Nebraska

SUMMARY

Nebraska has been active in promoting price transparency and continues to introduce new legislation in the 2017 and 2018 legislative terms aimed at price transparency.  In the past, Nebraska passed the 2014 Health Care Transparency Act, which created an advisory committee to investigate the creation of an all-payer claims database, and facilitate the reporting of health care and health quality data, provide for the facilitation of value-based, cost-effective purchasing of health care services by public and private purchasers and consumers, and includes provisions regarding claims and eligibility standards. In addition, Nebraska patients have the ability to petition hospitals for a written estimate of average charges for health care services, which promotes transparency and facilitates price shopping. One of Nebraska’s three insurance carriers, and the second largest cooperative non-profit under the ACA, is slated to be liquidated after financing dried up, which could be expected to lessen competition in the state.

 

LEGISLATION/REGULATION

Legislative Calendar

Nebraska’s current regular legislative session runs from 1/3/2018 – 4/18/2018.

 

Recent Legislative Developments

Healthcare Transparency

2018 LB 862 PRESCRIPTION DRUG COST TRANSPARENCY ACT: This Act is intended to promote transparency of the cost of manufacturing prescription pharmaceuticals. The Act would require that a manufacturer of a prescription drug notify certain parties such as insurance companies and health providers in the event that a cost increase on prescription drugs with a wholesale cost of forty dollars for one course of therapy is to increase more than sixteen percent in a prescribed period of time. LB 862 also assigns reporting requirements and publishing of such cost increases by the Department of Administrative Services. Active – Introduced on 1/5/18
2017 LB 604 RIGHT TO SHOP ACT: The intention of this Act is to empower patients with the knowledge to make smart choices about how and where to consume health care. Patients are given the tools through his or her insurance carrier to find the best value. The patient is incentivized to find the best value by receiving cash from the shared savings.

LB 604 requires the State of Nebraska to participate in Right to Shop for state employees. LB 604 requires all insurance carriers that elect to participate to follow the requirements of the Right to Shop Act.

Active – Introduced on 2/27/17 and carried over to 2018 session
LB 324 PHARMACY BENEFIT FAIRNESS AND TRANSPARENCY ACT: Requires that all pharmacy benefit managers (PBMs) doing business in Nebraska obtain certification as a Third Party Administrator, with oversight by the Nebraska Department of Insurance. Violation of these Acts shall be considered unfair trade practices per the Unfair Insurance Trade Practices Act. LB 324 allows the Director to examine the financial condition of the PBM pursuant to the Insurers Examination Act.

LB 324 establishes transparency provisions for the PBMs to follow when contracting with pharmacies, as well as prompt payment provisions, and payment calculation and pricing methodology. PBMs are not allowed to include in their contracts with pharmacies

(a) language that is more restrictive than state law,

(b) any restrictions on sharing pricing information with patients for their medications,

(c) restrictions on pharmacies mailing medications to patients at the request of the patients or mandating the use of the PBM owned mail-order pharmacies, and

(d) restrictions on pharmacies being allowed in preferred networks.

PBMs cannot charge transaction-based fees. LB 324 establishes fair audit provisions and processes that must be complied with regarding performing audits and appeals. PBMs are required to provide Explanation of Benefits to patients for pharmacy claims. The PBMs are required to notify the Department of Insurance if fraud or drug diversion is suspected by the pharmacy.

Active – Introduced on 2/27/17 and carried over to 2018 session


Healthcare Cost

  • None identified.

 

Healthcare Markets

  • None identified.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • Rev. Stat. § 71-2075 requires that hospitals provide a written estimate of the average charges for health services relating to a particular condition or medical procedure upon the written request of a prospective patient or his/her attending physician. The prospective patient or his/her agent may provide the hospital with additional medical history in order that the hospital provide a more accurate estimate of the charges, which in any case must be provided within seven working days from the date of the original submission. Hospitals and ambulatory surgical centers must give notice to the public of their ability to seek an estimate of charges.

 

  • Rev. Stat. § 439B.400 requires that hospitals maintain a uniform list of billed charges for goods and services provided to all inpatients. Generally, a hospital may not use a billed charge for an inpatient that is different than the billed charge used for another inpatient for the same good or service; however, a hospital or other person may negotiate a discounted rate from the billed charges.

 

  • Rev. Stat. § 44-1317 requires that health carriers include a description of their external review procedures in documents provided to covered persons, and that the carrier inform patients of a right a means to challenge an adverse determination.

 

Healthcare Markets

  • Rev. Stat. § 71-5801 through 5870, the “Nebraska Health Care Certificate of Need Act,” prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Nebraska Department of Health and Human Services through the state’s Certificate of Need process. A Certificate of Need regime aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants. Nebraska currently has imposed a moratorium on new long-term care beds and rehabilitation beds.

 

 

  • Rev. Stat. § 44-5258 establishes a system of regulation for health insurance premium rates for small employer health benefit plans.

 

2018-2019 BUDGET

The Nebraska state budget operates on a biennium cycle, covering two fiscal years. Nebraska’s fiscal year begins on July 1 and ends on June 30 of the following year. Nebraska passed its 2018-2019 Budget in the 2017 regular legislative session. To view Nebraska’s Department of Health and Human Services 2018-2019 Budget, visit pages 38-42.

 

KEY RESOURCES

Nebraska Legislature

Nebraska Office of the Attorney General

Nebraska Department of Insurance

Nebraska Health Care Database Advisory Committee

Nebraska Hospital Association Care Compare