Section 467-4-001 - SPECIALIZED MEDICAL CARESpecialized medical care is covered, according to each diagnoses' service components, for eligible recipients age 21 years and older. The medical care must be outlined in the individual medical treatment plan that is developed and signed by a health care professional. The specialized medical care must be directly related to the medically eligible diagnosis. Routine, general health care is not a covered service.
001.01LOCATION OF SERVICES. Recipients are encouraged to use medical providers and facilities closest to their place of residence. If a medical provider or facility is available closer to the residence and the recipient chooses one further away, the Department is not obligated to pay for services.001.02SERVICES PROVIDED OUTSIDE NEBRASKA. Specialized medical care received from Nebraska medical providers is covered by the Program. The recipient, parent, or legal guardian must obtain prior approval from the Department for all non-emergency services outside of Nebraska. In the following situations, the Department may approve specialized medical care to be provided outside Nebraska: (A) A medical service is not available in Nebraska but is available in another state. Written documentation must be provided by the medical provider to explain the medical service requested and that the service is not available in Nebraska;(B) Emergency situations that arise while the recipient is visiting in another state and the recipient's health would be jeopardized if care was postponed until the recipient returned to Nebraska. Medical services are covered as if it were provided in Nebraska. Emergency services may be reviewed by the medical consultant. Emergency services will be covered up to five days; or(C) The medical service is more accessible in another state.001.03NON COVERED SERVICES. Services and care of recipients residing in an institution setting are not covered. Funds are not used to cover fees for long term care facilities, including skilled nursing facilities, and intermediate care facilities.467 Neb. Admin. Code, ch. 4, § 001
Amended effective 5/17/2022