In the 2017 legislative term, Nebraska was inactive in regard to healthcare price transparency, costs, or market legislation. In the past, Nebraska had been active in promoting price transparency, through passing the 2014 Health Care Transparency Act. The Act 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.
Nebraska’s current regular legislative session runs from 1/3/2018 – 4/18/2018.
Recent Legislative Developments
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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.
- 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. St. § 71-7701 through 71-7711 (Health Care Facility-Provider Cooperation Act) permits the state attorney general to authorize cooperative agreements between healthcare providers, purchasers, and provider networks by issuing a Certificate of Public Advantage (COPA) if the likely benefits resulting from the agreements outweigh the disadvantages attributable to a reduction in competition that may result from such agreements. Providers issued a COPA are immune from civil or criminal antitrust action under the state action doctrine for actions within the scope of the Certificate.
- Rev. Stat. § 44-5258 establishes a system of regulation for health insurance premium rates for small employer health benefit plans.
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.