Nursing Facility Provider Handbook

 
2
Medicaid Related Assistance
Medicaid & Long-Term Care
 
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No

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What you need to know

​​​This handbook is your primary resource on the Nebraska Medicaid program, including program regulations and service coverage requirements, as well as limitations, forms, billing requirements, and payment information.

Please review this handbook before providing services and requesting payment from Nebraska Medicaid, and share the handbook with personnel who perform referrals, authorization, coding, and claims submission for your office.

If you have questions or comments about this information, contact the Medicaid program specialist for this service type: Medicaid Contacts

For more information, please visit the page below and refer to the Additional Resources table:

MDS and Casemix Information

 

Regulations
Chapter 1 Administration
Chapter 2 Provider Participation
Chapter 3 Payment for Medical Services
​Chapter 12​Nursing Facility Services
​Chapter 36
​Hospice Services
​Chapter 43
​Nursing Facility Level of Care Determination for Children
Chapter 44
​Nursing Facility Level of Care Determination for Adults
Chapter 45
​Rates for Nursing Facility Services​

 

Appendices (Forms, Reports and Instructions)
​471-000-2

​Form DM-5, “Physician's Confidential Report" and Completion Instructions
​471-000-4
​Form MLTC-78 Instructions for Completing Form MLTC-78 "Prior Authorization for Specialized Add-On Services"
471-000-6
​Billing Instructions for Specialized Add-On Services Utilizing CMS-1500 Claim Form
​471-000-41​Instructions for Completing Form FA-66, “Long Term Care Cost Report"
​471-000-45​Instructions for Completing Form MC-75-7, “MDS Section S"
​471-000-80

​Nebraska Medicaid Long-Term Care UB-04 Billing Instructions for Durable Medical Equipment (DME) submitted by Nursing Facilities (NF's) and Intermediate Care Facilities (ICFs)

471-000-99 Medicaid Claim Adjustment and Refund Procedures
​471-000-203​Instructions for Completing Form MC-9NF, “Prior Authorization for Nursing Facility Care"
​471-000-220​Instructions for Completing Form DSS-14AD, “Functional Criteria"
​471-000-230​Instructions for Completing Form DPI-OBRA8, “Authorization for Release of Information"

 



Provider Bulletins
​​Provider Bulletin 22-10
​Specialized Add-on Services for Individuals in a Nursing Facility with ID/RC
Provider Bulletin 21-16
​Swing Bed Prior Authorization Process
Provider Bulletin 21-14​ 
​Long-Term Care Clients with Special Needs Authorization Process
​Provider Bulletin 20-44
​New Pre-Admission Screening and Resident Review (PASRR) Vendor​
Provider Bulletin 16-05
​Required Notifications to DHHS Medicaid and Eligibility Staff
Provider Bulletin 07-07

​Clarification of Facility Obligation to Reimburse for Nurse Aide

​Training and Competency Evaluation Program (NATCEP) Costs

 

Additional Resources
​Notification of Changes to DHHS Caseworkers/ACCESS Nebraska
​Prior Authorization Elimination/MDS Assessments Question and Answers
​Preadmission Screening and Resident Review (PASRR) - Kepro, Additional Resources
​PASRR Level 1 Kepro Portal - Additional Resources
​Level of Care Evaluation Memo
Level of Care Evaluation Requirements Questions and Answers
​Area Agencies on Aging / League of Human Dignity Maps
​Nursing Facility Level of Care Determination