Nebraska 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 submit a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) in accordance with Neb. Rev. Stat. 68-977 to 68-988.
 
The Ground Emergency Medical Transportation Act directs the agency to submit a SPA allowing for an intergovernmental transfer program relating to Medicaid managed care, ground emergency medical transportation services.
 
The estimated increase in annual aggregate expenditures is:
FFY18: Total $567,480 (FF $310,549; GF $256,931)
FFY19: Total $756,639 (FF $414,065; GF $342,574)
 
 
Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax 402-471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.
 
Posted: November 29, 2017
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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 a change for therapeutic and medical leave days for Psychiatric Residential Treatment Facilities (PRTFs) and Therapeutic Group Homes (ThGHs).
 
Effective 11-01-2017 Medical leave days will be reimbursed to PRTFs and ThGHs at 50% of the per-diem. Medical leave days include medical/surgical and inpatient psychiatric stays. Five days of leave are allowed for medical/surgical stays per treatment episode, and five days of leave are allowed for inpatient psychiatric stays per treatment episode. Therapeutic leave days will be reimbursed to these facilities at 50% of the per diem for a maximum of 10 days per treatment episode.
 
The estimated decrease in annual aggregate expenditures is:
FFY18: Total $45,203 (FF $23,754; GF $21,449)
FFY19: Total $49,313 (FF $25,929; GF $23,384)
 
Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax 402-471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.
 
Posted: October 30, 2017
_______________________________________________________________________________________________
 
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 regarding Nursing Facility & ICF-DD SFY18 Medicaid rate.
Nursing Facilities: For the rate period of July 1, 2017 through June 30, 2018 the inflation factor is negative 2.65%. 
ICF-DD: For the rate period of July 1, 2017 through June 30, 2018 the inflation factor is positive 21.86%.
There is no federal fiscal impact.
Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax 402-471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.
Posted: September 29, 2017 (updated to note the ICF/DD inflation factor is positive)
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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
Nebraska Department of Health and Human Services (DHHS) Division of Medicaid and Long-Term Care (MLTC) has reviewed the Heritage Health managed care plans’ administration of benefits for compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.  Participants in this review, led by MLTC, included representatives from the DHHS Division of Behavioral Health, DHHS Legal Services, and Nebraska Department of Insurance. 
 
The health plans are contractually required to comply with the MHPAEA (IV.E.3.a-e) and can be sanctioned for failing to meet contract requirements if found to be in violation of parity.  Facets of the review included analyzing the treatment limitations, medical management standards, and operational strategies to ensure that administration of the mental health and addiction benefits are comparable to, and no more stringent than, how they are applied to the physical health benefits. 
 
Ongoing compliance with MHPAEA will be monitored and re-analyzed upon changes in Medicaid benefits or designs.  To report a concern to one of the managed care plans regarding parity, please follow the Grievance Process for each plan.  For further information from MLTC, please contact DHHS.MedicaidMHSU@nebraska.gov.  
 
Posted: September 27, 2017
 
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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 change in the annual dental benefit limit for adults. 
Effective October 1, 2017, dental services provided to Medicaid adult clients (age 21 and older) will be subject to an annual dental benefit of $750.  Exemptions are in place for dental services for emergencies, for extensive special needs and ill clients, and for dentures.  Medicaid will review and consider coverage of these services that cause the client to exceed the $750 annual limit.  A prior authorization request must be submitted with medical necessity documentation.
The estimated decrease in annual aggregate expenditures by the benefit category or service being affected is as follows:
FFY18: $848,407 (FF $445,838  GF $402,569)
FFY19: $848,407 (FF $453,898  GF $394,509)
Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax 402-471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.
Posted: September 22, 2017 (comment contact information updated 9-29-17)
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NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
Effective August 23, 2017, all notices required by LB268 (2017), including requests for waivers on restriction of transfer, must be submitted to the following e-mail address: DHHS.MedicaidEstateRecovery@nebraska.gov
 
Notices may also be mailed to the Department of Health and Human Services, Nebraska Medicaid Estate Recovery, P.O. Box 95026, Lincoln, Nebraska 68509-5026.
 
Posted: August 23, 2017
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         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 expanded school-based services and cost settlement
 
Nebraska Medicaid is requesting an amendment to the State Medicaid Plan to be effective September 1, 2017. The purpose of this amendment is to add additional Medicaid reimbursable services when provided by a school district pursuant to Nebraska Legislative Bill 276 (2014), now Nebraska Revised Statute 68-911.  Current Medicaid reimbursable services are physical therapy, occupational therapy, and speech language pathology services.  The additional services reimbursable to school districts include nursing, personal assistance, medical transportation, vision, and mental health services.
 
The estimated increase in annual aggregate expenditures is:
FFY18: $23,737,674 (FF $12,422,400 GF $11,315,274)
FFY19: $29,441,702 (FF $15,677,424 GF $13,764,278)
 
Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax 402-471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.
 
Posted: August 23, 2017
           ______________________________________________________________________________________________________________________
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 a change in payment methodology for dual eligible Medicare/Medicaid crossover claims.
 
Effective July 1, 2017, Medicaid will pay the lesser of the Medicare or Medicaid allowable amount.  The Department will accept Medicare's utilization review and payment decisions for Medicare allowable fees, except that after crediting any amount received from Medicare for Medicare-covered services and crediting any amount received from any third party resource (TPR), Medicaid will pay the lesser of the Medicare or Medicaid allowable amount of any remaining amount due.
 
The estimated decrease in annual aggregate expenditures is:
FFY17: $5,911,585.86 (FF $3,065,157.27 GF $2,846,428.59)
FFY18: $23,646,343.45 (FF $12,426,153.49 GF $11,220,189.97)
 
 
Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax 402-471-9092 or e-mail to DHHS.MedicaidSPA@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 26, 2017
_____________________________________________________________________________________
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: Medical Nutrition Therapy and Lactation Counseling.  The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:
Medical Nutrition Therapy
FFY17: $378,236 (FF $196,115 GF $182,120)
FFY18: $1,530,113 (FF $804,074 GF $726,038)
 
Lactation Counseling:
FFY17: $86,062 (FF $44,623 GF $41,439)
FFY18: $344,249 (FF $180,903 GF $163,346)
 
Rates:
Title
CPT Code
Modifier
Unit Value
Rate
Medical Nutrition Therapy; initial
97802
 
15 minute increment
26.11
Medical Nutrition Therapy; initial
97802
EP
15 minute increment
26.11
Medical Nutrition Therapy; re-assessment
97803
 
15 minute increment
21.60
Medical Nutrition Therapy; re-assessment
97803
EP
15 minute increment
21.60
 
Medical Nutrition Therapy; group
97804
EP
30 minute increment
13.52
Medical Nutrition Therapy
G0270
 
For use with Medicare crossover claims only
23.42
Unlisted Preventative Medicine Services (used for Lactation Consultation Services- Non Physician)
99429
EP
30 minute increment
18.50
 
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 22, 2017
Update June 23, 2017: SFY in the original updated to the FFY17 and FFY18 and amounts adjusted for FFY.
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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: peer support services. The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:

FFY17: $585,836 (FF $314,958 GF $270,879)
FFY18: $2,343,345 (FF $1,275,983 GF $1,067,362)
 
Peer Support
Rates:
 
Title
CPT Code
Modifier
Unit value
Rate
Peer Support Services for Mental Health
H0038
HE
15 minute increments
$11.50
Peer Support Services for Substance Use
H0038
HF
15 minute increments
$11.50
Group Peer Support Services for Mental Health
H0038
HE/HQ
15 minute increments
$7.91
Group Peer Support Services for Substance Use
H0038
HF/HQ
15 minute increments
$7.91
 
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: March 30, 2017
  

 
 
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