive test) to corroborate the deficit is not
acceptable. It is not acceptable to mark Memory as a deficit solely because the
individual or a family member says they forget things, they have to make lists, or
they have short-term memory loss. If the individual or family indicates such
things and there is no supporting documentation then you need to administer the
SLUMS and if the scoring supports a deficit then document the score.
Communication is not to be marked unless information is provided to support

the person’s inability to understand information or to communicate information (if
the person has assistance devices, such as a hearing aid, and the person uses
the device and is able to hear adequately then it is not a communication deficit).
Not being able to speak English is not a communication deficit as Medicaid
providers are required to either be able to communicate with the individual
directly or utilize interpreters.
Judgment is not to be marked unless there is information provided on

CONNECT to support the individual has documented cognitive or mental
capacity limitations and is unable to make an informed decision. If an individual
has the capacity to make an informed decision (e.g. they understand the cause
and effect of their choice) and makes a choice that may be considered by some
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to be a poor choice that in and of itself is not a judgment deficit. It may become a
judgment issue if there is medical documentation that the choice resulted in
personal harm, e.g. a diabetic has no cognitive or mental capacity limitations but
has engaged in behavior exacerbating their diabetes to the point hospitalization
is required.
When you get to the below portion of this, if you mark a yes here and have no
diagnosis entered for a cognitive related disorder on the waiver case page you
will need to enter a cognitive testing score in the notes section as the Mini-Mental
is no longer allowed due to it being copyrighted. The cognitive test score should
be from the allowed SLUMS test (St. Louis University Mental Status Exam).
Certification Summary Section
If you have not already entered information for this section by completing the top
section of the Functional Criteria then you will need to enter the information now.
The Functional Criteria Eligibility section is automatically calculated by

CONNECT and will show the results for which LOC eligibility criteria is met, if
any. The bottom section will state whether NF criteria was or was not met. The
first example below shows that LOC was not met so you would need to send a
HHS-6 as instructed previously. The name of the services coordinator shows
and a signature line is available for the printer version.
52
This second examples shows NF LOC was met.
Once you have completed the LOC print off a hard copy for the file by clicking on
“Printer Friendly” towards the top of the screen. The SC who made the LOC
determination needs to sign the hard copy that is placed in the file.
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Adding, Editing and Finalizing Narratives
Contact with clients referred to or being served by waiver should be documented

in the narrative feature on CONNECT. The narrative needs to be complete to
show any and all contacts to support services coordination activities have
occurred. Any narrative entered on CONNECT has to be entered related to a
specific case. To add a narrative you need to be on the waiver case action page
and then click on <Select Narrative>.
After clicking on <Select Narrative> you will see a screen similar to the below. If
there are already narratives entered on the case you will see a list of those
narratives (as shown in the example below). Services coordination agency staff
will not have the Delete or unfinalize option as shown below as only certain staff
in central office will have that feature. Too create/add a new narrative you will
need to click on the <Add> button.
After clicking on the <Add> button you will see a screen similar to the below. At
this screen you will need to enter information in all mandatory fields (those fields
with an asterisk beside the field name).
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*Note: If you have multiple contacts on a case on the same day that have the
same type of contact and reason for contact you can enter those contacts on one
narrative. If you have multiple contacts on one date but the contacts are of
different types and for different reasons then you will need to compete a separate
narrative for each contact.
At “Date of Contact” it is mandatory that you enter the date of contact. “Start
Time” and “Stop Time” are not mandatory since you may be entering multiple
contacts in one narrative (see *Note above). At “Type of Contact” select one of
the following from the drop down list:
Administrative – select this for activities such as SC case consultation with the
supervisor
In person-client – select this for home or community visits with the client by the
SC or other SC agency staff
Other-Client – select this for any case contact with the client that does not match
any of the other choices listed
Other-Non-Client – select this for any case contact with someone other than the
client that does not match any of the other choices listed
Phone-Client – select this for any phone calls to or from the client
Phone-Other – select this for any phone calls to or from someone other than the
client
Writing-Client – select this when any written correspondence is sent to or from

the client
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At “Reason for Contact” select one of the following from the drop down list:
Annual Review – select this when the contact is for conducting and completing
the annual review
Initial Assessment – select this when the contact is related to any task, other than
scheduling, involved in conducting and completing the initial assessment
Intake – select this for any contact made during the waiver intake and waiver
referral phase for a case that will be pending or open on CONNECT (if the
person does not meet the initial criteria for the SC agency to accept a referral
then the individual, as well as any narratives, are not loaded on to CONNECT)
Monthly Contact – select this to document monthly contacts for the monitoring of
client
Ongoing – select this for any contact related to the activities for the case that do
not fit any other option
Reassessment – select this for activities, other than scheduling, related to doing
an annual review
Referral – select this for contacts related to referrals to other agencies, services
or providers
Scheduling Contact – select this for any contacts related to scheduling contact
with the client/guardian.
At “Place/Location of Contact” type in where the contact occurred, e.g. client’s

home, nursing facility, office, etc. At “Person Completing Contact” type in the
name of the person at the SC agency who did the contact. At “Primary Contact
with Whom” enter the name/title of person who was the focus of your contact,
e.g. Joe/client, guardian, Susie/provider, etc. At “Names/Titles of others
present during contact” type in, at minimum the name of any other essential
party present (e.g. if you met with the guardian but the client was also present
and the primary contact was the guardian then enter the name of the client in this
field).
At “Description of Contact” enter key information related to the content of the

contact that does not fit under “Goal Progress”, “Service Delivery
Monitoring” or “Further Follow-Up Needed”. There is no spell check feature
on CONNECT so you type the content in Microsoft Word and use the spell check
feature there and then cut and paste the content in to CONNECT. The “Goal
Progress” section is needed for programs other than waiver. For waiver cases
you can enter information in this section but it is required that the documentation
to support the monitoring of the POSS is required to be entered on the POSS.
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In the “Service Delivery Monitoring” section provide additional information not
on the POSS to document the ongoing monitoring of the services provided (e.g.
the services are occurring as authorized and identified in the plan, to identify
issues with the services, etc.) If you enter the information in the narrative then in
the POSS you need to refer to the specific narrative, if you enter the information
on the POSS then the narrative should refer to the POSS. If there are any
matters the SC (or other person making the contact) needs to follow up then
enter notes reflecting that in the “Further Follow-Up Needed” section.
Once all sections necessary are completed and you have reviewed the
information for accuracy click on <Submit> to save the narrative on CONNECT.
If you have not completed a mandatory section you will receive an error message
in a red box after clicking on <Submit> telling you what information needs to be
completed before CONNECT can save the narrative.
Once the narrative has been submitting successfully the final checkbox will be
enabled.
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*Note: Before clicking the “Final” box make sure all information is complete and
accurate as you will not have the ability to edit the information once the narrative
is finalized.
All narratives should be entered and finalized on CONNECT within 30 days of the
contact. A case can not be closed or transferred unless all narratives have been
finalized. If you have started a narrative and are unable to complete at that time
then you will need to click on <Submit> to save what you have so that you can
return to it later.
Viewing, Editing and Printing Existing Narratives
To view or edit an existing narrative (see *Note above - you can only edit an
existing narrative prior to it being finalized) click on the <Select Narrative> from
the waiver case screen. After clicking on <Select Narrative> you will see a
screen with a list of any existing narratives. If the narrative has not been finalized
you can edit the narrative by clicking on <Edit> (if it’s been finalized <Edit> will
not be available). To view the narrative you can either click on <View> or click
on the PDF icon next to the narrative you wish to view or edit (using the PDF icon
will show you the version of how it will look if the narrative is printed).
To print narratives you have the option to print one narrative, multiple narratives,
or all narratives. To print one narrative you can either click on the PDF icon or
check the box in the “Check to Print” column and then click on <Print Selected
Narratives>. If you want to print multiple narratives then place a check in the box
by each narrative you wish to print and the click on <Print Selected Narratives>.
If you wish to print all narratives you will not need to check any box as you can
simply click on <Print All Narratives> and you will get a separate window pop up
with a box asking you if you want to save or open the file and you will click on the
<Open> box. You will then get a PDF version of all the narratives together with
the most recent at the top. You will then click on the printer icon on that window
to print out the narratives.
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Adding and Editing an AD Waiver Worksheet
The waiver worksheet function is two-fold. The worksheet is used to document
the plan to provide specific Medicaid non-waiver and Medicaid waiver services
and to determine the estimated total monthly cost of the plan. The worksheet will
calculate the monthly costs for an individual and this will assist you in
determining if the individual can be served with a cost-effective plan (at or under
the established waiver cap).
Adding a Worksheet
Once you are in the individual’s waiver case click on <Select Worksheet>. Then
click on <Add> to create a new worksheet. A new waiver worksheet will need to
be added for every new eligibility period. Do not edit an existing worksheet for
a new eligibility period. If there are service changes not requiring a
reassessment, those changes can be made to the current worksheet (you can
choose to create a new worksheet for revisions but it is not required – keep in
mind creating a new worksheet will make you fill in everything rather than
carrying over the existing information so you can just make a change to a portion
of it).
Once you have clicked on <Add> the Aged and Disabled Medicaid Waiver
Worksheet (similar to below) will pop up in a separate window. To navigate
through the worksheet while entering information you can use the tab key to
move to the next
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field.
Adding Medicaid Non-Waiver Services to a Worksheet
Under the heading of Medicaid Non-Waiver Services you will enter specific
non-waiver services with costs that are to be included on the worksheet. Those
services to be included are home health aide, home health nursing, medical
transportation, personal attendant services or private duty nursing. To enter
those services under Service Type click on the u or use your keyboard arrow
keys to scroll through the options and select the appropriate service type (if the
individual is receiving more than one of the non-waiver services you will have to
complete the entire entry for the first service before adding an additional service).
At Prov Type or Name enter the name or the agency to provide the service. If
the name of the provider is not yet known, enter the provider type being recruited
and estimate the cost. Update this form when specific information is available.
At Number Units/Freq enter the number of units in the first box. In the next
field select the appropriate frequency (day, hrs. for hours, mi. for mile, occ. for
occurrence, ow for one way trip, or partial day). Regardless of the frequency
chosen, the system will calculate costs for a month. Example, if you have a
service 1 hour a day for $40 an hour, 5 days a week then enter 5 under number
to show the total hours per week (CONNECT doesn’t allow to break it down
further to 1 hour a day for 5 days a week so if the service isn’t daily you’ll need to
do some calculations to show the service as weekly), hours under unit, and $40
under unit cost to get the correct calculation of $860 a month.
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At Begin Date enter the date the service begins by using a 2 digit month, 2 digit
day and 4 digit year (mmddyyyy).
At End Date enter the last day of the service eligibility by again using a 2 digit
month, 2 digit day and 4 digit year (mmddyyyy) up to 12 months from the Begin
Date.
At Unit Cost enter the cost per unit of service.
When you have completed all the fields for the service click on <Add> or (recalc)
to enter the information in to CONNECT. The Mo. Cost field and the Est.
Monthly Medicaid Cost will be calculated automatically by CONNECT.
If you have additional non-waiver services to add you would repeat the above
steps.
To delete an entire line, click on <DEL> under Action (<DEL> will only show as
an option after you have either clicked on <ADD> or <(recalc).
If a service line is correctly entered, it appears outlined in green. If a service line

is incorrectly entered, it appears outlined in red. Hold the cursor over the “ * “ to
read the error message as shown below. To correct the error change the
information and then client on (recal) to have the information entered in to the
system.
End date is before begin date
Adding Medicaid Waiver Services to a Worksheet
Under the heading of Medicaid Waiver Services you will enter all Medicaid
Waiver Services, and related costs, the client will be receiving. Complete this
section following the same instructions provided under Adding Medicaid Non-
Waiver Services.
*Note: Back-up Plans and Informal Supports are to be reflected in the Plan of
Services and Supports and not in the waiver worksheet.
After you enter all waiver and non-waiver services you will need to add
information to justify if the cap is being exceeded and if approval for the
exception has been granted.
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You will also need to enter if the client has a monthly spend down (AKA share of
cost or payment on service). If the client does have a spend down you will need
to click on <recalc> after entering the amount in order to have the worksheet
incorporate the spend down.
You will also need to enter the client’s eligibility period (the eligibility period
cannot exceed 12 months and should coordinate with the reassessment, editing
the worksheet does not extend the eligibility period).
*Note: The following boxes are not used Inclusion of Assisted Living,
Assistive Equipment, Home Modification, Take Me Home
To View or Print a Client’s Worksheet
To view or print an existing worksheet you will first need to access the worksheet
by clicking on <Select Worksheet>.
After clicking on <Select Worksheet> you will see the above screen where you
will be able to view or print a worksheet. To view, click on <View> on the row
with the worksheet you wish to see. To print a copy of the worksheet click on the
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PDF form which will pop up the worksheet in a separate window, and then click
on the printer icon from the toolbar.
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Adding, Viewing or Printing a Client’s Service Needs
Page
On the <View Waiver Case Action> screen, click on <Service Needs>.
The <Service Needs> screen will be displayed similar to the below. On the
Service Needs form mark (by either using your mouse to move the cursor to a
box and then right clicking or by using your tab key to move from field to field and
then using the space bar to enter a check in a box) each service that the client
has been referred to, currently receives, needs but is not available, or the client
was referred to but the client declined the service. Most of the services listed are
self-explanatory but a few may be questionable so the following are definitions
for some of the services which may not be self-explanatory.
Assistive Technology - the purchase or lease of assistive technology devices and

any evaluation, technical assistance, training, etc., needed in able to utilize the
device and does not include home remodeling or modification as that is a
separate category.
Audiology/Hearing Services – the identification or evaluation of an auditory

impairment, provision of services for prevention of hearing loss, or referral for
medical or other services necessary for the habilitation or rehabilitation for those
with an auditory impairment.
CHIP – Comprehensive Health Insurance Pool is a non-profit program offering a

source of private insurance for persons who cannot purchase health insurance
because they are “uninsurable” due to health conditions or disabilities. Blue
Cross and Blue Shield of Nebraska administers the plan.
Health Insurance – check this related to insurance other than CHIP or Medicaid.
This may include a Medicare Supplemental Policy.
Health Services – includes services that are surgical or purely medical in nature
as well as devices necessary to control or treat a medical condition.
Home Modifications – remodeling or modifying of a home (the use of assistive

devices does not fall under this unless home remodeling or medications are
needed)
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Medical Occupational Therapy – occupation therapy not provided by the school
system and not part of the child’s IEP. This would include occupational therapy
for an adult or aged person.
Medical Physical Therapy – physical therapy not provided by the school system
and not part of the child’s IEP. This would include physical therapy for an adult
or aged person.
Medical Speech Language – speech language therapy not provided by the

school system and not part of the child’s IEP. This would include speech
language therapy for an adult or aged person.
Nursing Services – The assessment of health status for the purpose of providing
nursing care, the provision of nursing care and/or the administration of
medications, treatment, and regimens prescribed by a licensed physician.
Occupational Therapy – occupational therapy related to the school system (e.g.

special education or MIPS).
Physical Therapy – physical therapy related to the school system.
Rehabilitation Services – any rehabilitation services other than physical,

occupational or speech language therapy.
Safety – this should be checked when the client is in danger of loss or injury.
This would include such things as unsafe housing, abuse or neglect (APS/CPS
referrals) and domestic violence.
Special Instruction – the design of environments and activities that promote skills,
including cognitive processes and social interactions; curriculum planning for an
individualized plan; and providing families with information, skills, and support
related to enhancing skill development.
Speech Language Therapy – speech language therapy related to the school

system.
Training – training for adaptive equipment or training for a caregiver in

techniques or methods regarding the care of a person with special needs.
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Type-in any useful Notes. The latest note should be on top of any previous
notes. At the beginning type in the date and at end of note type in your name.
Recheck your entries, and click on <Submit>. .
Any time a new service is needed, a service is no longer being received, was
previously needed but not available and has now become available, or the client
had previously declined and now wishes to accept the service the Service
Needs form is to be updated on the CONNECT to reflect the change. This
information needs to be completed as the data gathered from this provides
valuable information. You will need to print a copy of the Service Needs sheet
when you initially complete it as well as when you make any changes to it. You
will print the sheet the way you print any item from the internet, such as clicking
on you print icon on your internet tool bar. CONNECT does not keep a separate
Service Needs sheet for each entry for a client but rather updates the existing
sheet but it will record the date in the upper right hand corner of when the sheet
was last updated (so no historical information will be available for each entry so
the only record that you have made prior entries will be from the copy in the
client’s file).
66
Adding and Completing a Local Level Complaint Form
The Complaint Process records problems and issues clients have with services
they receive and/or accessing services they have been authorized to receive that
are likely to result in actions against providers such as corrective action or
termination. Clients or their representatives may report complaints.
Each local agency/office providing Services Coordination and Resource

Development for waiver services will investigate and track complaints that are
likely to result in actions against providers. Complaints may be received either
verbally or in writing. Local agency/office staff must begin the investigation and
respond to the complainant either verbally or in writing within 7 working days.
Local agency/office staff must complete the investigation and take action to
resolve the complaint within 30 working days.
The Local Level Complaint form can be accessed from the QA tab or the Waiver
Case Page. To add a complaint from the QA tab, click on the <QA> tab from the
Welcome Page.
Then click on <Add New Complaint>
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A new window will appear and you will have to enter the Client ID or Name to
search and add a new complaint. Enter the Client ID, SSN, or Last Name and
then click on the button to display the client name. Then click on
<Add> to complete a new complaint form.
Search to add
by Client ID,
SSN, or Last
Name
The Local Level Complaint form can also be accessed from the Waiver Case
Page. To create a complaint form from the Waiver Case Page, click on <Add
New Complaint> at the top of the page.
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The <Local Level Complaint Form> screen will be displayed similar to the one
below. On the Complaint form complete the Provider ID section by filling in the
provider ID (N-FOCUS Provider ID # or Medicaid Provider ID for Assisted Living
Facilities) of the provider the complaint is to be reported against. If the provider
is the Services Coordinator, enter the Services Coordinator name. Next,
complete all fields related to the Source of the Complaint, Nature of the
Complaint, and Action Taken.
The Description of Complaint field must be completed providing additional

detail around the complaint and follow up action taken.
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Once you have completed all fields, click on the <Submit> button at the top of the
form.
If any fields have not been completed, you will receive an error message
informing you what needs to be completed. If an error message is displayed, the
FINAL checkbox will not be allowed until all errors have been corrected.
If an error message occurs, follow the instructions to complete the fields listed,
then click the <Submit> button again. When the form is complete and free of
errors, the Final Checkbox will be allowed. Click on the <FINAL > checkbox and
submit a final time. Once the form is finalized, no other edits will be allowed to
the form.
Make sure the
form is
complete and
accurate!
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The finalized version is now displayed. You now can print the complaint by
clicking on the icon at the top of the page. A new window will appear
and you can print from the new page.
You also will need to notify Central Office that a complaint has been completed. .
Click on the <Email Central Office> link and a new email window will appear.
Complete the message or type in your own message before sending the email.
You can notify Central Office at anytime during the investigation but you must
notify Central Office once the Local Level Complaint Form is finalized. You
will send the email once you click on the button at the bottom of the
page.
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Adding and Completing a Local Level Incident Form
The Incident Process records critical events or incidents. Critical events or

incidents are those events that bring harm or risk of harm to clients including
abuse, neglects, exploitation, or licensing violations. These events must be
reported to appropriate authorities to conduct follow-up action. Appropriate
authorities include Adult or Child Protective Services, Law Enforcement, and
Regulation and Licensure for licensed facilities. An incident may be received
from any source.
The Local Level Incident form can be accessed from the QA tab or the Waiver
Case Page. To add an incident from the QA tab, click on the <QA> tab from the
Welcome Page.
Then click on <Add New Incident>
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A new window will appear and you will have to enter the Client ID or Name to
search and add a new incident. Enter the Client ID, SSN, or Last Name and then
click on the button to display the client name. Then click on the
<Add> to complete a new incident form.
Click on Add
to complete a
new incident
form
The Local Level Incident form can also be accessed from the Waiver Case Page.
To create an incident form from the Waiver Case Page, click on <Add New
Incident> at the top of the page.
*Note: For incidents representing imminent (serious or life threatening) danger,

the local agency staff must begin completing the incident form and the local
supervisor must notify Central Office, by e-mail or phone of the report within 24
hours of the report. Central Office staff will review the incident with the
supervisor to determine if appropriate action is being taken.
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The <Local Level Incident Form> screen will be displayed similar to the one
below. Complete the Provider ID # if the incident involved a Waiver Services
provider. Next, complete all fields related to the Source of the Incident, Nature
of the Incident, Action Taken, and Waiver Resolution Activities.
The Action Taken refers to the appropriate authorities that must be reported to
for investigation. The Waiver Resolution Activities refer to the actions taken by
the Services Coordinator to determine whether the client’s Plan of Services and
Supports continues to ensure the health and safety of client after the incident.
The Further Details field must be completed providing additional detail around
the incident and Waiver action taken.
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Upon completion of these fields, click the <Submit> button at the top of the form
to check for errors and to enable the <Email Central Office> link to appear.
If any fields have not been completed, you will receive an error message
informing you what needs to be completed. If an error message occurs, follow
the instructions to complete the fields listed, then click the <Submit> button
again. When the form is complete and free of errors, you will need to notify
Central Office of the incident for review.
You can notify Central Office at anytime during the investigation but you must
notify Central Office for review of the incident within 15 working days of
completion of the waiver resolution activities. Click on the <Email Central
Office> link and a new email window will appear.
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You will send the email once you click on the button at the bottom of
the page.
Central Office staff will review the report within 30 working days upon receipt of
the notification. In order to determine if appropriate Waiver actions have been
taken, more information may be requested. Local agency/office staff has up to
15 working days to provide the information requested. Central Office staff will
then complete the State Oversight Review section and finalize the review.
Central Office staff will

finalize the Local Level
Incident Report
Central Office staff will notify the staff completing the incident form that the
incident has been finalized. The finalized version will now be displayed. You
now can print the incident form by clicking on the icon at the top of
the page. A new window will appear and you can print from this page.
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Adding and Editing Waiver Assisted Living Providers
Adding a Waiver Assisted Living Provider
From the Connect <Home> screen click on <Providers>. In the Assisted Living
section of CONNECT you can use the tab key, just as in other CONNECT area,
to move from field/blank to field/blank.
Then click on <Assisted Living Facilities>.
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A list of the current Assisted Living Facilities will then be alphabetically
displayed. Before entering a facility you will need to check the list to make sure
the facility has not already been entered by someone else. If the facility you wish
to add is not already displayed click on <Add New Office> located at the bottom
of the page.
The first section you will need to complete is the name and address of the
assisted living facility. At Office Provider Name type in the name of the facility
(be sure to use the correct name and spelling as others will be selecting from the
assisted livings entered in CONNECT when creating authorization). If you are
entering the name of a facility with multiple locations please use the “doing
business as” name rather than the corporate office name in order to distinguish
one facility from another (e.g. see the two listings above for Alpine Village).
At Address type in the address (physical address), using two lines if necessary
(the second line may be used to enter a post office box).
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Note: The physical address of where the services are being provided is
required. The <County> will be displayed automatically.
The next section (similar to the below) is the Additional Assisted Living
Facility Details where you’ll enter more specific information on the provider.
At the Nebraska Medicaid Provider Number type in the complete 11-digit

Medicaid provider number for the facility (you should be coordinating with the
staff in the HHSS Medicaid Provider Enrollment Unit as they will be entering the
provider on their system, C1, as well so they should be able to provide you with
the Medicaid provider number or you may get it from the provider or C1). If the
correct Medicaid Provider Number is not 11-digits then you will need to add
enough 0 (zeros) at the beginning to make the number 11-digits (if the number is
not 11-digits then any assisted living authorization for the facility will not print
correctly).
At the Assisted Living Facility Type choose the appropriate selection

(Freestanding if the facility is not attached to a nursing facility, Nursing Facility if
the facility is attached to a nursing facility or Trust Fund if the facility was built
using Trust Fund dollars from Nebraska Medicaid).
At Certification Effective Date type in the date the facility is certified as a

Medicaid Waiver provider.
*Note: This date is not changed at annual recertification.
At the Certification Through Date type in the end date of when the current
certification period ends (a recertification of the facility is to be done annually so
this date should be reflective of when an annual review is to be completed) or
when the provider requests to be terminated as a Medicaid Waiver provider.
*Note: This date is changed at annual recertification.
At Notes type in information that may be useful to you, e.g. number of licensed
beds (mandatory), changes in administration or other services provided with the
latest note on top. With each entry type-in the date and your name or initial.
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The next section is Office/Provider Contact. In this section you will enter the
facility representative’s name and contact information for the staff services
coordinators or resource developers will routinely communicate.
After you have completed all information click <Submit>. Make sure you only
click on <Submit> once and do not use the back button to avoid a duplicate entry
(if you end up with a duplicate entry, meaning the exact same provider is listed
twice, you will need to contact your central office contact person to have one of
the entries deleted).
*Note: If a facility changes names or ownership you will need to inactivate the
current provider and add a new. Enter an explanation in the discontinued facility’s
note section, including the date of the change in ownership and the new facilities
name along and/or ownership along with your name (e.g. 1/1/01 facility changed
to Times Square due to change in ownership, noted 1/2/01, Silly Sally, RD). You
can also note on the new facilities screen the facility’s prior name/ownership
information and prior Medicaid Provider #. Any time you make a change like this
you will need to inform all services coordinators with an active authorization for
the facility so they can terminate the current authorization and add a new one.
You will also need to coordinate with the central office Medicaid provider
enrollment and claims staff by sending them a copy of the new and terminated
authorizations.
Ending a Waiver Assisted Living Facility Provider
If the provider will no longer be a waiver facility, regardless of why, you will need
to inactivate the provider in CONNECT. After selecting the correct provider from
the provider list type information in the Notes section to explain why the facility is
ending as a waiver provider then click on <Deactivate Assisted Living Facility>.
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Once you click on <Deactivate Assisted Living Facility> a box will pop up to verify
you wish to deactivate in the facility as you will not be able to undo the action.
Once the facility is inactive it should appear similar to the below.
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Adding, Editing, or Viewing Assisted Living
Authorizations
To view the client’s authorization or to check whether the client has a current or
past authorization, click on <Select an Auth> from the <Waiver> screen.
If an authorization has been entered on the system it will show and you can click
on <View> to display the authorization screen.
A client may have multiple authorizations listed, each having a separate Auth ID
number. The most recent authorization is at the top.
Adding an Assisting Living Authorization
To Add a New Authorization from the “View Waiver Case Action” screen click on
<Select an Auth> and then on <Add New Authorization>. At the “Add Waiver
Authorization” screen click on <Search> to locate and select an assisted living
facility.
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At the “Search for Assisted Living Facility Provider for Authorization” screen
either type in the name of the provider (or at minimum the letter the facility name
starts with) or click on <Search> to see the entire alphabetic list of providers.
After locating the assisted living facility click on <Select AL Facility>.
After selecting a facility the <New Auth> screen will again be displayed with the
name and information of the facility inserted in to the authorization.
The next section to complete is the Authorization Information: MC-9AD. At

*Level select the appropriate level of care that matches the payment level for the
client (40 Rural Single, 41 Rural Multiple, 42 Urban Single or 43 Urban Multiple).
At Service Begin Date enter the day the client actually moved into the assisted
living facility, regardless of payment source. At Service End Date no date is
entered if the client is residing in the assisted living facility and is authorized for
waiver assisted living services. The only time a date will be entered in the
Service End Date is if/when you are terminating the waiver payment for the
client.
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At Waiver Payment Effective Date enter the date the client is eligible for waiver
assisted living services (the date Medicaid is to begin covering the assisted living
costs).
Once you have completed an authorization click on <Submit>. After clicking on

<Submit> then click on <Email Auth #>. This will create a pre-addressed e-mail
to the Medicaid claims staff and you will need to then access your e-mail system
to send the e-mail. This e-mail contains the authorization number and is to be
sent for any assisted living authorization (whether it’s a new authorization, an
amended authorization, or an ended authorization).
*Note: If the client moves from In-Home to Assisted Living or from Assisted
Living to In-Home, once you have completed creating or terminating the assisted
living authorization you must also edit the Living Status in the waiver case. To
edit the Living Status go in to the “Edit Waiver Case Action” screen. Change
the selection to the appropriate choice and then click on <Submit> to save the
change.
Editing a Waiver Assisted Living Authorization
To Edit an Assisted Living Authorization click on <Edit Auth> from the “Waiver
Authorization” screen.The <Edit Waiver Authorization> screen will be displayed.
Type-in the changes needed, such as changing information that was incorrectly
entered previously or to restart an authorization. If an assisted living changed
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ownership and the Medicaid provider number changed the new Medicaid
provider number will automatically be updated if the resource developer has
made the changes under the assisted living provider information. Check the box
to indicate if you are amending an existing authorization and type in Notes an
explanation (type in the date of the note at the beginning of the note and your
name or initials at the end of the note). Once you have completed any needed
changes click on <Submit>.
You will need to send copies to the parties indicated in the comments next to the
box you’ve checked. You will also need to notify the Medicaid Claims Payment
staff by notifying them of the amended authorization number electronically by
clicking on <Email Auth #> and following the process as previously instructed on
page 84.
To Close an existing authorization, at “Close Reason”, click on uand

click on the appropriate reason from the drop-down box.
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From the Close Reasonudrop-down box you will need to select one of the
following reasons:
Case Closed, Client Transferred To Another SC Agency-if the current

authorization is closing because the client’s case is being transferred and
another SC will be completing a new authorization
Client Declined Waiver Services – if the client chooses to discontinue AL but to
continue on MW with other services
Closing Requested – if the client chooses to discontinue waiver payment and

none of the other reasons apply
Death
Entered a Nursing Facility Long Term – if the client entered a nursing facility long
term so waiver had to close (do not select this if the client went to a nursing
home because no safe plan could be developed or because the client went short
term and the assisted living will still be paid as the individual is to return within 30
days)
Failure to notify-if the authorization is closing due to non-compliance by the AL

facility for notifying of an out of facility stay
Moved out of Nebraska
Moved to another AL Facility
No Longer Medicaid Eligible
No longer meets level of care
Plan cannot maintain health/welfare
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Returned Home – do not select this if the client returned for any of the above
reasons.
Click on <Submit>. The <Waiver Authorization> <View Auth> screen will be

displayed with the entered information.
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Closing or Denying a Waiver Case
The Denied field should be used when the initial determination is to deny a client
waiver eligibility; this is not to be used for an individual who already has an open
waiver case.
The Closed field should be used if you are closing an open waiver case (not
denying a case). The Closed field will only become available after an open date
has been entered and submitted. All narratives will need to be finalized before
you can close a waiver case.
To close or deny a waiver case click on <Edit Case> from the “View Waiver Case
Action” screen.
After clicking on <Edit Case> you should see a screen similar to the following
and you will need to enter either the date the case closure is effective in the
Closed field (if you are transferring a case to another SC agency enter the date
the receiving SC agency assumes responsibility for SC activities as the date for
closure) or the date the waiver eligibility was denied in the Denied field (this
should correspond with the date you sent a notice of action/HHS-6 to the
client/legal guardian).
You will also need to select a reason for the case closure or denial from the drop
down list. A selection will need to be made from one of the following choices:
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Cannot develop safe Plan – this can be used for an initial denial or to close an
ongoing case when services cannot be provided to meet the needs and safety of
the client
Client Declined Waiver Services - this can be used for both an initial denial or to
close an ongoing case, whether the client withdraws their application, declines
waiver services any time after a referral is accepted, or chooses to discontinue
waiver services after a case is opened and no other option applies (e.g. client
chose to discontinue waiver as choosing a nursing facility so you should select
Moved to nursing facility)
Consent Form has not been signed – this can only be selected for an initial case
as the consent is only signed at the beginning
Contact lost and whereabouts unknown
Death
Does not meet functional criteria – this can be used for an initial denial or to close
an ongoing case if the client does not meet level of care
Duplicate Case - if you have a duplicate case please check with your contact
person in central office first to determine whether the case should be deleted or
closed as only those cases which can’t be deleted should be closed with the
reason of Duplicate Case
Moved from Nebraska
Moved to nursing facility
Needed information has not been supplied
Needs met by another source - this can be used for an initial denial or to close an
ongoing case if the client met LOC but their needs are being met through another
source, such as informal supports or block grant services
No Waiver Service need – this can be used for an initial denial or to close an
ongoing case if the client meets level of care but will not need any waiver
services
Not Medicaid eligible – this could be used for an initial denial if the referral was
accepted and addressed while Medicaid was pending and then Medicaid was
denied or for an ongoing case when the Medicaid eligibility terminated
Plan not cost effective - this could be used for an initial denial or to close an
ongoing case if the services needed cannot be set up with the established cap.
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Priority ranking not met
Transfer to Another SC Agency – this is for an ongoing case when the individual
continues to meet LOC but is either moving to another SC agency area or is
transferring to a different population served by another SC agency
Unavailability of Waiver Slots
Once you have entered the closure date and reason, as well as any notes
appropriate to explain the action taken, you will then click on <Submit> or
<Submit and Create HHS-6> depending on the closure reason. If the client is to
continue on waiver but with a different SC agency then the CONNECT waiver
case assigned to you and your agency needs closed due to the case being
transferred then you will click on <Submit> to save the changes your entered, not
<Submit and Create HHS-6> as you will not be sending a notice of action since
the waiver case eligibility is to continue (see the following directions for
transferring a case for additional information on this topic). If the client’s waiver
eligibility is being discontinued for any reason (this does not include transferring a
case to a new SC agency as the waiver eligibility continues but the CONNECT
case for you and your agency would be closed) then click on <Submit and Create
HHS-6> to save the changes on CONNECT as well as generate a notice of
action.. For instructions on creating and completing the HHS-6 please refer to
page 30 of this manual.
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Transferring Cases and Clients
Transferring a Case to a Different Services Coordinator Within Your
Agency
If the client is transferred within the agency, then the Services Coordinator or
other approved staff will need to click on <(Transfer to Another Services
Coordinator)> from the “Edit Waiver Case Action” screen. The <(Transfer to
Another Services Coordinator)> option will not be available unless all narratives
for the case have been finalized.
You will then see a screen similar to the below where you will select the services
coordinator to receive the case.
Type in the last name of the Services Coordinator and then click on <Search> to
receive a screen similar to the below. The search may return more than one
name so after locating the correct name click on <Select>.
Transferring an Entire Caseload to a One of More Services Coordinators

Within Your Agency
Currently, MW staff do not have the ability to do this. If you wish to have an
entire caseload transferred ILCs please contact the HCBS Waiver Services Unit
contact and area agencies on aging contact Jodie Gibson at 402-471-8091as
they can transfer the entire caseload for you.
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Transferring a Case to a Services Coordinator at Another Agency
When the transition planning is complete between the current agency (e.g., LHD)
and the receiving agency (e.g., AAA), the current agency’s Service Coordinator
(or designated staff) will transfer the case/client on CONNECT by completing the
following actions:
1. The waiver case is closed on CONNECT by the current or “sending”

agency (instructions for closing a waiver case can be found on page
88). There may be one month during transition activities where both
the receiving and sending SC agencies are involved. Both agencies
will be able to bill for the waiver case and include the client in their
caseloads in the same month if service coordination activity was
involved during the month of transfer.
NOTE: The sending agency does not leave their waiver case open
for the receiving agency to use for CONNECT, the receiving agency
will open a new waiver case on CONNECT.
2. To transfer the client you need to click on <Edit Client> (not <Edit
Case>) from the “View Client Information” screen so that you can
unsponsor the client.
3. Unsponsor the client by clicking on <Unsponsor Client> (this option will

not appear if there are any narratives which have not been finalized).
While the client will now no longer be assigned to the sending agency
SC the closed waiver case will continue to be assigned to the sending
agency SC and SC agency.
In the <Notes> field, additional information can be entered such as the date
of the joint transfer meeting of both agencies.
Receiving a Case Transferred from Another Agency
When the transition planning is complete between the current agency (e.g., LHD)
and the agency (e.g., AAA) receiving the transfer, the receiving agency’s Service
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Coordinator (or designated staff) will open up a new waiver case (by using <Add
New Referral>) for the receiving agency by completing the following actions:
1. Open a new waiver case on the existing client (directions for adding an
AD waiver case can be found on page 23). This can be done if the
“sending” agency’s Service Coordinator is the client’s sponsor. During
transition, there can be 2 open cases attached to a single client. Both
the “sending” and “receiving” agencies can bill in the same month for the
same client during the transitional month.
At Referral Date, type in the date the client was referred from the
“sending” agency. Under Eligibility Status, in the Opened field type in
the date the case is opened for waiver with the receiving agency. This
can be on or after the Referral Date.
2. Sponsor the client once transferred (if the sending agency still shows as
the client sponsor then let your supervisor know so that the supervisor
can contact the sending agency to coordinate the needed change).
Directions for selecting a client sponsor can be found on page 17. After
sponsoring the client review the client information and make any needed
changes to update information.
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Billing for Services Coordination
MW billing on CONNECT provides the capability to electronically generate your
monthly Medicaid case management billing and report monthly case activity.
Some services coordination agencies can electronically submit their claims to the
Department of Health and Human Services System (DHHS) for payment and all
services coordination agencies use the monthly billing to submit their case
counts and activity.
General Billing Security
The billing system is a subprogram of CONNECT which is protected by

Guardian, a security system developed and owned by the State of Nebraska,
Department of Administrative Services (DAS), Division of Information
Management Services (IMS). Additional information regarding Guardian and
CONNECT security is addressed in the “Security” section of this manual.
As with all of CONNECT, MW Billing contains information which is confidential

and legally privileged. It is intended only for use by the individuals or entities
legally authorized and all information therein should be held in the strictest
confidence. Additionally, any disclosure, copying, printing, distribution or the
taking of any action in reliance on the contents of this information, other than that
which is pertinent to work assigned and authorized by the Nebraska Department
of Health and Human Services System (DHHS), is strictly prohibited.
MW Billing Overview
The success and effectiveness of the system depends to a large extent on

services coordinators’ timely and accurate entry of information into CONNECT.
CONNECT claims can only be generated based on information entered on
CONNECT. If you are doing June billing then all services coordination case
activities completed in June need to be on CONNECT in order to appear in the
billing.
Upon referral to MW, each client is assigned a services coordinator by the

responsible contracting agency/HHS service area. The services coordinator (or
agency designated staff) is responsible for accurately entering in CONNECT all
demographic and program information regarding each client. The aggregate of all
those clients is the services coordinator’s caseload.
For MW, CONNECT generates a contact list for billing purposes. The cases
appearing on the SC’s list will be those open during the billing month being
viewed. Each services coordination agency and/or supervisor should establish a
timeline for SC’s to complete and submit their billing (e.g. no sooner than the first
day of the following month and no later than the middle of the month following).
Each SC’s list is automatically routed to their supervisor when <Submit> is
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clicked (contact your central office contact person if it is not being routed
correctly). Once submitted, the claim items and completed billing can no longer
be edited by the SC unless returned by the supervisor.
The supervisor reviews and approves or deletes case lists submitted by his/her
agencies staff. The supervisor will need to determine if the information is not
complete or inaccurate. The supervisor can enter additional information or return
the services coordinator billing to the services coordinator for further review and
completion. Upon receipt of all services coordinators’ billing documents for the
agency, the supervisor submits the monthly claim/reports. The submission will
automatically be directed to the State Unit on Aging program coordinator for the
AAAs or the Waiver Units designated staff for the ILCs, as set up in the
CONNECT system.
Billing Roles
To facilitate the AD Waiver billing process, roles and responsibilities are

recognized and assigned with corresponding security and capabilities built in to
CONNECT. State Unit on Aging program coordinator for the AAAs or the Waiver
Unit’s designated staff for the ILCs will assign roles and security in the
CONNECT system so that the billing submissions will process as needed. The
“User ID” you enter when accessing CONNECT is tied to the the role and
security of the user. If changes are necessary please call your central office
contact person for assistance.
The CONNECT system allows supervisors and support staff to perform the SC
waiver billing duties on behalf of services coordinators assigned to them.
However, the expectation is that the SC will assume this duty as his/her
assurance that SC activities were performed as required in order to bill Medicaid.
There are four MW roles involved with billing, each with its own security and
responsibilities:
¾ MW SUPPORT STAFF are those who work for contracting agencies/HHS

but do not have caseloads assigned to them. However, they may perform
many of the billing functions on behalf of services coordinators. Therefore,
the billing system allows them to choose services coordinators to whom
they are assigned and perform billing functions just as the services
coordinators would.
¾ MW SERVICES COORDINATORS are responsible for MW cases assigned

to them. Those cases eligible for payment/reporting will appear on the
billing document for the month requested. When complete, coordinators
submit the document to their supervisors for review and approval.
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¾ MW SUPERVISORS are those to whom the services coordinators are
assigned in CONNECT. Supervisors receive Services Coordinators’
billing/reporting documents for completion and approval or return them to
the SC for completion and/or revision. Completed and approved claims are
consolidated by month and agency and submitted to the SUA program
coordinator for payment/reporting. Supervisors may also work with billings
for any of the Services Coordinators assigned to them in the same manner
as SCO Support Staff. A supervisor may also be a SC for a caseload of
clients and acts just as any other services coordinator for the billing on
those cases.
¾ MW PAYMENT MANAGER is for the central office staff responsible for

reviewing caseload billing submissions, the SUA program coordinator for
the AAAs billing and the designated Waiver Unit staff for the ILCs.
MW Billing Process
To access MW billing you must first log in to CONNECT (see instructions starting
on page 5 if you need assistance with logging in to CONNECT).
From the main menu you will need to click on <Billing>.
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After clicking on <Billing> you should see a screen similar to the following.
SC Billing
To initiate and complete SC billing for MW cases click on <SC> under Waiver
and a screen similar to the below should appear. From the screen below select
your agency and then click on <Submit>.
If you are a staff member approved by your agency to complete billing for a SC
click on <SC by staff>. A screen similar to the below should appear. You will
need to select the name of the SC you will be doing the billing for and then click
on <Submit>. After clicking on <Submit> the above screen may appear and you
would then select your agency and click <Submit>.
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Once the SC, and office if needed, is selected you should see a screen similar to
the following. If the Billing Month is not accurate you will need to select the
correct month and then click on <Submit> so CONNECT will retrieve and display
the information from the correct month. CONNECT Billing will always default
to the current month so if you are working on the previous month’s
billings, you will need to change the month.
This will pull a list of all the open MW cases during that month. For clients who
should be included in the billing for the month (those that you had contact with)
you will to enter a place of contact and the charge type in the appropriate boxes
by selecting the correct choice from the drop down list. For “Place” you will
select Home, Community or Office if you had contact during the month. For
“Charge Type” you will select ATO (select this if the case is only for Assistive
Technology and no other waiver services and it’s the initial month or the closing
month as services coordination can only be billed twice on an ATO case – and
the charge type should match the priority code entered for the case, i.e. if you are
billing an ATO charge then the priority code should be Assistive Technology
Only), NONE (select this if you did not have billable contact with the client or it’s
for ATO cases when it’s not the first or last month of the case), or Ongoing
(select this if you have a billable contact with the client and it is not an ATO
case). Any comments for a case the supervisor or central office staff may need
to know related to the billing should be included under notes.
Once you are finished selecting the place and charge type, and have double
checked to make sure you have not included someone who there was no billable
contact for, click on <Save> (you can return to this list to enter the place and
charge type for other clients if you do not complete all at one time). Once you
click on <Save> you will not be able to exclude that client for billing. If you
included a client in error you will need to let your supervisor know as the
supervisor can exclude or delete the person from the supervisors list. Once
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you’ve clicked on <Save> your supervisor will be able to retrieve your billings to
process and submit the entire agencies MW billing to central office.
Note: To reveal more information about the client, simply pass the cursor over
the name without clicking. When you’ve filled-in all the information, for all the
clients, listed on the <SCO Billing Services Coordinators Review> screen, click
on <Submit>.
Supervisor Review and Submission
The supervisor is responsible for reviewing all claims prior to submission to

central office. Once each SC has processed their billing all the MW billing
information is included in the Waiver Supervisor’s billing review. If the supervisor
had any open cases with billable contacts he/she will need to complete the SC
billing for those clients as well as the supervisory billing.
By signing into CONNECT with your supervisor name, you will have access
appropriate for supervisors. At the CONNECT home screen, click on <Billing>
and under Waiver click on <Supervisor>.
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Once you click on <Supervisor> you should see a screen similar to the below.
The <Waiver Supervisor Billing Overview> screen (above) will provide a list of
months with “outstanding claims” that have been submitted to the supervisor.
The list for each month is a total of all pending MW bills for all staff tied to the
supervisor. If the month you wish to process shows then click on <Select> to
retrieve the information for the month you want to review. If the month you wish
to process does not show in the list already you will need to click on <Create
New Batch for Waiver Office> towards the bottom of the screen (the link should
have your AAA as the option available to you). Clicking on <Create New Batch
for Waiver Office> will pull back any months, such as the current billing month to
be processed, that have not been processed before. Once you have clicked on
<Select> or <Create New Batch for Waiver Office> you should receive a list of
MW clients similar to the below format.
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The list should include all pending, open and closed cases during that month for
your SCs for the month you are viewing as well as unbilled ones from past
months. You will need to review and check all claims to be included in the billing.
Any billing not checked/included will be returned to the SC’s billing list once you
click on <Submit>. You may also click on <NOTES> to type-in any information
that would be useful to the DHHS payment staff or to the SC if you will be
returning the item. This field is not limited to the space that appears on the
screen. If a claim is returned to the SC the SC can take action and then you can
go back in to the above screen and check the claim to be included in billing for
the month, if you have not already completed the steps below to <Submit this
Batch to Manager> (the designated central office staff for your agency). If you
did not add the claim prior to submitting the batch to central office you’ll have the
option to include the case in the next month’s billing. To accurately reflect your
agency’s activities for the month all cases should be included in the billing, it
should only be a rare exception when a case contact is not billed during the
correct month (e.g. on an open case the SC had contact in June 2007 and the
June contact should be including in the June 2007 billing, not a later month such
as July 2007).
*Do not click on <Delete> unless you want to remove the line/claim from all future
payment consideration. If you click on <Delete> you will have to take additional
steps, to be discussed later, in order to create a contact for billing to submit the
claim to central office.
When you have finished selecting all claims to be included click on <Submit> and
you should see a screen formatted similar to the following.
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If you wish to go back to make any changes on individual claims you can do so
prior to submitting it for payment by clicking on <Work with this Batch>. When
you have determined the billing is complete and accurate and you will not need
to make any further changes you may want to print and copy (see NOTE below)
and then you will submit it by clicking on <Submit this Batch to Agency> if you
are an ILC or <Submit this Batch to Manager> if you are a HHS office or an AAA.
When a supervisor with an ILC clicks on the <Submit this Batch to Agency> it will
go to the ILC’s agency contact. When a supervisor with an AAA or HHS office
clicks on the <Submit this Batch to the Manager> it will be submitted to the
DHHS Central Office billing contact. If you detect an error after you have
submitted it, the ILC’s will need to contact their agency billing contact and the
AAAs will need to call their central office contact person for billing.
For the ILC, once the supervisor has submitted the billing, the ILC agency billing
manager will need to click on <Merge> link, select the batch to work with and
follow steps outlined above.
The agency billing manager will then click on <Submit this Batch to Manager> for
submission to the DHHS Central Office billing contact.
NOTE: After clicking <Submit> you cannot retrieve or recreate the billing/activity
report. If you wish to have a copy of the monthly billing as shown above you will
need to print it prior to submitting. A report for information about claims
submitted and processed can be generated through Answers.
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Quality Assurance Supervisory File Review
The purpose of the HCBS Waivers’ Quality Assurance System is to ensure the
health and well-being of clients through continuous client focused monitoring and
improvement by implementing and sustaining a quality management system.
All HCBS Waivers’ Supervisors (or designated staff) are required to complete a
review of Services Coordination and Resource Development files on an on-going
basis. Supervisors will be required to complete the “Waiver QA File Review”
form on CONNECT for each file reviewed.
Accessing the QA File Review Form
From the CONNECT home page, click on the QA tab. This will bring up a new
window.
Now choose the Section you want to review. If you will be completing a new
form for the file review, click on <New Section A>. If you are returning to a form
that was previously started, click on <Section A Search>. A Section A form must
be added for the client chosen for review before a Section B or Section C form
can be created.
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You can search for the client chosen for review either by Client ID, Social
Security Number, or Last Name. After entering the Client ID, Social Security
Number, or Last Name, click on the Search button to pull up the client’s name.
Once the client’s name is displayed, choose either the <ADD Initial File Review>
or <ADD Ongoing File Review>. An initial file is defined as the first year of
waiver eligibility determination OR a case re-opened for waiver after the case has
been closed and a new referral date is in place. An on-going file is defined as
completion of at least one annual review and continuing to receive on-going
service provision.
Don’t forget to
click on the
“Search”
Initial File Review Ongoing File Review
Once a Section A File Review Form is finalized, a Section B (Resource

Development) and Section C (Service Utilization) can be completed. Section B
and C can also be accessed from the QA page or from the client page. From the
QA page, click on <New Section B> or <New Section C>. You will need to enter
client information on the next page as you did for a Section A search. Click on
<Add> to access a new Section B or Section C.
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Completing the QA File Review Form
Now that you have chosen the client whose file is to be reviewed and have
opened the Section A form, you are ready to complete the form. You can view
the form standard by standard so that is in not so long or you can show all of the
standards to be completed. Click on the Standard you would like to display or
click on <Show All Standards> to view the form in its entirety. After you have
chosen what standards to display, click on the <Show> button to display those
standards.
Click here to
display the
entire form
If the review is part of the review of client names provided from Central Office for
the Supervisory Review, leave the box next to “Supervisory Quality Management
Review” checked. If the review is part of the local office quality management
process and the files reviewed are separate from those provided by Central
Office, uncheck this box. This will allow reports to be run for the Supervisory
Quality Management Review and for the local office reviews.
105
Next, in the text box, list all of the providers that are authorized and providing
services to the client.
Click “Show” (above)

after choosing the
services for the
changes to be saved
Now, choose (by clicking the box in front of the service) the services that the
client is authorized to receive. Click on the <Show> button for the services to be
saved. You are now ready to begin completing the indicators for each of the
standards.
106
Complete each indicator by choosing “Y” for Yes, “N” for No, or “NA” if the
indicator does not apply to the client file chosen for review. Section A must be
completed for the current eligibility period for each client file selected by Central
Office. Click on the “Help” bubble if you are unsure how to complete the
indicator. The “Help” bubble information will appear in a new window so you
must allow pop-ups for the help function to display. Comments related to the file
review and indicator can be entered into the “Comments” textbox. Strengths
identified during the review related to the indicator are entered into the
“Strengths” textbox.
Once all of the indicators have been completed, click on the “Submit” button at
the top of the page. The form will now display the “results” of the review.
Click here to
view results
107
The form will now display all of the indicators with the results. Those indicators
that were not completed correctly will be highlighted red. These indicators will
need to be corrected before the review can be finalized. Indicators that were
answered with a “Yes” or “NA” will be highlighted green. These indicators reflect
that the standard has been met and require no further action. Indicators that
were answered “No” will be highlighted blue. These indicators reflect that the
standard was not met and require remediation/supervisory follow up.
Remediation
Action
Required
Will need to
be corrected
In addition to results of the review being displayed, a “Remediation/Supervisory

Action” text box will appear. A listing of Indicators requiring Supervisory follow up
will also display.
Will not appear
until after the
“Submit” button
is clicked
Follow up action must be taken if there are any “No” responses and must occur
within thirty (30) calendar days from date of review. Indications of abuse,
neglect, exploitation, and client safety risks with no indication that a referral,
investigation and/or action occurred to address the problem must be followed up
on immediately with the Services Coordinator or Resource Developer. Follow up
action must be recorded in the “Remediation/Supervisory Action” Section. After
the remediation/supervisory action is recorded, click on the “Submit” button at the
top of the page for the action to be saved. This will allow the review to be
finalized.
108
Finalizing the QA File Review
Once all errors have been corrected and the remediation/supervisory actions are
documented, the review can be finalized. Once the review is finalized, no other
edits will be allowed to the review.
Now that Section A has been finalized for the client review, Section B and
Section C can be completed. Section B must be completed for the current
authorization period for all of the providers authorized to provide services for the
client and the provider contract is maintained by the agency completing the
review. Section C must be completed by reviewing the authorizations/
timesheets/billings for all of the providers authorized to provide services for the
selected client during the specified month. Section C is completed for clients
receiving in-home services only. Section B and C are completed following the
same steps as for Section A.
Emailing Central Office
You have the option of notifying Central Office Staff when you have completed
any sections of the review. The “Email Central Office” link will appear after the
first “save” (clicking on “Show” or “Submit”). Click on <Email Central Office (new
window)> and a new email window will appear.
You must have an
email address loaded
in CONNECT for this
function to work
109
A message can be sent to Central Office Staff anytime during the review.
Printer Friendly Options
The CONNECT application of the QA File Review allows the supervisor the
option of printing blank forms to assist in the process of completing the review. A
blank file review form can be printed by clicking on <Print Form>. A new window
will appear and you can print from this window.
All of the “Help” bubble instructions can be printed in one document by clicking
on the <View Section Instructions> and choosing the print option from the
window displayed. The Section Instructions can also be used as a worksheet to
assist in completing the review.
110
The CMS Assurances and Nebraska Client Outcomes can also be viewed and
printed from the CONNECT File Review form.
Lastly, CONNECT allows you to print the finalized review. This option is not
available until the “Final” Checkbox has been marked and submitted. Once the
review is finalized, <Print PDF> icon will appear. By clicking on this icon, the
finalized review will display in a new window and you can print the review by
choosing the print option in the new window.
This icon will not

display until the
review is finalized
For technical assistance regarding the QA Supervisory File Review or the

application in CONNECT, contact the HCBS Waiver Services Unit Program
Specialist handling the CONNECT QA reviews.
111
CONNECT Reports
Each waiver supervisor (or other designated waiver staff given access by the
supervisor) has access to CONNECT reports. Through the Dashboard,
supervisors can view and run existing reports. In addition, supervisors also have
the ability to create reports.
You can access CONNECT reports/Dashboards through two avenues. One

avenue is after you log on you can click on <CONNECT Reports> from the
applications list OR
you can click on <Reports> from the CONNECT home page.
After accessing reports through either avenue you should be taken to the Oracle
Dashboard page where all reports are located. Your Dashboard page may not
look the same as the following as you can set it to open to a certain page each
time you get in to reports.
112
Running and Viewing Reports
Reports on CONNECT are generated and stored under topics listed on the top of
the page. The waiver reports are located under <Waiver>. By clicking on
Waiver you should be taken to the Waiver page (the page may no longer look the
same as the format and content may change over time but you’ll know you are
on the Waiver page as long as it says Waiver in the upper left hand corner).
General information, changes to the system, and other things such as hints will
be placed at the top of the page.
Three reports are set up to run automatically when the waiver office and/or
Services Coordinator are chosen. These reports are: “60 Days or Less Until
Review,” Pending Over 14 Days,” and “Transition Planning At 3, 18, & 65.”
These reports serve as “Alerts” to remind staff of cases that are coming up for
review (or overdue), cases that are still in pending status, and clients who are
approaching transition planning and require transition planning.
113
To access these reports from the “Home page,” select the Waiver office and/or
Services Coordinator’s name from the drop down boxes titled “Waiver Office
Name” and “Case SC Name.” You have the option of viewing these reports for
all waiver offices, one waiver office, or one waiver office/Services Coordinator.
After selecting the waiver office and/or Services Coordinator name, click the
<Go> button. This is an important step to ensure the report runs accurately.
Lastly, click on the <Check Case Status> tab. The three reports will
automatically run and display the results for the criteria chosen.
114
The Waiver Dashboard also provides reports which are already written.
Supervisors have the option of viewing these reports with statewide data or
limiting the reports to display specific Waiver Agency/Services Coordinator data.
To view the statewide data for the reports, simply click on the report title. The
report will automatically run and display statewide data.
115
To limit these reports to a specific Waiver office/Services Coordinator, click on
the Waiver office name/Service Coordinator from the drop down boxes titled
“Waiver Office Name”/”Case SC Name”
Next, click on the <Go> button. Then choose the report you wish to run. The
report will run and display in a new window.
116
Once a report is run, it will display the first 25 records for the report. If a report
contains more that 25 lines of data, you will need to display all results. To view
all of the records for the report, click on the “All Pages” navigation button at the
bottom of the page. This button is a forward arrow with an asterisk next to it.
Clicking on this page will ensure that all of the data will be displayed when the
report is printed. To print the report, click on the <Print> option at the bottom of
the page.
Writing Reports
In addition to running and viewing already written reports, supervisors (or other
designated waiver staff given access by central office approval at the
supervisor’s request) also have the ability to create reports. To begin creating
reports, you must first access the Oracle Dashboard using the directions listed at
the beginning of this chapter. After accessing the Oracle Dashboard, click on
<Answers> at the top right hand of the page. This will take you to the start page
for Answers.
Next, click on the <CONNECT Waiver> option in the subject areas box. This will
take you to the <Criteria> page which is where you will begin creating your report
by determining the fields, data, and parameters of your report.
117
On the left side of the Criteria page is the selection pane (this is the listing of all
of the fields from which data can be pulled from the CONNECT database). By
clicking on the + tab next to each field, you will see the expanded options from
that field. Click on the column name in the selection pane to add the data from
that field to your report. As you can see below, Program Type was chosen from
the selection pane and that field pre-populated on the right hand side of the
window. Program Type will now display in the first column of your report.
To edit a column’s format, formula, or filter, click on the buttons below the name
of the column. For this example, you will set a filter to limit the data based on the
criteria you select. To filter the data, click on the filter button under program
type. A “Create Filter” window will display. Click on <All Choices> and all the
program types which you can choose from will display. Click on the program
type you which to see data around, in this case “ATP” (you have the ability to
include multiple choices). ATP will pre-populate in the Value field on the left
hand side of the window. Your report will now display only cases which are
categorized as ATP in CONNECT.
118
Now choose other columns from the selection pane that you would like to view
data on. For this example, click on “Waiver Office Name” (or EDN Office Name)
by expanding the “Case Office” column from the selection pane. Using the
directions above, filter the “Waiver Office Name” (or EDN Office Name) to your
Agency. Next click on “Client Name” by expanding the “Client” column from the
selection pane. Lastly, click on “# Clients” by expanding the “Counts” column
from the selection pane. Your screen should look similar to this:
The filters you have chosen to limit the data are listed under the Filter title on the
Criteria page.
You also can sort information in the column by clicking on the arrow button
next to the column title. You can choose to sort the data by ascending or
descending order.
You can also set prompts in reports which will allow you to select only certain
values for specific columns when running a report. You have the options
available for a prompt as you do for a filter, the difference is the filter is set
permanently set in the report criteria when you create the report (you can go
back and edit the criteria of a report later if you chose) while a prompt lets you
select which column you want “filter” while selecting the value you want to use
when running the report. Prompts may be helpful to you if you have a report
you’d like to run separately for each services coordinator, such as a case list.
119
The following is an example of creating a prompt for services coordinators in a
report to run a case list. After all the columns/fields have been added (or at least
the column you wish to create a prompt for) you will the click on the Prompts
tab.
After clicking on the Prompts tab you should see a screen similar to the following
where you will then set the prompt. Click on <Create Prompt> to get the options
as shown below. Click on “Column Filter Prompt” to be able to set a prompt
based on the columns you’ve added to the report criteria.
120
If you want to select a prompt to be able to run the report for different SC’s you
would select the “Case SC Name” column from the drop down list (only the
names of columns you have included in the criteria will show in the list). You will
also need to select the operation you wish to use, “is equal to/is in” is the default
setting and will only include the data for that SC. In the next section, leaving the
radio button selection on “Select it from a drop down list” will have the prompt
show you a list of SC’s to choose from when you go to run the report. In the next
section, leaving the radio button selection on “All Values” will show all the SC’s in
CONNECT but changing the selection to “Limited Values” by click on that radio
button will mean at the prompt in the report you will only see the SC’s you
supervise or aide in the drop down list. In the next section you can check “Allow
user to skip prompt” if you may want to sometime run the report for all SCs at
once but sometimes only for one SC at other times. When you are done setting
the prompt options click on <OK>. If you wish to set any additional prompts for
other columns repeat the above steps.
121
You can edit or the delete prompts from the “Prompts” tab. To delete a prompt
click on the button. To edit a prompt click on the button to get the
“Column Filter Prompt Properties” pop up. To change the order in which the
prompts appear click on the buttons to move them to up or down.
Once you have chosen all of the parameters for your report, you are ready to run
the report and display the results. You can run the results by clicking the
<Display Results> button under the column listings or clicking the “Results” tab at
the top of the page.
The report will display in the “Compound Layout” results view. You can print this
report by clicking on the picture of the printer in the right hand corner of the page.
You can also save this report by clicking on the picture of the disc in the right
hand corner. You can also download the data in to Excel by clicking on
<Download>. To download then data to Excel you can select either “Download
to Excel” or “Download Data”. Either option will work but they will be downloaded
using different formats so you’ll have to decide if you prefer one over the other.
122
When you click on the save button, a new window will appear titled “Create
Folder.” All of the reports you create will need to be saved to “My Folder”.
Reports saved in “My Folder” can only be accessed by you. Complete the
Name field and click <OK>. The description field is optional.
You have now created a report which will appear in the selection pane under “My
Folder” the next time you open Answers. You can run this report by clicking on
the title of the report from the selection pane.
123
Technical Information
Location of Information:
The CONNECT computer program and the client, provider, and Service
Coordinator information included in CONNECT is located on a server owned by
the State of Nebraska and located in Lincoln, NE.
Computer Language:
CONNECT is written in a common Internet programming language, Java. The
user interface is implemented using hypertext markup language (HTML) and
JavaScript.
Computer Hardware:
Since CONNECT is written in a commonly used Internet computer language the
Program is available to anyone who has capability to "surf" the Internet and has
the authority to obtain access to the website which hosts Connect. This includes
all makes and brands of computers. You must have at least a 56K modem
installed on your computer unless you have a direct internet line connection (all
State of Nebraska offices/staff and most of the Area Agencies on Aging have a
direct connection to the State of Nebraska Computers). Your computer must be
capable of at least 133 MHz processing speed. Most of the new computers sold
since 1996 were this fast or faster.
Monitor Screen Settings:
CONNECT is designed to fit on a 800x600 pixels display. This is the minimum

size recommendation. Any monitor set for a 640x480 size will require scrolling
from left to right and right to left in order to view CONNECT.
The following shows the monitor size, the default setting and the maximum (for
some models):
Size: Default Max
14" 640 x 480 800 x 600
15" 800 x 600 1024 x 768
17" 1024 x 768 1152 x 864
19" 1152 x 864 1280 x 1024
As can be seen, 800 x 600 is at the low end of the size spectrum. Most
manufacturers don't sell 14" monitors anymore. Most 14" monitors can be set for
800 x 600.
Most NT operating systems (required to operate N-Focus) already have the

monitor sized for 800x600 pixels. If a monitor can be resized depends on the
make and model of the monitor and the video card installed. Most Windows
systems can be resized by the user. We have experienced one N-focus user
with an NT operating system where a technician was required to resize the
monitor on-site.
124
Internet Service Provider:
The user must also have a way to connect to the Internet. The most common
way has been through telephone lines using a computer modem. Providers
include America Online, Alltel, SWnebr.net, EarthLink, and Internet.com, etc.
There are also direct connect services which can be through cable TV cable like
Road Runner (in Lincoln) or through a dedicated telephone line (ISDN and ADSL
lines), etc. The user must have the ability to use the Internet, "surf the net",
through this provider. Some providers will allow messaging/mail for free or a
very small fee but will charge for internet use. The software you need to use for
CONNECT is listed below. A contact may be needed with your internet Services
Provider to enable to use the software listed below with their services.
Software:
The user must have a computer program installed on his/her computer, which will
provide the ability to search the World Wide Web. This software is called a
browser. Microsoft Internet Explorer (version 5.5 or higher) is the standard
browser for the use with CONNECT. Other browsers may work, but they may
not work as well. If Netscape is your preferred browser, it is recommended that
you use version 6.2 or higher. Version 4.XX of Netscape does not render the
pages as nicely as the other browsers. Whichever browser is used, the browser
software must have the ability to accommodate 128 bit encryption.
HHS users have Microsoft Internet Explorer 5.0 higher already installed on their
computer. This is free software that can be downloaded by non DHHS users
from a number of sources including many Internet Service Providers. The
following are Internet sites from which Microsoft Internet Explorer can be
downloaded:
http://www.microsoft.com/windows/ie/default.asp (for windows)

http://www.microsoft.com/mac/products/ie/ie_default.asp (for Mac)
Link Your Internet Mail Provider to CONNECT:
Following these instructions will enable sending a note by clicking on the email
addresses of Services Coordinators while using the CONNECT database.
This function can use Lotus Notes or any other Mail Provider the User has active
to send a message to the "owner" of the case while in CONNECT:
Open Microsoft Internet Explorer (your usual home page or CONNECT will do).
<Tools> at the top of the screen
<Internet Options>
125
<Programs>
Click on the arrow to the right of the "e-mail" line
Select "Lotus Notes" or your usual Internet Provider.
(the internet provider you use to send messages should
appear in the window)
<Apply>
<OK>
The next time you are into the internet, you can send a note by clicking on the
email address listed as the case owner in CONNECT.
126

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CONNECT Manual for the Medicaid Aged and Disabled

Let’s Get Started and Getting in to the CONNECT System .................................. 5

Helpful Hints ......................................................................................................... 9

General Security Information .............................................................................. 10

Adding a Client to CONNECT ............................................................................. 11

When the Client is Already in CONNECT .................................................12

When the Client is Not Already in CONNECT ..........................................14

Emergency Contact ..................................................................................17

Selecting a Client Sponsor .......................................................................17

Transferring the Client to a Different Sponsor/Services Coordinator ........18

Add an Authorized Representative to Client’s General information ..........19

Edit a Client’s General Information ...........................................................20

Adding an AD Waiver Case ................................................................................ 23

Adding, Completing and Viewing a HHS-6 Notice .............................................. 34

Adding a HHS-6 Notice ............................................................................34

Finalizing and Printing the HHS-6.............................................................36

Viewing a HHS-6 ......................................................................................38

Children’s Level of Care................................................................................ 39

Adult/Aged Level of Care .............................................................................. 46

Adding, Editing, and Finalizing Narratives .......................................................... 54

Adding an AD Waiver Worksheet ....................................................................... 59

Adding Medicaid Non-Waiver Services to a Worksheet ...........................60

Adding Medicaid Waiver Services to a Worksheet ...................................61

To View of Print a Client’s Worksheet ......................................................62

Adding, Viewing, or Printing a Client’s Service Needs Page............................... 64

Adding and Completing a Local Level Complaint Form ...................................... 67

Adding and Completing a Local Level Incident Form.......................................... 72

Adding and Editing Waiver Assisted Living Providers ........................................ 77

Adding a Waiver Assisted Living Provider ................................................77

Ending a Waiver Assisted Living Provider ................................................80

Adding, Editing, or Viewing Assisted Living Authorizations................................. 82

Adding an Assisted Living Authorization...................................................82

Editing a Waiver Assisted Living Authorization.........................................84

Closing or Denying a Waiver Case ..................................................................... 88

Transferring Cases and Clients .......................................................................... 91

Transferring an Entire Caseload to a One of More Services Coordinators

Transferring A Case to a Services Coordinator at Another Agency..............92

Receiving a Case Transferred from Another Agency ...................................92

Billing for Services Coordination ......................................................................... 94

Supervisor Review and Submission ........................................................99

Quality Assurance Supervisory File Review ..................................................... 103

Accessing the QA File Review Form ......................................................103

Completing the QA File Review Form ....................................................105

Finalizing the QA File Review.................................................................109

E-mailing Central Office..........................................................................109

Printer Friendly Options..........................................................................110

CONNECT Reports........................................................................................... 112

Technical Information........................................................................................ 124

CONNECT (Coordinating Options in Nebraska’s Network Through Effective

CONNECT is an evolving system. Enhancements will be developed so that

For questions, problems or deletion requests related to CONNECT please

Getting in to the CONNECT System

You’ll access CONNECT through the internet by typing in the following

Never use your browser’s back arrow to exit a page.

Never Double Click the on the

Click on < Home> or to return to the CONNECT main

General Security Information

You should then be taken to a screen similar to the following.

1 Early Development Network

3 Medically Handicapped Children’s

5 Area Agencies on Aging

Disabled Persons and Family