Nebraska

Last updated 03/10/2023

Consent Requirements

Written or email consent required before initial service delivery. Must include this information:

• A list of alternative care options, including in-person services;
• All existing laws and protections including: confidentiality protections, patient access to all medical information from the consult, and dissemination of client identifiable information;
• Whether the telehealth consultation will be recorded;
• The identification of all the parties who will be present at each telehealth consultation, and a statement indicating that the client has the right to exclude anyone from either the originating or the distant site; and
• The written consent form becomes a part of the client’s medical record and a copy must be provided to the client or the client’s authorized representative.

For each adult client or for a client who is a child but who is not receiving telehealth behavioral health services, a safety plan must be developed, should it be needed at any time during or after the provision of telehealth; Special rules apply for a child who is receiving telehealth behavioral health services;

If the client is a child or otherwise unable to sign the consent form, the client’s legally authorized representative shall provide the consent.

Sample patient consent form available in Manual Appendix.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.04, Ch. 1, & Appendix, 471-000-10 Instructions for Completing NE Medicaid Telehealth Patient Consent Form.  (Accessed Mar. 2023).

Written information must be provided to the patient.  See statute for specific requirements of written information.

The patient shall sign a statement prior to or during an initial telehealth consultation, or give verbal consent during the telehealth consultation, indicating that the patient understands the written information provided and that this information has been discussed with the health care practitioner or the practitioner’s designee. The signed statement may be collected by paper or electronic signature and shall become a part of the patient’s medical record. If the patient gives verbal consent during the initial telehealth consultation, the signed statement shall be collected within ten days after such telehealth consultation.

If the patient is a minor or is incapacitated or mentally incompetent such that he or she is unable to sign the statement or give verbal consent, such statement shall be signed, or such verbal consent given, by the patient’s legally authorized representative.

Does not apply in an emergency situation in which the patient is unable to sign the statement or give verbal consent and the patient’s legally authorized representative is unavailable.

SOURCE: NE Revised Statutes Sec. 71-8505, (Accessed Mar. 2023).

Last updated 03/10/2023

Definitions

Telehealth consultation means any contact between a client and a health care practitioner relating to the health care diagnosis or treatment of such client through telehealth.  For the purposes of telehealth, a consultation includes any service delivered through telehealth.

Telemonitoring means the remote monitoring of a client’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.01, (Accessed Mar. 2023).

Telehealth means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care practitioner in the diagnosis or treatment of a patient.  Telehealth includes

• Services originating from a patient’s home or any other location where such patient is located,
• Asynchronous services involving the acquisition and storage of medical information at one site that is then forwarded to or retrieved by a health care practitioner at another site for medical evaluation, and
• Telemonitoring.

Telehealth also includes audio-only services for the delivery of individual behavioral health services for an established patient, when appropriate, or crisis management and intervention for an established patient as allowed by federal law.

Telehealth consultation means any contact between a patient and a health care practitioner relating to the health care diagnosis or treatment of such patient through telehealth; and

Telemonitoring means the remote monitoring of a patient’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.

SOURCE: NE Rev. Statute, 71-8503 (Accessed Mar. 2023).

Teledentistry is the use of technology, including digital radiographs, digital photos and videos, and electronic health records, to facilitate delivery of oral healthcare and oral health education services from a provider in one location to a patient in a physically different location. Teledentistry is to be used for the purposes of evaluation, diagnosis, or treatment.

SOURCE: NE Admin Code Title 471, Ch. 6, Sec. 002.06. (Accessed Mar. 2023).

Last updated 03/10/2023

Email, Phone & Fax

Telehealth also includes audio-only services for the delivery of individual behavioral health services for an established patient, when appropriate, or crisis management and intervention for an established patient as allowed by federal law.

SOURCE: NE Rev. Statute, 71-8503, (Accessed Mar. 2023).

Telephone Consultations

Nebraska Medicaid does not cover telephone calls to or from an individual, pharmacy, nursing home, or hospital. Nebraska Medicaid may cover telephone consultations with another physician if the name of the consulting physician is indicated on or in the claim.

SOURCE: NE Admin. Code Title 471, Ch. 18-005.30, . (Accessed Mar. 2023).

Last updated 03/10/2023

Live Video

POLICY

Nebraska Medicaid provides coverage for telehealth at the same rate as in-person services when the technology meets industry standards and is HIPAA compliant.

Medicaid will reimburse a consulting health care provider if the following are met:

• After obtaining and analyzing the transmitted information, the consulting provider reports back to the referring health care practitioner;
• The consulting health care practitioner must bill for services using the appropriate modifier;
•  Payment is not made to the referring health care practitioner who sends the medical documentation. Reimbursement is at the same rate as in-person services.

Practitioner consultation is not covered for behavioral health when the client has an urgent psychiatric condition requiring immediate attention by a licensed mental health practitioner.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.08-.09, Ch. 1,  (Accessed Mar. 2023).

In-person contact is not required for reimbursable services under the Medicaid program, subject to reimbursement policies developed.  This policy also applies to managed care plans who contract with the Department only to the extent that:

• Services delivered via telehealth are covered and reimbursed under the fee-for-service program and
• Managed care contracts are amended to add coverage of services delivered via telehealth and appropriate capitation rate adjustments are incorporated.

Reimbursement shall, at a minimum, be set at the same rate as a comparable in-person consult and the rate must not depend on the distance between the health care practitioner and the patient.

The department shall establish rates for transmission cost reimbursement for telehealth consultations, considering, to the extent applicable, reductions in travel costs by health care practitioners and patients to deliver or to access health care services and such other factors as the department deems relevant. Such rates shall include reimbursement for all two-way, real-time, interactive communications, unless provided by an Internet service provider, between the patient and the physician or health care practitioner at the distant site which comply with the federal Health Insurance Portability and Accountability Act of 1996 and rules and regulations adopted thereunder and with regulations relating to encryption adopted by the federal Centers for Medicare and Medicaid Services and which satisfy federal requirements relating to efficiency, economy, and quality of care.

SOURCE: NE Revised Statutes Sec. 71-8506. (Accessed Mar. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Federally Qualified Health Centers & Rural Health Clinics

FQHC and RHC payment for telehealth services is the Medicaid rate for a comparable in-person service. FQHC & RHC core services provided via telehealth are not covered under the encounter rate.

SOURCE: NE Admin. Code Title 471, Sec. 29-004.05, Ch. 29, & NE Admin. Code Title 471, Sec. 34-007, Ch. 34, Manual Letter #11-2010. (Accessed Mar. 2023).

Assertive Community Treatment (ACT)

ACT Team Interventions may be provided via telehealth when provided according to certain regulations.

SOURCE: NE Admin. Code Title 471 Sec. 35-013.11, Ch. 35,  (Accessed Mar. 2023).

Indian Health Service (IHS) Facilities

Encounter: A face-to-face visit, including telehealth services provided in accordance with 471 NAC 1-006, between a health care professional and an individual eligible for the provision of medically necessary Medicaid-defined services in an IHS or Tribal (638) facility within a 24-hour period ending at midnight, as documented in the client’s medical record.

SOURCE: NE Admin. Code Title 471 Sec. 11-001, Ch. 11, (Accessed Mar. 2023).

Services for Individuals with Developmental Disabilities

Providers may conduct observations in-person or by telehealth.

SOURCE: NE Admin. Code Title 403 Sec. 004.04, Ch. 4, p. 5 & Sec. 004.04, Ch. 5, p. 5  (Accessed Mar. 2023).

Children’s Behavioral Health

The Department of Health and Human Services shall adopt and promulgate rules and regulations providing for telehealth services for children’s behavioral health. The rules and regulations required shall include, but not be limited to:

An appropriately trained staff member or employee familiar with the child’s treatment plan or familiar with the child shall be immediately available in person to the child receiving a telehealth behavioral health service in order to attend to any urgent situation or emergency that may occur during provision of such service. This requirement may be waived by the child’s parent or legal guardian; and

In cases in which there is a threat that the child may harm himself or herself or others, before an initial telehealth service the health care practitioner shall work with the child and his or her parent or guardian to develop a safety plan. Such plan shall document actions the child, the health care practitioner, and the parent or guardian will take in the event of an emergency or urgent situation occurring during or after the telehealth session. Such plan may include having a staff member or employee familiar with the child’s treatment plan immediately available in person to the child, if such measures are deemed necessary by the team developing the safety plan.

SOURCE: NE Statute Sec. 71-8509, (Accessed Mar. 2023).

An appropriately trained staff member or employee familiar with the child’s treatment plan or familiar with the child must be immediately available in person to the child receiving a telehealth behavioral consultation in order to attend to any urgent situation or emergency that may occur.  This requirement may be waived by a legal guardian.  In cases where there is a threat that the child may harm themselves or others, a safety plan must be developed before the telehealth interaction takes place.

SOURCE: NE Admin. Code Title 471, Sec. 1-004.05, Ch. 1, (Accessed Mar. 2023).

Teledentistry follows the requirements of telehealth in accordance with 471 NAC 1. Services requiring hands on professional care are excluded.

SOURCE: NE Admin Code Title 471, Ch. 6, Sec. 006. (Accessed Mar. 2023).

ELIGIBLE PROVIDERS

Health care practitioner means a Nebraska Medicaid-enrolled provider who is licensed, registered, or certified to practice in this state by the department.

SOURCE: NE Rev. Statute, 71-8503(2) (Accessed Mar. 2023).

ELIGIBLE SITES

Health care practitioners must ensure that the originating sites meet the standards for telehealth services.  Originating sites must provide a place where the client’s right to receive confidential and private services is protected.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.03, Ch. 1, (Accessed Mar. 2023).

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

Telehealth services and transmission costs are covered by Medicaid when:

• The technology used meets industry standards;
•  The technology is Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant; and
• The telehealth technology solution in use at both the originating and the distant site must be sufficient to allow the health care practitioner to appropriately complete the service billed to Medicaid

An originating site fee is paid to the Medicaid-enrolled facility hosting the client at a rate set forth in the Medicaid fee schedule or under arrangement with the Managed Care Organization (MCO).

SOURCE: NE Admin. Code Title 471 Sec. 1-004.06 & 1-004.010, Ch. 1, (Accessed Mar. 2023).

Federally Qualified Health Centers & Rural Health Clinics

Telehealth transmission cost related to non-core services will be the lower of:

• The provider’s submitted charge; or
• The maximum allowable amount

The Department will pay for transmission costs for line charges when directly related to a covered telehealth service. The provider must be in compliance with the standards for real time, two way interactive audiovisual transmissions (see 471 NAC 1-006).

SOURCE:  NE Admin. Code Title 471, Sec. 29-004.05A, Ch. 29, Manual Letter #11-2010, & NE Admin. Code Title 471, Sec. 34-007.01, Ch. 34, Manual Letter #11-2010, (Accessed Mar. 2023).

Last updated 03/10/2023

Miscellaneous

NE Medicaid does provide an outpatient cardiac rehabilitation program consisting of physical exercise or conditioning and concurrent telemetric monitoring. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.

SOURCE: NE Admin. Code Title 471, Sec. 10-006.16(B) (Accessed Mar. 2023).

The commission may establish a telehealth system to provide access for deaf and hard of hearing persons in remote locations to mental health, alcoholism, and drug abuse services. The telehealth system may (a) provide access for deaf or hard of hearing persons to counselors who communicate in sign language and are knowledgeable in deafness and hearing loss issues, (b) promote access for hard of hearing persons through contacts with counselors in which hard of hearing persons receive both visual cues, or reading lips, and auditory cues, (c) offer remote interpreter services for deaf or hard of hearing persons to interact with counselors who are not fluent in sign language, and (d) promote participation in educational programs.

The commission shall set and charge a fee between the range of twenty and one hundred fifty dollars per hour for the use of the telehealth system. The commission shall remit all fees collected pursuant to this section to the State Treasurer for credit to the Telehealth System Fund.

SOURCE: NE Statute Sec. 71-4728-.04, (Accessed Mar. 2023).

The Telehealth System Fund is created. The fund shall be used for any expenses related to the operation and maintenance of the telehealth system established in section 71-4728.04. Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska State Funds Investment Act.

SOURCE: NE Statute Sec. 71-4732-.01, (Accessed Mar. 2023).

A health care facility licensed under the Health Care Facility Licensure Act that receives reimbursement under the Nebraska Telehealth Act for telehealth consultations shall establish quality of care protocols and patient confidentiality guidelines to ensure that such consultations meet the requirements of the act and acceptable patient care standards.

SOURCE: NE Statute Sec. 71-8507, (Accessed Mar. 2023).

The department shall adopt and promulgate rules and regulations to carry out the Nebraska Telehealth Act, including, but not limited to, rules and regulations to: (1) Ensure the provision of appropriate care to patients; (2) prevent fraud and abuse; and (3) establish necessary methods and procedures.

SOURCE: NE Statute Sec. 71-8508, (Accessed Mar. 2023).

Last updated 03/10/2023

Out of State Providers

Payment in fee-for-service and Managed Care may be approved for services provided outside Nebraska in the following situations:

• When an emergency arises from accident or sudden illness while a client is visiting in another state and the client’s health would be endangered if medical care is postponed until the client returns to Nebraska;
• When a client customarily obtains a medically necessary service in another state because the service is more accessible; and
• When the client requires a medically necessary service that is not available in Nebraska.

Prior authorization is required for out-of-state services.  See regulation for procedures.

Out-of-State telehealth services are covered if the telehealth services otherwise meet the regulatory requirements for payment for services provided outside Nebraska and:

• When the distant site is located in another state and the originating site is located in Nebraska; or
• When the Nebraska client is located at an originating site in another state, whether or not the provider’s distant site is located in or out of Nebraska.

SOURCE: NE Admin. Code Title 471, Ch. 1,  Sec. 1-002.02(E) & 1-004.11, (Accessed Mar. 2023).

Last updated 03/10/2023

Overview

Nebraska Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under some circumstances. Reimbursement for store-and-forward is only specified for teleradiology.  Passage of LB 400 expanded the Medicaid definition of telehealth to include audio-only in specific circumstances however no further information has been provided regarding reimbursement on a permanent basis.

Last updated 03/10/2023

Remote Patient Monitoring

POLICY

Telemonitoring: The remote monitoring of a client’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.

Medicaid will reimburse for telemonitoring when all of the following requirements are met:

• Telemonitoring is covered only when the services are from the originating site;
• The client is cognitively capable to operate the equipment or has a willing and able person to assist in the transmission of electronic data;
• The originating site has space for all program equipment and full transmission capability;
• The provider maintains a client’s record supporting the medical necessity of the service, all transmissions and subsequent review received from the client, and how the data transmitted from the client is being utilized in the continuous development and implementation of the client’s plan of care.

Paid at daily per diem-rate and includes:

• Healthcare practitioner review and interpretation of client data;
• Equipment and all supplies, accessories, and services necessary for proper functioning and use of equipment;
• Medically necessary visits to the home by a health care practitioner;
• Training on the use of the equipment and completion of necessary records.

No additional or separate payment beyond the fixed payment is allowed.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.01(F) & 1-004.07, Ch. 1, (Accessed Mar. 2023).

No later than January 1, 2023, the department shall provide coverage for continuous glucose monitors under the medical assistance program for all eligible recipients who have a prescription for such device.

SOURCE: NE Revised Statute Sec. 68-911, (Accessed Mar. 2023).

Nebraska Medicaid will provide coverage for Continuous Glucose Monitoring (CGM) devices for eligible beneficiaries with diabetes beginning January 1, 2023.

SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Mar. 2023).

CONDITIONS

Outpatient cardiac rehabilitation programs consisting of individually prescribed physical exercise or conditioning and concurrent telemetric monitoring. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.

SOURCE: NE Admin. Code Title 471 Ch. 10, Sec. 006.16(B), Hospital Services, (Accessed Nov. 2022).

Nebraska Medicaid will provide coverage for both long-term (therapeutic) and short-term (diagnostic) CGM for eligible beneficiaries who have diabetes mellitus when medically necessary. CGM devices measure interstitial glucose, which correlates well with plasma glucose.

The initial authorization period for therapeutic CGM is 6 months, while the renewal period is yearly. Supplies will be provided for 30 days or up to 90 days at a time. Beneficiaries must meet medical necessity criteria in order to be eligible for coverage. See bulletin for prior authorization requirements.

SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Mar. 2023).

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

The following devices are covered under Medicaid:

• FreeStyle Libre 2
• Dexcom G6

The Medtronic CGM may be covered for beneficiaries who meet the medical necessity criteria for long-term CGM and are on a Medtronic insulin pump.

CGM devices that use an implantable glucose sensor such as an Eversense CGM system (CPT codes 0046T, 00447T, and 0448T) or a noninvasive glucose sensor (e.g., optical and transdermal sensors) are considered investigational and not medically necessary due to insufficient evidence of clinical efficacy and long-term health outcomes. Any related HCPC codes for implantable or noninvasive glucose sensors are also considered investigational and not medically necessary.

SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Mar. 2023).

Last updated 03/10/2023

Store and Forward

POLICY

Asynchronous service is included in the definition for telehealth in Nebraska statutes.

SOURCE: NE Rev. Statute, 71-8503(3) (Accessed Mar. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Nebraska Medicaid will reimburse for teleradiology when it meets the American College of Radiology standards for tele-radiology.  There is no other reference to reimbursing for other specialties.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.06(B), Ch. 1  (Accessed Mar. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found