471 Neb. Admin. Code, ch. 46, § 011

Current through June 17, 2024

Section 471-46-011 - OUT-OF-PLAN SERVICES

When enrollees in the Nebraska Health Connection are provided hospital inpatient services by facilities not under contract with the Department's prepaid health care organizations, the Department contracted prepaid health care organizations are authorized, but are not required, to pay providers of hospital inpatient services who care for individuals enrolled in the Nebraska Health Connection at rates the Department would otherwise reimburse providers under this chapter.

011.FREE-STANDING PSYCHIATRIC HOSPITALS. When a free-standing psychiatric hospital, in Nebraska or out of state, does not have ancillary services on-site, such as pharmacy or laboratory, the provider of the ancillary service shall bill Medicaid for the ancillary services provided to inpatients. The hospital shall not include these ancillary costs on its cost report. The hospital's rate is calculated according to this chapter. This is an exception to policies related to the elimination of combined billing in this chapter.

471 Neb. Admin. Code, ch. 46, § 011

Adopted effective 6/6/2022