All Roll Calls
Yes: 182 • No: 1
NebraskaLB380109th Legislature 1st and 2nd SessionslegislatureWALLET
Change provisions regarding program integrity, ground emergency medical transport, and mental health and substance use disorder services under the Medical Assistance Act and provide duties for the Division of Medicaid and Long-Term Care
Sponsored By: John Fredrickson
Signed by Governor
Health and Human Services Committee
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Bill Overview
Analyzed Economic Effects
12 provisions identified: 6 benefits, 0 costs, 6 mixed.
Stronger mental health access in Medicaid
The Division enforces Medicaid rules for mental health and substance use care, including required EPSDT care for children and youth. It works to keep access and payment for behavioral health on par with medical and surgical care by reviewing claims, reimbursement rules, networks, and rates. The Division defines network adequacy and each year posts the standards and whether each plan meets them. It also posts contractor surveys, financial reviews, audits, and parity reports, and sends monthly electronic updates to all Medicaid providers about contract changes.
Stronger mental health coverage in Medicaid
Your Medicaid plan cannot limit mental health or addiction care more than it limits other medical care. Plans must keep enough behavioral health providers under time and distance rules. They cannot cancel an authorization after care is given, unless there is fraud or a provider contract breach. Plans must use recognized standards for reviews and make those rules available to you and providers.
Fairer Medicaid audits for providers
The law sets clear guardrails for Medicaid audits. Auditors must give a written reason before starting and at least 10 business days’ notice for onsite visits. Record requests must be specific and proportional, capped at 200 records for a service every 180 days, with at least 45 days to respond. Reviews can look back only four years, and contractors must finish within 180 days after you submit all records. You get appeal steps upfront, an informal meeting within 30 days of a preliminary finding, and 30 days to file an administrative appeal after an adverse decision. Recoupment notices must list key details and cannot trigger takebacks for at least 60 days. No takebacks in medical-necessity reviews when you had and followed prior authorization. Extrapolation is allowed only for sustained patterns, very high error rates, or if you agree. Auditors must allow claim resubmissions for clerical or documentation issues and let you fix code differences or disallow only the payment difference, with 90 days to correct. A specialist in your field must set audit methods that match Medicaid handbooks and clinical guidelines, audit files must include the governing rules, and certain claims (managed care capitated, non-primary, or already audited) are off-limits. Any private contract term that violates these audit rules cannot be enforced.
More Medicaid dollars go to care
Managed care plans must spend at least 85% of total contract revenue on medical care. Contractor incentives are capped at 2% of revenue. Extra funds, unearned incentives, and amounts owed when plans miss the 85% mark go back to the State Treasurer. The law creates the Medicaid Managed Care Excess Profit Fund to hold these dollars. Money first covers plan losses under profit limits, then pays for listed Medicaid services like system improvements, home visiting, medical respite, translation, continuous glucose monitors, Prenatal Plus, and intergenerational facility grants.
Caps and transparency for audit contractors
Contingency fees for recovery contractors are capped at 12.5% of money actually recovered. Contracts must pay the same for finding overpayments and underpayments. Each contractor must publish yearly performance metrics and a copy of its contract on the Department’s website. All recoveries and savings from program integrity work return to Medicaid.
Medicaid ambulance pay tied to federal match
Supplemental pay for ground ambulance rides equals the federal match (FFP) generated by the claims. The Department may pay per transport based on actual and allowable costs, or another federally allowed method. Total Medicaid payments cannot exceed 100% of a provider’s documented costs. The program covers only Title XIX–allowable costs and runs only with federal approvals and matching funds. The Department may return or refuse transfers and must claim FFP only for allowable costs each year. If a final court or CMS decision expands provider eligibility beyond the law, these supplemental payments stop that day.
Medicaid fraud checks and early recoupment
If there is a credible allegation of fraud, contractors may recover payments before appeals finish, but only after they refer the claims and the Department starts an investigation. The contractor must give a written reason for early recovery. After an audit shows a significant error rate, the contractor may ask the Department for another records request, but only after your appeal window closes. A 'credible allegation of fraud' means an allegation the Department verifies, such as from a hotline tip, data mining, audit patterns, court cases, or law enforcement.
New Medicaid support for ambulance transport
The Department may apply to CMS by January 1, 2026 to add extra Medicaid payments for ground emergency transport. These payments start only if CMS approves. If approved, higher capitation payments can begin for dates of service on or after January 1, 2026. Government ambulance providers that seek these payments must certify compliance with 42 C.F.R. 433.51 as of January 1, 2025, submit required data, and keep retrievable records.
Profit and admin caps for Medicaid plans
At-risk managed care contracts in effect on or after August 11, 2020 must keep administrative spending at or below 12% of contract revenue and report it every quarter. Contracts must limit annual profit to a Department-set rate, capped at 3% of total contract revenue. All such contracts must be awarded through competitive state procurement. Starting October 1, 2024, investment earnings from the Medicaid Managed Care Excess Profit Fund go to the State’s General Fund.
Coordinated Medicaid audits for providers
When a managed care claim is audited, the Department, its contractor, and the plan coordinate scope, method, and timing. They avoid duplicate or simultaneous audits. Providers can send requested records electronically or by fax. After audits, the Department and contractors provide training on common errors and how to improve.
State can hire premium help vendors
The Department can contract with vendors to help run a health insurance premium assistance payment program. This adds capacity to operate the program. It does not set funding levels or who qualifies.
Old Medicaid statutes repealed
The law repeals listed earlier Medicaid statutes so the new program integrity, ambulance payment, and managed care rules apply cleanly. This updates the code without changing your eligibility directly.
Sponsors & Cosponsors
Sponsor
John Fredrickson
legislature
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
legislature vote • 4/24/2026
Vote
Yes: 25 • No: 0 • Other: 24
legislature vote • 4/24/2026
Vote
Yes: 26 • No: 0 • Other: 23
legislature vote • 5/28/2025
Final Reading
Yes: 48 • No: 1
legislature vote • 4/2/2025
Vote
Yes: 32 • No: 0 • Other: 17
legislature vote • 4/2/2025
Vote
Yes: 25 • No: 0 • Other: 24
legislature vote • 4/2/2025
Vote
Yes: 26 • No: 0 • Other: 23
Actions Timeline
Provisions/portions of LB381 amended into LB380 by AM728
6/6/2025legislatureProvisions/portions of LB610 amended into LB380 by AM814
6/6/2025legislatureApproved by Governor on May 30, 2025
6/2/2025legislatureDispensing of reading at large approved
5/28/2025legislaturePassed on Final Reading 48-1*-0
5/28/2025legislaturePresident/Speaker signed
5/28/2025legislaturePresented to Governor on May 28, 2025
5/28/2025legislaturePlaced on Final Reading
5/6/2025legislatureEnrollment and Review ER39 adopted
4/30/2025legislatureFredrickson AM1034 withdrawn
4/30/2025legislatureAdvanced to Enrollment and Review for Engrossment
4/30/2025legislatureFredrickson AM1034 filed
4/14/2025legislaturePlaced on Select File with ER39
4/8/2025legislatureEnrollment and Review ER39 filed
4/8/2025legislatureBostar AM814 adopted
4/2/2025legislatureHealth and Human Services AM728 adopted
4/2/2025legislatureFredrickson FA79 filed
4/2/2025legislatureFredrickson FA79 withdrawn
4/2/2025legislatureAdvanced to Enrollment and Review Initial
4/2/2025legislatureBostar AM814 to AM728 filed
3/28/2025legislaturePlaced on General File with AM728
3/26/2025legislatureHealth and Human Services AM728 filed
3/26/2025legislatureFredrickson priority bill
3/14/2025legislatureNotice of hearing for February 26, 2025
2/7/2025legislatureReferred to Health and Human Services Committee
1/21/2025legislature
Bill Text
Introduced
6/6/2025
Enrolled / Slip Law
Final / Enacted