Nebraska Gov. Jim Pillen has signed the Ensuring Transparency in Prior Authorization Act, which aims to overhaul the prior authorization process in the state by making prior auth requirements publicly available on insurers’ websites and ensuring that providers are given 60 days’ notice before any new requirements are implemented.
The new law, signed June 5, introduces a standard prior auth form for all insurers and allows the use of digital tools to simplify the process for providers.
The legislation mandates that any adverse prior auth decision be made by a physician and requires a peer-to-peer consultation when requested. Appeals will be reviewed by a physician from the same or a similar specialty, and AI cannot be the sole basis for denial decisions. The law also sets specific response times, with urgent requests needing to be addressed within 72 hours and non-urgent requests requiring a response within 7 days. In 2028, the timeframe for urgent requests will be reduced to 48 hours. If insurers fail to meet these deadlines, the prior auth request will automatically be approved.
The legislation also mandates that a prior auth approval be valid for up to a year in most cases. Approvals will follow a patient for 60 days if they switch health plans and the law will prohibit prior auth requirements for emergency services, emergency ground transportation, and common preventive services.
This law is effective January 1, 2026.
