Learn About Nebraska SBL

The Nebraska SBL

The Nebraska SBL became effective October 22, 2020. Nebraska Revised Statutes 44-6849 and 44-6850. The Nebraska Law essentially ties reimbursement to either INN rates or 175% of Medicare.

Regarding bifurcation, according to CMS,

Nebraska does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response and CMS communications with the Nebraska Department of Insurance staff, CMS understands that Nebraska Revised Statutes 44-6849 and 44-6850 are specified state laws that will apply for purposes of determining the out-of-network rate with respect to emergency services furnished to individuals in health benefit plans in Nebraska by out-of-network health care providers. 1 The federal independent dispute resolution process under section 2799A-1(c) of the PHS Act and 45 CFR 149.510 will apply for purposes of determining the out-of-network rate with respect to any items and services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Nebraska by nonparticipating providers and nonparticipating emergency facilities to which Nebraska Revised Statute 44-6849 and 44-6850 do not apply. The federal independent dispute resolution process under section 2799A-2(b) of the PHS Act and 45 CFR 149.520 will apply for purposes of determining the out-of-network rate with respect to services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in Nebraska by nonparticipating providers of air ambulance services. The Nebraska Department of Insurance will enforce the outcome of the federal independent resolution process for cases in Nebraska through a collaborative enforcement agreement.

Letter from CMS to Governor of Nebraska, dated December 27, 2021.