Nebraska Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Nebraska's plan contracts, statutes and notices. For 9 of 22 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 9of 22
- Plans on record
- 5
- Directed payments
- 9
- Capitation cells
- 911$176.12–$14,866.25 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 18,360 | State sets the plan rate |
| Nursing facility | Paid by the state, outside plansPaid directly by the state, outside managed care | 4,548 | Plans negotiate; applies out of network |
| Hospice | Paid by the state, outside plansPaid directly by the state, outside managed care | 4,524 | |
| Lab & pathology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 2,777 | State sets the plan rate |
| Equipment & supplies | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 2,755 | |
| Radiology | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,795 | State sets the plan rate |
| Hospital inpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,680 | Plans expected to pay at least thisState sets the plan rate |
| Pharmacy | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 1,019 | |
| Behavioral health | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 866 | State sets the plan ratePlans expected to pay at least this |
| Hospital outpatient | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 794 | Plans expected to pay at least this |
| Dental | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 200 | State sets the plan rate |
| Clinics (FQHC/RHC) | State sets the plan rateThe state sets the rate plans pay | 173 | |
| Other | State-directed paymentDirected payments add to plan rates | 165 | |
| Vision & hearing | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 125 | |
| Other home & community services | Paid by the state, outside plansPaid directly by the state, outside managed care | 103 | Plans negotiate; applies out of network |
| IDD services | Paid by the state, outside plansPaid directly by the state, outside managed care | 76 | |
| Therapy (PT/OT/speech) | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 73 | |
| ABA / autism services | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 49 | State sets the plan rate |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 49 | Plans negotiate; applies out of network |
| Transportation | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 40 | Paid by the state, outside plans |
| Private duty nursing | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 11 | |
| Home health | Plans negotiate; applies out of networkPlans negotiate; the published rate applies out of network | 10 |
State-directed payments
Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.
Frequently asked questions
Do Nebraska Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Lab & pathology, Radiology, Hospital inpatient, Behavioral health, Hospital outpatient, Dental, Clinics (FQHC/RHC), ABA / autism services. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Nebraska's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.