Medical Program Management
               Medicaid Policy and Procedure Manual

Policy

Nebraska Urban Indian Medical Center shall have a contract with the State of Nebraska, Department of Health and Human Services to provide medical services to those who are unable to afford to pay for medically necessary services.

 Procedure

1. The term of the contract shall be in effect from July 1, 2001 to June 30, 2006, unless otherwise terminated as provided in the contract.

2. The State of Nebraska, Department of Health and Human Services (DHHS) will pay NUIMC for Federal Financial Participation (FFP) share of all allowable, reasonable, and necessary costs incurred in carrying out the terms of this contract.  These costs may include costs such as salary, fringe benefits, travel, training, equipment, and space directly attributable to the requirements of the contract.  The bill will be submitted to DHHS (Lincoln, NE office) quarterly.

3. DHHS will provide training on receiving applications, completing applications, providing information and referrals and the required documentation necessary to complete an application.  DHHS will provide NUIMC with all necessary forms to complete the initial processing of applications.

4. NUIMC will maintain complete records regarding the expenditures of funds provided by the DHHS and will allow free access to these records for the purpose of making audits, examinations, excerpts, and transcripts.  Access to these records will continue beyond the termination date of the contract for a period of three (3) years.

5. NUIMC will not discriminate against any applicant because of age, color, national origin, ancestry, race, religion, creed,

6. NUIMC will not assign or transfer interest, rights, or duties in the contract to any person, firm, or corporation without prior written consent of the DHHS.  NUIMC will not utilize subcontractors in the performance of this contract without prior written authorization of the DHHS.

7. The contract between NUIMC and DHHS may be amended at any time in writing upon the agreement of both parties.

8. The contract may be cancelled for any reason upon submission of written notice to the other party at least thirty (30) days prior to the effective date of cancellation.

9. Information gathered in the performance of the contract will be held in the strictest confidence and shall be released to no one other than the DHHS, without the prior written authorization of the DHHS.

10. DHHS may terminate the contract should NUIMC breach the contract.

11. DHHS may terminate the contract or reduce the consideration upon notice in writing to NUIMC if State/Federal funds become unavailable.

12. NUIMC will operate a drug-free workplace in accordance with State guidelines.

13. Funds received from DHHS will not be used to pay an officer or employee of any agency, member of Congress, officer or employee of Congress for the (a) awarding of any federal contract; (b) the making of any federal grant; (c) the entering into of any cooperative agreement; and (d) the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.

14. NUIMC will not engage in research utilizing the information obtained through the performance of the contract without the express written consent of the Director of DHHS.

Scope of Services – The contract between Nebraska Urban Indian Medical Center and State of Nebraska, Department of Health and Human Services will provide funding for outstationed eligibility functions.  These functions are:

1. To receive, date, and perform initial processing of Medicaid applicatiosn on a form designated by the DHHS.

2. To assist applicants in completing the Application Form.

3. To conduct the face-to-face interview required as part of the application process.

4. To assist applicants to obtain any required documentation readily available and needed to establish eligibility.  See also Job Description of Eligibility Determinations Specialist.

5. To provide information to applicants including the individual’s right and responsibilities as provided on the application.

6. To provide referral to other department, state, federal and local community services.

7. To explain the applicant’s right to claim Good Cause for noncooperation with Child Support or Medical Support.

8. To have the individual sign and date the required forms.

9. To refer all applicants with zero income in appropriate living arrangements as defined in DHHS regulations to the Lincoln, NE office of the DHHS within 48 hours for a determination of expedited Food Stamp eligibility.

10. To gather appropriate information for a determination of disability, where appropriate.

11. To advise individuals of the eligibility requirements of the Medicaid program before accepting an application.

12. To promptly refer all individuals making disability applications and whose income is below the Federal Benefit Rate to the Social Security Administration.

13. To provide to the designated Local Office of the department within 5 days from application date, the application forma dn all document that has been obtained.

14. To attend all required training sessions conducted by the DHHS.

To testify at administrative hearings when necessary pertaining to Medicaid applications that NUIMC has taken.