Revising the State's Tribal consultation process. This SPA added language changing the current process of Tribal consulting on all proposed SPAs and waivers regardless of impact, to not providing Tribal consultation on SPAs that are purely technical in nature (i.e. pagination changes, renumbering of lists, etc.) and therefore; have no direct impact on the Tribes.

Distribution of disproportionate share hospital payments.

This SPA provides clarification of current practices regarding Home Health Services, Personal Care Services, and Hospice. This SPA was in response to concerns identified through the companion letter dated June 17, 2011 for CMS approval of NE State Plan Amendment 09-08.

Proposes to reduce the fee schedule rate for physician services by 2.5% with a proposed effective date of July 1, 2011.

Update the effective date of rates for Pediatric Feeding Disorder Clinic Intensive Day Treatment Services.

To comply with Section 2301 of the patient Protection and Affordable Care Act. This provision requires State that recognize freestanding birth centers to provide coverage and separate payments for freestanding birth center facility services and services rendered by certain professionals providing services in freestanding birth centers.

Which proposes to reduce the fee schedule rates for outpatient hospital and lab services by 2.5% with a proposed effective date of July 1, 2011.

Rate reduction for nursing facilities and ICF-MR.

Which proposes to reduce the fee schedule rates for clinical laboratory services by 2.5% with a proposed effective date of July 1, 2011.

Makes a technical correction to the State Plan regarding the State's payment of crossover claims.