reglab/statecodes huggingface dataset:
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM › Chapter 4 - STATE DISABILITY PROGRAM - MEDICAL › Section 469-4-004 - EFFECTIVE DATE OF STATE DISABILITY MEDICAL ELIGIBILITY

Current through June 17, 2024
If an individual is eligible for medical assistance one day
				  of the month, the individual is eligible the entire month. The effective date
				  of eligibility for State Disability Program Medical is determined as
				  follows:
(A) Prospective eligibility
				is effective the first day of the month of request if the individual was
				eligible for State Disability Program Medical in that same month and had a
				medical need.
(i) The State Disability
				Program Medical eligibility cannot begin prior to the start date of the
				disability as determined by the medical consultant review.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM › Chapter 4 - STATE DISABILITY PROGRAM - MEDICAL › Section 469-4-005 - USE OF MEDICAL BUDGET FOR STATE DISABILITY PROGRAM MEDICAL

Current through June 17, 2024
Determine eligibility for medical assistance only and medical
				  assistance share of cost cases. If at any time factors change that affect the
				  budget, the budget must be recomputed.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM › Chapter 4 - STATE DISABILITY PROGRAM - MEDICAL › Section 469-4-006 - TREATMENT OF RESOURCES FOR STATE DISABILITY PROGRAM MEDICAL

Current through June 17, 2024
The application for an individual who has excess resources,
				  other than real property, may be held pending until the resources are reduced.
				  Excess resources may be reduced by paying obligations for medical costs. State
				  Disability Program Medical eligibility begins with the first day of the month
				  of the incurred obligation which was used to reduce the resources to the
				  allowable maximum. Medical eligibility may not be established earlier than the
				  three-month retroactive period.
006.01
MAXIMUM AVAILABLE RESOURCE LEVELS.
The established
				maximum for available resources which the recipient, or the recipient and
				responsible relative, may own and still be considered eligible for Medical
				under the State Disability Program according to unit size, are as follows:
(1) One member unit - recipient only $4000
(a) If a couple has a valid designation of
				resources and:
(1) There is an eligible spouse
				and an ineligible spouse, the resource level for the eligible spouse is $4,000;
				or
(2) The ineligible spouse later
				becomes eligible, each spouse is allowed $4,000.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM › Chapter 4 - STATE DISABILITY PROGRAM - MEDICAL › Section 469-4-007 - TREATMENT OF INCOME

Current through June 17, 2024
The following disregards are allowed:
007.01
MEDICAL INSURANCE
				DISREGARDS.
A deduction for the cost of medical insurance premiums
				is allowable in the State Disability Program budget. The cost of premiums for
				policies that are not considered health insurance are not allowed as a
				deduction for medical budgeting.
007.02
GUARDIAN OR CONSERVATOR
				FEE.
The expense of a guardian or conservator fee is allowed as
				paid, up to a maximum of $10 per month. If the guardian or conservator is
				required by the court to purchase a bond and file an annual report with the
				court, the amount allowed by the court for expenses, in excess of $120, may
				also be disregarded.
007.03
REPAYMENT OF STATE DISABILITY MEDICAL BENEFITS PROVIDED IN
				ERROR.
When an error has occurred in the paid amount of State
				Disability Program Medical benefits received by the recipient because of
				erroneously reported income, changes in income, or private health insurance
				premiums, not including Medicare, under Neb. Rev. Stat. §
									68-138,
				repayment cannot be required unless such benefits were obtained through
				misrepresentation or fraud. Voluntary repayment in the following situations:
(1) The recipient failed to report a change
				timely and the amount of benefits in error is $76 or more;
(2) The recipient reported a change timely
				but the Department failed to take action in the first month possible and the
				amount of benefits in error is $251 or more; or
(3) The recipient failed to report a change
				timely and the Department failed to take action in the first month possible
				with the amount of benefits in error is $251 or more.
007.03(A)
AMOUNT OF BENEFITS IN
				ERROR.
The amount of benefits in error for a recipient of the
				Assistance to the Aged, Blind, Disabled or State Disability grant or medical,
				or State Disability Program Medical only, but should have been, State
				Disability Program Medical with a share of C=cost, or who was State Disability
				Program Medical with share of cost but who should have had a larger share of
				cost, is the smaller of:
(i) The amount of
				State Disability Program Medical services received for that month;
				or,
(ii) The amount of share of
				cost in error.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 469 - ASSISTANCE TO THE AGED, BLIND, OR DISABLED PROGRAM › Chapter 4 - STATE DISABILITY PROGRAM - MEDICAL › Section 469-4-008 - COMPUTING A STATE DISABILITY MEDICAL BUDGET

Current through June 17, 2024
When computing a State Disability Medical budget, the amount
				  of income when compared to the Federal Poverty Level will determine the
				  applicant or recipient's State Disability Medical eligibility for medical,
				  medical with a share of cost, or ineligibility.
008.01
ENTERING LONG TERM
				CARE.
When a recipient enters long term care, the standard is not
				reduced to the long term care level or Assisted Living Waiver level until the
				first full month that the recipient resides in long term care, or at a later
				month if certain other criteria is are met, such as home liquidation.
008.02
INCOME WHEN ONE RECIPIENT
				OF THE HOUSEHOLD IS IN A SPECIFIED LIVING ARRANGEMENT.
The
				following definitions apply when the eligible spouse is in a specified living
				arrangement and the ineligible spouse or family member is in the community:
(A)
COMMUNITY
				SPOUSE.
A spouse who is:
(i) Not
				applying for or receiving assistance;
(ii) Not residing with the alternate care
				spouse unless the alternate care spouse is in the home and eligible for Home
				and Community-Based Waiver Services; and,
(iii) Not in a hospital, skilled nursing
				facility, intermediate care facility, or intermediate care facility for persons
				with developmental disabilities.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
The Refugee Act (Public Law 96-212), Refugee Assistance
				  Amendments of 1982 (Public Law 97-363), and the Federal Deficit Reduction Act
				  of 2005 (Public
				  Law 109-171) authorize the financial and medical
				  assistance to refugees in the United States. The program is governed by federal
				  regulations found at 45 CFR 5400. The program is funded completely with federal
				  money. The Department operates the program in accordance with its federally
				  approved state plan.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-002 - PURPOSE

Current through June 17, 2024
The purpose of the Refugee Resettlement Program is to provide
				  assistance to refugees who are not eligible for another categorical assistance
				  program so they may achieve economic self-sufficiency as guickly as possible
				  and to assist with refugees' financial and medical assistance during their
				  initial resettlement in the United States.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-003 - ADMINISTRATION

Current through June 17, 2024
The Refugee Resettlement Program is administered by the
				  Department in accordance with federal and state laws and regulations
				  established by the Department.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-004 - DEFINITIONS

Current through June 17, 2024
The following definitions apply:
004.01
ADEQUATE
				NOTICE.
Notice of case action which includes a statement of what
				action the Department intends to take, the reason for the intended action, the
				specific regulation or guidance document that supports the action, or the
				change in federal or state law that requires the action.
004.02
APPLICATION.
The action by which the individual indicates in writing on a Department
				approved form the desire to receive Program assistance.
004.03
CATEGORICAL ASSISTANCE.
				Assistance administered by the Department.
For the purposes of
				this definition, it includes Aid to Dependent Children (ADC), Child Welfare
				Payment and Medical Services Program, Assistance to the Aged, Blind, or
				Disabled (AABD), State Disability Program (SDP), and the Refugee Resettlement
				Program (RRP).
004.04
DEPARTMENT.
The Nebraska Department of Health and
				Human Services.
004.05
GRANT CASE.
A case receiving a Refugee Resettlement
				payment or eligible to receive payment but not receiving it because of the
				minimum payment requirement.
004.06
HOUSEHOLD,
individuals living together. There may be
				more than one public assistance unit within a household.
004.07
MATCH GRANT.
An agreement with a voluntary resettlement agency that enables the agency to
				issue the assistance grant for the first time four months of a refugee's
				eligibility.
004.08
OFFICE OF REFUGEE RESETTLEMENT.
A federal office
				created by The Refugee Act of 1980. The office is housed within the United
				States Department of Health and Human Services and is primarily responsible for
				federal oversight of federal refugee resettlement services and program
				administration.
004.09
REFUGEE.
A refugee is defined by the Immigration and
				Nationality Act at 8 (United States Code) U.S.C. § 1101
004.10
REFUGEE RESETTLEMENT CASH
				AND MEDICAL.
A categorical program consisting of financial and
				medical assistance to eligible refugees.
004.11
REFUGEE MEDICAL ASSISTANCE
				PROGRAM.
A program providing medical assistance, but no cash
				assistance, to eligible refugees.
004.12
SHARE OF
				COST.
An individual's monthly financial out-of-pocket obligation
				for medical services when the individual's income exceeds the program
				limits.
004.13
TIMELY
				NOTICE.
A notice of case action dated and mailed at least 10
				calendar days before the date the action becomes effective).
004.14
UNIT.
Eligible individuals considered in determining the grant and medical
				assistance.
004.15
WITHDRAWAL.
A voluntary written retraction of an
				application.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-005 - CONFIDENTIALITY

Current through June 17, 2024
The records of those applying for or receiving assistance
				  under this Program are safeguarded in accordance with
				  45 CFR
				  400.27 and Nebraska Revised Statute (Neb.
				  Rev. Stat.) jg 68-313
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-006 - INDIVIDUAL RESPONSIBILITIES

Current through June 17, 2024
Individuals applying for or receiving Refugee Resettlement
				  benefits are required to:
(A) Provide
				complete and accurate information. State and federal law provides penalties of
				a fine, imprisonment, or both for persons found guilty of obtaining assistance
				or services for which they are not eligible by making false statements or
				failing to report promptly any in their circumstances;
(B) Report a change in circumstances no later
				than 10 days following the change, unless good cause is shown. The recipient is
				responsible for establishing the existence of a good cause circumstance.
				Unverified statements do not constitute good cause. Changes required to be
				reported include;
(i) Change or receipt of a
				resource;
(ii) Changes in who lives
				in the home of the refugee resettlement unit;
(iii) New employment must be reported within
				ten days of receipt of the first paycheck;
(iv) When employment has ended;
(v) Changes in the amount of monthly income,
				including:
(1) All changes in unearned income;
				and
(2) Changes in the source of
				employment, in the wage rate and in employment status, such as part-time to
				full-time or full-time to part-time. For reporting purposes for the Refugee
				Resettlement Program, 30 hours per week is considered full- time;
				and.
(vi) Changes in
				residence.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-007 - INDIVIDUAL RIGHTS

Current through June 17, 2024
Individuals applying for or receiving assistance have the
				  right to:
(A) An individual who wishes
				to reguest and apply for assistance must be given the opportunity to do so. No
				individual may be denied the right to apply for the Refugee Resettlement cash
				and medical assistance program;
(B)
				Reasonably prompt action on their applications for assistance;
(C) Adequate notice of any action affecting
				their application or assistance cases;
(D) Appeal to the Director for a hearing on
				any action or inaction with regard to their applications, the amount of the
				assistance payments, or failure to act with reasonable promptness. The appeal
				must be filed in writing within 90 days of the action or inaction;
(E) Have their information treated
				confidentially;
(F) Have their
				civil rights upheld. No person may be subjected to discrimination on the
				grounds of their race, color, national origin, sex, age, disability, religion,
				or political belief;
(G) Have the
				program requirements and benefits fully explained;
(H) Be assisted in the application process by
				the person of their choice; and
(l)
				Referral to other agencies.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-008 - APPLICATION

Current through June 17, 2024
An application must be properly signed by an individual for
				  himself or herself, by the applicant's guardian or conservator, by an
				  individual acting under a duly executed power of attorney, or by a specified
				  relative applying on behalf of or for a child. When adding a program to the
				  application, the application date is the date the reguest to add the program is
				  made. A properly signed application contains:
(A) Name;
(B) Address; and
(C) Proper signature, as defined by the
				appropriate program.
008.01
PROMPT ACTION ON APPLiCATIQNS.
The Department has 30
				days from the date the application is received to make an eligibility
				determination.
008.02
WITHDRAWALS.
The applicant may voluntarily withdraw an
				application.
008.03
AUTHORIZATION FOR RELEASING INFORMATION.
For some
				sources the Department asks the individual to sign a Release of Information
				when it appears that information given is incorrect, when the individual is
				unable to furnish the necessary information, or for sample quality control
				verification. A copy of the authorization for information from the application
				for assistance may be used if the source will accept it.
008.04
NEW
				APPLICATION.
A new application is required after one calendar
				month of ineligibility or after an application has been
				denied.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-009 - NOTICE OF ACTION

Current through June 17, 2024
A Notice of Action is sent to inform the applicant or
				  recipient of any action affecting his or her eligibility.
009.01
ADEQUATE
				NOTICE.
An adequate notice must include a statement of what action
				the Department intends to take, the reason for the intended action, the
				specific regulation or guidance document that supports the action, or the
				change in federal or state law that requires the action.
009.02
TIMELY
				NOTICE.
A timely notice must be dated and mailed at least ten
				calendar days before the date that action would become effective, which is
				always the first day of the month.
009.03
ADEQUATE AND TIMELY
				NOTICE.
In cases of intended adverse action, including action to
				discontinue, terminate, suspend, or reduce assistance, or to change the manner
				or form of payment or service to a more restrictive method, such as a
				protective payee, the applicant or recipient is given adequate and timely
				notice.
009.04
SITUATIONS REQUIRING ADEQUATE NOTICE ONLY.
In the
				following situations, only adequate notice is required:
(A) The Department has factual information
				confirming the death of an individual in the unit;
(B) The Department receives a written and
				signed statement from an individual in the unit:
(i) Stating that assistance is no longer
				required; or
(ii) Giving
				information which requires termination or reduction of assistance, and
				indicating, in writing, that the individual understands the consequences of
				supplying such information;
(C) An individual in the unit has been
				admitted or committed to an institution, and no longer qualifies for
				assistance;
(D) An individual in
				the unit has been placed in skilled nursing care, intermediate care, or
				long-term hospitalization or the individual is receiving assisted living waiver
				services;
(E) An individual in the
				unit's whereabouts are unknown and agency mail directed to the individual has
				been returned by the post office indicating no known forwarding
				address;
(F) An individual in the
				unit has been accepted for assistance in another state and that fact has been
				established; or
(G) A child in the
				unit is removed from the home as a result of a judicial determination or is
				voluntarily placed in foster care.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-010 - ELIGIBILITY REVIEW

Current through June 17, 2024
Eligibility is redetermined at six months. Eligibility may be
				  redetermined in less than six months to coordinate review dates for more than
				  one program. An application is required as part of the eligibility review and
				  to establish a new eligibility period.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 1 - GENERAL BACKGROUND › Section 470-1-011 - COMPUTATION OF TIME

Current through June 17, 2024
In computing time prescribed or allowed by Title 470 NAC or
				  by any applicable statute or regulation in which the method of computing time
				  is not specifically provided, days will be computed by excluding the day of the
				  act or event and including the last day of the period. If the last day of the
				  period fails on a Saturday, Sunday, or state holiday, the period shall include
				  the next working day.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-001 - APPLICATION

Current through June 17, 2024
An individual wishing to apply for assistance must complete
				  and submit an application. A relative or other person acting for the client may
				  complete the application.
001.01
INTERVIEW.
An interview is required at initial
				application.
(A) Applicants can request a
				face-to-face interview or the Department can request a face-to-face interview
				if determined necessary; and
(B)
				For medical benefits only, an application may be signed by and an interview
				held with a relative or another individual acting on the applicant's
				behalf.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-002 - TIME LIMIT ON CASH AND MEDICAL ASSISTANCE

Current through June 17, 2024
Effective June 1, 2022, if the refugee's date of eligibility
				  for Office of Refugee Resettlement benefits is before October 1, 2021, the
				  refugee may receive a maximum of eight months of refugee cash and medical
				  assistance. Refugees whose date of eligibility for Office of Refugee
				  Resettlement benefits is on or after October 1, 2021, may receive a maximum of
				  twelve months of refugee cash and medical assistance. The number of months is
				  determined by the Office of Refugee Resettlement and is subject to change.
				  Eligibility begins with the date of arrival in the United States, if the
				  refugee meets all eligibility requirements. For asylees, victims of severe
				  forms of trafficking, and Cuban and Haitian Parolees eligibility begins with
				  the date of granted status. The time limit is applied to each refugee
				  separately, not to the unit as a whole. If the refugee applies after the date
				  of arrival in the United States, they may receive assistance for the remaining
				  months of their eligibility period. If an asylee applies after the date of
				  arrival in the United States, they may receive assistance for the remaining
				  eligibility period, after they are granted asylum.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-003 - RESIDENCE

Current through June 17, 2024
To be eligible for assistance, individuals must be a Nebraska
				  resident. A resident is defined as an individual who is living in the state
				  voluntarily with the intent of making Nebraska their home and who is not
				  receiving Refugee Resettlement Program services from another state. Residence
				  starts with the month the refugee moves into the state, even if the refugee
				  received categorical assistance in another state. An individual cannot be
				  denied assistance if they have not resided in the state for a specified period
				  within their cash and medical assistance time limit.
003.01
ABSENCE FROM THE
				STATE.
An individual cannot be denied assistance due to being
				temporarily absent from the state.
003.02
LOSS OF STATE
				RESIDENCE.
Eligibility for assistance ends if the individual or
				family unit leaves Nebraska with the intent of establishing a home in another
				state.
003.03
DISQUALIFICATION FOR MISREPRESENTING RESIDENCE.
Any
				individual convicted in federal or state court of having fraudulently
				misrepresented their residence in order to obtain refugee assistance in two or
				more states is ineligible for refugee assistance.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-004 - REQUIREMENT OF SOCIAL SECURITY NUMBER

Current through June 17, 2024
All eligible individuals of the Refugee Resettlement Program
				  unit must apply for a social security number. The social security number, in
				  conjunction with other information, provides evidence of identify of the
				  individual.
004.01
INDIVIDUALS WHO HAVE NOT BEEN ISSUED A SOCIAL SECURITY
				NUMBER.
Individuals who have not been issued a Social Security
				Number must apply for a Social Security Number within 30 days of being notified
				of the requirement.
004.02
INDIVIDUALS WHO DO NOT PROVIDE A SOCIAL SECURITY
				NUMBER.
When a financially responsible individual does not provide
				a Social Security Number, the entire Refugee Resettlement Program case is
				closed.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-005 - INELIGIBILITY FOR OTHER CATEGORICAL ASSISTANCE

Current through June 17, 2024
The Refugee Resettlement Program is available only if the
				  individual or family is ineligible for another categorical assistance program.
				  Exception: An 18-year-old who is not in school may apply as a separate grant
				  case if their time limit for eligibility has not expired and they meet other
				  eligibility requirements.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-006 - RESOURCES

Current through June 17, 2024
For purposes of determining resources and resource
				  eligibility for the Cash and Medical Assistance Refugee Resettlement Program
				  under Chapter 3 of this Title, the Department applies the rules and regulations
				  from the Aid to Dependent Children Program, Title 468 Nebraska Administrative
				  Code (NAC).
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-007 - INCOME

Current through June 17, 2024
For purposes of determining income eligibility for Refugee
				  Resettlement Cash and Medical Assistance benefits of Chapter 3, the Department
				  applies the rules and regulations from the Aid to Dependent Children Program,
				  Title 468 NAC and the following:
007.01
RESETTLEMENT
				ASSISTANCE.
Supportive services may be provided by an individual,
				a family, or a group of people representing a church or another organization
				who have agreed to sponsor a refugee family or individual. Assistance may
				include, but is not limited to clothing, food, and housing. The assistance is
				disregarded as income.
007.02
RESETTLEMENT CASH ASSISTANCE.
Voluntary resettlement
				agencies may provide cash assistance for the initial resettlement of the
				refugee family or individual. Resettlement assistance from a voluntary
				resettlement agency is disregarded as income.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-008 - MEDICAL ASSISTANCE ONLY CASES

Current through June 17, 2024
For individuals applying only for Medical Assistance Program
				  benefits under Chapter 4 of this Title, the income and resource guidelines of
				  Title 477 NAC, Medicaid program apply.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-009 - COMPLIANCE WITH EMPLOYMENT AND TRAINING REQUIREMENTS

Current through June 17, 2024
Unless determined exempt by the Department, a refugee is
				  required to register for employment services within 30 days from the date of
				  application with one of the state's Refugee Social Service Employment Providers
				  and accept appropriate employment or training opportunities.
009.01
APPROPRIATE WORK AND
				TRAINING CRITERIA.
The following outlines appropriate work and
				training:
(A) May be temporary, permanent,
				full-time, part-time, or seasonal if this work meets the other work standards
				outlined in this section;
(B) The
				wage must meet or exceed the minimum wage established by law; and
(C) The daily and weekly hours of work must
				be those customary to the occupation.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-010 - ELIGIBILITY FOR MEDICAL ASSISTANCE FOLLOWING INELIGIBILITY FOR A GRANT

Current through June 17, 2024
The following individuals remain eligible without a Share of
				  Cost after losing cash assistance if the individual is still within their time
				  limit for eligibility:
(A) Individuals
				sanctioned for not cooperating with employment services; and
(B) Individuals who become ineligible for
				cash assistance because of increased earnings or increased hours of
				employment.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 470-2-011 - OTHER RELATED ELIGIBILITY REQUIREMENTS

Current through June 17, 2024
Other eligibility requirements are described in this
				  section.
011.01
RECEIPT OF
				OTHER ASSISTANCE.
An individual whose needs are included in the
				refugee resettlement program payment must not at the same time receive a
				payment of another type of categorical assistance that is administered by the
				Department. Assistance from a source other than the Department may be used to
				supplement, but not to duplicate, an assistance payment made for a particular
				case.
011.02
INELIGIBILITY OF FLEEING FELON.
An individual is
				ineligible for refugee resettlement program cash and medical assistance during
				any period in which the individual is:
(A)
				Fleeing to avoid prosecution or custody or confinement after conviction for a
				crime in the United States or attempt to commit a crime that is a felony under
				the law of the place from which the individual is fleeing; or
(B) Violating a condition of United States
				federal or state probation or parole.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 3 - REFUGEE RESETTLEMENT PROGRAM CASH AND MEDICAL ASSISTANCE BENEFITS › Section 470-3-001 - REFUGEE RESETTLEMENT PROGRAM BENEFITS

Current through June 17, 2024
if an individual is eligible for a cash assistance payment
				  they are also eligible for medical assistance. An individual may apply for;
				  medical assistance only. Refugee Resettlement benefits consist of:
(A) Cash assistance payments to the refugee
				payee; and
(B) Payments made
				directly to the provider for medical care and services as identified in the
				Medicaid Program, Title 477 Nebraska Administrative Code (NAC).
001.01
THOSE WHO RECEIVE OTHER
				ASSISTANCE.
An individual who receives assistance from the Aid to
				Dependent Children program or Assistance to the Aged, Blind, or Disabled
				program is ineligible for the Refugee Resettlement Program.
001.02
DETERMINATION OF CASH
				ASSISTANCE PAYMENT.
For purposes of calculating cash assistance
				for the Refugee Resettlement Program, the Department applies the rules and
				regulations from the Aid to Dependent Children Program, Title 468 NAC.
001.02(A)
BUDGET
				COMPUTATION.
For purposes of calculating cash payment for the
				Refugee Resettlement program, the Department applies the rules and regulations
				from the Aid to Dependent Children program. Title 468 NAC.
001.02(B)
MULTIPLE
				HOUSEHOLDS.
When a refugee resettlement program unit lives with an
				individual who is receiving assistance from another categorical program, the
				eligibility case is budgeted separately.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 470 - REFUGEE RESETTLEMENT PROGRAM AND THE REFUGEE MEDICAL ASSISTANCE PROGRAM › Chapter 4 - REFUGEE MEDICAL ASSISTANCE PROGRAM › Section 470-4-001 - REFUGEE MEDICAL ASSISTANCE PROGRAM

Current through June 17, 2024
The Refugee Medical Assistance Program provides medical care
				  and services to refugees who:
(A) Are
				eligible for Refugee cash assistance based on Title 468 Nebraska Administrative
				Code (NAC);
(B) Do not have
				sufficient income to meet their medical needs;
(C) Qualify according to the program
				requirements;
(D) Are within the
				time limit; and
(E) Are eligible
				based on the requirements and limitations of the Nebraska Medical Assistance
				Program (see NAC 471 and 477).
001.01
RESOURCES.
For purposes of determining resources and resource levels for the Refugee
				Resettlement Medical Assistance Program only, the Department applies the rules
				and regulations from the Medicaid Program, Title 477 NAC.
001.02
TREATMENT OF
				INCOME.
For purposes of determining income and income levels for
				the Refugee Resettlement Medical Assistance Program only, the Department
				applies the rules and regulations from the Medicaid Program, Title 477
				NAC.
001.03
MEDICALLY
				NEEDY INCOME LEVEL.
For purposes of determining the medically
				needy income level for the Refugee Resettlement Medical Assistance Program
				only, the Department applies the rules and regulations from the Medicaid
				Program. Title 477 NAC.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 1 - ADMINISTRATION › Section 471-1-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
The regulations govern the services provided under Nebraska's Medicaid
	 program as defined by Nebraska Revised Statute (Neb. Rev. Stat.) §§
									68-901
	 to
	 68-991.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 1 - ADMINISTRATION › Section 471-1-002 - NEBRASKA MEDICAID-COVERABLE SERVICES

Current through June 17, 2024
Medicaid covers the services included and outlined in each service
	 specific chapter in Nebraska Administrative Code (NAC) Titles 471, 473, 480,
	 and 482. Each service must be medically necessary and appropriate, in
	 accordance with this chapter, and any additional medical necessity requirements
	 imposed by each service specific chapter in Title 471 NAC.
002.01
NEBRASKA MEDICAID MANAGED
  CARE PROGRAM.
Each Managed Care Organization (MCO) provides behavioral health,
	 physical health, and pharmacy services to eligible enrolled Medicaid clients.
	 The Dental Benefits Manager is a Pre-Paid Ambulatory Health Plan (PAHP) that
	 provides dental services to eligible enrolled Medicaid clients. Medicaid
	 operates Managed Care in accordance with Title 482 NAC.
002.01(A)
BENEFITS.
The Heritage Health plan is required to provide the services in the core
  benefits package as defined in 482 NAC 4, in the amount, duration, and scope as
  described in this chapter. The Managed Care Organizations (MCOs) and Pre-Paid
  Ambulatory Health Plan (PAHP) can place appropriate limits on covered services
  consistent with medical necessity or based on utilization control.
002.01(B)
PRIOR AUTHORIZATION,
  BILLING, AND PAYMENT.
Services provided to clients enrolled in
  Managed Care are not billed to Medicaid. The provider will provide services
  only under an arrangement with the Managed Care Organization (MCO) or PrePaid
  Ambulatory Health Plan (PAHP), and the Managed Care Organization (MCO) or
  PrePaid Ambulatory Health Plan (PAHP) will make timely payment in accordance
  with 482 NAC 4. The prior authorization requirements, payment limitations, and
  billing instructions outlined in Title 471 NAC do not apply to services
  provided to clients enrolled in Managed Care unless otherwise stated in this
  chapter.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 1 - ADMINISTRATION › Section 471-1-003 - FEDERAL AND STATE REQUIRMENTS

Current through June 17, 2024
The Department is required by federal and state law to meet certain
	 provisions in the administration of Medicaid.
003.01
MEDICAL ASSISTANCE
  ADVISORY COMMITTEE.
The Medicaid Director will appoint an advisory
  committee to advise the Director in the development of health and medical care
  services policies. Members of the committee include: physicians and other
  representatives of the health professions who are familiar with the medical
  needs of low-income population groups and with the resources available and
  required for their care; members of consumers' groups, including Medicaid
  clients; and consumer organizations, such as labor unions, cooperatives,
  consumer-sponsored prepaid group practice plans, and others; the of Director
  Public Health and the Chief Executive Officer of Health and Human Services.
  Members are appointed on a rotating basis to provide continuity of
  membership.
003.02
UTILIZATION REVIEW.
Any individual or entity must
  provide the Department with any documentation or information requested as part
  of the Department's utilization review.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 1 - ADMINISTRATION › Section 471-1-004 - TELEHEALTH SERVICES FOR PHYSICAL AND BEHAVIORAL HEALTH SERVICES

Current through June 17, 2024
This section applies to medical services in Medicaid fee-for-service
	 and Managed Care.
004.01
DEFINITIONS.
The following definitions apply to this
  section:
004.01(A)
CHILD.
An individual under 19 years of age.
004.01(B)
COMPARABLE
  SERVICE.
A service provided face-to-face.
004.01(C)
DISTANT
  SITE.
The location of the provider of the telehealth
  service.
004.01(D)
ORIGINATING SITE.
The location of the client at the
  time of the telehealth consultation.
004.01(E)
TELEHEALTH
  CONSULATION.
Any contact between a client and a health care
  practitioner relating to the health care diagnosis or treatment of such client
  through telehealth. For the purposes of telehealth services, a consultation
  includes any service delivered through telehealth.
004.01(F)
TELEMONITORING.
The remote monitoring of a client's
  vital signs, biometric data, or subjective data by a monitoring device which
  transmits such data electronically to a health care practitioner for analysis
  and storage.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 1 - ADMINISTRATION › Section 471-1-005 - CLIENT RESTRICTED SERVICES PROGRAM

Current through June 17, 2024
This section applies to medical services in Medicaid fee-for-service
	 and Managed Care
005.01
RESTRICTED SERVICES CRITERIA.
The Department may
  restrict a client to obtain Medicaid services only from a designated provider,
  or renew a period of restricted services, when the client has used Medicaid
  services at a frequency or amount that is not medically necessary. When
  evaluating whether a client has used services at a frequency or amount that is
  not medically necessary, the Department may consider any of the following
  criteria:
(A) Number, type, or dosage of
  prescriptions obtained by the client;
(B) Number of prescribers prescribing
  medication to the client;
(C)
  Number of pharmacies dispensing to a client;
(D) Number of clinic or emergency room
  encounters; or
(E) Whether the
  client displays at-risk behavior, as exhibited by any of the following:
(i) A client with a medical history of
  seeking and obtaining health care services at a frequency or amount that is not
  medically necessary; or
(ii)
  Behaviors or practices that could jeopardize a client's medical treatment or
  health including, but not limited to:
(1)
  Forging or altering prescriptions;
(2) Noncompliance with medical or drug and
  alcohol treatment;
(3) Paying cash
  for medical services that result in a controlled substance prescription or
  paying cash for controlled substances;
(4) Arrests for diversion of controlled
  substance prescriptions;
(5)
  Positive urine drug screen for illicit drugs or non-prescribed controlled
  substances;
(6) Negative urine drug
  screen for prescribed controlled substances; or
(7) Use of a client's Medicaid card for an
  unauthorized purpose.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 1 - ADMINISTRATION › Section 471-1-006 - ADVANCE DIRECTIVES

Current through June 17, 2024
An advance directive is a written instruction, such as a living will
	 or durable power of attorney for health care, recognized under applicable law
	 that relates to the provision of medical care if the client becomes
	 incapacitated. Medicaid-participating hospitals, nursing facilities, providers
	 of home health care or personal care services, hospice programs, and Managed
	 Care Organizations (MCOs) must.
(A)
  Maintain written policies, procedures, and materials concerning advance
  directives;
(B) Provide written
  information to all adult clients receiving medical care by or through the
  provider or organization concerning their rights under applicable law to:
(1) Make decisions concerning their medical
  care;
(2) Accept or refuse medical
  or surgical treatment; and
(3)
  Formulate advance directives, such as living wills or durable power of attorney
  for health care; and
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 2 - PROVIDER PARTICIPATION › Section 471-2-001 - SCOPE AND AUTHORITY

Current through June 17, 2024
These regulations govern services provided under the Medical Assistance
	 Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§
									68-901
	 to
	 68-991.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 2 - PROVIDER PARTICIPATION › Section 471-2-002 - DEFINITIONS

Current through June 17, 2024
The following definitions apply:
002.01
ABUSE.
Practices or actions that are inconsistent with sound fiscal, business, or
  medical practices and result in an unnecessary cost to Medicaid or in
  reimbursement for services that are not medically necessary or that fail to
  meet professionally recognized standards for health care. Abuse may include
  underutilization or overutilization.
002.02
AFFILIATES.
Persons having an overt or covert relationship such that any one of them
  directly or indirectly controls or has the power to control another.
002.03
BILLING.
Presenting, or causing to be presented, a claim for payment to the Department,
  its agents, or assignees.
002.04
BILLING AGENT.
An entity that submits or facilitates
  the submission of claims for payment to the Department.
002.05
CLAIM.
A
  request for payment for services rendered or supplied by a provider to a
  client.
002.06
CLEARINGHOUSE.
An entity that processes or facilitates
  the processing of information received from another entity in the following
  formats:
(A) In a nonstandard format or
  containing nonstandard data content into a standard transaction; or
(B) In a standard transaction into
  nonstandard format or data content.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 2 - PROVIDER PARTICIPATION › Section 471-2-003 - PROVIDER REQUIREMENTS

Current through June 17, 2024
003.01
PROVIDER ELIGILIBITY.
To be eligible to participate in
  Title XIX (Medicaid) and Title XXI Children's Health Insurance Program (CHIP),
  the provider must meet the general standards for all providers in 471 Nebraska
  Administrative Code (NAC) Chapters 1, 2, and 3, if appropriate, and the
  standards for participation for each provider type included within:
(A) Each provider specific chapter of Title
  471 NAC;
(B) Title 480 NAC for Home
  and Community-Based Waiver Services;
(C) Title 403 and 404 NAC for Community-Based
  Services for Individuals with Developmental Disabilities; and
(D) Title 482 NAC for Managed Care
  Services.
Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 2 - PROVIDER PARTICIPATION › Section 471-2-004 - SERVICE PROVIDER REQUIREMENTS

Current through June 17, 2024
The following provider types have additional participation
	 requirements that must be met in order to enroll and remain enrolled.
004.01
SCHOOL-BASED
  SERVICES.
To participate in Medicaid, the Pay-to Provider must be
  a recognized public school, Educational Services Unit (ESU), or approved
  cooperative providing special education and related services. The following
  provider types are eligible to enroll as service rendering providers for
  school-based services:
(A) Occupational
  therapist, physical therapist, speech pathology, and audiologist;
(B) Mental health services:
(i) Physician;
(ii) Licensed psychologist;
(iii) Provisionally licensed
  psychologist;
(iv) Licensed
  independent mental health practtioner (LIMHP);
(v) Licensed mental health practitioner
  (LMHP);
(vi) Provisionally licensed
  mental health practitioner (PLMHP);
(vii) Licensed alcohol and drug counselor
  (LADC);
(viii) Provisionally
  licensed alcohol and drug counselor (PLADC);
(ix) Board certified behavioral analyst
  (BCBA);
(x) Board certified
  assistant behavioral analyst; and
(xi) Registered behavioral
  technician;
(C) Nursing
  services:
(i) Registered nurse
  (RN);
(ii) Licensed practical nurse
  (LPN);
(iii) Health technician;
  and
(iv) Health
  paraprofessional;
(D)
  Personal assistance service providers: Personal assistance service providers
  must be age 19 or older. Provider personnel must be employed by or under
  contract with the school district, Educational Services Unit (ESU), or approved
  cooperatives providing special education and related services. Nebraska school
  districts, Educational Services Units (ESUs), and approved cooperatives
  providing special education and related services must be enrolled in Medicaid
  as the qualified providers of services;
(E) Specialized transportation services:
  Provider personnel, driver, or transportation aide must be employed by or under
  contract with the school district, Educational Service Unit (ESU), or approved
  cooperatives providing special education and related services; and
(F) Optometrist services: Must be provided by
  a currently licensed optometrist in the school attended by the client. Provider
  personnel must be employed by or under contract with the school district,
  Educational Service Unit (ESU), or approved cooperatives providing special
  education and related services.