44-5434. Prior authorization requirements and restrictions; utilization review agent; provide website access and notice; when.
159 words·~1 min read·
/ne/chapter-44/44-5434A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)A utilization review agent shall make prior authorization requirements and restrictions, including written clinical review criteria, accessible on its website. Such requirements, restrictions, and clinical review criteria shall be accurate and current and shall clearly communicate what information and documentation is needed to decide the prior authorization. Prior authorization requirements shall also be made available on the website in a searchable format no later than July 1, 2027.
(2)If a utilization review agent intends either to implement a new prior authorization requirement or restriction or to amend an existing requirement or restriction, the utilization review agent shall:
(a)Ensure that the new or amended requirement or restriction is not implemented unless the utilization review agent's website has been updated to reflect the new or amended requirement or restriction; and
(b)Provide contracted health care providers with notice of the new or amended requirement or restriction no less than sixty days before the requirement or restriction is implemented.