End of the Public Health Emergency

What flexibility was granted during the PHE?
During the PHE, Nebraska Medicaid allowed annual physical examinations for LTC residents to be performed through telehealth.

What will be allowed as of May 11, 2023?
Annual physical examinations for LTC residents will be required to be conducted in person. These in-person examinations for each LTC resident must be completed by November 11, 2023.​​

Nebraska Medicaid generally covers home health services ordered by physicians and APRNs that are deemed medically necessary.

What flexibility was granted during the PHE?
During the PHE, Nebraska Medicaid expanded coverage for home health services prescribed by nurse practitioners, and physician assistants.

What will be allowed as of May 11, 2023?
Nebraska Medicaid will continue to cover home health services provided by each of these provider types.​​

Hospice aides generally are required to be supervised in person by registered nurses (RNs).

What flexibility was granted during the PHE?
During the PHE, this in-person requirement was suspended but allowed by telehealth to sustain quality care during an extraordinary time.

What will be allowed as of May 11, 2023?
Hospice aides will once again need to have supervisory visits by RNs at least every 14 days.

Certain providers are allowed to make on-the-spot initial Medicaid presumptive eligibility determinations for certain applicants.

What flexibility was granted during the PHE?
During the PHE, pregnancy-only providers were allowed to make presumptive eligibility determinations for not only pregnant women, but also for parents and caretaker relatives, children, persons formerly in the foster care system, adults of working age without a disability (adult expansion), and breast and cervical cancer patients.

What will be allowed as of May 11, 2023?
Pregnancy-only providers will no longer be allowed to make presumptive eligibility determinations for anyone other than pregnant mothers.

Other providers who have signed up and completed the necessary training to perform presumptive eligibility determinations will continue to be allowed to make these determinations for those other groups mentioned above.

Certain services require prior authorization (PA). Both fee-for-service (FFS) and the health plans use PAs. This flexibility refers to FFS PAs only.

What flexibility was granted during the PHE?
During the PHE, FFS providers could extend PAs that existed before the pandemic started, through to the end of the pandemic, without requiring follow-up visits.

What will be allowed as of May 11, 2023?
This flexibility will no longer be available.​

Nebraska Medicaid requires currently enrolled providers to revalidate every five years to be able to continue to be reimbursed for services provided to members.

What flexibility was granted during the PHE?
During the PHE, revalidation deadlines were postponed indefinitely.

What will be allowed as of May 11, 2023?
Providers will need to revalidate their agreement with Nebraska Medicaid prior to the end date of their enrollment. It will be closed if their enrollment is not revalidated before the end date. If the end date is missed, providers that are licensed professionals or facilities will have a 180-day grace period to complete revalidation. After 180 days, a new enrollment request would need to be submitted.

For waiver and personal assistance service (PAS) providers, a new enrollment request will need to be submitted if the end date is missed because a closed enrollment cannot be reopened or revalidated.

Nebraska Medicaid completes pre- and post-enrollment site visits of certain providers who are enrolled with Nebraska Medicaid.

What flexibility was granted during the PHE?
During the PHE, Nebraska Medicaid waived the in-person site visit requirement.

What will be allowed as of May 11, 2023?
Beginning July 1, 2023, pre-enrollment site visits will be completed in person. Post-enrollment site visits after this date will also be completed in person. All site visits will be unannounced.

What flexibility was granted during the PHE?
During the PHE, long-term care providers received an additional vaccine administration fee on top of the per diem. Nebraska Medicaid also provided an increased rate for COVID-19 vaccinations administered in a member's home or small communal group setting. Retail pharmacies received an enhanced administration fee. Additionally, providers reimbursed through enhanced ambulatory patient groups (EAPGs) could receive reimbursement for the COVID-19 vaccine administration outside of the EAPG.

What will be allowed as of July 1, 2023?
At this time, there will be no changes to this reimbursement methodology. If any changes occur, a provider bulletin will be released with more information.

Assisted living facilities (ALFs) receive reimbursement for certain services they provide to members.

What happened during the PHE?
During the PHE, Nebraska Medicaid continued to pay the waiver rate to an ALF if a resident was temporarily transferred out of the facility to quarantine in another ALF or a skilled nursing facility, if the ALF held the resident's place.

What will be allowed as of July 1, 2023?
This flexibility will no longer be available.

“Bed-hold days" are the number of days in which a nursing facility (NF) or skilled nursing facility (SNF) allows a resident to return to the facility after temporarily transferring to a hospital or therapeutic leave.

What flexibility was granted during the PHE?
During the PHE, bed-hold days were increased to a maximum of 90 days in cases when a resident left the facility to quarantine in an alternate setting and was re-admitted after the quarantine period.

What will be allowed as of July 1, 2023?
Bed-hold days will return to the pre-PHE standard of a maximum of 15 days and for hospitalization only.

What flexibility was granted during the PHE?
During the PHE, an extraordinary statewide process for facility transfers was put in place, with instructions for discharging and receiving facilities.

What will be allowed as of July 1, 2023?
LTC facility transfers will return to the pre-PHE standard.

Each Medicaid health plan has a policy that indicates how often medication refills are allowed.

What flexibility was granted during the PHE?
During the PHE, members could receive a one-time early refill of their non-Schedule II medications to align with PHE social distancing policies.

What will be allowed as of July 1, 2023?
The flexibility for allowing an early refill for specific circumstances will continue to be allowed.

​Nebraska Medicaid does not generally cover emergency use authorization (EUA) medications.

What flexibility was granted during the PHE?
During the PHE, Nebraska Medicaid covered the following:

• FDA-approved drugs and licensed biologicals with a labeled indication to treat COVID-19
• FDA-approved drugs and licensed biologicals without a labeled indication to treat COVID-19, but for which an FDA EUA authorizes a new indication to treat COVID-19
• non-FDA approved drugs and licensed biologicals approved to treat COVID-19 under FDA EUA

What will be allowed as of May 11, 2023?
This flexibility will continue through the end of the continuous coverage unwind period​. 

​During the Pandemic, federal guidelines allowed states to suspend Level I and Level II PASRRs to reduce the amount of overflow in hospitals.

Nebraska Medicaid did not participate in this flexibility, and nothing will be changing.

​During the pandemic, federal guidelines allowed states to waive requirements stating that Nebraska Medicaid providers were required to be licensed in Nebraska

Nebraska Medicaid did not participate in this flexibility, and nothing will be changing.