Section 181-1-007 - PROVIDER REQUIREMENTS AND PAYMENTSTo participate in the Chronic Renal Disease Program, service providers must be licensed by the Department, or its equivalent in another state. Service providers must complete and sign the Chronic Renal Disease Program's Service Provider Enrollment Form prior to participation. Providers not meeting the standards set out in the Provider Enrollment Form are not eligible to receive payment for covered services
007.01PHARMACEUTICAL PAYMENT. Only pharmaceutical products listed on the Chronic Renal Disease Program's Reimbursable Drug Formulary are eligible for payment. Payments are made in accordance with the Provider Standards noted in the Chronic Renal Disease Program's Service Provider Enrollment Form and follow the Payment procedures outlined in this chapter. Invoicing procedures are outlined in the Chronic Renal Disease Program's Reimbursement Procedures for Pharmacies and may be adjusted upon the discretion of the Department.007.02PAYMENT DETERMINATION. The pharmaceutical payment amount is based on Nebraska Medicaid fee for service allowable cost. Any remaining cost after the Department has paid is the responsibility of the client. Payment is subject to the limitations in this chapter and is made on behalf of a client directly to the pharmacy.007.03DIALYSIS SERVICE PAYMENT. The Department pays up to fifty (50) percent of the client co-pay after all other insurances or third-party payers have paid their share. The payment percentage may be adjusted upon the discretion of the Department. The remaining dialysis service cost after the Chronic Renal Disease Program has paid is the responsibility of the client. Payments are made directly to the service provider in accordance with the Provider Standards in the Chronic Renal Disease Program Service Provider Enrollment Form and follow the Payment procedures outlined in this chapter. Invoicing procedures are outlined in the Chronic Renal Disease Program's Reimbursement Procedures for Dialysis Services and may be adjusted upon the discretion of the Department.181 Neb. Admin. Code, ch. 1, § 007
Amended effective 6/14/2022