Bill > SB420

Introduced Session

Legislative Counsel's Digest: Existing law requires the Department of Health and Human Services to administer the Medicaid program, which is a joint program of the state and federal governments to provide health coverage to indigent persons. (NRS 422.270, 439B.120) Existing law also creates the Silver State Health Insurance Exchange to assist natural persons and small businesses in purchasing health coverage. (Chapter 695I of NRS) Section 10 of this bill requires the Director of the Department, in consultation with the Executive Director of the Exchange and the Commissioner of Insurance, to design, establish and operate a public health benefit plan known as the Public Option. Section 2 of this bill sets forth the purposes of the Public Option, and sections 3.5-9 of this bill define terms relevant to the Public Option. Section 10 requires the Public Option to be available through the Exchange and for direct purchase and authorizes the Director to make the Public Option available to small employers in this State or their employees. Section 10 requires the Public Option to meet the requirements established by federal and state law for individual health insurance or health insurance for small employers where applicable. Section 10 also establishes requirements governing the levels of coverage provided by the Public Option and the premiums for the Public Option. Sections 38 and 41 of this bill remove the requirements relating to premiums on January 1, 2030. Section 11 of this bill requires the Director, the Commissioner and the Executive Director of the Exchange to apply for certain waivers to obtain federal financial support for the Public Option. Section 39 of this bill requires the Director, the Commissioner and the Executive Director of the Exchange to contract for the performance of an actuarial study before submitting the initial waiver application. Section 12 of this bill requires the Director to use a statewide competitive bidding process to solicit and enter into contracts with health carriers and other qualified persons to administer the Public Option. Section 12 requires a health carrier that provides health care services to recipients of Medicaid through managed care to participate in the competitive bidding process. Section 12 additionally authorizes the Director to directly administer the Public Option if necessary. Sections 13, 21 and 29 of this bill require providers of health care, including health care facilities, who participate in Medicaid or the Public Employees Benefits Program or provide care to injured employees under the State s workers compensation program to enroll in the Public Option as a participating provider of health care. Section 14 of this bill prescribes requirements governing the establishment of networks and the reimbursement of providers under the Public Option. Section 15 of this bill establishes the Public Option Trust Fund to hold certain funds for the purpose of implementing the Public Option. Section 20 of this bill exempts rules and policies governing the Public Option from provisions governing notice-and-comment rulemaking. Sections 16, 19, 22, 32 and 34-37 of this bill make various changes so that the Public Option is treated similarly to comparable forms of public health insurance. Section 16.5 of this bill requires the Executive Director of the Exchange to apply to the federal government for a waiver to authorize certain labor, agricultural and horticultural organizations to offer on the Exchange a policy of insurance to meet the unique needs of tradespersons that can serve as an alternative to the continuation of certain group health benefits. Section 16.5 requires such a policy to be annually certified by the Executive Director in order to be offered on the Exchange. Sections 16.3 and 16.8 of this bill make conforming changes to reflect the fact that a policy of insurance offered pursuant to section 16.5 may not meet all requirements: (1) for individual health insurance prescribed by state law; or (2) to be considered a qualified health plan under federal law. Section 39.5 of this bill requires the Executive Director to apply for the waiver and submit certain recommendations concerning such policies to the Legislature on or before January 1, 2025. Sections 24-28 of this bill expand coverage under Medicaid in various manners. Specifically, section 24 of this bill requires the Director of the Department to expand coverage under the State Plan for Medicaid for pregnant women by: (1) providing coverage for pregnant women whose household income is between 165 percent and 200 percent of the federally designated level signifying poverty if money is available; (2) providing that pregnant women who are determined by certain entities to qualify for Medicaid are presumptively eligible for Medicaid for a prescribed period of time, without submitting an application for enrollment in Medicaid which includes additional proof of eligibility; and (3) prohibiting the imposition of a requirement that a pregnant woman who is otherwise eligible for Medicaid and resides in this State must reside in the United States for a prescribed period of time before enrolling in Medicaid. Section 25 of this bill requires Medicaid to cover the services of a community health worker who provides services under the supervision of a physician, physician assistant or advanced practice registered nurse. Section 26 of this bill requires Medicaid to cover certain costs for doula services provided to Medicaid recipients by a doula who has enrolled with the Division of Health Care Financing and Policy of the Department. Sections 17 and 33 of this bill require a registered doula to report the suspected abuse, neglect, exploitation, isolation or abandonment of older or vulnerable persons or the suspected abuse or neglect of a child. Section 27 of this bill requires Medicaid to reimburse services provided to recipients of Medicaid who do not receive services through managed care by an advanced practice registered nurse to the same extent as if those services were provided by a physician if money is available to reimburse those services at those rates. If money is available, section 28 of this bill requires Medicaid to cover breastfeeding supplies, certain prenatal screenings and tests and lactation consultation and support. Section 18 of this bill makes a conforming change to indicate the proper placement of sections 24-28 in the Nevada Revised Statutes. Existing law establishes certain requirements that apply if a Medicaid managed care program is established in this State. (NRS 422.273) To the extent that money is available, section 30 of this bill requires the Department to: (1) establish such a program to provide health care services to recipients of Medicaid in all geographic areas of this State; and (2) conduct a statewide procurement process to select health maintenance organizations to provide such services. To the extent that money is available, section 30 requires the Medicaid managed care program to include a state-directed payment arrangement to require Medicaid managed care organizations to reimburse critical access hospitals and any affiliated federally-qualified health centers or rural health clinics for covered services at a rate that is equal to or greater than the rate those facilities receive for services provided to recipients of Medicaid on a fee-for-service basis. Existing law requires certain health insurers, including local governments that adopt a system of group health insurance for their employees, to cover enteral formulas under certain conditions. (NRS 287.010, 689A.0423, 689B.0353, 695B.1923, 695C.1723) Sections 16.35-16.47 of this bill specify that enteral formulas include formulas that are ingested orally. Section 20.5 of this bill requires the Public Employees Benefits Program to cover enteral formulas, including formulas that are ingested orally, under the same conditions as health insurers that are currently required to cover enteral formulas. Section 38.3 of this bill appropriates money to the Division of Welfare and Supportive Services of the Department to pay the costs of making enhancements to its information technology system that are necessary to carry out the provisions of sections 24-28 of this bill. Sections 38.6 and 38.8 of this bill appropriate money to the Public Option Trust Fund and the Silver State Health Insurance Exchange, respectively, to implement the Public Option. SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Title 57 of NRS is hereby amended by adding thereto a new chapter to consist of the provisions set forth as sections 2 to 15, inclusive, of this act. Sec. 2. It is hereby declared to be the purpose and policy of the Legislature in enacting this chapter to: 1. Leverage the combined purchasing power of the State to lower premiums and costs relating to health insurance for residents of this State; 2. Improve access to high-quality, affordable health care for residents of this State, including residents of this State who are employed by small businesses; 3. Reduce disparities in access to health care and health outcomes and increase access to health care for historically marginalized communities; and 4. Increase competition in the market for individual health insurance in this State to improve the availability of coverage for residents of rural areas of this State. Sec. 3. As used in this chapter, unless the context otherwise requires, the words and terms defined in sections 3.5 to 9, inclusive, of this act have the meanings ascribed to them in those sections. Sec. 3.5. Certified community behavioral health clinic means a community behavioral health clinic certified in accordance with section 223 of the Protecting Access to Medicare Act of 2014, Public Law No. 113-93. Sec. 4. Commissioner means the Commissioner of Insurance. Sec. 5. Director means the Director of the Department of Health and Human Services. Sec. 6. Exchange means the Silver State Health Insurance Exchange. Sec. 6.5. Federally qualified health center has the meaning ascribed to it in 42 C.F.R. 405.2401. Sec. 7. Provider of health care has the meaning ascribed to it in NRS 695G.070. Sec. 8. Public Option means the Public Option established pursuant to section 10 of this act. Sec. 8.5. Rural health clinic has the meaning ascribed to it in 42 C.F.R. 405.2401. Sec. 9. Trust Fund means the Public Option Trust Fund created by section 15 of this act. Sec. 10. 1. The Director, in consultation with the Commissioner and the Executive Director of the Exchange, shall design, establish and operate a health benefit plan known as the Public Option. 2. The Director: (a) Shall make the Public Option available: (1) As a qualified health plan through the Exchange to natural persons who reside in this State and are eligible to enroll in such a plan through the Exchange under the provisions of 45 C.F.R. 155.305; and (2) For direct purchase as a policy of individual health insurance by any natural person who resides in this State. The provisions of chapter 689A of NRS and other applicable provisions of this title apply to the Public Option when offered as a policy of individual health insurance. (b) May make the Public Option available to small employers in this State or their employees to the extent authorized by federal law. The provisions of chapter 689C of NRS and other applicable provisions of this title apply to the Public Option when it is offered as a policy of health insurance for small employers. (c) Shall comply with all state and federal laws and regulations applicable to insurers when carrying out the provisions of sections 2 to 15, inclusive, of this act, to the extent that such laws and regulations are not waived. 3. The Public Option must: (a) Be a qualified health plan, as defined in 42 U.S.C. 18021; and (b) Provide at least levels of coverage consistent with the actuarial value of one silver plan and one gold plan. 4. Except as otherwise provided in this section, the premiums for the Public Option: (a) Must be at least 5 percent lower than the reference premium for that zip code; and (b) Must not increase in any year by a percentage greater than the increase in the Medicare Economic Index for that year. 5. The Director, in consultation with the Commissioner and the Executive Director of the Exchange, may revise the requirements of subsection 4, provided that the average premiums for the Public Option must be at least 15 percent lower than the average reference premium in this State over the first 4 years in which the Public Option is in operation. 6. As used in this section: (a) Gold plan means a qualified health plan that meets the requirements established by 42 U.S.C. 18022 for a gold level plan. (b) Health benefit plan means a policy, contract, certificate or agreement to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. (c) Medicare Economic Index means the Medicare Economic Index, as designated by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services pursuant to 42 C.F.R. 405.504. (d) Reference premium means, for any zip code, the lower of: (1) The premium for the second-lowest cost silver level plan available through the Exchange in the zip code during the 2024 plan year, adjusted by the percentage change in the Medicare Economic Index between January 1, 2024, and January 1 of the year to which a premium applies; or (2) The premium for the second-lowest cost silver level plan available through the Exchange in the zip code during the year immediately preceding the year to which a premium applies. (e) Silver plan means a qualified health plan that meets the requirements established by 42 U.S.C. 18022 for a silver level plan. (f) Small employer has the meaning ascribed to it in 42 U.S.C. 18024(b)(2). Sec. 11. 1. The Director, the Commissioner and the Executive Director of the Exchange: (a) Shall collaborate to apply to the Secretary of Health and Human Services for a waiver pursuant to 42 U.S.C. 18052 to obtain pass-through federal funding to carry out the provisions of sections 2 to 15, inclusive, of this act; and (b) Except as otherwise provided in subsection 4, may collaboratively apply to the Secretary of Health and Human Services for any other federal waivers or approval necessary to carry out the provisions of sections 2 to 15, inclusive, of this act, including, without limitation, and to the extent necessary, a waiver pursuant to 42 U.S.C. 1315 of Title XIX of the Social Security Act. Such waivers or approval may include, without limitation, any waiver or approval necessary to: (1) Combine risk pools for the Public Option with risk pools established for Medicaid, if the Director can demonstrate that doing so would lower costs, result in savings to the federal and state governments and not increase the costs of private insurance or Medicaid; or (2) Obtain federal financial participation to subsidize the cost of health insurance for residents of this State with low incomes. 2. In preparing an application for any waiver described in subsection 1, the Director, the Commissioner and the Executive Director of the Exchange may contract with an independent actuary to assess the impact of the Public Option on the markets for health care and health insurance in this State and health coverage for natural persons, families and small businesses. The actuary must have specialized expertise or experience with state health insurance exchanges, the type of waiver for which the application is being made, measures to contain the costs of providing health coverage, reforming procedures for the purchasing and delivery of government services and Medicaid managed care programs. A contract pursuant to this subsection is exempt from the provisions of chapter 333 of NRS. 3. The Director, the Commissioner and the Executive Director of the Exchange shall: (a) Cooperate with the Federal Government in obtaining any waiver for which he or she applies pursuant to this section. (b) Deposit any money received from the Federal Government pursuant to such a waiver in the Trust Fund. 4. The Director, the Commissioner and the Executive Director of the Exchange shall not apply under the provisions of subsection 1 to waive any provision of federal law prescribing conditions of eligibility to purchase a qualified health plan, as defined in 42 U.S.C. 18021, through the Exchange or receive federal advanced payment of premium tax credits pursuant to 42 U.S.C. 18082 for such a purchase. 5. The Director may: (a) Accept gifts, grants and donations to carry out the provisions of sections 2 to 15, inclusive, of this act. The Director shall deposit any such gifts, grants or donations in the Trust Fund. (b) Employ or enter into contracts with actuaries and other professionals and may enter into contracts with other state agencies, health carriers or other qualified persons and entities as are necessary to carry out the provisions of sections 2 to 15, inclusive, of this act. Such contracts are exempt from the requirements of chapter 333 of NRS. Sec. 12. 1. The Director, in consultation with the Commissioner and the Executive Director of the Exchange, shall use a statewide competitive bidding process, including, without limitation, a request for proposals, to solicit and enter into contracts with health carriers or other qualified persons or entities to administer the Public Option. If a statewide Medicaid managed care program is established pursuant to subsection 1 of NRS 422.273, the competitive bidding process must coincide with the statewide procurement process for that Medicaid managed care program. 2. Each health carrier that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or the Children s Health Insurance Program shall, as a condition of continued participation in any Medicaid managed care program established in this State, submit a good faith proposal in response to a request for proposals issued pursuant to subsection 1. 3. Each proposal submitted pursuant to subsection 2 must demonstrate that the applicant is able to meet the requirements of section 10 of this act. 4. When selecting a health carrier or other qualified person or entity to administer the Public Option, the Director shall prioritize applicants whose proposals: (a) Demonstrate alignment of networks of providers between the Public Option and Medicaid managed care, where applicable; (b) Provide for the inclusion of critical access hospitals, rural health clinics, certified community behavioral health clinics and federally-qualified health centers in the networks of providers for the Public Option and Medicaid managed care, where applicable; (c) Include proposals for strengthening the workforce in this State and particularly in rural areas of this State for providers of primary care, mental health care and treatment for substance use disorders; (d) Use payment models for providers included in the networks of providers for the Public Option that increase value for persons enrolled in the Public Option and the State; and (e) Include proposals to contract with providers of health care in a manner that decreases disparities among different populations in this State with regard to access to health care and health outcomes and supports culturally competent care. 5. Notwithstanding the provisions of subsections 1 to 4, inclusive, the Director may directly administer the Public Option if necessary to carry out the provisions of sections 2 to 15, inclusive, of this act. 6. Any health carrier or other person or entity with which the Director contracts to administer the Public Option pursuant to this section or the Director, if the Director directly administers the Public Option pursuant to subsection 5, shall take any measures necessary to make the Public Option available as described in paragraph (a) of subsection 2 of section 10 of this act and, if required by the Director, paragraph (b) of that subsection. Such measures include, without limitation: (a) Filing rates and supporting information with the Commissioner of Insurance as required by NRS 686B.010 to 686B.1799, inclusive; and (b) Obtaining certification as a qualified health plan pursuant to 42 U.S.C. 18031. 7. The Director shall deposit into the Trust Fund any money received from: (a) A health carrier or other person or entity with which the Director contracts to administer the Public Option pursuant to subsection 1 which relates to duties performed under the contract; or (b) If the Director directly administers the Public Option pursuant to subsection 5, any money received from any person or entity in the course of administering the Public Option. 8. As used in this section: (a) Critical access hospital means a hospital which has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C. 1395i-4(e). (b) Health carrier means an entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including, without limitation, a sickness and accident health insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health care services. Sec. 13. 1. Except as otherwise provided in subsection 2, each provider of health care who participates in the Public Employees Benefits Program established pursuant to subsection 1 of NRS 287.043 or the Medicaid program, or who provides care to an injured employee pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS, shall: (a) Enroll as a participating provider in at least one network of providers established for the Public Option; and (b) Accept new patients who are enrolled in the Public Option to the same extent as the provider or facility accepts new patients who are not enrolled in the Public Option. 2. The Director and the Executive Officer of the Public Employees Benefits Program may waive the requirements of subsection 1 when necessary to ensure that recipients of Medicaid and officers, employees and retirees of this State who receive benefits under the Public Employees Benefits Program have sufficient access to covered services. Sec. 14. 1. In establishing networks for the Public Option and reimbursing providers of health care that participate in the Public Option, the Director shall, to the extent practicable: (a) Ensure that care for persons who were previously covered by Medicaid or the Children s Health Insurance Program and enroll in the Public Option is minimally disrupted; (b) Encourage the use of payment models that increase value for persons enrolled in the Public Option and the State; (c) Improve health outcomes for persons enrolled in the Public Option; (d) Reward providers of health care and medical facilities for delivering high-quality services; and (e) Lower the cost of care in both urban and rural areas of this State. 2. Except as otherwise provided in subsections 3 to 6, inclusive, reimbursement rates under the Public Option must be, in the aggregate, comparable to or better than reimbursement rates available under Medicare. For the purposes of this section, the aggregate reimbursement rate under Medicare: (a) Includes any add-on payments or other subsidies that a provider receives under Medicare; and (b) Does not include payments under Medicare for a patient encounter or a cost-based payment rate under Medicare. 3. If a provider of health care currently receives reimbursement under Medicare at rates that are cost-based, the reimbursement rates for that provider of health care under the Public Option must be comparable to or better than the cost-based reimbursement rates provided for that provider of health care by Medicare. 4. The reimbursement rates for a federally-qualified health center or a rural health clinic under the Public Option must be comparable to or better than the reimbursement rates established for patient encounters under the applicable Prospective Payment System established for Medicare by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. 5. The reimbursement rates for a certified community behavioral health clinic under the Public Option must be comparable to or better than the reimbursement rates established for community behavioral health clinics under the State Plan for Medicaid. 6. The requirements of subsections 2 to 5, inclusive, do not apply to a payment model described in paragraph (b) of subsection 1. 7. As used in this section, Medicare means the program of health insurance for aged persons and persons with disabilities established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq. Sec. 15. 1. There is hereby created in the State Treasury the Public Option Trust Fund as a nonreverting trust fund. The Trust Fund must be administered by the State Treasurer. 2. The Trust Fund consists of: (a) Any money deposited in the Trust Fund pursuant to sections 11 and 12 of this act; (b) Any money appropriated by the Legislature for the purpose of carrying out the provisions of sections 2 to 15, inclusive, of this act; and (c) All income and interest earned on the money in the Trust Fund. 3. Any interest earned on money in the Trust Fund, after deducting any applicable charges, must be credited to the Trust Fund. Money that remains in the Trust Fund at the end of a fiscal year does not revert to the State General Fund, and the balance in the Trust Fund must be carried forward to the next fiscal year. 4. Except as otherwise provided in subsection 5, the money in the Trust Fund must be used to carry out the provisions of sections 2 to 15, inclusive, of this act. Such money must not be used to pay administrative costs that are not directly related to the operations of the Public Option. 5. If the State Treasurer determines that there is sufficient money in the Trust Fund to carry out the provisions of sections 2 to 15, inclusive, of this act, for the current fiscal year, the Director may use a portion determined by the State Treasurer of any additional money in the Trust Fund to increase the affordability of the Public Option. Sec. 16. NRS 683A.176 is hereby amended to read as follows: 683A.176 Third party means: 1. An insurer, as that term is defined in NRS 679B.540; 2. A health benefit plan, as that term is defined in NRS 687B.470, for employees which provides a pharmacy benefits plan; 3. A participating public agency, as that term is defined in NRS 287.04052, and any other local governmental agency of the State of Nevada which provides a system of health insurance for the benefit of its officers and employees, and the dependents of officers and employees, pursuant to chapter 287 of NRS; or 4. The Public Option established pursuant to section 10 of this act; or 5. Any other insurer or organization that provides health coverage or benefits or coverage of prescription drugs as part of workers compensation insurance in accordance with state or federal law. The term does not include an insurer that provides coverage under a policy of casualty or property insurance. Sec. 16.3. NRS 689A.020 is hereby amended to read as follows: 689A.020 Nothing in this chapter applies to or affects: 1. Any policy of liability or workers compensation insurance with or without supplementary expense coverage therein. 2. Any group or blanket policy. 3. Life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as to: (a) Provide additional benefits in case of death or dismemberment or loss of sight by accident or accidental means; or (b) Operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity if the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract. 4. Reinsurance, except as otherwise provided in NRS 689A.470 to 689A.740, inclusive, and 689C.610 to 689C.940, inclusive, relating to the program of reinsurance. 5. Any policy of insurance offered on the Silver State Health Insurance Exchange in accordance with section 16.5 of this act. Sec. 16.35. NRS 689A.0423 is hereby amended to read as follows: 689A.0423 1. A policy of health insurance must provide coverage for: (a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and (b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a). 2. The coverage required by subsection 1 must be provided whether or not the condition existed when the policy was purchased. 3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January July 1, 1998, 2021, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void. 4. As used in this section: (a) Enteral formula includes, without limitation, a formula that is ingested orally. (b) Inherited metabolic disease means a disease caused by an inherited abnormality of the body chemistry of a person. (b) (c) Special food product means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein. Sec. 16.4. NRS 689B.0353 is hereby amended to read as follows: 689B.0353 1. A policy of group health insurance must provide coverage for: (a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and (b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a). 2. The coverage required by subsection 1 must be provided whether or not the condition existed when the policy was purchased. 3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January July 1, 1998, 2021, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void. 4. As used in this section: (a) Enteral formula includes, without limitation, a formula that is ingested orally. (b) Inherited metabolic disease means a disease caused by an inherited abnormality of the body chemistry of a person. (b) (c) Special food product means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein. Sec. 16.43. NRS 695B.1923 is hereby amended to read as follows: 695B.1923 1. A contract for hospital or medical service must provide coverage for: (a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and (b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a). 2. The coverage required by subsection 1 must be provided whether or not the condition existed when the contract was purchased. 3. A contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January July 1, 1998, 2021, has the legal effect of including the coverage required by this section, and any provision of the contract or the renewal which is in conflict with this section is void. 4. As used in this section: (a) Enteral formula includes, without limitation, a formula that is ingested orally. (b) Inherited metabolic disease means a disease caused by an inherited abnormality of the body chemistry of a person. (b) (c) Special food product means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein. Sec. 16.47. NRS 695C.1723 is hereby amended to read as follows: 695C.1723 1. A health maintenance plan must provide coverage for: (a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and (b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a). 2. The coverage required by subsection 1 must be provided whether or not the condition existed when the health maintenance plan was purchased. 3. Any evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January July 1, 1998, 2021, has the legal effect of including the coverage required by this section, and any provision of the evidence of coverage or the renewal which is in conflict with this section is void. 4. As used in this section: (a) Enteral formula includes, without limitation, a formula that is ingested orally. (b) Inherited metabolic disease means a disease caused by an inherited abnormality of the body chemistry of a person. (b) (c) Special food product means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein. Sec. 16.5. Chapter 695I of NRS is hereby amended by adding thereto a new section to read as follows: 1. The Executive Director, in collaboration with the Director of the Department of Health and Human Services, shall apply to the Secretary of Health and Human Services for a waiver pursuant to 42 U.S.C. 18052 to authorize an organization described in section 501(c)(5) of the Internal Revenue Code that processes health claims in this State to offer on the Exchange a policy of insurance to meet the unique needs of tradespersons, including, without limitation, persons who work temporary or seasonal jobs, that is capable of serving as an alternative to the continuation of group health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985. 2. The application for a waiver submitted pursuant to subsection 1 must include, without limitation, an application for a waiver of any provisions of federal law or regulations that would otherwise require a policy described in subsection 1 to meet the requirements of chapter 689A of NRS in order to be offered on the Exchange or for persons who purchase the plan on the Exchange to receive applicable federal subsidies. 3. To be offered on the Exchange, a policy of insurance described in subsection 1 must: (a) Meet all requirements established by the Federal Act for a qualified health plan, to the extent that those requirements do not prevent an organization described in section 501(c)(5) of the Internal Revenue Code from offering such a policy; and (b) Be certified by the Executive Director. Such certification must be renewed annually. 4. The Executive Director shall prescribe: (a) Requirements for certification of a policy of insurance pursuant to paragraph (b) of subsection 3; and (b) Criteria to determine when a person becomes eligible for a policy of insurance described in subsection 1. Those criteria must address: (1) Persons who recently began employment but have not yet met the requirements concerning hours of work necessary to receive insurance through their employer; and (2) Persons who have recently lost their jobs. 5. When performing the duties described in subsections 1 and 4, the Executive Director shall consult with organizations described in section 501(c)(5) of the Internal Revenue Code and other interested persons and entities concerning the requirements for certification of a policy of insurance described in subsection 1 and the criteria described in paragraph (b) of subsection 4. Sec. 16.8. NRS 695I.210 is hereby amended to read as follows: 695I.210 1. The Exchange shall: (a) Create and administer a health insurance exchange; (b) Facilitate the purchase and sale of qualified health plans consistent with established patterns of care within the State; (c) Provide for the establishment of a program to assist qualified small employers in Nevada in facilitating the enrollment of their employees in qualified health plans offered in the small group market; (d) Make Except as otherwise authorized by a waiver obtained pursuant to section 16.5 of this act, make only qualified health plans available to qualified individuals and qualified small employers ; on or after January 1, 2014; and (e) Unless the Federal Act is repealed or is held to be unconstitutional or otherwise invalid or unlawful, perform all duties that are required of the Exchange to implement the requirements of the Federal Act. 2. The Exchange may: (a) Enter into contracts with any person, including, without limitation, a local government, a political subdivision of a local government and a governmental agency, to assist in carrying out the duties and powers of the Exchange or the Board; and (b) Apply for and accept any gift, donation, bequest, grant or other source of money to carry out the duties and powers of the Exchange or the Board. 3. The Exchange is subject to the provisions of chapter 333 of NRS.

AI Summary

Committee Categories

Teresa Benitez-Thompson (D)*,  Nicole Cannizzaro (D)*,  Fabian Donate (D)*,  Jason Frierson (D)*,  Roberta Lange (D)*,  Pat Spearman (D)*,  Christopher Brooks (D),  Mo Denis (D),  Marilyn Dondero Loop (D),  Dallas Harris (D),  James Ohrenschall (D),  Julia Ratti (D),  Melanie Scheible (D), 

Chapter 537. (on 06/11/2021)

Official Document