Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 181 - SPECIAL HEALTH PROGRAMS
Chapter 1 - NEBRASKA CHRONIC RENAL DISEASE PROGRAM
Section 181-1-006 - LIMITATIONS

Universal Citation: 181 NE Admin Rules and Regs ch 1 ยง 006

Current through September 17, 2024

The annual amount paid by the Department on behalf of any one client will not exceed one and a one half percent (1.5%) of the amount allocated to the Department to operate the Chronic Renal Disease Program by the Nebraska Legislature for that state fiscal year. This amount may be adjusted upon the discretion of the Department based on the availability of funds and the number of clients served by the Chronic Renal Disease Program. A client will be given adequate notice that he or she has met his or her annual Program allotment. Service costs not covered by the Program after all other available insurance resources have determined and paid their share are the responsibility of the client.

006.01 OUT-OF-STATE SERVICES. Only out-of-state dialysis service providers or pharmacies, within fifty (50) miles of the Nebraska border that have signed a Chronic Renal Disease Program Service Provider Enrollment Form, may receive payment from the Department for providing covered services for a client subject to the limitations noted in this chapter.

006.02 PAYER OF LAST RESORT. The Chronic Renal Disease Program is A payer of last resort. Primary insurance providers, private, Medicaid or Medicare, must be invoiced first and have paid on a client's behalf before an invoice is sent to the Chronic Renal Disease Program for payment consideration.

006.03 TERMINATION. Clients are no longer eligible for participation in the Chronic Renal Disease Program under the following circumstances:

(A) Clients who stop dialysis treatments will be terminated from participation twelve (12) months after the month in which the course of dialysis is terminated;

(B) Clients who receive a kidney transplant and no longer require dialysis will be terminated from participation thirty-six (36) months after the month in which the kidney transplant is received;

(C) If a client's annual income exceeds three-hundred (300) percent of the federal poverty level;

(D) If the client moves out-of-state he or she is terminated from participation effective the date of the move;

(E) If the client fails to provide updated income-verifying or insurance documentation within the time frame requested by the Department;

(F) Misrepresentation on the part of a client;

(G) Upon death ;

(H) If there have been no payments for pharmaceutical or dialysis services processed on a client's behalf in one year. The year is calculated from the start of each state fiscal year;

(I) Failure to inform the Department of changes to the client status as required by this chapter; or

(J) Failure to submit a renewal application when due.

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