Nebraska LB 77 (Ensuring Transparency in Prior Authorization Act)

Binding law — in force

AI may not be the sole basis to deny, delay or modify care; a physician or clinical peer makes adverse determinations (Nebraska LB 77)

From 2026-01-01, an artificial intelligence-based algorithm shall not be the sole basis of a utilization review agent's decision to deny, delay or modify health care services based in whole or in part on medical necessity (LB 77 sec. 12(1)), and the agent must ensure that all adverse determinations for prior authorization are made by a physician (or, where the requesting provider is not a physician, a clinical peer of that provider) holding a current nonrestricted U.S. licence, with appropriate training, knowledge or expertise, under the clinical direction of a medical director responsible for Nebraska enrollees (sec. 4(1)). Detect automated output that sets a denial, delay or modification without a physician's decision.

ne-lb77.ai-not-sole-basis-physician-decides · Nebraska LB 77, Sec. 12(1) · official source · jurisdictions: US-NE

The guard to add, and how far to trust this rule

Binding law — in force

Disclose AI use in utilization review to the Department, network providers, enrollees and the public website (Nebraska LB 77)

From 2026-01-01, a utilization review agent must disclose to the Department of Insurance, to each health care provider in its network, to each enrollee, and on its public website if artificial intelligence-based algorithms are used or will be used in the utilization review process (LB 77 sec. 12(2)); the Department may audit its automated utilization management system at any time (sec. 12(3)). Detect the absence of the four disclosures.

ne-lb77.ai-use-disclosure · Nebraska LB 77, Sec. 12(2) · official source · jurisdictions: US-NE

The guard to add, and how far to trust this rule