Nebraska Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

Nebraska Grantee: Nebraska Department of Insurance

Award Date: October 31, 2016

Total Award: $1,068,804.31

Baseline Award: $476,998

Selected Market Reforms Amount: $450,000

Workload Award Amount: $141,806.31

• Section 2713 - To facilitate the coverage of specified preventive health services without cost sharing, the Nebraska Department of Insurance will review health insurance issuer forms more robustly and develop a better review program by using best internal practices, meeting with stakeholders and providing better access to Nebraska’s plan comparison site. Nebraska will create a stakeholder outreach campaign using new and established forms of media, and will also develop Frequently Asked Questions brochures. Additionally, the Department of Insurance develop guidance documents for health insurance issuers and for market conduct reviewers, to aid them in the review of policy provisions regarding preventative services. Finally, Nebraska will update its' website to specifically denote preventive health services that are available through a policy.

• Section 2719 – The Nebraska Department of Insurance will develop external checklists and provide information to providers on the procedures to file external appeals. In addition, Nebraska will travel to meet the needs of stakeholders across the State. The Nebraska Department of Insurance will also develop an IT infrastructure, database, and a secure portal for external review submissions. Nebraska will conduct a public campaign to alert consumers of their ability to have an external review. Finally, the Department of Insurance will develop internal training manuals and will provide staff training on how to thoroughly review external review processes, including assisting the Independent Review Organization with any issues they may have in the collection of money owed to them by a health insurance issuer for the review process.

• Section 2726 – The Nebraska Department of Insurance will foster inter-agency working groups with the Department of Behavioral Health, to develop mental health parity tools and an IT infrastructure. Nebraska will also conduct a thorough review of issuer policy forms, summary plan descriptions, certificates of coverage and other plan documents to assess health plans compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). Nebraska will review any non-quantitative treatment limitations on mental health and substance abuse benefits, and request written documentation from the health insurance issuer of processes, strategies, evidentiary standards, and other factors. In addition, the Nebraska Department of Insurance will assist in enforcing mental health parity by educating consumers, providers and health insurance issuers.