Bill > LB77

This bill, known as the Ensuring Transparency in Prior Authorization Act, establishes comprehensive regulations for prior authorization processes in healthcare. The bill introduces detailed requirements for utilization review agents (insurance companies or their representatives) when reviewing and approving medical services, including mandating transparent and accessible prior authorization requirements, ensuring medical professionals make authorization decisions, and establishing clear timelines for decision-making. Key provisions include requiring utilization review agents to post their authorization criteria online, make decisions within specific timeframes (72 hours for urgent services and 7 days for non-urgent services), and prohibit basing compensation on the volume of service denials. The bill also includes a significant provision requiring insurance and Medicaid coverage of biomarker testing for various medical conditions, starting January 1, 2028, when the testing demonstrates clinical utility and is used for diagnosis, treatment, or monitoring of specific health conditions like cancer, autoimmune diseases, neurological disorders, and organ transplants. Additionally, the bill prevents artificial intelligence from being the sole basis for denying medical services and ensures that prior authorizations remain valid for at least one year, with some exceptions. These regulations aim to improve transparency, reduce administrative burdens, and ensure more patient-centered healthcare decision-making.

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https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=58825