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2,111 sections in this chapter.
Neb. Rev. Stat. § 44-5418 Terms, defined.
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For purposes of the Utilization Review Act: (1) Adverse determination means a determination by a health carrier or its designee utilization review agent that an admission, availability of care, continued stay, or other health care service has been reviewed and, based upon the inf…
Neb. Rev. Stat. § 44-5419 Utilization review agent; certificate required; term.
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On or after July 1, 1993, a utilization review agent may not conduct utilization review upon a covered person in this state unless the agent is granted a certificate by the director. Certificates granted under the Utilization Review Act shall be valid for two years from the date …
Neb. Rev. Stat. § 44-5420 Certificate; application; fee.
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(1) An applicant for a certificate as a utilization review agent shall submit an application to the department upon a form which may be obtained from the department. The application shall be signed and verified by the applicant. Along with the application, the applicant shall pay…
Neb. Rev. Stat. § 44-5421 Certificate; director; grant or deny; notice and hearing requirements.
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The director shall grant or deny a certificate within forty-five days of receipt of a completed application under section 44-5420. The director shall deny a certificate if the applicant does not meet the requirements of the Utilization Review Act. If a certificate is denied, the …
Neb. Rev. Stat. § 44-5422 Utilization review agents; procedures applicable; exceptions.
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(1) Utilization review agents operating in this state shall comply with the following provisions: (a) A utilization review agent, employees of a utilization review agent, or persons acting on behalf of a utilization review agent may not refer a patient who has undergone utilizati…
Neb. Rev. Stat. § 44-5423 Utilization review agent; notify director of changes; when.
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A utilization review agent shall notify the director within five working days of any change of the agent's approval or accreditation status or of any material change in the information contained in the agent's application or renewal or that the agent no longer meets the requireme…
Neb. Rev. Stat. § 44-5424 Certificates; renewal; fee.
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Certificates granted under the Utilization Review Act may be renewed prior to their expiration date upon the filing of the following with the department (1) a renewal fee of one hundred dollars, (2) a statement detailing any changes in the information or documentation filed with …
Neb. Rev. Stat. § 44-5425 Health carrier; oversight of utilization review activities.
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A health carrier shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of the Utilization Review Act and applicable rules and regulations are met. The health carrier shall a…
Neb. Rev. Stat. § 44-5426 Utilization review program; use of clinical review criteria.
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A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health carrier may develop its own clinical review criteria, or it may purchase or license clinical re…
Neb. Rev. Stat. § 44-5427 Description of review procedures; toll-free number.
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(1) In the certificate of coverage or member handbook provided to covered persons, a health carrier shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement o…
Neb. Rev. Stat. § 44-5428 Agent violation; notice; hearing.
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If the director finds that any utilization review agent doing business in this state is engaging in any violation of the Utilization Review Act and that a proceeding in respect thereto would be in the public interest, he or she shall issue and serve upon such utilization review a…
Neb. Rev. Stat. § 44-5429 Violation; penalty.
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If, after the hearing, the director finds a utilization review agent has violated the Utilization Review Act, the director shall reduce his or her findings to writing and shall issue and cause to be served upon the utilization review agent charged with the violation a copy of the…
Neb. Rev. Stat. § 44-5430 Violation of cease and desist order; penalty.
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Any utilization review agent who violates a cease and desist order of the director under section 44-5429 may after notice and hearing and upon order of the director be subject to: (1) A monetary penalty of not more than thirty thousand dollars for each violation, not to exceed an…
Neb. Rev. Stat. § 44-5431 Rules and regulations.
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The director may adopt and promulgate rules and regulations to carry out the Utilization Review Act.
Neb. Rev. Stat. § 44-5432 Ensuring Transparency in Prior Authorization Act, how cited.
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Sections 44-5432 to 44-5444 shall be known and may be cited as the Ensuring Transparency in Prior Authorization Act.
Neb. Rev. Stat. § 44-5433 Terms, defined.
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For purposes of the Ensuring Transparency in Prior Authorization Act, unless the context otherwise requires: (1) Adverse determination has the same meaning as in section 44-1303; (2) Clinical peer means a health care provider in the same, or in a similar, specialty that typically…
Neb. Rev. Stat. § 44-5434 Prior authorization requirements and restrictions; utilization review agent; provide website access and notice; when.
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(1) A utilization review agent shall make prior authorization requirements and restrictions, including written clinical review criteria, accessible on its website. Such requirements, restrictions, and clinical review criteria shall be accurate and current and shall clearly commun…
Neb. Rev. Stat. § 44-5435 Adverse determinations; utilization review agent; procedure.
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(1) A utilization review agent shall ensure that all adverse determinations for prior authorization are made by a physician, except that if the requesting health care provider is not a physician, the adverse determination may be made by a clinical peer of the requesting health ca…
Neb. Rev. Stat. § 44-5436 Adverse determinations; appeals; review by physician.
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A utilization review agent shall ensure that all appeals of an adverse determination for prior authorization are reviewed by a physician. Such physician shall: (1) Possess a current and valid unrestricted license in a United States jurisdiction; (2) Be of the same or similar spec…
Neb. Rev. Stat. § 44-5437 Uniform prior authorization request forms; use; required, when.
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(1)(a) On or before November 1, 2025, the department shall approve a single uniform prior authorization request form for prescription drugs, devices, and durable medical equipment and a single uniform prior authorization request form for all other health care services. The unifor…
Neb. Rev. Stat. § 44-5438 Prior authorization; decision; notice; when required.
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(1) Prior to January 1, 2028, if a utilization review agent requires prior authorization of a health care service, the utilization review agent shall make a decision on the prior authorization request and provide notice of its decision to the enrollee and the enrollee's health ca…
Neb. Rev. Stat. § 44-5439 Prior authorization; not required; services enumerated.
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No utilization review agent shall require prior authorization of: (1) Emergency confinement or an emergency health care service; (2) Pre-hospital transportation for the provision of emergency health care services or for transfers between facilities as required by the federal Emer…
Neb. Rev. Stat. § 44-5440 Prior authorization; provision of care permitted; conditions; health care service; payments; rate.
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(1) A utilization review agent shall not revoke, limit, condition, or restrict an approved prior authorization if care is provided within sixty days from the date the health care provider received the prior authorization approval unless the enrollee was no longer eligible for car…
Neb. Rev. Stat. § 44-5441 Prior authorization; period of validity.
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(1) Except as otherwise provided in this section, prior authorization shall be valid for at least one year from the date the utilization review agent approves the prior authorization request, except for a prescription drug that has a treatment schedule or dosing limitation from t…
Neb. Rev. Stat. § 44-5442 Prior authorization; change in utilization review agent, coverage of or approval criteria for health care service, or health insurance product; effect.
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(1) On receipt of information documenting an approved prior authorization from the enrollee or from the enrollee's health care provider, a utilization review agent shall honor the approved prior authorization granted to an enrollee from a previous utilization review agent for at …
Neb. Rev. Stat. § 44-5443 Artificial intelligence-based algorithm; use; restrictions; automated utilization management system; audit.
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(1) An artificial intelligence-based algorithm shall not be the sole basis of a utilization review agent's decision to deny, delay, or modify health care services based, in whole or in part, on medical necessity. (2) A utilization review agent shall disclose to the department, to…
Neb. Rev. Stat. § 44-5444 Utilization review agent; compensation; incentive or penalty; restrictions.
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A utilization review agent shall not: (1) Be compensated based on its volume of denials; or (2) Base any incentive or penalty for a medical reviewer of such agent based on the volume of denials such reviewer issues or upholds.
Neb. Rev. Stat. § 44-5501 Act, how cited.
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Sections 44-5501 to 44-5515 shall be known and may be cited as the Surplus Lines Insurance Act.
Neb. Rev. Stat. § 44-5502 Terms, defined.
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For purposes of the Surplus Lines Insurance Act, unless the context otherwise requires: (1) Affiliated group means a group of entities in which each entity, with respect to an insured, controls, is controlled by, or is under common control with the insured; (2) Control means: (a)…
Neb. Rev. Stat. § 44-5503 Surplus lines license; issuance.
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The department, in consideration of the payment of the license fee, may issue a surplus lines license, revocable at any time, to any individual who currently holds an insurance producer license or to a foreign or domestic corporation. The corporate surplus lines license shall lis…
Neb. Rev. Stat. § 44-5504 Nonadmitted insurer; surplus lines license; application; fee; expiration; renewal.
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(1) No person, other than an exempt commercial purchaser, shall place, procure, or effect insurance for or on behalf of an insured whose home state is the State of Nebraska in any nonadmitted insurer until such person has first been issued a surplus lines license from the departm…
Neb. Rev. Stat. § 44-5505 Nonadmitted insurer; surplus lines licensee; record of business; contents; how kept.
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Each surplus lines licensee shall keep in the licensee's office a true and complete record of the business transacted by the licensee showing (1) the exact amount of insurance or limits of exposure, (2) the gross premiums charged therefor, (3) the return premium paid thereon, (4)…
Neb. Rev. Stat. § 44-5506 Surplus lines licensee; quarterly statement; tax payment.
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(1) Every surplus lines licensee transacting business under the Surplus Lines Insurance Act shall, on or before March 1 for the quarter ending the preceding December 31, June 1 for the quarter ending the preceding March 31, September 1 for the quarter ending the preceding June 30…
Neb. Rev. Stat. § 44-5506.01 Nonadmitted insurer; certificate of authority; director; powers; provisions applicable.
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(1) The director may provide written authority in the form of a certificate of authority to operate as a domestic surplus lines insurer in the State of Nebraska to a nonadmitted insurer domiciled in this state if the director determines that such nonadmitted insurer: (a) Possesse…
Neb. Rev. Stat. § 44-5507 Nonadmitted insurer; personal jurisdiction.
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Every nonadmitted insurer accepting business under the Surplus Lines Insurance Act shall be held to have sufficient contact with this state for the exercise of personal jurisdiction over such insurer (1) upon any cause of action arising out of any such transaction or (2) in any p…
Neb. Rev. Stat. § 44-5508 Surplus lines licensee; requirements; duties of licensee; violations; penalty; nonadmitted insurer; requirements.
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(1) A surplus lines licensee shall not place coverage with a nonadmitted insurer unless, at the time of placement, the surplus lines licensee has determined that the nonadmitted insurer is a domestic surplus lines insurer or meets the following criteria: (a) Is authorized to writ…
Neb. Rev. Stat. § 44-5509 Surplus lines licensee; policy; information required.
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A surplus lines licensee shall stamp or type upon the declaration page of each policy procured and delivered under the Surplus Lines Insurance Act the following information: (1) The licensee's name, business address, and surplus lines license number; (2) the name under which the …
Neb. Rev. Stat. § 44-5510 Insurance; procurement from nonadmitted insurer; when; terms and conditions; surplus lines licensee; exempt from due diligence search; conditions.
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(1) If an applicant for insurance is unable to procure such insurance as he or she deems reasonably necessary to insure a risk or exposure from an admitted insurer, such insurance may be procured from a nonadmitted insurer upon the following terms and conditions: (a) The insuranc…
Neb. Rev. Stat. § 44-5511 Surplus lines licensee; report; contents; when due.
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On or before March 1 for the quarter ending the preceding December 31, June 1 for the quarter ending the preceding March 31, September 1 for the quarter ending the preceding June 30, and December 1 for the quarter ending the preceding September 30 of each year, every surplus line…
Neb. Rev. Stat. § 44-5512 Violations; director; hearing; orders; penalty; appeal.
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(1) Whenever the director has reason to believe that any person has engaged in any activities in violation of the Surplus Lines Insurance Act, the director may: (a) Issue an order and notice of hearing directing such person to cease and desist from engaging in such activities; or…
Neb. Rev. Stat. § 44-5514 Rules and regulations.
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The director may adopt and promulgate rules and regulations to carry out the Surplus Lines Insurance Act.
Neb. Rev. Stat. § 44-5515 Exempt commercial purchaser; taxes; form.
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Every exempt commercial purchaser whose home state is the State of Nebraska shall, on or before March 1 for the quarter ending the preceding December 31, June 1 for the quarter ending the preceding March 31, September 1 for the quarter ending the preceding June 30, and December 1…
Neb. Rev. Stat. § 44-5601 Act, how cited.
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Sections 44-5601 to 44-5613 shall be known and may be cited as the Reinsurance Intermediary Act.
Neb. Rev. Stat. § 44-5602 Terms, defined.
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For purposes of the Reinsurance Intermediary Act: (1) Actuary shall mean a person who is a member in good standing of the American Academy of Actuaries; (2) Controlling person shall mean any person, firm, association, or corporation which directly or indirectly has the power to d…
Neb. Rev. Stat. § 44-5603 Reinsurance intermediary-broker; reinsurance intermediary-manager; license; requirements; issuance; director; duties; fee; renewal; exemption.
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(1) No person, firm, association, or corporation shall act as a reinsurance intermediary-broker in this state if the reinsurance intermediary-broker maintains an office directly, as a member or employee of a firm or association, or as an officer, director, or employee of a corpor…
Neb. Rev. Stat. § 44-5603.01 Nonresident reinsurance intermediary license; reciprocal licensure; continuing education.
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(1) The director shall waive any requirements for a nonresident reinsurance intermediary license applicant with a valid license from the applicant's home state, except the requirements imposed by section 44-5603, if the applicant's home state awards nonresident licenses to reside…
Neb. Rev. Stat. § 44-5603.02 Licensed reinsurance intermediary; consent to jurisdiction.
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A reinsurance intermediary, by accepting licensure in this state, is deemed to have consented to the jurisdiction of the director and of the courts of this state with respect to all activities conducted under the license and to have designated the director as its agent for servic…
Neb. Rev. Stat. § 44-5604 Reinsurance; written authorization required; contents.
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Transactions between a reinsurance intermediary-broker and the insurer it represents in such capacity shall only be entered into pursuant to a written authorization specifying the responsibilities of each party. The authorization shall at a minimum provide that: (1) The insurer m…
Neb. Rev. Stat. § 44-5605 Reinsurance intermediary-broker; records; requirements.
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For at least ten years after expiration of each contract of reinsurance transacted by a reinsurance intermediary-broker, the reinsurance intermediary-broker shall keep a complete record for each transaction showing: (1) Type of contract, limits, underwriting restrictions, classes…
Neb. Rev. Stat. § 44-5606 Insurer; prohibited acts; copy of statement of financial condition; obtain.
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(1) An insurer shall not engage the services of any person, firm, association, or corporation to act as a reinsurance intermediary-broker on its behalf unless such person, firm, association, or corporation is licensed as required by subsection (1) of section 44-5603. (2) An insur…