reglab/statecodes huggingface dataset:
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 1 - ADMINISTRATION › Section 467-1-002 - APPLICANT AND RECIPIENT RIGHTS

Current through June 17, 2024
Applicants and recipients applying for or receiving services
				  have the rights to confidentiality, non-discrimination, and grievance and fair
				  hearing.
002.01
CONFIDENTIALITY.
Applicants and recipients have the
				right to have their information treated confidentially.
002.02
NON-DISCRIMINATION.
No individual may be subjected to
				discrimination on the grounds of his or her race, color, national origin, sex,
				age, disability, religion, or political belief.
002.03
GRIEVANCE AND FAIR
				HEARING.
Applicants and recipients have the right to a Fair
				Hearing on any action or inaction with regard to an application, the amount of
				assistance, or failure to act with reasonable promptness. The appeal must be
				filed in writing within 90 days of the Department's action or
				inaction.
002.04
APPLICANT AND RECIPIENT RESPONSIBILITIES.
Applicants,
				recipients, parents, and legal guardians must comply with the following:
(A) Report accurate financial
				information;
(B) Report accurate
				information about the applicant's or recipient's needs;
(C) Report a change of address, household
				size, or income within ten days following the change;
(D) Participate in any financial or medical
				eligibility review;
(E) Notify the
				Department before receiving services at scheduled appointments and
				tests;
(F) Keep all appointments
				for care and services related to the special health care need;
(G) Follow the individual medical treatment
				plan;
(H) Notify the Department of
				any emergency care or hospitalizations within five working days;
(I) Obligate payment for any part of
				treatment which has been determined to be the recipient's
				responsibility;
(J) Assume
				responsibility for the general health care of the recipient; and
(K) Ensure the Department and medical
				providers have any third party liability information prior to care, if
				applicable, and supply necessary documentation for filing claims before the
				Medically Handicapped Children's Program, Genetically Handicapped Persons
				Program, and Disabled Children's Program pays for any service.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 2 - REFERRAL, APPLICATION, AND ELIGIBILITY FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM AND THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-2-001 - REFERRAL

Current through June 17, 2024
Any individual, health care professional, or agency may refer
				  a potential applicant to the Medically Handicapped Children's Program or
				  Genetically Handicapped Persons Program.
001.01
INITIATING A
				REFERRAL.
A referral for services is made by the applicant, any
				individual, health care professional, or agency. A referral is made by
				completion of the application or, at a minimum, providing the Department with
				the potential applicant's following information:
(1) Name;
(2) Date of birth;
(3) Parent or legal guardian's
				name;
(4) Address;
(5) Phone number;
(6) Diagnosis or medical condition;
				and
(7) Reason for
				referral.
001.01(A)
EMERGENCY REFERRAL.
A hospital emergency department
				who wishes to refer potential applicants must make the referral within five
				days of admission to the hospital.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 2 - REFERRAL, APPLICATION, AND ELIGIBILITY FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM AND THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-2-002 - APPLICATIONS

Current through June 17, 2024
Upon receiving a referral, the Department will mail the
				  potential applicant an application form and a release of information form. The
				  Department must receive the completed application and signed release from the
				  applicant within 30 days after the Department mails the forms. A legally
				  responsible adult age 19 or older must complete the application.
002.01
RESIDENT OF
				NEBRASKA.
Applicants and recipients must reside in
				Nebraska.
002.02
CITIZENSHIP.
The applicant must be a citizen of the
				United States of America or a qualified alien and be lawfully present in the
				United States of America as required by Nebraska Revised Statute (Neb. Rev.
				Stat.) §§
									4-108 to
				4-112. The applicant must sign an
				attestation required by Nebraska Revised Statute (Neb. Rev. Stat.) §
									4-111. The applicant's citizenship
				or alien status must be verifiable by the Department.
002.03
AGE
				REQUIREMENT.
The age requirement for the Medically Handicapped
				Children's Program is birth through 20 years. The age requirement for the
				Genetically Handicapped Persons Program is 21 years and older.
002.04
WITHDRAWAL.
The applicant may voluntarily withdraw an application.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 2 - REFERRAL, APPLICATION, AND ELIGIBILITY FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM AND THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-2-004 - NOTICES FROM DEPARTMENT

Current through June 17, 2024
A notice is sent to applicants and recipients in the
				  following instances:
(A) An applicant
				is determined eligible or ineligible for the program;
(B) A recipient is determined eligible or
				ineligible at time of redetermination; or
(C) Services are reduced or terminated.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 2 - REFERRAL, APPLICATION, AND ELIGIBILITY FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM AND THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-2-005 - NOTICES NOT REQUIRED BY DEPARTMENT

Current through June 17, 2024
A notice is not sent to applicants or recipients in the
				  following instances:
(A) Services are
				no longer needed and applicant or recipient requests the closure;
(B) Applicant or recipient has
				died;
(C) Applicant or recipient
				becomes institutionalized;
(D)
				Applicant or recipient whereabouts are unknown; or
(E) Failure to act upon request for
				redetermination.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-001 - SPECIALIZED MEDICAL CARE

Current through June 17, 2024
Specialized medical care is covered, according to each
				  diagnoses' service components, for eligible recipients. The medical care must
				  be outlined in the individual medical treatment plan that is developed and
				  signed by a health care professional. The specialized medical care must be
				  directly related to the medically eligible diagnosis. Routine, general health
				  care is not a covered service.
001.01
LOCATION OF SERVICES.
Recipients are encouraged to use
				medical providers and facilities closest to their place of residence. If a
				medical provider or facility is available closer to the residence and the
				recipient chooses one further away, the Department is not obligated to pay for
				services.
001.02
SERVICES PROVIDED OUTSIDE NEBRASKA.
Specialized
				medical care received from Nebraska medical providers is covered by the
				Program. The recipient, parent, or legal guardian must obtain prior approval
				from the Department for all non-emergency services outside of Nebraska. In the
				following situations, the Department may approve specialized medical care to be
				provided outside Nebraska:
(A) A medical
				service is not available in Nebraska but is available in another state. Written
				documentation must be provided by the medical provider to explain the medical
				service requested and that the service is not available in Nebraska;
(B) Emergency situations that arise while the
				recipient is visiting in another state and the recipient's health would be
				jeopardized if care was postponed until the recipient returned to Nebraska.
				Medical services are covered as if it were provided in Nebraska. Emergency
				services may be reviewed by the medical consultant. Emergency services will be
				covered up to five days; or
(C) The
				medical service is more accessible in another state.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-002 - ASTHMA DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for severe, persistent asthma
				  in recipients.
002.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
Applicants and
				recipients must meet specific criteria for severe, persistent or moderate,
				persistent with several complicating factors. Persistent asthma is having more
				than two episodes of asthma symptoms per week. Severe asthma is continual daily
				symptoms and frequent nightly symptoms prior to treatment. Daily symptoms or
				more per month nightly symptoms fall into the more moderate category. Life
				threatening episodes, frequent hospitalizations, evidence of chronic lung
				disease, evidence of the disease adversely affecting every day functioning,
				including psychological disturbances secondary to the disease will all be taken
				into account.
002.01(A)
MEDICAL
				ELIGIBILITY DETERMINATION.
The medical consultant determines
				medical eligibility for asthma.
002.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-003 - BURNS DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for serious burn injuries
				  through the burn centers in the metro-area.
003.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
When determining eligibility, the medical
				consultant takes into account the referring physician's report of the burn
				injury, the degree of the burn, percentage of body surface burned, and the
				physical location of the burn.
003.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for burns.
003.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-004 - CEREBRAL PALSY DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides screening and treatment for applicants
				  or recipients who have residual alterations in motor function as a result of
				  brain or brain stem damage or spinal cord injury from any cause.
004.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
The most common diagnoses covered are
				quadriplegia, hemiplegia, diplegia, and paraplegia. Other applicants and
				recipients with motor difficulties may be eligible as authorized by the medical
				consultant or clinic team.
004.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for cerebral palsy. If a Department
				sponsored medical clinic is available in the applicant or recipient's
				community, the clinic evaluation may take the place of the medical consultant
				review for eligibility determination.
004.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met. If applicant is utilizing a Department
				sponsored medical clinic for medical eligibility, the certification date is the
				date the applicant was first seen at the medical clinic.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-005 - CRANIOFACIAL DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for recipients with
				  craniofacial anomalies.
005.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
Eligible diagnosis
				include bilateral, unilateral, complete, and incomplete cleft lip and cleft
				palate. Other craniofacial anomalies may be considered. Department sponsored
				medical clinics may be offered in the applicant or recipient's community to
				provide diagnostic evaluations.
005.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The Department
				determines medical eligibility for craniofacial diagnosis. The medical
				consultant only determines eligibility for craniofacial diagnosis which falls
				under the "other craniofacial anomalies".
005.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-006 - CYSTIC FIBROSIS DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for cystic fibrosis which is
				  commonly associated with the pancreas, respiratory system, and sweat
				  glands.
006.01
MEDICAL
				ELIGIBILITY CONSIDERATIONS.
The only eligible diagnosis is cystic
				fibrosis, fibrocystic disease. Cystic fibrosis is an inherited disease of the
				exocrine glands.
006.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for cystic fibrosis.
006.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-007 - DIABETES DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for diabetes mellitus.
007.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
The only eligible diagnosis is diabetes mellitus,
				Type I or Type II.
007.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The Department
				determines medical eligibility for diabetes diagnosis. Medical consultant does
				not determine medical eligibility.
007.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-008 - EYE DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for eye defects which include
				  the need for surgeries.
008.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
The most common
				diagnoses covered are ptosis, exotropia, congenital cataracts, glaucoma, and
				blocked tear ducts. Medical eligibility is dependent upon the need for surgery.
008.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for eye diagnosis.
008.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-009 - HEARING DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for recipients with
				  significant hearing loss requiring amplification or have a condition which may
				  result in a hearing loss. The purpose is to improve hearing acuity and prevent
				  further hearing loss.
009.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
The hearing
				diagnosis may be used to fill the service gaps for infants that need additional
				diagnostic, medical treatment planning, and medical treatment services beyond
				the newborn hearing screening phase, subject to local school system's
				responsibilities. Eligibility for hearing services must be evidenced by a
				permanent hearing loss or a medical condition resulting in a permanent hearing
				loss. Medical conditions which include hearing loss but respond to medication
				and placement of tube, myringotomy, and usually result in normal hearing are
				considered acute conditions which are not medically eligible.
009.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for hearing.
009.01(B)
CERTIFICATION DATE.
The certification date is the date
				of referral, once medical and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-010 - HEART DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for congenital and acquired
				  heart disease.
010.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
The most common
				diagnoses covered are Tetralogy of Fallot, transposition of the great vessels,
				coarctation of the aorta, mitral/aortic valve stenosis, ventricular septal
				defect, and atrial septal defect. Other chronic heart conditions may be
				considered.
010.01(A)
MEDICAL
				ELIGIBILITY DETERMINATION.
The Department determines medical
				eligibility for heart diagnosis. The medical consultant only determines
				eligibility for heart diagnosis which falls under the "other diagnoses may be
				considered" category.
010.01(B)
CERTIFICATION DATE.
The certification date is the date
				of referral, once medical and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-011 - HEMOPHILIA DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for hemophilia and certain
				  bleeding disorders.
011.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
Hemophilia is a
				genetically transmitted disease caused by deficiency of an antihemophilic
				globulin, Factor VIII. Bleeding episodes may occur due to minor injuries,
				surgeries, dental work, and other procedures and may require extensive
				treatment. Medically eligible diagnoses are congenital Factor VII and severe
				Factor IX disorders, such as hemophilia and Christmas disease.
011.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for hemophilia diagnosis.
011.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-012 - MAJOR MEDICAL DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for diagnoses determined to
				  be congenital, chronic, or prolonged, and in need of active treatment. If the
				  applicant or recipient's diagnosis does not meet criteria for other services,
				  the applicant or recipient may be considered for this service.
012.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
Common diagnoses covered are Addison's disease,
				Turner's syndrome, hypothyroidism, esophageal strictures, imperforate anus,
				tracheoesophageal fistula, choanal atresia, enterocolitis, Hirschsprung's
				disease, aplastic anemia, gastroschisis, growth hormone deficiency,
				phenylketonuria, and duodenal atresia. Medically eligible immunological
				deficiencies are congenital hypogammaglobinemia, acquired hypogammaglobinemia,
				DiGeorge's syndrome, severe combined immunodeficiency, ataxia-telangiectasia
				syndrome, Wiskott-Aldrich syndrome, chronic granulomatous disease,
				Chediak-Higashi syndrome, and Kostmann's syndrome. Complement deficiencies may
				be considered. Not covered are growth hormone transplants of bone marrow and
				thymus or selective IgA deficiency, chronic mucocutaneous candidiasis, hyper
				IgE syndrome, and Quie-Hill syndrome.
012.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for major medical.
012.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-013 - MIDLINE NEUROLOGICAL DEFECT DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for spina bifida,
				  meningomyelocele, or other central nervous system neurological defects.
013.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
Common diagnoses covered are spina bifida aperta
				with hydrocephalus, spina bifida aperta without hydrocephalus, spina bifida
				occulta, congenital hydrocephalus, encephalocele, obstructive hydrocephalus -
				acquired, hydranencephaly, spinal cord lesion, and craniosynostosis requiring
				surgery. Other central nervous system neurological defects may be considered.
013.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for midline neurological defect.
013.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-014 - NEOPLASM DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for neoplastic (cancerous)
				  diseases or non-malignant tumors when the tumor is potentially
				  disabling.
014.01
MEDICAL
				ELIGIBILITY CONSIDERATIONS.
Common diagnoses covered are leukemia,
				lymphoma, Ewing's sarcoma, Wilm's tumor, rhabdomyosarcoma, neuroblastoma,
				astrocytoma, and osteogenic sarcoma. Other brain tumors that are potentially
				disabling may be considered.
014.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for neoplasm.
014.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-015 - NEUROLOGICAL DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for neurological
				  conditions.
015.01
MEDICAL
				ELIGIBILITY CONSIDERATIONS.
Common diagnoses covered are seizures,
				subdural hematoma, encephalocele, and Guillain-Barre syndrome. Seizures are not
				a covered diagnosis during a newborn's initial hospitalization at birth. Other
				chronic neurological conditions may be considered.
015.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for neurological.
015.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-016 - ORTHOPEDIC DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for general orthopedic
				  problems, congenital or acquired, excluding recent fractures.
016.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
Common diagnoses covered are talipes equinovarus,
				arthrogryposis, Legg-Calve-Perthes disease, congenital dislocation of the hip,
				and the need for prostheses. Spinal cord injuries may be considered for
				rehabilitative care. Additional diagnoses that may be considered are tibial
				torsion, bowed legs, torn medial meniscus, leg length discrepancy, and
				fractures that have not healed properly. Other severe and chronic orthopedic
				conditions may be considered.
016.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for orthopedic.
016.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-017 - PREMATURE BIRTHS DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for certain premature infants
				  with medical complications and must be referred to other available resources or
				  programs that assist with this population.
017.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
Medical eligibility is based on seriousness of the
				condition for each applicant or recipient. Covered diagnoses may include
				bronchopulmonary dysplasia and hyaline membrane disease or respiratory distress
				syndrome when the infant has been on mechanical ventilation for more than five
				days. Certain other conditions associated with prematurity may be considered.
				Diagnoses not covered are meconium aspiration, neonatal sepsis, hypoglycemia,
				and neonatal meningitis. Low birth weight and gestational age alone are not
				medically eligible. Hospitalizations for acute care or weight gain are not
				medically eligible.
017.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for premature births. All inpatient
				hospitalization discharge summaries are required.
017.01(B)
CERTIFICATION
				DATE.
The certification date is the date of birth, if referred
				within 30 days of the date of birth, once medical and financial eligibility is
				met. If the referral is not made within the 30 days of birth, the certification
				date is the date of referral, once medical and financial eligibility is
				met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-018 - RHEUMATOID ARTHRITIS DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for juvenile rheumatoid
				  arthritis and related conditions.
018.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
The covered diagnosis is juvenile rheumatoid
				arthritis. Other related conditions may be considered.
018.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for rheumatoid arthritis.
018.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-019 - SCOLIOSIS DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for anomalies of the
				  spine.
019.01
MEDICAL
				ELIGIBILITY CONSIDERATIONS.
Eligible diagnoses are congenital
				scoliosis, spondylolisthesis, and congenital absence of vertebra, hemivertebra,
				and congenital fusion of the spine. Other conditions of the spine may be
				considered.
019.01(A)
MEDICAL
				ELIGIBILITY DETERMINATION.
The medical consultant determines
				medical eligibility for scoliosis.
019.01(B)
CERTIFICATION
				DATE.
The certification date is the referral date, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 3 - DIAGNOSES AND SERVICES FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Section 467-3-020 - UROLOGY DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for kidney, urinary, and
				  genital anomalies determined to be chronic and disabling or potentially
				  disabling and active treatment is necessary.
020.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
Covered diagnoses are exstrophy of the bladder,
				bilateral ureteral reflux, extensive hypospadias, ambiguous genitalia, and
				hydronephrosis. Other related diagnoses may be considered. Eligibility ends
				when dialysis or transplant is required - other public programs are available
				for this stage of disease.
020.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for urology.
020.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 4 - DIAGNOSES AND SERVICES FOR THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-4-001 - SPECIALIZED MEDICAL CARE

Current through June 17, 2024
Specialized medical care is covered, according to each
				  diagnoses' service components, for eligible recipients age 21 years and older.
				  The medical care must be outlined in the individual medical treatment plan that
				  is developed and signed by a health care professional. The specialized medical
				  care must be directly related to the medically eligible diagnosis. Routine,
				  general health care is not a covered service.
001.01
LOCATION OF
				SERVICES.
Recipients are encouraged to use medical providers and
				facilities closest to their place of residence. If a medical provider or
				facility is available closer to the residence and the recipient chooses one
				further away, the Department is not obligated to pay for services.
001.02
SERVICES PROVIDED OUTSIDE
				NEBRASKA.
Specialized medical care received from Nebraska medical
				providers is covered by the Program. The recipient, parent, or legal guardian
				must obtain prior approval from the Department for all non-emergency services
				outside of Nebraska. In the following situations, the Department may approve
				specialized medical care to be provided outside Nebraska:
(A) A medical service is not available in
				Nebraska but is available in another state. Written documentation must be
				provided by the medical provider to explain the medical service requested and
				that the service is not available in Nebraska;
(B) Emergency situations that arise while the
				recipient is visiting in another state and the recipient's health would be
				jeopardized if care was postponed until the recipient returned to Nebraska.
				Medical services are covered as if it were provided in Nebraska. Emergency
				services may be reviewed by the medical consultant. Emergency services will be
				covered up to five days; or
(C) The
				medical service is more accessible in another state.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 4 - DIAGNOSES AND SERVICES FOR THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-4-002 - CYSTIC FIBROSIS DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for cystic fibrosis which is
				  commonly associated with pancreas, respiratory system and sweat glands.
002.01
MEDICAL ELIGIBILITY
				CONSIDERATIONS.
The only eligible diagnosis is cystic fibrosis
				fibrocystic disease. Cystic fibrosis is an inherited disease of the exocrine
				glands.
002.01(A)
MEDICAL
				ELIGIBILITY DETERMINATION.
The medical consultant determines
				medical eligibility for cystic fibrosis.
002.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 4 - DIAGNOSES AND SERVICES FOR THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-4-003 - HEMOPHILIA DIAGNOSIS AND SERVICES

Current through June 17, 2024
This service provides treatment for hemophilia and certain
				  bleeding disorders.
003.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
Hemophilia is a
				genetically transmitted disease caused by deficiency of an antihemophilic
				globulin, Factor VIII. Bleeding episodes may occur due to minor injuries,
				surgeries, dental work, and other procedures and may require extensive
				treatment. Medically eligible diagnoses are congenital Factor VII and severe
				Factor IX disorders, such as hemophilia and Christmas disease.
003.01(A)
MEDICAL ELIGIBILITY
				DETERMINATION.
The medical consultant determines medical
				eligibility for hemophilia diagnosis.
003.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 4 - DIAGNOSES AND SERVICES FOR THE GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-4-004 - SICKLE CELL DISEASE DIAGNOSIS AND SERVICES

Current through June 17, 2024
This services provides treatment for sickle cell disease -
				  sickle cell anemia.
004.01
MEDICAL ELIGIBILITY CONSIDERATIONS.
The only eligible
				diagnosis is sickle cell disease.
004.01(A)
MEDICAL ELIGIBILITY DETERMINATION.
The medical
				consultant determines medical eligibility for sickle cell disease.
004.01(B)
CERTIFICATION
				DATE.
The certification date is the date of referral, once medical
				and financial eligibility is met.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 5 - MEDICAL PROVIDERS AND PAYMENTS FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM AND GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-5-001 - MEDICAL PROVIDERS

Current through June 17, 2024
Medical providers provide services and treatment to
				  recipients with special health care needs and receive payment for prior
				  authorized services.
001.01
PROVIDER ENROLLMENT.
Prior to services being
				authorized for payment, providers must sign a Department form which requires
				the following:
(A) The Provider must follow
				the Program regulations and other applicable laws;
(B) The Provider must maintain current
				licensing and certifications required by state law;
(C) The Provider must be screened for abuse
				and neglect on the child and adult central registry and must have criminal
				background checks completed; and,
(D) The Provider must maintain records on
				services provided for a minimum of six years after the date of
				service.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 5 - MEDICAL PROVIDERS AND PAYMENTS FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM AND GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-5-002 - MEDICAL PAYMENTS

Current through June 17, 2024
Medical payments are made to medical providers for authorized
				  services after the Department reviews the billings for compliance with
				  requirements.
002.01
BILLING REQUIREMENTS.
The Department only considers
				payment for claims when the following billing requirements are met:
002.01(A)
THIRD
				PARTY.
All third party sources must be exhausted before payment
				may be considered.
002.01(B)
REQUIRED DETAIL ON CLAIMS.
The detail required on
				claims is dependent upon the type of medical claim being submitted. All medical
				claims submitted to the Department for payment must be completed in its
				entirety by the provider. Additional supporting documentation may be requested
				in order to process the claim. Failure to submit additional documentation
				timely will result in the claim being denied payment.
002.01(C)
ACCEPT PAYMENT IN
				FULL.
Medical providers must accept the Department's payment as
				payment in full. Any balance remaining on a claim after payment has been made
				cannot be billed to the recipient. If the Department does not make payment due
				to third party sources paying more than the Department's rate, the remaining
				balance must not be billed to the recipient. Recipients must not be billed for
				claims denied by the Department for untimely filing.
002.01(D)
TIMELY
				FILING.
Medical providers must bill within six months from the
				date of service for payment to be considered by the Department. Claims received
				beyond six months from the date of service will be denied.
002.01(E)
REFUNDS.
Medical providers have 45 days to refund any overages or erroneous payments or
				to show that the refunds have already been made or that the refund requests
				were made in error.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 5 - MEDICAL PROVIDERS AND PAYMENTS FOR THE MEDICALLY HANDICAPPED CHILDREN'S PROGRAM AND GENETICALLY HANDICAPPED PERSONS PROGRAM › Section 467-5-003 - PAYMENT RATES FOR MEDICAL SERVICES

Current through June 17, 2024
The Department follows the rates below for medical services
				  provided while allowing the Department the discretion to negotiate rates when
				  excessive costs are billed.
003.01
PHARMACY RATES.
Pharmacy rates are as
				billed.
003.02
DURABLE
				MEDICAL EQUIPMENT.
Durable medical equipment rates follow the
				Medicaid fee schedules.
003.03
PHYSICIAN RATES.
Physician rates follow the Medicaid
				fee schedules.
003.04
HOSPITAL RATES.
Hospital rates follow the Medicaid fee
				schedules.
003.05
DENTAL RATES.
Dental rates follow the Medicaid fee
				schedules.
003.06
UNKNOWN RATES.
Certain medical services do not have
				available Medicaid pricing. Rates that are unknown are determined by the
				Department on a negotiated basis until pricing becomes available.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-001 - INTRODUCTION

Current through June 17, 2024
The Disabled Children's Program serves eligible children with
				  special health care needs and their families by providing medical support
				  services. Family needs are assessed to determine the support services that may
				  be covered based on available funding.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-002 - REFERRALS

Current through June 17, 2024
Any individual or agency may refer children who are
				  determined to be eligible for Supplemental Security Income
				  benefits.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-003 - APPLICATIONS

Current through June 17, 2024
Upon receiving a referral, the Department verifies
				  Supplemental Security Income current pay status prior to applications being
				  mailed to potential applicants. The Department must receive the completed
				  application within 30 days after the Department mails the application. A
				  legally responsible adult age 19 or older must complete the application. A
				  referral is not a requirement for completing an application.
003.01
WITHDRAWAL.
The applicant may voluntarily withdraw an application.
003.02
ELIGIBILITY
				REQUIREMENTS.
The following are the eligibility requirements:
003.02(A)
RESIDENT OF
				NEBRASKA.
Applicants and recipients must reside in
				Nebraska.
003.02(B)
CITIZENSHIP OR ALIEN STATUS.
Applicants and recipients
				must be United States citizens or qualified aliens as required by Nebraska
				Revised Statute §§
										4-108 to 4112. Applicants and
				recipients must sign an attestation form verifying lawful presence in the
				United States. The Department must be able to verify the status of applicants
				and recipients.
003.02(C)
AGE REQUIREMENT.
Applicants and recipients must be age
				15 years or younger.
003.02(D)
SUPPLEMENTAL SECURITY INCOME.
Applicants and
				recipients must be in current pay status with Supplemental Security Income
				benefits.
003.02(E)
NEED FOR SERVICES.
Applicants and recipients must have
				an identified disability-related need for services.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-004 - NOTICES FROM DEPARTMENT

Current through June 17, 2024
A notice is sent to applicants and recipients in the
				  following instances:
(A) An applicant
				is determined eligible or ineligible for the program;
(B) A recipient is determined eligible or
				ineligible at time of redetermination; or,
(C) Services are reduced or
				terminated.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-005 - NOTICES NOT REQUIRED BY DEPARTMENT

Current through June 17, 2024
A notice is not sent to applicants or recipients in the
				  following instances:
(A) Services are
				no longer needed and applicant or recipient requests the closure;
(B) Applicant or recipient has
				died;
(C) Applicant or recipient
				becomes institutionalized;
(D)
				Applicant or recipient whereabouts are unknown; or,
(E) Failure to act upon request for
				redetermination.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-006 - NEEDS ASSESSMENT

Current through June 17, 2024
Once the applicant or recipient is determined eligible, a
				  needs assessment is completed to identify the disability-related needs of the
				  family.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-008 - FRAUDULANT ACTIONS

Current through June 17, 2024
The Department has the authority to terminate any
				  relationship with a provider who has committed fraud in another government
				  program. The Department has the authority to terminate provider relationships
				  and deny payments to any provider that engages in fraudulent
				  billing.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 467 - MEDICALLY HANDICAPPED CHILDREN'S PROGRAM › Chapter 6 - REFERRAL, APPLICATION, ELIGIBILITY, AND SERVICES FOR THE DISABLED CHILDREN'S PROGRAM › Section 467-6-009 - PAYMENTS

Current through June 17, 2024
Payments are made to the parent or legal guardian of the
				  recipient in specific situations and in other situations payments are made
				  directly to the providers.
009.01
PAYMENTS TO THE PROVIDER.
Payments are made directly
				to the provider for respite care services, special equipment, and accessibility
				modifications. Billing documents must be completed accurately and received by
				the Department timely, within 60 days from the date of service, in order to be
				considered for payment. Billings received by the Department after the 60 days
				from the date of service will be denied payment. One billing document must be
				completed for each month for each type of service authorized. Special equipment
				and accessibility modifications are paid once the purchase or project is
				complete to satisfaction of the family. Inaccurate or incomplete billing claims
				may be denied.
009.02
PAYMENTS TO THE RECIPIENT'S PARENT OR LEGAL GUARDIAN.
Payments are made as reimbursement to the parent or legal guardian of the
				recipient for medical mileage and lodging services. Billing documents must be
				completed accurately and received by the Department timely, within 60 days from
				the date of service, in order to be considered for payment. Billings received
				by the Department after the 60 days from the date of service will be denied
				payment. One billing document must be completed for each month for each type of
				service authorized. Inaccurate or incomplete billing claims may be
				denied.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 468 - AID TO DEPENDENT CHILDREN (ADC) › Chapter 1 - GENERAL BACKGROUND › Section 468-1-001 - LEGAL BASIS

Current through June 17, 2024
The Nebraska Aid to Dependent Children (ADC) Program is
				  governed and funded by state and federal sources. Title IV-A of the Social
				  Security Act governs the Temporary Assistance to Needy Families (TANF) federal
				  block grant program which partially funds Aid to Dependent Children. See also
				  Nebraska Revised Statutes (Neb. Rev. Stat.) §§
									43-501
				  through
				  43-517
				  and various sections in chapters 45, 61, and 68 of Nebraska Revised
				  Statutes.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 468 - AID TO DEPENDENT CHILDREN (ADC) › Chapter 1 - GENERAL BACKGROUND › Section 468-1-002 - PURPOSE AND SCOPE

Current through June 17, 2024
The purpose of Aid to Dependent Children is to provide
				  assistance to needy families so that children can be cared for in their own
				  homes and to reduce the dependency of needy parents by promoting job
				  preparation, work, and marriage.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 468 - AID TO DEPENDENT CHILDREN (ADC) › Chapter 1 - GENERAL BACKGROUND › Section 468-1-003 - ADMINISTRATION

Current through June 17, 2024
The Aid to Dependent Children Program is administered by the
				  Nebraska Department of Health and Human Services in accordance with state laws
				  and with rules, regulations, and procedures established by the
				  Director.