Upcoming Public Hearings on
Proposed DHHS Regulations

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All interested persons are invited to attend and comment at the hearing. Written comments are also welcome and will be given the same consideration as comments made in person. Written comments must be postmarked or received by the deadline indicated for each hearing. Written comments should be sent to DHHS Legal Services, 301 Centennial Mall South, P.O. Box 95026, Lincoln, NE 68509-5026, faxed 402-742-2382, or e-mailed to DHHS.RulesandRegs@nebraska.gov. Copies of written comments and names of persons submitting them will be available after the hearing from DHHS as above.

Draft copies of the regulations and the estimated schedule for rulemaking are available at DHHS as above, phone 402-471-8223, and at the office of the Secretary of State, Regulations Division, Room 1305, State Capitol, Lincoln, NE 68509, phone 402-471-2385. The draft fiscal impact statement for these regulations is available at DHHS as above. Draft regulations will be available online 3 weeks before the hearing at http://www.sos.ne.gov/rules-and-regs/regtrack/index.cgi
 
If auxiliary aids or reasonable accommodations are needed to participate in a hearing, please call 402-471-8223. For persons with hearing impairments, please call DHHS at 402-471-9570 (voice and TDD) or the Nebraska Relay System at 711 or 800-833-7352 TDD at least 2 weeks before the hearing date. This notice is given in compliance with Neb. Rev. Stat. Section 84-907.
 
The link for each hearing date below will take you to the Notice of Public Hearings for that date.
Hearing Date      Subjects
Thursday February 13, 2014 ​ADC Updates
Thursday February 13, 2014 ​AABD & State Disability Updates
Thursday February 13, 2014 ​Child Welfare, Juvenile Services, Foster Care Licensing
Thursday March 20, 2014 ​Newborn Screening for SCID
Thursday March 20, 2014 ​Newborn Screening for CCHD, LB 225 (2013)
Thursday March 20, 2014 ​Water Well Construction, Pump Installation and Water Well Decommissioning Standards
Public Notice ​All-Patient Refined Diagnosis-Related Group notice
Public Notice ​Rate change notice
Public Notice DME Rate Method
Public Notice ​​Amended Indian Health Services Nursing Facility Medicaid Reimbursement Methodology

 

 
 
Hearing
Thursday, February 13, 2014
State Office Building, Lower Level Conf. Room A
301 Centennial Mall South, Lincoln, NE
 
The Department of Health and Human Services (DHHS) Division of Children and Family Services is holding this hearing to accept comments on proposed changes to regulations relating to the Aid to Dependent Children Program. These regulations are found in Title 468, Chapters 1-6 of the Nebraska Administrative Code (NAC).  The proposed changes correspond with new Medicaid Eligibility regulations in 477 NAC 1-25.  The proposed changes will:
 
• Remove now-obsolete Medicaid provisions throughout Chapters 1-3 and 6;
• Repeal Chapters 4 and 5 in their entirety;
• Update the Standard of Need;
• Update regulations on withdrawal of applications, treatment of resources, budgeting procedures, and payments;
• Require eligibility redeterminations every six months, rather than once a year;
• Add federally required provisions on indigent immigrants; and
• Remove provisions on the loss of Medicaid after an Employment First sanction.
 
Authority for these regulations is found in Neb. Rev. Stat. Sections 43-513, 68-309, 68-717, 68-720, 68-1715, and 81-3117(7).
Written comments must be postmarked or received by 5:00 p.m. CT on February 13, 2014.

Hearing
Thursday, February 13, 2014
State Office Building, Lower Level Conf. Room A
301 Centennial Mall South, Lincoln, NE
 
The DHHS Division of Children and Family Services is holding this hearing to accept comments on proposed changes to regulations relating to the Aid to the Aged, Blind, or Disabled Program and the State Disability Program. These regulations are found in Title 469, Chapters 1-11 of the NAC.  The proposed changes correspond with new Medicaid Eligibility regulations in 477 NAC 1-25.  The proposed changes will:
 
• Remove now-obsolete Medicaid provisions throughout Chapters 1-4;
• Repeal Chapters 5-11 in their entirety;
• Change references from “mental retardation” to “developmental disabilities” under Legislative Bill 23 (2013);
• Update provisions relating to disability determinations; and
• Update various provisions relating to time limits, documentation, and other requirements.
Authority for these regulations is found in Neb. Rev. Stat. Sections 68-309, 68-717, 68-1001.01, and 81-3117(7).
 
Written comments must be postmarked or received by 5:00 p.m. CT on February 13, 2014.

 
Hearing
Thursday, February 13, 2014
State Office Building, Lower Level Conf. Room A
301 Centennial Mall South, Lincoln, NE
 
The DHHS Division of Children and Family Services is holding this hearing to accept comments on proposed changes to regulations related to child welfare, juvenile services, and foster care licensure.  These regulations are found in Title 390 NAC Chapters 1-12; Title 395 NAC Chapters 1-3 and 6; and Title 474 NAC Chapter 6, Sections 6-003 and 6-004
 
This is a rewrite of Title 390 NAC intended to simplify and clarify the regulations, to remove provisions that are duplicative of statutory language, and to limit the regulations to those provisions that fit the definition of a rule or regulation under the Administrative Procedure Act at Neb. Rev. Stat. Section 84-901 (2).  The proposed changes will:
 
• Repeal 390 NAC Chapters 1-7 and 9-12 in their entirety;
• Revise 390 NAC 8 in response to LB 561 (2013), which reformed the juvenile justice system in Nebraska;
• Adopt 395 NAC 1-3 and 6, which provide an overview of legal authority and definitions, establish confidentiality and disclosure of information provisions, incorporate foster care licensing and approval provisions, and establish provisions relating to the education of children in DHHS custody; and
• Repeal 474 NAC 6-003 and 6-004, which contain current foster care licensing standards.
 
Authority for these regulations is found in Neb. Rev. Stat. Sections 28-719, 28-727, 43-405, 43-412, 43-1310, 43-1320, 68-1210, 79-215, 81-3117(7), and 81-3126.
 
Written comments must be postmarked or received by 5:00 p.m. CT on February 13, 2014.

 
Hearing
Thursday, March 20, 2014
State Office Building, Lower Level Conf. Room A
301 Centennial Mall South, Lincoln, NE
 
The Department of Health and Human Services (DHHS) Division of Public Health is holding this hearing to accept comments on proposed changes to regulations related to newborn screening for metabolic diseases.  These regulations are found in Title 181, Chapter 2 of the Nebraska Administrative Code (NAC).  The proposed changes will:
 
• Add a requirement to screen all infants born in Nebraska for Severe Combined Immune Deficiency (SCID);
• Define SCID and Institutional Review Board;
• Clarify and replace language related to a physician’s “reasonable attempt”;
• Enhance protections on the use of residual dried blood spots for research; and
• Update the blood spot collection form.
 
Authority for these regulations is found in Neb. Rev. Stat. Sections 71-519 to 71-524 and 81-3117(7).
 
Written comments must be postmarked or received by 5:00 p.m. CT on March 20, 2014.

Hearing
Thursday, March 20, 2014
State Office Building, Lower Level Conf. Room A
301 Centennial Mall South, Lincoln, NE
 
The DHHS Division of Public Health is holding this hearing to accept comments on proposed new regulations related to newborn screening for critical congenital heart disease, as required under Legislative Bill 225 (2013).  These regulations are found in Title 181, Chapter 10 of the NAC.  The proposed regulations will:
 
• Define terms;
• Specify the diseases for which screening is required;
• Establish hospital and birthing facility responsibilities;
• Establish physician duties; and
• Provide for births occurring outside a hospital or birthing facility.
 
Authority for these regulations is found in Neb. Rev. Stat. Sections 71-553 to 71-557 and 81-3117(7).
 
Written comments must be postmarked or received by 5:00 p.m. CT on March 20, 2014.

 
Hearing
Thursday, March 20, 2014
State Office Building, Lower Level Conf. Room A
301 Centennial Mall South, Lincoln, NE
 
The DHHS Division of Public Health is holding this hearing to accept comments on proposed changes to regulations relating to water well construction, pump installation, and water well decommissioning in Nebraska.  These regulations are found in Title 178, Chapter 12 of the Nebraska Administrative Code.  The changes will change the way water wells are constructed or decommissioned after the regulations become effective.  The changes are intended to improve the protection of the state’s groundwater and public health by incorporating research findings on the performance of specific grout materials, grout seals, and fill materials. 
 
Authority for these regulations is found in Neb. Rev. Stat. Sections 46-602, 46-1201 to 46-1241 (the Water Well Standards and Contractors’ Practice Act), and 81-3117(7).
 
Written comments must be postmarked or received by 5:00 p.m. CT on March 20, 2014.

 
 NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act.  The Nebraska Department of Health and Human Services Division of Medicaid and Long Term Care hereby provides notice of a proposed change in Medicaid hospital payment methodology.
 
Effective July 1, 2014, Nebraska Medicaid will implement the All-Patient Refined Diagnosis-Related Group (APR-DRG) Grouper to reimburse hospitals now paid under the DRG payment methodology.  Critical Access Hospitals and Indian Health Service facilities are not paid using the DRG payment methodology, and neither is expected to be impacted by this change.
 
The cost outlier threshold amount for neonate and nervous system APR-DRGs will be reduced to $30,000.  Hospital base rates will be adjusted uniformly to maintain budget neutrality.
 
Regulations to implement this change have been drafted and are scheduled for public hearing on December 26, 2013.  Draft regulations are available online from the Secretary of State at http://www.sos.state.ne.us/rules-and-regs/regtrack/index.cgi.

A State Plan Amendment will be submitted for approval by the Centers for Medicare and Medicaid Services (CMS).
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.RulesandRegs@nebraska.gov.  
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
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 2.25 percent provider rate increase effective July 1, 2013.   The rate increase is the result of an increase in appropriations by the Nebraska Legislature in LB 195 (2013).
The rate increase will exclude primary care procedure codes, prescription drugs, clinical laboratory services, injectable medications, Critical Access Hospitals, Rural Health Clinics, Federally Qualified Health Centers, and Indian Health Services (IHS).   Medicaid will increase the rate for Critical Access Hospitals to 100% of the reasonable cost of providing Medicaid covered services.
The total increased expenditures as a result of a 2.25 percent rate increase to the Children’s Health Insurance (CHIP) and Medicaid Programs is $29,342,009 with $13,053,660 from General Funds and $16,288,349 from Federal match. 
The rate change is reflected in the Nebraska Medicaid Practitioner Fee Schedules.  Specifically, the rate change impacts the following services:
• Ambulance
• Chiropractic
• Dental
• Durable Medical Equipment and Supplies, including Orthotics and Prosthetics
• Health Check
• Hearing Aids
• Home Health Agency
• Hospitals (non-Critical Access Hospitals)
• ICF/MR services
• Mental Health and Substance Abuse
• Non-Emergency Transportation
• Nursing Facility
• Nursing Services
• Occupational Therapy
• Personal Assistance Services
• Physical Therapy
• Physicians (excluding primary care codes)
• Podiatry
• Speech Pathology and Audiology
• Visual Care
 
The current and revised rate schedules are available online for public view at http://dhhs.ne.gov/medicaid/Pages/med_practitioner_fee_schedule.aspx.    The schedules are also available for viewing at each local office of the Department of Health and Human Services. 
 
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.RulesandRegs@nebraska.gov.
 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
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 proposed change to the reimbursement of Durable Medical Equipment and Supplies for Medicaid residents in Nursing Facilities (NF) and Intermediate Care Facilities and/or for persons with Mental Retardation and Related Conditions (ICF/MR). This change in policy will allow Nebraska’s reimbursement methodology to comply with federal requirements, 42 CFR 440.70.
 
DHHS will apply a per diem amount equal to the Medicaid day-weighted average calculated for nursing facilities and intermediate care facilities. The per diem add on will no longer be applied when the facility’s rate reflects the full cost of providing the medical equipment. Air fluidized beds, non-standard wheelchairs and wheelchair components, and negative pressure wound therapy (wound VAC) will be reimbursed separately to the facility according to the maximum allowable rate on the durable medical equipment and supplies fee schedule found at 471-000-507: http://dhhs.ne.gov/Documents/471-000-507.pdf.
 
This change will not result in any savings or additional cost to the Nebraska Medicaid program. Regulations will be developed to implement this change and a public hearing will be held during the regulation review process. This change will be implemented after the effective date of the regulations.
 
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.RulesandRegs@nebraska.gov.

 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
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 proposed change to the reimbursement methodology for Medicaid residents of Indian Health Service (IHS) nursing facilities. This change will allow Nebraska’s current methodology to comply with federal requirements.
The same prospective Medicaid rate would be paid to IHS nursing facilities for Medicaid residents who are IHS eligible and those who are not IHS-eligible.
 
IHS providers may receive quarterly Special Funding payments, the Federal Financial Participation share of allowable costs exceeding the rates paid for the Direct Nursing, Support Services and Fixed Cost Components for all Medicaid residents. After desk audit and determination of allowable costs for a Report Period, this amount would be calculated by adding the following two figures:
      1) The allowable Medicaid Federal Financial Participation percentage for IHS-eligible Medicaid residents multiplied by   
      the difference between the allowable costs and the total amount paid for all IHS-eligible Medicaid residents, if greater
      than zero; and
      2) The allowable Medicaid Federal Financial Participation percentage for non-IHS-eligible Medicaid residents multiplied
      by the difference between the allowable costs and the total amount paid for all non-IHS eligible Medicaid residents, if
      greater than zero.
Based on current allowable Medicaid Federal Financial Participation percentages, IHS nursing facilities would receive 100 percent reimbursement for their allowable costs exceeding the prospective rates for Medicaid residents who were IHS-eligible and approximately 60 percent reimbursement for their allowable costs exceeding the prospective rates for Medicaid residents who were not IHS-eligible.
This change will not result in any savings or additional cost to the Nebraska Medicaid program and will be consistent with current Medicaid reimbursement methodologies for governmental nursing facilities. Regulations will be developed to implement this change and a public hearing will be held during the regulation review process. This change will be implemented after the effective date of the regulations.
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.RulesandRegs@nebraska.gov.