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LEGISLATURE OF NEBRASKA
ONE HUNDRED NINTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 1222
Introduced by Prokop, 27; Bostar, 29.
Read first time January 21, 2026
Committee: Banking, Commerce and Insurance
A BILL FOR AN ACT relating to public health and welfare; to require1
insurance coverage of acquired brain injury services as prescribed;2
to define terms; to require an expedited appeal process; to provide3
duties for the Department of Insurance; and to require insurance and4
medicaid coverage for diagnostic testing and treatments or5
medications prescribed to slow the progression of Alzheimer's6
disease and related dementia. 7
Be it enacted by the people of the State of Nebraska,8
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Section 1. (1) No later than January 1, 2027, and notwithstanding1
section 44-3,131, (a) an individual or group sickness and accident2
insurance policy or subscriber contract delivered, issued for delivery,3
or renewed in this state and a hospital, medical, or surgical expense-4
incurred policy, except a policy that provides coverage for a specified5
disease or other limited-benefit coverage, and (b) a self-funded employee6
benefit plan to the extent not preempted by federal law shall provide7
coverage for medically necessary treatment related to, or as a result of,8
an acquired brain injury. 9
(2) Such coverage shall not include a lifetime limitation or annual10
limitation which is inconsistent with generally accepted standards of11
medical necessity or established clinical guidelines for brain injury12
rehabilitation. A limitation on inpatient rehabilitation services shall13
be separate from, and shall not be included in, a limitation on post-14
acute rehabilitation including outpatient day treatment, residential15
rehabilitation, or community reintegration. A limitation shall be16
separately stated by the insurer. The benefits in this section shall not17
be subject to a greater deductible, coinsurance, copayment, or out-of-18
pocket limit than any other benefit provided by the insurer under a19
comprehensive health insurance policy. 20
Sec. 2. For purposes of sections 1 to 3 of this act:21
(1) Acquired brain injury means an injury to the brain which occurs22
after birth and can be caused by an infectious disease, a metabolic23
disorder, an endocrine disorder, diminished oxygen, a brain tumor, a24
toxin, a disease that affects the blood supply to the brain, a stroke, or25
a traumatic brain injury; 26
(2) Adverse determination means a determination by a clinical peer27
reviewer, based on the clinical information provided, that an admission,28
extension of stay, or another covered acquired brain injury service is29
not medically necessary; 30
(3) Cognitive communication therapy means treatment that addresses31
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an individual's communication problems that have an underlying cause in1
one or more cognitive deficits rather than a deficit in primary language2
or speech; 3
(4) Cognitive rehabilitation therapy means a process of re-learning4
cognitive skills essential for daily living through coordinated,5
specialized, integrated therapeutic treatments that are provided in6
dynamic settings designed for efficient and effective re-learning7
following damage to brain cells or brain chemistry due to brain injury;8
(5) Community reintegration services means services that provide9
incremental guided real-world therapeutic training to develop skills10
essential for an individual to participate in life, re-enter employment,11
attend school and engage in other productive activity, safely live12
independently, and participate in the community while avoiding re-13
hospitalization and long-term support needs; 14
(6) Functional rehabilitation therapy means a structured approach15
that emphasizes learning by doing, and focuses re-learning a specific16
task in a prescribed format with maximum opportunity for repeated correct17
practice. Compensatory strategies are developed for each skill that is18
persistently impaired and each individual is trained on daily19
implementation. To ensure acquisition and use, focus is set on re-20
learning those skills essential for safe daily living in home and21
community-based settings; 22
(7) Insurer has the same meaning as defined in section 44-103;23
(8) Medical necessity or medically necessary treatment means24
services that are consistent with generally accepted principles of25
professional medical practice and includes, but is not limited to, (a)26
cognitive rehabilitation therapy; (b) cognitive communication therapy;27
(c) neurocognitive therapy and rehabilitation; (d) neurobehavioral,28
neurophysiological, and neuropsychological therapy and testing; (e)29
neurofeedback therapy; (f) functional rehabilitation therapy; (g)30
community reintegration services; (h) post-acute residential treatment31
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services; (i) inpatient services; (j) outpatient and day treatment1
services; and (k) home and community-based treatment;2
(9) Neurobehavioral therapy means a set of medical and therapeutic3
assessment and treatments focused on behavioral impairments associated4
with brain disease or injury and the amelioration of such impairments5
through the development of pro-social behavior; 6
(10) Neurocognitive therapy means treatment of a disorder in which7
the primary clinical deficit is in cognitive function that has not been8
present since birth and is a decline from a previously attained level of9
function; 10
(11) Neurofeedback therapy means a direct training of brain function11
to enhance self-regulatory capacity or an individual's ability to exert12
control over behavior, thoughts, and feelings. It is a form of13
biofeedback whereby a patient can learn to control brain activity that is14
measured and recorded by an electroencephalogram; 15
(12) Neuropsychological testing means the administration of a16
comprehensive battery of tests to evaluate neurocognitive, behavioral,17
and emotional strengths and weaknesses and their relationship to abnormal18
central nervous system functioning; and 19
(13) Post-acute residential treatment means integrated medical and20
therapeutic services, treatment, education, and skills-training provided21
in a home and community-based setting. Such treatment is designed to22
create the maximum opportunity for correct practice of the skill in the23
context of use to develop new neural pathways to enable the individual to24
avoid re-hospitalization and long-term care. 25
Sec. 3. (1) The Department of Insurance shall adopt and promulgate26
rules and regulations to implement sections 1 to 3 of this act and shall27
create a process to permit an expedited appeal of an adverse28
determination by an insurer for acquired brain injury services covered29
under section 1 of this act. An expedited appeal shall be resolved within30
five business days of the date such appeal is filed with the department.31
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Coverage for ongoing rehabilitation shall continue until such appeal is1
resolved if the treating clinician determines that the interruption of2
rehabilitation would risk regression. 3
(2) The department shall monitor compliance with sections 1 to 3 of4
this act and shall publish an annual report on its website that5
summarizes coverage determinations, coverage denials, and appeals related6
to the denial of coverage for acquired brain injury services required by7
section 1 of this act. 8
Sec. 4. No later than January 1, 2028, and notwithstanding section9
44-3,131, (a) any individual or group sickness and accident insurance10
policy or subscriber contract delivered, issued for delivery, or renewed11
in this state and any hospital, medical, or surgical expense-incurred12
policy, except for policies that provide coverage for a specified disease13
or other limited-benefit coverage, and (b) any self-funded employee14
benefit plan to the extent not preempted by federal law shall provide15
coverage for all medically necessary diagnostic testing and treatment or16
medication approved by the federal Food and Drug Administration17
prescribed to slow the progression of Alzheimer's disease or another18
related dementia. Coverage of the treatment and medication described in19
this section shall not be subject to step-therapy.20
Sec. 5. No later than January 1, 2028, the medical assistance21
program shall provide coverage for all medically necessary diagnostic22
testing and treatment or medication approved by the federal Food and Drug23
Administration prescribed to slow the progression of Alzheimer's disease24
or another related dementia. Coverage of the treatment and medication25
described in this section shall not be subject to step-therapy.26
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