471 NAC 20-011. Provider Enrollment

011. Provider Enrollment. 011.01 PROVIDER AGREEMENT. A provider of psychiatric services for beneficiaries age 21 and over must complete the appropriate Nebraska Medicaid approved provider agreement form , and submit the completed form to Nebraska Medicaid for approval. Specific requirements for each type of care are listed in the respective subpart. The provider must meet all of these standards in order to be enrolled with Nebraska Medicaid. Nebraska Medicaid is the sole determiner of which providers are approved for participation in this program. The provider will be advised in writing when their participation is approved. A separate application must be submitted for each particular service and each service will be approved separately. The provider must meet the standards for participation as outlined in each subpart of the provider agreement. 011.02 Provider Enrollment Status. The provider enrollment process allows for three types of provider enrollment status based on information from the provider and other sources. Nebraska Medicaid must notify the provider of the status assigned. 011.02(A) PROVISIONAL STATUS. A provider who has recently established services within this chapter or who is new to Nebraska Medicaid will be enrolled with a provisional status. After a minimum of one year of services, Nebraska Medicaid may choose to grant ongoing status to the provider. 011.02(A)(i) APPEAL OF TERMINATION OF PROVIDER ENROLLMENT. Providers can appeal the decision to terminate a provider enrollment. 011.02(B) ONGOING STATUS. A provider must establish ongoing status after a minimum of one year of service within the Nebraska Medicaid requirements. 011.02(C) PROBATIONARY STATUS. A provider can be placed on probationary status when there are deficiencies in meeting Nebraska Medicaid requirements or there are other concerns about the provider's program or practices. While on probationary status, a provider can be required to work with Nebraska Medicaid to develop a corrective action plan. This plan must be submitted to Nebraska Medicaid for approval. 011.02(C)(i) APPEAL OF PROBATIONARY STATUS. Providers can appeal the decision to place a provider on probationary status. 011.02(C)(ii) PROBATIONARY STATUS EVALUATION. The probationary status will be evaluated by Nebraska Medicaid on a frequency based on the situation. At these evaluations, a provider's enrollment may be terminated, placed on further probation, or returned to ongoing status. Providers can appeal these decisions. 011.02(C)(iii) CONTINUED PARTICIPATION. If the deficiencies are not causing immediate jeopardy or compromising the safety of the beneficiaries, then the facility can continue to participate in Nebraska Medicaid. A prohibition of new admissions may occur if there are allegation of abuse or neglect under investigation in relation to the program or staff, the quality of treatment is significantly compromised by the deficiencies, or the provider is violating any laws, regulations, or code of ethics governing their program. 011.02(D) UPDATES. The provider will send to Nebraska Medicaid an update of the services provided in its facility and the current list of staff each year during the anniversary quarter of the provider's enrollment in Nebraska Medicaid as a provider of psychiatric services for beneficiaries 21 and over. This information will also be sent to Nebraska Medicaid if a provider makes changes in how they provide a service. These changes and updates must be indicated on the appropriate Nebraska Medicaid approved provider agreement form.