This bill amends sections 68-927 and 68-928 of the Reissue Revised Statutes of Nebraska, focusing on the Medical Assistance Act. It redefines the term "health plan" to include not only traditional insurance policies but also service benefit plans, managed care organizations, and pharmacy benefit managers, thereby broadening the scope of entities responsible for health care payments. Additionally, the bill establishes new requirements for entities issuing health plans, mandating that they respond to requests from the department regarding claims for health care items or services within three years of provision. It also prohibits these entities from denying claims based solely on submission dates, claim formats, or documentation issues, provided that the claims are submitted within specified timeframes.

Furthermore, the bill clarifies the responsibilities of licensed insurers and self-funded insurers in providing coverage information to the department without individual authorization, specifically for determining eligibility for state benefit programs and coordinating benefits. The amendments aim to streamline the process of accessing health coverage information and ensure timely responses to claims, ultimately enhancing the efficiency of the Medical Assistance program in Nebraska. The original sections 68-927 and 68-928 are repealed as part of this legislative update.

Statutes affected:
Introduced: 68-927, 68-928