Section 68-911 - Medical assistance; mandated and optional coverage; department; submit state plan amendment or waiver; specified coverage requirements(1) Medical assistance shall include coverage for health care and related services as required under Title XIX of the federal Social Security Act, including, but not limited to: (a) Inpatient and outpatient hospital services;(b) Laboratory and X-ray services;(c) Nursing facility services;(d) Home health services;(h) Medical and surgical services of a dentist;(i) Nurse practitioner services;(j) Nurse midwife services;(k) Pregnancy-related services;(m) Mental health and substance abuse services;(n) Early and periodic screening and diagnosis and treatment services for children which shall include both physical and behavioral health screening, diagnosis, and treatment services;(o) Rural health clinic services; and(p) Federally qualified health center services.(2) In addition to coverage otherwise required under this section, medical assistance may include coverage for health care and related services as permitted but not required under Title XIX of the federal Social Security Act, including, but not limited to: (b) Intermediate care facilities for persons with developmental disabilities;(c) Home and community-based services for aged persons and persons with disabilities;(e) Rehabilitation services;(f) Personal care services;(g) Durable medical equipment;(h) Medical transportation services;(i) Vision-related services;(j) Speech therapy services;(k) Physical therapy services;(l) Chiropractic services;(m) Occupational therapy services;(q) Mental health and substance abuse services;(r) Hearing screening services for newborn and infant children; and(s) Administrative expenses related to administrative activities, including outreach services, provided by school districts and educational service units to students who are eligible or potentially eligible for medical assistance.(3) No later than July 1, 2009, the department shall submit a state plan amendment or waiver to the federal Centers for Medicare and Medicaid Services to provide coverage under the medical assistance program for community-based secure residential and subacute behavioral health services for all eligible recipients, without regard to whether the recipient has been ordered by a mental health board under the Nebraska Mental Health Commitment Act to receive such services.(4) On or before October 1, 2014, the department, after consultation with the State Department of Education, shall submit a state plan amendment to the federal Centers for Medicare and Medicaid Services, as necessary, to provide that the following are direct reimbursable services when provided by school districts as part of an individualized education program or an individualized family service plan: Early and periodic screening, diagnosis, and treatment services for children; medical transportation services; mental health services; nursing services; occupational therapy services; personal care services; physical therapy services; rehabilitation services; speech therapy and other services for individuals with speech, hearing, or language disorders; and vision-related services.(5)(a) No later than January 1, 2023, the department shall provide coverage for continuous glucose monitors under the medical assistance program for all eligible recipients who have a prescription for such device.(b) Effective August 1, 2024, eligible recipients shall include all individuals who meet local coverage determinations, as defined in section 1869(f)(2)(B) of the federal Social Security Act, as amended, as such act existed on January 1, 2024, and shall include individuals with gestational diabetes.(c) It is the intent of the Legislature that no more than six hundred thousand dollars be appropriated annually from the Medicaid Managed Care Excess Profit Fund, as described in section 68-996, for the purpose of implementing subdivision (5)(b) of this section. Any amount in excess of six hundred thousand dollars shall be funded by the Medicaid Managed Care Excess Profit Fund.(6) On or before October 1, 2023, the department shall seek federal approval for federal matching funds from the federal Centers for Medicare and Medicaid Services through a state plan amendment or waiver to extend postpartum coverage for beneficiaries from sixty days to at least six months. Nothing in this subsection shall preclude the department from submitting a state plan amendment for twelve months.(7)(a) No later than October 1, 2025, the department shall submit a medicaid waiver or state plan amendment to the federal Centers for Medicare and Medicaid Services to designate two medical respite facilities to reimburse for services provided to an individual who is:(ii) An adult in the expansion population.(b) For purposes of this subsection:(i) Adult in the expansion population means an adult (A) described in 42 U.S.C. 1396a(a)(10)(A)(i) (VIII) as such section existed on January 1, 2024, and (B) not otherwise eligible for medicaid as a mandatory categorically needy individual;(ii) Homeless has the same meaning as provided in 42 U.S.C. 11302 as such section existed on January 1, 2024;(iii) Medical respite care means short-term housing with supportive medical services; and(iv) Medical respite facility means a residential facility that provides medical respite care to homeless individuals.(c) The department shall choose two medical respite facilities, one in a city of the metropolitan class and one in a city of the primary class, best able to serve homeless individuals who are adults in the expansion population.(d) Once such waiver or state plan amendment is approved, the department shall submit a report to the Health and Human Services Committee of the Legislature on or before November 30 each year, which provides the (i) number of homeless individuals served at each facility, (ii) cost of the program, and (iii) amount of reduction in health care costs due to the program's implementation.(e) The department may adopt and promulgate rules and regulations to carry out this subsection.(f) The services described in subdivision (7)(a) of this section shall be funded by the Medicaid Managed Care Excess Profit Fund as described in section 68-996.(8)(a) No later than January 1, 2025, the department shall provide coverage for an electric personal-use breast pump for every pregnant woman covered under the medical assistance program, or child covered under the medical assistance program if the pregnant woman is not covered, beginning at thirty-six weeks gestation or the child's date of birth, whichever is earlier. The electric personal-use breast pump shall be capable of (i) sufficiently supporting milk supply, (ii) double and single side pumping, and (iii) suction power ranging from zero mmHg to two hundred fifty mmHg. No later than January 1, 2025, the department shall provide coverage for a minimum of ten lactation consultation visits for every mother covered under the medical assistance program or child covered under the medical assistance program, if the mother is not covered under such program.(b) It is the intent of the Legislature that the appropriation for lactation consultation visits shall be equal to an amount that is a one hundred forty-five percent rate increase over the current lactation consultation rate paid by the department.(9)(a) No later than January 1, 2024, the department shall provide coverage, and reimbursement to providers, for all necessary translation and interpretation services for eligible recipients utilizing a medical assistance program service. The department shall take all actions necessary to maximize federal funding to carry out this subsection.(b) The services described in subdivision (9)(a) of this section shall be funded by the Medicaid Managed Care Excess Profit Fund as described in section 68-996.Neb. Rev. Stat. §§ 68-911
Laws 1965, c. 397, § 4, p. 1277; Laws 1967, c. 413, § 1, p. 1278; Laws 1969, c. 542, § 1, p. 2193; Laws 1993, LB 804, § 1; Laws 1993, LB 808, § 1; Laws 1996, LB 1044, § 315; Laws 1998, LB 1063, § 5; Laws 1998, LB 1073, § 60; Laws 2002, Second Spec. Sess., LB 8, § 1; R.S.1943, (2003), § 68-1019; Laws 2006, LB 1248, § 11; Laws 2009, LB 603, § 1; Laws 2013, LB 23, § 12; Laws 2013, LB 556, § 5; Laws 2014, LB 276, § 4; Laws 2022, LB 698, § 1; Laws 2022, LB 855, § 1; Laws 2023, LB 227, § 61; Laws 2024, LB 62, § 2; Laws 2024, LB 857, § 8; Laws 2024, LB 905, § 1; Laws 2024, LB 1215, § 20. The Revisor of Statutes has pursuant to section 49-769 correlated LB62, section 2, with LB857, section 8, LB905, section 1, and LB1215, section 20, to reflect all amendments. Changes made by LB62 became effective July 19, 2024. Changes made by LB857 became effective July 19, 2024. Changes made by LB905 became effective July 19, 2024. Changes made by LB1215 became operative July 19, 2024.Amended by Laws 2024, LB 62,§ 2, eff. 7/19/2024.Amended by Laws 2024, LB 1215,§ 20, eff. 4/3/2024, op. 7/19/2024.Amended by Laws 2024, LB 857,§ 8, eff. 7/19/2024.Amended by Laws 2024, LB 905,§ 1, eff. 7/19/2024.Amended by Laws 2023, LB 227,§ 61, eff. 6/7/2023, op. 9/2/2023.Amended by Laws 2022, LB 855,§ 1, eff. 7/21/2022.Amended by Laws 2022, LB 698,§ 1, eff. 9/2/2023.Amended by Laws 2014, LB 276,§ 4, eff. 7/18/2014.