Section 471-16-011 - PHARMACY SERVICES FOR CLIENTS RESIDING IN CERTAIN CARE FACILITIES011.01NON-COVERED ITEMS. Nebraska Medicaid does not cover hydrogen peroxide, rubbing alcohol, and over-the-counter enemas as pharmacy services for clients residing in a nursing facility or intermediate care facility. The nursing facility or intermediate care facility may be reimbursed for these items under the Department's payment plan for nursing facility and intermediate care facility services. For clients residing in nursing facilities and intermediate care facilities, the Department does not cover medical supplies or durable medical equipment as pharmacy services.011.02REPLACEMENT COST. Providers cannot duplicate medication, at the Department's expense, for clients residing in facilities. The pharmacy or the facility is responsible for providing a replacement. Providers cannot bill the Department for medication which was destroyed upon a client's discharge.011.03PROFESSIONAL DISPENSING FEES. Pharmacies providing medications to nursing facility and intermediate care facility patients are allowed one professional dispensing fee per recipient and drug per month.011.04UNIT DOSE DEFINITIONS.011.04(A)TRADITIONAL BOTTLE METHOD. Dispensing multiple tablets and capsules in one vial or bottle. This excludes systems such as cassettes, individually packaged doses on cards containing multiple doses, and all similar systems. 011.04(B)UNIT DOSE. A system of drug packaging, dispensing, returning, billing, and crediting by a unit dose provider. 011.04(C)UNIT DOSE PACKAGING. Drug packaging approved by the Nebraska Board of Pharmacy.011.04(D)UNIT DOSE DISPENSING. The provision to the patient of a 14-day or less supply of a drug in unit dose packaging.011.04(E)UNIT DOSE RETURNING. The process of returning unit dose packaged drugs to the dispensing pharmacy.011.04(F)UNIT DOSE BILLING. Billing the Department one time per calendar month for the quantity of drug used by the patient during the month, with the exceptions described in this chapter. The quantity used is the difference between the quantity dispensed and the quantity returned. The date of service for each unit dose billing must be consistent from month to month.011.04(G)UNIT DOSE CREDITING. A process of issuing credits by the pharmacy to the Department for drugs accepted for return into inventory which were previously billed to and covered by the Department.011.04(H)UNIT DOSE PROVIDER. A pharmacy approved by the Department as a unit dose provider, initial approval is contingent upon written agreement by the provider and demonstration by the provider, to the satisfaction of the Department, of the provider's ability to use unit dose packaging, unit dose dispensing, unit dose returning, unit dose billing, and unit dose crediting. Continuing approval is contingent upon the provider's actual performance as specified in the written agreement.011.05.REIMBURSEMENT. The Department will only reimburse unit dose providers for prescribed drugs dispensed to Medicaid clients residing in facilities.011.06.DRUGS RETURNED FOR CREDIT. Providers which accept returns of dispensed drugs from long term care facilities must credit the Department for those drugs. A drug cost level, below which credits will not be mandatory, may be established by the Department.471 Neb. Admin. Code, ch. 16, § 011
Adopted effective 12/26/2021