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LEGISLATURE OF NEBRASKA
ONE HUNDRED NINTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 942
Introduced by Riepe, 12.
Read first time January 09, 2026
Committee: Health and Human Services
A BILL FOR AN ACT relating to the Medical Assistance Act; to amend1
section 68-901, Revised Statutes Cumulative Supplement, 2024; to2
provide requirements for the reimbursement of emergency and3
inpatient services as prescribed; and to repeal the original4
section. 5
Be it enacted by the people of the State of Nebraska,6
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Section 1. Section 68-901, Revised Statutes Cumulative Supplement,1
2024, is amended to read: 2
68-901 Sections 68-901 to 68-9,111 and sections 2 to 4 of this act3
shall be known and may be cited as the Medical Assistance Act.4
Sec. 2. For purposes of sections 2 and 3 of this act:5
(1) Emergency medical condition means a medical condition6
manifesting itself by acute symptoms of sufficient severity, including7
severe pain, such that a prudent layperson could reasonably expect the8
absence of immediate medical attention to result in (a) placing the9
patient's health in serious jeopardy, (b) serious impairment to bodily10
functions, or (c) serious dysfunction of any bodily organ or part; and11
(2) Prudent layperson means an individual who possesses an average12
knowledge of health and medicine. 13
Sec. 3. (1) The department or a managed care organization shall14
determine whether a service provided to a medicaid recipient in an15
emergency department is an emergency medical condition based solely on16
the recipient's presenting symptoms, medical condition, or clinical17
presentation at the time the recipient sought care as perceived by a18
prudent layperson. 19
(2)(a) The department or a managed care organization shall not20
determine services to be nonemergent, or reduce or deny reimbursement for21
such services, based on the final diagnosis, discharge code, or any22
condition identified after completion of the medical screening23
examination required under the federal Emergency Medical Treatment and24
Labor Act. A payment policy, a screening tool, an algorithm, or a25
diagnosis list used for determining emergent or nonemergent status that26
is based on the final diagnosis is prohibited. 27
(b) The department or a managed care organization shall not reduce28
reimbursement for emergent services to any fractional amount based on a29
classification of such services as nonemergent. 30
(3) Emergency services provided to a medicaid recipient by a31
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hospital or an emergency care provider shall be reimbursed at a rate no1
less than the medicaid fee-for-service rate in effect at the time the2
services were provided. 3
(4) Nothing in this section prohibits the department or a managed4
care organization from negotiating a higher rate with a contracting5
provider if the negotiated rate is not lower than the minimum rate6
required under subsection (3) of this section. 7
Sec. 4. (1) For purposes of reimbursement, a medicaid recipient is8
an inpatient of a hospital if such recipient is formally admitted as an9
inpatient pursuant to an order for admission by a physician or other10
qualified practitioner. The order shall be furnished by a physician or11
other qualified practitioner with admitting privileges at such hospital,12
as permitted by state law, and who is knowledgeable about the recipient's13
hospital course, medical plan of care, and current condition.14
(2) An inpatient admission is appropriate for reimbursement under15
the medical assistance program if the admitting physician or other16
qualified practitioner expects the recipient to require the length of17
hospital care to last at least two consecutive midnights, regardless of18
the facility or hospital location at which the two consecutive midnights19
occur. 20
(3) The expectation of the physician or other qualified practitioner21
shall be based on medical factors including, but not limited to, the22
recipient's, (a) medical history and comorbidities, (b) severity of23
symptoms, (c) current medical needs, and (d) risk of an adverse event.24
The factors that support the physician's or other qualified25
practitioner's clinical expectation shall be documented in the medical26
record. 27
(4) If an unforeseen circumstance, including death or transfer,28
results in a shorter inpatient stay than the expectation of at least two29
consecutive midnights, the medicaid recipient may be considered to be30
treated on an inpatient basis and reimbursement for an inpatient hospital31
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stay may be made under the medical assistance program consistent with1
medicare regulations. 2
(5) If the physician or other qualified practitioner expects a3
recipient to require hospital care for a period of time that does not4
meet the two consecutive midnights requirement described in subsection5
(3) of this section, an inpatient admission may be appropriate for6
reimbursement under the medical assistance program based on the clinical7
judgment of the physician or other qualified practitioner and the medical8
record. The physician's or other qualified practitioner's decision shall9
be based on medical factors including, but not limited to, the10
recipient's, (a) medical history and comorbidities, (b) severity of11
symptoms, (c) current medical needs, and (d) risk of an adverse event.12
Sec. 5. Original section 68-901, Revised Statutes Cumulative13
Supplement, 2024, is repealed. 14
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