All Roll Calls
Yes: 87 • No: 2
NebraskaLB77A109th Legislature 1st and 2nd SessionslegislatureWALLET
Appropriation Bill
Sponsored By: Eliot Bostar
Signed by Governor
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 8 benefits, 0 costs, 0 mixed.
Biomarker testing covered in private plans
Beginning January 1, 2028, most individual and group health plans in Nebraska must cover biomarker testing. Coverage applies when a test is used for diagnosis, treatment, management, monitoring, transplants, or pharmacogenomics and shows clinical value using FDA labels, CMS coverage, or recognized guidelines. Coverage must limit care disruptions, like avoiding repeat biopsies. Insurers must keep an easy exception process on their websites for patients and prescribers. Self‑funded employer plans are covered only as federal law allows, and specified‑disease and other limited‑benefit policies are excluded.
Medicaid covers biomarker testing by 2028
Medicaid covers biomarker testing no later than January 1, 2028, using the same clinical‑use and evidence rules. Contractors must provide testing with the same scope, duration, and frequency as the program. DHHS must keep a clear, easy exception process for recipients and providers on its website.
Human review and faster denial timelines
A licensed physician, or a clinical peer for non‑physician requests, must make denial decisions under a physician medical director. If a denial questions medical necessity, your provider can ask to talk with the reviewer within three business days. After the talk, the agent must reply in one business day for urgent care or two business days for nonurgent care. Appeals must be reviewed by an independent, same or similar specialty physician with no financial interest, who considers all records and evidence.
No preapproval for emergencies and preventive care
Plans cannot require prior authorization for emergency confinement or emergency care. They also cannot require it for emergency transport or transfers required by EMTALA. Preventive services with a USPSTF grade A or B, ACIP‑recommended vaccines, and specified women’s preventive services do not need prior authorization.
Short, uniform prior authorization forms
The Department of Insurance approves one uniform PA form for drugs/devices and one for other services by November 1, 2025. Each form is no more than two printed pages. Starting January 1, 2026, providers use these forms and review agents must accept them. Agents may use a standard prior authorization API instead, with at least 90 days’ notice to providers.
Stronger protections after prior approval
Carriers must pay the contracted rate for care given under an approved authorization unless: fraud or material misrepresentation, the service was not covered that day, the provider was not contracted that day, filing was late, the patient was ineligible that day, or required authorization was missing. An authorization stays valid at least one year unless an FDA drug schedule is shorter, and it cannot be revoked for care delivered within 60 days of approval unless the patient was ineligible that day. For inpatient care, if your provider asks to continue on time and the reviewer does not answer before it expires, the carrier must keep paying until a decision; if a denial is overturned and no other legal action is pending, the carrier must reimburse at the contracted rate. When you change plans, the new plan must honor an existing authorization for at least 60 days after it gets the paperwork; authorizations also carry over within the same company, and new criteria do not change past approvals.
Transparent prior authorization rules and notices
Plan review agents must post prior authorization rules and clinical criteria on public websites and keep them current. By July 1, 2027, the rules must be searchable. Before a new or changed rule starts, the site must be updated and providers must get 60 days’ notice. If a denial or cancellation happens, your provider must get the reason and a citation to the criteria used.
No AI-only denials, disclosure and audits
An AI algorithm cannot be the only reason to deny, delay, or change care when medical necessity is at issue. If a plan uses AI in reviews, it must tell the Department of Insurance, your provider, you, and post it online. The Department can audit automated review systems and hire outside auditors. Review agents and medical reviewers cannot be paid based on how many denials they make or uphold.
Sponsors & Cosponsors
Sponsor
Eliot Bostar
Senate
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
legislature vote • 5/30/2025
Final Reading
Yes: 46 • No: 2
legislature vote • 5/15/2025
Vote
Yes: 41 • No: 0 • Other: 8
Actions Timeline
Approved by Governor on June 4, 2025
6/4/2025legislaturePresented to Governor on May 30, 2025
5/30/2025legislaturePresident/Speaker signed
5/30/2025legislaturePassed on Final Reading 46-2*-1
5/30/2025legislaturePlaced on Final Reading
5/27/2025legislatureAdvanced to Enrollment and Review for Engrossment
5/21/2025legislatureEnrollment and Review ER88 adopted
5/21/2025legislatureEnrollment and Review ER88 filed
5/19/2025legislaturePlaced on Select File with ER88
5/19/2025legislatureAdvanced to Enrollment and Review Initial
5/15/2025legislaturePlaced on General File
5/14/2025legislatureDate of introduction
5/14/2025legislature
Bill Text
Introduced
5/14/2025
Enrolled / Slip Law
Final / Enacted