482 Neb. Admin. Code, ch. 6, § 001

Current through June 17, 2024

Section 482-6-001 - SCOPE AND AUTHORITY

This chapter sets forth the requirements of the Nebraska Medicaid Managed Care Quality Strategy (See 480-000-10). This chapter also establishes the Department's expectation for each of the health plans and the dental plan (collectively referred to as plans), in effectively managing and monitoring the quality of care provided to members. In addition to abiding to all provisions in this chapter, the plans must abide by the provisions found in 42 Code of Federal Regulations (CFR) 438, Subpart D.

001.01QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT REQUIREMENT. The contract between the Department and each plan requires the plan to have an ongoing quality assessment and performance improvement program that Medicaid must approve.

001.02EVALUATION REQUIREMENTS. The Department, its contracted entities or designees, or the Centers for Medicare and Medicaid Services officials may evaluate, through inspection or other means, the quality, appropriateness, and timeliness of services performed under managed care.

482 Neb. Admin. Code, ch. 6, § 001