Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 16 - PHARMACY SERVICES › Section 471-16-011 - PHARMACY SERVICES FOR CLIENTS RESIDING IN CERTAIN CARE FACILITIES

Current through June 17, 2024
011.01
NON-COVERED
  ITEMS.
Nebraska Medicaid does not cover hydrogen peroxide, rubbing
  alcohol, and over-the-counter enemas as pharmacy services for clients residing
  in a nursing facility or intermediate care facility. The nursing facility or
  intermediate care facility may be reimbursed for these items under the
  Department's payment plan for nursing facility and intermediate care facility
  services. For clients residing in nursing facilities and intermediate care
  facilities, the Department does not cover medical supplies or durable medical
  equipment as pharmacy services.
011.02
REPLACEMENT
  COST.
Providers cannot duplicate medication, at the Department's
  expense, for clients residing in facilities. The pharmacy or the facility is
  responsible for providing a replacement. Providers cannot bill the Department
  for medication which was destroyed upon a client's discharge.
011.03
PROFESSIONAL DISPENSING
  FEES.
Pharmacies providing medications to nursing facility and
  intermediate care facility patients are allowed one professional dispensing fee
  per recipient and drug per month.
011.04
UNIT DOSE
  DEFINITIONS.
011.04(A)
TRADITIONAL BOTTLE METHOD.
Dispensing multiple
  tablets and capsules in one vial or bottle. This excludes systems such as
  cassettes, individually packaged doses on cards containing multiple doses, and
  all similar systems.
011.04(B)
UNIT DOSE.
A system of drug packaging, dispensing,
  returning, billing, and crediting by a unit dose provider.
011.04(C)
UNIT DOSE
  PACKAGING.
Drug packaging approved by the Nebraska Board of
  Pharmacy.
011.04(D)
UNIT DOSE DISPENSING.
The provision to the patient of
  a 14-day or less supply of a drug in unit dose packaging.
011.04(E)
UNIT DOSE
  RETURNING.
The process of returning unit dose packaged drugs to
  the dispensing pharmacy.
011.04(F)
UNIT DOSE BILLING.
Billing the Department one time per
  calendar month for the quantity of drug used by the patient during the month,
  with the exceptions described in this chapter. The quantity used is the
  difference between the quantity dispensed and the quantity returned. The date
  of service for each unit dose billing must be consistent from month to
  month.
011.04(G)
UNIT
  DOSE CREDITING.
A process of issuing credits by the pharmacy to
  the Department for drugs accepted for return into inventory which were
  previously billed to and covered by the Department.
011.04(H)
UNIT DOSE
  PROVIDER.
A pharmacy approved by the Department as a unit dose
  provider, initial approval is contingent upon written agreement by the provider
  and demonstration by the provider, to the satisfaction of the Department, of
  the provider's ability to use unit dose packaging, unit dose dispensing, unit
  dose returning, unit dose billing, and unit dose crediting. Continuing approval
  is contingent upon the provider's actual performance as specified in the
  written agreement.