Latest Updates Title 482

Update      Effective Date
482 NAC 1 Updates introductory information, revises definitions, and adds new terms and definitions, including claim, clean claim, external quality review organization, grievance, managed care organization, Updates introductory information, revises definitions, and adds new terms and definitions, including claim, clean claim, external quality review organization, grievance, managed care organization, medical home, peer review organization, returned claim, risk contract;  (EffectiveAugust 18, 2010)
482 NAC 2 Uses the term “Physical Health Managed Care” instead of “Basic Benefits Package”, clarifies the enrollment process, removes references to coverage of the unborn, and revises other references to pregnant woman and/or newborn child, and revises provisions for disenrollment and transfers; (Effective August 18, 2010)
482 NAC 3 Uses the term “Physical Health Managed Care” instead of “medical/surgical” and removes the requirement for the enrollment broker to ensure external review of informational materials; (Effective August 18, 2010)
482 NAC 4 ses the term “Physical Health Managed Care” instead of “Basic Benefits Package” and “medical/surgical”, allows graduate medical residents or interns to be assigned as the PCP, revises the requirement of the PCP to provide the client with a medical home, revises disenrollment to voluntary termination for a PCP’s participation in the NHC, requires health plans to provide information in Spanish and alternative formats for those with special needs, revises the requirement of the plan to pursue collection of third party resources from the liable third party payers and not from the clients, , sets claims processing standards for the plans, adds standards for encounter data, requires the plan to cover emergency services regardless of whether the provider is contracted with the plan, and requires timely payment by the plan to its providers; (Effective August 18, 2010)
482 NAC 6 Incorporates the Department’s overall quality strategy, continuous quality assurance/quality improvement requirements, and provisions for the Quality Management Committee; and (Effective August 18, 2010)
482 NAC 7 Revises the list of clients’ rights and responsibilities, revises requirements for the grievance process operated by each physical health or MH/SA plan, specifies the appeals process to be operated by each plan, and requires each physical health plan to promote themselves in a culturally competent manner. (Effective August 18, 2010)
482 Appendix Revises the entire appendix in its entirety (Effective August 1, 2010)
482 NAC 1-004 Revises definitions (Effective July 11, 2009)
482 NAC 2-001.01 Revises “mandatory” participation which is now based on the client’s county of residence instead of being based on which DHHS office handles the client’s case (Effective July 11, 2009)
482 NAC 2-001.02 Adds these counties to the designated coverage area for the basic benefits package: Cass, Dodge, Gage, Otoe, Saunders, Seward, and Washington (in addition to Douglas, Sarpy, and Lancaster, which remain in the designated coverage area) (Effective July 11, 2009)
482 NAC 2-001.03 Updates the list of excluded clients (Effective July 11, 2009)
2-002.03 and 2-002.06 Changes the timeframe allowed for certain enrollment activities from 45 days to 15 days (Effective July 11, 2009)
2-002.02, 2-003.03D, and 2-004.02B Removes obsolete language regarding the enrollment broker and function (Effective July 11, 2009)
2-002.05B and 2-003.03E2 Revises information regarding the Nebraska Medicaid ID Document to reflect the changeover to the newly designed Medicaid Identification Card; the new card will be issued one time instead of monthly and will be a wallet sized card; and (Effective July 11, 2009)
482 NAC 2-003 Specifies situations and timeframes for managed care client disenrollment (Effective July 11, 2009)
4-002.01, 4-002.04 and 4-003.01    Allows physician to physician referrals without authorization by PCCM plan (Effective February 14, 2009)
482 NAC 3-000 Revise provisions for enrollment broker services to allow greater flexibility in contracting for these services and to remove requirements for Public Health Nursing services, health assessment, EPSDT Outreach, operation of the helpline, and client advocacy. (Effective October 28, 2008)
482 NAC 6-000 Repeal Chapter 6, Quality Assurance/Improvement (QA/QI). (Effective October 28, 2008)
482 NAC7-002 Eliminate a reference to contacting the State Ombudsman for information regarding appeals and grievances. (Effective October 28, 2008)
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