Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 18 - PHYSICIANS' SERVICES
Section 471-18-003 - PROVIDER REQUIREMENTS
Universal Citation: 471 NE Admin Rules and Regs ch 18 ยง 003
Current through September 17, 2024
003.01 GENERAL PROVIDER REQUIREMENTS. To participate in Nebraska Medicaid, providers of physician services must comply with all applicable provider participation requirements codified in 471 Nebraska Administrative Code (NAC) 2 and 3. In the event provider participation requirements in 471 NAC 2 or 3 conflict with requirements outlined in this 471 NAC 18, the individual provider participation requirements in 471 NAC 18 will govern.
003.02 SPECIFIC PROVIDER REQUIREMENTS.
003.02(A)
INDEPENDENT CLINICAL LABORATORIES. An independent
clinical laboratory must have a separate provider agreement with the
Department. In addition to the provider agreement, independent clinical
laboratories must meet the following requirements:
(i) When state or applicable local law
requires licensing of independent clinical laboratories, the laboratory must be
licensed under the law; and
(ii)
The laboratory must meet the health or safety requirements of the United States
Secretary of Health and Human Services.
003.02(B)
PROVIDERS OF PORTABLE
X-RAY SERVICES. To be approved as a Nebraska Medicaid provider,
providers of portable x-ray services must be certified by the Centers for
Medicare and Medicaid Services (CMS) Regional Office. Each provider must submit
to the Department a copy of Form CMS-1539, Medicare and Medicaid Certification
and Transmittal, and remain in compliance with
42 CFR
486.100 through
486.110. An out-of-state portable
x-ray provider must provide the Department with verification of certification
from the Centers for Medicare and Medicaid Services (CMS) Regional Office. The
Department approves or denies enrollment as a Nebraska Medicaid provider based
on the certification information received from the Centers for Medicare and
Medicaid Services (CMS) Regional Office.
003.02(B)(i)
APPLICABILITY OF
HEALTH AND SAFETY STANDARDS. Providers of portable x-ray services,
except physicians who provide immediate personal supervision during the
administration of diagnostic x-ray services, must comply with all health and
safety standards in NAC Title 180.
003.02(C)
PROVIDERS OF NURSE
MIDWIFE SERVICES. The nurse midwife is approved for enrollment in
Medicaid under a group provider agreement with the physician with whom they
have a practice agreement.
003.02(D)
PROVIDERS OF NURSE
PRACTITIONER SERVICES. A nurse practitioner may provide services
within the specialty areas in which they hold certification. They must be
enrolled in accordance with the Provider Agreement.
003.02(E)
FEEDING AND SWALLOWING
CLINIC. Along with the completed form MC-19: Medical Assistance
Provider Agreement, the provider must submit a program overview which
demonstrates the following components of service are available within the
program:
(i) Interdisciplinary team
evaluation which provides information to team members on the individual's
medical status and nutrition and diet status and also addresses feeding and
behavioral concerns. In the process of the interdisciplinary team evaluation,
the team must review and consider information from other available resources
such as attending or referring physician, nursing home, school;
(ii) Assessment by the occupational therapist
of the individual's tone and posture to determine seating and positioning for
feeding and for the video fluoroscopy procedure;
(iii) Examination by the speech pathologist
to assess the individual's oral structures and clinical swallowing
evaluation;
(iv) A video
fluoroscopy swallow study to determine conditions which are most favorable for
a safe, efficient swallow and management of feeding problems;
(v) Assessment of oral motor function and
feeding behaviors. Depending on the needs of the individual, some or all of the
team members may be involved in this component. This assessment includes
presentation of a variety of amounts and types of foods and liquids to the
individual to provide additional information used to establish therapeutic
intervention;
(vi) Conference by
team members to review finding, establish priorities, and coordinate treatment
and follow-up recommendations; and
(vii) Presentation of plan of care to the
individual or family, including instruction, demonstration, and written
recommendations for feeding procedures at home and in other environments. This
may include school, nursing home, or others involved in the individual's
care.
Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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