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--- version:As Introduced+++ version:(document, no version)@@ -1,958 +1,85 @@- A.B. 399+JOE LOMBARDO+Governor+STATE OF NEVADA+ DR. KRISTOPHER SANCHEZ+Director-- *AB399*+SCOTT J. KIPPER+Commissioner+DEPARTMENT OF BUSINESS AND INDUSTRY+DIVISION OF INSURANCE+1818 East College Pkwy., Suite 103+Carson City, Nevada 89706+(775) 687-0700 Fax (775) 687-0787+Website: doi.nv.gov+E-mail: insinfo@doi.nv.gov-ASSEMBLY BILL NO. 399–ASSEMBLYMEMBER EDGEWORTH+March 18, 2025-MARCH 11, 2025-____________+Assembly Committee on Commerce and Labor+Via email: AsmCL@asm.state.nv.us-Referred to Committee on Commerce and Labor+RE: Division of Insurance Testimony on AB 399-SUMMARY—Requires certain health insurance to cover certain-health care related to severe obesity. (BDR 57-657)+Chair Marzola and Members of the Assembly Committee on Commerce and Labor:-FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.- Effect on the State: Yes.+The Nevada Division of Insurance of the Department of Business and Industry is here today to testify neutral+on Assembly Bill 399 and clarify the bill’s applicability and effect.-CONTAINS UNFUNDED MANDATE (§ 13)-(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)+As previously provided in testimony to the Committee, federal law requires that States select a benchmark+health insurance plan defining the essential health benefits, or EHB, which must be covered by all applicable+health benefit plans sold in the individual and small group markets within each State.+1 Nevada’s EHB+benchmark plan is the 2017 Health Plan of Nevada HPN Solutions HMO Platinum plan (“Benchmark”).-~+The Evidence of Coverage for the Benchmark provides at Section 6.25, page 20,2 that gastric restrictive+surgical services are a covered benefit, subject to limitations. A plan enrollee must:+• Have a body mass index of greater than 40; or+• Have a body mass index of greater than 35 with significant co-morbidities; and+• Provide documented evidence that dietary attempts at weight control are ineffective; and+• Be at least 18 years old.+Additional documentation and clinical evidence will also be required.-EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.+1 42 U.S.C. § 18022+2 Nevada Division of Insurance, accessed March 18, 2025 htps://doi.nv.gov/uploadedFiles/doinvgov/_public-+documents/Healthcare-Reform/2017%20Evidence%20of%20Coverage.pdf+By virtue of its inclusion in the Benchmark, gastric restrictive surgical services that are no more restrictive than+those in the Benchmark must be provided by all commercial plans sold in the individual and small group+markets in Nevada. Any enrollee who experiences otherwise is encouraged to contact the Division’s Consumer+Services section at our toll-free number, (888) 872-3234, or online at doi.nv.gov.-AN ACT relating to insurance; requiring that certain policies of-health insurance include coverage for certain health care-to treat and care for diseases and conditions caused by-severe obesity; and providing other matters proper ly-relating thereto.-Legislative Counsel’s Digest:- Existing law requires public and private policies of insurance regulated under 1-Nevada law to include certain coverage. (NRS 287.01 0, 287.04335, 422.27172 -2-422.272428, 689A.04033 -689A.0465, 689B.0303 -689B.0379, 689C.1652 -3-689C.169, 689C.194, 689C.1945, 689C.195, 689C.425, 695A.184 -695A.1875, 4-695A.265, 695B.1901 -695B.1948, 695C.050, 695C.1691 -695C.176, 695G.162 -5-695G.177) Existing law also require s employers to provide certain benefits for 6-health care to emplo yees, including the coverage required of health insurers, if the 7-employer provides health benefits for its employees. (NRS 608.1555) 8- Sections 1, 3-9, 11 and 13-15 of this bill require that certain public and private 9-policies of health insurance and health plans, including Medicaid, include 10-medically necessary treatment and care , including bariatric surgery, for diseases 11-and conditions caused by severe obesit y under certain circumstances and with 12-certain restrictions. Sections 1, 3-9, 11 and 13-15 exclude from this required 13-coverage drugs for weight loss. Section 2 of this bill authorizes the Commissioner 14-of Insurance to require that certain policies of health insurance issued by a domestic 15-insurer to a person who resides in another state include the coverage required by 16-section 1. Section 10 of this bill authorizes the Commissioner to suspend or revoke 17-the certificate of a healt h maintenance organization that fails to comply with the 18-requirements of section 8. The Commissioner would also be authorized to take 19-such actions against other health insurers who fail to comply with the requirements 20-of sections 1, 3-7, 9 and 11. (NRS 680A.200) Section 12 of this bill requires the 21+Assembly Bill 399 codifies a requirement that certain health benefit plans or policies of insurance provide+medically necessary coverage bariatric surgery. The coverage required by the bill is subject to the following+requirements:+• The enrollee must have a body mass index of 40 or higher; or+• The enrollee must have a body mass index of 35 or higher with an associated comorbidity; and+• The enrollee must provide documented evidence that dietary attempts at weight control are+ineffective; and+• The enrollee must be at least 18 years old.+The bill also imposes additional restrictions on the manner in which the surgery is provided and the number of+lifetime surgeries the enrollee is entitled to.- – 2 –+Assembly Bill 399 would make changes to the following chapters of the Nevada Revised Statutes:+• Chapter 689A – Individual Health Insurance;+• Chapter 689B – Group and Blanket Health Insurance;+• Chapter 689C – Health Insurance for Small Employers;+• Chapter 695A – Fraternal Benefit Societies;+• Chapter 695B – Nonprofit Corporations for Hospital, Medical and Dental Service;+• Chapter 695C – Health Maintenance Organizations; and+• Chapter 695G – Managed Care.+Because the provisions of Assembly Bill 399 essentially mirror those of the Benchmark, Assembly Bill 399 as+introduced will have no practical effect on policies subject to chapters 689A and 689C of NRS as well as+policies issued pursuant to chapters 695B, 695C and 695G and covering enrollees in the individual or small+group markets; these plans are required to offer identical coverage by virtue of its inclusion in the Benchmark.+The Division’s review of Assembly Bill 399 indicates that only plans offered to large groups pursuant to 689B,+695A, 695B, 695C and 695G would be affected by the bill.-- *AB399*-Director of the Department of Health and Human Services to administer section 15 22-in the same manner as other provisions governing Medicaid. 23+Concerning federal defrayal, defrayal provisions are only triggered when a state-mandated benefit affects+Qualified Health Plans sold in the individual market. Since the provisions of Assembly Bill 399 mirror those of+the Benchmark the Division concludes that Assembly Bill 399 does not trigger federal defrayal as introduced.-THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN-SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:+As always, the Division is available for any questions the Committee may have.- Section 1. Chapter 689A of NRS is hereby amended by 1-adding thereto a new section to read as follows: 2- 1. Subject to the limitation s authorized by this section, a n 3-insurer that offers or issues a policy of health insurance shall 4-include in the policy coverage for medically necessary treatment 5-and care for diseases and conditions caused by severe obesity, 6-including, without limitation: 7- (a) Medically necessary bariatric surgery for an insured who is 8-18 years of age or older; and 9- (b) Related preoperative and postoperative services, including, 10-without limitation, psy chological screening, counseling, behavior 11-modification, physical therapy and nutritional education. 12- 2. As conditions of providing coverage for bariatric surgery 13-pursuant to subsection 1, an insurer may require: 14- (a) An insured to successfully complete a preoperative period 15-of not more than 3 months that includes services recommended by 16-the American Society for Metabolic and Bariatric Surgery , or its 17-successor organization; and 18- (b) That the bariatric surgery be performed in a medical 19-facility that holds Metabolic and Bariatric Surgery Accreditation 20-issued by the American College of Surgeons , or its successor 21-organization. 22- 3. An insurer may l imit coverage for bariatric surgery and 23-related preoperative and postoperative services to not more than 24-one such surgery per lifetime. 25- 4. An insurer may require the physician seeking coverage for 26-bariatric surgery pursuant to subsection 1 to provide a written 27-statement to the insurer that the treatment prescribed is medically 28-necessary and will be provided in accordance with the American 29-Society for Metabolic and Bariatric S urgery, or its successor 30-organization, or the American College of Surgeons , or its 31-successor organization. 32- 5. This section does not require a policy of health insurance 33-to include coverage for any drug that is injected to lower glucose 34-levels or any other drug prescribed for weight loss. 35- 6. A policy of health insurance subject to the provisions of 36-this chapter which is delivered, issued for delivery or renewed on 37-or after January 1, 2026, has the legal effect of including the 38-- – 3 –--- *AB399*-coverage required by this section and any provision of the policy 1-which is in conflict with this section is void. 2- 7. As used in this section: 3- (a) “Medical facility” has the meaning ascribed to it in 4-NRS 449.0151. 5- (b) “Medically necessary” means health care services or 6-products that a prudent physician would provide to a patient to 7-prevent, diagnose or treat an illness, injury or disease or any 8-symptom thereof, that are necessary and: 9- (1) Provided in accordance wi th generally accepted 10-standards of medical practice; 11- (2) Clinically appropriate with regard to type, frequency, 12-extent, location and duration; 13- (3) Not primarily provided for the convenience of the 14-patient, physician or other provider of health care; 15- (4) Required to improve a specific health condition of an 16-insured or to preserve the existing state of health of the insured; 17-and 18- (5) The most clinically appropriate level of health care that 19-may be safely provided to the insured. 20- (c) “Provider of health care” has the meaning ascribed to it in 21-NRS 629.031. 22- (d) “Severe obesity” means: 23- (1) A body mass index of 40 or higher; or 24- (2) A body mass index of 35 or higher with an associated 25-comorbidity, which may include, without limitation, hypertension, 26-cardiopulmonary conditions, sleep apnea or diabetes. 27- Sec. 2. NRS 689A.330 is hereby amended to read as follows: 28- 689A.330 If any policy is issued by a domestic insurer for 29-delivery to a person residing in another state, and if the insurance 30-commissioner or corresponding public officer of that other state has 31-informed the Commissioner that the policy is not subject to approval 32-or disapproval by that officer, the Commissioner may by ruling 33-require that the policy meet the standards set forth in NRS 689A.030 34-to 689A.320, inclusive [.] , and section 1 of this act. 35- Sec. 3. Chapter 6 89B of NRS is hereby amended by adding 36-thereto a new section to read as follows: 37- 1. Subject to the limitation s authorized by this section, a n 38-insurer that offers or issues a policy of group health insurance 39-shall include in the policy coverage for medically necessary 40-treatment and care for diseases and conditions caused by severe 41-obesity, including, without limitation: 42- (a) Medically necessary bariatric surgery for an insured who is 43-18 years of age or older; and 44-- – 4 –--- *AB399*- (b) Related preoperative and postop erative services, including, 1-without limitation, psychological screening, counseling, behavior 2-modification, physical therapy and nutritional education. 3- 2. As conditions of providing coverage for bariatric surgery 4-pursuant to subsection 1, an insurer may require: 5- (a) An insured to successfully complete a preoperative period 6-of not more than 3 months that includes services recommended by 7-the American Society for Metabolic and Bariatric Surgery , or its 8-successor organization; and 9- (b) That the bariatric su rgery be performed in a medical 10-facility that holds Metabolic and Bariatric Surgery Accreditation 11-issued by the American College of Surgeons , or its successor 12-organization. 13- 3. An insurer may limit coverage for bariatric surgery and 14-related preoperative a nd postoperative services to not more than 15-one such surgery per lifetime. 16- 4. An insurer may require the physician seeking coverage for 17-bariatric surgery pursuant to subsection 1 to provide a written 18-statement to the insurer that the treatment is medicall y necessary 19-and will be provided in accordance with the American Society for 20-Metabolic and Bariatric S urgery, or its successor organization, or 21-the American College of Surgeons, or its successor organization. 22- 5. This section does not require a policy of group health 23-insurance to include coverage for any drug that is injected to 24-lower glucose levels or any other drug prescribed for weight loss. 25- 6. A policy of group health insurance subject to the 26-provisions of this chapter which is delivered, issued for delivery or 27-renewed on or after January 1, 2026, has the legal effect of 28-including the coverage required by this section and any provision 29-of the policy which is in conflict with this section is void. 30- 7. As used in this section: 31- (a) “Medical facility” h as the meaning ascribed to it in 32-NRS 449.0151. 33- (b) “Medically necessary” means health care services or 34-products that a prudent physician would provide to a patient to 35-prevent, diagnose or treat an illness, injury or disease or any 36-symptom thereof, that are necessary and: 37- (1) Provided in accordance with generally accepted 38-standards of medical practice; 39- (2) Clinically appropriate with regard to type, frequency, 40-extent, location and duration; 41- (3) Not primarily provided for the convenience of the 42-patient, physician or other provider of health care; 43-- – 5 –--- *AB399*- (4) Required to improve a specific health condition of an 1-insured or to preserve the existing state of health of the insured; 2-and 3- (5) The most clinically appropriate level of health care that 4-may be safely provided to the insured. 5- (c) “Provider of health care” has the meaning ascribed to it in 6-NRS 629.031. 7- (d) “Severe obesity” means: 8- (1) A body mass index of 40 or higher; or 9- (2) A body mass index of 35 or higher with an associated 10-comorbidity, which may include, without limitation , hypertension, 11-cardiopulmonary conditions, sleep apnea or diabetes. 12- Sec. 4. Chapter 689C of NRS is hereby amended by adding 13-thereto a new section to read as follows: 14- 1. Subject to the limitations authorized by this section, a 15-carrier that offers or issues a health benefit plan shall include in 16-the plan coverage for medically necessary treatment and care for 17-diseases and conditions caused by severe obesity, including, 18-without limitation: 19- (a) Medically necessary bariatric surgery for an insured who is 20-18 years of age or older; and 21- (b) Related preoperative and postoperative services, including, 22-without limitation, psych ological screening, counseling, behavior 23-modification, physical therapy and nutritional education. 24- 2. As conditions of providing coverage for bariatric surgery 25-pursuant to subsection 1, a carrier may require: 26- (a) An insured to successfully complete a preoperative period 27-of not more than 3 months that includes services recommended by 28-the American Society for Metabolic and Bariatric Surgery , or its 29-successor organization; and 30- (b) That the bariatric surgery be performed in a medical 31-facility that holds Metabolic and Bariatric Surgery Accreditation 32-issued by the American Col lege of Surgeons , or its successor 33-organization. 34- 3. A carrier may limit coverage for bariatric surgery and 35-related preoperative and postoperative services to not more than 36-one such surgery per lifetime. 37- 4. A carrier may require the physician seeking co verage for 38-bariatric surgery pursuant to subsection 1 to provide a written 39-statement to the carrier that the treatment prescribed is medically 40-necessary and will be provided in accordance with the American 41-Society for Metabolic and Bariatric S urgery, or it s successor 42-organization, or the American College of Surgeons , or its 43-successor organization. 44-- – 6 –--- *AB399*- 5. This section does not require a health benefit plan to 1-include coverage for any drug that is injected to lower glucose 2-levels or any other drug prescribed for weight loss. 3- 6. A health benefit plan subject to the provisions of this 4-chapter which is delivered, issued for delivery or renewed on or 5-after January 1, 2026, has the legal effect of including the 6-coverage required by this section and any provision of the plan 7-which is in conflict with this section is void. 8- 7. As used in this section: 9- (a) “Medical facility” has the meaning ascribed to it in 10-NRS 449.0151. 11- (b) “Medically necessary” means health care services or 12-products that a prudent physician wou ld provide to a patient to 13-prevent, diagnose or treat an illness, injury or disease or any 14-symptom thereof, that are necessary and: 15- (1) Provided in accordance with generally accepted 16-standards of medical practice; 17- (2) Clinically appropriate with regard to type, frequency, 18-extent, location and duration; 19- (3) Not primarily provided for the convenience of the 20-patient, physician or other provider of health care; 21- (4) Required to improve a specific health condition of an 22-insured or to preserve the existing state of health of the insured; 23-and 24- (5) The most clinically appropriate level of health care that 25-may be safely provided to the insured. 26- (c) “Provider of health care” has the meaning ascribed to it in 27-NRS 629.031. 28- (d) “Severe obesity” means: 29- (1) A body mass index of 40 or higher; or 30- (2) A body mass index of 35 or higher with an associated 31-comorbidity, which may include, without limitation , hypertension, 32-cardiopulmonary conditions, sleep apnea or diabetes. 33- Sec. 5. NRS 689C.425 is hereby amended to read as follows: 34- 689C.425 A voluntary purchasing group and any contract 35-issued to such a group pursuant to NRS 689C.360 to 689C.600, 36-inclusive, are subject to the provisions of NRS 689C.015 to 37-689C.355, inclusive, and se ction 4 of this act to the extent 38-applicable and not in conflict with the express provisions of NRS 39-687B.408 and 689C.360 to 689C.600, inclusive. 40- Sec. 6. Chapter 695A of NRS is hereby amended by adding 41-thereto a new section to read as follows: 42- 1. Subject to the limitation s authorized by this section, a 43-society that offers or issues a benefit contract shall include in the 44-contract coverage for medically necessary treatment and care for 45-- – 7 –--- *AB399*-diseases and conditions caused by severe obesity, including, 1-without limitation: 2- (a) Medically necessary bariatric surgery for an insured who is 3-18 years of age or older; and 4- (b) Related preoperative and postoperative services, including, 5-without limitation, psychological screening, counseling, behavior 6-modification, physical therapy and nutritional education. 7- 2. As conditions of providing coverage for bariatric surgery 8-pursuant to subsection 1, a society may require: 9- (a) An insured to successfully complete a preoperative period 10-of not more than 3 months that includes services recommended by 11-the American Society for Metabolic and Bariatric Surgery , or its 12-successor organization; and 13- (b) That the bariatric surgery be performed in a medical 14-facility that holds Metabolic and Bariatric Surgery Accreditation 15-issued by the American College of Surgeons , or its successor 16-organization. 17- 3. A society may limit coverage for bariatric surgery an d 18-related preoperative and postoperative services to not more than 19-one such surgery per lifetime. 20- 4. A society may require the physician seeking coverage for 21-bariatric surgery pursuant to subsection 1 to provide a written 22-statement to the society that th e treatment is medically necessary 23-and will be provided in accordance with the American Society for 24-Metabolic and Bariatric S urgery, or its successor organization, or 25-the American College of Surgeons, or its successor organization. 26- 5. This section does n ot require a benefit contract to include 27-coverage for any drug that is injected to lower glucose levels or 28-any other drug prescribed for weight loss. 29- 6. A benefit contract subject to the provisions of this chapter 30-which is delivered, issued for delivery or renewed on or after 31-January 1, 2026, has the legal effect of including the coverage 32-required by this section and any provision of the contract which is 33-in conflict with this section is void. 34- 7. As used in this section: 35- (a) “Medical facility” has the meaning ascribed to it in 36-NRS 449.0151. 37- (b) “Medically necessary” means health care services or 38-products that a prudent physician would provide to a patient to 39-prevent, diagnose or treat an illness, injury or disease or any 40-symptom thereof, that are necessary and: 41- (1) Provided in accordance with generally accepted 42-standards of medical practice; 43- (2) Clinically appropriate with regard to type, frequency, 44-extent, location and duration; 45-- – 8 –--- *AB399*- (3) Not primarily provided for the convenience of the 1-patient, physician or other provider of health care; 2- (4) Required to improve a specific health condition of an 3-insured or to preserve the existing state of health of the insured; 4-and 5- (5) The most clinically appropriate level of health care that 6-may be safely provided to the insured. 7- (c) “Provider of health care” has the meaning ascribed to it in 8-NRS 629.031. 9- (d) “Severe obesity” means: 10- (1) A body mass index of 40 or higher; or 11- (2) A body mass index of 35 or higher with an associated 12-comorbidity, which may inc lude, without limitation, hypertension, 13-cardiopulmonary conditions, sleep apnea or diabetes. 14- Sec. 7. Chapter 695B of NRS is hereby amended by adding 15-thereto a new section to read as follows: 16- 1. Subject to the limitation s authorized by this section, a 17-hospital or medical services corporation that offers or issues a 18-policy of health insurance shall include in the policy coverage for 19-medically necessary treatment and care for diseases and 20-conditions caused by severe obesity, including, without limitation: 21- (a) Medically necessary bariatric surgery for an insured who is 22-18 years of age or older; and 23- (b) Related preoperative and postoperative services, including, 24-without limitation, psychological screening, counseling, behavi or 25-modification, physical therapy and nutritional education. 26- 2. As conditions of providing coverage for bariatric surgery 27-pursuant to subsection 1 , a hospital or medical services 28-corporation may require: 29- (a) An insured to successfully complete a preoper ative period 30-of not more than 3 months that includes services recommended by 31-the American Society for Metabolic and Bariatric Surgery , or its 32-successor organization; and 33- (b) That the bariatric surgery be performed in a medical 34-facility that holds Metabolic and Bariatric Surgery Accreditation 35-issued by the American College of Surgeons , or its successor 36-organization. 37- 3. A hospital or medical service s corporation may limit 38-coverage for bariatric surgery and related preoperative and 39-postoperative services to not more than one such surgery per 40-lifetime. 41- 4. A hospital or medical services corporation may require the 42-physician seeking coverage for bariatric surgery pursuant to 43-subsection 1 to provide a written statement to the hospital or 44-medical services corporation that the treatment is medically 45-- – 9 –--- *AB399*-necessary and will be provided in accordance with the Amer ican 1-Society for Metabolic and Bariatric S urgery, or its successor 2-organization, or the American College of Surgeons , or its 3-successor organization. 4- 5. This section does not require a policy of health insurance 5-to include coverage for any drug that is in jected to lower glucose 6-levels or any other drug prescribed for weight loss. 7- 6. A policy of health insurance subject to the provisions of 8-this chapter which is delivered, issued for delivery or renewed on 9-or after January 1, 2026, has the legal effect of including the 10-coverage required by this section and any provision of the policy 11-which is in conflict with this section is void. 12- 7. As used in this section: 13- (a) “Medical facility” has the meaning ascribed to it in 14-NRS 449.0151. 15- (b) “Medically necessary ” means health care services or 16-products that a prudent physician would provide to a patient to 17-prevent, diagnose or treat an illness, injury or disease or any 18-symptom thereof, that are necessary and: 19- (1) Provided in accordance with generally accepted 20-standards of medical practice; 21- (2) Clinically appropriate with regard to type, frequency, 22-extent, location and duration; 23- (3) Not primarily provided for the convenience of the 24-patient, physician or other provider of health care; 25- (4) Required to improve a specific health condition of an 26-insured or to preserve the existing state of health of the insured; 27-and 28- (5) The most clinically appropriate level of health care that 29-may be safely provided to the insured. 30- (c) “Provider of health care” has the meaning ascribed to it in 31-NRS 629.031. 32- (d) “Severe obesity” means: 33- (1) A body mass index of 40 or higher; or 34- (2) A body mass index of 35 or higher with an associated 35-comorbidity, which may include, without limitation, hypertension, 36-cardiopulmonary conditions, sleep apnea or diabetes. 37- Sec. 8. Chapter 695C of NRS is hereby amended by adding 38-thereto a new section to read as follows: 39- 1. Subject to the limitation s authorized by this section, a 40-health maintenance organization that offers or issues a health 41-care plan shall include in the plan coverage for medically 42-necessary treatment and care for diseases and conditions caused 43-by severe obesity, including, without limitation: 44-- – 10 –--- *AB399*- (a) Medically necessary bariatric surgery for an enrollee who 1-is 18 years of age or older; and 2- (b) Related preoperative and postoperative services, including, 3-without limitation, psychological screening, counseling, behavior 4-modification, physical therapy and nutritional education. 5- 2. As conditions of providing coverage for bariatric surgery 6-pursuant to subsection 1 , a health maintenance organization may 7-require: 8- (a) An enrollee to successfully complete a preoperative period 9-of not more than 3 months that includes servic es recommended by 10-the American Society for Metabolic and Bariatric Surgery , or its 11-successor organization; and 12- (b) That the bariatric surgery be performed in a medical 13-facility that holds Metabolic and Bariatric Surgery Accreditation 14-issued by the American College of Surgeons , or its successor 15-organization. 16- 3. A health maintenance organization may limit coverage for 17-bariatric surgery and related preoperative and postoperative 18-services to not more than one such surgery per lifetime. 19- 4. A health maintena nce organization may require the 20-physician seeking coverage for bariatric surgery pursuant to 21-subsection 1 to provide a written statement to the health 22-maintenance organization that the treatment is medically 23-necessary and will be provided in accordance wi th the American 24-Society for Metabolic and Bariatric S urgery, or its successor 25-organization, or the American College of Surgeons , or its 26-successor organization. 27- 5. This section does not require a health care plan to include 28-coverage for any drug that is injected to lower glucose levels or 29-any other drug prescribed for weight loss. 30- 6. A health care plan subject to the provisions of this chapter 31-which is delivered, issued for delivery or renewed on or after 32-January 1, 2026, has the legal effect of including the coverage 33-required by this section and any provision of the plan which is in 34-conflict with this section is void. 35- 7. As used in this section: 36- (a) “Medical facility” has the meaning ascribed to it in 37-NRS 449.0151. 38- (b) “Medically necessary” means health care services or 39-products that a prudent physician would provide to a patient to 40-prevent, diagnose or treat an illness, injury or disease or any 41-symptom thereof, that are necessary and: 42- (1) Provided in accordance with generally ac cepted 43-standards of medical practice; 44-- – 11 –--- *AB399*- (2) Clinically appropriate with regard to type, frequency, 1-extent, location and duration; 2- (3) Not primarily provided for the convenience of the 3-patient, physician or other provider of health care; 4- (4) Required to improve a specific health condition of an 5-enrollee or to preserve the existing state of health of the enrollee; 6-and 7- (5) The most clinically appropriate level of health care that 8-may be safely provided to the enrollee. 9- (c) “Provider of health care” has the meaning ascribed to it in 10-NRS 629.031. 11- (d) “Severe obesity” means: 12- (1) A body mass index of 40 or higher; or 13- (2) A body mass index of 35 or higher with an associated 14-comorbidity, which may include, without limitation, hypertension, 15-cardiopulmonary conditions, sleep apnea or diabetes. 16- Sec. 9. NRS 695C.050 is hereby amended to read as follows: 17- 695C.050 1. Except as otherwise provided in this chapter or 18-in specific provisions of this title, the provisions of this title are not 19-applicable to any health maintenance organization granted a 20-certificate of authority under this chapter. This provision does not 21-apply to an insurer licensed and regulated pursuant to this title 22-except with respect to its activities as a heal th maintenance 23-organization authorized and regulated pursuant to this chapter. 24- 2. Solicitation of enrollees by a health maintenance 25-organization granted a certificate of authority, or its representatives, 26-must not be construed to violate any provision of law relating to 27-solicitation or advertising by practitioners of a healing art. 28- 3. Any health maintenance organization authorized under this 29-chapter shall not be deemed to be practicing medicine and is exempt 30-from the provisions of chapter 630 of NRS. 31- 4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 32-695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 33-695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 34-695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 35-inclusive, and 695C.265 do not ap ply to a health maintenance 36-organization that provides health care services through managed 37-care to recipients of Medicaid under the State Plan for Medicaid or 38-insurance pursuant to the Children’s Health Insurance Program 39-pursuant to a contract with the Di vision of Health Care Financing 40-and Policy of the Department of Health and Human Services. This 41-subsection does not exempt a health maintenance organization from 42-any provision of this chapter for services provided pursuant to any 43-other contract. 44-- – 12 –--- *AB399*- 5. The p rovisions of NRS 695C.16932 to 695C.1699, 1-inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 2-695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, 3-inclusive, and section 8 of this act, 695C.1757 and 695C.204 apply 4-to a health maintenance organization that provides health care 5-services through managed care to recipients of Medicaid under the 6-State Plan for Medicaid. 7- 6. The provisions of NRS 695C.17095 do not apply to a health 8-maintenance organization that provides health care services to 9-members of the Public Employees’ Benefits Program. This 10-subsection does not exempt a health maintenance organization from 11-any provision of this chapter for services provided pursuant to any 12-other contract. 13- 7. The provisions of NRS 695C.1735 do not apply to a health 14-maintenance organization that provides health care services to: 15- (a) The officers and employees, and the dependents of officers 16-and employees, of the governing body of any county, school district, 17-municipal corporation, political subdivision, public corporation or 18-other local governmental agency of this State; or 19- (b) Members of the Public Employees’ Benefits Program. 20- This subsection does not exempt a h ealth maintenance 21-organization from any provision of this chapter for services 22-provided pursuant to any other contract. 23- Sec. 10. NRS 695C.330 is hereby amended to read as follows: 24- 695C.330 1. The Commissioner may suspend or revoke any 25-certificate of authority issued to a health maintenance organization 26-pursuant to the provisions of this chapter if the Commissioner finds 27-that any of the following conditions exist: 28- (a) The health maintenance organization is operating 29-significantly in contravention of its basic organizational document, 30-its health care plan or in a manner contrary to that described in and 31-reasonably inferred from any other information submitted pursuant 32-to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 33-to those submissions have been filed with and approved by the 34-Commissioner; 35- (b) The health maintenance organization issues evidence of 36-coverage or uses a schedule of charges for health care services 37-which do not comply with the requirements of NRS 6 95C.1691 to 38-695C.200, inclusive, and section 8 of this act, 695C.204 or 39-695C.207; 40- (c) The health care plan does not furnish comprehensive health 41-care services as provided for in NRS 695C.060; 42- (d) The Commissioner certifies that the health maintenance 43-organization: 44-- – 13 –--- *AB399*- (1) Does not meet the requirements of subsection 1 of 1-NRS 695C.080; or 2- (2) Is unable to fulfill its obligations to furnish health care 3-services as required under its health care plan; 4- (e) The health maintenance organization is no longer financially 5-responsible and may reasonably be expected to be unable to meet its 6-obligations to enrollees or prospective enrollees; 7- (f) The health mainte nance organization has failed to put into 8-effect a mechanism affording the enrollees an opportunity to 9-participate in matters relating to the content of programs pursuant to 10-NRS 695C.110; 11- (g) The health maintenance organization has failed to put into 12-effect the system required by NRS 695C.260 for: 13- (1) Resolving complaints in a manner reasonably to dispose 14-of valid complaints; and 15- (2) Conducting external reviews of adverse determinations 16-that comply with the provisions of NRS 695G.241 to 695G.310, 17-inclusive; 18- (h) The health maintenance organization or any person on its 19-behalf has advertised or merchandised its services in an untrue, 20-misrepresentative, misleading, deceptive or unfair manner; 21- (i) The continued operation of the health maintenance 22-organization would be hazardous to its enrollees or creditors or to 23-the general public; 24- (j) The health maintenance organization fails to provide the 25-coverage required by NRS 695C.1691; or 26- (k) The health maintenance organization has otherwise failed to 27-comply substantially with the provisions of this chapter. 28- 2. A certificate of authority must be suspended or revoked only 29-after compliance with the requirements of NRS 695C.340. 30- 3. If the certificate of authority of a health maintenance 31-organization is suspended, the health maintenance organization shall 32-not, during the period of that suspension, enroll any additional 33-groups or new individual contracts, unless those groups or persons 34-were contracted for before the date of suspension. 35- 4. If the certificate of authority of a health maintenance 36-organization is revoked, the organization shall proceed, immediately 37-following the effective date of the order of revocation, to wind up its 38-affairs and shall conduct no further business except as may be 39-essential to the orderly conclusion of the affairs of the organization. 40-It shall engage in no further advertising or solicitation of any kind. 41-The Commissioner may, by written order, permit such further 42-operation of the organization as the Commissioner may find to be in 43-the best interest of enrollees to the end that enrollees are afforded 44-- – 14 –--- *AB399*-the greatest practical opportunity to obtain continuing coverage for 1-health care. 2- Sec. 11. Chapter 695G of NRS is hereby amended by adding 3-thereto a new section to read as follows: 4- 1. Subject to the limitation s authorized by this section, a 5-managed care organization that offers or issues a health care plan 6-shall include in the plan coverage for medically necessary 7-treatment and care for diseases and condit ions caused by severe 8-obesity, including, without limitation: 9- (a) Medically necessary bariatric surgery for an insured who is 10-18 years of age or older; and 11- (b) Related preoperative and postoperative services, including, 12-without limitation, psychological screening, counseling, behavior 13-modification, physical therapy and nutritional education. 14- 2. As conditions of providing coverage for a bariatric surgery 15-pursuant to subsection 1 , a managed care organization may 16-require: 17- (a) An insured to successfully complete a preoperative period 18-of not more than 3 months that includes services recommended by 19-the American Society for Metabolic and Bariatric Surgery , or its 20-successor organization; and 21- (b) That the bariatric surgery be performed in a medi cal 22-facility that holds Metabolic and Bariatric Surgery Accreditation 23-issued by American College of Surgeons , or its successor 24-organization. 25- 3. A managed care organization may limit coverage for 26-bariatric surgery and related preoperative and postoperativ e 27-services to not more than one such surgery per lifetime. 28- 4. A managed care organization shall require the physician 29-seeking coverage for bariatric surgery pursuant to subsection 1 to 30-provide a written statement to the managed care organization that 31-the treatment is medically necessary and will be provided in 32-accordance with the American Society for Metabolic and Bariatric 33-Surgery, or its successor organization, or the American College of 34-Surgeons, or its successor organization. 35- 5. This section does no t require a health care plan to include 36-coverage for any drug that is injected to lower glucose levels or 37-any other drug prescribed for weight loss. 38- 6. A health care plan subject to the provisions of this chapter 39-which is delivered, issued for delivery o r renewed on or after 40-January 1, 2026, has the legal effect of including the coverage 41-required by this section and any provision of the plan which is in 42-conflict with this section is void. 43- 7. As used in this section: 44-- – 15 –--- *AB399*- (a) “Medical facility” has the meani ng ascribed to it in 1-NRS 449.0151. 2- (b) “Provider of health care” has the meaning ascribed to it in 3-NRS 629.031. 4- (c) “Severe obesity” means: 5- (1) A body mass index of 40 or higher; or 6- (2) A body mass index of 35 or higher with an associated 7-comorbidity, which may include, without limitation, hypertension, 8-cardiopulmonary conditions, sleep apnea or diabetes. 9- Sec. 12. NRS 232.320 is hereby amended to read as follows: 10- 232.320 1. The Director: 11- (a) Shall appoint, with the consent of the Governor, 12-administrators of the divisions of the Department, who are 13-respectively designated as follows: 14- (1) The Administrator of the Aging and Disability Services 15-Division; 16- (2) The Administrator of the Division of Welf are and 17-Supportive Services; 18- (3) The Administrator of the Division of Child and Family 19-Services; 20- (4) The Administrator of the Division of Health Care 21-Financing and Policy; and 22- (5) The Administrator of the Division of Public and 23-Behavioral Health. 24- (b) Shall administer, through the divisions of the Department, 25-the provisions of chapters 63, 424, 425, 427A, 432A to 442, 26-inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 27-127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 28-section 15 of this act, 422.580, 432.010 to 432.133, inclusive, 29-432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 30-and 445A.010 to 445A.055, inclusive, and all other provisions of 31-law relating to the functions of the divisions of the Department, but 32-is not responsible for the clinical activities of the Division of Public 33-and Behavioral Health or the professional line activities of the other 34-divisions. 35- (c) Shall administer any state program for persons with 36-developmental disabilities established pursuant to the 37-Developmental Disabilities Assistance and Bill of Rights Act of 38-2000, 42 U.S.C. §§ 15001 et seq. 39- (d) Shall, after considering advice fr om agencies of local 40-governments and nonprofit organizations which provide social 41-services, adopt a master plan for the provision of human services in 42-this State. The Director shall revise the plan biennially and deliver a 43-copy of the plan to the Governor and the Legislature at the 44-beginning of each regular session. The plan must: 45-- – 16 –--- *AB399*- (1) Identify and assess the plans and programs of the 1-Department for the provision of human services, and any 2-duplication of those services by federal, state and local agencies; 3- (2) Set forth priorities for the provision of those services; 4- (3) Provide for communication and the coordination of those 5-services among nonprofit organizations, agencies of local 6-government, the State and the Federal Government; 7- (4) Identify the so urces of funding for services provided by 8-the Department and the allocation of that funding; 9- (5) Set forth sufficient information to assist the Department 10-in providing those services and in the planning and budgeting for the 11-future provision of those services; and 12- (6) Contain any other information necessary for the 13-Department to communicate effectively with the Federal 14-Government concerning demographic trends, formulas for the 15-distribution of federal money and any need for the modification of 16-programs administered by the Department. 17- (e) May, by regulation, require nonprofit organizations and state 18-and local governmental agencies to provide information regarding 19-the programs of those organizations and agencies, excluding 20-detailed information relating to their budgets and payrolls, which the 21-Director deems necessary for the performance of the duties imposed 22-upon him or her pursuant to this section. 23- (f) Has such other powers and duties as are provided by law. 24- 2. Notwithstanding any other provision of law , the Director, or 25-the Director’s designee, is responsible for appointing and removing 26-subordinate officers and employees of the Department. 27- Sec. 13. NRS 287.010 is hereby amended to read as follows: 28- 287.010 1. The governing body of any county, school 29-district, municipal corporation, political subdivision, public 30-corporation or other local governmental agency of the State of 31-Nevada may: 32- (a) Adopt and carry into effect a system of group life, accident 33-or health insurance, or any combination thereof, for the benefit of its 34-officers and employees, and the dependents of officers and 35-employees who elect to accept the insurance and who, where 36-necessary, have authorized the governing body to make deductions 37-from their compe nsation for the payment of premiums on the 38-insurance. 39- (b) Purchase group policies of life, accident or health insurance, 40-or any combination thereof, for the benefit of such officers and 41-employees, and the dependents of such officers and employees, as 42-have authorized the purchase, from insurance companies authorized 43-to transact the business of such insurance in the State of Nevada, 44-and, where necessary, deduct from the compensation of officers and 45-- – 17 –--- *AB399*-employees the premiums upon insurance and pay the deductions 1-upon the premiums. 2- (c) Provide group life, accident or health coverage through a 3-self-insurance reserve fund and, where necessary, deduct 4-contributions to the maintenance of the fund from the compensation 5-of officers and employees and pay the deductions into the fund. The 6-money accumulated for this purpose through deductions from the 7-compensation of officers and employees and contributions of the 8-governing body must be maintained as an internal service fund as 9-defined by NRS 354.543. The money must be deposited in a state or 10-national bank or credit union authorized to transact business in the 11-State of Nevada. Any independent administrator of a fund created 12-under this section is subject to the licensing requirements of chapter 13-683A of NRS, and must be a res ident of this State. Any contract 14-with an independent administrator must be approved by the 15-Commissioner of Insurance as to the reasonableness of 16-administrative charges in relation to contributions collected and 17-benefits provided. The provisions of NRS 439 .581 to 439.597, 18-inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 19-687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs 20-(b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 21-and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, and 22-section 3 of this act, 689B.0375 to 689B.050, inclusive, 689B.0675, 23-689B.265, 689B.287 and 689B.500 apply to coverage provided 24-pursuant to th is paragraph, except that the provisions of NRS 25-689B.0378, 689B.03785 and 689B.500 only apply to coverage for 26-active officers and employees of the governing body, or the 27-dependents of such officers and employees. 28- (d) Defray part or all of the cost of main tenance of a self -29-insurance fund or of the premiums upon insurance. The money for 30-contributions must be budgeted for in accordance with the laws 31-governing the county, school district, municipal corporation, 32-political subdivision, public corporation or other local governmental 33-agency of the State of Nevada. 34- 2. If a school district offers group insurance to its officers and 35-employees pursuant to this section, members of the board of trustees 36-of the school district must not be excluded from participating in the 37-group insurance. If the amount of the deductions from compensation 38-required to pay for the group insurance exceeds the compensation to 39-which a trustee is entitled, the difference must be paid by the trustee. 40- 3. In any county in which a legal services organization exists, 41-the governing body of the county, or of any school district, 42-municipal corporation, political subdivision, public corporation or 43-other local governmental agency of the State of Nevada in the 44-county, may enter into a contract with the legal services 45-- – 18 –--- *AB399*-organization pursuant to which the officers and employees of the 1-legal services organization, and the dependents of those officers and 2-employees, are eligible for any life, accident or health insurance 3-provided pursuant to this section to th e officers and employees, and 4-the dependents of the officers and employees, of the county, school 5-district, municipal corporation, political subdivision, public 6-corporation or other local governmental agency. 7- 4. If a contract is entered into pursuant to subsection 3, the 8-officers and employees of the legal services organization: 9- (a) Shall be deemed, solely for the purposes of this section, to be 10-officers and employees of the county, school district, municipal 11-corporation, political subdivision, public co rporation or other local 12-governmental agency with which the legal services organization has 13-contracted; and 14- (b) Must be required by the contract to pay the premiums or 15-contributions for all insurance which they elect to accept or of which 16-they authorize the purchase. 17- 5. A contract that is entered into pursuant to subsection 3: 18- (a) Must be submitted to the Commissioner of Insurance for 19-approval not less than 30 days before the date on which the contract 20-is to become effective. 21- (b) Does not become effective unless approved by the 22-Commissioner. 23- (c) Shall be deemed to be approved if not disapproved by the 24-Commissioner within 30 days after its submission. 25- 6. As used in this section, “legal services organization” means 26-an organization that operates a program for legal aid and receives 27-money pursuant to NRS 19.031. 28- Sec. 14. NRS 287.04335 is hereby amended to read as 29-follows: 30- 287.04335 If the Board provides health insurance through a 31-plan of self -insurance, it shall co mply with the provisions of NRS 32-439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 33-687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 34-695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 35-695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167 , 36-695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 37-695G.174, inclusive, and section 11 of this act, 695G.176, 38-695G.177, 695G.200 to 695G.230, inclus ive, 695G.241 to 39-695G.310, inclusive, 695G.405 and 695G.415, in the same manner 40-as an insurer that is licensed pursuant to title 57 of NRS is required 41-to comply with those provisions. 42-- – 19 –--- *AB399*- Sec. 15. Chapter 422 of NRS is hereby amended by adding 1-thereto a new section to read as follows: 2- 1. To the extent that federal financial participation is 3-available and subject to the limitation s authorized by this section, 4-the director shall include under Medicaid coverage for medically 5-necessary treatment and care for diseases and conditions caused 6-by severe obesity, including, without limitation: 7- (a) Medically necessary bariatric surgery for a person who is 8-18 years of age or older; and 9- (b) Related preoperative and postoperative services , including, 10-without limitation, psychological screening, counseling, behavior 11-modification, physical therapy and nutritional education. 12- 2. As a condition of providing coverage for a bariatric 13-surgery, the Director may require: 14- (a) A person to successfully complete a preoperative period of 15-not more than 3 months that includes services recommended by 16-the American Society for Metabolic and Bariatric Surgery , or its 17-successor organization; and 18- (b) That the bariatric surgery be performed in a medical 19-facility that holds Metabolic and Bariatric Surgery Accreditation 20-issued by the American College of Surgeons , or its successor 21-organization. 22- 3. The Director may limit coverage for bariatric surgery and 23-related preoperative and postoperative services to not mor e than 24-one such surgery per lifetime. 25- 4. The Director may require the physician seeking coverage 26-for bariatric surgery pursuant to subsection 1 to provide a written 27-statement to the Director that the treatment is medically necessary 28-and will be provided in accordance with the American Society for 29-Metabolic and Bariatric Surgery, or its successor organization, or 30-the American College of Surgeons, or its successor organization. 31- 5. This section does not require Medicaid to include coverage 32-for any drug tha t is injected to lower glucose levels or any other 33-drug prescribed for weight loss. 34- 6. The Department shall: 35- (a) Apply to the Secretary of Health and Human Services for 36-any waiver of federal law or apply for any amendment of the State 37-Plan for Medicaid that is necessary for the Department to receive 38-federal funding to provide the coverage described in subsection 1. 39- (b) Fully cooperate in good faith with the Federal Government 40-during the application process to satisfy the requirement of the 41-Federal Government for obtaining a waiver or amendment 42-pursuant to paragraph (a). 43- 7. As used in this section: 44-- – 20 –--- *AB399*- (a) “Medical facility” has the meaning ascribed to it in 1-NRS 449.0151. 2- (b) “Medically necessary” means health care services or 3-products that a prudent physician would provide to a patient to 4-prevent, diagnose or treat an illness, injury or disease or any 5-symptom thereof, that are necessary and: 6- (1) Provided in accordance with generally accepted 7-standards of medical practice; 8- (2) Clinically appropria te with regard to type, frequency, 9-extent, location and duration; 10- (3) Not primarily provided for the convenience of the 11-patient, physician or other provider of health care; 12- (4) Required to improve a specific health condition of a 13-patient or to preserve the existing state of health of the patient; 14-and 15- (5) The most clinically appropriate level of health care that 16-may be safely provided to the patient. 17- (c) “Provider of health care” has the meaning ascribed to it in 18-NRS 629.031. 19- (d) “Severe obesity” means: 20- (1) A body mass index of 40 or higher; or 21- (2) A body mass index of 35 or higher with an associated 22-comorbidity, which may include, without limitation, hypertension, 23-cardiopulmonary conditions, sleep apnea or diabetes. 24- Sec. 16. The provisions of NRS 354.599 do not apply to any 25-additional expenses of a local government that are related to the 26-provisions of this act. 27- Sec. 17. 1. This section becomes effective upon passage and 28-approval. 29- 2. Sections 1 to 16, inclusive, of this act become effective: 30- (a) Upon passage and approval for the purpose of adopting any 31-regulations and performing any other preparatory administrative 32-tasks that are necessary to carry out the provisions of this act; and 33- (b) On January 1, 2026, for all other purposes. 34--H+Adam Plain+CPCU, AIE, AIAF, AFSB, API, ARC, ARe+Insurance Regulation Liaison
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