Section 6411 of the Patient Protection and Affordability Care Act of 2010 requires states to contract with a recovery audit contractor (RAC) to identify and recover overpayments and underpayments. The complete final rule may be viewed at http://www.gpo.gov/fdsys/pkg/FR-2011-09-16/pdf/2011-23695.pdf
Nebraska Medicaid submitted an amendment to the Centers for Medicare and Medicaid Services (CMS) on November 15, 2017, requesting an exception to the Medicaid Recovery Audit Contractor program, which was approved. In December 2019, Nebraska submitted and received another exception by CMS for the RAC Program requirement through December 2021. Nebraska again received an exception by CMS for the RAC Program requirements through December 2023.
This exception request was based on the fact that Nebraska implemented Heritage Health effective January 1, 2017, a program which combines physical health, behavioral health, and pharmacy programs into a single managed care system. A dental benefits manager for dental services launched October 1, 2017.
Nebraska Rev State 68-974 (3)(a) excludes managed care claims from the scope of the Recovery Audit Contractor. This leaves few claims for review or recovery from the fee for service program.
Health Management Systems, Inc. (HMS) contract ended on November 30, 2017.
2016 Nebraska RAC Annual Report from HMS
2017 Nebraska RAC Annual Report from HMS
2018 Nebraska RAC Annual Report from HMS