§ 44-1312 — Independent review organizations; approval; qualifications; application; contents; fee; termination of approval; director; powers and duties

Nebraska § 44-1312

• Jurisdiction: Nebraska
• Ch. 44: Insurance

Text

(1) The director shall approve independent review organizations
eligible to be assigned to conduct external reviews under the Health Carrier
External Review Act.
(2) In order to be eligible
for approval by the director under this section to conduct external reviews
under the act, an independent review organization:
(a) Except as otherwise provided
in this section, shall be accredited by a nationally recognized private accrediting
entity that the director has determined has independent review organization
accreditation standards that are equivalent to or exceed the minimum qualifications
for independent review organizations established under section 44-1313 ; and
(b) Shall submit an application
for approval in accordance with subsection (4) of this section.
(3) The director shall
develop an application form for initially approving and for reapproving independent
review organizations to conduct external reviews.
(4)(a) Any independent review organization
wishing to be approved to conduct external reviews under the act shall submit
the application form and include with the form all documentation and information
necessary for the director to determine if the independent review organization
satisfies the minimum qualifications established under section 44-1313 .
(b)(i) Subject to subdivision
(4)(b)(ii) of this section, an independent review organization is eligible
for approval under this section only if it is accredited by a nationally recognized
private accrediting entity that the director has determined has independent
review organization accreditation standards that are equivalent to or exceed
the minimum qualifications for independent review organizations under section 44-1313 .
(ii)
The director may approve independent review organizations that are not accredited
by a nationally recognized private accrediting entity if there are no acceptable
nationally recognized private accrediting entities providing independent review
organization accreditation.
(c) The director may charge an application fee that
independent review organizations shall submit to the director with an application
for approval and reapproval.
(5)(a) An approval is effective for two years, unless
the director determines before its expiration that the independent review
organization is not satisfying the minimum qualifications established under
section 44-1313 .
(b)
Whenever the director determines that an independent review organization has
lost its accreditation or no longer satisfies the minimum requirements established
under section 44-1313 , the director shall terminate the approval of the independent
review organization and remove the independent review organization from the
list of independent review organizations approved to conduct external reviews
under the act that is maintained by the director pursuant to subsection (6)
of this section.
(6)
The director shall maintain and periodically update a list of approved independent
review organizations.
(7)
The director may adopt and promulgate rules and regulations to carry out the
provisions of this section.

Legislative History

Source: Laws 2013, LB147, § 12.