Section 471-21-002 - Provider Requirements21-002.01General Provider Requirements: To participate in the Nebraska Medical Assistance Program (Medicaid), providers of rehabilitation services shall comply with all applicable participation requirements codified in 471 NAC Chapters 2 and 3. In the event that provider participation requirements in 471 NAC Chapters 2 or 3 conflict with requirements outlined in 471 NAC Chapter 21, the individual provider participation requirements in 471 NAC Chapter 21 shall govern.
21-002.02Specific Provider Requirements: Rehabilitation services must be provided in a hospital or a distinct part of a hospital that:
i. Provides rehabilitation services;ii. Is licensed or formally approved as a hospital by the Nebraska Department of Health and Human Services, Division of Public Health or, if the hospital is located in another state, the authority responsible for licensing or formal approval in that state; iii. Has licensed and certified rehabilitation beds;iv. Meets the requirements for participation in Medicare for rehabilitation hospitals; and v. Has in effect a utilization review plan which applies to all Medicaid clients. 21-002.02AProvider Agreement: A hospital which provides rehabilitation services shall complete and sign Form MC-20, "Medical Assistance Hospital Provider Agreement" (see 471-000-91) and submit the completed form to the Department for approval and enrollment as a provider. Each hospital shall have a separate provider agreement (and a separate provider number) for rehabilitation services. The hospital shall submit a description of the rehabilitation program with the provider agreement. 21-002.02A1Out-of-State Hospital Provider Agreement: In addition to a completed and signed Form MC-20, an out-of-state hospital shall also submit documentation of its certification/accreditation status from the state survey agency in the state where the hospital is located. The Department will not process claims received from an out-of-state hospital until all information required under this section has been received. Also see 471 NAC 10-010.03J, Out-of-State Hospital Rates, and 10-010.06G, Payment to an Out-of-State Hospital for Outpatient Hospital and Emergency Room Services.
21-002.02BHospital Level of Rehabilitation Care: The Rehabilitation hospital must provide a hospital level of rehabilitative care. Hospitals with a significant number of rehabilitation team members working on a part time basis must provide evidence to establish that the hospital did, in fact, provide a hospital level of rehabilitative care. Evidence documenting the hospital level of rehabilitative care includes, but is not limited to:1. Verification that team conferences were held at least once every two weeks;2. Verification that there was a need for, and involvement of, various allied health professionals; and,3. Verification of the intensity of the rehabilitative program.471 Neb. Admin. Code, ch. 21, § 002