Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 25 - SCHOOL BASED SERVICES
Section 471-25-006 - REIMBURSEMENT METHODOLOGY FOR SCHOOL-BASED SERVICES: DIRECT AND INDIRECT SERVICES

Universal Citation: 471 NE Admin Rules and Regs ch 25 ยง 006

Current through September 17, 2024

006.01 ADHERENCE TO NEBRASKA EDUCATION-BASED MEDICAID ADMINISTRATION (NEBMAC) GUIDE. All claims submitted by a provider must be based on random moment time studies which comply with the requirements of the Nebraska Education-Based Medicaid Administrative Claiming (NEBMAC) Guide, dated September 1, 2017, which is adopted and incorporated herein by this reference. A copy of the Nebraska Education-Based Medicaid Administrative Claiming Guide is available on the Department's website or by request at 301 Centennial Mall South, P.O. Box 95026, Lincoln, NE 68509-5026.

006.02 RETENTION OF RECORDS. Each public school district or Educational Service Unit (ESU) and approved cooperative participating in Medicaid administrative claiming must separately retain time-study methodology, instructions, financial accounting records, and other documents or records related to participation for a minimum of six years.

006.03 TIMELY FILING REQUIREMENTS. School districts, Educational Service Units (ESU's) and approved cooperatives must file their claims no later than 15 months from the end of the quarter in which direct services or indirect services were provided.

006.04 PAYMENT METHODOLOGY. Expenditures for direct school-based health services that are within the scope of Medicaid coverage and furnished to Medicaid eligible children may be claimed as medical assistance. Expenditures for administrative activities in support of these school-based services including outreach and coordination may be claimed as costs of administering Medicaid.

006.04(A) DIRECT SERVICE QUARTERLY INTERIM SETTLEMENTS. Quarterly interim settlements for services will be based on the quarterly random moment time study (RMTS) and use of the interim cost reports compiled on a quarterly basis. The cost report then calculates the amount of reimbursement that each school district is eligible to receive as an interim payment.
006.04(A)(i) ANNUAL SETTLEMENT. On an annual basis, a cost settlement process must be completed by each school district. Each school district completes an annual cost report which compares their total Medicaid-allowable costs from the year to each school district's Medicaid interim payments delivered during the quarterly reporting periods, to determine the final cost reconciliation and settlement. If a provider's interim payments exceed the actual, certified costs for Medicaid services provided in schools to Medicaid clients, the provider must remit the federal share of the overpayment at the time the annual settlement cost report is submitted.

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