68-912. Limits on goods and services; considerations; procedure.
(1) The department may establish (a) premiums, copayments, and deductibles for goods and services provided under the medical assistance program, (b) limits on the amount, duration, and scope of goods and services that recipients may receive under the medical assistance program subject to subsection (5) of this section, and (c) requirements for recipients of medical assistance as a necessary condition for the continued receipt of such assistance, including, but not limited to, active participation in care coordination and appropriate disease management programs and activities.
(2) In establishing and limiting coverage for services under the medical assistance program, the department shall consider (a) the effect of such coverage and limitations on recipients of medical assistance and medical assistance expenditures, (b) the public policy in section 68-905, (c) the experience and outcomes of other states, (d) the nature and scope of benchmark or benchmark-equivalent health insurance coverage as recognized under federal law, and (e) other relevant factors as determined by the department.
(3) Coverage for mandatory and optional services and limitations on covered services as established by the department prior to July 1, 2006, shall remain in effect until revised, amended, repealed, or nullified pursuant to law. Any proposed reduction or expansion of services or limitation of covered services by the department under this section shall be subject to the reporting and review requirements of section 68-909.
(4) Except as otherwise provided in this subsection, proposed rules and regulations under this section relating to the establishment of premiums, copayments, or deductibles for eligible recipients or limits on the amount, duration, or scope of covered services for eligible recipients shall not become effective until the conclusion of the earliest regular session of the Legislature in which there has been a reasonable opportunity for legislative consideration of such rules and regulations. This subsection does not apply to rules and regulations that are (a) required by federal or state law, (b) related to a waiver in which recipient participation is voluntary, or (c) proposed due to a loss of federal matching funds relating to a particular covered service or eligibility category. Legislative consideration includes, but is not limited to, the introduction of a legislative bill, a legislative resolution, or an amendment to pending legislation relating to such rules and regulations.
(5) Any limitation on the amount, duration, or scope of goods and services that recipients may receive under the medical assistance program shall give full and deliberate consideration to the role of home health services from private duty nurses in meeting the needs of a disabled family member or disabled person.
Source
Structure Nebraska Revised Statutes
Chapter 68 - Public Assistance
68-114 - Nonresident poor persons; temporary aid; relief when legal residence not determined.
68-115 - Legal settlement, defined; exclusions; minors; termination.
68-128 - Emergency assistance; families with children.
68-129 - Public assistance; computation of available resources; exclusions.
68-130 - Counties; maintain office and service facilities; review by department.
68-131 - Poor person; support by county; when eligible.
68-132 - County board; duties.
68-133 - County; adopt standards; requirements.
68-134 - Standards; review; filing; availability.
68-135 - Standards; hearing and notice.
68-136 - Failure to adopt or review standards; judicial review.
68-137 - Repayment; when required.
68-138 - Assistance; denial; termination; reduction; notice; hearing.
68-139 - Hearing before county board or hearing examiner; when allowed.
68-140 - Hearing; rights of person requesting.
68-142 - Judicial review; procedure.
68-143 - Poor person; where chargeable.
68-144 - Poor person; duties of county where found and county of legal settlement.
68-145 - Poor person; county where found; action to recover costs; when authorized.
68-146 - Nonresident poor person; general assistance; legal settlement verified; assurances.
68-148 - General assistance; not alienable; exception.
68-149 - Reimbursement to county; when; procedure.
68-150 - Application; right of subrogation.
68-151 - Employable recipients; legislative findings.
68-152 - Employable recipients; programs authorized.
68-153 - Employable recipients; terms, defined.
68-154 - Employable recipients; rules and regulations.
68-154.01 - Employable recipient; community service required; exception.
68-154.02 - Employable recipient; community service; costs; paid by county.
68-154.03 - Employable recipient; community service; participation; how construed.
68-155 - Employable recipients; ineligible; when; notice; appeal.
68-216 - Transferred to section 68-1001.02.
68-301 - State Assistance Fund; created; investment.
68-313 - Records and information; use and disclosure; limitations.
68-326 - Transferred to section 68-702.01.
68-328 - Assistance; application; furnish with reasonable promptness.
68-601 - Social security; policy.
68-603 - Agreement with federal government; state agency; approval of Governor.
68-604 - Agreement with federal government; instrumentality jointly created with other state.
68-605 - Contributions by state employees; amount.
68-606 - Contribution by state employees; collection.
68-607 - Contribution by state employees; adjustments.
68-608 - Coverage by political subdivisions; plan; modification; approval by state agency.
68-610 - Coverage by political subdivisions; amount; payment.
68-611 - Coverage by political subdivisions; delinquent payments; penalty; collection.
68-620.01 - Transferred to section 18-1221.
68-622 - Referendum; persons eligible to vote; Governor; powers.
68-623 - Referendum; how conducted.
68-624 - Referendum; completion; certification; notice; contents.
68-625 - Referendum; state agency; prepare plan; modification of state agreement.
68-626 - Referendum; state agency; forms; make available; aid political subdivisions.
68-627 - Referendum; supervision.
68-629 - Referendum; Governor; appointment of agency to conduct; cost; payment.
68-630 - Political subdivisions; delinquency in payment; manner of collection.
68-703.01 - Department of Health and Human Services; federal funds; expenditures; authorized.
68-716 - Department of Health and Human Services; medical assistance; right of subrogation.
68-719 - Certain vendor payments prohibited.
68-901 - Medical Assistance Act; act, how cited.
68-903 - Medical assistance program; established.
68-904 - Legislative findings.
68-905 - Program of medical assistance; statement of public policy.
68-906 - Medical assistance; state accepts federal provisions.
68-908 - Department; powers and duties.
68-910 - Medical assistance payments; source of funds.
68-912 - Limits on goods and services; considerations; procedure.
68-913 - Medical assistance program; public awareness; public school district; hospital; duties.
68-916 - Medical assistance; application; assignment of rights; exception.
68-917 - Applicant or recipient; failure to cooperate; effect.
68-918 - Restoration of rights; when.
68-920 - Department; garnish employment income; when; limitation.
68-921 - Entitlement of spouse; terms, defined.
68-922 - Amount of entitlement; department; rules and regulations.
68-923 - Assets; eligibility for assistance; future medical support; considerations; subrogation.
68-924 - Designation of assets; procedure.
68-925 - Department; furnish statement.
68-926 - Legislative findings.
68-928 - Licensed insurer or self-funded insurer; provide coverage information.
68-929 - Licensed insurer; violation.
68-930 - Self-funded insurer; violation; civil penalty.
68-931 - Recovery; authorized.
68-932 - Process for resolving violations; appeal.
68-933 - Civil penalties; disposition.
68-934 - False Medicaid Claims Act; act, how cited.
68-938 - Charge, solicitation, acceptance, or receipt; unlawful; when.
68-939 - Records; duties; acts prohibited; liability; costs and attorney's fees.
68-940 - Penalties or damages; considerations; liability; costs and attorney's fees.
68-940.01 - State Medicaid Fraud Control Unit Cash Fund; created; use; investment.
68-941 - Limitation of actions; burden of proof.
68-942 - Investigation and prosecution.
68-943 - State medicaid fraud control unit; certification.
68-944 - State medicaid fraud control unit; powers and duties.
68-945 - Attorney General; powers and duties.
68-946 - Attorney General; access to records.
68-949 - Medical assistance program; legislative intent; department; duties.
68-950 - Medicaid Prescription Drug Act, how cited.
68-954 - Preferred drug list; considerations; availability of list.
68-962 - Autism Treatment Program Act; act, how cited.
68-963 - Purpose of Autism Treatment Program Act.
68-964 - Autism Treatment Program; created; administration; funding.
68-965 - Autism Treatment Program Cash Fund; created; use; investment.
68-966 - Department; apply for medical assistance program waiver or amendment; legislative intent.
68-968 - School-based health centers; School Health Center Advisory Council; members.
68-970 - Nebraska Regional Poison Center; legislative findings.
68-975 - Department; apply for amendment to medicaid state plan; multisystemic therapy for youth.
68-977 - Ground Emergency Medical Transport Act; act, how cited.
68-980 - Supplemental reimbursement.
68-981 - Supplemental reimbursement; eligibility.
68-982 - Supplemental reimbursement; calculation and payment.
68-983 - Intergovernmental transfer program; department; powers and duties.
68-985 - Governmental entity; duties.
68-986 - Department; amendment to medicaid state plan; department; powers.
68-988 - Increased capitation payments; commencement.
68-991 - Medical provider; authority to apply for medical assistance.
68-993 - Medical parole; protocol.
68-995 - Contracts and agreements; department; duties.
68-996 - Medicaid Managed Care Excess Profit Fund; created; use; investment.
68-997 - Job-skills programs; voluntary; departments; powers and duties.
68-998 - Managed care organization; provider contract; material change; notice.
68-999 - Direct care staff; psychiatric facilities caring for juveniles; standards.
68-9,101 - Multiple procedure payment reduction policy; implementation; when prohibited.
68-1001 - Assistance to the aged, blind, or disabled; program; administration.
68-1001.01 - Department of Health and Human Services; rules and regulations; promulgate.
68-1001.02 - Assistance; action for reimbursement; statute of limitations; when commences to run.
68-1002 - Persons eligible for assistance.
68-1003 - Assistance to the aged; additional qualifications required.
68-1004 - Assistance to the blind; additional qualifications required.
68-1006 - Assistance to the aged, blind, or disabled; amount authorized per person; payment.
68-1006.01 - Personal needs allowance; amount authorized.
68-1007 - Determination of need; elements considered; amounts disregarded.
68-1008 - Application for assistance; investigation; notification.
68-1014 - Assistance; payment to guardian or conservator; when authorized.
68-1016 - Assistance; appeals; procedure.
68-1017 - Assistance; violations; penalties.
68-1017.01 - Supplemental Nutrition Assistance Program; violations; penalties.
68-1018 - Transferred to section 68-903.
68-1019 - Transferred to section 68-911.
68-1019.01 - Transferred to section 68-912.
68-1020 - Transferred to section 68-915.
68-1021 - Transferred to section 68-906.
68-1022 - Transferred to section 68-910.
68-1023 - Transferred to section 68-908.
68-1025.01 - Transferred to section 68-913.
68-1026 - Transferred to section 68-916.
68-1027 - Transferred to section 68-917.
68-1028 - Transferred to section 68-918.
68-1036.02 - Transferred to section 68-919.
68-1036.03 - Transferred to section 68-920.
68-1037.01 - Transferred to section 68-1073.
68-1037.02 - Transferred to section 68-1074.
68-1037.03 - Transferred to section 68-1075.
68-1037.04 - Transferred to section 68-1079.
68-1037.05 - Transferred to section 68-1080.
68-1038 - Transferred to section 68-921.
68-1039 - Transferred to section 68-922.
68-1040 - Transferred to section 68-923.
68-1042 - Transferred to section 68-924.
68-1043 - Transferred to section 68-925.
68-1073 - Transferred to section 68-934.
68-1074 - Transferred to section 68-935.
68-1075 - Transferred to section 68-936.
68-1076 - Transferred to section 68-937.
68-1077 - Transferred to section 68-938.
68-1078 - Transferred to section 68-939.
68-1079 - Transferred to section 68-940.
68-1080 - Transferred to section 68-941.
68-1081 - Transferred to section 68-942.
68-1082 - Transferred to section 68-943.
68-1083 - Transferred to section 68-944.
68-1084 - Transferred to section 68-945.
68-1085 - Transferred to section 68-946.
68-1086 - Transferred to section 68-947.
68-10,100 - Transferred to section 68-926.
68-10,101 - Transferred to section 68-927.
68-10,102 - Transferred to section 68-928.
68-10,103 - Transferred to section 68-929.
68-10,104 - Transferred to section 68-930.
68-10,105 - Transferred to section 68-931.
68-10,106 - Transferred to section 68-932.
68-10,107 - Transferred to section 68-933.
68-1103 - Committee; officers; meetings.
68-1105 - Committee; special committees; members; expenses.
68-1106 - Committee; federal funds; grants; gifts; acceptance; disposition.
68-1108 - Department of Health and Human Services; report.
68-1112 - Legislative findings.
68-1113 - Purpose of act; legislative intent.
68-1115 - Funding for aging and disability resource centers.
68-1116 - Aging and disability resource centers; services.
68-1117 - Area agency on aging or partnering organization; powers and duties.
68-1119 - Reimbursement; schedule.
68-1120 - Funding; legislative intent.
68-1201 - Eligibility determination; exclusion of certain assets and income.
68-1202 - Social services; services included.
68-1207.01 - Department of Health and Human Services; caseloads report; contents.
68-1208 - Rules and regulations; right of appeal and hearings.
68-1209 - Applications for social services; information; safeguarded.
68-1211 - Case management of child welfare services; legislative findings and declarations.
68-1214 - Case managers; training program; department; duties; training curriculum; contents.
68-1215 - Low-income home energy assistance program; eligibility; determination.
68-1216 - Low-income home energy assistance program; allocation of funds.
68-1403 - Genetically handicapped persons; medical care program; services and treatment included.
68-1404 - Medical care of genetically handicapping conditions; reimbursement.
68-1406 - Benefits and services; payment liability.
68-1502 - Legislative findings.
68-1504 - Department of Health and Human Services; provide support; expenses; compensation.
68-1505 - Support; families; eligibility requirements.
68-1506 - Support; disabled person in independent living situation; eligibility requirements.
68-1507 - Eligibility; department determine.
68-1508 - Support; allocation of costs; basis.
68-1509 - Department; needs and eligibility criteria; factors.
68-1511 - Department; payment of support; provide assistance; providers of programs and services.
68-1512 - Support; maximum allowance; limitations.
68-1513 - Department; review needs of support recipient.
68-1514 - Denial of support; hearing provided.
68-1515 - Rules and regulations; contents.
68-1516 - Department; provide support; when; priorities.
68-1517 - Department; expenditure of funds authorized.
68-1518 - Department; report; contents.
68-1519 - Obtaining support in violation of sections; violation; penalty.
68-1520 - Legislative findings.
68-1522 - Nebraska Lifespan Respite Services Program; established.
68-1523 - Program; administration.
68-1524 - Program; requirements.
68-1525 - Services; requirements.
68-1526 - Rules and regulations.
68-1529 - Legislative findings and declarations.
68-1531 - Services and support; eligibility.
68-1532 - Family support program; services and support; priorities.
68-1533 - Family support program; implementation; conditions.
68-1534 - Family support program; evaluation.
68-1603 - Department, defined.
68-1604 - Homeless Shelter Assistance Trust Fund; created; use; investment.
68-1605 - Department; grants; requirements; application; considerations.
68-1607 - Recipients; requirements.
68-1608 - Rules and regulations.
68-1709 - Legislative findings and declarations.
68-1711 - Assessment tool; state agencies; utilize.
68-1715 - Rules and regulations.
68-1719 - Self-sufficiency contract; purpose.
68-1720 - Self-sufficiency contract; contents.
68-1721 - Principal wage earner and other nonexempt members of applicant family; duties.
68-1723 - Cash assistance; requirements; extension of time limit; when; hearing; review.
68-1725 - Alternative payment systems authorized.
68-1726 - Assistance under act; eligibility factors.
68-1727 - Family resource centers; legislative intent.
68-1728 - Services for families and children; legislative findings and declarations.
68-1731 - Family services; legislative intent.
68-1732 - Integrated programs and policies; legislative intent.
68-1733 - Planning process; state agencies; duty to establish.
68-1734 - Application process; legislative intent; common assessment tool.
68-1735.02 - Department of Health and Human Services; report; contents.
68-1735.03 - Legislative intent.
68-1738 - Department of Health and Human Services; duty.
68-1803 - Tax; rate; collection; report.
68-1804 - ICF/DD Reimbursement Protection Fund; created; use; allocation; investment; report.
68-1805 - State medicaid plan; application for amendment; tax; when due.
68-1806 - Collection of tax; discontinued; when; effect.
68-1807 - Failure to pay tax; penalty.
68-1809 - Rules and regulations.
68-1902 - Definitions, where found.
68-1903 - Bed-hold day, defined.
68-1904 - Continuing care retirement community, defined.
68-1905 - Department, defined.
68-1906 - Gross inpatient revenue, defined.
68-1908 - Life care contract, defined.
68-1909 - Medical assistance program, defined.
68-1910 - Medicare day, defined.
68-1911 - Medicare upper payment limit, defined.
68-1912 - Nursing facility, defined.
68-1913 - Quality assurance assessment, defined.
68-1914 - Resident day, defined.
68-1915 - Skilled nursing facility, defined.
68-1916 - Total resident days, defined.
68-1917 - Quality assurance assessment; payment; computation.
68-1919 - Reduction of quality assurance assessment; when.
68-1920 - Aggregate quality assurance assessment; limitation.
68-1921 - Quality assurance assessment; payments; form.
68-1922 - Department; collect quality assurance assessment; remit to State Treasurer.
68-1923 - Quality assurance assessment; report; medicaid cost report; how treated.
68-1924 - Underpayment or overpayment; notice.
68-1926 - Nursing Facility Quality Assurance Fund; created; use; investment.
68-1929 - Aggrieved party; hearing; petition.
68-1930 - Rules and regulations.