Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 482 - NEBRASKA MEDICAID MANAGED CARE
Chapter 3 - ENROLLMENT BROKER
Section 482-3-005 - ENROLLMENT ACTIVITIES AND CHOICE COUNSELING

Universal Citation: 482 NE Admin Rules and Regs ch 3 ยง 005

Current through September 17, 2024

The enrollment broker must complete the following enrollment and choice counseling activities for mandatory and potential mandatory members in coordination with the health plans and Medicaid:

(A) Educate members concerning Heritage Health including:

(i) A general explanation of Heritage Health;

(ii) Mandatory and excluded members; and

(iii) The role of the health plans in coordinating care.

(B) Provide information specific to each health plan available in the State, including:

(i) Covered benefits;

(ii) Cost sharing, if any;

(iii) Names, locations telephone numbers of, and non-English languages spoken by current contracted providers;

(iv) Identification of providers not accepting new patients; and

(v) For Medicaid benefits not covered under Heritage Health, the enrollment broker must provide information about how and where to obtain services, any cost sharing, and how transportation is provided;

(C) Provide an explanation of those services which do not require primary care provider or health plan approval or prior authorization;

(D) Provide an explanation of the availability of interpreter services and alternative formats for written materials;

(E) Provide an explanation of passive enrollment;

(F) Provide an explanation of disenrollment and waiver of enrollment;

(G) Provide the member with enrollment materials that are easily understood by the member, and developed in ways appropriate to meet the needs of the member; and

(H) Enter the health plan and primary care provider (PCP) selection in the Heritage Health file.

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