All Roll Calls
Yes: 209 • No: 2
NebraskaLB77109th Legislature 1st and 2nd SessionslegislatureWALLET
Adopt the Ensuring Transparency in Prior Authorization Act and provide for insurance and medicaid coverage of biomarker testing
Sponsored By: Eliot Bostar
Signed by Governor
Banking, Commerce and Insurance Committee
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 6 benefits, 0 costs, 0 mixed.
Faster prior authorization answers and auto-approval
Plans must answer prior authorization requests fast. Before January 1, 2028, urgent cases get a decision in 72 hours and nonurgent in 7 days after the plan has all information. Beginning January 1, 2028, urgent decisions are due in 48 hours; nonurgent stays at 7 days. If a plan misses the deadline, the service is treated as authorized. Approval notices must say when the authorization ends.
No prior auth for emergencies and preventive care
Plans cannot require prior authorization for emergency care, emergency transport, or transfers required by EMTALA. Plans also cannot require it for preventive services rated A or B by the U.S. Preventive Services Task Force, ACIP-recommended vaccines, or women’s preventive services under 45 C.F.R. 147.130.
Real doctors review denials and appeals
A physician must make adverse prior authorization decisions. If the requester is not a doctor, a qualified clinical peer may decide. Reviewers must hold a current U.S. license and work under a physician medical director. All appeals must be reviewed by a licensed physician in the same or a similar specialty, with no conflicts and no role in the first decision, and they must review the records and literature. If your provider disagrees on medical necessity, they can request a discussion within three business days. After the talk, the plan must confirm its decision within one business day for urgent care or within two business days for nonurgent care. This does not apply to denials for contract exclusions and does not replace formal appeals.
Standard forms and clear prior auth rules
By November 1, 2025, the Department of Insurance approves two short, uniform prior authorization forms. Starting January 1, 2026, providers must use them and plans must accept them. By July 1, 2027, plans and their reviewers must post prior authorization rules and clinical criteria online in a searchable format. A plan may not start a new prior authorization rule until its website shows the change and it has given providers 60 days’ notice. Denial or cancellation notices must state the reason and cite the criteria used. Plans may use a compliant electronic prior authorization API if they give providers 90 days’ advance notice.
Stronger, longer approvals and payment protection
Prior authorizations last at least one year from approval, unless a drug’s FDA schedule is shorter. Insurers cannot revoke an approval if you get care within 60 days, unless you were not covered that day. If a plan approved a request and you got the service, it must pay the contracted rate, except for cases like fraud, the service not being covered that day, the provider being out of network, late filing, loss of eligibility, or no authorization. For hospital stays, approvals cover the approved days; if your provider asks in time to continue and the reviewer does not answer, the plan must keep paying until a decision. When you change plans, your new plan must honor your existing approval for at least 60 days, and approvals continue when you switch products within the same insurer. Later rule changes do not cancel approvals already granted.
AI limits and fair pay in reviews
Plans and reviewers must disclose any use of AI in utilization review to the Department of Insurance, network providers, enrollees, and on their websites. An AI tool cannot be the only reason to deny, delay, or change care when medical necessity is at issue. The Department of Insurance can audit automated review systems at any time and can hire outside firms. Plans cannot pay reviewers or agents based on how many denials they make or uphold.
Sponsors & Cosponsors
Sponsor
Eliot Bostar
legislature
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
legislature vote • 4/24/2026
Vote
Yes: 32 • No: 0 • Other: 17
legislature vote • 4/24/2026
Vote
Yes: 31 • No: 0 • Other: 18
legislature vote • 5/30/2025
Final Reading
Yes: 46 • No: 2
legislature vote • 5/9/2025
Vote
Yes: 31 • No: 0 • Other: 18
legislature vote • 5/9/2025
Vote
Yes: 37 • No: 0 • Other: 12
legislature vote • 5/9/2025
Vote
Yes: 32 • No: 0 • Other: 17
Actions Timeline
Approved by Governor on June 4, 2025
6/6/2025legislatureProvisions/portions of LB253 amended into LB77 by AM1187
6/6/2025legislatureDispensing of reading at large approved
5/30/2025legislaturePassed on Final Reading 46-2*-1
5/30/2025legislaturePresident/Speaker signed
5/30/2025legislaturePresented to Governor on May 30, 2025
5/30/2025legislaturePlaced on Final Reading
5/27/2025legislatureEnrollment and Review ER86 adopted
5/21/2025legislatureAdvanced to Enrollment and Review for Engrossment
5/21/2025legislaturePlaced on Select File with ER86
5/14/2025legislatureEnrollment and Review ER86 filed
5/14/2025legislatureBostar AM1261 adopted
5/9/2025legislatureBanking, Commerce and Insurance AM1187 adopted
5/9/2025legislatureAdvanced to Enrollment and Review Initial
5/9/2025legislatureBostar AM1261 to AM1187 filed
5/8/2025legislaturePlaced on General File with AM1187
4/28/2025legislatureBanking, Commerce and Insurance AM1187 filed
4/28/2025legislatureSpeaker priority bill
3/17/2025legislatureNotice of hearing for February 10, 2025
1/27/2025legislatureReferred to Banking, Commerce and Insurance Committee
1/13/2025legislatureDate of introduction
1/9/2025legislature
Bill Text
Introduced
6/6/2025
Enrolled / Slip Law
Final / Enacted