Section 471-15-005 - BILLING AND PAYMENT FOR PERSONAL ASSISTANCE SERVICES005.01BILLING.005.01(A)GENERAL BILLING REQUIREMENTS. Providers will comply with all applicable billing requirements located in 471 NAC 3, and with all applicable billing requirements for the Electronic Visit Verification (EVV) system.005.02PAYMENT.005.02(A)GENERAL PAYMENT REQUIREMENTS. Medicaid will reimburse the provider for services rendered in accordance with the applicable payment regulations codified in 471 NAC 3. Services must be delivered before they can be billed. Providers cannot provide services to more than one client at a time. Medicaid will not pay for services that were not performed during the actual hours noted by the provider in the Electronic Visit Verification (EVV) system.005.02(B)SPECIFIC PAYMENT REQUIREMENTS.005.02(B)(i)FREQUENCY OF BILLING. Providers may not bill more frequently than weekly but must bill at least monthly. Claims must be submitted within six months from the date of service in accordance with 471 NAC 3.005.02(B)(ii)PROVIDER RATES. Rates are set by the Department, and are contained in the Nebraska Medicaid Personal Assistance Service Rate Listing.005.02(B)(iii)PROVIDER SOCIAL SECURITY TAX WITHHOLDING.005.02(B)(iii)(1)AFFECTED PROVIDERS. When required by law, the Department withholds Social Security taxes from provider payments. The employee's share of Social Security tax is withheld from provider payments only when in-home service is provided by an individual not affiliated with an agency. The Department, upon receiving a signed Internal Revenue Service Form FA-65, Employer Appointment of Agent, acts on behalf of clients who receive in-home services to withhold mandatory Federal Insurance Contribution Act taxes from individual providers and pays the client's matching tax share to the Internal Revenue Service.005.02(B)(iii)(2)EARNINGS TAXED FOR SOCIAL SECURITY. Affected providers are subject to Social Security tax payment for each calendar year in which they are paid a federally determined amount or more for services provided to one client. The Department withholds this tax from all payments to affected providers. If a provider's earnings do not reach this annual amount for Federal Insurance Contribution Act services per client, the amount withheld for that year is refunded to the provider. The Department remits to the Internal Revenue Service an amount equal to the current Social Security tax rate for specified in-home services. Half of this amount is withheld from the provider as the employee's share; the other half is provided by the Department on behalf of the client employer.005.02(B)(iv)PROVIDER PAYMENT PROCESS. Providers must confirm that services were received in the manner authorized according to Department procedures.471 Neb. Admin. Code, ch. 15, § 005
Amended effective 6/6/2022