- There were a total of 237,484 beneficiaries enrolled in Nebraska’s Medicaid program as of July 2011. Of these, 202,189 were enrolled in managed care. Of these 100,972 were enrolled in an MCO; 7,282 were enrolled in a PCCM program. Also, 202, 189 received behavioral health services through a specialize managed care program.
- Beginning in July 2012 Nebraska expanded managed care for physical health benefits statewide under its 1915(b) waiver program, Nebraska Health Connection. Dental services are carved out of managed care and are delivered on a fee-for-service basis. In September 2013, the state implemented a full-risk behavioral health managed care program. The state contracts with Magellan of Nebraska to deliver behavioral health benefits.
|Medical Necessity||Regulations in Nebraska establish that:”Nebraska Medical Assistant Program (NMAP) applies the following definition of medical necessity: Health care services and supplies which are medically appropriate and –
|Initiatives to Improve Access
|Reporting & Data Collection||
Managed care contracts specify that “improvement in child/adolescent care” are an objective of the Nebraska Health Connection managed care program and:
“Data for the measures used in this approach are derived from HEDIS and HEDIS-like measures of data collection for performance measures, encounter data, quarterly and annually data reporting required of the contractors, and client satisfaction surveys. Other sources of data may include findings from the External Quality Review (EQR) Technical Report, evaluation results of improvement initiatives, and results from on-site visits.”
In September 2013, Nebraska’s Medicaid program implemented a full-risk behavioral health managed care program.
The state’s managed care contract with Magellan lists a number of services covered for Medicaid-enrollees under ago 19, including:
|Support to Providers and Families||
Support to Families
Nebraska Medicaid offers a Client Information page with information about the program and I has a created a Frequently Asked Questions document on Medicaid managed care for families. The managed care organizations in the state have produced Client Guidebooks with more information about covered benefits, including EPSDT.
Support to Providers
According to Medicaid managed care contracts,
“Care coordination [under the EPSDT, or Health Check, benefit] must include:
Nebraska has also launched a multi-payer patient-centered medical home pilot in which Medicaid managed care plans are participating.
||The state’s Medicaid dental provider handbook contains information on covered services for children, as well as the dental periodicity schedule for children.|