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Acute Care Services
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Benefits by State: Nebraska (October 2008) Notes
 
 
 
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Acute Care Services

Is the Benefit Covered? Copayment Requirement Prior Approval Requirement Coverage Limitations Reimbursement Methodology Populations Covered


Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes Medicare methodology for grouping and reimbursing covered surgical procedures CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes Public Health Clinic: $2/physician visit (not applicable to primary care services), $3/dental visit (specified services) - see state-specific FN Coverage limitations dependent upon type of service rendered Public Health Clinic: fee for service, Mental Health Clinic: cost based or prospective cost based per diem or fee for service, depending on mental health clinic service CN & MN
Federally Qualified Health Center Services
Yes Prospective cost based rate/visit CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes Psych services limited to approved facilities Prospective payment/discharge using DRG and peer groups, cost based payment for critical access hospitals, prospective cost based per diem for psych and rehab hospitals/units CN & MN
Outpatient Hospital Services
Yes $3/visit No visit payable within 3 days of inpatient admission, substance abuse treatment not covered Percentage of charge with limits, lab services paid fee for service, cost based payment for critical access hospitals CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes Fee for service CN & MN
Rural Health Clinic Services
Yes Prospective cost based rate/visit CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes Fee for service CN & MN
Chiropractor Services
Yes $1/visit 20 visits/year, 1 x-ray/year Fee for service CN & MN
Dental Services
Yes $3/specified services Specified services including periodontia, crowns and root canals Exam and cleaning 1/year, $1,000 maximum benefit/year included with denture services Fee for service CN & MN
Medical and Remedial Care - Other Practitioners
Medical/Surgical Services of a Dentist
Yes $2/visit, not applicable to primary care services - see state-specific FN Services limited to what a physician would provide Fee for service CN & MN
Nurse Midwife Services
Yes $2/visit, not applicable to primary care services - see state-specific FN Fee for service CN & MN
Nurse Practitioner Services
Yes $2/visit, not applicable to primary care services - see state-specific FN Fee for service CN & MN
Optometrist Services
Yes $2/visit 1 refractive exam/2 years Fee for service CN & MN
Physician Services
Yes $2/visit, not applicable to primary care services - see state-specific FN Telemedicine consultations require minimum 30 mile distance Fee for service CN & MN
Podiatrist Services
Yes $1/visit 1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory Fee for service CN & MN
Psychologist Services
Yes Fee for service CN & MN
Prescription Drugs
Prescription Drugs
Yes $2/Rx Specified drugs 90 day supply AWP-11%, plus pharmacy specific dispensing fee of $3.27-$5.00 CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
Yes $2 or $3/specified services - see state-specific FN 60 visits/year in combination with other therapies, rehab potential required Fee for service CN & MN
Physical Therapy Services
Yes $1 or $3/specified services - see state-specific FN 60 visits/year in combination with other therapies, rehab potential required Fee for service CN & MN
Services for Speech, Hearing and Language Disorders
Yes $2 or $3/specified services - see state-specific FN 60 visits/year in combination with other therapies, rehab potential required Fee for service CN & MN
Products and Devices
Dentures
Yes $3/specified services Replacement dentures Replacement covered only if existing denture cannot be made wearable by reline or repair, $1,000 maximum benefit/year included with dental services Fee for service CN & MN
Eyeglasses
Yes $2/pair Minimum diopter correction required for initial and replacement eyeglasses, replacements one/2 years and only if eyeglasses lost or unusable, contact lenses for specified medical conditions Fee for service CN & MN
Hearing Aids
Yes $3/single or pair of hearing aids New or replacement hearing aids, repairs over $150 1 hearing aid/4 years, hearing loss must exceed specified decibel criteria Acquisition cost plus dispensing fee CN & MN
Medical Equipment and Supplies
Yes Specified med equipment and med supply items costing more than $500 Fee for service CN & MN
Prosthetic and Orthotic Devices
Yes Fee for service CN & MN
Transportation Services
Ambulance Services
Yes Fee for service CN & MN
Non-Emergency Medical Transportation Services
Yes Yes See service-specific FN CN & MN
Other Services
Diagnostic, Screening and Preventive Services
Yes Limited to screening services only, specified coverage criteria for mammography Fee for service CN & MN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women
Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes Fee for service, and using Medicare payment ceilings for lab services CN & MN
Targeted Case Management
Yes Fee for service CN & MN


Long-Term Care Services

Community Based Care
Home and Community Based Services Waiver
Yes Services for the following populations: 1, 2, 4 & 8 - See service-specific FN Dependent upon the services provided CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes Initiation of care 8 hours/day up to 40 hours/week Fee for service CN & MN
Hospice Care
Yes Initiation of care Prospective rates based on Medicare methodology CN & MN
Personal Care Services
Yes Yes 40 hours/week Federal minimum hourly wage, increased following training or licensure CN & MN
Private Duty Nursing Services
Yes Fee for service CN & MN
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes Preadmission certification Prospective cost based per diem CN & MN
Inpatient Psychiatric Services, under age 21
Yes Psych services limited to approved facilities Prospective cost based per diem using peer groups, with limits CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes Yes 15 hosp leave days/hospitalization, 36 therapeutic leave days/year Private facilities paid prospective cost based per diem with limits, cost based payment for state-operated facility CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes Admission of beneficiaries over age 64 15 hosp leave days/hospitalization, 18 therapeutic leave days/year Prospective cost based per diem, with limits CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No


Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Balanced Budget Act of 1997. These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the federal poverty level (FPL). Beneficiaries in this group with income above 200 percent of the FPL pay a monthly premium. Any identified copayment requirements are applicable to beneficiaries age 19 and older. The State does not require a copayment for mental health care, irrespective of the provider of service. The State’s copayment requirements for physicians are not applicable to primary care services; only the services of specialists are subject to copayments. The State’s copayment requirements for nurse practitioners are not applicable to advance practice nurses with specialties in family practice, general practice, pediatrics or internal medicine. The State requires a $1/visit copayment for physical therapy and a $2/visit copayment for occupational therapy or speech pathology services rendered in an independent clinic setting but requires a $3/visit copayment if the services are rendered in an outpatient hospital setting.
 
 
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