Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 45 - RATES FOR NURSING FACILITY SERVICES › Section 471-45-018 - PAYMENT FOR SERVICES FOR LONG TERM CARE CLIENTS WITH SPECIAL NEEDS

Current through June 17, 2024
Payment for services to all special needs clients must be prior
	 authorized by Department staff in the Central Office.
018.01
NEBRASKA
  FACILITIES.
To establish a Nebraska facility's payment rate for
  care of special needs clients:
(A) The
  facility must submit Form FA-66, Long Term Care Cost Report, to the Department
  for each fiscal year ending June 30. Medicare cost reporting forms may be
  substituted when Form FA-66 is not otherwise required to be submitted. Form
  FA-66 must be completed in accordance with this chapter, Completion of Form
  FA-66, Long Term Care Cost Report, Rates for Nursing Facility Services, as
  applicable. Medicare cost reports must be completed in accordance with
  Medicare's Provider Reimbursement Manual (HIM15). If the facility provides both
  nursing facility services and special needs services, direct accounting, or
  cost allocations necessary to distribute costs between the nursing facility and
  the special needs unit must be approved by the Department;
(B) The Department shall compute the
  allowable cost per day from the most recent State fiscal year Form FA-66 or the
  most recent Medicare cost report, as applicable, which will be the basis from
  which a prospective rate is negotiated. Payment for fixed costs is limited to
  the lower of the individual facility's fixed cost per diem or a maximum per
  diem of $54.00 excluding personal property and real estate taxes. Negotiations
  may include, but are not limited to, discussion of appropriate inflation or
  deflation expectations for the rate period and significant increases or
  decreases in the cost of providing services that are not reflected in the
  applicable cost report;
(C) If the
  facility has no prior cost experience in providing special needs services, the
  facility must submit a budget for the provision of the intended service. The
  Department must concur that the budgeted cost per day meets a reasonable
  expectation of the cost of providing said service, taking into account the cost
  per day of similar facilities providing similar services. Budgets will be used
  until the facility has at least six months of actual cost experience;
(D) An incentive factor calculated at eight
  per cent of allowable costs is added to the allowable costs of proprietary
  facilities. An incentive factor calculated at four percent of allowable costs
  is added to the allowable costs of other than propriety facilities;
(E) After a rate is agreed upon, the provider
  must sign a provider agreement addendum. The addendum originated by the
  Department, must include:
(i) The rate and its
  applicable dates;
(ii) A
  description of the criteria for care; and
(iii) A full description of the services to
  be provided under the established per diem as well as any services that are not
  provided under the per diem and are billed separately; and
(F) Reimbursement must reflect the facility's
  actual reasonable cost of providing services to special needs clients and must
  be updated annually using an appropriate inflation
  adjustment.