reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-909 - Existing contracts, agreements, rules, regulations, plan, and waivers; how treated; report required; exception; department; powers and duties.

68-909.
Existing contracts, agreements, rules, regulations, plan, and waivers; how treated; report required; exception; department; powers and duties.
(1) All contracts, agreements, rules, and regulations relating to the medical assistance program as entered into or adopted and promulgated by the department prior to July 1, 2006, and all provisions of the medicaid state plan and waivers adopted by the department prior to July 1, 2006, shall remain in effect until revised, amended, repealed, or nullified pursuant to law.
(2) Prior to the adoption and promulgation of proposed rules and regulations under section 68-912 or relating to the implementation of medicaid state plan amendments or waivers, the department shall provide a report to the Governor and the Legislature no later than December 1 before the next regular session of the Legislature summarizing the purpose and content of such proposed rules and regulations and the projected impact of such proposed rules and regulations on recipients of medical assistance and medical assistance expenditures. The report submitted to the Legislature shall be submitted electronically. Any changes in medicaid copayments in fiscal year 2011-12 are exempt from the reporting requirement of this subsection and the requirements of section 68-912.
(3) The department shall monitor the implementation of rules and regulations, medicaid state plan amendments, and waivers adopted under the Medical Assistance Act and the effect of such rules and regulations, amendments, or waivers on eligible recipients of medical assistance and medical assistance expenditures.
Source
Laws 2006, LB 1248, § 9;
Laws 2008, LB928, § 15;
Laws 2011, LB468, § 1;
Laws 2012, LB782, § 92;
Laws 2017, LB417, § 8;
Laws 2017, LB644, § 16.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-910 - Medical assistance payments; source of funds.

68-910.
Medical assistance payments; source of funds.
(1) Medical assistance shall be paid from General Funds, cash funds, federal funds, and such other funds as may qualify for federal matching funds under federal law. General Fund appropriations for the program shall be based on an assessment by the Legislature of General Fund revenue and the competing needs of other state-funded programs.
(2) Medical assistance paid on behalf of eligible recipients may include, but is not limited to, (a) direct payments to vendors under a fee-for-service, managed care, or other provider contract, (b) premium payments, deductibles, and coinsurance for private health insurance coverage, employer-sponsored coverage, catastrophic health insurance coverage, or long-term care insurance coverage, and (c) payments to providers who serve eligible recipients of medical assistance or low-income uninsured persons and meet federal and state disproportionate-share payment requirements.
(3) Medical assistance shall not be paid directly to eligible recipients.
Source
Laws 1965, c. 397, § 7, p. 1278;
Laws 1967, c. 410, § 2, p. 1274;
Laws 1979, LB 138, § 1;
Laws 1981, LB 39, § 1;
Laws 1982, LB 522, § 42;
Laws 1983, LB 604, § 24;
Laws 1986, LB 1253, § 1;
R.S.1943, (2003), § 68-1022;
Laws 2006, LB 1248, § 10.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-912 - Limits on goods and services; considerations; procedure.

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
Laws 1993, LB 804, § 2;
Laws 1996, LB 1044, § 316;
R.S.1943, (2003), § 68-1019.01;
Laws 2006, LB 1248, § 12;
Laws 2012, LB1122, § 1.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-913 - Medical assistance program; public awareness; public school district; hospital; duties.

68-913.
Medical assistance program; public awareness; public school district; hospital; duties.
(1) Each public school district shall annually, at the beginning of the school year, provide written information supplied by the department to every student describing the availability of children's health services provided under the medical assistance program.
(2) Each hospital shall provide the mother of every child born in such hospital, at the time of such birth, written information provided by the department describing the availability of children's health services provided under the medical assistance program.
(3) The department shall develop and implement other activities designed to increase public awareness of the availability of children's health services provided under the medical assistance program. Such activities shall include materials and efforts designed to increase participation in the program by minority populations.
Source
Laws 1998, LB 1063, § 10;
R.S.1943, (2003), § 68-1025.01;
Laws 2006, LB 1248, § 13;
Laws 2007, LB296, § 248.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-914 - Application for medical assistance; form; department; decision; notice; requirements; appeal.

68-914.
Application for medical assistance; form; department; decision; notice; requirements; appeal.
(1) An applicant for medical assistance shall file an application with the department in a manner and form prescribed by the department. The department shall process each application to determine whether the applicant is eligible for medical assistance. The department shall provide a determination of eligibility for medical assistance in a timely manner in compliance with 42 C.F.R. 435.911, including, but not limited to, a timely determination of eligibility for coverage of an emergency medical condition, such as labor and delivery.
(2) The department shall notify an applicant for or recipient of medical assistance of any decision of the department to deny or discontinue eligibility or to deny or modify medical assistance. Except in the case of an emergency, the notice shall be mailed on the same day as or the day after the decision is made. In addition to mailing the notice, the department may also deliver the notice by any form of electronic communication if the department has the agreement of the recipient to receive such notice by means of such form of electronic communication. Decisions of the department, including the failure of the department to act with reasonable promptness, may be appealed, and the appeal shall be in accordance with the Administrative Procedure Act.
(3) Notice of a decision to discontinue eligibility or to modify medical assistance shall include an explanation of the proposed action, the reason for the proposed action, the information used to make the decision including specific regulations or laws requiring such action, contact information for personnel of the department to address questions regarding the action, information on the right to appeal, and an explanation of the availability of continued benefits pending such appeal.
Source
Laws 2006, LB 1248, § 14;
Laws 2011, LB494, § 1;
Laws 2020, LB956, § 3.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-916 - Medical assistance; application; assignment of rights; exception.

68-916.
Medical assistance; application; assignment of rights; exception.
The application for medical assistance shall constitute an automatic assignment of the rights specified in this section to the department or its assigns effective from the date of eligibility for such assistance. The assignment shall include the rights of the applicant or recipient and also the rights of any other member of the assistance group for whom the applicant or recipient can legally make an assignment.
Pursuant to this section and subject to sections 68-921 to 68-925, the applicant or recipient shall assign to the department or its assigns any rights to medical care support available to him or her or to other members of the assistance group under an order of a court or administrative agency and any rights to pursue or receive payments from any third party liable to pay for the cost of medical care and services arising out of injury, disease, or disability of the applicant or recipient or other members of the assistance group which otherwise would be covered by medical assistance. Medicare benefits shall not be assigned pursuant to this section. Rights assigned to the department or its assigns under this section may be directly reimbursable to the department or its assigns by liable third parties, as provided by rule or regulation of the department, when prior notification of the assignment has been made to the liable third party.
Source
Laws 1984, LB 723, § 1;
Laws 1988, LB 419, § 15;
Laws 1989, LB 362, § 10;
Laws 1996, LB 1044, § 326;
Laws 1996, LB 1155, § 23;
R.S.1943, (2003), § 68-1026;
Laws 2006, LB 1248, § 16.
Annotations
The statutory assignment to Department of Social Services under this section is subject to a valid hospital lien acquired under section 52-401 when the hospital lien exists before the department obligates itself to pay, or does pay, medical assistance benefits under this section. Ehlers v. Perry, 242 Neb. 208, 494 N.W.2d 325 (1993).
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-917 - Applicant or recipient; failure to cooperate; effect.

68-917.
Applicant or recipient; failure to cooperate; effect.
Refusal by the applicant or recipient specified in section 68-916 to cooperate in obtaining reimbursement for medical care or services provided to himself or herself or any other member of the assistance group renders the applicant or recipient ineligible for assistance. Ineligibility shall continue for so long as such person refuses to cooperate. Cooperation may be waived by the department upon a determination of the reasonable likelihood of physical or emotional harm to the applicant, recipient, or other member of the assistance group if the applicant or recipient were to cooperate. Eligibility shall continue for any individual who cannot legally assign his or her own rights and who would have been eligible for assistance but for the refusal by another person, legally able to assign such individual's rights, to cooperate as required by this section.
Source
Laws 1984, LB 723, § 2;
Laws 1997, LB 307, § 108;
R.S.1943, (2003), § 68-1027;
Laws 2006, LB 1248, § 17.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-918 - Restoration of rights; when.

68-918.
Restoration of rights; when.
If the applicant or recipient or any member of the assistance group becomes ineligible for medical assistance, the department shall restore to him or her the rights assigned under section 68-916.
Source
Laws 1984, LB 723, § 3;
Laws 1997, LB 307, § 109;
R.S.1943, (2003), § 68-1028;
Laws 2006, LB 1248, § 18.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-920 - Department; garnish employment income; when; limitation.

68-920.
Department; garnish employment income; when; limitation.
The department may garnish the wages, salary, or other employment income of a person for the costs of health services provided to a child who is eligible for medical assistance pursuant to the medical assistance program if:
(1) The person is required by court or administrative order to provide health care coverage for the costs of such services; and
(2) The person has received payment from a third party for the costs of such services but has not used the payment to reimburse either the other parent or guardian or the provider of such services.
The amount garnished shall be limited to the amount necessary to reimburse the department for its expenditures for the costs of such services under the medical assistance program. Any claim for current or past-due child support shall take priority over a claim for the costs of health services.
Source
Laws 1994, LB 1224, § 71;
Laws 1996, LB 1044, § 335;
R.S.1943, (2003), § 68-1036.03;
Laws 2006, LB 1248, § 20.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-921 - Entitlement of spouse; terms, defined.

68-921.
Entitlement of spouse; terms, defined.
For purposes of sections 68-921 to 68-925:
(1) Assets means property which is not exempt from consideration in determining eligibility for medical assistance under rules and regulations adopted and promulgated under section 68-922;
(2) Community spouse monthly income allowance means the amount of income determined by the department in accordance with section 1924 of the federal Social Security Act, as amended, Public Law 100-360, 42 U.S.C. 1396r-5;
(3) Community spouse resource allowance means the amount of assets determined in accordance with section 1924 of the federal Social Security Act, as amended, Public Law 100-360, 42 U.S.C. 1396r-5. For purposes of 42 U.S.C. 1396r-5(f)(2)(A)(i), the amount specified by the state shall be twelve thousand dollars;
(4) Home and community-based services means services furnished under home and community-based waivers as defined in Title XIX of the federal Social Security Act, as amended, 42 U.S.C. 1396;
(5) Qualified applicant means a person (a) who applies for medical assistance on or after July 9, 1988, (b) who is under care in a state-licensed hospital, a nursing facility, an intermediate care facility for persons with developmental disabilities, an assisted-living facility, or a center for the developmentally disabled, as such terms are defined in the Health Care Facility Licensure Act, or an adult family home certified by the department or is receiving home and community-based services, and (c) whose spouse is not under such care or receiving such services and is not applying for or receiving medical assistance;
(6) Qualified recipient means a person (a) who has applied for medical assistance before July 9, 1988, and is eligible for such assistance, (b) who is under care in a facility certified to receive medical assistance funds or is receiving home and community-based services, and (c) whose spouse is not under such care or receiving such services and is not applying for or receiving medical assistance; and
(7) Spouse means the spouse of a qualified applicant or qualified recipient.
Source
Laws 1988, LB 419, § 1;
Laws 1989, LB 362, § 11;
Laws 1991, LB 244, § 1;
Laws 1996, LB 1044, § 336;
Laws 1997, LB 608, § 4;
Laws 2000, LB 819, § 81;
R.S.1943, (2003), § 68-1038;
Laws 2006, LB 1248, § 21;
Laws 2007, LB185, § 3;
Laws 2007, LB296, § 250;
Laws 2013, LB23, § 14.
Cross References
Health Care Facility Licensure Act, see section 71-401.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-922 - Amount of entitlement; department; rules and regulations.

68-922.
Amount of entitlement; department; rules and regulations.
For purposes of determining medical assistance eligibility and the right to and obligation of medical support pursuant to sections 68-716, 68-915, and 68-916, a spouse may retain (1) assets equivalent to the community spouse resource allowance and (2) an amount of income equivalent to the community spouse monthly income allowance.
The department shall administer this section in accordance with section 1924 of the Social Security Act, as amended, Public Law 100-360, 42 U.S.C. 1396r-5, and shall adopt and promulgate rules and regulations as necessary to implement and enforce sections 68-921 to 68-925.
Source
Laws 1988, LB 419, § 2;
Laws 1989, LB 362, § 12;
R.S.1943, (2003), § 68-1039;
Laws 2006, LB 1248, § 22;
Laws 2007, LB296, § 251.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-923 - Assets; eligibility for assistance; future medical support; considerations; subrogation.

68-923.
Assets; eligibility for assistance; future medical support; considerations; subrogation.
If a portion of the aggregate assets is designated in accordance with section 68-924:
(1) Only the assets not designated for the spouse shall be considered in determining the eligibility of an applicant for medical assistance;
(2) In determining the eligibility of an applicant, the assets designated for the spouse shall not be taken into account and proof of adequate consideration for any assignment or transfer made as a result of the designation of assets shall not be required;
(3) The assets designated for the spouse shall not be considered to be available to an applicant or recipient for future medical support and the spouse shall have no duty of future medical support of the applicant or recipient from such assets;
(4) Recovery may not be made from the assets designated for the spouse for any amount paid for future medical assistance provided to the applicant or recipient; and
(5) Neither the department nor the state shall be subrogated to or assigned any future right of the applicant or recipient to medical support from the assets designated for the spouse.
Source
Laws 1988, LB 419, § 3;
Laws 1989, LB 362, § 13;
R.S.1943, (2003), § 68-1040;
Laws 2006, LB 1248, § 23;
Laws 2007, LB296, § 252.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-924 - Designation of assets; procedure.

68-924.
Designation of assets; procedure.
A designation of assets pursuant to section 68-922 shall be evidenced by a written statement listing such assets and signed by the spouse. A copy of such statement shall be provided to the department at the time of application and shall designate assets owned as of the date of application. Failure to complete any assignments or transfers necessary to place the designated assets in sole ownership of the spouse within a reasonable time after the statement is signed as provided in rules and regulations adopted and promulgated under section 68-922 may render the applicant or recipient ineligible for assistance in accordance with such rules and regulations.
Source
Laws 1988, LB 419, § 5;
Laws 1989, LB 362, § 14;
R.S.1943, (2003), § 68-1042;
Laws 2006, LB 1248, § 24;
Laws 2007, LB296, § 253.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-925 - Department; furnish statement.

68-925.
Department; furnish statement.
The department shall furnish to each qualified applicant for and each qualified recipient of medical assistance a clear and simple written statement explaining the provisions of section 68-922.
Source
Laws 1988, LB 419, § 6;
Laws 1989, LB 362, § 15;
Laws 1996, LB 1044, § 337;
R.S.1943, (2003), § 68-1043;
Laws 2006, LB 1248, § 25;
Laws 2007, LB296, § 254.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-926 - Legislative findings.

68-926.
Legislative findings.
The Legislature finds that (1) the department relies on health insurance and claims information from private insurers to ensure accuracy in processing state benefit program payments to providers and in verifying individual recipients' eligibility, (2) delay or refusal to provide such information causes unnecessary expenditures of state funds, (3) disclosure of such information to the department is permitted pursuant to the federal Health Insurance Portability and Accountability privacy rules under 45 C.F.R. part 164, and (4) for medical assistance program recipients who also have other insurance coverage, including coverage by licensed and self-funded insurers, the department is required by 42 U.S.C. 1396a(a)(25) to assure that licensed and self-funded insurers coordinate benefits with the program.
Source
Laws 2005, LB 589, § 1;
R.S.Supp.,2005, § 68-10,100;
Laws 2006, LB 1248, § 26;
Laws 2007, LB296, § 255.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-927 - Terms, defined.

68-927.
Terms, defined.
For purposes of sections 68-926 to 68-933:
(1) Coordinate benefits means:
(a) Provide to the department information regarding the licensed insurer's or self-funded insurer's existing coverage for an individual who is eligible for a state benefit program; and
(b) Meet payment obligations;
(2) Coverage information means health information possessed by a licensed insurer or self-funded insurer that is limited to the following information about an individual:
(a) Eligibility for coverage under a health plan;
(b) Coverage of health care under the health plan; or
(c) Benefits and payments associated with the health plan;
(3) Health plan means any policy of insurance issued by a licensed insurer or any employee benefit plan offered by a self-funded insurer that provides for payment to or on behalf of an individual as a result of an illness, disability, or injury or change in a health condition;
(4) Individual means a person covered by a state benefit program, including the medical assistance program, or a person applying for such coverage;
(5) Licensed insurer means any insurer, except a self-funded insurer, including a fraternal benefit society, producer, or other person licensed or required to be licensed, authorized or required to be authorized, or registered or required to be registered pursuant to the insurance laws of the state; and
(6) Self-funded insurer means any employer or union who or which provides a self-funded employee benefit plan.
Source
Laws 2005, LB 589, § 2;
R.S.Supp.,2005, § 68-10,101;
Laws 2006, LB 1248, § 27;
Laws 2007, LB296, § 256.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-928 - Licensed insurer or self-funded insurer; provide coverage information.

68-928.
Licensed insurer or self-funded insurer; provide coverage information.
(1) Except as provided in subsection (2) of this section, at the request of the department, a licensed insurer or a self-funded insurer shall provide coverage information to the department without an individual's authorization for purposes of:
(a) Determining an individual's eligibility for state benefit programs, including the medical assistance program; or
(b) Coordinating benefits with state benefit programs.
Such information shall be provided within thirty days after the date of request unless good cause is shown. Requests for coverage information shall specify individual recipients for whom information is being requested.
(2)(a) Coverage information requested pursuant to subsection (1) of this section regarding a limited benefit policy shall be limited to whether a specified individual has coverage and, if so, a description of that coverage, and such information shall be used solely for the purposes of subdivision (1)(a) of this section.
(b) For purposes of this section, limited benefit policy means a policy of insurance issued by a licensed insurer that consists only of one or more, or any combination of the following:
(i) Coverage only for accident or disability income insurance, or any combination thereof;
(ii) Coverage for specified disease or illness; or
(iii) Hospital indemnity or other fixed indemnity insurance.
Source
Laws 2005, LB 589, § 3;
R.S.Supp.,2005, § 68-10,102;
Laws 2006, LB 1248, § 28;
Laws 2007, LB296, § 257.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-929 - Licensed insurer; violation.

68-929.
Licensed insurer; violation.
Any violation of section 68-928 by a licensed insurer shall be subject to the Unfair Insurance Claims Settlement Practices Act.
Source
Laws 2005, LB 589, § 4;
R.S.Supp.,2005, § 68-10,103;
Laws 2006, LB 1248, § 29.
Cross References
Unfair Insurance Claims Settlement Practices Act, see section 44-1536.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-930 - Self-funded insurer; violation; civil penalty.

68-930.
Self-funded insurer; violation; civil penalty.
The department may impose and collect a civil penalty on a self-funded insurer who violates the requirements of section 68-928 if the department finds that the self-funded insurer:
(1) Committed the violation flagrantly and in conscious disregard of the requirements; or
(2) Has committed violations with such frequency as to indicate a general business practice to engage in that type of conduct.
The civil penalty shall not be more than one thousand dollars for each violation, not to exceed an aggregate penalty of thirty thousand dollars, unless the violation by the self-funded insurer was committed flagrantly and in conscious disregard of section 68-928, in which case the penalty shall not be more than fifteen thousand dollars for each violation, not to exceed an aggregate penalty of one hundred fifty thousand dollars.
Source
Laws 2005, LB 589, § 5;
R.S.Supp.,2005, § 68-10,104;
Laws 2006, LB 1248, § 30;
Laws 2007, LB296, § 258.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-931 - Recovery; authorized.

68-931.
Recovery; authorized.
The department is authorized to recover all amounts paid or to be paid to state benefit programs as a result of failure to coordinate benefits by a licensed insurer or a self-funded insurer.
Source
Laws 2005, LB 589, § 6;
R.S.Supp.,2005, § 68-10,105;
Laws 2006, LB 1248, § 31;
Laws 2007, LB296, § 259.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-932 - Process for resolving violations; appeal.

68-932.
Process for resolving violations; appeal.
The department shall establish a process by rule and regulation for resolving any violation by a self-funded insurer of section 68-928 and for assessing the financial penalties contained in section 68-930. Any appeal of an action by the department under such policies shall be in accordance with the Administrative Procedure Act.
Source
Laws 2005, LB 589, § 7;
R.S.Supp.,2005, § 68-10,106;
Laws 2006, LB 1248, § 32;
Laws 2007, LB296, § 260.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-933 - Civil penalties; disposition.

68-933.
Civil penalties; disposition.
All money collected as a civil penalty under section 68-929 or 68-930 shall be remitted to the State Treasurer for distribution in accordance with Article VII, section 5, of the Constitution of Nebraska.
Source
Laws 2005, LB 589, § 8;
R.S.Supp.,2005, § 68-10,107;
Laws 2006, LB 1248, § 33.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-934 - False Medicaid Claims Act; act, how cited.

68-934.
False Medicaid Claims Act; act, how cited.
Sections 68-934 to 68-947 shall be known and may be cited as the False Medicaid Claims Act.
Source
Laws 1996, LB 1155, § 67;
R.S.1943, (2003), § 68-1037.01;
Laws 2004, LB 1084, § 1;
R.S.Supp.,2004, § 68-1073;
Laws 2006, LB 1248, § 34;
Laws 2009, LB288, § 21.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-935 - Terms, defined.

68-935.
Terms, defined.
For purposes of the False Medicaid Claims Act:
(1) Attorney General means the Attorney General, the office of the Attorney General, or a designee of the Attorney General;
(2) Claim means any request or demand, whether under a contract or otherwise, for money or property, and whether or not the state has title to the money or property, that:
(a) Is presented to an officer, employee, or agent of the state; or
(b) Is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the state's behalf or to advance a state program or interest, and if the state:
(i) Provides or has provided any portion of the money or property requested or demanded; or
(ii) Will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded;
(3) Good or service includes (a) any particular item, device, medical supply, or service claimed to have been provided to a recipient and listed in an itemized claim for payment and (b) any entry in the cost report, books of account, or other documents supporting such good or service;
(4)(a) Knowing and knowingly means that a person, with respect to information:
(i) Has actual knowledge of the information;
(ii) Acts in deliberate ignorance of the truth or falsity of the information; or
(iii) Acts in reckless disregard of the truth or falsity of the information.
(b) Acts committed in a knowing manner or committed knowingly shall not require proof of a specific intent to defraud;
(5) Material means having a natural tendency to influence or be capable of influencing the payment or receipt of money or property;
(6) Obligation means an established duty, whether or not fixed, arising from (a) an express or implied contractual, grantor-grantee, or licensor-licensee relationship, (b) a fee-based or similar relationship, (c) statute or rule or regulation, or (d) the retention of any overpayment;
(7) Person means any body politic or corporate, society, community, the public generally, individual, partnership, limited liability company, joint-stock company, or association; and
(8) Recipient means an individual who is eligible to receive goods or services for which payment may be made under the medical assistance program.
Source
Laws 1996, LB 1155, § 68;
R.S.1943, (2003), § 68-1037.02;
Laws 2004, LB 1084, § 2;
R.S.Supp.,2004, § 68-1074;
Laws 2006, LB 1248, § 35;
Laws 2013, LB277, § 1.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-936 - Presentation of false medicaid claim; civil liability; violation of act; civil penalty; damages; costs and attorney's fees.

68-936.
Presentation of false medicaid claim; civil liability; violation of act; civil penalty; damages; costs and attorney's fees.
(1) A person presents a false medicaid claim and is subject to civil liability if such person:
(a) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;
(b) Knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim;
(c) Conspires to commit a violation of the False Medicaid Claims Act;
(d) Has possession, custody, or control of property or money used, or to be used, by the state and knowingly delivers, or causes to be delivered, less than all of the money or property;
(e) Is authorized to make or deliver a document certifying receipt of property used, or to be used, by the state and, intending to defraud the state, makes or delivers the receipt knowing that the information on the receipt is not true;
(f) Knowingly buys, or receives as a pledge of an obligation or debt, public property from any officer or employee of the state who may not lawfully sell or pledge such property; or
(g) Knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the state or knowingly conceals, avoids, or decreases an obligation to pay or transmit money or property to the state.
(2) A person who commits a violation of the False Medicaid Claims Act is subject to, in addition to any other remedies that may be prescribed by law, a civil penalty of not more than ten thousand dollars. In addition to any civil penalty, any such person may be subject to damages in the amount of three times the amount of the false claim because of the act of that person.
(3) If the state is the prevailing party in an action under the False Medicaid Claims Act, the defendant, in addition to penalties and damages, shall pay the state's costs and attorney's fees for the civil action brought to recover penalties or damages under the act.
(4) Liability under this section is joint and several for any act committed by two or more persons.
Source
Laws 1996, LB 1155, § 69;
Laws 1997, LB 307, § 110;
R.S.1943, (2003), § 68-1037.03;
Laws 2004, LB 1084, § 3;
R.S.Supp.,2004, § 68-1075;
Laws 2006, LB 1248, § 36;
Laws 2013, LB277, § 2.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-937 - Failure to report.

68-937.
Failure to report.
A person violates the False Medicaid Claims Act, and is subject to civil liability as provided in section 68-936, if such person is a beneficiary of an inadvertent submission of a false medicaid claim to the state, and subsequently discovers and, knowing the claim is false, fails to report the claim to the department within sixty days of such discovery. The beneficiary is not obliged to make such a report to the department if more than six years have passed since submission of the claim.
Source
Laws 2004, LB 1084, § 4;
R.S.Supp.,2004, § 68-1076;
Laws 2006, LB 1248, § 37.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-938 - Charge, solicitation, acceptance, or receipt; unlawful; when.

68-938.
Charge, solicitation, acceptance, or receipt; unlawful; when.
A person violates the False Medicaid Claims Act, and a claim submitted with regard to a good or service is deemed to be false and subjects such person to civil liability as provided in section 68-936, if he or she, acting on behalf of a provider providing such good or service to a recipient under the medical assistance program, charges, solicits, accepts, or receives anything of value in addition to the amount legally payable under the medical assistance program in connection with a provision of such good or service knowing that such charge, solicitation, acceptance, or receipt is not legally payable.
Source
Laws 2004, LB 1084, § 5;
R.S.Supp.,2004, § 68-1077;
Laws 2006, LB 1248, § 38.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-939 - Records; duties; acts prohibited; liability; costs and attorney's fees.

68-939.
Records; duties; acts prohibited; liability; costs and attorney's fees.
(1) A person violates the False Medicaid Claims Act and is subject to civil liability as provided in section 68-936 and damages as provided in subsection (2) of this section if he or she:
(a) Having submitted a claim or received payment for a good or service under the medical assistance program, knowingly fails to maintain such records as are necessary to disclose fully the nature of all goods or services for which a claim was submitted or payment was received, or such records as are necessary to disclose fully all income and expenditures upon which rates of payment were based, for a period of at least six years after the date on which payment was received; or
(b) Knowingly destroys such records within six years from the date payment was received.
(2) A person who knowingly fails to maintain records or who knowingly destroys records within six years from the date payment for a claim was received shall be subject to damages in the amount of three times the amount of the claim submitted for which records were knowingly not maintained or knowingly destroyed.
(3) If the state is the prevailing party in an action under this section, the defendant, in addition to penalties and damages, shall pay the state's costs and attorney's fees for the civil action brought to recover penalties or damages under the act.
Source
Laws 2004, LB 1084, § 6;
R.S.Supp.,2004, § 68-1078;
Laws 2006, LB 1248, § 39.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-940 - Penalties or damages; considerations; liability; costs and attorney's fees.

68-940.
Penalties or damages; considerations; liability; costs and attorney's fees.
(1) In determining the amount of any penalties or damages awarded under the False Medicaid Claims Act, the following shall be taken into account:
(a) The nature of claims and the circumstances under which they were presented;
(b) The degree of culpability and history of prior offenses of the person presenting the claims;
(c) Coordination of the total penalties and damages arising from the same claims, goods, or services, whether based on state or federal statute; and
(d) Such other matters as justice requires.
(2)(a) Any person who presents a false medicaid claim is subject to civil liability as provided in section 68-936, except when the court finds that:
(i) The person committing the violation of the False Medicaid Claims Act furnished officials of the state responsible for investigating violations of the act with all information known to such person about the violation within thirty days after the date on which the defendant first obtained the information;
(ii) Such person fully cooperated with any state investigation of such violation; and
(iii) At the time such person furnished the state with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under the act with respect to such violation and the person did not have actual knowledge of the existence of an investigation into such violation.
(b) The court may assess not more than two times the amount of the false medicaid claims submitted because of the action of a person coming within the exception under subdivision (2)(a) of this section, and such person is also liable for the state's costs and attorney's fees for a civil action brought to recover any penalty or damages.
(3) Amounts recovered under the False Medicaid Claims Act shall be remitted to the State Treasurer for credit to the Health and Human Services Cash Fund, except that (a) amounts recovered for the state's costs and attorney's fees pursuant to subdivision (2)(b) of this section and sections 68-936 and 68-939 shall be remitted to the State Treasurer for credit to the State Medicaid Fraud Control Unit Cash Fund and (b) the State Treasurer shall distribute civil penalties in accordance with Article VII, section 5, of the Constitution of Nebraska.
Source
Laws 1996, LB 1155, § 70;
Laws 1997, LB 307, § 111;
R.S.1943, (2003), § 68-1037.04;
Laws 2004, LB 1084, § 7;
R.S.Supp.,2004, § 68-1079;
Laws 2006, LB 1248, § 40;
Laws 2007, LB296, § 261;
Laws 2009, LB288, § 22.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-940.01 - State Medicaid Fraud Control Unit Cash Fund; created; use; investment.

68-940.01.
State Medicaid Fraud Control Unit Cash Fund; created; use; investment.
The State Medicaid Fraud Control Unit Cash Fund is created. The fund shall be maintained by the Department of Justice and administered by the Attorney General. The fund shall consist of any recovery for the state's costs and attorney's fees received pursuant to subdivision (2)(b) of section 68-940 and sections 68-936 and 68-939, except criminal penalties, whether such recovery is by way of verdict, judgment, compromise, or settlement in or out of court, or other final disposition of any case or controversy under such subdivision or sections. Money in the fund shall be used to pay the salaries and related expenses of the Department of Justice for the state medicaid fraud control unit.
The State Treasurer shall transfer five hundred thousand dollars from the State Medicaid Fraud Control Unit Cash Fund to the General Fund on or before June 30, 2018, on such dates and in such amounts as directed by the budget administrator of the budget division of the Department of Administrative Services.
Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska State Funds Investment Act.
Source
Laws 2009, LB288, § 23;
Laws 2017, LB331, § 35.
Cross References
Nebraska Capital Expansion Act, see section 72-1269.
Nebraska State Funds Investment Act, see section 72-1260.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-941 - Limitation of actions; burden of proof.

68-941.
Limitation of actions; burden of proof.
(1) A civil action under the False Medicaid Claims Act shall be brought within six years after the date the claim is discovered or should have been discovered by exercise of reasonable diligence and, in any event, no more than ten years after the date on which the violation of the act was committed.
(2) In an action brought under the act, the state shall prove all essential elements of the cause of action, including damages, by a preponderance of the evidence.
Source
Laws 1996, LB 1155, § 71;
R.S.1943, (2003), § 68-1037.05;
Laws 2004, LB 1084, § 8;
R.S.Supp.,2004, § 68-1080;
Laws 2006, LB 1248, § 41.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-942 - Investigation and prosecution.

68-942.
Investigation and prosecution.
(1) In any case involving allegations of civil violations or criminal offenses under the False Medicaid Claims Act, the Attorney General may take full charge of any investigation or advancement or prosecution of the case.
(2) The department shall cooperate with the state medicaid fraud control unit in conducting such investigations, civil actions, and criminal prosecutions and shall provide such information for such purposes as may be requested by the Attorney General.
Source
Laws 2004, LB 1084, § 9;
R.S.Supp.,2004, § 68-1081;
Laws 2006, LB 1248, § 42.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-943 - State medicaid fraud control unit; certification.

68-943.
State medicaid fraud control unit; certification.
The Attorney General shall:
(1) Establish a state medicaid fraud control unit that meets the standards prescribed by 42 U.S.C. 1396b(q); and
(2) Apply to the Secretary of Health and Human Services for certification of the unit under 42 U.S.C. 1396b(q).
Source
Laws 2004, LB 1084, § 10;
R.S.Supp.,2004, § 68-1082;
Laws 2006, LB 1248, § 43.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-944 - State medicaid fraud control unit; powers and duties.

68-944.
State medicaid fraud control unit; powers and duties.
The state medicaid fraud control unit shall employ such attorneys, auditors, investigators, and other personnel as authorized by law to carry out the duties of the unit in an effective and efficient manner. The purpose of the state medicaid fraud control unit is to conduct a statewide program for the investigation and prosecution of medicaid fraud and violations of all applicable state laws relating to the providing of medical assistance and the activities of providers. The state medicaid fraud control unit may review and act on complaints of abuse and neglect of patients at health care facilities that receive payments under the medical assistance program and may provide for collection or referral for collection of overpayments made under the medical assistance program that are discovered by the unit.
Source
Laws 2004, LB 1084, § 11;
R.S.Supp.,2004, § 68-1083;
Laws 2006, LB 1248, § 44.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-945 - Attorney General; powers and duties.

68-945.
Attorney General; powers and duties.
In carrying out the duties and responsibilities under the False Medicaid Claims Act, the Attorney General may:
(1) Enter upon the premises of any provider participating in the medical assistance program (a) to examine all accounts and records that are relevant in determining the existence of fraud in the medical assistance program, (b) to investigate alleged abuse or neglect of patients, or (c) to investigate alleged misappropriation of patients' private funds. The accounts or records of a nonmedicaid patient may not be reviewed by, or turned over to, the Attorney General without the patient's written consent or a court order;
(2) Subpoena witnesses or materials, including medical records relating to recipients, within or outside the state and, through any duly designated employee, administer oaths and affirmations and collect evidence for possible use in either civil or criminal judicial proceedings;
(3) Request and receive the assistance of any prosecutor or law enforcement agency in the investigation and prosecution of any violation of this section; and
(4) Refer to the department for collection each instance of overpayment to a provider under the medical assistance program which is discovered during the course of an investigation.
Source
Laws 2004, LB 1084, § 12;
R.S.Supp.,2004, § 68-1084;
Laws 2006, LB 1248, § 45.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-946 - Attorney General; access to records.

68-946.
Attorney General; access to records.
(1) Notwithstanding any other provision of law, the Attorney General, upon reasonable request, shall have full access to all records held by a provider, or by any other person on his or her behalf, that are relevant to the determination of (a) the existence of civil violations or criminal offenses under the False Medicaid Claims Act or related offenses, (b) the existence of patient abuse, mistreatment, or neglect, or (c) the theft of patient funds.
(2) In examining such records, the Attorney General shall safeguard the privacy rights of recipients, avoiding unnecessary disclosure of personal information concerning named recipients. The Attorney General may transmit such information as he or she deems appropriate to the department and to other agencies concerned with the regulation of health care facilities or health professionals.
(3) No person holding such records may refuse to provide the Attorney General access to such records for the purposes described in the act on the basis that release would violate (a) a recipient's right of privacy, (b) a recipient's privilege against disclosure or use, or (c) any professional or other privilege or right.
Source
Laws 2004, LB 1084, § 13;
R.S.Supp.,2004, § 68-1085;
Laws 2006, LB 1248, § 46.
2023 Nebraska Revised Statutes › Chapter 68 - Public Assistance › 68-947 - Contempt of court.

68-947.
Contempt of court.
Any person who, after being ordered by a court to comply with a subpoena issued under the False Medicaid Claims Act, fails in whole or in part to testify or to produce evidence, documentary or otherwise, shall be in contempt of court as if the failure was committed in the presence of the court. The court may assess a fine of not less than one hundred dollars nor more than one thousand dollars for each day such person fails to comply. No person shall be found to be in contempt of court nor shall any fine be assessed if compliance with such subpoena violates such person's right against self-incrimination.
Source
Laws 2004, LB 1084, § 14;
R.S.Supp.,2004, § 68-1086;
Laws 2006, LB 1248, § 47.