Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 21 - REHABILITATION CARE IN HOSPITALS › Section 471-21-002 - Provider Requirements

Current through June 17, 2024
21-002.01
General Provider
  Requirements
:
To participate in the Nebraska Medical Assistance Program (Medicaid),
	 providers of rehabilitation services shall comply with all applicable
	 participation requirements codified in 471 NAC Chapters 2 and 3. In the event
	 that provider participation requirements in 471 NAC Chapters 2 or 3 conflict
	 with requirements outlined in 471 NAC Chapter 21, the individual provider
	 participation requirements in 471 NAC Chapter 21 shall govern.
21-002.02
Specific Provider
  Requirements
:
Rehabilitation services must be provided in a hospital or a distinct
	 part of a hospital that:
i. Provides
  rehabilitation services;
ii. Is
  licensed or formally approved as a hospital by the Nebraska Department of
  Health and Human Services, Division of Public Health or, if the hospital is
  located in another state, the authority responsible for licensing or formal
  approval in that state;
iii. Has
  licensed and certified rehabilitation beds;
iv. Meets the requirements for participation
  in Medicare for rehabilitation hospitals; and
v. Has in effect a utilization review plan
  which applies to all Medicaid clients.
21-002.02A
Provider
  Agreement
: A hospital which provides rehabilitation services shall
  complete and sign Form MC-20, "Medical Assistance Hospital Provider Agreement"
  (see 471-000-91) and submit the completed form to the Department for approval
  and enrollment as a provider. Each hospital shall have a separate provider
  agreement (and a separate provider number) for rehabilitation services. The
  hospital shall submit a description of the rehabilitation program with the
  provider agreement.
21-002.02A1
Out-of-State Hospital Provider Agreement
: In addition
  to a completed and signed Form MC-20, an out-of-state hospital shall also
  submit documentation of its certification/accreditation status from the state
  survey agency in the state where the hospital is located. The Department will
  not process claims received from an out-of-state hospital until all information
  required under this section has been received.
Also see 471 NAC
	 10-010.03J,
	 Out-of-State Hospital Rates, and
	 10-010.06G,
	 Payment to an Out-of-State Hospital for Outpatient Hospital and Emergency Room
	 Services.
21-002.02B
Hospital Level of
  Rehabilitation Care
: The Rehabilitation hospital must provide a
  hospital level of rehabilitative care. Hospitals with a significant number of
  rehabilitation team members working on a part time basis must provide evidence
  to establish that the hospital did, in fact, provide a hospital level of
  rehabilitative care. Evidence documenting the hospital level of rehabilitative
  care includes, but is not limited to:
1.
  Verification that team conferences were held at least once every two
  weeks;
2. Verification that there
  was a need for, and involvement of, various allied health professionals;
  and,
3. Verification of the
  intensity of the rehabilitative program.