Medicaid Public Notices

 
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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: July 30, 2019

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice of Medicaid payment rate change for some Medicaid covered services for Nebraska eligible clients.  Medicaid will implement a 2.00% increase in provider rates and an additional 2.00% increase for behavioral health providers.  The rate increases are the result of an increase in appropriations by the Nebraska Legislature via LB294 (2019).  The current and revised rate and fee schedules are available online for public view at the page below.

Provider Rates and Fee Schedules 

The updated Medicaid payment rates are effective for services with a date of service on or after July 1, 2019.

The estimated increase in annual aggregate expenditures is:

FFY2019:  $3,277,014 Federal Funds Fiscal Impact (8.1.2019 to 9.30.2019)

FFY2020:  $20,525,847 Federal Funds Fiscal Impact (10.1.2019 to 9.30.2020)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or email to DHHS.MedicaidSPA@nebraska.gov. Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: June 20, 2019

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long-Term Care hereby provides notice regarding nursing facility and ICF-DD rates for state fiscal year 2020.

Nursing facilities: For the rate period of July 1, 2019, through June 30, 2020, the inflation factor is negative 4.98%.

ICF-DD: For the rate period of July 1, 2019, through June 30, 2020, the inflation factor is positive 21.24%.

Federal fiscal impact

Nursing facilities: $11,730,461

ICF-DD: $834,581

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov. Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: June 14, 2019

This notice is given in compliance with 42CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long-Term Care here by provides notice that it will implement changes to the 1915 (c) Home and community Based (HCBS) Waiver for Aged and Adults and children with disabilities.

The following lists a summary of the proposed changes:

  1. Update language related to compliance with the Home and Community Based Settings Final rule: CMS provided stock language that has been updated in the Main Attachment #2: Home and Community-Based Settings Waiver Transition Plan section of the application.
  2. Increase the number of unduplicated waiver participant slots for waiver years 3, 4, and 5:  Due to an increased number of individuals choosing home and community based services over nursing facility based service the number of slots available in the waiver is being increased.

Current numbers:

 

Waiver YearUnduplicated Number of Participants
Year 36300
Year 46400
Year 56500

 

Amended to:

 

Waiver YearUnduplicated Number of Participants
Year 37200
Year 47500
Year 57700

 

There is no federal fiscal impact.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026.  Fax (402) 471-9092 or email to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: May 10, 2019

Updated: May 15, 2019

Pursuant to 42 C.F.R. §441.301(c)(6)(iii), the Nebraska Department of Health and Human Services (DHHS) is required to give public notice related to the state's plan to comply with new regulation governing the settings in which the delivery of services to Medicaid Home and Community-Based Services waiver recipients may be provided.

The state's transition plan Final Draft will incorporate stakeholder input to include public comment. The transition plan will be available to view on Friday, May 10, 2019, on the HCBS Statewide Transition Plan webpage and will be available for public comment from May 16 to June 17, 2019. Comments may be submitted to the designated e-mail address: DHHS.HCBSPublicComments@nebraska.gov with the subject heading State Transition Plan.

DHHS staff will make available hard copies of the transition plan to any participant once posted upon request. An opportunity for public comment will be held at the following locations:

​DateCity​​LocationTime​
​May 22, 2019​LincolnState Office Building - Lower Level B

Come in Person, Join the Zoom Meeting, or Join by Phone.

Please join the Zoom meeting AND by phone

Join Zoom Meeting
https://go.unl.edu/stppubliccomment

Join by phone 
Toll-free: (888) 820-1398
Participant code: 3925547#

​10:00 AM – 11:30 AM CST
​May 30, 2019​StatewideLive Webinar

Please join the Zoom meeting AND by phone

Join Zoom Meeting
https://go.unl.edu/stppubliccomment

Join by phone 
Toll-free: (888) 820-1398
Participant code: 3925547#

​5:30 PM – 7:00 PM CST
​June 5, 2019 ​StatewideLive Webinar

Please join the Zoom meeting AND by phone

Join Zoom Meeting
https://go.unl.edu/stppubliccomment


Join by phone 
Toll-free: (888) 820-1398
Participant code: 3925547#

​1:30 PM – 3:00 PM  CST
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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: February 25, 2019

Medicaid State Plan Amendments (SPA) regarding an Alternative Benefit Plan for an Expanded Adult Population 

Notice is hereby given, in accordance with 42 CFR 440.386. This notice provides a summary of the purpose of the SPAs and also serves to open the 30-day public comment period. All comments must be received by March 29, 2019.

The Nebraska Department of Health and Human Services provides notice of its intent to submit a State Plan Amendment (SPA) to define the Alternative Benefit Plan (ABP) that will be used to allow for expansion of Medicaid eligibility to individuals aged 19‐64 with incomes at or below 138% of the Federal Poverty Level (FPL) who are not enrolled in or eligible for Medicare, consistent with the expanded eligibility criteria as defined by the Affordable Care Act (referred to here as the “Adult Expansion Group"). This ABP will be applicable to individuals in the Adult Expansion Group who are eligible for Nebraska's Medicaid program. The Nebraska Department of Health and Human Services expects to submit this SPA to the Centers for Medicare and Medicaid Services no later than April 1, 2019.

Once approved, the ABP will provide eligible individuals in the Adult Expansion Group with access to the federally mandated Essential Health Benefits. These Essential Health Benefits include the following services:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Pursuant to 42 CFR 440.345, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services will be provided to those eligible individuals in the Adult Expansion Group who are under age 21 as required by law and regulation, and consistent with current state policy regarding the delivery of these services.

The section 1937 coverage option for the ABP will be Secretary-Approved Coverage that is based on, and consistent with, the benefits provided in Nebraska's approved state Medicaid plan. The base benchmark plan will be the largest plan by enrollment of the three largest small group insurance products in Nebraska's small-group market.

Consistent with federal law and the Nebraska Medicaid State Plan, the State Medicaid Director provided written notice regarding the proposed State Plan Amendment to the appropriate tribal contacts on January 31, 2019. In accordance with the State Plan, additional information regarding the proposed changes will be provided to the tribal contacts upon request, and consultation will occur as requested or as otherwise appropriate.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Non-electronic copies will be made available for review at each local office of the Department of Health and Human Services. All comments must be received by March 29, 2019

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: August 29, 2018

In accordance with 42 CFR 431.408, the Nebraska Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care (MLTC) hereby provides notice of MLTC's intent to submit to the Centers for Medicare and Medicaid Services (CMS) an application to implement a Section 1115 Medicaid Demonstration Waiver for Substance Use Disorder Services.

MLTC currently allows residential substance use disorder (SUD) services (a combination of substance use treatment services provided to a patient in the facility in which that patient is currently residing) to be provided to Medicaid-enrolled adults ages 21-64 residing in inpatient facilities that meet the federal regulatory definition of an Institution for Mental Diseases (IMD). IMDs are generally defined as inpatient facilities with more than 16 beds that provide behavioral health services to a majority of its patients.

Recently enacted federal Medicaid regulations found in 42 CFR 438.6(e) impose new limitations on MLTC's ability to continue allowing residential SUD services in IMDs for Medicaid-enrolled adults ages 21-64. These limitations have the potential to disrupt treatment programs for some of Nebraska Medicaid's most vulnerable adults, as those individuals may be forced to seek treatment in less appropriate and more costly settings, such as emergency departments.

As a result of these new regulations, MLTC intends to submit an application to CMS to implement a Section 1115 demonstration waiver to continue MLTC's policy of allowing SUD residential services in IMDs for Medicaid-enrolled adults ages 21-64. Implementation of this demonstration program requires CMS approval.

For more information on MLTC's intent to submit this application, including the public comment period, visit the following webpage: Substance Use Disorder Demonstration Program.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: June 27, 2018

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice that it will implement specialized add-on services for individuals with intellectual disabilities or a related condition in nursing facilities.

Nebraska Medicaid is requesting an amendment to the Medicaid state plan to add specialized add-on services for individuals with intellectual disabilities or a related condition who reside in a nursing facility.  The additional services include habilitative skills training, habilitative community inclusion, employment assistance, employment support, and non-medical transportation (specific to specialized add-on services).  These add-on services are to be provided to residents in nursing facilities and are reimbursed by Medicaid to the specialized services providers, not to the nursing facility.

The estimated increase in annual aggregate expenditures is:

FFY18: $435,628 (FF $228,922 / GF $206,705)

FFY19: $1,808,082 (FF $950,690 / GF $857,392)

 

Rates:

Title CPT CodeUnit ValueRate (Agency Provider)Rate ( Individual Provider)
Habilitative Community InclusionH2015Hourly increments$38.53$25.25
Habilitative Skills trainingS5108Hourly increments$33.91$21.67
Employment SupportT201915-minute increments$10.52$6.27
Employment AssistanceT2015Hourly increments$42.16$25.25
Non-Medical Transportation (specific to Specialized add-on Services)A0080Per mile increments$1.635$0.55

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: June 27, 2018

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice regarding Nursing Facility & ICF-DD State Fiscal Year Rates for 2019.

Nursing Facilities: For the rate period of July 1, 2018 through June 30, 2019 the inflation factor is negative 7.17%

ICF-DD: For the rate period of July 1, 2018 through June 30, 2019 the inflation factor is positive 22.10%.

There is no federal fiscal impact.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: May 17, 2018

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice of Medicaid rate reduction for certain durable medical equipment (DME).

Through passage of section 503 of the Consolidated Appropriations Act, 2016 and section 5002 of the 21st Century Cures Act of 2016, Congress added section 1903(i)(27) to the Social Security Act (the Act) which prohibits federal Medicaid reimbursement to states for certain durable medical equipment (DME) expenditures that are, in the aggregate, in excess of what Medicare would have paid for such items.


Effective January 1, 2018, the statute requires a limit to available federal financial participation (FFP) for state Medicaid fee-for-service expenditures for DME, per Section 1903(i)(27). The limit is calculated in the aggregate to the amount that Medicare would have paid for the same items through the Medicare DMEPOS fee schedule, or, as applicable, the Medicare competitive bidding program. The statute specifically applies to items of DME that are covered by both Medicare and Medicaid.


A review of Nebraska Medicaid DME paid claims and payment amounts has revealed expenditures that are, in the aggregate, in excess of what Medicare would have paid for such items. To comply with the aforementioned rule, the State of Nebraska intends to reduce the rates of certain DME items. The reduced rates are effective for service provided on July 1, 2018, and thereafter.

 

The proposed rates are as follows:

 

 Proposed DME Rates Effective July 1, 2018
CODEMODDESCRIPTIONMEDICARE
LOWEST RATE
000A7007LARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED W/AEROSOL COMPRESSOR$2.42
000E0143NUWALKER,FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT$41.31
000E0148NUWALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH$80.37
000E0149NUWALKER,HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE$112.80
000E0181RRPOWERED PRESSURE REDUCING MATTRESS OVERLAY/PAD, ALTERNATING, WITH PUMP, INCLUDES HEAVY DUTY$14.07
000E0184NUDRY PRESSURE MATTRESS$160.36
000E0185NUGEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STD MATTRESS LENGTH AND WIDTH$153.33
000E0196NUGEL PRESSURE MATTRESS.$309.90
000E0255NUHOSPITAL BED, VARIABLE HGT, HI-LO WITH ANY TYPE SIDE RAILS, WITH MATTRES$599.20
000E0260NUHOSPITAL BED SEMI-ELEC (HEAD & FT ADJ) WITH ANY TYPE SIDE RAILS W/MATTRS$577.60
000E0260RRHOSPITAL BED SEMI-ELEC (HEAD & FT ADJ) WITH ANY TYPE SIDE RAILS W/MATTRS$57.76
000E0261NUHOSPITAL BED SEMI-ELEC (HEAD & FT ADJ) WITH ANY TYPE SIDE RAILS W/O MATT$526.50
000E0265RRHOSPITAL BED ELECTRIC (HEAD, FT & HGT ADJ) W/ANY TYPE SIDE RAILS W/MATTR -PA REQUIRED AS OF 07012017$139.64
000E0266NUHOSPITAL BED, ELECTRIC (HEAD, FT & HGT ADJ) WITH ANY TYPE RAILS W/O MATT$1,215.10
000E0303NUHOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350 POUNDS,BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE$1,397.30
000E0371NUNONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STD LGTH/WID$1,997.80
000E0431RRPORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER/REG ULATOR/FLOWMETER/HUMIDIFIER/CANNULA OR MASK, AND TUBING$17.50
000E0434RRPORTABLE LIQUID OXYGEN SYSTEM,RENTAL$17.50
000E0439RRSTATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER/CONTENTS/ REGULATOR/FLOWMETER/HUMIDIFIER/NEBULIZER, CANNULA OR MASK, & TUBING$69.99
000E0465RRHOME VENTILATOR, ANY TYPE, USED WITH INVASIVE INTERFACE, (E.G., TRACHEOSTOMY TUBE)$1,038.25
000E0466RRHOME VENTILATOR, ANY TYPE, USED WITH NON-INVASIVE INTERFACE, (E.G., MASK, CHEST SHELL)$1,038.25
000E0470RRRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL$100.00
000E0471RRRESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL$247.65
000E0570NUNEBULIZER W COMPRESSOR$47.50
000E0570RRNEBULIZER W COMPRESSOR$4.75
000E0600RRRESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC$46.46
000E0601NUCONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE$353.50
000E0601RRCONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE$35.35
000E0627NUSEAT LIFT MECHANISM INCORP COMBINATION LIFT CHR MECHANISM$266.40
000E0630NUPATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD(S)$574.60
000E0630 RRPATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD(S)$57.46
000E0635RRPATIENT LIFT,ELEC,W SEAT OR SLING$113.27
000E0730NUTRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, FOUR OR MORE LEADS,FOR MULTIPLE NERVE STIMULATION$49.62
000E0910NUTRAPEZE BAR,A.K.A. PAT HELPER, ATTACHED TO BED,COMPLETE W GRAB BAR$104.60
000E1390RROXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE$69.99
000E1392 RRPORTABLE OXYGEN CONCENTRATOR, RENTAL$38.68
000K0001NUSTANDARD WHEELCHAIR$185.00
000K0001RRSTANDARD WHEELCHAIR $18.50
000K0002NUSTANDARD HEMI (LOW SEAT) WHEELCHAIR$290.00
000K0002RRSTANDARD HEMI (LOW SEAT) WHEELCHAIR$29.00
000K0004NUHIGH STRENGTH, LT WT WHLCHR$379.00
000K0007NUEXTRA HEAVY DUTY WHLCHR$675.00
000K0738RRPORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; HOME COMPRESSOR TO FILL PORT O2*CYLINDERS, INCL PORT CONTAINERS, REG, FLOWMETER, HUMID, CANNULA/MSK,TUBE$38.68
000K0822NUPOWER WHEELCHAIR, GROUP 2 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS$1,900.00
000K0823NUPOWER WHEELCHAIR, GROUP 2 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS$1,841.60
000K0848NUPOWER WHEELCHAIR, GROUP 3 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS$5,126.77
000K0853NUPOWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS$7,057.73
000K0856NUPOWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS$5,502.40
000K0861NUPOWER WHEELCHAIR, GROUP 3 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUND$5,511.20
000K0862NUPOWER WHEELCHAIR, GROUP 3 HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS$6,826.93

 

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: April 3, 2018

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice that it will implement a change for therapeutic and medical leave days for Psychiatric Residential Treatment Facilities (PRTFs).

Nebraska Medicaid is requesting an amendment to the Medicaid state plan. Medical leave days will be reimbursed to PRTFs at 50% of the per-diem. Medical leave days include medical/surgical and inpatient psychiatric stays. Five days of leave are allowed for medical/surgical stays per treatment episode, and five days of leave are allowed for inpatient psychiatric stays per treatment episode. Therapeutic leave days will be reimbursed at 50% of the per diem for a maximum of 10 days per treatment episode.

The estimated decrease in annual aggregate expenditures is:

FFY18: Total $17,420 (FF $9,154; GF $8,266)

FFY19: Total $41,808 (FF $21,983; GF $19,825)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: February 14, 2018

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice that it will implement specialized services for individuals with intellectual disabilities or a related condition in nursing facilities.

Nebraska Medicaid is requesting an amendment to the Medicaid state plan to add specialized services for individuals with intellectually disability or a related condition who reside in a nursing facility.  The additional services include residential habilitative training, day services, vocational services, habilitative community inclusion, and related transportation.  These services are to be provided to residents in nursing facilities and are reimbursed by Medicaid to the specialized services providers, not to the nursing facility.

The estimated increase in annual aggregate expenditures is:

FFY18: $1,016,465 (FF $534,152 GF $482,313)

FFY19: $1,808,082 (FF $950,690 GF $857,392)   

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: November 29, 2017

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long-Term Care hereby provides notice that it will submit a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) in accordance with Neb. Rev. Stat. 68-977 to 68-988.

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long-Term Care hereby provides notice that it will submit a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) in accordance with Neb. Rev. Stat. 68-977 to 68-988.

The Ground Emergency Medical Transportation Act directs the agency to submit a SPA allowing for an intergovernmental transfer program relating to Medicaid managed care, ground emergency medical transportation services.

The estimated increase in annual aggregate expenditures is:

FFY18: Total $567,480 (FF $310,549; GF $256,931)

FFY19: Total $756,639 (FF $414,065; GF $342,574)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: October 30, 2017

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long-Term Care hereby provides notice that it will implement a change for therapeutic and medical leave days for Psychiatric Residential Treatment Facilities (PRTFs) and Therapeutic Group Homes (ThGHs

).

DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: September 29, 2017 (updated to note the ICF/DD inflation factor is positive)

This notice is given in compliance with 42 CFR 447.205 and Section 1902 (a)(13)(A) of the Social Security Act.  The Department of Health and Human Services Division of Medicaid and Long-Term Care hereby provides notice regarding Nursing Facility & ICF-DD SFY18 Medicaid rate.

Nursing Facilities: For the rate period of July 1, 2017 through June 30, 2018 the inflation factor is negative 2.65%. 

ICF-DD: For the rate period of July 1, 2017 through June 30, 2018 the inflation factor is positive 21.86%.

There is no federal fiscal impact.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: September 27, 2017

Nebraska Department of Health and Human Services (DHHS) Division of Medicaid and Long-Term Care (MLTC) has reviewed the Heritage Health managed care plans' administration of benefits for compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.  Participants in this review, led by MLTC, included representatives from the DHHS Division of Behavioral Health, DHHS Legal Services, and Nebraska Department of Insurance. 

The health plans are contractually required to comply with the MHPAEA (IV.E.3.a-e) and can be sanctioned for failing to meet contract requirements if found to be in violation of parity.  Facets of the review included analyzing the treatment limitations, medical management standards, and operational strategies to ensure that administration of the mental health and addiction benefits are comparable to, and no more stringent than, how they are applied to the physical health benefits. 

Ongoing compliance with MHPAEA will be monitored and re-analyzed upon changes in Medicaid benefits or designs.  To report a concern to one of the managed care plans regarding parity, please follow the Grievance Process for each plan.  For further information from MLTC, please contact DHHS.MedicaidMHSU@nebraska.gov.  

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: September 22, 2017 (comment contact information updated 9-29-17)

This notice is given in compliance with 42 CFR 447.205 and Section 1902 (a)(13)(A) of the Social Security Act.  The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice of a change in the annual dental benefit limit for adults. 

Effective October 1, 2017, dental services provided to Medicaid adult clients (age 21 and older) will be subject to an annual dental benefit of $750.  Exemptions are in place for dental services for emergencies, for extensive special needs and ill clients, and for dentures.  Medicaid will review and consider coverage of these services that cause the client to exceed the $750 annual limit.  A prior authorization request must be submitted with medical necessity documentation.

The estimated decrease in annual aggregate expenditures by the benefit category or service being affected is as follows:

FFY18: $848,407 (FF $445,838  GF $402,569)

FFY19: $848,407 (FF $453,898  GF $394,509)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: August 23, 2017

Effective August 23, 2017, all notices required by LB268 (2017), including requests for waivers on restriction of transfer, must be submitted to the following e-mail address: DHHS.MedicaidEstateRecovery@nebraska.gov

Notices may also be mailed to the Department of Health and Human Services, Nebraska Medicaid Estate Recovery, P.O. Box 95026, Lincoln, Nebraska 68509-5026.


 

NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: August 23, 2017

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice that it will implement expanded school-based services and cost settlement.

Nebraska Medicaid is requesting an amendment to the State Medicaid Plan to be effective September 1, 2017. The purpose of this amendment is to add additional Medicaid reimbursable services when provided by a school district pursuant to Nebraska Legislative Bill 276 (2014), now Nebraska Revised Statute 68-911.  Current Medicaid reimbursable services are physical therapy, occupational therapy, and speech language pathology services.  The additional services reimbursable to school districts include nursing, personal assistance, medical transportation, vision, and mental health services.

The estimated increase in annual aggregate expenditures is:

FFY18: $23,737,674 (FF $12,422,400 GF $11,315,274)

FFY19: $29,441,702 (FF $15,677,424 GF $13,764,278)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: June 26, 2017

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice that it will implement a change in payment methodology for dual eligible Medicare/Medicaid crossover claims.

Effective July 1, 2017, Medicaid will pay the lesser of the Medicare or Medicaid allowable amount.  The Department will accept Medicare's utilization review and payment decisions for Medicare allowable fees, except that after crediting any amount received from Medicare for Medicare-covered services and crediting any amount received from any third party resource (TPR), Medicaid will pay the lesser of the Medicare or Medicaid allowable amount of any remaining amount due.

The estimated decrease in annual aggregate expenditures is:

FFY17: $5,911,585.86 (FF $3,065,157.27 GF $2,846,428.59)

FFY18: $23,646,343.45 (FF $12,426,153.49 GF $11,220,189.97)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: June 22, 2017

Updated June 23, 2017

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice of rates for new services covered under the Medicaid program: Medical Nutrition Therapy and Lactation Counseling.  The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:

Medical Nutrition Therapy

FFY17: $378,236 (FF $196,115 GF $182,120)

FFY18: $1,530,113 (FF $804,074 GF $726,038)

Lactation Counseling:

FFY17: $86,062 (FF $44,623 GF $41,439)

FFY18: $344,249 (FF $180,903 GF $163,346)

Rates:

TitleCPT CodeModifierUnit ValueRate
Medical Nutrition Therapy; initial97802 15 minute increment26.11
Medical Nutrition Therapy; initial97802EP15 minute increment26.11
Medical Nutrition Therapy; re-assessment97803 15 minute increment21.60
Medical Nutrition Therapy; re-assessment97803EP15 minute increment

21.60

 

Medical Nutrition Therapy; group97804EP30 minute increment13.52
Medical Nutrition TherapyG0270 For use with Medicare crossover claims only23.42
Unlisted Preventative Medicine Services (used for Lactation Consultation Services- Non Physician)99429EP30 minute increment18.50

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Legal Services, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 742-2382 or e-mail to DHHS.Regulations@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: March 30, 2017

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice of rates for new services covered under the Medicaid program: peer support services. The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:

FFY17: $585,836 (FF $314,958 GF $270,879)
FFY18: $2,343,345 (FF $1,275,983 GF $1,067,362)

Peer Support Rates:

TitleCPT CodeModifierUnit valueRate
Peer Support Services for Mental HealthH0038HE15 minute increments$11.50
Peer Support Services for Substance UseH0038HF15 minute increments$11.50
Group Peer Support Services for Mental HealthH0038HE/HQ15 minute increments$7.91
Group Peer Support Services for Substance UseH0038HF/HQ15 minute increments$7.91

 

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Legal Services, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 742-2382 or e-mail to DHHS.Regulations@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

Posted: March 23, 2017

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act.  The Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice that it will implement an Actual Acquisition Cost (AAC) methodology when paying Medicaid pharmacy claims to meet requirements of the Medicaid covered outpatient drugs final rule (effective April 1, 2017).  This rule changes the pricing methodology for covered outpatient legend and non-legend drugs for all fee-for-service pharmacy claims.

In order to come into compliance with the rule, Nebraska will be reimbursing claims at the lesser of the following:

a. The usual and customary charge to the public, or;
b. The National Average Drug Acquisition cost (NADAC), plus the established professional dispensing fee, or;
c. The ACA Federal Upper Limit (FUL) plus the established professional dispensing fee, or;
d. The calculated State Maximum Allowable Cost (SMAC) plus the established professional dispensing fee.

The professional dispensing fee has been determined to be $10.02.

A financial impact analysis was completed by the state and is found to be budget neutral.

Comments may be submitted to and reviewed by the public at the Department of Health and Human Services Legal Services, 301 Centennial Mall South, P.O. Box 95026, Lincoln Nebraska 68509-5026.  Fax (402) 742-2382 or e-mail to DHHS.Regulations@nebraska.gov. The proposed State Plan Amendment will also be accessible at each local office of the Nebraska Department of Health and Human Services.

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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC NOTICE

ACCESS TO CARE

In November 2015, the Centers for Medicare and Medicaid Services (CMS) issued the Access to Care Final Rule. The Final Rule requires states to assess access to care for their Fee-For-Service (FFS) populations and to analyze whether reductions in provider reimbursement rates impact the ability of Medicaid eligible individuals to receive covered services.

States are required to develop an initial Access Monitoring Review Plan (AMRP) for specific categories of services as detailed in 42 Code of Federal Regulations (CFR) §447.203(b)(5)(ii) for submission to CMS by October 1, 2016. The Final Rule requires that the initial AMRP be made available to the public for review and comment for 30 calendar days prior to submission to CMS.

This webpage includes the draft AMRP along with links to the Access to Care Final Rule and CMS' Access to Care website. The public is invited to review the AMRP and submit comments. The public comment period starts on August 16, 2016 and ends on September 15, 2016. Nebraska Medicaid will review comments and incorporate public feedback into the AMRP prior to submission to CMS.

Comments on the AMRP may be submitted to the designated email address: DHHS.mltcpubliccomment@nebraska.gov with the subject heading AMRP Comments. Comments may also be mailed to The Department of Health and Human Services, Attention: Nancy Becker, 301 Centennial Mall South, P.O. Box 95026, Lincoln, NE 68509-5026 or by fax to (402) 471-9092.

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