Rule 51: Managed Care — Purpose

A. The purpose of Rule 51 through Rule 61 is to establish procedures and requirements for certification of a managed care plan relating to the management and delivery of medical, surgical, and hospital services to injured employees under the Nebraska Workers’ Compensation Act, and for contracting between a certified managed care plan and an insurer, risk management pool, or self-insured employer.

B. No health care provider, network of providers, employer, insurer, risk management pool or any other person may make any representation or state in any name, contract, or literature that an entity constitutes workers’ compensation managed care for the provision of services under the Nebraska Workers’ Compensation Act unless the entity is a certified managed care plan under these rules.

C. No employee may be required to receive services under a managed care plan, including but not limited to a preferred provider organization, point of service plan, health maintenance organization, or similar entity, unless the plan has been certified by the court.