Medicaid Public Notices

The estimated increase in annual aggregate expenditures is:

FFY20: $979,052 ($535,737 Federal Funds / $443,315 General Funds)

FFY21: $1,322,692 ($746,924 Federal Funds / $575,768 General Funds)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or email to DHHS.MedicaidSPA@nebraska.gov. Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

The estimated increase in annual aggregate expenditures is:

FFY20: $1,268,400 ($694,068 Federal funds / $574,332 General funds)

FFY21: $1,713,600 ($968,355 Federal funds / $745,245 General funds)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or email to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

The estimated increase in annual aggregate expenditures is:

FFY20: $2,265,500 ($1,239,408 Federal funds / $1,025,592 General funds)

FFY21: $3,060,000 ($1,729,206 Federal funds / $1,330,794 General funds)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or email to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

The anticipated effective date is January 1, 2020. The estimated increase in annual aggregate expenditures i

s:

FFY20:  $2,378,250 ($1,301,378 Federal funds / $1,076,872 General funds)

FFY21:  $3,213,000 ($1,815,666 Federal funds / $1,397,334 General funds)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or email DHHS.MedicaidSPA@nebraska.gov. Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

This ABP (referred to here as “Nebraska Basic ABP") will be applicable to individuals in the Adult Expansion Group who are eligible for Nebraska's Medicaid program and who do not meet criteria for the Nebraska Prime ABP as established in the State's proposed 1115 Demonstration Waiver. Under the proposed 1115 Demonstration Waiver, all newly enrolled individuals will receive services under the Nebraska Basic ABP. Under the proposed 1115 Demonstration Waiver, all newly enrolled individuals and individuals who do not meet wellness initiatives and personal responsibility activities will receive services under the Nebraska Basic ABP. Beginning in waiver demonstration year 2, individuals not participating in community engagement activities will also receive services under the Nebraska Basic ABP.

Once approved, the Nebraska Basic ABP will provide eligible individuals in the Adult Expansion Group with access to all of the federally mandated Essential Health Benefits. These Essential Health Benefits include the following services:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management

The following services are not included in the Nebraska Basic ABP:

• Vision
• Dental
• Over the counter medications
• Pediatric services, including oral and vision care (Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services)

The Nebraska Department of Health and Human Services expects to submit this SPA to the Centers for Medicare and Medicaid Services no later than December 15, 2019.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, pursuant to 42 CFR 440.345, will not be provided under the Nebraska Basic ABP.  These services will be provided in the Nebraska Prime ABP as those eligible individuals in the Adult Expansion Group who are under age 21 will be a targeted group enrolled in the Nebras

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.

Consistent with federal law and the Nebraska Medicaid State Plan, the State Medicaid Director provided written notice regarding the proposed State Plan Amendment to the appropriate tribal contacts on October 25, 2019. In accordance with the State Plan, additional information regarding the proposed changes will be provided to the tribal contacts upon request, and consultation will occur as requested or as otherwise appropriate.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov. Non-electronic copies will be made available for review at each local office of the Department of Health and Human Services. All comments must be received by November 26, 2019.

Notice is hereby given, in accordance with 42 CFR 440.386, to provide a summary of an amendment to the previous SPA and notice provided.

The previous ABP noticed on February 25, 2019 will now be referred to as the “Nebraska Prime ABP".  The Nebraska Prime ABP will be applicable to individuals in the Adult Expansion Group who are eligible for Nebraska's Medicaid program and who meet criteria established in the State's proposed 1115 Demonstration Waiver. Under the proposed 1115 Demonstration Waiver, individuals must meet wellness initiatives and personal responsibility activities, and beginning in demonstration year 2 participate in certain community engagement activities in order to receive coverage under the Nebraska Prime ABP.

The Nebraska Prime ABP will provide services to the following targeted populations of the Adult Expansion Group:

• Medically frail;
• Age 19-20 years old; and
• Pregnant women.

Once approved, the Nebraska Prime ABP will provide eligible individuals in the Adult Expansion Group with access to the federally mandated Essential Health Benefits. These Essential Health Benefits include all services provided in the Nebraska Basic Alternative Benefit Plan with the inclusion of:

• Vision
• Denta
• l
• Over the counter medications
• Pediatric services, including oral and vision care (Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services)

The Nebraska Department of Health and Human Services expects to submit the amended SPA to the Centers for Medicare and Medicaid Services no later than December 15, 2019.

Pursuant to 42 CFR 440.345, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services will be provided in the Nebraska Prime ABP to those eligible individuals in the Adult Expansion Group who are under age 21 as required by law and regulation, and consistent with current state policy regarding the delivery of these services.

The section 1937 coverage option for the ABP will be Secretary-Approved Coverage that is based on, and consistent with, the benefits provided in Nebraska's approved state Medicaid plan. The base benchmark plan will be the largest plan by enrollment of the three largest small group insurance products in Nebraska's small-group market.

Consistent with federal law and the Nebraska Medicaid State Plan, the State Medicaid Director provided written notice regarding the proposed State Plan Amendment to the appropriate tribal contacts on October 25, 2019. In accordance with the State Plan, additional information regarding the proposed changes will be provided to the tribal contacts upon request, and consultation will occur as requested or as otherwise appropriate.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov. Non-electronic copies will be made available for review at each local office of the Department of Health and Human Services. All comments must be received by November 26, 2019.

MLTC is providing this abbreviated public notice of its intent to: (1) request, on or before December 20, 2019, approval of a Section 1115 demonstration project from the Centers for Medicare & Medicaid Services that will implement Medicaid expansion through a program that will be known as “Heritage Health Adult" (“HHA"); (2) hold public hearings to receive comments on the Section 1115 demonstration application.

Summary of HHA Program Features

Unlike existing Medicaid-eligible individuals, HHA adults will have a tiered benefit system through which all eligible HHA beneficiaries will receive either the “Basic" benefits package or the “Prime" benefits package. The Basic benefits package includes comprehensive medical, behavioral health, and prescription drug coverage. The Prime benefits package is the Basic benefits package plus vision, dental, and over-the-counter medication. Both benefit packages will be provided through the State's current managed care entities.

All beneficiaries newly eligible for Medicaid under the HHA program will receive the Basic benefits package for the initial six-month benefit tier period.

HHA beneficiaries will receive the Prime benefits package if:

• They are medically frail; or
• They are age 19 or 20; or
• They are a pregnant woman eligible under expansion; or
• Beginning in Demonstration Year (DY) 1, they engage in the wellness initiatives and personal responsibility activities. Beginning in DY2, HHS beneficiaries must also participate in community engagement activities, including but not limited to, employment, job-seeking activities, and educational activities. HHA beneficiaries who do not engage in these activities will be assigned to the Basic benefits package. 

In addition to the tiered benefit structure, MLTC will encourage timely enrollment and promote increased continuity of care through a waiver of retroactive eligibility for HHA and most other adult Medicaid beneficiaries, with the exception of pregnant women, individuals dually-eligible for Medicare and Medicaid, and individuals in nursing facilities. 

Finally, MLTC plans to facilitate and encourage more widespread enrollment in private health insurance through a future amendment to the demonstration. 

Public Meetings and Comment

The public is invited to review and comment on the State's demonstration request.

A full public notice statement describing the demonstration application in more detail can be found at the following link: Full Public Notice. A draft of the demonstration application itself can be found on the Heritage Health Adult Demonstration webpage.  Paper copies of the full public notice document and a draft of the amendment application can be picked up during regular business hours at the Department of Health and Human Services, 301 Centennial Mall South, Lincoln, Nebraska 68509

Comments will be accepted 30 days from the publication of this notice. The comment period ends November 26, 2019. Comments may be sent to:

Department of Health and Human Services 
Nebraska Medicaid
ATTN: HHA Waiver
301 Centennial Mall South
P.O. Box 95026
Lincoln, Nebraska 68509-5026

Comments may also be sent by email to DHHS.HHAWaiver@Nebraska.gov.

Public hearings are scheduled at the following times/locations:

Meeting Date (Agenda)	Time	Location	Call-in Information
Tuesday, October 29, 2019	7 pm - 8:30 pm MDT	Board Room, Scottsbluff High School 313 E 27th St, Scottsbluff NE 69361	(844) 588-2804 Meeting ID: 704387476
Wednesday, October 30, 2019	6:45 pm - 8:15 pm CDT	South Platte Room, Kearney Public Library 2020 1st Ave, Kearney NE 68847	(844) 588-2804 Meeting ID: 985819573
Thursday, November 7, 2019	6 pm - 7:30 pm CST	Meeting Room A, Norfolk Public Library 308 W Prospect Ave, Norfolk, NE 68701	--
Tuesday, November 12, 2019	7 pm - 8:30 pm CST	Room 132, UNO College of Public Affairs and Community Service 6320 Maverick Plaza, Omaha, NE 68182	(888) 820-1398 Attendee code: 7300221

Please note: Spoken comments will be accepted over the phone at the Kearney meeting on October 30. For the other meetings with call-in information, the phone line will be open as listen-only for callers. We would encourage those calling into the Scottsbluff or Omaha meetings to submit written comments.

After the State reviews comments submitted during this state public comment period, it will submit a revised application to CMS. Interested parties will also have opportunity to officially comment during the federal public comment period after CMS finds the application and public notice requirements met.

The updated Medicaid payment rates are effective for services with a date of service on or after July 1, 2019.

The estimated increase in annual aggregate expenditures is:

FFY2019:  $3,277,014 Federal Funds Fiscal Impact (8.1.2019 to 9.30.2019)

FFY2020:  $20,525,847 Federal Funds Fiscal Impact (10.1.2019 to 9.30.2020)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or email to DHHS.MedicaidSPA@nebraska.gov. Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Nursing facilities: For the rate period of July 1, 2019, through June 30, 2020, the inflation factor is negative 4.98%.

ICF-DD: For the rate period of July 1, 2019, through June 30, 2020, the inflation factor is positive 21.24%.

Federal fiscal impact

Nursing facilities: $11,730,461

ICF-DD: $834,581

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov. Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

The following lists a summary of the proposed changes:

1. Update language related to compliance with the Home and Community Based Settings Final rule: CMS provided stock language that has been updated in the Main Attachment #2: Home and Community-Based Settings Waiver Transition Plan section of the application.
2. Increase the number of unduplicated waiver participant slots for waiver years 3, 4, and 5:  Due to an increased number of individuals choosing home and community based services over nursing facility based service the number of slots available in the waiver is being increased.

Current numbers:

Amended to:

There is no federal fiscal impact.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026.  Fax (402) 471-9092 or email to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

The state's transition plan Final Draft will incorporate stakeholder input to include public comment. The transition plan will be available to view on Friday, May 10, 2019, on the HCBS Statewide​ Transition Plan webpage and will be available for public comment from May 16 to June 17, 2019. Comments may be submitted to the designated e-mail address: DHHS.HCBSPublicComments@nebraska.gov with the subject heading State Transition Plan.

DHHS staff will make available hard copies of the transition plan to any participant once posted upon request. An opportunity for public comment will be held at the following locations:

Once approved, the ABP will provide eligible individuals in the Adult Expansion Group with access to the federally mandated Essential Health Benefits. These Essential Health Benefits include the following services:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

Pursuant to 42 CFR 440.345, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services will be provided to those eligible individuals in the Adult Expansion Group who are under age 21 as required by law and regulation, and consistent with current state policy regarding the delivery of these services.

The section 1937 coverage option for the ABP will be Secretary-Approved Coverage that is based on, and consistent with, the benefits provided in Nebraska's approved state Medicaid plan. The base benchmark plan will be the largest plan by enrollment of the three largest small group insurance products in Nebraska's small-group market.

Consistent with federal law and the Nebraska Medicaid State Plan, the State Medicaid Director provided written notice regarding the proposed State Plan Amendment to the appropriate tribal contacts on January 31, 2019. In accordance with the State Plan, additional information regarding the proposed changes will be provided to the tribal contacts upon request, and consultation will occur as requested or as otherwise appropriate.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Non-electronic copies will be made available for review at each local office of the Department of Health and Human Services. All comments must be received by March 29, 2019

MLTC currently allows residential substance use disorder (SUD) services (a combination of substance use treatment services provided to a patient in the facility in which that patient is currently residing) to be provided to Medicaid-enrolled adults ages 21-64 residing in inpatient facilities that meet the federal regulatory definition of an Institution for Mental Diseases (IMD). IMDs are generally defined as inpatient facilities with more than 16 beds that provide behavioral health services to a majority of its patients.

Recently enacted federal Medicaid regulations found in 42 CFR 438.6(e) impose new limitations on MLTC's ability to continue allowing residential SUD services in IMDs for Medicaid-enrolled adults ages 21-64. These limitations have the potential to disrupt treatment programs for some of Nebraska Medicaid's most vulnerable adults, as those individuals may be forced to seek treatment in less appropriate and more costly settings, such as emergency departments.

As a result of these new regulations, MLTC intends to submit an application to CMS to implement a Section 1115 demonstration waiver to continue MLTC's policy of allowing SUD residential services in IMDs for Medicaid-enrolled adults ages 21-64. Implementation of this demonstration program requires CMS approval.

For more information on MLTC's intent to submit this application, including the public comment period, visit the following webpage: Substance Use Disorder Demonstration Program.

Nebraska Medicaid is requesting an amendment to the Medicaid state plan to add specialized add-on services for individuals with intellectual disabilities or a related condition who reside in a nursing facility.  The additional services include habilitative skills training, habilitative community inclusion, employment assistance, employment support, and non-medical transportation (specific to specialized add-on services).  These add-on services are to be provided to residents in nursing facilities and are reimbursed by Medicaid to the specialized services providers, not to the nursing facility.

The estimated increase in annual aggregate expenditures is:

FFY18: $435,628 (FF $228,922 / GF $206,705)

FFY19: $1,808,082 (FF $950,690 / GF $857,392)

Rates:

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Nursing Facilities: For the rate period of July 1, 2018 through June 30, 2019 the inflation factor is negative 7.17%

ICF-DD: For the rate period of July 1, 2018 through June 30, 2019 the inflation factor is positive 22

.10%.

There is no federal fiscal impact.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Through passage of section 503 of the Consolidated Appropriations Act, 2016 and section 5002 of the 21st Century Cures Act of 2016, Congress added section 1903(i)(27) to the Social Security Act (the Act) which prohibits federal Medicaid reimbursement to states for certain durable medical equipment (DME) expenditures that are, in the aggregate, in excess of what Medicare would have paid for such items.

Effective January 1, 2018, the statute requires a limit to available federal financial participation (FFP) for state Medicaid fee-for-service expenditures for DME, per Section 1903(i)(27). The limit is calculated in the aggregate to the amount that Medicare would have paid for the same items through the Medicare DMEPOS fee schedule, or, as applicable, the Medicare competitive bidding program. The statute specifically applies to items of DME that are covered by both Medicare and Medicaid.

A review of Nebraska Medicaid DME paid claims and payment amounts has revealed expenditures that are, in the aggregate, in excess of what Medicare would have paid for such items. To comply with the aforementioned rule, the State of Nebraska intends to reduce the rates of certain DME items. The reduced rates are effective for service provided on July 1, 2018, and thereafter.

The proposed rates are as follows:

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Nebraska Medicaid is requesting an amendment to the Medicaid state plan. Medical leave days will be reimbursed to PRTFs at 50% of the per-diem. Medical leave days include medical/surgical and inpatient psychiatric stays. Five days of leave are allowed for medical/surgical stays per treatment episode, and five days of leave are allowed for inpatient psychiatric stays per treatment episode. Therapeutic leave days will be reimbursed at 50% of the per diem for a maximum of 10 days per treatment episode.

The estimated decrease in annual aggregate expenditures is:

FFY18: Total $17,420 (FF $9,154; GF $8,266)

FFY19: Total $41,808 (FF $21,983; GF $19,825)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Nebraska Medicaid is requesting an amendment to the Medicaid state plan to add specialized services for individuals with intellectually disability or a related condition who reside in a nursing facility.  The additional services include residential habilitative training, day services, vocational services, habilitative community inclusion, and related transportation.  These services are to be provided to residents in nursing facilities and are reimbursed by Medicaid to the specialized services providers, not to the nursing facility.

The estimated increase in annual aggregate expenditures is:

FFY18: $1,016,465 (FF $534,152 GF $482,313)

FFY19: $1,808,082 (FF $950,690 GF $857,392)   

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

This notice is given in compliance with 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act. The Department of Health and Human Services Division of Medicaid and Long-Term Care hereby provides notice that it will submit a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) in accordance with Neb. Rev. Stat. 68-977 to 68-988.

The Ground Emergency Medical Transportation Act directs the agency to submit a SPA allowing for an intergovernmental transfer program relating to Medicaid managed care, ground emergency medical transportation services.

The estimated increase in annual aggregate expenditures is:

FFY18: Total $567,480 (FF $310,549; GF $256,931)

FFY19: Total $756,639 (FF $414,065; GF $342,574)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Nursing Facilities: For the rate period of July 1, 2017 through June 30, 2018 the inflation factor is negative 2.65%. 

ICF-DD: For the rate period of July 1, 2017 through June 30, 2018 the inflation factor is positive 21.86%.

There is no federal fiscal impact.

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

The health plans are contractually required to comply with the MHPAEA (IV.E.3.a-e) and can be sanctioned for failing to meet contract requirements if found to be in violation of parity.  Facets of the review included analyzing the treatment limitations, medical management standards, and operational strategies to ensure that administration of the mental health and addiction benefits are comparable to, and no more stringent than, how they are applied to the physical health benefits. 

Ongoing compliance with MHPAEA will be monitored and re-analyzed upon changes in Medicaid benefits or designs.  To report a concern to one of the managed care plans regarding parity, please follow the Grievance Process for each plan.  For further information from MLTC, please contact DHHS.MedicaidMHSU@nebraska.gov.  

Effective October 1, 2017, dental services provided to Medicaid adult clients (age 21 and older) will be subject to an annual dental benefit of $750.  Exemptions are in place for dental services for emergencies, for extensive special needs and ill clients, and for dentures.  Medicaid will review and consider coverage of these services that cause the client to exceed the $750 annual limit.  A prior authorization request must be submitted with medical necessity documentation.

The estimated decrease in annual aggregate expenditures by the benefit category or service being affected is as follows:

FFY18: $848,407 (FF $445,838  GF $402,569)

FFY19: $848,407 (FF $453,898  GF $394,509)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Nebraska Medicaid is requesting an amendment to the State Medicaid Plan to be effective September 1, 2017. The purpose of this amendment is to add additional Medicaid reimbursable services when provided by a school district pursuant to Nebraska Legislative Bill 276 (2014), now Nebraska Revised Statute 68-911.  Current Medicaid reimbursable services are physical therapy, occupational therapy, and speech language pathology services.  The additional services reimbursable to school districts include nursing, personal assistance, medical transportation, vision, and mental health services.

The estimated increase in annual aggregate expenditures is:

FFY18: $23,737,674 (FF $12,422,400 GF $11,315,274)

FFY19: $29,441,702 (FF $15,677,424 GF $13,764,278)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Effective July 1, 2017, Medicaid will pay the lesser of the Medicare or Medicaid allowable amount.  The Department will accept Medicare's utilization review and payment decisions for Medicare allowable fees, except that after crediting any amount received from Medicare for Medicare-covered services and crediting any amount received from any third party resource (TPR), Medicaid will pay the lesser of the Medicare or Medicaid allowable amount of any remaining amount due.

The estimated decrease in annual aggregate expenditures is:

FFY17: $5,911,585.86 (FF $3,065,157.27 GF $2,846,428.59)

FFY18: $23,646,343.45 (FF $12,426,153.49 GF $11,220,189.97)

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Nebraska Medicaid, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 471-9092 or e-mail to DHHS.MedicaidSPA@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

Rates:

Comments pertaining to the aforementioned may be submitted to the Department of Health and Human Services Legal Services, 301 Centennial Mall South, P.O. Box 95026, Lincoln, Nebraska 68509-5026. Fax (402) 742-2382 or e-mail to DHHS.Regulations@nebraska.gov.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.

In order to come into compliance with the rule, Nebraska will be reimbursing claims at the lesser of the following:

a. The usual and customary charge to the public, or;
b. The National Average Drug Acquisition cost (NADAC), plus the established professional dispensing fee, or;
c. The ACA Federal Upper Limit (FUL) plus the established professional dispensing fee, or;
d. The calculated State Maximum Allowable Cost (SMAC) plus the established professional dispensing fee.

The professional dispensing fee has been determined to be $10.02.

A financial impact analysis was completed by the state and is found to be budget neutral.

Comments may be submitted to and reviewed by the public at the Department of Health and Human Services Legal Services, 301 Centennial Mall South, P.O. Box 95026, Lincoln Nebraska 68509-5026.  Fax (402) 742-2382 or e-mail to DHHS.Regulations@nebraska.gov. The proposed State Plan Amendment will also be accessible at each local office of the Nebraska Department of Health and Human Services.

This webpage includes the draft AMRP along with links to the Access to Care Final Rule and CMS' Access to Care website. The public is invited to review the AMRP and submit comments. The public comment period starts on August 16, 2016 and ends on September 15, 2016. Nebraska Medicaid will review comments and incorporate public feedback into the AMRP prior to submission to CMS.

Comments on the AMRP may be submitted to the designated email address: DHHS.mltcpubliccomment@nebraska.gov with the subject heading AMRP Comments. Comments may also be mailed to The Department of Health and Human Services, Attention: Nancy Becker, 301 Centennial Mall South, P.O. Box 95026, Lincoln, NE 68509-5026 or by fax to (402) 471-9092.

• Access Monitoring Review Plan Draft
• Attachmen​t 1 - SFY 2015 Medicaid Report
• Attachment 2 - Nebraska Counties Classified by Urban Rural Frontier Status
• Attachment 3 - State-Designated Shortage Areas for Medical and Mental Health
• Attachment 4 - State-Designated Shortage Areas Mental Health
  
• Attachment 5 - Heritage Health Access Standards
• Attachment 6 - Reimbursement Rate Comparison