Hospital and Pregnant Women Presumptive Eligibility

 
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Medicaid Related Assistance
Medicaid & Long-Term Care
 
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Medicaid providers must make presumptive eligibility (PE) determinations for Nebraska Medicaid consistent with DHHS policies and procedures for Qualified Hospitals and Entities, in accordance with 42 CFR 435.1110, HHA criteria guidelines, as well as state regulations as of January 1, 2014, at 477 NAC 1-000 through 477 NAC 29-000. A provider must be enrolled with Medicaid prior to making PE determinations. In order to become accepted, the Medicaid provider must fulfill the following requirements.

  1. For Medicaid hospitals to be accepted as PE providers, the hospital or entity's CEO or executive director must sign and submit Acknowledgment of Participation after training is successfully completed.　
  2. All Medicaid providers intending to make PE determinations, including hospitals, entities, and pregnant women's providers, must complete and submit a Confirmation of Interest to the DHHS Division of Medicaid and Long-Term Care at DHHS.MedicaidPE@nebraska.gov and include the following information:
    • Full company or corporate name and primary contact;
    • Proposed timeline to begin PE determinations;
    • An estimated number of individuals who will make PE determinations within the organization; and
    • A list of locations where determinations will be made.
  3. Each PE provider must complete DHHS Medicaid Presumptive Eligibility Training.
  4. Each individual that has completed the DHHS Medicaid Presumptive Eligibility training must complete and submit a Confirmation of Training to DHHS Division of Medicaid and Long-Term Care at DHHS.MedicaidPE@nebraska.gov.

In accordance with Nebraska regulations all PE determinations shall be indicated on a DHHS Presumptive Eligibility Form  and electronically sent to DHHS.MedicaidPE@nebraska.gov. The accepted provider shall provide each beneficiary with an agency approved application for Medicaid and Insurance Affordability programs.