471 Neb. Admin. Code, ch. 10, § 003

Current through June 17, 2024

Section 471-10-003 - PROVIDER REQUIREMENTS

003.01GENERAL PROVIDER REQUIREMENTS. To participate in Nebraska Medicaid, hospital providers must comply with all the applicable participation requirements. In the event that provider participation requirements in 471 NAC 2 or 3 conflict with the requirements outlined in this 471 NAC 10, the individual provider participation requirements in 471 NAC 10 will govern.

003.02SPECIFIC PROVIDER REQUIREMENTS. To participate in Nebraska Medicaid, a hospital that provides hospital inpatient or outpatient or emergency room services must:

(i) Be maintained primarily for the care and treatment of patients with disorders other than mental disease;

(ii) Be licensed as a hospital by the Department or the officially designated authority for state standard-setting in the state where the hospital is located;

(iii) Have licensed and certified hospital beds; and

(iv) Meet the requirements for participation in Medicare and Medicaid.

003.02(A)PROVIDER AGREEMENT. To participate in Nebraska Medicaid, a hospital must complete Form MC-20: "Medical Assistance Hospital Provider Agreement," and submit the completed form to the Department. A copy of Form CMS-1539: Medicare/Medicaid Certification and Transmittal, must be submitted as part of the enrollment process.

003.02(B)INDEPENDENT CLINICAL LABORATORY. An independent clinical laboratory must be independent both of an attending or consulting physician's office, and of a hospital. A clinical laboratory must meet the following criteria:

(i) When state or applicable local law provides for licensing of independent clinical laboratories, the laboratory must be licensed under the law; and

(ii) The laboratory must also meet the health and safety requirements prescribed by the U.S. Secretary of Health and Human Services.

003.02(C)PROVIDERS OF PORTABLE X-RAY SERVICES. To be approved as a Nebraska Medicaid provider, providers of portable x-ray services must be certified by the Centers for Medicare and Medicaid Services (CMS) Regional Office. Each provider must submit a copy of Form CMS-1539: Medicare/Medicaid Certification and Transmittal, and remain in compliance with 42 CFR 486.100 through 486.110. An out-of-state portable x-ray provider must provide the Department with verification of certification from the Centers for Medicare and Medicaid Services Regional Office. The Department approves or denies enrollment as a Nebraska Medicaid provider based on the certification information received from the Centers for Medicare and Medicaid Services Regional Office.

003.02(C)(i)APPLICABILITY OF HEALTH AND SAFETY STANDARDS. Health and safety standards outlined in 180 NAC will apply to all providers of portable x-ray services, except physicians who provide immediate personal supervision during the administration of diagnostic x-ray services. Payment is made only for services of approved providers who have been found to meet the standards.

003.02(D)DURABLE MEDICAL EQUIPMENT AND MEDICAL SUPPLIES. The Department does not generally approve hospitals as providers of durable medical equipment and medical supplies. Exception: Apnea monitors and home phototherapy equipment.

003.02(E)APPROVAL AS AN AMBULATORY ROOM AND BOARD PROVIDER. The Department approves only hospitals as ambulatory room and board providers. To be eligible to receive Nebraska Medicaid payment for ambulatory room and board services, each hospital providing those services must be enrolled with the Department as a provider for hospital services and must submit Form MS-6: Ambulatory Room and Board Agreement. The Department may request additional information from the hospital to approve ambulatory room and board services.

003.02(E)(i)PROVIDER RE-APPROVAL. Each hospital approved by the Department to provide ambulatory room and board services must seek re-approval of its ambulatory room and board services from the Department when any of the following occur:

(1) The charge to the Department for ambulatory room and board services changes;

(2) There is a change in the physical location of the ambulatory room and board facility or the distance from the hospital building;

(3) There is a change in the services the hospital is able to provide to clients in the ambulatory room and board facility; or

(4) Other substantial changes are made to the hospital's ambulatory room and board services.

471 Neb. Admin. Code, ch. 10, § 003

Amended effective 11/9/2020

Amended effective 6/6/2022