Bill > LB1091

This bill mandates that the Department of Health and Human Services (DHHS) ensure that long-term care services for clients with special needs under the medical assistance program, also known as Medicaid, are managed in a way that maintains continuity of care, program stability, and specialized oversight. Specifically, it requires that skilled nursing facility and nursing facility services for these clients be excluded from enrollment with Medicaid managed care organizations, which are private companies that manage healthcare services for Medicaid recipients. A "long-term care client with special needs" is defined as a Medicaid recipient whose medical or nursing needs are complex or intensive, exceeding the usual expertise and services provided in a standard nursing facility. These specialized services will continue to be administered and paid for through a fee-for-service Medicaid system or another authorized delivery method, rather than through managed care. The bill also states that DHHS cannot require providers of these specialized services to enroll with a managed care organization as a condition of serving these clients, though managed care organizations may still be involved in coordinating other benefits or providing wraparound services as long as they do not manage the financial risk or utilization of the specialized nursing facility services. Finally, DHHS is required to update its managed care contracts within six months of the bill's effective date to reflect these changes and may adopt necessary rules and regulations.