NMA Legislative Wins in 2025

As the 2025 legislative session began, it was clear it would be a challenging and important session for the NMA’s physician and medical student members. Leading up to the session, the NMA worked closely with physician leaders and other stakeholders to bring forward two ambitious proposals: (1) meaningful prior authorization reform and (2) a significant increase in Medicaid reimbursement rates. While those priorities remained a focus throughout the session, the NMA faced additional challenges when a dangerous direct-entry midwife proposal was introduced. These three topics—(1) prior authorization reform, (2) Medicaid reimbursement, and (3) midwives—shaped a busy and successful legislative session for the NMA.

Reforming Prior Authorization

In the final days of the session, the Legislature passed LB77, the Ensuring Transparency in Prior Authorization Act. Addressing prior authorization challenges and insurance barriers was among the NMA’s top legislative priorities in 2025. Over the last several years, the NMA has heard growing frustration with the endless administrative burden of prior authorization and concerns about the real, debilitating effects it is having on patients. The NMA championed LB77 in partnership with the Nebraska Hospital Association and Senator Eliot Bostar. LB77 addresses some of the top prior authorization challenges while improving transparency, accountability, efficiency, and continuity of care:

  • Health plans must make prior authorization requirements, including clinical criteria, readily accessible to enrollees and health care providers.
  • Adverse determinations must be made by a physician, cite the clinical criteria used to deny the request, and provide the requesting practitioner with an opportunity to contact the physician who made the determination.
  • Appeals must be reviewed by a physician of the same or similar specialty as a physician who typically manages the medical condition.
  • The Department of Insurance must develop standard prior authorization forms, not to exceed two pages, to be used by all health plans.
  • Health plans must respond to urgent prior authorization requests within 72 hours and non-urgent requests within 7 days. Beginning in 2028, plans must respond to urgent requests within 48 hours.
  • Prior authorization requirements are prohibited for emergency services, emergency ground transportation, and common preventative services.

LB77 becomes effective January 1, 2026.

Increasing Medicaid Reimbursement and Access to Care

On April 7, 2025, Governor Pillen signed LB527, the NMA’s “Medicaid Access and Quality Act” into law. This important legislation, which passed with broad support, represents a major step toward improving access to care for patients covered by Medicaid by addressing inadequate Medicaid reimbursement. For too long, inadequate Medicaid reimbursement rates have made it increasingly difficult for physicians and other practitioners to care for patients covered by Medicaid. In recent years, these challenges have been compounded by rising costs and staff shortages. While inadequate Medicaid reimbursement affects all specialties, it has reached a critical point for primary care, especially in rural areas. Access to these services is critical for some of our most vulnerable citizens, including pregnant patients, newborns, and children, approximately one-third of whom are covered by Medicaid.

Over the 2024 interim, the NMA worked diligently to create a sustainable and significant investment in Medicaid reimbursement for nonhospital providers, with the goal of improving access to quality care in urban and rural areas. Senator Mike Jacobsen agreed to introduce this bill to implement an HMO assessment that will, in turn, draw down federal funds to:

  • Enhance rates paid to nonhospital providers of physical health services, with the goal of attaining an overall 20% increase.
  • Include additional targeted increases for evaluation and management services, as well as labor and delivery services.
  • Provide an additional rate enhancement for physical health care services provided in rural areas.
  • Implement a primary care medical home program by providing at least a $75 monthly per-member fee to qualified primary care providers to serve as a primary care medical home for target populations.

Once implemented, LB527 will generate approximately $130 million in new, dedicated funding for broad-based increases to Medicaid reimbursement for physicians and other providers. Implementation of LB527 requires federal approval, and the NMA remains engaged with our partners at the state and federal levels to secure that approval as quickly as possible.

Maintaining Safe Standards for Maternity Care

Throughout the 2025 session, the NMA led the effort to stop a dangerous proposal to license direct-entry Certified Professional Midwives (CPMs) in Nebraska. Originally introduced as LB374, and later included in the committee amendment to LB676, the proposal would have given CPMs broad authority to provide labor and delivery care, including home deliveries, along with gynecological, postpartum, and newborn care—despite their minimal training requirements. NMA advocacy efforts were critical in educating senators on the dangers of this proposal, ultimately leading to defeat of an attempt to adopt the CPM licensure amendment to LB676.