Nebraska Administrative Code Topic - HEALTH AND HUMAN SERVICES SYSTEM
Here’s an overview of Nebraska’s Administrative Code under the Health and Human Services System:
📘 Titles & Scope
Title 471 – Nebraska Medical Assistance Program Services
Covers Medicaid services including administration, provider participation, payment, and specific services (e.g., home health, pharmacy, DME). Each service is detailed in its own chapter (e.g., Chapter 15: Personal Assistance Services; Chapter 9: Home Health & Skilled Nursing) (dhhs.ne.gov).
Title 477 – Medicaid Eligibility
Includes rules on eligibility categories like aged, blind, disabled, children, pregnant women, CHIP, former wards, and Heritage Health adult program (law.cornell.edu).
Title 175 – Health Care Facilities & Services Licensure
Establishes licensing requirements for healthcare facilities: initial license, renewals, zoning approval, fire marshal clearance, etc. (regulations.justia.com).
Title 482 – Medicaid Managed Care
Governs the Heritage Health managed care program—client rights, responsibilities, benefit packages, quality standards (law.cornell.edu).
Other Related Titles
Title 480: Home & Community-Based Waiver Services (dhhs.ne.gov).
Titles 473, 480, 482: Additional Medicaid provisions across the system (law.cornell.edu).
🔍 Key Highlights
Title 471 (Medicaid Services)
Chapter 1: Defines "medical necessity" and outlines managed-care billing versus fee-for-service (law.cornell.edu).
Chapter 15: Specifies provider requirements for personal assistance services—age, training, background checks, documentation, EVV compliance, confidentiality (regulations.justia.com).
Chapter 9: Sets standards for home health and skilled nursing providers, including licensing, care plans, recordkeeping, prior authorizations, extended-hour nursing; requires 6-year record retention (nebraska.gov).
Title 477 (Eligibility)
Offers eligibility rules for categories like SIMP (Spousal Impoverishment), AABD, medically needy, CHIP, former foster youth, etc., per chapter ranges (14–29) (law.cornell.edu).
Title 175 (Licensure)
Requires facilities to meet statutory requirements prior to licensing; applications need building approvals, fire marshal reports, zoning, engineer/architect certifications, etc. .
Title 482 (Managed Care)
Defines Heritage Health plan’s benefits, enrollment procedures, client rights/responsibilities, appeals, and quality assurance frameworks .
✅ Summary Table
| Title | Topic | Highlights |
|---|---|---|
| 471 | Medicaid Services | Service-by-service rules: provider eligibility, billing, medical necessity |
| 477 | Medicaid Eligibility | Standards for various populations & enrollment types |
| 175 | Facility Licensure | Legal and structural prerequisites for healthcare operations |
| 482 | Managed Care | Heritage Health plan rules, covered benefits, client protections |
💡 How to Use This
Providers should reference Title 471 chapters specific to their service (e.g., Chapter 15 for personal assistance).
Eligibility questions? See Title 477 for detailed rules.
If opening a facility, consult Title 175 for licensing procedures.
Medicaid managed-care participants should review Title 482, especially Chapter 7 on rights and responsibilities (casetext.com, regulations.justia.com, law.cornell.edu, regulations.justia.com).
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