Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 3 - PAYMENT FOR MEDICAID SERVICES › Section 471-3-006 - COPAYMENTS

Current through June 17, 2024
006.01
COPAYMENT
  SCHEDULE.
The Department has established the following schedule of
  copayments for Medicaid services:
(A) Chiropractic Office Visits
				  ..............................
... $1 per visit
(B) Dental Services
				  ............................................
... $3 per specified service
(C) Durable Medical Equipment
				  .........................
... $3 per specified service
(D) Drugs (except birth control)
(i) Generic drugs
				  .........................................
... $2 copay
(ii) Brand name drugs
				  ..................................
... $3 copay
(E) Eyeglasses
				  ...................................................
... $2 per frames, lens, or frames with lens
(F) Hearing Aids
				  ................................................
... $3 per hearing aid
(G) Inpatient Hospital
				  .........................................
... $15 per admission
(H) Mental Health/Substance Abuse Visits
				  .........
... $2 per specified service
(i) Occupational Therapy (non-hospital based)
				  .
... $1 per specified service
(J) Optometric Office Visits
				  ................................
... $2 per visit
(K) Outpatient Hospital Services
				  ........................
... $3 per visit
(L) Physical Therapy (non-hospital based)
				  ........
... $1 per specified service
(M) Physicians (M.D.'s and D.O.'s) Office Visits
				  .
... $2 per visit
(i) Excluding Primary Care Physicians Family Practice,
				  General Practice, Pediatricians, Internists, and physician extenders, including
				  physician assistants, nurse practitioners, and nurse midwives, who provide
				  primary care services.
(N) Podiatrists Office Visits
				  .................................
... $1 per visit
(O) Speech Therapy (non-hospital based)
				  ..........
... $2 per specified service
006.02
EXCLUDED SERVICES.
The following services are excluded
  from the above copayment requirement by federal regulations:
(A) Emergency services provided to treat an
  emergency medical condition in a hospital, clinic, office, or other facility
  equipped to provide the required care. An emergency condition is defined as a
  medical or behavioral condition, the onset of which is sudden, manifests itself
  by symptoms of sufficient severity, including but not limited to, severe pain,
  which a prudent layperson possessing an average knowledge of medicine and
  health could reasonably expect the absence of immediate medical attention to
  result in (a) placing the health of the person, or with respect to a pregnant
  woman, the health of the woman and her unborn child, afflicted with such
  condition in serious jeopardy or, in the case of a behavioral condition,
  placing the health of such persons or others in serious jeopardy, (b) serious
  impairment to such person's bodily functions, (c) serious impairment of any
  bodily organ or part of such person, or (d) serious disfigurement of such
  person; and
(B) Family planning
  services, supplies, and drugs provided to individuals of child-bearing
  age.