2-004.01C Out-of-State Medical

If an out-of-state provider does not sign an agreement with Medicaid and accept the reimbursement rate, the client is liable for any medical bills. Payment may be approved for services provided outside Nebraska in the following situations:

1. When an emergency arises from accident or sudden illness while a client is visiting in another state and the client's health would be endangered if care is postponed until s/he returned to Nebraska or if s/he traveled to Nebraska;

2. When a client customarily obtains service in another state because the service is more accessible;

3. When the client requires a medically necessary service that is not available in Nebraska but is available in another state; and

4. When long term care services are provided in another state.

Payment for items 3 and 4 must be prior authorized by the Division of Medicaid and Long Term Care before the services are provided. The provider must request prior authorization of payment from the appropriate staff of the Division. Prior authorization of item 3 may include economical transportation as a provider payment if needed.