AGO 97033.

• Court: Nebraska

Nebraska Attorney General Opinions 1997. AGO 97033. DATE: June 4, 1997SUBJECT: Definition of Public Records Under the Public Records Statutes, Neb. Rev. Stat. §§ 84-712 through 84-712.09 (1994, Cum. Supp. 1996), and the Exception to Disclosure for Proprietary or Commercial Information Contained in § 84-712.05(3) REQUESTED BY: Jeff Elliott, Director Department of Health and Human Services Finance and SupportWRITTEN BY: Don Stenberg, Attorney General Dale A. Comer, Assistant Attorney General In 1995, the Nebraska Department of Social Services contracted with Exclusive Healthcare, Inc., a health maintenance organization or HMO, to provide certain health care services in return for periodic fixed payments by the State. That contract requires Exclusive Healthcare, Inc. (the "HMO") to provide the Department with access to certain data, reports and information regarding various aspects of its operation and the contract with the Department. You now have posed two questions to us regarding application of the Nebraska Public Records Statutes, Neb. Rev. Stat. §§ 84-712 through 84-712.09 (1994, Cum. Supp. 1996), to the data, reports and information covered under the terms of the Exclusive Healthcare, Inc. contract. Four portions of the Exclusive Healthcare, Inc. contract with the Department are at issue in your opinion request: 1. Section 4.4.1(b) of the contract requires the HMO to maintain and operate a Quality Assurance Plan. Under § 4.4.1(b)(7)(c), the HMO must "maintain adequate records of services delivered [to certain dental patients] (including preventive education provided) for each encounter with [a client] . . . ." § 4.4.1(b)(7)(d) requires the HMO and its affiliated dental providers to establish and document a recall system for routine dental check-ups and other appointments, and § 4.4.1(b)(7)(f) requires the HMO to be able to document follow-up and evaluation of all client complaints. 2. Section 4.5 of the contract requires the HMO to manage and document a credentialling and re-credentialling process for its physicians and providers, and to provide a report indicating the number and percentage of providers denied credentialling and/or re- credentialling in the first year of the contract term. That report must be provided within 60 days after the contract year. 3. Under § 4.7.1 of the contract, the HMO is required to develop and adopt two clinical practice guidelines for conditions which have traditionally exhibited high cost and/or variation among provider treatment methodologies. Within thirty days after the end of the first contract year, the HMO must document both the process for the dissemination of the clinical practice guidelines to participating providers and the ongoing evaluation process for updating and revising those guidelines as indicated by current medical practice standards...