Bill > LB987

This bill, known as the Vision Benefit Plan Act, establishes new regulations for vision benefit plans and managers, aiming to increase transparency and fairness in the vision care industry. Key provisions include requiring insurers and vision benefit managers (entities that create, sell, or administer vision plans) to publicly disclose detailed information about their business, including legal and operational details, litigation history, and formal complaints, all presented in plain language. The act also mandates that insurers and vision benefit managers provide participating eye care providers (licensed optometrists or medical doctors) with at least 90 days' notice for any changes to agreements or fee schedules, and these changes must be clearly marked. Furthermore, the bill prohibits insurers and vision benefit managers from dictating specific fee limits unless the services are clearly defined as "covered services" (services for which reimbursement is provided, even if limited by deductibles or copays) or "covered materials" (materials for which reimbursement is provided), and requires the use of standardized coding systems like those from the Healthcare Common Procedure Coding System (HCPCS) for describing services and materials. It also ensures that reimbursements are not "nominal" (meaningfully low) and that providers can negotiate their own fee schedules, while also preventing insurers from misleading the public about covered benefits or provider availability. The act prohibits "bundling" or "downcoding" (altering or combining codes in a way that reduces payment) and ensures that providers are not reimbursed at a financial loss. It also prevents insurers from requiring providers to participate in multiple plans as a condition of joining one, and establishes clear processes for provider credentialing and agreement negotiations, including timelines for decisions and appeals. Finally, the bill prohibits insurers and vision benefit managers from controlling a provider's professional judgment, dictating their choice of suppliers or software, or retaliating against providers for negotiating terms or filing complaints.

Business and Industry

https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=63333