Section 15-3-011 - REIMBURSEMENT The Department may reimburse a Care Management Unit for costs not required to be paid for by the client and not paid through other sources.
011.01REIMBURSABLE SERVICES. A casework time unit is one hour of reimbursable service by a Care Management Unit for a client. The reimbursable services are consultation, assessment, Care Plan development and coordination, referral of a client to other agencies and services, and Care Plan review and monitoring.011.02VALUE OF TIME UNITS. The value of a casework time unit is calculated by dividing all expenses by the number of actual casework time units to be delivered by a Care Management Unit during the fiscal year as approved by the State Unit on Aging in the budget for the Care Management Unit.011.03REIMBURSABLE TIME. The reimbursable amount of a casework time unit is based upon the difference between actual value of a casework time unit less fees required to be paid for by the client, payment from Medicaid and other third-party payers, and other sources of income to the Care Management Unit as specified in the Act.011.04MAXIMUM REIMBURSABLE AMOUNT. The maximum reimbursable dollar amount per casework time unit follows the fee schedule as prescribed by the Department, however, the maximum reimbursement must not exceed the cost of an actual casework time unit minus costs required to be paid for by the client or through other reimbursement specified in the Act.011.05REIMBURSEMENT LIMIT. The State Unit on Aging provides reimbursement only up to the limit of funds appropriated to the State Unit on Aging under the Act and may not exceed the approved budget and projected actual casework time units in a Care Management Unit's Plan of Operation.011.06VERIFICATION OF SERVICES DELIVERED. In requesting reimbursement, the Care Management Unit grants authority to the State Unit on Aging to verify the service delivered to the client by inspecting individual client files and records which must be maintained in the client files and records which must be maintained in the Care Management Unit office, to verify costs allocated to the casework time unit, and to verify total income from an individual or client and from other sources. 011.06(A)NON REIMBURSABLE UNITS OR COSTS. A Care Management Unit may seek reimbursement from the State Unit on Aging for otherwise allowable costs, except for costs required to be paid by the client or those that are paid by another person or entity.15 Neb. Admin. Code, ch. 3, § 011
Adopted effective 9/21/2020