473 NAC 3-002.02
Before furnishing any service, each provider shall sign Form DSS-9, agreeing to -
1. Provide no service to be paid through the Social Services Program before receiving authorization from the worker;
2. Provide service only as authorized, in accordance with the Department's standards as set forth in NAC Titles 473, 474, and/or 480. If providing medical transportation, NAC Title 471 also applies to Medicaid providers;
3. Submit Form DSS-5B, "Social Services Billing Document," after service is provided and within 90 days;
4. Provide service as an independent contractor. I understand and agree that I am not providing service as an employee of the State of Nebraska or of the Department;
5. Accept social services reimbursement as payment in full for each contracted services (e.g., provider will not charge clients the difference between this contract rate and private pay rate);
6. Accept a rate which is reasonable, necessary, and does not exceed the amount charged to private-paying persons;
7. Apply to social services clients the same standards applied to private-paying persons;
8. Retain financial and statistical records for four years to support and document all claims and allow federal, state, or local offices responsible for program administration or audit to review service records, in accordance with 45 CFR 74.20 through 74.24;
9. Permit federal, state, and local officials to monitor and evaluate the program by means such as inspecting the facility, observing service delivery, and interviewing the provider or if an emergency, the staff members;
10. Keep current any state or local license required for service provisions;
11. Respect every client's right to confidentiality and safeguard confidential information;
12. Not discriminate against any employee, applicant for employment, or social services program participant or applicant because of race, age, color, religion, sex, handicap, or national origin, in accordance with 45 CFR Parts 80, 84, 90, and 41 CFR Part 60;
13. Not assign or transfer the agreement. That is, no payment for authorized services made under this agreement can go to anyone other than the service provider named in this agreement;
14. Understand and accept responsibility for the client's safety and property;
15. Continue to meet all standards pertaining to the service provided;
16. Operate a drug-free workplace;
17. Not use any federal funds received to influence agency or congressional staff; and
18. Allow Central Registry checks on himself/herself, family member if appropriate, or if an agency, agree to allow Department of Social Services staff to review agency policies regarding hiring and reporting to ensure that appropriate procedures regarding abuse, neglect, and law violations are in place.