Nebraska Medicaid Program

State Plan

PDF Table of Contents

Section 1 – Single State Agency Organization

1.1  Designation and Authority
1.2  Organization for Administration
1.3  Statewide Operation
1.4  State Medical Care Advisory Committee
1.5  Pediatric Immunization Program

Section 2 – Coverage and Eligibility

2.1   Application, Determination of Eligibility and Furnishing     Medicaid
2.2   Coverage and Conditions of Eligibility
2.3   Residence
2.4   Blindness
2.5   Disability
2.6   Financial Eligibility
2.7   Medicaid Furnished Out of State

Section 3 – Services: General Provisions

3.1   Amount, Duration, and Scope of Services
3.2   Coordination of Medicaid with Medicare and Other Insurance
3.3   Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases
3.4   Special Requirements Applicable to Sterilization Procedures
3.5   Families Receiving Extended Medicaid Benefits

Section 4 –General Program Administration

4.1   Methods of Administration
4.2   Hearings for Applicants and Recipients
4.3   Safeguarding Information on Applicants and Recipients
4.4   Medicaid Quality Control
4.5   Medicaid Agency Fraud Detection and Investigation Program
4.6   Reports
4.7   Maintenance of Records
4.8   Availability of Agency Program Manuals
4.9   Reporting Provider Payments to the Internal Revenue Service
4.10  Free Choice of Providers
4.11  Relations with Standard-Setting and Survey Agencies
4.12  Consultation to Medical Facilities
4.13  Required Provider Agreement
4.14  Utilization/Quality Control
4.15  Inspection of Care in Intermediate Care Facilities for the Mentally Retarded, Facilities Providing Inpatient Psychiatric Services for Individuals Under 21, and Mental Hospitals
4.16  Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees
4.17  Liens and Adjustments or Recoveries
4.18  Cost Sharing and Similar Charges
4.19  Payment for Services
4.20  Direct Payments to Certain Recipients for Physicians’ or Dentists’ Services
4.21  Prohibition Against Reassignment of Provider Claims
4.22  Third Party Liability
4.23  Use of Contracts
4.24  Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services
4.25  Program for Licensing Administrators of Nursing Homes
4.26  Drug Utilization Review Program
4.27  Disclosure of Survey Information and Provider or Contractor Evaluation
4.28  Appeals Process (Long-Term Care Facilities)
4.29  Conflict of Interest Provisions
4.30  Exclusion of Providers and Suspension of Practitioners and Other Individuals
4.31  Disclosure of Information by Providers and Fiscal Agents
4.32  Income and Eligibility Verification System
4.33  Medicaid Eligibility Cards for Homeless Individuals
4.34  Systematic Alien Verification for Entitlements
4.35  Enforcement of Compliance for Nursing Facilities
4.36  Required Coordination Between the Medicaid and WIC Programs
4.38  Nurse Aide Training and Competency Evaluation for Nursing Facilities
4.39  Preadmission Screening and Annual Resident Review in Nursing Facilities
4.40  Survey and Certification Process
4.41  Resident Assessment for Nursing Facilities
4.42  Employee Education About False Claims Recoveries
4.43  Cooperation with Medicaid Integrity Program Efforts
4.44 Medicaid Prohibition on Payments to Institutions or Entities Located Outside of the United States

Section 5 – Personnel Administration

5.1  Standards of Personnel Administration
5.2  RESERVED
5.3  Training Programs; Subprofessional and Volunteer Programs

Section 6 – Financial Administration

6.1  Fiscal Policies and Accountability
6.2  Cost Allocation
6.3  State Financial Participation

Section 7 – General Provisions

7.1  Plan Amendments
7.2  Nondiscrimination
7.4  State Governor’s Review

ATTACHMENTS


Documents in PDF PDF format require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Systems, Inc.