reglab/housing_qa huggingface dataset:
NE Code § 44-7101 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7101 - Act, how cited.

44-7101.  Act, how cited.Sections 44-7101 to 44-7112 shall be known and may be cited as the Managed Care Plan Network Adequacy Act.Source  Laws 1998, LB 1162, § 39.
NE Code § 44-7102 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7102 - Purpose and intent.

44-7102.  Purpose and intent.The purpose and intent of the Managed Care Plan Network Adequacy Act are to establish standards for the creation and maintenance of networks by health carriers and to assure the adequacy, accessibility, and quality of health care services offered under a managed care plan by establishing requirements for written agreements between health carriers offering managed care plans and participating providers regarding the standards, terms, and provisions under which the participating provider will provide services to covered persons.Source  Laws 1998, LB 1162, § 40.
NE Code § 44-7104 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7104 - Applicability of act.

44-7104.  Applicability of act.The Managed Care Plan Network Adequacy Act applies to all health carriers that offer managed care plans.Source  Laws 1998, LB 1162, § 42.
NE Code § 44-7107 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7107 - Intermediaries.

44-7107.  Intermediaries.(1) A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section.(2)(a) Intermediaries and participating providers with whom they contract shall comply with all the applicable requirements of section 44-7106.(b) A health carrier's statutory responsibility to monitor the offering of covered benefits to covered persons shall not be delegated or assigned to the intermediary.(c) A health carrier shall have the right to approve or disapprove participation status of a subcontracted provider in its own or a contracted network for the purpose of delivering covered benefits to the health carrier's covered persons.(d) A health carrier shall maintain copies of all intermediary health care subcontracts at its principal place of business in the state, or ensure that it has access to all intermediary subcontracts, including the right to make copies to facilitate regulatory review, upon twenty days' prior written notice from the health carrier. A health carrier may meet the requirements of this subdivision by maintaining a copy of the intermediary health care subcontract forms used by its intermediaries, and if the health carrier does so, the health carrier shall also maintain a copy of any portion of an intermediary health care subcontract which substantially differs from the intermediary health care subcontract form in subject areas other than reimbursement.(e) If applicable, an intermediary shall transmit utilization documentation and claims paid documentation to the health carrier. The health carrier shall monitor the timeliness and appropriateness of payments made to providers and health care services received by covered persons.(f) If applicable, an intermediary shall maintain the books, records, financial information, and documentation of health care services provided to covered persons at its principal place of business in the state and preserve them for five years in a manner that facilitates regulatory review.(g) An intermediary shall allow the director and a health maintenance organization shall allow the director and the Department of Health and Human Services access to the intermediary's books, records, financial information, and any documentation of health care services provided to covered persons, as necessary to determine compliance with the Managed Care Plan Network Adequacy Act.(h) A health carrier shall have the right, in the event of the intermediary's insolvency, to require the assignment to the health carrier of the provisions of a provider's contract addressing the provider's obligation to furnish covered services.Source   Laws 1998, LB 1162, § 45;  Laws 2007, LB296, § 199.
NE Code § 44-7108 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7108 - Filing requirements.

44-7108.  Filing requirements.(1) A health carrier that offers closed plans or combination plans having a closed component shall file with the director sample contract forms proposed for use with its participating providers and intermediaries.(2) A health carrier that offers closed plans or combination plans having a closed component shall submit material changes to a contract that would affect a provision required by the Managed Care Plan Network Adequacy Act or applicable rules and regulations to the director for approval. Changes in provider payment rates, coinsurance, copayments, or deductibles, or other plan benefit modifications are not considered material changes for the purpose of this subsection.(3) If the director takes no action within thirty days after submission of a material change to a contract by a health carrier, the change is deemed approved.(4) The health carrier shall maintain provider and intermediary contracts at its principal place of business in the state, or the health carrier shall have access to all contracts and provide copies to facilitate regulatory review upon twenty days' prior written notice from the director.Source  Laws 1998, LB 1162, § 46.
NE Code § 44-7109 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7109 - Health carrier violation; notice; hearing.

44-7109.  Health carrier violation; notice; hearing.If the director finds that any health carrier doing business in this state is engaging in any violation of the Managed Care Network Adequacy Act and that a proceeding in respect thereto would be in the public interest, the director shall issue and serve upon such health carrier a statement of the charges in that respect and a notice of hearing thereon, which notice shall set a hearing date not less than ten days after the date of the notice.Source  Laws 1998, LB 1162, § 47.
NE Code § 44-7110 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7110 - Violation; penalty.

44-7110.  Violation; penalty.If, after the hearing, the director finds a health carrier has violated the Managed Care Network Adequacy Act, the director shall reduce his or her findings to writing and shall issue and cause to be served upon the health carrier charged with the violation a copy of the findings and an order requiring the health carrier to cease and desist from engaging in the violation and the director may order any one or more of the following:(1) Payment of a monetary penalty of not more than one thousand dollars for each violation, not to exceed an aggregate penalty of thirty thousand dollars, unless the violation was committed flagrantly and in conscious disregard of the Managed Care Network Adequacy Act, in which case the penalty shall not be more than fifteen thousand dollars for each violation, not to exceed an aggregate penalty of one hundred fifty thousand dollars; and(2) Suspension or revocation of the health carrier's certificate of authority if the health carrier knew or reasonably should have known it was in violation of the act.Source  Laws 1998, LB 1162, § 48.
NE Code § 44-7111 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7111 - Violation of cease and desist order; penalty.

44-7111.  Violation of cease and desist order; penalty.Any health carrier who violates a cease and desist order of the director under section 44-7110 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 aggregate penalty of one hundred fifty thousand dollars; and(2) Suspension or revocation of the health carrier's certificate of authority.Source  Laws 1998, LB 1162, § 49.
NE Code § 44-7112 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7112 - Rules and regulations.

44-7112.  Rules and regulations.The director may adopt and promulgate rules and regulations to carry out the Managed Care Plan Network Adequacy Act.Source  Laws 1998, LB 1162, § 50.
NE Code § 44-7201 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7201 - Act, how cited.

44-7201.  Act, how cited.Sections 44-7201 to 44-7215 shall be known and may be cited as the Quality Assessment and Improvement Act.Source  Laws 1998, LB 1162, § 51.
NE Code § 44-7202 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7202 - Purpose and intent.

44-7202.  Purpose and intent.The Quality Assessment and Improvement Act establishes criteria for the quality assessment activities of all health carriers that offer managed care plans and for the quality improvement activities of health carriers issuing closed plans or combination plans having a closed component. The purpose of the criteria is to enable health carriers to evaluate, maintain, and improve the quality of health care services provided to covered persons.Source  Laws 1998, LB 1162, § 52.
NE Code § 44-7204 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7204 - Applicability of act.

44-7204.  Applicability of act.The Quality Assessment and Improvement Act applies to all health carriers that offer closed plans or combination plans having a closed component on and after July 15, 1998. The act, except sections 44-7207 to 44-7209, applies to all health carriers that offer open plans on and after July 1, 1999.Source  Laws 1998, LB 1162, § 54.
NE Code § 44-7205 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7205 - Use of nationally recognized private accrediting entities; authorized.

44-7205.  Use of nationally recognized private accrediting entities; authorized.The director may recognize accreditation by one or more nationally recognized private accrediting entities, with established and maintained standards, as evidence of meeting some or all of the requirements of the Quality Assessment and Improvement Act. A recognized accrediting entity shall make available to the director its current standards to demonstrate that the entity's standards meet or exceed this state's requirements. The health carrier may provide the director with documentation that a managed care plan has been accredited by the entity.Source  Laws 1998, LB 1162, § 55.
NE Code § 44-7206 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7206 - Quality assessment; infrastructure and disclosure systems.

44-7206.  Quality assessment; infrastructure and disclosure systems.A health carrier that provides managed care plans shall develop and maintain the infrastructure and disclosure systems necessary to measure the quality of health care services provided to covered persons on a regular basis and appropriate to the types of managed care plans offered by the health carrier. A health carrier shall:(1) Establish a system designed to assess the quality of health care provided to covered persons and appropriate to the types of managed care plans offered by the health carrier. The system shall include systematic collection, analysis, and reporting of relevant data in accordance with statutory and regulatory requirements;(2) Communicate findings in a timely manner to applicable regulatory agencies, providers, and consumers as provided in section 44-7209;(3) Report to the appropriate licensing authority any persistent pattern of problematic care provided by a provider that is sufficient to cause the health carrier to terminate or suspend contractual arrangements with the provider. A health carrier acting in good faith shall be granted immunity from any cause of action under state law in making the report; and(4) Develop a written description of the quality assessment program available for review by the director, which shall include a signed certification by a corporate officer of the health carrier that the filing meets the requirements of the Quality Assessment and Improvement Act. The written description of the quality assessment program of a health maintenance organization shall also be available for review by the Department of Health and Human Services.Source   Laws 1998, LB 1162, § 56;  Laws 2007, LB296, § 200.
NE Code § 44-7208 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7208 - Quality assessment and quality improvement activities; oversight.

44-7208.  Quality assessment and quality improvement activities; oversight.The chief medical officer or clinical director of the health carrier shall have primary responsibility for the quality assessment and quality improvement activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of the Quality Assessment and Improvement Act are met. The chief medical officer or clinical director shall approve the written quality assessment and quality improvement programs, as applicable, implemented in compliance with the act, and shall periodically review and revise the program document and act to assure ongoing appropriateness. Not less than semiannually, the chief medical officer or clinical director shall review reports of quality assessment and quality improvement activities. The director shall hold the health carrier responsible for the actions of the chief medical officer or clinical director carried out on behalf of the health carrier and shall hold the health carrier responsible for ensuring that all requirements of the act are met.Source  Laws 1998, LB 1162, § 58.
NE Code § 44-7209 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7209 - Reporting and disclosure requirements.

44-7209.  Reporting and disclosure requirements.(1) A health carrier shall document and communicate information, as provided in this section, about its quality assessment program and its quality improvement program, if it has one, and shall include a description of its quality assessment and quality improvement programs and a statement of patient rights and responsibilities with respect to those programs in the certificate of coverage or handbook provided to newly enrolled covered persons.(2)(a) A health carrier shall certify to the director annually that its quality assessment program and its quality improvement program, if it has one, along with the materials provided to providers and consumers in accordance with subsection (1) of this section, meet the requirements of the Quality Assessment and Improvement Act.(b) A health carrier shall make available for review by the public upon request, subject to a reasonable fee, the materials certified pursuant to subdivision (2)(a) of this section, except for the materials subject to the confidentiality requirements of section 44-7210 and materials that are proprietary to the health benefit plan. A health carrier shall retain all certified materials for at least three years from the date the material has been used or until the material has been examined as part of a market conduct examination, whichever is longer.Source  Laws 1998, LB 1162, § 59.
NE Code § 44-7211 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7211 - Contracts; duties.

44-7211.  Contracts; duties.Whenever a health carrier contracts to have another entity perform the quality assessment or quality improvement functions required by the Quality Assessment and Improvement Act or applicable rules and regulations, the director shall hold the health carrier responsible for monitoring the activities of the entity with which it contracts and for ensuring that the requirements of the act and applicable rules and regulations are met.Source  Laws 1998, LB 1162, § 61.
NE Code § 44-7212 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7212 - Health carrier violation; notice; hearing.

44-7212.  Health carrier violation; notice; hearing.If the director finds that any health carrier doing business in this state is engaging in any violation of the Quality Assessment and Improvement Act and that a proceeding in respect thereto would be in the public interest, the director shall issue and serve upon such health carrier a statement of the charges in that respect and a notice of hearing thereon, which notice shall set a hearing date not less than ten days from the date of the notice.Source  Laws 1998, LB 1162, § 62.
NE Code § 44-7213 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7213 - Violation; penalty.

44-7213.  Violation; penalty.If, after the hearing, the director finds a health carrier has violated the Quality Assessment and Improvement Act, the director shall reduce his or her findings to writing and shall issue and cause to be served upon the health carrier charged with the violation a copy of the findings and an order requiring the health carrier to cease and desist from engaging in the violation and the director may order any one or more of the following:(1) Payment of a monetary penalty of not more than one thousand dollars for each violation, not to exceed an aggregate penalty of thirty thousand dollars, unless the violation was committed flagrantly and in conscious disregard of the Quality Assessment and Improvement Act, in which case the penalty shall not be more than fifteen thousand dollars for each violation, not to exceed an aggregate penalty of one hundred fifty thousand dollars; and(2) Suspension or revocation of the health carrier's certificate of authority if the health carrier knew or reasonably should have known it was in violation of the act.Source  Laws 1998, LB 1162, § 63.
NE Code § 44-7214 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7214 - Violation of cease and desist order; penalty.

44-7214.  Violation of cease and desist order; penalty.Any health carrier who violates a cease and desist order of the director under section 44-7213 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 aggregate penalty of one hundred fifty thousand dollars; and(2) Suspension or revocation of the health carrier's certificate of authority.Source  Laws 1998, LB 1162, § 64.
NE Code § 44-7215 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7215 - Rules and regulations.

44-7215.  Rules and regulations.The director may adopt and promulgate rules and regulations to carry out the Quality Assessment and Improvement Act.Source  Laws 1998, LB 1162, § 65.
NE Code § 44-7301 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7301 - Act, how cited.

44-7301.  Act, how cited.Sections 44-7301 to 44-7315 shall be known and may be cited as the Health Carrier Grievance Procedure Act.Source  Laws 1998, LB 1162, § 66.
NE Code § 44-7302 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7302 - Purpose of act.

44-7302.  Purpose of act.The purpose of the Health Carrier Grievance Procedure Act is to provide standards for the establishment and maintenance of procedures by health carriers to assure that covered persons have the opportunity for the appropriate resolution of their grievances as defined in the act.Source  Laws 1998, LB 1162, § 67.
NE Code § 44-7304 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7304 - Applicability of act.

44-7304.  Applicability of act.Except as otherwise specified, the Health Carrier Grievance Procedure Act applies to all health carriers that offer managed care plans.Source  Laws 1998, LB 1162, § 69.
NE Code § 44-7305 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7305 - Use of nationally recognized private accrediting entities; authorized.

44-7305.  Use of nationally recognized private accrediting entities; authorized.The director may recognize accreditation by one or more nationally recognized private accrediting entities, with established and maintained standards, as evidence of meeting some or all of the requirements of the Health Carrier Grievance Procedure Act. A recognized accrediting entity shall make available to the director its current standards to demonstrate that the entity's standards meet or exceed this state's requirements. The health carrier may provide the director with documentation that a managed care plan has been accredited by the entity.Source  Laws 1998, LB 1162, § 70.
NE Code § 44-7306 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7306 - Grievance register.

44-7306.  Grievance register.(1) A health carrier shall maintain in a grievance register written records to document all grievances received during a calendar year. A request for a review of an adverse determination shall be processed in compliance with section 44-7308 but not considered a grievance for purposes of the grievance register unless such request includes a written grievance. For each grievance required to be recorded in the grievance register, the grievance register shall contain, at a minimum, the following information:(a) A general description of the reason for the grievance;(b) Date received;(c) Date of each review or hearing;(d) Resolution of the grievance;(e) Date of resolution; and(f) Name of the covered person for whom the grievance was filed.(2) The grievance register shall be maintained in a manner that is reasonably clear and accessible to the director. A grievance register maintained by a health maintenance organization shall also be accessible to the Department of Health and Human Services.(3) A health carrier shall retain the grievance register compiled for a calendar year for the longer of three years or until the director has adopted a final report of an examination that contains a review of the grievance register for that calendar year.Source   Laws 1998, LB 1162, § 71;  Laws 2007, LB296, § 201;  Laws 2013, LB147, § 19.
NE Code § 44-7307 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7307 - Grievance procedures.

44-7307.  Grievance procedures.(1) Except as specified in section 44-7311, a health carrier shall use written procedures for receiving and resolving grievances from covered persons.(2)(a) A copy of the grievance procedures, including all forms used to process a grievance, shall be made available to the director upon request. A health carrier shall file annually with the director a certificate of compliance stating that the health carrier has established and maintains grievance procedures that fully comply with the provisions of the Health Carrier Grievance Procedure Act.(b) A description of the grievance procedure shall be set forth in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage provided to covered persons.(c) The grievance procedure documents shall include a statement of a covered person's right to contact the director's office for assistance at any time. The statement shall include the telephone number and address of the director.Source  Laws 1998, LB 1162, § 72.