471 Neb. Admin. Code, ch. 26, § 001

Current through June 17, 2024

Section 471-26-001 - Standards for Participation

NMAP covers facility services provided by ambulatory surgical centers in connection with certain surgical procedures. To participate in the Nebraska Medical Assistance Program, an ambulatory surgical center must:

1. Be certified as meeting the requirements for an ASC under Medicare;

2. Have an agreement with CMS under Medicare to participate as an ASC; and

3. Have an agreement with the Nebraska Department of Health and Human Services to participate in NMAP. NMAP covers ASC facility services for only the surgical procedures defined in 471 NAC 26-004. The ASC must accept the Department's payment for the facility services as payment in full for those services defined as ASC facility services in 471 NAC 26-002.

001.01 Definition of an ASC

An ASC is a distinct entity that operates exclusively to provide outpatient surgical services to patients. An ASC may be either:

1. Independent (not part of a provider of services or any other facility); or

2. Operated by a hospital (under the common ownership, licensure, or control of a hospital).

26-001.01AASC's Operated by Hospitals: If an ASC is operated by a hospital, it may be covered under Medicare as an independent ASC or as a hospital-affiliated ambulatory surgical center (HAASC). The Department enrolls ASC's to participate in NMAP as they are enrolled to participate in Medicare. To be covered as a Medicare-participating ASC operated by a hospital, a facility must:

1. Elect to do so, and continued to be covered as an ASC unless CMS determines there is good cause to do otherwise;

2. Be a separately identifiable entity, physically, administratively, and financially independent and distinct from other operations of the hospital; and

3. Meet all Medicare's requirements for independent ASC's.

Facilities operated by a hospital as Medicare-participating ASC's are paid according to 471 NAC 26-005. Other HAASC's are paid according to 471 NAC 10-010.06.

001.02 Provider Agreement

The provider must complete and sign Form MC-19, "Medical Assistance Provider Agreement," (see 471-000-90) and submit it to the Department to be approved for provider enrollment.

471 Neb. Admin. Code, ch. 26, § 001