2006 Nebraska Revised Statutes - § 71-7009 — Department; adopt fee schedule; waiver; denial of eligibility; appeal; application; certificate of eligibility; reimbursement.

Section 71-7009
Department; adopt fee schedule; waiver; denial of eligibility; appeal; application; certificate of eligibility; reimbursement.

(1) The department, with the advice and assistance of the Breast and Cervical Cancer Advisory Committee, shall adopt a schedule of fees to be charged for screening mammography performed pursuant to the program established under section 71-7002 based upon the ability to pay. The fees shall be such as to make screening mammography available to the greatest possible number of asymptomatic women. The fee may be waived by the department based on income guidelines established under subsection (2) of this section. The maximum fee shall be equal to the amount reimbursed to the mammogram supplier. All fees received under this section shall be collected by the department and remitted to the State Treasurer for credit to the Breast and Cervical Cancer Cash Fund. The program established under section 71-7002 shall not pay for screening mammography for women who have public or private insurance that covers screening mammography, whose personal family income exceeds the maximum income in the guidelines adopted by the department, or who are eligible for mammography screening under any federal or state health benefit program. Any person aggrieved by a decision of the department made pursuant to this section may appeal. The appeal shall be in accordance with the Administrative Procedure Act.

(2) The department shall, with the advice and assistance of the committee, establish income guidelines based on a multiplier of the federal poverty guidelines which shall serve as a basis for a partial or complete waiver of the fee provided by subsection (1) of this section as follows:

(a) Women with household incomes of one hundred percent of the federal poverty level or below will be eligible for the program with no fees charged;

(b) Women with household incomes at a point in the range of two hundred percent of the federal poverty level or above will pay the full mammogram reimbursement rate established; and

(c) Women with household incomes at a point in the range between one hundred and two hundred percent of the federal poverty level will pay one-half of the mammogram reimbursement rate established.

After each three months of program operation, the department, with the advice and assistance of the committee, shall evaluate participation levels of the program to determine if the fee schedule is facilitating participation at an appropriate level compared to program funding and shall make adjustments in the fee schedule or multipliers used, as necessary.

(3) Application for participation in the program shall be distributed statewide through a variety of media, including, but not limited to, mail and news media. Promotional information and the application for participation may be distributed through community organizations and health care facilities. After the determination of eligibility is complete for women who apply, the applicant shall be notified in writing and may be notified by first-class mail of her eligibility for participation.

(4) The department may issue a certificate of eligibility to each woman who applies to the department for screening mammography upon determination of eligibility pursuant to section 71-7003 and payment or waiver of the fee as provided by this section. The certificate of eligibility shall be valid for one mammogram and shall not be transferable to another person.

(5) A woman eligible to receive screening mammography under the program established pursuant to section 71-7002 shall present the certificate of eligibility to a mammogram supplier within ninety days of issuance, who shall conduct screening mammography and present the certificate to the department for reimbursement within sixty days of the date of the mammogram.

Source:

Laws 1991, LB 256, § 9

Laws 1995, LB 68, § 8

Cross References:

Administrative Procedure Act,see section 84-920.

~Reissue Revised Statutes of Nebraska