Newsroom > DHHS News Release
For Immediate Release
September 23, 2016
Leah Bucco-White, Communications and Legislative Services, 402-471-9356
DHHS Identifies Developmental Disability Billing Issue
Working with providers and federal partner on resolution
Lincoln – The Nebraska Department of Health and Human Services recently identified that some reimbursements to developmental disability residential service providers may not fall within federal billing guidelines.
In the process of developing new rate methodology for providers, the Division of Developmental Disabilities and the Centers for Medicare and Medicaid Services discovered that a portion of existing provider billing guidelines implemented in 2014 are not available for federal funding participation.
The division learned that the federally approved application for its Home and Community-Based Services waiver included an allowance for day programming for up to 35 hours a week. The division then found that the billing guidelines implemented July 1, 2014 also allowed residential habilitation providers to bill for day programming beyond 35 hours a week which was already included in the rate. CMS advised that DHHS must end the unallowable payments and reimburse claims already submitted.
DHHS will complete a review of all claims since July 1, 2014 for people receiving both residential habilitation and day habilitation services which total approximately $32 million, to determine any unallowable federal payments over 35 hours per week. DHHS expects many of the existing charges in those claims will be validated. Both state and federal funds support the Home and Community-Based Services waiver program. DHHS is working closely with providers and CMS as it develops a comprehensive claims review process to determine fiscal impact.
“Our focus is to ensure continued health and safety and quality services in a supportive environment for the people we serve,” said Courtney Miller, Director of the Division of Developmental Disabilities. “DHHS will continue to reimburse providers the state general fund portion of the rate over 35 hours per week.”
DHHS has an ongoing dialogue with the Nebraska Association of Service Providers and CMS to explore other options until the new rate methodology is federally approved and implemented.