Nebraska Medicaid Public Notices 
 
 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice
 
In accordance with 42 CFR 431.408, the Nebraska Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care (MLTC) hereby provides notice of MLTC’s intent to submit to the Centers for Medicare and Medicaid Services (CMS) an application to implement a Section 1115 Medicaid Demonstration Waiver for Substance Use Disorder Services.
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
Posted: August 29, 2018
___________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 implement specialized add-on services for individuals with intellectual disabilities or a related condition in nursing facilities.
 
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:
 

Title ​

 ​CPT Code ​Unit Value ​Rate (Agency Provider) Rate (​Individual Provider)
​Habilitative Community Inclusion ​H2015 ​Hourly increments ​$38.53 ​$25.25
​Habilitative Skils training ​S5108 ​Hourly increments ​$33.91 ​$21.67
​Employment Support ​T2019 ​15-minute increments ​$10.52 ​$6.27
​Employment Assistance ​T2015 ​Hourly increments ​$42.16 ​$25.25
​Non-Medical Transportation (specific to Specialized add-on Services) ​A0080 ​Per mile increments ​$1.635 ​$0.55
 
 
         
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.
 
Posted: June 27, 2018
___________________________________________________________________________________
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 regarding Nursing Facility & ICF-DD State Fiscal Year Rates for 2019.
 
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.
 
Posted: June 27, 2018
___________________________________________________________________________________
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 of Medicaid rate reduction for certain durable medical equipment (DME).
 
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:
 
  Proposed DME Rates Effective July 1, 2018
CODE MOD DESCRIPTION MEDICARE
LOWEST RATE
000A7007 LARGE VOLUME NEBULIZER, DISPOSABLE, UNFILLED, USED W/AEROSOL COMPRESSOR $2.42
000E0143 NU WALKER,FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT $41.31
000E0148 NU WALKER, HEAVY DUTY, WITHOUT WHEELS, RIGID OR FOLDING, ANY TYPE, EACH $80.37
000E0149 NU WALKER,HEAVY DUTY, WHEELED, RIGID OR FOLDING, ANY TYPE $112.80
000E0181 RR POWERED PRESSURE REDUCING MATTRESS OVERLAY/PAD, ALTERNATING, WITH PUMP, INCLUDES HEAVY DUTY $14.07
000E0184 NU DRY PRESSURE MATTRESS $160.36
000E0185 NU GEL OR GEL-LIKE PRESSURE PAD FOR MATTRESS, STD MATTRESS LENGTH AND WIDTH $153.33
000E0196 NU GEL PRESSURE MATTRESS. $309.90
000E0255 NU HOSPITAL BED, VARIABLE HGT, HI-LO WITH ANY TYPE SIDE RAILS, WITH MATTRES $599.20
000E0260 NU HOSPITAL BED SEMI-ELEC (HEAD & FT ADJ) WITH ANY TYPE SIDE RAILS W/MATTRS $577.60
000E0260 RR HOSPITAL BED SEMI-ELEC (HEAD & FT ADJ) WITH ANY TYPE SIDE RAILS W/MATTRS $57.76
000E0261 NU HOSPITAL BED SEMI-ELEC (HEAD & FT ADJ) WITH ANY TYPE SIDE RAILS W/O MATT $526.50
000E0265 RR HOSPITAL BED ELECTRIC (HEAD, FT & HGT ADJ) W/ANY TYPE SIDE RAILS W/MATTR -PA REQUIRED AS OF 07012017 $139.64
000E0266 NU HOSPITAL BED, ELECTRIC (HEAD, FT & HGT ADJ) WITH ANY TYPE RAILS W/O MATT $1,215.10
000E0303 NU HOSPITAL BED, HEAVY DUTY, EXTRA WIDE, WITH WEIGHT CAPACITY GREATER THAN 350 POUNDS,BUT LESS THAN OR EQUAL TO 600 POUNDS, WITH ANY TYPE SIDE $1,397.30
000E0371 NU NONPOWERED ADVANCED PRESSURE REDUCING OVERLAY FOR MATTRESS, STD LGTH/WID $1,997.80
000E0431 RR PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER/REG ULATOR/FLOWMETER/HUMIDIFIER/CANNULA OR MASK, AND TUBING $17.50
000E0434 RR PORTABLE LIQUID OXYGEN SYSTEM,RENTAL $17.50
000E0439 RR STATIONARY LIQUID OXYGEN SYSTEM, RENTAL; INCLUDES CONTAINER/CONTENTS/ REGULATOR/FLOWMETER/HUMIDIFIER/NEBULIZER, CANNULA OR MASK, & TUBING $69.99
000E0465 RR HOME VENTILATOR, ANY TYPE, USED WITH INVASIVE INTERFACE, (E.G., TRACHEOSTOMY TUBE) $1,038.25
000E0466 RR HOME VENTILATOR, ANY TYPE, USED WITH NON-INVASIVE INTERFACE, (E.G., MASK, CHEST SHELL) $1,038.25
000E0470 RR RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL $100.00
000E0471 RR RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL $247.65
000E0570 NU NEBULIZER W COMPRESSOR $47.50
000E0570 RR NEBULIZER W COMPRESSOR $4.75
000E0600 RR RESPIRATORY SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC $46.46
000E0601 NU CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE $353.50
000E0601 RR CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE $35.35
000E0627 NU SEAT LIFT MECHANISM INCORP COMBINATION LIFT CHR MECHANISM $266.40
000E0630 NU PATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD(S) $574.60
000E0630 RR PATIENT LIFT, HYDRAULIC OR MECHANICAL, INCLUDES ANY SEAT, SLING, STRAP(S) OR PAD(S) $57.46
000E0635 RR PATIENT LIFT,ELEC,W SEAT OR SLING $113.27
000E0730 NU TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, FOUR OR MORE LEADS,FOR MULTIPLE NERVE STIMULATION $49.62
000E0910 NU TRAPEZE BAR,A.K.A. PAT HELPER,ATTACHED TO BED,COMPLETE W GRAB BAR $104.60
000E1390 RR OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCENTRATION AT THE PRESCRIBED FLOW RATE $69.99
000E1392 RR PORTABLE OXYGEN CONCENTRATOR, RENTAL $38.68
000K0001 NU STANDARD WHEELCHAIR $185.00
000K0001 RR STANDARD WHEELCHAIR $18.50
000K0002 NU STANDARD HEMI (LOW SEAT) WHEELCHAIR $290.00
000K0002 RR STANDARD HEMI (LOW SEAT) WHEELCHAIR $29.00
000K0004 NU HIGH STRENGTH,LT WT WHLCHR $379.00
000K0007 NU EXTRA HEAVY DUTY WHLCHR $675.00
000K0738 RR PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; HOME COMPRESSOR TO FILL PORT O2*CYLINDERS, INCL PORT CONTAINERS, REG, FLOWMETER, HUMID, CANNULA/MSK,TUBE $38.68
000K0822 NU POWER WHEELCHAIR, GROUP 2 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS $1,900.00
000K0823 NU POWER WHEELCHAIR, GROUP 2 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS $1,841.60
000K0848 NU POWER WHEELCHAIR, GROUP 3 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS $5,126.77
000K0853 NU POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS $7,057.73
000K0856 NU POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS $5,502.40
000K0861 NU POWER WHEELCHAIR, GROUP 3 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUND $5,511.20
000K0862 NU POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS $6,826.93
 
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.

Posted: May 17, 2018
___________________________________________________________________________________
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 implement a change for therapeutic and medical leave days for Psychiatric Residential Treatment Facilities (PRTFs).
 
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.
 
Posted: April 3, 2018
______________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 implement specialized services for individuals with intellectual disabilities or a related condition in nursing facilities.
 
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.
 
Posted: February 14, 2018 
______________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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.
 
Posted: November 29, 2017
_____________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 implement a change for therapeutic and medical leave days for Psychiatric Residential Treatment Facilities (PRTFs) and Therapeutic Group Homes (ThGHs).
 
Effective 11-01-2017 Medical leave days will be reimbursed to PRTFs and ThGHs 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 to these facilities 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 $45,203 (FF $23,754; GF $21,449)
FFY19: Total $49,313 (FF $25,929; GF $23,384)
 
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.
 
Posted: October 30, 2017
_______________________________________________________________________________________________
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 regarding Nursing Facility & ICF-DD SFY18 Medicaid rate.
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.
Posted: September 29, 2017 (updated to note the ICF/DD inflation factor is positive)
____________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
Nebraska Department of Health and Human Services (DHHS) Division of Medicaid and Long-Term Care (MLTC) has reviewed the Heritage Health managed care plans’ administration of benefits for compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.  Participants in this review, led by MLTC, included representatives from the DHHS Division of Behavioral Health, DHHS Legal Services, and Nebraska Department of Insurance. 
 
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.  
 
Posted: September 27, 2017
 
____________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
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 of a change in the annual dental benefit limit for adults. 
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.
Posted: September 22, 2017 (comment contact information updated 9-29-17)
_____________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
Effective August 23, 2017, all notices required by LB268 (2017), including requests for waivers on restriction of transfer, must be submitted to the following e-mail address: DHHS.MedicaidEstateRecovery@nebraska.gov
 
Notices may also be mailed to the Department of Health and Human Services, Nebraska Medicaid Estate Recovery, P.O. Box 95026, Lincoln, Nebraska 68509-5026.
 
Posted: August 23, 2017
______________________________________________________________________________________________________________________
         NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
         Public Notice 
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 implement expanded school-based services and cost settlement
 
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.
 
Posted: August 23, 2017
           ______________________________________________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 implement a change in payment methodology for dual eligible Medicare/Medicaid crossover claims.
 
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.
 
Posted: June 26, 2017
_____________________________________________________________________________________
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 of rates for new services covered under the Medicaid program: Medical Nutrition Therapy and Lactation Counseling.  The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:
Medical Nutrition Therapy
FFY17: $378,236 (FF $196,115 GF $182,120)
FFY18: $1,530,113 (FF $804,074 GF $726,038)
 
Lactation Counseling:
FFY17: $86,062 (FF $44,623 GF $41,439)
FFY18: $344,249 (FF $180,903 GF $163,346)
 
Rates:
Title
CPT Code
Modifier
Unit Value
Rate
Medical Nutrition Therapy; initial
97802
 
15 minute increment
26.11
Medical Nutrition Therapy; initial
97802
EP
15 minute increment
26.11
Medical Nutrition Therapy; re-assessment
97803
 
15 minute increment
21.60
Medical Nutrition Therapy; re-assessment
97803
EP
15 minute increment
21.60
 
Medical Nutrition Therapy; group
97804
EP
30 minute increment
13.52
Medical Nutrition Therapy
G0270
 
For use with Medicare crossover claims only
23.42
Unlisted Preventative Medicine Services (used for Lactation Consultation Services- Non Physician)
99429
EP
30 minute increment
18.50
 
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.
Posted: June 22, 2017
Update June 23, 2017: SFY in the original updated to the FFY17 and FFY18 and amounts adjusted for FFY.
____________________________________________________________________ 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 of rates for new services covered under the Medicaid program: peer support services. The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:

FFY17: $585,836 (FF $314,958 GF $270,879)
FFY18: $2,343,345 (FF $1,275,983 GF $1,067,362)
 
Peer Support
Rates:
 
Title
CPT Code
Modifier
Unit value
Rate
Peer Support Services for Mental Health
H0038
HE
15 minute increments
$11.50
Peer Support Services for Substance Use
H0038
HF
15 minute increments
$11.50
Group Peer Support Services for Mental Health
H0038
HE/HQ
15 minute increments
$7.91
Group Peer Support Services for Substance Use
H0038
HF/HQ
15 minute increments
$7.91
 
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.
Posted: March 30, 2017
  
 
 
Nebraska Department of Health and Human Services
Public Notice:
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 implement an Actual Acquisition Cost (AAC) methodology when paying Medicaid pharmacy claims to meet requirements of the Medicaid covered outpatient drugs final rule (effective 4/1/2017).  This rule changes the pricing methodology for covered outpatient legend and non-legend drugs for all fee-for-service pharmacy claims.
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.  
   
Posted: March 23, 2017
 
 
ACCESS TO CARE
In November 2015, the Centers for Medicare and Medicaid Services (CMS) issued the Access to Care Final Rule. The Final Rule requires states to assess access to care for their Fee-For-Service (FFS) populations and to analyze whether reductions in provider reimbursement rates impact the ability of Medicaid eligible individuals to receive covered services.
States are required to develop an initial Access Monitoring Review Plan (AMRP) for specific categories of services as detailed in 42 Code of Federal Regulations (CFR) §447.203(b)(5)(ii) for submission to CMS by October 1, 2016. The Final Rule requires that the initial AMRP be made available to the public for review and comment for 30 calendar days prior to submission to CMS.
 
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.
  

  

Proposed Medicaid Payment Rate Changes
 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice - NF APPROVED BY DD'S RECOVERED
 
 
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 of a special funding provision for governmental nursing facilities.
City and county-owned and operated nursing facilities will be eligible to receive the federal financial participation share of allowable costs exceeding the rates paid for the direct nursing, support services, and fixed cost components for all Medicaid residents effective July 1, 2016.The reimbursement is subject to the payment limits of 42 CFR 447.272. 
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.
 
Posted: June 30, 2016
 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice 
 
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 of rates for new services covered under the Medicaid program: multisystemic therapy and functional family therapy. The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:
 
FFY16: $456,745 (FF $263,591, GF $193,154)
FFY17: $2,255,233 (FF $1,340,240, GF $914,994)
FFY18: $3,539,994 (FF $2,104,610, GF $1,435,382)
 
 
Multis
yste
mic Therapy and Functional Family Therapy
Rates:
 
emic  Therapy
Modifier
Service
Rate
Procedure Code H2033
none
Per 15 minute increments
$38.28
 
Functional Family Therapy
 
Modifier
Service
Rate
Procedure Code 90832
U9
Psychotherapy 30 minutes
 
$63.91
Procedure Code 90834
U9
Psychotherapy 45 minutes
 
$95.87
Procedure Code 90837
U9
Psychotherapy 60 minutes
 
$127.82
Procedure Code 90846
 
 
U9
Family therapy without identified client present
 
$102.52
Procedure Code 90847
 
U9
Family therapy with identified client present
$106.10
 
Comments pertaining to the aforementioned may be submitted to 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.  Copies of this change are also available for viewing at each local office of the Department of Health and Human Services.
Posted:  June 30, 2016
Update July 12, 2016 (The only change from the original June 30, 2016 posting is the Procedure Code for “Family therapy with identified client present” changed from 90846 to 90847.)
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice:
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 of Medicaid payment rate change for some Medicaid covered services for Nebraska eligible clients. Medicaid will implement a 2.00% increase in provider rates and an additional .25% increase for behavioral health, nursing facilities, assisted living and ICF-DD providers effective July 1, 2016. The rate increase is the result of an increase in appropriations by the Nebraska Legislature in LB657 (2015). The estimated increase in annual aggregate expenditures by the benefit category or service being affected is as followed:
 
  ALL SERVICE TYPES
Total GF FF
Inpatient Hospital $977,613 $477,466 $500,147
Physicians (excl primary care) $1,036,68 8 $506,318 $530,370
Dental $493,830 $241,186 $252,644
Capitated Svcs $12,888,478 $6,294, 7 33 $6,593,745
Outpatient Hospital $1,052,306 $513,946 $538,360
Nursing Facility $7,280,720 $3,555,904 $3,724,816
Lab $24,749 $12,088 $12,661
Radiology $28,983 $14,156 $14,827
Home Health/PAS/Hospice $662,553 $323,591 $338,962
All Other $12,334,139 $6,023,993 $6,310,146
TOTAL $36,780,058 $17,963,380 $18,816,678
 
 
• Ambulance
• Chiropractic
• Dental
• Durable Medical Equipment and Supplies, including Orthotics and Prosthetics
• Health Check
• Hearing Aids
• Home Health Agency
• Hospitals (non-Critical Access Hospitals)
• Mental Health and Substance Abuse
• Non-Emergency Transportation
• Nursing Services
• Occupational Therapy
• Personal Assistance Services
• Physical Therapy
• Physicians (excluding primary care codes)
• Podiatry
• Speech Pathology and Audiology
• Visual Care
 
The current and revised rate and fee schedules will be available online for public view at http://dhhs.ne.gov/medicaid/Pages/med_provhome.aspx. The schedules are also available for viewing at each local office of the Department of Health and Human Services. 
 
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.
 
Posted: June 30, 2016
 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice
 
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 of a special funding provision for governmental nursing facilities.
 
City and county-owned and operated nursing facilities will be eligible to receive the federal financial participation share of allowable costs exceeding the rates paid for the direct nursing, support services, and fixed cost components for all Medicaid residents effective July 1, 2016.The reimbursement is subject to the payment limits of 42 CFR 447.272.  The estimated increase in annual aggregate federal expenditures for this benefit is $120,000.00
 
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.
 
Posted: June 30, 2016 
 
 
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Notice - New Payment Methodology for FQHCs
 
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 of Medicaid payment methodology change for Federally Qualified Health Centers (FQHCs). 
 
The State of Nebraska currently reimburses FQHCs under the Prospective Payment System (PPS) rate methodology. Payment for FQHCs is guided by Section 1902(bb) of the Social Security Act, which defines parameters for a prospective payment system (PPS), and includes the option of an alternative payment methodology. FQHCs provide an essential primary care backbone for the Nebraska Medicaid delivery system. FQHCs serve low income and underserved populations, including but not limited to: migrant, homeless, and school based populations, and public housing residents. FQHCs provide a scope of services including: primary medical, dental, and behavioral health, case management and enabling services, such as interpretation. Services are provided on a discount fee schedule and no one is refused services based on inability to pay. Thus, the State of Nebraska intends to update the reimbursement methodology to reflect the federally approved Alternative Payment Methodology (APM) for FQHCs.
 
The State of Nebraska has elected to cover services for Nebraska eligible clients under the APM rate consistent with the PPS rate. Also similar to the PPS rate, the APM rate will exclude dental costs as FQHCs will continue to be reimbursed fee-for-service (FFS) for dental services outside of the APM rate. The implementation of the proposed payment methodology may result in an estimated increase in annual aggregate expenditures of $4.5 million dollars.
 
The effective date of the FQHC payment methodology change is January 1, 2016.
 
The current and revised rate schedules are available for public view at each local office of the Department of Health and Human Services.
 
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