21-002.01
General Provider
Requirements:
To participate in the Nebraska Medical Assistance Program
(Medicaid), providers of rehabilitation services shall comply with all
applicable participation requirements codified in 471 NAC Chapters 2 and 3. In
the event that provider participation requirements in 471 NAC Chapters 2 or 3
conflict with requirements outlined in 471 NAC Chapter 21, the individual
provider participation requirements in 471 NAC Chapter 21 shall
govern.
21-002.02
Specific Provider Requirements:
Rehabilitation services must be provided in a hospital or a
distinct part of a hospital that:
i.
Provides rehabilitation services;
ii. Is licensed or formally approved as a
hospital by the Nebraska Department of Health and Human Services, Division of
Public Health or, if the hospital is located in another state, the authority
responsible for licensing or formal approval in that state;
iii. Has licensed and certified
rehabilitation beds;
iv. Meets the
requirements for participation in Medicare for rehabilitation hospitals; and
v. Has in effect a utilization
review plan which applies to all Medicaid clients.
21-002.02A
Provider
Agreement: A hospital which provides rehabilitation services shall
complete and sign Form MC-20, "Medical Assistance Hospital Provider Agreement"
(see 471-000-91) and submit the completed form to the Department for approval
and enrollment as a provider. Each hospital shall have a separate provider
agreement (and a separate provider number) for rehabilitation services. The
hospital shall submit a description of the rehabilitation program with the
provider agreement.
21-002.02A1
Out-of-State Hospital Provider Agreement: In addition
to a completed and signed Form MC-20, an out-of-state hospital shall also
submit documentation of its certification/accreditation status from the state
survey agency in the state where the hospital is located. The Department will
not process claims received from an out-of-state hospital until all information
required under this section has been received.
Also see 471 NAC 10-010.03J, Out-of-State Hospital Rates,
and 10-010.06G, Payment to an Out-of-State Hospital for Outpatient Hospital and
Emergency Room Services.
21-002.02B
Hospital Level of
Rehabilitation Care: The Rehabilitation hospital must provide a
hospital level of rehabilitative care. Hospitals with a significant number of
rehabilitation team members working on a part time basis must provide evidence
to establish that the hospital did, in fact, provide a hospital level of
rehabilitative care. Evidence documenting the hospital level of rehabilitative
care includes, but is not limited to:
1.
Verification that team conferences were held at least once every two
weeks;
2. Verification that there
was a need for, and involvement of, various allied health professionals;
and,
3. Verification of the
intensity of the rehabilitative program.
