Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 33 - HEALTH CHECK (EARLY PERIODIC SCREENING, DIAGNOSIS AND TREATMENT [EPSDT]) SERVICES › Section 471-33-003 - PROVIDER REQUIREMENTS

Current through June 17, 2024
003.01
GENERAL PROVIDER REQUIREMENTS.
To participate in
  Nebraska Medicaid, providers of HEALTH CHECK services must comply with all
  applicable provider participation requirements codified in 471 NAC 2 and 3. in
  the event that provider participation requirements in 471 NAC 2 or 3 conflict
  with requirements outlined in this 471 NAC 33. the individual provider
  participation requirements in 471 NAC 33 will govern.
003.02
SERVICE SPECIFIC PROVIDER
  REQUIREMENTS.
003.02(A)
SCREENING PROVIDERS.
Screening services must be
  performed by or under the supervision of a physician, dentist, or other
  provider licensed under State or Federal law to furnish primary medical and
  health services. Periodic and interperiodic examinations must, at a minimum,
  include the health screening services defined within this chapter. Vision and
  hearing screening examinations cannot be limited to the screening physician but
  may be obtained directly from an ophthalmologist or optometrist for vision
  services and licensed audiologist for the hearing service.
003.02(B)
CONTINUING CARE
  PROVIDERS.
Managed care plans will be considered continuing care
  providers if the following provisions are met. A continuing care provider is
  one who:
(1) Agrees to provide to formally
  enrolled children screening, diagnosis, and treatment for conditions identified
  during screening or referral to a provider capable of providing the appropriate
  services. As appropriate, the formal enrollment means that the HEALTH
  CHECK-eligible child or family has agreed to use one provider as a regular
  source of continuing care services for a stated period of time, and that mutual
  obligations of both client and provider are recognized by signed enrollment
  agreement;
(2) Maintains a complete
  health history, including information received from other providers;
(3) is responsible for providing needed
  physician services for acute, episodic, and chronic illnesses and
  conditions;
(4) Ensures
  accountability by submitting reports reasonably required by the Department;
  and
(5) Works with the HEALTH CHECK
  case manager, if one is assigned.
003.02(B)(i)
ENROLLMENT
  AGREEMENT.
The enrollment agreement must specify what options the
  provider will use to provide the following HEALTH CHECK services:
(1) Provision of dental services, or direct
  referral to a dentist or referral to the Department to obtain dental
  services;
(2) Provision of ail or
  part of the required transportation and scheduling assistance, or referral to
  the Department to obtain such assistance; and
(3) Referral assistance for treatment not
  covered by the plan but needed, or referral to the Department to obtain
  assistance as well as other provisions outlined in the agreement.
003.02(C)
HEALTH CHECK SPECIAL SERVICES.
All providers of the
  following special services must be licensed Nebraska Medicaid-enrolled
  providers who have submitted written required documentation and received
  written approval from the Department. All providers requesting to provide the
  following HEALTH CHECK special services must submit a request in writing.
003.02(C)(i)
NUTRITIONAL
  COUNSELING.
Physicians providing HEALTH CHECK services or licensed
  medical nutrition therapists may be approved to provide nutritional counseling.
  Those requesting to provide this service must submit a written request and
  include (1) person(s) providing services and their credentials, (2) general
  content of nutritional counseling session, (3) conditions most frequently
  expected to be encountered, (4) usual length and frequency of sessions, and (5)
  customary charge. The Department may request periodic review of the services.
  Requests for reapproval must be submitted when a change in approved content
  occurs. A referral must be made to the Special Supplemental Food Program for
  Women, Infants, and Children (WIC) for ongoing nutritional counseling for
  children under five, or for lactating, postpartum, or pregnant women.
003.02(C)(ii)
LACTATION
  COUNSELING.
The following providers may provide all lactation
  counseling services: physician, nurse practitioner (NP), physician assistant
  (PA), midwife (MW), and registered nurse (RN). Any such provider must have
  current certification as an International Board Certified Lactation Consultant.
  The Department may request periodic review of the services.
003.02(C)(iii)
CHILDBIRTH
  EDUCATORS.
Licensed practitioners who are Lamaze Certified
  Childbirth Educator (LCCE) or Certified Childbirth Educator (CCCE) and request
  to provide this service for Nebraska Medicaid-eligible individuals age 20 and
  younger must complete Form MC-19: Medical Assistance Provider Agreement, and
  return the form with a letter stating the class type, general description,
  class outline or statement of content, and length of sessions for initial
  approval. Childbirth educators must include proof of certification or course
  completion by a recognized childbirth education association. Requests for
  reapproval must be submitted when a change in the initial proposal occurs. The
  Department may request periodic review of the services. Requests to approve
  changes to approved services must be submitted to the Department. Approval is
  based on guidelines from recognized childbirth education associations and
  demonstrate appropriateness.
003.02(C)(iv)
WELL CHILD CLUSTER
  VISITS.
Providers interested in providing this service must submit
  a description of the cluster visit, including format, group size, scheduling,
  and content to the Department to request initial prior approval. Requests to
  approve any changes to the approved service must be submitted to the
  Department.