LB917 LB917
2024 2024
LEGISLATURE OF NEBRASKA
ONE HUNDRED EIGHTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 917
Introduced by Wayne, 13.
Read first time January 04, 2024
Committee: Banking, Commerce and Insurance
1 A BILL FOR AN ACT relating to insurance; to define terms; to require the
2 establishment of a standard prior authorization process; to require
3 approval and use of prior authorization forms as prescribed; and to
4 provide certain response time requirements for prior authorization
5 requests.
6 Be it enacted by the people of the State of Nebraska,
-1-
LB917 LB917
2024 2024
1 Section 1. (1) For purposes of this section:
2 (a) Director means the Director of Insurance;
3 (b) Health benefit plan has the same meaning as in section 44-1303;
4 (c) Health care professional has the same meaning as in section
5 44-1303;
6 (d) Health care provider has the same meaning as in section 44-1303;
7 (e) Health carrier has the same meaning as in section 44-1303; and
8 (f) Pharmacy benefit manager has the same meaning as in section
9 44-4603.
10 (2) The director shall adopt and promulgate rules and regulations to
11 establish a standard prior authorization process. Such process shall meet
12 all of the following requirements:
13 (a) Health carriers and pharmacy benefit managers shall allow health
14 care providers to submit a prior authorization request electronically;
15 (b) Health carriers and pharmacy benefit managers shall provide that
16 approval of a prior authorization request shall be valid for a minimum
17 length of time in accordance with the rules and regulations adopted and
18 promulgated under this subsection. In setting such minimum time periods,
19 the director may consult with health care professionals who seek prior
20 authorization for particular types of drugs and, as the director
21 determines to be appropriate, negotiate standards for such minimum time
22 periods with individual health carriers and pharmacy benefit managers;
23 (c) Health carriers and pharmacy benefit managers shall make the
24 following available and accessible on their websites:
25 (i) Prior authorization requirements and restrictions, including a
26 list of drugs that require prior authorization;
27 (ii) Clinical criteria that are easily understandable to health care
28 providers, including clinical criteria for reauthorization of a
29 previously approved drug after the prior authorization period has
30 expired; and
31 (iii) Standards for submitting and considering requests, including
-2-
LB917 LB917
2024 2024
1 evidence-based guidelines, when possible, for making prior authorization
2 determinations; and
3 (d) Health carriers shall provide a process for health care
4 providers to appeal a prior authorization determination as provided in
5 the Health Carrier External Review Act. Pharmacy benefit managers shall
6 provide a process for health care providers to appeal a prior
7 authorization determination that is consistent with the process provided
8 in the Health Carrier External Review Act.
9 (3) In establishing a standard prior authorization process pursuant
10 to subsection (2) of this section, the director shall consider national
11 standards pertaining to electronic prior authorization, such as those
12 developed by the National Council for Prescription Drug Programs.
13 (4) The director shall adopt and promulgate rules and regulations to
14 establish a process, for use by each health carrier and pharmacy benefit
15 manager that requires prior authorization for prescription drug benefits
16 pursuant to a health benefit plan, to submit a single prior authorization
17 form for approval by the director. Such form shall be submitted by
18 January 1, 2025, and the submitting health carrier or pharmacy benefit
19 manager shall be required to use such form beginning on July 1, 2025. The
20 process shall provide that if a prior authorization form submitted to the
21 director by a health carrier or pharmacy benefit manager is not approved
22 or disapproved within thirty days after its receipt by the director, the
23 form shall be deemed approved.
24 (5) In order for a prior authorization form to be approved by the
25 director pursuant to subsection (4) of this section, such form shall:
26 (a) Not exceed two pages in length, except that a form may exceed
27 such length as determined to be appropriate by the director;
28 (b) Be available in electronic format; and
29 (c) Be transmissible in electronic format.
30 (6) Beginning on July 1, 2025, each health carrier and pharmacy
31 benefit manager shall use and accept the prior authorization form that
-3-
LB917 LB917
2024 2024
1 was submitted by that health carrier or pharmacy benefit manager and
2 approved for the use of that health carrier or pharmacy benefit manager
3 by the director pursuant to this section. Beginning on July 1, 2025,
4 health care providers shall use and submit the prior authorization form
5 that has been approved for the use of a health carrier or pharmacy
6 benefit manager, when prior authorization is required by a health benefit
7 plan.
8 (7) The director shall adopt and promulgate rules and regulations to
9 provide requirements, not to exceed seventy-two hours for urgent claims
10 and five calendar days for nonurgent claims, for a health carrier or
11 pharmacy benefit manager to respond to a health care provider's request
12 for prior authorization of prescription drug benefits or to request
13 additional information from a health care provider concerning such a
14 request.
-4-