(Lincoln, NE) – Yesterday, Nebraska Governor Jim Pillen signed the Ensuring Transparency in Prior Authorization Act (LB 77) into law. The new law reforms the prior authorization (PA) processes that require a patient’s health plan to approve a service or medication before it can be provided and seeks to streamline processes and increase transparency and accountability.

“Timely access to care is critical,” said Jeremy Nordquist, President of the Nebraska Hospital Association (NHA). “This new law will improve health care for patients across Nebraska and simplify the processes around receiving that care.”

The Nebraska Hospital Association, Nebraska Medical Association, and Blue Cross and Blue Shield of Nebraska collaborated on this critical legislation. Among the many reforms, the new law requires the use of a singular prior authorization form that can be no more than two pages in length. The law also prohibits prior authorization requirements for emergency services, emergency ground transportation, and preventative services.

“This legislation takes meaningful steps to address one of the most persistent and frustrating administrative barriers in medicine today,” said Dr. David Ingvoldstad, President of the Nebraska Medical Association. “These are commonsense reforms that will help physicians and other practitioners provide the care patients need.”

“We are committed to helping our members access safe, effective and affordable health care,” said Jeff Russell, BCBSNE’s president and CEO. “LB77 brings some standardization to prior authorization processes for all health insurers and makes things simpler and more straightforward for patients and providers. Our partnership with the Nebraska Hospital Association and the Nebraska Medical Association to seek consensus and find solutions demonstrates how being local and ‘of Nebraska’ makes a real difference.”

The Ensuring Transparency in Prior Authorization Act will:

Increase Transparency

  • PA requirements must be publicly available on insurance companies’ websites.
  • Requires 60 days’ notice to providers before implementing new PA requirements.

 Streamline Processes and Accountability

  • Creates a standard PA form for all health insurers.
  • Allows the use of digital tools and technology to streamline and simplify processes for both health care providers and insurers.
  • Adverse decisions on PA requests must be made by a physician and require a peer-to-peer consult when requested.
  • Requires appeals to be reviewed by a physician of the same or similar specialty.
  • Prohibits use of AI as the sole basis of a denial decision.

Require Response Times

  • 72 hours for urgent requests and 7 days for non-urgent. Beginning in 2028, urgent request timeframe is reduced to 48 hours.
  • If insurer fails to meet deadlines, PA request automatically approved.

Protect Patient’s Continuity of Care

  • A PA is valid for one year in most cases.
  • Approved prior authorizations can follow a patient for 60 days if they switch plans.

Prohibit Prior Authorizations Requirements for:

  • Emergency services
  • Emergency ground transportation
  • Common preventative services

“On behalf of Nebraska hospitals, we are grateful to Senator Eliot Bostar who carried this bill, our coalition partners, and to Governor Pillen for his support,” said Nordquist. “We look forward to continued collaboration to improve health care for patients in our state.”

 

 About
 The Nebraska Hospital Association is the trusted and influential voice for Nebraska’s hospitals and health systems. The NHA has a statewide membership of 92 member hospitals and over 50,000 employees. Through collaborative leadership, our members rely on the NHA for advocacy, data, education, and more to advance Nebraska hospitals’ ability to provide exceptional, quality care to Nebraska’s patients and communities. The NHA has been a vital part of our member hospitals’ missions since our founding in 1927.

The Nebraska Medical Association was founded in 1868 and represents nearly 3,000 active and retired physicians, residents, and medical students from across the state of Nebraska.

Blue Cross and Blue Shield of Nebraska is part of the Blue Cross and Blue Shield system, a national association of 33 independent, community-based and locally operated companies. Blue Cross and Blue Shield represents the nation’s largest and most experienced health insurance brands, collectively covering one in three Americans. Blue Cross and Blue Shield of Nebraska has been providing security and peace of mind to its members since 1939.