Bill > LB942

This bill amends the Medical Assistance Act to establish specific requirements for how Medicaid reimburses healthcare providers for emergency medical conditions and inpatient hospital services. It defines an "emergency medical condition" as a situation with acute symptoms, including severe pain, that a reasonable person would expect to result in serious health jeopardy, bodily impairment, or organ dysfunction if immediate medical attention is not received, and clarifies that a "prudent layperson" has average health knowledge. The bill mandates that the determination of whether a service in an emergency department constitutes an emergency medical condition must be based solely on the patient's symptoms and condition at the time they sought care, as perceived by a prudent layperson, and prohibits denials or reductions in reimbursement based on later diagnoses or codes, or on payment policies that rely on final diagnoses. Furthermore, it requires that emergency services provided to Medicaid recipients by hospitals or emergency care providers be reimbursed at a rate no less than the Medicaid fee-for-service rate, though higher negotiated rates are permitted. For inpatient services, the bill states that a Medicaid recipient is considered an inpatient if formally admitted by a physician or qualified practitioner, and an admission is appropriate for reimbursement if the admitting practitioner expects the patient to require at least two consecutive midnights of hospital care, considering various medical factors documented in the patient's record, with provisions for exceptions in cases of unforeseen circumstances or when clinical judgment supports an inpatient stay even if the two-midnight threshold isn't met.

Health and Social Services

https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=63221