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369 sections in this chapter.
Neb. Rev. Stat. § 68-926 Legislative findings.
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The Legislature finds that (1) the department relies on health insurance and claims information from private insurers to ensure accuracy in processing state benefit program payments to providers and in verifying individual recipients' eligibility, (2) delay or refusal to provide …
Neb. Rev. Stat. § 68-927 Terms, defined.
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For purposes of sections 68-926 to 68-933: (1) Coordinate benefits means: (a) Provide to the department information regarding the licensed insurer's or self-funded insurer's existing coverage for an individual who is eligible for a state benefit program; and (b) Meet payment obli…
Neb. Rev. Stat. § 68-928 Licensed insurer or self-funded insurer; provide coverage information; health plan; requirements regarding claims.
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(1) Except as provided in subsection (2) of this section, at the request of the department, a licensed insurer or a self-funded insurer shall provide coverage information to the department without an individual's authorization for purposes of: (a) Determining an individual's elig…
Neb. Rev. Stat. § 68-929 Licensed insurer; violation.
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Any violation of section 68-928 by a licensed insurer shall be subject to the Unfair Insurance Claims Settlement Practices Act.
Neb. Rev. Stat. § 68-930 Self-funded insurer; violation; civil penalty.
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The department may impose and collect a civil penalty on a self-funded insurer who violates the requirements of section 68-928 if the department finds that the self-funded insurer: (1) Committed the violation flagrantly and in conscious disregard of the requirements; or (2) Has c…
Neb. Rev. Stat. § 68-931 Recovery; authorized.
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The department is authorized to recover all amounts paid or to be paid to state benefit programs as a result of failure to coordinate benefits by a licensed insurer or a self-funded insurer.
Neb. Rev. Stat. § 68-932 Process for resolving violations; appeal.
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The department shall establish a process by rule and regulation for resolving any violation by a self-funded insurer of section 68-928 and for assessing the financial penalties contained in section 68-930. Any appeal of an action by the department under such policies shall be in …
Neb. Rev. Stat. § 68-933 Civil penalties; disposition.
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All money collected as a civil penalty under section 68-929 or 68-930 shall be remitted to the State Treasurer for distribution in accordance with Article VII, section 5, of the Constitution of Nebraska.
Neb. Rev. Stat. § 68-934 False Medicaid Claims Act; act, how cited.
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Sections 68-934 to 68-947 shall be known and may be cited as the False Medicaid Claims Act.
Neb. Rev. Stat. § 68-935 Terms, defined.
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For purposes of the False Medicaid Claims Act: (1) Attorney General means the Attorney General, the office of the Attorney General, or a designee of the Attorney General; (2) Claim means any request or demand, whether under a contract or otherwise, for money or property, and whet…
Neb. Rev. Stat. § 68-936 Presentation of false medicaid claim; civil liability; violation of act; civil penalty; damages; costs and attorney's fees.
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(1) A person presents a false medicaid claim and is subject to civil liability if such person: (a) Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval; (b) Knowingly makes, uses, or causes to be made or used, a false record or statem…
Neb. Rev. Stat. § 68-937 Failure to report.
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A person violates the False Medicaid Claims Act, and is subject to civil liability as provided in section 68-936, if such person is a beneficiary of an inadvertent submission of a false medicaid claim to the state, and subsequently discovers and, knowing the claim is false, fails…
Neb. Rev. Stat. § 68-938 Charge, solicitation, acceptance, or receipt; unlawful; when.
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A person violates the False Medicaid Claims Act, and a claim submitted with regard to a good or service is deemed to be false and subjects such person to civil liability as provided in section 68-936, if he or she, acting on behalf of a provider providing such good or service to …
Neb. Rev. Stat. § 68-939 Records; duties; acts prohibited; liability; costs and attorney's fees.
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(1) A person violates the False Medicaid Claims Act and is subject to civil liability as provided in section 68-936 and damages as provided in subsection (2) of this section if he or she: (a) Having submitted a claim or received payment for a good or service under the medical ass…
Neb. Rev. Stat. § 68-940 Penalties or damages; considerations; liability; costs and attorney's fees.
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(1) In determining the amount of any penalties or damages awarded under the False Medicaid Claims Act, the following shall be taken into account: (a) The nature of claims and the circumstances under which they were presented; (b) The degree of culpability and history of prior off…
Neb. Rev. Stat. § 68-940.01 State Medicaid Fraud Control Unit Cash Fund; created; use; investment.
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The State Medicaid Fraud Control Unit Cash Fund is created. The fund shall be maintained by the Department of Justice and administered by the Attorney General. The fund shall consist of any recovery for the state's costs and attorney's fees received pursuant to subdivision (2)(b)…
Neb. Rev. Stat. § 68-941 Limitation of actions; burden of proof.
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(1) A civil action under the False Medicaid Claims Act shall be brought within six years after the date the claim is discovered or should have been discovered by exercise of reasonable diligence and, in any event, no more than ten years after the date on which the violation of th…
Neb. Rev. Stat. § 68-942 Investigation and prosecution.
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(1) In any case involving allegations of civil violations or criminal offenses under the False Medicaid Claims Act, the Attorney General may take full charge of any investigation or advancement or prosecution of the case. (2) The department shall cooperate with the state medicaid…
Neb. Rev. Stat. § 68-943 State medicaid fraud control unit; certification.
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The Attorney General shall: (1) Establish a state medicaid fraud control unit that meets the standards prescribed by 42 U.S.C. 1396b(q); and (2) Apply to the Secretary of Health and Human Services for certification of the unit under 42 U.S.C. 1396b(q).
Neb. Rev. Stat. § 68-944 State medicaid fraud control unit; powers and duties.
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The state medicaid fraud control unit shall employ such attorneys, auditors, investigators, and other personnel as authorized by law to carry out the duties of the unit in an effective and efficient manner. The purpose of the state medicaid fraud control unit is to conduct a stat…
Neb. Rev. Stat. § 68-945 Attorney General; powers and duties.
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In carrying out the duties and responsibilities under the False Medicaid Claims Act, the Attorney General may: (1) Enter upon the premises of any provider participating in the medical assistance program (a) to examine all accounts and records that are relevant in determining the …
Neb. Rev. Stat. § 68-946 Attorney General; access to records.
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(1) Notwithstanding any other provision of law, the Attorney General, upon reasonable request, shall have full access to all records held by a provider, or by any other person on the provider's behalf, that are relevant to the determination of (a) the existence of civil violation…
Neb. Rev. Stat. § 68-947 Contempt of court.
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Any person who, after being ordered by a court to comply with a subpoena issued under the False Medicaid Claims Act, fails in whole or in part to testify or to produce evidence, documentary or otherwise, shall be in contempt of court as if the failure was committed in the presenc…
Neb. Rev. Stat. § 68-949 Medical assistance program; legislative intent; department; duties; medicaid nursing facility rates; appropriations; reports; money follows the person program.
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(1) It is the intent of the Legislature that the department implement reforms to the medical assistance program such as those contained in the Medicaid Reform Plan, including (a) an incremental expansion of home and community-based services for aged persons and persons with disab…
Neb. Rev. Stat. § 68-950 Medicaid Prescription Drug Act, how cited.
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Sections 68-950 to 68-956 shall be known and may be cited as the Medicaid Prescription Drug Act.
Neb. Rev. Stat. § 68-951 Purpose of act.
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The purpose of the Medicaid Prescription Drug Act is to provide appropriate pharmaceutical care to medicaid recipients in a cost-effective manner by requiring the establishment of a preferred drug list and other activities as prescribed. The preferred drug list and other activiti…
Neb. Rev. Stat. § 68-952 Terms, defined.
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For purposes of the Medicaid Prescription Drug Act: (1) Labeler means a person or entity that repackages prescription drugs for retail sale and has a labeler code from the federal Food and Drug Administration under 21 C.F.R. 207.20, as such regulation existed on January 1, 2008; …
Neb. Rev. Stat. § 68-953 Preferred drug list; department; establish and maintain; pharmaceutical and therapeutics committee; members; expenses.
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(1) No later than July 1, 2010, the department shall establish and maintain a preferred drug list for the medical assistance program. The department shall establish a pharmaceutical and therapeutics committee to advise the department on all matters relating to the establishment a…
Neb. Rev. Stat. § 68-954 Preferred drug list; considerations; availability of list.
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(1) The department and the pharmaceutical and therapeutics committee shall consider all therapeutic classes of prescription drugs for inclusion on the preferred drug list, except that antidepressant, antipsychotic, and anticonvulsant prescription drugs shall not be subject to con…
Neb. Rev. Stat. § 68-955 Prescription of drug not on preferred drug list; conditions; antidepressant, antipsychotic, or anticonvulsant prescription drug; prior authorization; not required, when.
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(1) Except as otherwise provided in subsection (3) of this section, a health care provider may prescribe a prescription drug not on the preferred drug list to a medicaid recipient if (a) the prescription drug is medically necessary, (b)(i) the provider certifies that the preferre…
Neb. Rev. Stat. § 68-956 Department; duties; contract; pharmacy benefit manager; comply with Pharmacy Benefit Manager Licensure and Regulation Act.
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(1) The department shall (a) enter into a multistate purchasing pool, (b) negotiate directly with manufacturers or labelers, or (c) contract with a pharmacy benefit manager for negotiated discounts or rebates for all prescription drugs under the medical assistance program in orde…
Neb. Rev. Stat. § 68-962 Autism Treatment Program Act; act, how cited.
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Sections 68-962 to 68-966 shall be known and may be cited as the Autism Treatment Program Act.
Neb. Rev. Stat. § 68-963 Purpose of Autism Treatment Program Act.
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The purpose of the Autism Treatment Program Act is to provide for the development and administration of a waiver or an amendment to an existing waiver under the medical assistance program established in section 68-903.
Neb. Rev. Stat. § 68-964 Autism Treatment Program; created; administration; funding.
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The Autism Treatment Program is created. The program shall be administered by the department.
Neb. Rev. Stat. § 68-965 Autism Treatment Program Cash Fund; created; use; investment.
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(1) The Autism Treatment Program Cash Fund is created. The fund shall include revenue received from gifts, grants, bequests, donations, other similar donation arrangements, or other contributions from public or private sources. The department shall administer the fund. The fund s…
Neb. Rev. Stat. § 68-966 Department; apply for medical assistance program waiver or amendment; legislative intent.
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(1) The department shall apply for a waiver or an amendment to an existing waiver under the medical assistance program established in section 68-903 for the purpose of providing medical assistance for intensive early intervention services based on behavioral principles for childr…
Neb. Rev. Stat. § 68-967 Comprehensive treatment of pediatric feeding disorders; amendment to state medicaid plan; department; duties.
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(1) On or before July 1, 2010, the Department of Health and Human Services shall submit an application to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services amending the state medicaid plan to provide for medicaid payments …
Neb. Rev. Stat. § 68-968 School-based health centers; School Health Center Advisory Council; members.
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(1) To ensure that the interests of the school district, community, and health care provider are reflected within the policies, procedures, and scope of services of school-based health centers, each school district shall establish a School Health Center Advisory Council for each …
Neb. Rev. Stat. § 68-969 Amendment to medicaid state plan or waiver; children eligible for medicaid and CHIP; treatment for pregnant women; department; duties.
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(1) On or before July 1, 2010, the department shall submit an application to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, amending the medicaid state plan or seeking a waiver thereto to provide for utilization of mon…
Neb. Rev. Stat. § 68-970 Nebraska Regional Poison Center; legislative findings.
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The Legislature finds that: (1) The Nebraska Regional Poison Center funded through the University of Nebraska Medical Center Cash Fund provides a valuable service to Nebraska; (2) The center receives over seventeen thousand calls annually, seventy-two percent of the calls involve…
Neb. Rev. Stat. § 68-971 Amendment to medicaid state plan or waiver; Nebraska Regional Poison Center; payments; use; department; duties; University of Nebraska Medical Center; report.
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(1) On or before January 1, 2012, the department shall submit an application to the federal Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to amend the medicaid state plan or seek a waiver to provide for utilization of the …
Neb. Rev. Stat. § 68-972 Prenatal care; legislative findings; creation of separate program; benefits provided; department; submit state plan amendment or waiver; eligibility.
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(1) The Legislature finds that: (a) Title XXI of the federal Social Security Act, as amended, and the rules and regulations promulgated pursuant thereto, authorize the State Children's Health Insurance Program to assist state efforts to initiate and expand provisions of child hea…
Neb. Rev. Stat. § 68-973 Medical assistance programs; improper payments; postpayment reimbursement; legislative findings; integrity procedures and guidelines; legislative intent.
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(1) The Legislature finds that the medical assistance program would benefit from increased efforts to (a) prevent improper payments to service providers, including, but not limited to, enforcement of eligibility criteria for recipients of benefits, enforcement of enrollment crite…
Neb. Rev. Stat. § 68-974 Program integrity contractors; contracts; contents; audit procedures; powers; health insurance premium assistance payment program; contract; department; powers and duties; form of records authorized; appeal.
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(1) One or more program integrity contractors may be used to promote the integrity of the medical assistance program, to assist with investigations and audits, or to investigate the occurrence of fraud, waste, or abuse. The contract or contracts may include services for (a) cost-…
Neb. Rev. Stat. § 68-975 Department; apply for amendment to medicaid state plan; multisystemic therapy for youth.
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(1) On or before May 1, 2016, the department shall submit an application to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services to amend the medicaid state plan to provide for utilization of money to allow for payments for m…
Neb. Rev. Stat. § 68-976 Provider with high categorical risk level; fingerprint-based criminal history record information check; Nebraska State Patrol; issue report; cost; department; powers and duties.
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(1)(a) Any provider with a high categorical risk level as determined by the Centers for Medicare and Medicaid Services or the medicaid assistance program established pursuant to the Medical Assistance Act shall be subject to a fingerprint-based criminal history record information…
Neb. Rev. Stat. § 68-977 Ground Emergency Medical Transport Act; act, how cited.
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Sections 68-977 to 68-988 shall be known and may be cited as the Ground Emergency Medical Transport Act.
Neb. Rev. Stat. § 68-978 Terms, defined.
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For purposes of the Ground Emergency Medical Transport Act: (1) Advanced life support means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation…
Neb. Rev. Stat. § 68-979 Legislative intent.
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It is the intent of the Legislature that no General Funds be used in carrying out the Ground Emergency Medical Transport Act. Revenue from the intergovernmental transfer program created under the Ground Emergency Medical Transport Act shall be deposited into the Health and Human …
Neb. Rev. Stat. § 68-980 Supplemental reimbursement.
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An eligible provider as described in section 68-981 shall, in addition to the rate of payment that the provider would otherwise receive for medicaid ground emergency medical transport services, receive supplemental reimbursement pursuant to the Ground Emergency Medical Transport …