Nebraska Medicaid Program
Recovery Audit Contractors (RAC)
Section 6411 of the Patient Protection and Affordability Care Act of 2010 requires states to contract with a Recovery Audit Contractor (RAC) to identify and recover overpayments and underpayments. The complete final rule may be viewed at http://www.gpo.gov/fdsys/pkg/FR-2011-09-16/pdf/2011-23695.pdf
Nebraska Medicaid submitted an amendment to the Centers for Medicare and Medicaid Services (CMS) on November 15, 2017, requesting an exception to the Medicaid Recovery Audit Contractor program. On December 18, 2017, CMS approved the exception to the RAC requirement for two years (until December 1, 2019).
This exception request was based on the fact that Nebraska implemented Heritage Health effective January 1, 2017, a program which combines physical health, behavioral health, and pharmacy programs into a single managed care system. A dental benefits manager for dental services launched October 1, 2017.
Nebraska Rev State 68-974 (3)(a) excludes managed care claims from the scope of the Recovery Audit Contractor. This leaves few claims for review or recovery from the fee for service program.
Health Management Systems, Inc. (HMS) contract ended on November 30, 2017.