Provide a duty to implement a prior authorization application programming interface under the Utilization Review Act

109th Legislature (2025-2026) Introduced by Merv Riepe

Nebraska LB 467 requires health insurers and utilization review entities to implement a uniform prior authorization API by Jan 1, 2028 (drugs exempt) per 45 C.F.R. 156.223(b).

Title printed. Carryover bill

Overview

Bill Number: LB 467

Title: Provide a duty to implement a prior authorization application programming interface under the Utilization Review Act

Introduced: January 21, 2025

Committee / Hearing: Banking, Commerce and Insurance; hearing date set for February 10, 2025

Status: Notice of hearing scheduled

LB 467 seeks to amend Nebraska’s Utilization Review Act to require health care payers and utilization review entities to implement and maintain an electronic prior authorization (PA) application programming interface (API) by January 1, 2028. The mandate aligns Nebraska’s standards with federal regulations, specifically 45 C.F.R. 156.223(b), as it existed on January 1, 2025. The requirement does not apply to prior authorization requests for drug coverage.

Purpose and Intent

Modernize the prior authorization process by mandating a standardized API to streamline electronic PA requests.

Align Nebraska law with federal interoperability requirements to reduce administrative burdens and improve processing times for PA requests.

Maintain a carve-out for prescription drug coverages, recognizing that drug PA processes may follow separate or existing pathways.

Key Provisions

Duty to Implement PA API:

Health carriers and utilization review agents must implement and maintain a prior authorization API in accordance with 45 C.F.R. 156.223(b) as it stood on January 1, 2025.

Effective Date:

The API requirement must be in place and operational by January 1, 2028.

Exemption for Drugs:

The API requirement does not apply to prior authorization requests for drug coverage.

Statutory Citation and Revisions:

Section 44-5416 of the Nebraska Revised Statutes (Utilization Review Act) is amended to accommodate the new API duty.
The act’s sections (44-5416 to 44-5431 and section 1 of this act) are referenced together under the Utilization Review Act.

Definitions:

“Drug” is defined to mirror 45 C.F.R. 156.221(b)(1)(v), as in effect on January 1, 2025.

Who Is Affected

Health Carriers: Health insurers or plans operating in Nebraska subject to the Utilization Review Act.

Utilization Review Agents: Entities performing utilization review for PA determinations.

End Users: Providers seeking PA determinations and, indirectly, patients whose PA requests flow through these systems.

Procedural and Timeline Details

Hearing Date: February 10, 2025, before the Banking, Commerce and Insurance Committee.

Implementation Timeline: By January 1, 2028, the PA API must be implemented and maintained.

Interplay with Federal Regulations: Compliance is tied to the specific federal regulation clarified as of January 1, 2025 (45 C.F.R. 156.223(b)).

Notes for Readers

The bill emphasizes interoperability and streamlined electronic PA requests.

The drug-coverage PA process is intentionally excluded from the API mandate.

As introduced, the bill would amend the Utilization Review Act to codify the API requirement and corresponding timelines.

If you’d like, I can provide a section-by-section map of the statute amendments or a side-by-side comparison with current law to highlight exact statutory changes.

Bill