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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

5 provisions identified: 5 benefits, 0 costs, 0 mixed.

Medicaid covers biomarker tests by 2028

By January 1, 2028, Nebraska Medicaid covers biomarker tests used to diagnose, treat, manage, or monitor listed conditions, for transplants, or for pharmacogenomic uses. Coverage applies when clinical usefulness is shown by FDA labeling or warnings, CMS national or local coverage decisions, or national clinical guidelines. Medicaid contractors must match the program’s scope, duration, and frequency. The Department posts a clear and easy exception request process on its website.

Private plans must cover biomarker tests

Starting January 1, 2028, health insurance policies issued or renewed in Nebraska cover biomarker tests when used to diagnose, treat, manage, or monitor listed conditions, for transplants, or for pharmacogenomic uses. The test must be supported by FDA labeling or warnings, CMS coverage decisions, or national clinical guidelines. Insurers must limit care disruptions, like avoiding extra biopsies when appropriate. Carriers must post a clear exception request process on their websites. Self-funded employer plans are covered only where not preempted by federal law, and specified-disease or other limited-benefit policies are not included.

Doctors must review denials and appeals

Beginning January 1, 2026, a physician or qualified clinical peer with an active U.S. license must make prior-authorization denials, under a physician medical director. Denial notices must give the reason and cite the clinical criteria. Providers may request a discussion within three business days; after the call, agents must confirm the decision within 1 business day for urgent care or 2 business days for nonurgent care. Appeals must be reviewed by an independent physician in the same or similar specialty who was not involved and has no financial interest, and who considers all records and materials.

Faster prior authorization with firm deadlines

The Department of Insurance approves one two-page prior-authorization form for drugs and equipment and one for other services by November 1, 2025. Starting January 1, 2026, providers use these forms and agents must accept them, unless an agent adopts an approved electronic method and gives 90 days’ notice. For required prior authorization, urgent requests are decided within 72 hours until January 1, 2028, then within 48 hours; nonurgent requests within 7 days. If an agent misses the deadline, the service is automatically authorized. Approval notices must state how long the authorization lasts or the expiration date.

Insurers must post prior authorization rules online

Starting January 1, 2026, utilization review agents must post all prior-authorization rules, restrictions, and written clinical criteria on a public website. The online information must be accurate and kept current, and it must be searchable by July 1, 2027. Agents must update the website before any change takes effect. They must also give contracted providers at least 60 days’ written notice before adding or changing a prior-authorization rule.

Sponsors & Cosponsors

Sponsor

  • Eliot Bostar

    Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 209 • No: 2

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: 32 • No: 0 • Other: 17

legislature vote • 5/9/2025

Vote

Yes: 37 • No: 0 • Other: 12

legislature vote • Unknown

Vote

Yes: 31 • No: 0 • Other: 18

legislature vote • Unknown

Vote

Yes: 32 • No: 0 • Other: 17

Actions Timeline

  1. Provisions/portions of LB253 amended into LB77 by AM1187

    6/6/2025legislature

  2. Approved by Governor on June 4, 2025

    6/4/2025legislature

  3. Presented to Governor on May 30, 2025

    5/30/2025legislature

  4. President/Speaker signed

    5/30/2025legislature

  5. Passed on Final Reading 46-2*-1

    5/30/2025legislature

  6. Dispensing of reading at large approved

    5/30/2025legislature

  7. Placed on Final Reading

    5/27/2025legislature

  8. Advanced to Enrollment and Review for Engrossment

    5/21/2025legislature

  9. Enrollment and Review ER86 adopted

    5/21/2025legislature

  10. Enrollment and Review ER86 filed

    5/14/2025legislature

  11. Placed on Select File with ER86

    5/14/2025legislature

  12. Advanced to Enrollment and Review Initial

    5/9/2025legislature

  13. Banking, Commerce and Insurance AM1187 adopted

    5/9/2025legislature

  14. Bostar AM1261 adopted

    5/9/2025legislature

  15. Bostar AM1261 to AM1187 filed

    5/8/2025legislature

  16. Banking, Commerce and Insurance AM1187 filed

    4/28/2025legislature

  17. Placed on General File with AM1187

    4/28/2025legislature

  18. Speaker priority bill

    3/17/2025legislature

  19. Notice of hearing for February 10, 2025

    1/27/2025legislature

  20. Referred to Banking, Commerce and Insurance Committee

    1/13/2025legislature

  21. Date of introduction

    1/9/2025legislature

Bill Text

  • Introduced

    1/9/2025

    PDF

  • Enrolled / Slip Law

    PDF

  • Final / Enacted

    PDF

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