Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 480 - HOME AND COMMUNITY-BASED SERVICES
Chapter 4 - PROVIDER REQUIREMENTS
Section 480-4-004 - PROVIDER ENROLLMENT

Universal Citation: 480 NE Admin Rules and Regs ch 4 ยง 004

Current through September 17, 2024

Refer to 471 NAC 2-000 for guidance regarding provider enrollment. Additional standards applicable to providers of Medicaid Home and Community-Based Waiver services follow.

004.01 PROVIDER SCREENING. In addition to requirements for provider screening found in 471 NAC 2-000, Department staff, or a designee of the Department, must conduct an in-person interview with each potential provider upon initial application and annually to review compliance with current service specific program standards. Monitoring visits will occur if a potential provider is approved. If the provider does not meet service specific standards at the time of the interview, but is willing to correct the deficiency within 30 days, staff will continue the interview when proof of compliance is received. If the provider is not willing to correct deficiencies within 30 days the provider will be denied or terminated.

004.02(A) DEPARTMENT STAFF RELATIVES AS PROVIDERS. In situations where a Department staff person's relative is the only resource, staff will obtain administrative approval. Department staff cannot approve, reapprove, evaluate, or negotiate provider agreements with, or authorize service provision from, providers to whom they are related.

004.02(B) PARTICIPANT RELATIVES AS PROVIDERS. A provider may not provide services for a relative participant that the provider has a legal responsibility to support.

004.03 DENIAL OR TERMINATION OF ENROLLMENT. Refer to 471 NAC 2-000.

004.03(A) DENIAL OR TERMINATION OF ENROLLMENT. Refer to 471 NAC 2-000. The Department, in its discretion, may deny or terminate a provider's enrollment for good cause.

004.03(B) VOLUNTARY WITHDRAWAL. Written notice to the potential provider is not required if the potential provider voluntarily withdraws from the evaluation process.

004.04 SERVICE PROVIDER AGREEMENT. Refer to 471 NAC 2-000.

004.04(A) AGREEMENT POLICIES. The following standard applies as found in 471 NAC 2-000:
(i) Service provider agreements are effective up to five years. Service provider agreements must be agreed upon and signed by all parties on or before the effective date.

004.05 APPEAL RIGHTS. Refer to 471 NAC 2-000. A provider of Waiver services has the right to appeal decisions or actions related to their enrollment as a Medicaid provider, including but not limited to:

(A) Reductions in rates;

(B) Sanctions; and

(C) Termination or denial of enrollment as a provider of Medicaid services.

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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