Medicaid Public Notices 
 
 
Nebraska Department of Health and Human Services
Public Notice:
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 4/1/2017).  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.  
   
Posted: March 23, 2017
 

 
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.
  

  

Proposed Medicaid Payment Rate Changes
 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice - NF APPROVED BY DD'S RECOVERED
 
 
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 special funding provision for governmental nursing facilities.
City and county-owned and operated nursing facilities will be eligible to receive 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 effective July 1, 2016.The reimbursement is subject to the payment limits of 42 CFR 447.272. 
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.
 
Posted: June 30, 2016

 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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: multisystemic therapy and functional family therapy. The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:
 
FFY16: $456,745 (FF $263,591, GF $193,154)
FFY17: $2,255,233 (FF $1,340,240, GF $914,994)
FFY18: $3,539,994 (FF $2,104,610, GF $1,435,382)
 
 
Multisystemic Therapy and Functional Family Therapy
Rates:
 
Multisystemic  Therapy
Modifier
Service
Rate
Procedure Code H2033
none
Per 15 minute increments
$38.28
 
Functional Family Therapy
 
Modifier
Service
Rate
Procedure Code 90832
U9
Psychotherapy 30 minutes
 
$63.91
Procedure Code 90834
U9
Psychotherapy 45 minutes
 
$95.87
Procedure Code 90837
U9
Psychotherapy 60 minutes
 
$127.82
Procedure Code 90846
 
 
U9
Family therapy without identified client present
 
$102.52
Procedure Code 90847
 
U9
Family therapy with identified client present
$106.10
 
Comments pertaining to the aforementioned may be submitted to 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.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.
Posted:  June 30, 2016
Update July 12, 2016 (The only change from the original June 30, 2016 posting is the Procedure Code for “Family therapy with identified client present” changed from 90846 to 90847.)

 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice:
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, 2016. The rate increase is the result of an increase in appropriations by the Nebraska Legislature in LB657 (2015). The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:
 
  ALL SERVICE TYPES
Total GF FF
Inpatient Hospital $977,613 $477,466 $500,147
Physicians (excl primary care) $1,036,688 $506,318 $530,370
Dental $493,830 $241,186 $252,644
Capitated Svcs $12,888,478 $6,294,733 $6,593,745
Outpatient Hospital $1,052,306 $513,946 $538,360
Nursing Facility $7,280,720 $3,555,904 $3,724,816
Lab $24,749 $12,088 $12,661
Radiology $28,983 $14,156 $14,827
Home Health/PAS/Hospice $662,553 $323,591 $338,962
All Other $12,334,139 $6,023,993 $6,310,146
TOTAL $36,780,058 $17,963,380 $18,816,678
 
 
• Ambulance
• Chiropractic
• Dental
• 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)
• Podiatry
• Speech Pathology and Audiology
• Visual Care
 
The current and revised rate and fee schedules will be available online for public view at http://dhhs.ne.gov/medicaid/Pages/med_provhome.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.Regulations@nebraska.gov.
 
Posted: June 30, 2016

 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice
 
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 special funding provision for governmental nursing facilities.
 
City and county-owned and operated nursing facilities will be eligible to receive 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 effective July 1, 2016.The reimbursement is subject to the payment limits of 42 CFR 447.272.  The estimated increase in annual aggregate federal expenditures for this benefit is $120,000.00
 
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.
 
Posted: June 30, 2016 

 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
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 dhhs.regulations@nebraska.gov