This bill amends the Medical Assistance Act in Nebraska, specifically section 68-901, to establish new requirements for the reimbursement of emergency and inpatient services. It introduces definitions for "emergency medical condition" and "prudent layperson," emphasizing that the determination of whether a service is emergent should be based solely on the recipient's presenting symptoms at the time of care, rather than on the final diagnosis. The bill prohibits managed care organizations from denying reimbursement for emergency services based on post-treatment evaluations and mandates that emergency services be reimbursed at no less than the Medicaid fee-for-service rate.

Additionally, the bill outlines criteria for inpatient admissions under the medical assistance program, stating that a Medicaid recipient is considered an inpatient if formally admitted by a qualified practitioner who expects the stay to last at least two consecutive midnights. It allows for reimbursement even if unforeseen circumstances lead to a shorter stay, as long as the admission was clinically justified. The bill also permits flexibility in inpatient admissions based on the clinical judgment of the admitting physician, taking into account various medical factors. The original section 68-901 is repealed as part of this amendment.

Statutes affected:
Introduced: 68-901