Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 46 - RATES FOR HOSPITAL SERVICES
Section 471-46-018 - LOWER LEVELS OF CARE

When the Department determines that a client no longer requires inpatient services but requires skilled nursing care and there are no skilled nursing beds available when the determination is made, the Department will pay only for authorized medically necessary skilled nursing care provided in an acute care hospital at a rate equal to the average rate per patient day paid by the Department to skilled nursing facilities during the previous calendar year. When a Medicaid patient no longer requires inpatient hospital services and has requested nursing home admission and is waiting for completion of the pre-admission screening process, the Department may pay for the pre-admission screening process days the client remains in the hospital before the pre-admission screening process is completed at a rate equal to the average rate per patient day paid by the Department to skilled nursing facilities during the previous calendar year. The hospital shall request prior authorization from the Medicaid Division before the pre-admission screening process days are provided. The Medicaid Division will send the authorization to the hospital. The hospital shall bill for class of care 81 and enter the prior authorization document number from Form MC-9 on Form HCFA-1450 (UB-92). The claim for the pre-admission screening process days must be separate from the claim for the inpatient days paid at the acute rate. The pre-admission screening process days will be disallowed as acute care days and Medicaid will pay the average rate per patient day paid by the Department to skilled nursing facilities during the previous calendar year for the pre-admission screening process day. Pre-admission screening process days will not be considered in computing the hospital's prospective rate.