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.

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

MDS and Casemix Information

Regulations

The following chapters under Regulation Title 417 Nebraska Medical Assistance Program Services can be found on the Secretary Of State's website:

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 (NFs) 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 23-17	Nursing Facility Reimbursement Model Migration from RUGs to PDPM
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