Nursing Facility Provider Handbook

Medicaid Related Assistance
Medicaid & Long-Term Care

What would you like to do?

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


Table of Contents
Chapter 1 Administration
Chapter 2 Provider Participation
Chapter 3 Payment for Medical Services
​Chapter 12​Nursing Facility Services
​Chapter 36​Hospice Services


Appendices (Forms, Reports and Instructions)
​471-000-2​Form DM-5, “Physician's Confidential Report" and Completion Instructions
​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"

​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 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)
​Nebraska Level I PASRR Form
​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
​Medicaid Swing Bed Program and Authorization