Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 15 - PERSONAL ASSISTANCE SERVICES
Section 471-15-005 - BILLING AND PAYMENT FOR PERSONAL ASSISTANCE SERVICES
Universal Citation: 471 NE Admin Rules and Regs ch 15 ยง 005
Current through September 17, 2024
005.01 BILLING.
005.01(A)
GENERAL BILLING
REQUIREMENTS. Providers will comply with all applicable billing
requirements located in 471 NAC 3, and with all applicable billing requirements
for the Electronic Visit Verification (EVV) system.
005.02 PAYMENT.
005.02(A)
GENERAL PAYMENT
REQUIREMENTS. Medicaid will reimburse the provider for services
rendered in accordance with the applicable payment regulations codified in 471
NAC 3. Services must be delivered before they can be billed. Providers cannot
provide services to more than one client at a time. Medicaid will not pay for
services that were not performed during the actual hours noted by the provider
in the Electronic Visit Verification (EVV) system.
005.02(B)
SPECIFIC PAYMENT
REQUIREMENTS.
005.02(B)(i)
FREQUENCY OF BILLING. Providers may not bill more
frequently than weekly but must bill at least monthly. Claims must be submitted
within six months from the date of service in accordance with 471 NAC
3.
005.02(B)(ii)
PROVIDER RATES. Rates are set by the Department, and
are contained in the Nebraska Medicaid Personal Assistance Service Rate
Listing.
005.02(B)(iii)
PROVIDER SOCIAL SECURITY TAX WITHHOLDING.
005.02(B)(iii)(1)
AFFECTED
PROVIDERS. When required by law, the Department withholds Social
Security taxes from provider payments. The employee's share of Social Security
tax is withheld from provider payments only when in-home service is provided by
an individual not affiliated with an agency. The Department, upon receiving a
signed Internal Revenue Service Form FA-65, Employer Appointment of Agent, acts
on behalf of clients who receive in-home services to withhold mandatory Federal
Insurance Contribution Act taxes from individual providers and pays the
client's matching tax share to the Internal Revenue Service.
005.02(B)(iii)(2)
EARNINGS TAXED
FOR SOCIAL SECURITY. Affected providers are subject to Social
Security tax payment for each calendar year in which they are paid a federally
determined amount or more for services provided to one client. The Department
withholds this tax from all payments to affected providers. If a provider's
earnings do not reach this annual amount for Federal Insurance Contribution Act
services per client, the amount withheld for that year is refunded to the
provider. The Department remits to the Internal Revenue Service an amount equal
to the current Social Security tax rate for specified in-home services. Half of
this amount is withheld from the provider as the employee's share; the other
half is provided by the Department on behalf of the client employer.
005.02(B)(iv)
PROVIDER
PAYMENT PROCESS. Providers must confirm that services were
received in the manner authorized according to Department
procedures.
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