Public Notice - New Payment Methodology for FQHCs
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 methodology change for Federally Qualified Health Centers (FQHCs).
The State of Nebraska currently reimburses FQHCs under the Prospective Payment System (PPS) rate methodology. Payment for FQHCs is guided by Section 1902(bb) of the Social Security Act, which defines parameters for a prospective payment system (PPS), and includes the option of an alternative payment methodology. FQHCs provide an essential primary care backbone for the Nebraska Medicaid delivery system. FQHCs serve low income and underserved populations, including but not limited to: migrant, homeless, and school based populations, and public housing residents. FQHCs provide a scope of services including: primary medical, dental, and behavioral health, case management and enabling services, such as interpretation. Services are provided on a discount fee schedule and no one is refused services based on inability to pay. Thus, the State of Nebraska intends to update the reimbursement methodology to reflect the federally approved Alternative Payment Methodology (APM) for FQHCs.
The State of Nebraska has elected to cover services for Nebraska eligible clients under the APM rate consistent with the PPS rate. Also similar to the PPS rate, the APM rate will exclude dental costs as FQHCs will continue to be reimbursed fee-for-service (FFS) for dental services outside of the APM rate. The implementation of the proposed payment methodology may result in an estimated increase in annual aggregate expenditures of $4.5 million dollars.
The effective date of the FQHC payment methodology change is January 1, 2016.
The current and revised rate schedules are available for public view 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 email@example.com
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice - SFY16-RATES
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 .25% increase for behavioral health, nursing facilities, assisted living and ICF-DD providers effective July 1, 2015. The rate increase is the result of an increase in appropriations by the Nebraska Legislature in LB657 (2015).
The rate increase will exclude enhanced 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).
The rate change will be reflected in the Nebraska Medicaid Practitioner Fee Schedules. Specifically, the rate change impacts the following services:
• Durable Medical Equipment and Supplies, including Orthotics and Prosthetics
• Health Check
• Hearing Aids
• Home Health Agency
• Hospitals (non-Critical Access Hospitals)
• Mental Health and Substance Abuse
• Non-Emergency Transportation
• Nursing Services
• Occupational Therapy
• Personal Assistance Services
• Physical Therapy
• Physicians (excluding primary care codes)
• Speech Pathology and Audiology
• Visual Care
The current and revised rate schedules will be available online for public view at http://dhhs.ne.gov/medicaid/Pages/med_provhome.aspx
. The schedules will also be 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.Regulations@nebraska.gov