Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 10 - HOSPITAL SERVICES › Section 471-10-003 - PROVIDER REQUIREMENTS

Current through June 17, 2024
003.01
GENERAL PROVIDER REQUIREMENTS.
To participate in
  Nebraska Medicaid, hospital providers must comply with all the applicable
  participation requirements. In the event that provider participation
  requirements in 471 NAC 2 or 3 conflict with the requirements outlined in this
  471 NAC 10, the individual provider participation requirements in 471 NAC 10
  will govern.
003.02
SPECIFIC PROVIDER REQUIREMENTS.
To participate in
  Nebraska Medicaid, a hospital that provides hospital inpatient or outpatient or
  emergency room services must:
(i) Be
  maintained primarily for the care and treatment of patients with disorders
  other than mental disease;
(ii) Be
  licensed as a hospital by the Department or the officially designated authority
  for state standard-setting in the state where the hospital is
  located;
(iii) Have licensed and
  certified hospital beds; and
(iv)
  Meet the requirements for participation in Medicare and Medicaid.
003.02(A)
PROVIDER
  AGREEMENT.
To participate in Nebraska Medicaid, a hospital must
  complete Form MC-20: "Medical Assistance Hospital Provider Agreement," and
  submit the completed form to the Department. A copy of Form CMS-1539:
  Medicare/Medicaid Certification and Transmittal, must be submitted as part of
  the enrollment process.
003.02(B)
INDEPENDENT CLINICAL LABORATORY.
An independent
  clinical laboratory must be independent both of an attending or consulting
  physician's office, and of a hospital. A clinical laboratory must meet the
  following criteria:
(i) When state or
  applicable local law provides for licensing of independent clinical
  laboratories, the laboratory must be licensed under the law; and
(ii) The laboratory must also meet the health
  and safety requirements prescribed by the U.S. Secretary of Health and Human
  Services.
003.02(C)
PROVIDERS OF PORTABLE X-RAY SERVICES.
To be approved
  as a Nebraska Medicaid provider, providers of portable x-ray services must be
  certified by the Centers for Medicare and Medicaid Services (CMS) Regional
  Office. Each provider must submit a copy of Form CMS-1539: Medicare/Medicaid
  Certification and Transmittal, and remain in compliance with
  42
  CFR 486.100 through
  486.110.
  An out-of-state portable x-ray provider must provide the Department with
  verification of certification from the Centers for Medicare and Medicaid
  Services Regional Office. The Department approves or denies enrollment as a
  Nebraska Medicaid provider based on the certification information received from
  the Centers for Medicare and Medicaid Services Regional Office.
003.02(C)(i)
APPLICABILITY OF
  HEALTH AND SAFETY STANDARDS.
Health and safety standards outlined
  in 180 NAC will apply to all providers of portable x-ray services, except
  physicians who provide immediate personal supervision during the administration
  of diagnostic x-ray services. Payment is made only for services of approved
  providers who have been found to meet the standards.
003.02(D)
DURABLE MEDICAL
  EQUIPMENT AND MEDICAL SUPPLIES.
The Department does not generally
  approve hospitals as providers of durable medical equipment and medical
  supplies. Exception: Apnea monitors and home phototherapy equipment.
003.02(E)
APPROVAL AS AN
  AMBULATORY ROOM AND BOARD PROVIDER.
The Department approves only
  hospitals as ambulatory room and board providers. To be eligible to receive
  Nebraska Medicaid payment for ambulatory room and board services, each hospital
  providing those services must be enrolled with the Department as a provider for
  hospital services and must submit Form MS-6: Ambulatory Room and Board
  Agreement. The Department may request additional information from the hospital
  to approve ambulatory room and board services.
003.02(E)(i)
PROVIDER
  RE-APPROVAL.
Each hospital approved by the Department to provide
  ambulatory room and board services must seek re-approval of its ambulatory room
  and board services from the Department when any of the following occur:
(1) The charge to the Department for
  ambulatory room and board services changes;
(2) There is a change in the physical
  location of the ambulatory room and board facility or the distance from the
  hospital building;
(3) There is a
  change in the services the hospital is able to provide to clients in the
  ambulatory room and board facility; or
(4) Other substantial changes are made to the
  hospital's ambulatory room and board services.