Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 33 - HEALTH CHECK (EARLY PERIODIC SCREENING, DIAGNOSIS AND TREATMENT [EPSDT]) SERVICES
Section 471-33-003 - PROVIDER REQUIREMENTS

Universal Citation: 471 NE Admin Rules and Regs ch 33 ยง 003

Current through September 17, 2024

003.01 GENERAL PROVIDER REQUIREMENTS. To participate in Nebraska Medicaid, providers of HEALTH CHECK services must comply with all applicable provider participation requirements codified in 471 NAC 2 and 3. in the event that provider participation requirements in 471 NAC 2 or 3 conflict with requirements outlined in this 471 NAC 33. the individual provider participation requirements in 471 NAC 33 will govern.

003.02 SERVICE SPECIFIC PROVIDER REQUIREMENTS.

003.02(A) SCREENING PROVIDERS. Screening services must be performed by or under the supervision of a physician, dentist, or other provider licensed under State or Federal law to furnish primary medical and health services. Periodic and interperiodic examinations must, at a minimum, include the health screening services defined within this chapter. Vision and hearing screening examinations cannot be limited to the screening physician but may be obtained directly from an ophthalmologist or optometrist for vision services and licensed audiologist for the hearing service.

003.02(B) CONTINUING CARE PROVIDERS. Managed care plans will be considered continuing care providers if the following provisions are met. A continuing care provider is one who:
(1) Agrees to provide to formally enrolled children screening, diagnosis, and treatment for conditions identified during screening or referral to a provider capable of providing the appropriate services. As appropriate, the formal enrollment means that the HEALTH CHECK-eligible child or family has agreed to use one provider as a regular source of continuing care services for a stated period of time, and that mutual obligations of both client and provider are recognized by signed enrollment agreement;

(2) Maintains a complete health history, including information received from other providers;

(3) is responsible for providing needed physician services for acute, episodic, and chronic illnesses and conditions;

(4) Ensures accountability by submitting reports reasonably required by the Department; and

(5) Works with the HEALTH CHECK case manager, if one is assigned.

003.02(B)(i) ENROLLMENT AGREEMENT. The enrollment agreement must specify what options the provider will use to provide the following HEALTH CHECK services:
(1) Provision of dental services, or direct referral to a dentist or referral to the Department to obtain dental services;

(2) Provision of ail or part of the required transportation and scheduling assistance, or referral to the Department to obtain such assistance; and

(3) Referral assistance for treatment not covered by the plan but needed, or referral to the Department to obtain assistance as well as other provisions outlined in the agreement.

003.02(C) HEALTH CHECK SPECIAL SERVICES. All providers of the following special services must be licensed Nebraska Medicaid-enrolled providers who have submitted written required documentation and received written approval from the Department. All providers requesting to provide the following HEALTH CHECK special services must submit a request in writing.
003.02(C)(i) NUTRITIONAL COUNSELING. Physicians providing HEALTH CHECK services or licensed medical nutrition therapists may be approved to provide nutritional counseling. Those requesting to provide this service must submit a written request and include (1) person(s) providing services and their credentials, (2) general content of nutritional counseling session, (3) conditions most frequently expected to be encountered, (4) usual length and frequency of sessions, and (5) customary charge. The Department may request periodic review of the services. Requests for reapproval must be submitted when a change in approved content occurs. A referral must be made to the Special Supplemental Food Program for Women, Infants, and Children (WIC) for ongoing nutritional counseling for children under five, or for lactating, postpartum, or pregnant women.

003.02(C)(ii) LACTATION COUNSELING. The following providers may provide all lactation counseling services: physician, nurse practitioner (NP), physician assistant (PA), midwife (MW), and registered nurse (RN). Any such provider must have current certification as an International Board Certified Lactation Consultant. The Department may request periodic review of the services.

003.02(C)(iii) CHILDBIRTH EDUCATORS. Licensed practitioners who are Lamaze Certified Childbirth Educator (LCCE) or Certified Childbirth Educator (CCCE) and request to provide this service for Nebraska Medicaid-eligible individuals age 20 and younger must complete Form MC-19: Medical Assistance Provider Agreement, and return the form with a letter stating the class type, general description, class outline or statement of content, and length of sessions for initial approval. Childbirth educators must include proof of certification or course completion by a recognized childbirth education association. Requests for reapproval must be submitted when a change in the initial proposal occurs. The Department may request periodic review of the services. Requests to approve changes to approved services must be submitted to the Department. Approval is based on guidelines from recognized childbirth education associations and demonstrate appropriateness.

003.02(C)(iv) WELL CHILD CLUSTER VISITS. Providers interested in providing this service must submit a description of the cluster visit, including format, group size, scheduling, and content to the Department to request initial prior approval. Requests to approve any changes to the approved service must be submitted to the Department.

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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.