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
5 provisions identified: 5 benefits, 0 costs, 0 mixed.
Biomarker testing covered starting 2028
Starting January 1, 2028, most Nebraska health plans and Medicaid cover biomarker testing when it helps diagnose, choose, or monitor treatment. Covered uses include cancer, autoimmune and autoinflammatory diseases, Parkinson’s, ALS, Alzheimer’s and related dementias, rheumatoid arthritis, preeclampsia, sickle cell anemia, cardiovascular conditions, transplants, and pharmacogenomics. The test must show clinical utility based on FDA labels or warnings, CMS coverage, or national medical guidelines or consensus statements. Plans and Medicaid must limit care disruptions, like extra biopsies. Plans must post an easy exception process on their websites, and Medicaid must provide an exception request process on the DHHS website.
No prior auth for emergencies and prevention
Emergency care and pre-hospital emergency transport do not require prior authorization. EMTALA-required transfers also do not need prior authorization. Preventive services rated A or B by the U.S. Preventive Services Task Force, ACIP-recommended vaccines, and women’s preventive services under federal rules are available without prior authorization.
Stronger protections for prior authorizations
The law sets firm decision deadlines. Urgent requests are decided within 72 hours (48 hours starting January 1, 2028); nonurgent within 7 days. If the agent misses the deadline, the service is treated as authorized. Approvals last at least one year (except some drugs with shorter FDA schedules) and stay valid for the approved inpatient length of stay. If a timely inpatient continuation request gets no answer before it expires, the carrier keeps paying at the contracted rate until a decision. Carriers must pay contracted rates for approved care unless defined issues apply (like fraud, noncoverage, noncontracted provider, missed filing, or ineligibility). When you switch plans, the new reviewer must honor your existing approval for at least 60 days once you show proof, and prior approvals remain valid when rules change or when you change products within the same insurer.
Human-led, fair reviews and appeals
A licensed physician or clinical peer with proper training must make any denial. The notice must say why and cite the criteria. Your provider can talk with the reviewer within three business days; after that, the agent must confirm the outcome within 1 business day for urgent care or 2 business days for nonurgent care. Appeals must be reviewed by a physician in the same or similar specialty, who was not involved before and has no financial stake, and who considers all pertinent records and medical literature. An AI tool cannot be the only reason to deny, delay, or change care when medical need is at issue. Agents must disclose AI use to the Insurance Department, providers, enrollees, and on their website; the Department can audit. Reviewers cannot be paid or penalized based on denial counts.
Simpler forms and clear PA rules
The state approves one short prior-authorization form for drugs and devices, and one for other services, by November 1, 2025. Each form is no more than two pages (supporting notes can be added). Starting January 1, 2026, providers use these forms and agents must accept them, unless the agent uses an approved electronic system and gives 90 days’ notice. Agents must post their prior-authorization rules and clinical criteria online and keep them current. The online rules must be searchable by July 1, 2027, and providers must get at least 60 days’ notice before new rules start.
Sponsors & Cosponsors
Sponsor
Eliot Bostar
legislature
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
6/6/2025legislaturePassed 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 ER88 adopted
5/21/2025legislatureAdvanced to Enrollment and Review for Engrossment
5/21/2025legislaturePlaced on Select File with ER88
5/19/2025legislatureEnrollment and Review ER88 filed
5/19/2025legislatureAdvanced to Enrollment and Review Initial
5/15/2025legislatureDate of introduction
5/14/2025legislaturePlaced on General File
5/14/2025legislature
Bill Text
Introduced
6/6/2025
Enrolled / Slip Law
Final / Enacted