How do I make a referral?

Documentation or records are required for all referrals. The information needs to include the current diagnosis and recommended level of care. This can be information from a current or recent inpatient stay, residential treatment, medication provider or physical health provider.

What is the admission criteria?

Adults age 19 or older, need to meet the criteria as set by the State of Nebraska for Severe and Persistent Mental Illness (SPMI) OR ASAM Level 1 Outpatient services for Substance Use Diagnosis. SPMI consists of a Major Mental Illness (schizophrenia, Major Depression, Bipolar Disorder and deficits in 2 out of 3 areas – vocational/educational functioning, social functioning and or Activities of Daily Living. ASAM Level 1 Outpatient Services is determined by a licensed professional within their scope of practice providing scoring in the six dimensions of ASAM.

What insurance is accepted?

At this time, Nebraska Medicaid is the only insurance that pays for the psych rehab levels of care. Individuals on Medicaid must have the Medicaid document called an Individual Diagnostic Interview (IDI), showing a current diagnosis and recommended level of care to be considered for admission.

What is the cost?

Individuals who have been authorized through their insurance or the Division of Behavioral Health have no costs for any rehab service. Individuals who are not authorized are assessed on a sliding fee scale from the State of Nebraska.

For ACT Referrals

The primary referral sources are psychiatric in-patient hospitals, as the admission criteria includes serving those who have had numerous in-patient hospitalizations. These hospitals include Lincoln Regional Center, Mary Lanning Healthcare in Hastings and Richard Young Hospital in Kearney. Other referral sources include a variety of other Behavioral Health service providers such as Community Support workers, Outpatient Psychiatrists, APRNs, therapists, probation, substance abuse dual diagnosis treatment centers or Residential Rehabilitation Services.

Admission Guidelines

1. DSM diagnosis consistent with a serious and persistent mental illness
2. Persistent mental illness as demonstrated by the presence of the disorder for the last 12 months or which is expected to last 12 months or longer and will result in a degree of limitation that seriously interferes with the client’s ability to function independently in an appropriate manner in two of three functional areas.
3. Presence of functional deficits in two of three functional areas: Vocational/ Education, Social Skills, Activities of Daily living

a. Vocational/Education: inability to be employed or an ability to be employed only with extensive support; or deterioration or decompensation resulting in inability to establish or pursue educational goals within normal time frame or without extensive supports; or inability to consistently and independently carry out home management tasks.

b. Social Skills: repeated inappropriate or inadequate social behavior or ability to behave appropriately only with extensive supports; or consistent participation in adult activities only with extensive supports or when involvement is mostly limits to special activities established for persons with mental illness; or history of dangerous to self/others.

c. Activities of Daily Living: inability to consistently perform the range of practical daily living tasks required for basic adult functioning in 3 of 5 of the following:

1. Grooming, hygiene, washing clothes. Meeting nutritional needs
2. Care of personal business affairs
3. Transportation and care of residence
4. Procurement of medical, legal, and housing service; or
5. Recognition and avoidance of common dangers or hazards to self and possession.

Ineligibility for Services: Exclusionary Guidelines

1. The individual does not meet DSM diagnosis consistent with severe and persistent mental illness.
2. The individual has a primary diagnosis of substance dependence/abuse or developmental disability.
3. The persistent mental illness has not been present for the last 12 months or is not expected to last 12 months or longer.
4. The persistent mental illness has not seriously interfered with the client’s ability to function independently in two of three functional areas.
5. The individual is a resident of a nursing facility or psychiatric residential rehabilitation facility.
6. The individual requires inpatient treatment services for a period exceeding 10 days. (No billing after this time, however may be considered for planned return)

Download Rehabilitation Services Referral Form

For ACT Referrals

The primary referral sources are psychiatric in-patient hospitals, as the admission criteria includes serving those who have had numerous in-patient hospitalizations. These hospitals include Lincoln Regional Center, Mary Lanning Healthcare in Hastings and Richard Young Hospital in Kearney. Other referral sources include a variety of other Behavioral Health service providers such as Community Support workers, Outpatient Psychiatrists, APRNs, therapists, probation, substance abuse dual diagnosis treatment centers or Residential Rehabilitation Services.

Admission Guidelines

1. DSM Axis I diagnosis consistent with a serious and persistent mental illness
2. Persistent mental illness as demonstrated by the presence of the disorder for the last 12 months or which is expected to last 12 months or longer and will result in a degree of limitation that seriously interferes with the client’s ability to function independently in an appropriate manner in two of three functional areas.
3. Presence of functional deficits in two of three functional areas: Vocational/ Education, Social Skills, Activities of Daily living

a. Vocational/Education: inability to be employed or an ability to be employed only with extensive support; or deterioration or decompensation resulting in inability to establish or pursue educational goals within normal time frame or without extensive supports; or inability to consistently and independently carry out home management tasks.

b. Social Skills: repeated inappropriate or inadequate social behavior or ability to behave appropriately only with extensive supports; or consistent participation in adult activities only with extensive supports or when involvement is mostly limits to special activities established for persons with mental illness; or history of dangerous to self/others.

c. Activities of Daily Living: inability to consistently perform the range of practical daily living tasks required for basic adult functioning in 3 of 5 of the following:

1. Grooming, hygiene, washing clothes. Meeting nutritional needs
2. Care of personal business affairs
3. Transportation and care of residence
4. Procurement of medical, legal, and housing service; or
5. Recognition and avoidance of common dangers or hazards to self and possession.

Ineligibility for services: Exclusionary Guidelines

1. The individual does not meet DSM Axis I diagnosis consistent with severe and persistent mental illness.
2. The individual has a primary diagnosis of substance dependence/abuse or developmental disability.
3. The persistent mental illness has not been present for the last 12 months or is not expected to last 12 months or longer.
4. The persistent mental illness has not seriously interfered with the client’s ability to function independently in two of three functional areas.
5. The individual is a resident of a nursing facility or psychiatric residential rehabilitation facility.
6. The individual requires inpatient treatment services for a period exceeding 10 days. (No billing after this time, however may be considered for planned return)

Download the ACT Referral Form