Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM
Chapter 4 - DIAGNOSES AND SERVICES FOR THE GENETICALLY HANDICAPPED PERSONS PROGRAM
Section 467-4-001 - SPECIALIZED MEDICAL CARE
Current through September 17, 2024
Specialized medical care is covered, according to each diagnoses' service components, for eligible recipients age 21 years and older. The medical care must be outlined in the individual medical treatment plan that is developed and signed by a health care professional. The specialized medical care must be directly related to the medically eligible diagnosis. Routine, general health care is not a covered service.
001.01 LOCATION OF SERVICES. Recipients are encouraged to use medical providers and facilities closest to their place of residence. If a medical provider or facility is available closer to the residence and the recipient chooses one further away, the Department is not obligated to pay for services.
001.02 SERVICES PROVIDED OUTSIDE NEBRASKA. Specialized medical care received from Nebraska medical providers is covered by the Program. The recipient, parent, or legal guardian must obtain prior approval from the Department for all non-emergency services outside of Nebraska. In the following situations, the Department may approve specialized medical care to be provided outside Nebraska:
001.03 NON COVERED SERVICES. Services and care of recipients residing in an institution setting are not covered. Funds are not used to cover fees for long term care facilities, including skilled nursing facilities, and intermediate care facilities.
