Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 482 - NEBRASKA MEDICAID MANAGED CARE
Chapter 4 - THE HERITAGE HEALTH MANAGED CARE CORE BENEFITS PACKAGE
Section 482-4-003 - HEALTH CHECK EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT

Universal Citation: 482 NE Admin Rules and Regs ch 4 ยง 003

Current through September 17, 2024

The health plan must develop a program to ensure the delivery of Health Check Early and Periodic Screening, Diagnosis and Treatment services.

003.01 CONTACT WITH ELIGIBLE FAMILIES. The health plan must contact eligible families who have children age twenty (20) and younger within sixty (60) days of enrollment and encourage them to make an appointment for the required components of Health Check Early and Periodic Screening, Diagnosis and Treatment. The health plan must also counsel the family regarding the importance of health supervision and regular check-ups and assist in removing barriers to care. If necessary, the health plan must assist families with appointment scheduling and arranging transportation.

003.01(A) REQUIRED COMPONENTS. The required components are health screening, including medical, vision, hearing and dental screening (see 471 NAC 33-000).

003.02 THIRD PARTY LIABILITY REQUIREMENTS. The health plan must utilize a cost avoidance methodology whenever there is a verified third party resource. Under Federal Law, the Department is required to identify legally liable third parties and treat verified third party liability as a resource of the member. The health plan, or its subcontractors or providers, must not pursue collection from the member, but directly from the liable third party payers, except as allowed in Title 477 NAC. The health plan must assume responsibility for all third party liability requirements.

003.02(A) ASSIGNMENT OF RIGHTS. The health plan shall exercise full assignment rights as applicable and shall be responsible for making every reasonable effort to determine third parties to pay for services rendered to members and cost avoid and/or recover any such liability for the third party.

003.02(B) COORDINATION OF BENEFITS. The health plan shall coordinate benefits in accordance with 42 CFR 133.135 et seq and Title 471 NAC 3-004, so that costs for services otherwise payable by the health plan are cost avoided or recovered from a liable party. The two methods used are cost avoidance and post-payment recovery.

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