- 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.|
One of the most critical steps in developing and implementing a multi-payer medical home initiative is securing health care payer and purchaser participation. This new NASHP brief discusses five overarching strategies that conveners can use to make the case: building trust among competitors; leveraging existing infrastructure; using the market to drive demand; striking the balance between flexibility and consistency; and illustrating the value of the model. The Commonwealth Fund provided support for the development of this issue brief.
|Click for the Publication||189.4 KB|
NASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email firstname.lastname@example.org.
Last updated: October 2012
States are seeking to strengthen primary care through the medical home model to achieve better outcomes and lower costs. The eight states profiled in this report—Alabama, Iowa, Kansas, Maryland, Montana, Nebraska, Texas, and Virginia—are at different stages in the development and implementation of medical home programs. The states have drawn on both well-tested approaches and innovative tactics to help primary care providers adopt the model. As a whole, their experiences demonstrate that states can play critical roles in convening stakeholders, helping practices improve performance, and addressing antitrust concerns that arise when multiple payers collaborate.
Nebraska’s Medicaid HIT targets include: e-eligibility; e-claims expansions; e-prescribing; identification of the Medicaid stakeholder provider community members that qualify for inclusion in HIE and associated EMR/EHR initiatives and incentives; identification of providers who demonstrate increased efficiencies, reduce overuse of services, reduce the duplication of services, and produce improved clinical health outcomes.
As a payer, Medicaid may participate in NeHII and/or Nebraska’s other HIEs.
Medicaid will be required to devise metrics and reporting capabilities that demonstrate value has been obtained from adoption and use of EHR pertaining to reduced prescribing error, reduced duplication of services, and possibly timeliness and accuracy measurement of provider submitted data.
Nebraska’s HIE Strategic Plan puts forth a plan for utilizing existing public-private relationships and regional HIEs to advance health information exchange in the state.
|Nebraska Strategic Plan||1.1 MB|