Chapter 44 — INSURANCE
2,728 sections in this chapter.
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-531 Reduction or elimination of coverage; restrictive condition; notice required; right of parties to amend contract.
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(1) If an insurer reduces or eliminates any coverage in or introduces a more restrictive condition as part of a policy in force delivered or issued for delivery in this state and subject to sections 44-514 to 44-521 or section 44-522 or 44-523 prior to renewal of the policy and o…
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Transferred to section 44-5416.
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[Repealed or reserved.]
Transferred to section 44-5417.
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[Repealed or reserved.]
Repealed. Laws 1998, LB 1162, § 90.
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[Repealed or reserved.]
Repealed. Laws 1998, LB 1162, § 90.
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[Repealed or reserved.]
Repealed. Laws 1998, LB 1162, § 90.
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[Repealed or reserved.]
Repealed. Laws 1998, LB 1162, § 90.
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[Repealed or reserved.]
Repealed. Laws 1998, LB 1162, § 90.
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[Repealed or reserved.]
Repealed. Laws 1998, LB 1162, § 90.
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[Repealed or reserved.]
Transferred to section 44-5419.
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[Repealed or reserved.]
Transferred to section 44-5420.
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[Repealed or reserved.]
Transferred to section 44-5421.
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[Repealed or reserved.]
Transferred to section 44-5422.
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[Repealed or reserved.]
Transferred to section 44-5423.
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[Repealed or reserved.]
Transferred to section 44-5424.
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[Repealed or reserved.]
Repealed. Laws 1998, LB 1162, § 90.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-5416 Utilization Review Act, how cited.
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Sections 44-5416 to 44-5431 shall be known and may be cited as the Utilization Review Act.
Neb. Rev. Stat. § 44-5417 Purpose of act.
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The purpose of the Utilization Review Act is to establish requirements and standards of operation for certification of medical utilization review agents. It is proper for the state to oversee utilization review agents as a part of the state's regulation and supervision of the bus…
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)…