S.B. 163
- *SB163*
SENATE BILL NO. 163–SENATORS SCHEIBLE, D. HARRIS AND
SPEARMAN
FEBRUARY 15, 2023
____________
JOINT SPONSOR: ASSEMBLYWOMAN GONZÁLEZ
____________
Referred to Committee on Commerce and Labor
SUMMARY—Requires certain health insurance to cover treatment
of certain conditions relating to gender dysphoria,
gender incongruence and other disorders of sexual
development. (BDR 57-129)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§§ 13, 14)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to insurance; requiring certain health insurance to
include coverage for the treatment of conditions relating
to gender dysphoria, gender incongruence and other
disorders of sexual development; and providing other
matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires public and private policies of health insurance regulated 1
under Nevada law to include certain coverage. (NRS 287.010, 287.04335, 2
422.2712-422.27241, 689A.04033-689A.0465, 689B.0303-689B.0379, 689C.1655-3
689C.169, 689C.194, 689C.1945, 689C.195, 695A.184-695A.1875, 695B.1901-4
695B.1948, 695C.1691-695C.176, 695G.162-695G.177) Existing law also requires 5
employers to provide certain benefits for health care to employees, including the 6
coverage required of health insurers, if the employer provides health benefits for its 7
employees. (NRS 608.1555) Sections 1, 3, 4, 6-8, 11 and 13-15 of this bill: (1) 8
require certain public and private policies of health insurance and health care plans, 9
including Medicaid, to cover the treatment of conditions relating to gender 10
dysphoria, gender incongruence and other disorders of sexual development; and (2) 11
authorize those policies and plans to prescribe requirements that must be satisfied 12
before the insurer will cover surgical treatment for conditions relating to gender 13
dysphoria, gender incongruence and other disorders of sexual development for 14
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persons who are less than 17 years of age. Sections 2, 5, 9 and 12 of this bill make 15
conforming changes to indicate the proper placement of sections 1, 4, 8 and 15 in 16
the Nevada Revised Statutes. 17
Section 10 of this bill authorizes the Commissioner of Insurance to suspend or 18
revoke the certificate of a health maintenance organization that fails to comply with 19
the requirements of section 8 to provide coverage for the treatment of conditions 20
relating to gender dysphoria, gender incongruence and other disorders of sexual 21
development. The Commissioner would also be authorized to take such action 22
against other health insurers who fail to comply with the requirements of sections 23
1, 3, 4, 6, 7 and 11 of this bill. (NRS 680A.200) 24
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 689A of NRS is hereby amended by 1
adding thereto a new section to read as follows: 2
1. An insurer that issues a policy of health insurance shall 3
include in the policy coverage for the medically necessary 4
treatment of conditions relating to gender dysphoria, gender 5
incongruence and other disorders of sexual development. Such 6
coverage must include, without limitation, coverage of medically 7
necessary psychosocial and surgical intervention and any other 8
medically necessary treatment for such disorders provided by: 9
(a) Endocrinologists; 10
(b) Pediatric endocrinologists; 11
(c) Social workers; 12
(d) Psychiatrists; 13
(e) Psychologists; 14
(f) Gynecologists; 15
(g) Plastic surgeons; and 16
(h) Any other providers of medically necessary services for the 17
treatment of gender dysphoria, gender incongruence and other 18
disorders of sexual development. 19
2. An insurer that issues a policy of health insurance may 20
prescribe requirements that must be satisfied before the insurer 21
covers surgical treatment of conditions relating to gender 22
dysphoria, gender incongruence and other disorders of sexual 23
development for an insured who is less than 17 years of age. Such 24
requirements may include, without limitation, requirements that: 25
(a) The treatment must be recommended by a psychologist, 26
psychiatrist or other mental health professional; 27
(b) The treatment must be recommended by a physician; 28
(c) The insured must provide a written expression of the desire 29
of the insured to undergo the treatment; and 30
(d) A written plan for treatment that covers at least 1 year must 31
be developed and approved by at least two providers of health care. 32
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3. An insurer shall make a reasonable effort to ensure that 1
the benefits required by subsection 1 are made available to an 2
insured through a provider of health care who participates in the 3
network plan of the insurer. If, after a reasonable effort, the 4
insurer is unable to make such benefits available through such a 5
provider of health care, the insurer must cover the benefits when 6
provided to an insured through a provider of health care who does 7
not participate in the network plan of the insurer. 8
4. A policy of health insurance subject to the provisions of 9
this chapter that is delivered, issued for delivery or renewed on or 10
after July 1, 2023, has the legal effect of including the coverage 11
required by subsection 1, and any provision of the policy or the 12
renewal which is in conflict with this section is void. 13
5. As used in this section: 14
(a) “Gender dysphoria” means distress or impairment in 15
social, occupational or other areas of functioning caused by a 16
marked difference between the gender identity or expression of a 17
person and the sex assigned to the person at birth which lasts at 18
least 6 months and is shown by at least two of the following: 19
(1) A marked difference between gender identity or 20
expression and primary or secondary sex characteristics or 21
anticipated secondary sex characteristics in young adolescents. 22
(2) A strong desire to be rid of primary or secondary sex 23
characteristics because of a marked difference between such sex 24
characteristics and gender identity or expression or a desire to 25
prevent the development of anticipated secondary sex 26
characteristics in young adolescents. 27
(3) A strong desire for the primary or secondary sex 28
characteristics of the gender opposite from the sex assigned at 29
birth. 30
(4) A strong desire to be of the opposite gender or a gender 31
different from the sex assigned at birth. 32
(5) A strong desire to be treated as the opposite gender or a 33
gender different from the sex assigned at birth. 34
(6) A strong conviction of experiencing typical feelings and 35
reactions of the opposite gender or a gender different from the sex 36
assigned at birth. 37
(b) “Medically necessary” means health care services or 38
products that a prudent provider of health care would provide to a 39
patient to prevent, diagnose or treat an illness, injury or disease, or 40
any symptoms 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
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- *SB163*
(3) Not provided primarily for the convenience of the 1
patient or provider of health care; 2
(4) Required to improve a specific health condition of a 3
patient or to preserve the existing state of health of the patient; 4
and 5
(5) The most clinically appropriate level of health care that 6
may be safely provided to the patient. 7
A provider of health care prescribing, ordering, recommending 8
or approving a health care service or product does not, by itself, 9
make that health care service or product medically necessary. 10
(c) “Network plan” means a policy of health insurance offered 11
by an insurer under which the financing and delivery of medical 12
care, including items and services paid for as medical care, are 13
provided, in whole or in part, through a defined set of providers 14
under contract with the insurer. The term does not include an 15
arrangement for the financing of premiums. 16
(d) “Provider of health care” has the meaning ascribed to it in 17
NRS 629.031. 18
Sec. 2. NRS 689A.330 is hereby amended to read as follows: 19
689A.330 If any policy is issued by a domestic insurer for 20
delivery to a person residing in another state, and if the insurance 21
commissioner or corresponding public officer of that other state has 22
informed the Commissioner that the policy is not subject to approval 23
or disapproval by that officer, the Commissioner may by ruling 24
require that the policy meet the standards set forth in NRS 689A.030 25
to 689A.320, inclusive [.] , and section 1 of this act. 26
Sec. 3. Chapter 689B of NRS is hereby amended by adding 27
thereto a new section to read as follows: 28
1. An insurer that issues a policy of group health insurance 29
shall include in the policy coverage for the medically necessary 30
treatment of conditions relating to gender dysphoria, gender 31
incongruence and other disorders of sexual development. Such 32
coverage must include, without limitation, coverage of medically 33
necessary psychosocial and surgical intervention and any other 34
medically necessary treatment for such disorders provided by: 35
(a) Endocrinologists; 36
(b) Pediatric endocrinologists; 37
(c) Social workers; 38
(d) Psychiatrists; 39
(e) Psychologists; 40
(f) Gynecologists; 41
(g) Plastic surgeons; and 42
(h) Any other providers of medically necessary services for the 43
treatment of gender dysphoria, gender incongruence and other 44
disorders of sexual development. 45
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2. An insurer that issues a policy of group health insurance 1
may prescribe requirements that must be satisfied before the 2
insurer covers surgical treatment of conditions relating to gender 3
dysphoria, gender incongruence and other disorders of sexual 4
development for an insured who is less than 17 years of age. Such 5
requirements may include, without limitation, requirements that: 6
(a) The treatment must be recommended by a psychologist, 7
psychiatrist or other mental health professional; 8
(b) The treatment must be recommended by a physician; 9
(c) The insured must provide a written expression of the desire 10
of the insured to undergo the treatment; and 11
(d) A written plan for treatment that covers at least 1 year must 12
be developed and approved by at least two providers of health care. 13
3. An insurer shall make a reasonable effort to ensure that 14
the benefits required by subsection 1 are made available to an 15
insured through a provider of health care who participates in the 16
network plan of the insurer. If, after a reasonable effort, the 17
insurer is unable to make such benefits available through such a 18
provider of health care, the insurer must cover the benefits when 19
provided to an insured through a provider of health care who does 20
not participate in the network plan of the insurer. 21
4. A policy of group health insurance subject to the 22
provisions of this chapter that is delivered, issued for delivery or 23
renewed on or after July 1, 2023, has the legal effect of including 24
the coverage required by subsection 1, and any provision of the 25
policy or renewal which is in conflict with the provisions of this 26
section is void. 27
5. As used in this section: 28
(a) “Gender dysphoria” means distress or impairment in 29
social, occupational or other areas of functioning caused by a 30
marked difference between the gender identity or expression of a 31
person and the sex assigned to the person at birth which lasts at 32
least 6 months and is shown by at least two of the following: 33
(1) A marked difference between gender identity or 34
expression and primary or secondary sex characteristics or 35
anticipated secondary sex characteristics in young adolescents. 36
(2) A strong desire to be rid of primary or secondary sex 37
characteristics because of a marked difference between such sex 38
characteristics and gender identity or expression or a desire to 39
prevent the development of anticipated secondary sex 40
characteristics in young adolescents. 41
(3) A strong desire for the primary or secondary sex 42
characteristics of the gender opposite from the sex assigned at 43
birth. 44
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(4) A strong desire to be of the opposite gender or a gender 1
different from the sex assigned at birth. 2
(5) A strong desire to be treated as the opposite gender or a 3
gender different from the sex assigned at birth. 4
(6) A strong conviction of experiencing typical feelings and 5
reactions of the opposite gender or a gender different from the sex 6
assigned at birth. 7
(b) “Medically necessary” means health care services or 8
products that a prudent provider of health care would provide to a 9
patient to prevent, diagnose or treat an illness, injury or disease, or 10
any symptoms thereof, that are necessary and: 11
(1) Provided in accordance with generally accepted 12
standards of medical practice; 13
(2) Clinically appropriate with regard to type, frequency, 14
extent, location and duration; 15
(3) Not provided primarily for the convenience of the 16
patient or provider of health care; 17
(4) Required to improve a specific health condition of a 18
patient or to preserve the existing state of health of the patient; 19
and 20
(5) The most clinically appropriate level of health care that 21
may be safely provided to the patient. 22
A provider of health care prescribing, ordering, recommending 23
or approving a health care service or product does not, by itself, 24
make that health care service or product medically necessary. 25
(c) “Network plan” means a policy of group health insurance 26
offered by an insurer under which the financing and delivery of 27
medical care, including items and services paid for as medical 28
care, are provided, in whole or in part, through a defined set of 29
providers under contract with the insurer. The term does not 30
include an arrangement for the financing of premiums. 31
(d) “Provider of health care” has the meaning ascribed to it in 32
NRS 629.031. 33
Sec. 4. Chapter 689C of NRS is hereby amended by adding 34
thereto a new section to read as follows: 35
1. A carrier that issues a health benefit plan shall include in 36
the health benefit plan coverage for the medically necessary 37
treatment of conditions relating to gender dysphoria, gender 38
incongruence and other disorders of sexual development. Such 39
coverage must include, without limitation, coverage of medically 40
necessary psychosocial and surgical intervention and any other 41
medically necessary treatment for such disorders provided by: 42
(a) Endocrinologists; 43
(b) Pediatric endocrinologists; 44
(c) Social workers; 45
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(d) Psychiatrists; 1
(e) Psychologists; 2
(f) Gynecologists; 3
(g) Plastic surgeons; and 4
(h) Any other providers of medically necessary services for the 5
treatment of gender dysphoria, gender incongruence and other 6
disorders of sexual development. 7
2. A carrier that issues a health benefit plan may prescribe 8
requirements that must be satisfied before the carrier covers 9
surgical treatment of conditions relating to gender dysphoria, 10
gender incongruence and other disorders of sexual development 11
for an insured who is less than 17 years of age. Such requirements 12
may include, without limitation, requirements that: 13
(a) The treatment must be recommended by a psychologist, 14
psychiatrist or other mental health professional; 15
(b) The treatment must be recommended by a physician; 16
(c) The insured must provide a written expression of the desire 17
of the insured to undergo the treatment; and 18
(d) A written plan for treatment that covers at least 1 year must 19
be developed and approved by at least two providers of health care. 20
3. A carrier shall make a reasonable effort to ensure that the 21
benefits required by subsection 1 are made available to an insured 22
through a provider of health care who participates in the network 23
plan of the carrier. If, after a reasonable effort, the carrier is 24
unable to make such benefits available through such a provider of 25
health care, the carrier must cover the benefits when provided to 26
an insured through a provider of health care who does not 27
participate in the network plan of the carrier. 28
4. A health benefit plan subject to the provisions of this 29
chapter that is delivered, issued for delivery or renewed on or after 30
July 1, 2023, has the legal effect of including the coverage 31
required by subsection 1, and any provision of the plan or renewal 32
which is in conflict with the provisions of this section is void. 33
5. As used in this section: 34
(a) “Gender dysphoria” means distress or impairment in 35
social, occupational or other areas of functioning caused by a 36
marked difference between the gender identity or expression of a 37
person and the sex assigned to the person at birth which lasts at 38
least 6 months and is shown by at least two of the following: 39
(1) A marked difference between gender identity or 40
expression and primary or secondary sex characteristics or 41
anticipated secondary sex characteristics in young adolescents. 42
(2) A strong desire to be rid of primary or secondary sex 43
characteristics because of a marked difference between such sex 44
characteristics and gender identity or expression or a desire to 45
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prevent the development of anticipated secondary sex 1
characteristics in young adolescents. 2
(3) A strong desire for the primary or secondary sex 3
characteristics of the gender opposite from the sex assigned at 4
birth. 5
(4) A strong desire to be of the opposite gender or a gender 6
different from the sex assigned at birth. 7
(5) A strong desire to be treated as the opposite gender or a 8
gender different from the sex assigned at birth. 9
(6) A strong conviction of experiencing typical feelings and 10
reactions of the opposite gender or a gender different from the sex 11
assigned at birth. 12
(b) “Medically necessary” means health care services or 13
products that a prudent provider of health care would provide to a 14
patient to prevent, diagnose or treat an illness, injury or disease, or 15
any symptoms thereof, that are necessary and: 16
(1) Provided in accordance with generally accepted 17
standards of medical practice; 18
(2) Clinically appropriate with regard to type, frequency, 19
extent, location and duration; 20
(3) Not provided primarily for the convenience of the 21
patient or provider of health care; 22
(4) Required to improve a specific health condition of a 23
patient or to preserve the existing state of health of the patient; 24
and 25
(5) The most clinically appropriate level of health care that 26
may be safely provided to the patient. 27
A provider of health care prescribing, ordering, recommending 28
or approving a health care service or product does not, by itself, 29
make that health care service or product medically necessary. 30
(c) “Network plan” means a health benefit plan offered by a 31
carrier under which the financing and delivery of medical care, 32
including items and services paid for as medical care, are 33
provided, in whole or in part, through a defined set of providers 34
under contract with the carrier. The term does not include an 35
arrangement for the financing of premiums. 36
(d) “Provider of health care” has the meaning ascribed to it in 37
NRS 629.031. 38
Sec. 5. NRS 689C.425 is hereby amended to read as follows: 39
689C.425 A voluntary purchasing group and any contract 40
issued to such a group pursuant to NRS 689C.360 to 689C.600, 41
inclusive, are subject to the provisions of NRS 689C.015 to 42
689C.355, inclusive, and section 4 of this act, to the extent 43
applicable and not in conflict with the express provisions of NRS 44
687B.408 and 689C.360 to 689C.600, inclusive. 45
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Sec. 6. Chapter 695A of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. A society that issues a benefit contract shall include in the 3
benefit contract coverage for the medically necessary treatment of 4
conditions relating to gender dysphoria, gender incongruence and 5
other disorders of sexual development. Such coverage must 6
include, without limitation, coverage of medically necessary 7
psychosocial and surgical intervention and any other medically 8
necessary treatment for such disorders provided by: 9
(a) Endocrinologists; 10
(b) Pediatric endocrinologists; 11
(c) Social workers; 12
(d) Psychiatrists; 13
(e) Psychologists; 14
(f) Gynecologists; 15
(g) Plastic surgeons; and 16
(h) Any other providers of medically necessary services for the 17
treatment of gender dysphoria, gender incongruence and other 18
disorders of sexual development. 19
2. A society that issues a benefit contract may prescribe 20
requirements that must be satisfied before the society covers 21
surgical treatment of conditions relating to gender dysphoria, 22
gender incongruence and other disorders of sexual development 23
for an insured who is less than 17 years of age. Such requirements 24
may include, without limitation, requirements that: 25
(a) The treatment must be recommended by a psychologist, 26
psychiatrist or other mental health professional; 27
(b) The treatment must be recommended by a physician; 28
(c) The insured must provide a written expression of the desire 29
of the insured to undergo the treatment; and 30
(d) A written plan for treatment that covers at least 1 year must 31
be developed and approved by at least two providers of health care. 32
3. A society shall make a reasonable effort to ensure that the 33
benefits required by subsection 1 are made available to an insured 34
through a provider of health care who participates in the network 35
plan of the society. If, after a reasonable effort, the society is 36
unable to make such benefits available through such a provider of 37
health care, the society must cover the benefits when provided to 38
an insured through a provider of health care who does not 39
participate in the network plan of the society. 40
4. A benefit contract subject to the provisions of this chapter 41
that is delivered, issued for delivery or renewed on or after July 1, 42
2023, has the legal effect of including the coverage required by 43
subsection 1, and any provision of the benefit contract or renewal 44
which is in conflict with the provisions of this section is void. 45
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5. As used in this section: 1
(a) “Gender dysphoria” means distress or impairment in 2
social, occupational or other areas of functioning caused by a 3
marked difference between the gender identity or expression of a 4
person and the sex assigned to the person at birth which lasts at 5
least 6 months and is shown by at least two of the following: 6
(1) A marked difference between gender identity or 7
expression and primary or secondary sex characteristics or 8
anticipated secondary sex characteristics in young adolescents. 9
(2) A strong desire to be rid of primary or secondary sex 10
characteristics because of a marked difference between such sex 11
characteristics and gender identity or expression or a desire to 12
prevent the development of anticipated secondary sex 13
characteristics in young adolescents. 14
(3) A strong desire for the primary or secondary sex 15
characteristics of the gender opposite from the sex assigned at 16
birth. 17
(4) A strong desire to be of the opposite gender or a gender 18
different from the sex assigned at birth. 19
(5) A strong desire to be treated as the opposite gender or a 20
gender different from the sex assigned at birth. 21
(6) A strong conviction of experiencing typical feelings and 22
reactions of the opposite gender or a gender different from the sex 23
assigned at birth. 24
(b) “Medically necessary” means health care services or 25
products that a prudent provider of health care would provide to a 26
patient to prevent, diagnose or treat an illness, injury or disease, or 27
any symptoms thereof, that are necessary and: 28
(1) Provided in accordance with generally accepted 29
standards of medical practice; 30
(2) Clinically appropriate with regard to type, frequency, 31
extent, location and duration; 32
(3) Not provided primarily for the convenience of the 33
patient or provider of health care; 34
(4) Required to improve a specific health condition of a 35
patient or to preserve the existing state of health of the patient; 36
and 37
(5) The most clinically appropriate level of health care that 38
may be safely provided to the patient. 39
A provider of health care prescribing, ordering, recommending 40
or approving a health care service or product does not, by itself, 41
make that health care service or product medically necessary. 42
(c) “Network plan” means a benefit contract offered by a 43
society under which the financing and delivery of medical care, 44
including items and services paid for as medical care, are 45
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provided, in whole or in part, through a defined set of providers 1
under contract with the society. The term does not include an 2
arrangement for the financing of premiums. 3
(d) “Provider of health care” has the meaning ascribed to it in 4
NRS 629.031. 5
Sec. 7. Chapter 695B of NRS is hereby amended by adding 6
thereto a new section to read as follows: 7
1. A hospital or medical services corporation that issues a 8
policy of health insurance shall include in the policy coverage for 9
the medically necessary treatment of conditions relating to gender 10
dysphoria, gender incongruence and other disorders of sexual 11
development. Such coverage must include, without limitation, 12
coverage of medically necessary psychosocial and surgical 13
intervention and any other medically necessary treatment for such 14
disorders provided by: 15
(a) Endocrinologists; 16
(b) Pediatric endocrinologists; 17
(c) Social workers; 18
(d) Psychiatrists; 19
(e) Psychologists; 20
(f) Gynecologists; 21
(g) Plastic surgeons; and 22
(h) Any other providers of medically necessary services for the 23
treatment of gender dysphoria, gender incongruence and other 24
disorders of sexual development. 25
2. A hospital or medical services corporation that issues a 26
policy of health insurance may prescribe requirements that must 27
be satisfied before the hospital or medical services corporation 28
covers surgical treatment of conditions relating to gender 29
dysphoria, gender incongruence and other disorders of sexual 30
development for an insured who is less than 17 years of age. Such 31
requirements may include, without limitation, requirements that: 32
(a) The treatment must be recommended by a psychologist, 33
psychiatrist or other mental health professional; 34
(b) The treatment must be recommended by a physician; 35
(c) The insured must provide a written expression of the desire 36
of the insured to undergo the treatment; and 37
(d) A written plan for treatment that covers at least 1 year must 38
be developed and approved by at least two providers of health care. 39
3. A hospital or medical services corporation shall make a 40
reasonable effort to ensure that the benefits required by subsection 41
1 are made available to an insured through a provider of health 42
care who participates in the network plan of the hospital or 43
medical services corporation. If, after a reasonable effort, the 44
hospital or medical services corporation is unable to make such 45
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benefits available through such a provider of health care, the 1
hospital or medical services corporation must cover the benefits 2
when provided to an insured through a provider of health care 3
who does not participate in the network plan of the hospital or 4
medical services corporation. 5
4. A policy of health insurance subject to the provisions of 6
this chapter that is delivered, issued for delivery or renewed on or 7
after July 1, 2023, has the legal effect of including the coverage 8
required by subsection 1, and any provision of the policy or 9
renewal which is in conflict with the provisions of this section is 10
void. 11
5. As used in this section: 12
(a) “Gender dysphoria” means distress or impairment in 13
social, occupational or other areas of functioning caused by a 14
marked difference between the gender identity or expression of a 15
person and the sex assigned to the person at birth which lasts at 16
least 6 months and is shown by at least two of the following: 17
(1) A marked difference between gender identity or 18
expression and primary or secondary sex characteristics or 19
anticipated secondary sex characteristics in young adolescents. 20
(2) A strong desire to be rid of primary or secondary sex 21
characteristics because of a marked difference between such sex 22
characteristics and gender identity or expression or a desire to 23
prevent the development of anticipated secondary sex 24
characteristics in young adolescents. 25
(3) A strong desire for the primary or secondary sex 26
characteristics of the gender opposite from the sex assigned at 27
birth. 28
(4) A strong desire to be of the opposite gender or a gender 29
different from the sex assigned at birth. 30
(5) A strong desire to be treated as the opposite gender or a 31
gender different from the sex assigned at birth. 32
(6) A strong conviction of experiencing typical feelings and 33
reactions of the opposite gender or a gender different from the sex 34
assigned at birth. 35
(b) “Medically necessary” means health care services or 36
products that a prudent provider of health care would provide to a 37
patient to prevent, diagnose or treat an illness, injury or disease, or 38
any symptoms thereof, that are necessary and: 39
(1) Provided in accordance with generally accepted 40
standards of medical practice; 41
(2) Clinically appropriate with regard to type, frequency, 42
extent, location and duration; 43
(3) Not provided primarily for the convenience of the 44
patient or provider of health care; 45
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(4) Required to improve a specific health condition of a 1
patient or to preserve the existing state of health of the patient; 2
and 3
(5) The most clinically appropriate level of health care that 4
may be safely provided to the patient. 5
A provider of health care prescribing, ordering, recommending 6
or approving a health care service or product does not, by itself, 7
make that health care service or product medically necessary. 8
(c) “Network plan” means a policy of health insurance offered 9
by a hospital or medical services corporation under which the 10
financing and delivery of medical care, including items and 11
services paid for as medical care, are provided, in whole or in part, 12
through a defined set of providers under contract with the hospital 13
or medical services corporation. The term does not include an 14
arrangement for the financing of premiums. 15
(d) “Provider of health care” has the meaning ascribed to it in 16
NRS 629.031. 17
Sec. 8. Chapter 695C of NRS is hereby amended by adding 18
thereto a new section to read as follows: 19
1. A health maintenance organization that issues a health 20
care plan shall include in the health care plan coverage for the 21
medically necessary treatment of conditions relating to gender 22
dysphoria, gender incongruence and other disorders of sexual 23
development. Such coverage must include, without limitation, 24
coverage of medically necessary psychosocial and surgical 25
intervention and any other medically necessary treatment for such 26
disorders provided by: 27
(a) Endocrinologists; 28
(b) Pediatric endocrinologists; 29
(c) Social workers; 30
(d) Psychiatrists; 31
(e) Psychologists; 32
(f) Gynecologists; 33
(g) Plastic surgeons; and 34
(h) Any other providers of medically necessary services for the 35
treatment of gender dysphoria, gender incongruence and other 36
disorders of sexual development. 37
2. A health maintenance organization that issues a health 38
care plan may prescribe requirements that must be satisfied before 39
the health maintenance organization covers surgical treatment of 40
conditions relating to gender dysphoria, gender incongruence and 41
other disorders of sexual development for an enrollee who is less 42
than 17 years of age. Such requirements may include, without 43
limitation, requirements that: 44
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(a) The treatment must be recommended by a psychologist, 1
psychiatrist or other mental health professional; 2
(b) The treatment must be recommended by a physician; 3
(c) The enrollee must provide a written expression of the desire 4
of the enrollee to undergo the treatment; and 5
(d) A written plan for treatment that covers at least 1 year must 6
be developed and approved by at least two providers of health care. 7
3. A health maintenance organization shall make a 8
reasonable effort to ensure that the benefits required by subsection 9
1 are made available to an enrollee through a provider of health 10
care who participates in the network plan of the 11
health maintenance organization. If, after a reasonable effort, the 12
health maintenance organization is unable to make such benefits 13
available through such a provider of health care, the health 14
maintenance organization must cover the benefits when provided 15
to an enrollee through a provider of health care who does not 16
participate in the network plan of the health maintenance 17
organization. 18
4. A health care plan subject to the provisions of this chapter 19
that is delivered, issued for delivery or renewed on or after July 1, 20
2023, has the legal effect of including the coverage required by 21
subsection 1, and any provision of the plan or renewal which is in 22
conflict with the provisions of this section is void. 23
5. As used in this section: 24
(a) “Gender dysphoria” means distress or impairment in 25
social, occupational or other areas of functioning caused by a 26
marked difference between the gender identity or expression of a 27
person and the sex assigned to the person at birth which lasts at 28
least 6 months and is shown by at least two of the following: 29
(1) A marked difference between gender identity or 30
expression and primary or secondary sex characteristics or 31
anticipated secondary sex characteristics in young adolescents. 32
(2) A strong desire to be rid of primary or secondary sex 33
characteristics because of a marked difference between such sex 34
characteristics and gender identity or expression or a desire to 35
prevent the development of anticipated secondary sex 36
characteristics in young adolescents. 37
(3) A strong desire for the primary or secondary sex 38
characteristics of the gender opposite from the sex assigned at 39
birth. 40
(4) A strong desire to be of the opposite gender or a gender 41
different from the sex assigned at birth. 42
(5) A strong desire to be treated as the opposite gender or a 43
gender different from the sex assigned at birth. 44
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(6) A strong conviction of experiencing typical feelings and 1
reactions of the opposite gender or a gender different from the sex 2
assigned at birth. 3
(b) “Medically necessary” means health care services or 4
products that a prudent provider of health care would provide to a 5
patient to prevent, diagnose or treat an illness, injury or disease, or 6
any symptoms thereof, that are necessary and: 7
(1) Provided in accordance with generally accepted 8
standards of medical practice; 9
(2) Clinically appropriate with regard to type, frequency, 10
extent, location and duration; 11
(3) Not provided primarily for the convenience of the 12
patient or provider of health care; 13
(4) Required to improve a specific health condition of a 14
patient or to preserve the existing state of health of the patient; 15
and 16
(5) The most clinically appropriate level of health care that 17
may be safely provided to the patient. 18
A provider of health care prescribing, ordering, recommending 19
or approving a health care service or product does not, by itself, 20
make that health care service or product medically necessary. 21
(c) “Network plan” means a health care plan offered by a 22
health maintenance organization under which the financing and 23
delivery of medical care, including items and services paid for as 24
medical care, are provided, in whole or in part, through a defined 25
set of providers under contract with the health maintenance 26
organization. The term does not include an arrangement for the 27
financing of premiums. 28
(d) “Provider of health care” has the meaning ascribed to it in 29
NRS 629.031. 30
Sec. 9. NRS 695C.050 is hereby amended to read as follows: 31
695C.050 1. Except as otherwise provided in this chapter or 32
in specific provisions of this title, the provisions of this title are not 33
applicable to any health maintenance organization granted a 34
certificate of authority under this chapter. This provision does not 35
apply to an insurer licensed and regulated pursuant to this title 36
except with respect to its activities as a health maintenance 37
organization authorized and regulated pursuant to this chapter. 38
2. Solicitation of enrollees by a health maintenance 39
organization granted a certificate of authority, or its representatives, 40
must not be construed to violate any provision of law relating to 41
solicitation or advertising by practitioners of a healing art. 42
3. Any health maintenance organization authorized under this 43
chapter shall not be deemed to be practicing medicine and is exempt 44
from the provisions of chapter 630 of NRS. 45
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4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 1
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 2
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 3
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 4
inclusive, and 695C.265 do not apply to a health maintenance 5
organization that provides health care services through managed 6
care to recipients of Medicaid under the State Plan for Medicaid or 7
insurance pursuant to the Children’s Health Insurance Program 8
pursuant to a contract with the Division of Health Care Financing 9
and Policy of the Department of Health and Human Services. 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
5. The provisions of NRS 695C.1694 to 695C.1698, inclusive, 14
695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17333, 15
695C.17345, 695C.17347, 695C.1735, 695C.1737, 695C.1743, 16
695C.1745 and 695C.1757 and section 8 of this act apply to a 17
health maintenance organization that provides health care services 18
through managed care to recipients of Medicaid under the State Plan 19
for Medicaid. 20
Sec. 10. NRS 695C.330 is hereby amended to read as follows: 21
695C.330 1. The Commissioner may suspend or revoke any 22
certificate of authority issued to a health maintenance organization 23
pursuant to the provisions of this chapter if the Commissioner finds 24
that any of the following conditions exist: 25
(a) The health maintenance organization is operating 26
significantly in contravention of its basic organizational document, 27
its health care plan or in a manner contrary to that described in and 28
reasonably inferred from any other information submitted pursuant 29
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 30
to those submissions have been filed with and approved by the 31
Commissioner; 32
(b) The health maintenance organization issues evidence of 33
coverage or uses a schedule of charges for health care services 34
which do not comply with the requirements of NRS 695C.1691 to 35
695C.200, inclusive, or 695C.207 [;] or section 8 of this act; 36
(c) The health care plan does not furnish comprehensive health 37
care services as provided for in NRS 695C.060; 38
(d) The Commissioner certifies that the health maintenance 39
organization: 40
(1) Does not meet the requirements of subsection 1 of NRS 41
695C.080; or 42
(2) Is unable to fulfill its obligations to furnish health care 43
services as required under its health care plan; 44
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(e) The health maintenance organization is no longer financially 1
responsible and may reasonably be expected to be unable to meet its 2
obligations to enrollees or prospective enrollees; 3
(f) The health maintenance organization has failed to put into 4
effect a mechanism affording the enrollees an opportunity to 5
participate in matters relating to the content of programs pursuant to 6
NRS 695C.110; 7
(g) The health maintenance organization has failed to put into 8
effect the system required by NRS 695C.260 for: 9
(1) Resolving complaints in a manner reasonably to dispose 10
of valid complaints; and 11
(2) Conducting external reviews of adverse determinations 12
that comply with the provisions of NRS 695G.241 to 695G.310, 13
inclusive; 14
(h) The health maintenance organization or any person on its 15
behalf has advertised or merchandised its services in an untrue, 16
misrepresentative, misleading, deceptive or unfair manner; 17
(i) The continued operation of the health maintenance 18
organization would be hazardous to its enrollees or creditors or to 19
the general public; 20
(j) The health maintenance organization fails to provide the 21
coverage required by NRS 695C.1691; or 22
(k) The health maintenance organization has otherwise failed to 23
comply substantially with the provisions of this chapter. 24
2. A certificate of authority must be suspended or revoked only 25
after compliance with the requirements of NRS 695C.340. 26
3. If the certificate of authority of a health maintenance 27
organization is suspended, the health maintenance organization shall 28
not, during the period of that suspension, enroll any additional 29
groups or new individual contracts, unless those groups or persons 30
were contracted for before the date of suspension. 31
4. If the certificate of authority of a health maintenance 32
organization is revoked, the organization shall proceed, immediately 33
following the effective date of the order of revocation, to wind up its 34
affairs and shall conduct no further business except as may be 35
essential to the orderly conclusion of the affairs of the organization. 36
It shall engage in no further advertising or solicitation of any kind. 37
The Commissioner may, by written order, permit such further 38
operation of the organization as the Commissioner may find to be in 39
the best interest of enrollees to the end that enrollees are afforded 40
the greatest practical opportunity to obtain continuing coverage for 41
health care. 42
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Sec. 11. Chapter 695G of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. A managed care organization that issues a health care 3
plan shall include in the health care plan coverage for the 4
medically necessary treatment of conditions relating to gender 5
dysphoria, gender incongruence and other disorders of sexual 6
development. Such coverage must include, without limitation, 7
coverage of medically necessary psychosocial and surgical 8
intervention and any other medically necessary treatment for such 9
disorders provided by: 10
(a) Endocrinologists; 11
(b) Pediatric endocrinologists; 12
(c) Social workers; 13
(d) Psychiatrists; 14
(e) Psychologists; 15
(f) Gynecologists; 16
(g) Plastic surgeons; and 17
(h) Any other providers of medically necessary services for the 18
treatment of gender dysphoria, gender incongruence and other 19
disorders of sexual development. 20
2. A managed care organization that issues a health care 21
plan may prescribe requirements that must be satisfied before the 22
managed care organization covers surgical treatment of 23
conditions relating to gender dysphoria, gender incongruence and 24
other disorders of sexual development for an insured who is less 25
than 17 years of age. Such requirements may include, without 26
limitation, requirements that: 27
(a) The treatment must be recommended by a psychologist, 28
psychiatrist or other mental health professional; 29
(b) The treatment must be recommended by a physician; 30
(c) The insured must provide a written expression of the desire 31
of the insured to undergo the treatment; and 32
(d) A written plan for treatment that covers at least 1 year must 33
be developed and approved by at least two providers of health care. 34
3. A managed care organization shall make a reasonable 35
effort to ensure that the benefits required by subsection 1 are 36
made available to an insured through a provider of health care 37
who participates in the network plan of the managed 38
care organization. If, after a reasonable effort, the managed care 39
organization is unable to make such benefits available through 40
such a provider of health care, the managed care organization 41
must cover the benefits when provided to an insured through a 42
provider of health care who does not participate in the network 43
plan of the managed care organization. 44
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4. Evidence of coverage subject to the provisions of this 1
chapter that is delivered, issued for delivery or renewed on or after 2
July 1, 2023, has the legal effect of including the coverage 3
required by subsection 1, and any provision of the plan or renewal 4
which is in conflict with the provisions of this section is void. 5
5. As used in this section: 6
(a) “Gender dysphoria” means distress or impairment in 7
social, occupational or other areas of functioning caused by a 8
marked difference between the gender identity or expression of a 9
person and the sex assigned to the person at birth which lasts at 10
least 6 months and is shown by at least two of the following: 11
(1) A marked difference between gender identity or 12
expression and primary or secondary sex characteristics or 13
anticipated secondary sex characteristics in young adolescents. 14
(2) A strong desire to be rid of primary or secondary sex 15
characteristics because of a marked difference between such sex 16
characteristics and gender identity or expression or a desire to 17
prevent the development of anticipated secondary sex 18
characteristics in young adolescents. 19
(3) A strong desire for the primary or secondary sex 20
characteristics of the gender opposite from the sex assigned at 21
birth. 22
(4) A strong desire to be of the opposite gender or a gender 23
different from the sex assigned at birth. 24
(5) A strong desire to be treated as the opposite gender or a 25
gender different from the sex assigned at birth. 26
(6) A strong conviction of experiencing typical feelings and 27
reactions of the opposite gender or a gender different from the sex 28
assigned at birth. 29
(b) “Medically necessary” means health care services or 30
products that a prudent provider of health care would provide to a 31
patient to prevent, diagnose or treat an illness, injury or disease, or 32
any symptoms thereof, that are necessary and: 33
(1) Provided in accordance with generally accepted 34
standards of medical practice; 35
(2) Clinically appropriate with regard to type, frequency, 36
extent, location and duration; 37
(3) Not provided primarily for the convenience of the 38
patient or provider of health care; 39
(4) Required to improve a specific health condition of a 40
patient or to preserve the existing state of health of the patient; 41
and 42
(5) The most clinically appropriate level of health care that 43
may be safely provided to the patient. 44
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A provider of health care prescribing, ordering, recommending 1
or approving a health care service or product does not, by itself, 2
make that health care service or product medically necessary. 3
(c) “Network plan” means a health care plan offered by a 4
managed care organization under which the financing and 5
delivery of medical care, including items and services paid for as 6
medical care, are provided, in whole or in part, through a defined 7
set of providers under contract with the managed care 8
organization. The term does not include an arrangement for the 9
financing of premiums. 10
(d) “Provider of health care” has the meaning ascribed to it in 11
NRS 629.031. 12
Sec. 12. NRS 232.320 is hereby amended to read as follows: 13
232.320 1. The Director: 14
(a) Shall appoint, with the consent of the Governor, 15
administrators of the divisions of the Department, who are 16
respectively designated as follows: 17
(1) The Administrator of the Aging and Disability Services 18
Division; 19
(2) The Administrator of the Division of Welfare and 20
Supportive Services; 21
(3) The Administrator of the Division of Child and Family 22
Services; 23
(4) The Administrator of the Division of Health Care 24
Financing and Policy; and 25
(5) The Administrator of the Division of Public and 26
Behavioral Health. 27
(b) Shall administer, through the divisions of the Department, 28
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 29
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 30
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 31
section 15 of this act, 422.580, 432.010 to 432.133, inclusive, 32
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 33
and 445A.010 to 445A.055, inclusive, and all other provisions of 34
law relating to the functions of the divisions of the Department, but 35
is not responsible for the clinical activities of the Division of Public 36
and Behavioral Health or the professional line activities of the other 37
divisions. 38
(c) Shall administer any state program for persons with 39
developmental disabilities established pursuant to the 40
Developmental Disabilities Assistance and Bill of Rights Act of 41
2000, 42 U.S.C. §§ 15001 et seq. 42
(d) Shall, after considering advice from agencies of local 43
governments and nonprofit organizations which provide social 44
services, adopt a master plan for the provision of human services in 45
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this State. The Director shall revise the plan biennially and deliver a 1
copy of the plan to the Governor and the Legislature at the 2
beginning of each regular session. The plan must: 3
(1) Identify and assess the plans and programs of the 4
Department for the provision of human services, and any 5
duplication of those services by federal, state and local agencies; 6
(2) Set forth priorities for the provision of those services; 7
(3) Provide for communication and the coordination of those 8
services among nonprofit organizations, agencies of local 9
government, the State and the Federal Government; 10
(4) Identify the sources of funding for services provided by 11
the Department and the allocation of that funding; 12
(5) Set forth sufficient information to assist the Department 13
in providing those services and in the planning and budgeting for the 14
future provision of those services; and 15
(6) Contain any other information necessary for the 16
Department to communicate effectively with the Federal 17
Government concerning demographic trends, formulas for the 18
distribution of federal money and any need for the modification of 19
programs administered by the Department. 20
(e) May, by regulation, require nonprofit organizations and state 21
and local governmental agencies to provide information regarding 22
the programs of those organizations and agencies, excluding 23
detailed information relating to their budgets and payrolls, which the 24
Director deems necessary for the performance of the duties imposed 25
upon him or her pursuant to this section. 26
(f) Has such other powers and duties as are provided by law. 27
2. Notwithstanding any other provision of law, the Director, or 28
the Director’s designee, is responsible for appointing and removing 29
subordinate officers and employees of the Department. 30
Sec. 13. NRS 287.010 is hereby amended to read as follows: 31
287.010 1. The governing body of any county, school 32
district, municipal corporation, political subdivision, public 33
corporation or other local governmental agency of the State of 34
Nevada may: 35
(a) Adopt and carry into effect a system of group life, accident 36
or health insurance, or any combination thereof, for the benefit of its 37
officers and employees, and the dependents of officers and 38
employees who elect to accept the insurance and who, where 39
necessary, have authorized the governing body to make deductions 40
from their compensation for the payment of premiums on the 41
insurance. 42
(b) Purchase group policies of life, accident or health insurance, 43
or any combination thereof, for the benefit of such officers and 44
employees, and the dependents of such officers and employees, as 45
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have authorized the purchase, from insurance companies authorized 1
to transact the business of such insurance in the State of Nevada, 2
and, where necessary, deduct from the compensation of officers and 3
employees the premiums upon insurance and pay the deductions 4
upon the premiums. 5
(c) Provide group life, accident or health coverage through a 6
self-insurance reserve fund and, where necessary, deduct 7
contributions to the maintenance of the fund from the compensation 8
of officers and employees and pay the deductions into the fund. The 9
money accumulated for this purpose through deductions from 10
the compensation of officers and employees and contributions of the 11
governing body must be maintained as an internal service fund as 12
defined by NRS 354.543. The money must be deposited in a state or 13
national bank or credit union authorized to transact business in the 14
State of Nevada. Any independent administrator of a fund created 15
under this section is subject to the licensing requirements of chapter 16
683A of NRS, and must be a resident of this State. Any contract 17
with an independent administrator must be approved by the 18
Commissioner of Insurance as to the reasonableness of 19
administrative charges in relation to contributions collected and 20
benefits provided. The provisions of NRS 686A.135, 687B.352, 21
687B.408, 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, 22
and section 3 of this act, 689B.265, 689B.287 and 689B.500 apply 23
to coverage provided pursuant to this paragraph, except that the 24
provisions of NRS 689B.0378, 689B.03785 and 689B.500 only 25
apply to coverage for active officers and employees of the 26
governing body, or the dependents of such officers and employees. 27
(d) Defray part or all of the cost of maintenance of a self-28
insurance fund or of the premiums upon insurance. The money for 29
contributions must be budgeted for in accordance with the laws 30
governing the county, school district, municipal corporation, 31
political subdivision, public corporation or other local governmental 32
agency of the State of Nevada. 33
2. If a school district offers group insurance to its officers and 34
employees pursuant to this section, members of the board of trustees 35
of the school district must not be excluded from participating in the 36
group insurance. If the amount of the deductions from compensation 37
required to pay for the group insurance exceeds the compensation to 38
which a trustee is entitled, the difference must be paid by the trustee. 39
3. In any county in which a legal services organization exists, 40
the governing body of the county, or of any school district, 41
municipal corporation, political subdivision, public corporation or 42
other local governmental agency of the State of Nevada in the 43
county, may enter into a contract with the legal services 44
organization pursuant to which the officers and employees of the 45
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legal services organization, and the dependents of those officers and 1
employees, are eligible for any life, accident or health insurance 2
provided pursuant to this section to the officers and employees, and 3
the dependents of the officers and employees, of the county, school 4
district, municipal corporation, political subdivision, public 5
corporation or other local governmental agency. 6
4. If a contract is entered into pursuant to subsection 3, the 7
officers and employees of the legal services organization: 8
(a) Shall be deemed, solely for the purposes of this section, to be 9
officers and employees of the county, school district, municipal 10
corporation, political subdivision, public corporation or other local 11
governmental agency with which the legal services organization has 12
contracted; and 13
(b) Must be required by the contract to pay the premiums or 14
contributions for all insurance which they elect to accept or of which 15
they authorize the purchase. 16
5. A contract that is entered into pursuant to subsection 3: 17
(a) Must be submitted to the Commissioner of Insurance for 18
approval not less than 30 days before the date on which the contract 19
is to become effective. 20
(b) Does not become effective unless approved by the 21
Commissioner. 22
(c) Shall be deemed to be approved if not disapproved by the 23
Commissioner within 30 days after its submission. 24
6. As used in this section, “legal services organization” means 25
an organization that operates a program for legal aid and receives 26
money pursuant to NRS 19.031. 27
Sec. 14. NRS 287.04335 is hereby amended to read as 28
follows: 29
287.04335 If the Board provides health insurance through a 30
plan of self-insurance, it shall comply with the provisions of NRS 31
686A.135, 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 32
689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 33
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 34
695G.1675, 695G.170 to 695G.174, inclusive, and section 11 of 35
this act, 695G.176, 695G.177, 695G.200 to 695G.230, inclusive, 36
695G.241 to 695G.310, inclusive, and 695G.405, in the same 37
manner as an insurer that is licensed pursuant to title 57 of NRS is 38
required to comply with those provisions. 39
Sec. 15. Chapter 422 of NRS is hereby amended by adding 40
thereto a new section to read as follows: 41
1. The Director shall include in the State Plan for Medicaid a 42
requirement that the State, to the extent authorized by federal law, 43
must pay the nonfederal share of expenditures incurred for the 44
medically necessary treatment of conditions relating to gender 45
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dysphoria, gender incongruence and other disorders of sexual 1
development. Such treatment includes, without limitation, 2
medically necessary psychosocial and surgical intervention and 3
any other medically necessary treatment for such disorders 4
provided by: 5
(a) Endocrinologists; 6
(b) Pediatric endocrinologists; 7
(c) Social workers; 8
(d) Psychiatrists; 9
(e) Psychologists; 10
(f) Gynecologists; 11
(g) Plastic surgeons; and 12
(h) Any other providers of medically necessary services for the 13
treatment of gender dysphoria, gender incongruence and other 14
disorders of sexual development. 15
2. As used in this section: 16
(a) “Gender dysphoria” means distress or impairment in 17
social, occupational or other areas of functioning caused by a 18
marked difference between the gender identity or expression of a 19
person and the sex assigned to the person at birth which lasts at 20
least 6 months and is shown by at least two of the following: 21
(1) A marked difference between gender identity or 22
expression and primary or secondary sex characteristics or 23
anticipated secondary sex characteristics in young adolescents. 24
(2) A strong desire to be rid of primary or secondary sex 25
characteristics because of a marked difference between such sex 26
characteristics and gender identity or expression or a desire to 27
prevent the development of anticipated secondary sex 28
characteristics in young adolescents. 29
(3) A strong desire for the primary or secondary sex 30
characteristics of the gender opposite from the sex assigned at 31
birth. 32
(4) A strong desire to be of the opposite gender or a gender 33
different from the sex assigned at birth. 34
(5) A strong desire to be treated as the opposite gender or a 35
gender different from the sex assigned at birth. 36
(6) A strong conviction of experiencing typical feelings and 37
reactions of the opposite gender or a gender different from the sex 38
assigned at birth. 39
(b) “Medically necessary” means health care services or 40
products that a prudent provider of health care would provide to a 41
patient to prevent, diagnose or treat an illness, injury or disease, or 42
any symptoms thereof, that are necessary and: 43
(1) Provided in accordance with generally accepted 44
standards of medical practice; 45
– 25 –
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(2) Clinically appropriate with regard to type, frequency, 1
extent, location and duration; 2
(3) Not provided primarily for the convenience of the 3
patient or provider of health care; 4
(4) Required to improve a specific health condition of a 5
patient or to preserve the existing state of health of the patient; 6
and 7
(5) The most clinically appropriate level of health care that 8
may be safely provided to the patient. 9
A provider of health care prescribing, ordering, recommending 10
or approving a health care service or product does not, by itself, 11
make that health care service or product medically necessary. 12
(c) “Provider of health care” has the meaning ascribed to it in 13
NRS 629.031. 14
Sec. 16. The provisions of NRS 354.599 do not apply to any 15
additional expenses of a local government that are related to the 16
provisions of this act. 17
Sec. 17. This act becomes effective on July 1, 2023. 18
H