EXEMPT
(Reprinted with amendments adopted on June 2, 2023)
SECOND REPRINT S.B. 163
- *SB163_R2*
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
and gender incongruence. (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 and gender incongruence; prohibiting
such insurers from engaging in certain discrimination on
the basis of gender identity or expression; making
appropriations and authorizing certain expenditures; 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, 3, 4, 6, 7, 8, 11, 13, 14 and 15 of this 8
bill: (1) require certain public and private policies of health insurance and health 9
care plans, including Medicaid, to cover the treatment of conditions relating to 10
gender dysphoria and gender incongruence; (2) authorize those policies and plans 11
to prescribe requirements that must be satisfied before the insurer will cover 12
surgical treatment for conditions relating to gender dysphoria or gender 13
– 2 –
- *SB163_R2*
incongruence for persons who are less than 18 years of age; and (3) require an 14
insurer to consult with a provider of health care with experience in prescribing or 15
delivering gender-affirming treatment when considering certain appeals of a denial 16
of coverage. Sections 1.6, 3.6, 4.6, 6.6, 7.6, 8.6, 11.6 and 15.6 of this bill prohibit 17
an insurer from engaging in certain discrimination on the basis of gender identity or 18
expression. Sections 2, 5, 9 and 12 of this bill make conforming changes to 19
indicate the proper placement of sections 1.3, 1.6, 4, 4.6, 8, 8.6, 15 and 15.6 in the 20
Nevada Revised Statutes. 21
Section 10 of this bill authorizes the Commissioner of Insurance to suspend or 22
revoke the certificate of a health maintenance organization that fails to comply with 23
the requirements of sections 8 and 8.6. The Commissioner would also be 24
authorized to take such action against other health insurers who fail to comply with 25
the requirements of sections 1.3, 1.6, 3, 3.6, 4, 4.6, 6, 6.6, 7, 7.6, 11 and 11.6. 26
(NRS 680A.200) Sections 16 and 17 of this bill make appropriations to the 27
Division of Health Care Financing and Policy of the Department of Health and 28
Human Services and authorize certain related expenditures for: (1) the costs of 29
providing the coverage under Medicaid required by section 15; and (2) certain 30
other costs associated with carrying out the provisions of this bill. 31
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 the provisions set forth as sections 1.3 and 1.6 of this 2
act. 3
Sec. 1.3. 1. Except as otherwise provided in this section, an 4
insurer that issues a policy of health insurance shall include in the 5
policy coverage for the medically necessary treatment of 6
conditions relating to gender dysphoria and gender incongruence. 7
Such coverage must include coverage of medically necessary 8
psychosocial and surgical intervention and any other medically 9
necessary treatment for such 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) Speech-language pathologists; 17
(h) Primary care physicians; 18
(i) Advanced practice registered nurses; 19
(j) Physician assistants; and 20
(k) Any other providers of medically necessary services for the 21
treatment of gender dysphoria or gender incongruence. 22
2. This section does not require a policy of health insurance 23
to include coverage for cosmetic surgery performed by a plastic 24
surgeon or reconstructive surgeon that is not medically necessary. 25
– 3 –
- *SB163_R2*
3. An insurer that issues a policy of health insurance shall 1
not categorically refuse to cover medically necessary gender-2
affirming treatments or procedures or revisions to prior treatments 3
if the policy provides coverage for any such services, procedures 4
or revisions for purposes other than gender transition or 5
affirmation. 6
4. An insurer that issues a policy of health insurance may 7
prescribe requirements that must be satisfied before the insurer 8
covers surgical treatment of conditions relating to gender 9
dysphoria or gender incongruence for an insured who is less than 10
18 years of age. Such requirements may include, without 11
limitation, requirements that: 12
(a) The treatment must be recommended by a psychologist, 13
psychiatrist or other mental health professional; 14
(b) The treatment must be recommended by a physician; 15
(c) The insured must provide a written expression of the desire 16
of the insured to undergo the treatment; 17
(d) A written plan for treatment that covers at least 1 year must 18
be developed and approved by at least two providers of health 19
care; and 20
(e) Parental consent is provided for the insured unless the 21
insured is expressly authorized by law to consent on his or her 22
own behalf. 23
5. When determining whether treatment is medically 24
necessary for the purposes of this section, an insurer must 25
consider the most recent Standards of Care published by the 26
World Professional Association for Transgender Health, or its 27
successor organization. 28
6. An insurer shall make a reasonable effort to ensure that 29
the benefits required by subsection 1 are made available to an 30
insured through a provider of health care who participates in the 31
network plan of the insurer. If, after a reasonable effort, the 32
insurer is unable to make such benefits available through such a 33
provider of health care, the insurer may treat the treatment that 34
the insurer is unable to make available through such a provider of 35
health care in the same manner as other services provided by a 36
provider of health care who does not participate in the network 37
plan of the insurer. 38
7. If an insured appeals the denial of a claim or coverage 39
under this section on the grounds that the treatment requested by 40
the insured is not medically necessary, the insurer must consult 41
with a provider of health care who has experience in prescribing 42
or delivering gender-affirming treatment concerning the medical 43
necessity of the treatment requested by the insured when 44
considering the appeal. 45
– 4 –
- *SB163_R2*
8. A policy of health insurance subject to the provisions of 1
this chapter that is delivered, issued for delivery or renewed on or 2
after July 1, 2023, has the legal effect of including the coverage 3
required by subsection 1, and any provision of the policy or the 4
renewal which is in conflict with this section is void. 5
9. As used in this section: 6
(a) “Cosmetic surgery”: 7
(1) Means a surgical procedure that: 8
(I) Does not meaningfully promote the proper function 9
of the body; 10
(II) Does not prevent or treat illness or disease; and 11
(III) Is primarily directed at improving the appearance 12
of a person. 13
(2) Includes, without limitation, cosmetic surgery directed 14
at preserving beauty. 15
(b) “Gender dysphoria” means distress or impairment in 16
social, occupational or other areas of functioning caused by a 17
marked difference between the gender identity or expression of a 18
person and the sex assigned to the person at birth which lasts at 19
least 6 months and is shown by at least two of the following: 20
(1) A marked difference between gender identity or 21
expression and primary or secondary sex characteristics or 22
anticipated secondary sex characteristics in young adolescents. 23
(2) A strong desire to be rid of primary or secondary sex 24
characteristics because of a marked difference between such sex 25
characteristics and gender identity or expression or a desire to 26
prevent the development of anticipated secondary sex 27
characteristics in young adolescents. 28
(3) A strong desire for the primary or secondary sex 29
characteristics of the gender opposite from the sex assigned at 30
birth. 31
(4) A strong desire to be of the opposite gender or a gender 32
different from the sex assigned at birth. 33
(5) A strong desire to be treated as the opposite gender or a 34
gender different from the sex assigned at birth. 35
(6) A strong conviction of experiencing typical feelings and 36
reactions of the opposite gender or a gender different from the sex 37
assigned at birth. 38
(c) “Medically necessary” means health care services or 39
products that a prudent provider of health care would provide to a 40
patient to prevent, diagnose or treat an illness, injury or disease, or 41
any symptoms thereof, that are necessary and: 42
(1) Provided in accordance with generally accepted 43
standards of medical practice; 44
– 5 –
- *SB163_R2*
(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
(d) “Network plan” means a policy of health insurance offered 13
by an insurer under which the financing and delivery of medical 14
care, including items and services paid for as medical care, are 15
provided, in whole or in part, through a defined set of providers 16
under contract with the insurer. The term does not include an 17
arrangement for the financing of premiums. 18
(e) “Provider of health care” has the meaning ascribed to it in 19
NRS 629.031. 20
Sec. 1.6. An insurer that issues a policy of health insurance 21
shall not discriminate against any person with respect to 22
participation or coverage under the policy on the basis of actual or 23
perceived gender identity or expression. Prohibited discrimination 24
includes, without limitation: 25
1. Denying, cancelling, limiting or refusing to issue or renew 26
a policy of health insurance on the basis of the actual or perceived 27
gender identity or expression of a person or a family member of 28
the person; 29
2. Imposing a payment or premium that is based on the 30
actual or perceived gender identity or expression of an insured or 31
a family member of the insured; 32
3. Designating the actual or perceived gender identity or 33
expression of a person or a family member of the person as 34
grounds to deny, cancel or limit participation or coverage; and 35
4. Denying, cancelling or limiting participation or coverage 36
on the basis of actual or perceived gender identity or expression, 37
including, without limitation, by limiting or denying coverage for 38
health care services that are: 39
(a) Related to gender transition, provided that there is 40
coverage under the policy for the services when the services are 41
not related to gender transition; or 42
(b) Ordinarily or exclusively available to persons of any sex. 43
– 6 –
- *SB163_R2*
Sec. 2. NRS 689A.330 is hereby amended to read as follows: 1
689A.330 If any policy is issued by a domestic insurer for 2
delivery to a person residing in another state, and if the insurance 3
commissioner or corresponding public officer of that other state has 4
informed the Commissioner that the policy is not subject to approval 5
or disapproval by that officer, the Commissioner may by ruling 6
require that the policy meet the standards set forth in NRS 689A.030 7
to 689A.320, inclusive [.] , and sections 1.3 and 1.6 of this act. 8
Sec. 2.8. Chapter 689B of NRS is hereby amended by adding 9
thereto the provisions set forth as sections 3 and 3.6 of this act. 10
Sec. 3. 1. Except as otherwise provided in this section, an 11
insurer that issues a policy of group health insurance shall 12
include in the policy coverage for the medically necessary 13
treatment of conditions relating to gender dysphoria and gender 14
incongruence. Such coverage must include coverage of medically 15
necessary psychosocial and surgical intervention and any other 16
medically necessary treatment for such disorders provided by: 17
(a) Endocrinologists; 18
(b) Pediatric endocrinologists; 19
(c) Social workers; 20
(d) Psychiatrists; 21
(e) Psychologists; 22
(f) Gynecologists; 23
(g) Speech-language pathologists; 24
(h) Primary care physicians; 25
(i) Advanced practice registered nurses; 26
(j) Physician assistants; and 27
(k) Any other providers of medically necessary services for the 28
treatment of gender dysphoria or gender incongruence. 29
2. This section does not require a policy of group health 30
insurance to include coverage for cosmetic surgery performed by a 31
plastic surgeon or reconstructive surgeon that is not medically 32
necessary. 33
3. An insurer that issues a policy of group health insurance 34
shall not categorically refuse to cover medically necessary gender-35
affirming treatments or procedures or revisions to prior treatments 36
if the policy provides coverage for any such services, procedures 37
or revisions for purposes other than gender transition or 38
affirmation. 39
4. An insurer that issues a policy of group health insurance 40
may prescribe requirements that must be satisfied before the 41
insurer covers surgical treatment of conditions relating to gender 42
dysphoria or gender incongruence for an insured who is less than 43
18 years of age. Such requirements may include, without 44
limitation, requirements that: 45
– 7 –
- *SB163_R2*
(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 insured must provide a written expression of the desire 4
of the insured to undergo the treatment; 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 7
care; and 8
(e) Parental consent is provided for the insured unless the 9
insured is expressly authorized by law to consent on his or her 10
own behalf. 11
5. When determining whether treatment is medically 12
necessary for the purposes of this section, an insurer must 13
consider the most recent Standards of Care published by the 14
World Professional Association for Transgender Health, or its 15
successor organization. 16
6. An insurer shall make a reasonable effort to ensure that 17
the benefits required by subsection 1 are made available to an 18
insured through a provider of health care who participates in the 19
network plan of the insurer. If, after a reasonable effort, the 20
insurer is unable to make such benefits available through such a 21
provider of health care, the insurer may treat the treatment that 22
the insurer is unable to make available through such a provider of 23
health care in the same manner as other services provided by a 24
provider of health care who does not participate in the network 25
plan of the insurer. 26
7. If an insured appeals the denial of a claim or coverage 27
under this section on the grounds that the treatment requested by 28
the insured is not medically necessary, the insurer must consult 29
with a provider of health care who has experience in prescribing 30
or delivering gender-affirming treatment concerning the medical 31
necessity of the treatment requested by the insured when 32
considering the appeal. 33
8. A policy of group health insurance subject to the 34
provisions of this chapter that is delivered, issued for delivery or 35
renewed on or after July 1, 2023, has the legal effect of including 36
the coverage required by subsection 1, and any provision of the 37
policy or renewal which is in conflict with the provisions of this 38
section is void. 39
9. As used in this section: 40
(a) “Cosmetic surgery”: 41
(1) Means a surgical procedure that: 42
(I) Does not meaningfully promote the proper function 43
of the body; 44
(II) Does not prevent or treat illness or disease; and 45
– 8 –
- *SB163_R2*
(III) Is primarily directed at improving the appearance 1
of a person. 2
(2) Includes, without limitation, cosmetic surgery directed 3
at preserving beauty. 4
(b) “Gender dysphoria” means distress or impairment in 5
social, occupational or other areas of functioning caused by a 6
marked difference between the gender identity or expression of a 7
person and the sex assigned to the person at birth which lasts at 8
least 6 months and is shown by at least two of the following: 9
(1) A marked difference between gender identity or 10
expression and primary or secondary sex characteristics or 11
anticipated secondary sex characteristics in young adolescents. 12
(2) A strong desire to be rid of primary or secondary sex 13
characteristics because of a marked difference between such sex 14
characteristics and gender identity or expression or a desire to 15
prevent the development of anticipated secondary sex 16
characteristics in young adolescents. 17
(3) A strong desire for the primary or secondary sex 18
characteristics of the gender opposite from the sex assigned at 19
birth. 20
(4) A strong desire to be of the opposite gender or a gender 21
different from the sex assigned at birth. 22
(5) A strong desire to be treated as the opposite gender or a 23
gender different from the sex assigned at birth. 24
(6) A strong conviction of experiencing typical feelings and 25
reactions of the opposite gender or a gender different from the sex 26
assigned at birth. 27
(c) “Medically necessary” means health care services or 28
products that a prudent provider of health care would provide to a 29
patient to prevent, diagnose or treat an illness, injury or disease, or 30
any symptoms thereof, that are necessary and: 31
(1) Provided in accordance with generally accepted 32
standards of medical practice; 33
(2) Clinically appropriate with regard to type, frequency, 34
extent, location and duration; 35
(3) Not provided primarily for the convenience of the 36
patient or provider of health care; 37
(4) Required to improve a specific health condition of a 38
patient or to preserve the existing state of health of the patient; 39
and 40
(5) The most clinically appropriate level of health care that 41
may be safely provided to the patient. 42
A provider of health care prescribing, ordering, recommending 43
or approving a health care service or product does not, by itself, 44
make that health care service or product medically necessary. 45
– 9 –
- *SB163_R2*
(d) “Network plan” means a policy of group health insurance 1
offered by an insurer under which the financing and delivery of 2
medical care, including items and services paid for as medical 3
care, are provided, in whole or in part, through a defined set of 4
providers under contract with the insurer. The term does not 5
include an arrangement for the financing of premiums. 6
(e) “Provider of health care” has the meaning ascribed to it in 7
NRS 629.031. 8
Sec. 3.6. An insurer that issues a policy of group health 9
insurance shall not discriminate against any person with respect 10
to participation or coverage under the policy on the basis of actual 11
or perceived gender identity or expression. Prohibited 12
discrimination includes, without limitation: 13
1. Denying, cancelling, limiting or refusing to issue or renew 14
a policy of group health insurance on the basis of the actual or 15
perceived gender identity or expression of a person or a family 16
member of the person; 17
2. Imposing a payment or premium that is based on the 18
actual or perceived gender identity or expression of an insured or 19
a family member of the insured; 20
3. Designating the actual or perceived gender identity or 21
expression of a person or a family member of the person as 22
grounds to deny, cancel or limit participation or coverage; and 23
4. Denying, cancelling or limiting participation or coverage 24
on the basis of actual or perceived gender identity or expression, 25
including, without limitation, by limiting or denying coverage for 26
health care services that are: 27
(a) Related to gender transition, provided that there is 28
coverage under the policy for the services when the services are 29
not related to gender transition; or 30
(b) Ordinarily or exclusively available to persons of any sex. 31
Sec. 3.8. Chapter 689C of NRS is hereby amended by adding 32
thereto the provisions set forth as sections 4 and 4.6 of this act. 33
Sec. 4. 1. Except as otherwise provided in this section, a 34
carrier that issues a health benefit plan shall include in the health 35
benefit plan coverage for the medically necessary treatment of 36
conditions relating to gender dysphoria and gender incongruence. 37
Such coverage must include coverage of medically necessary 38
psychosocial and surgical intervention and any other medically 39
necessary treatment for such disorders provided by: 40
(a) Endocrinologists; 41
(b) Pediatric endocrinologists; 42
(c) Social workers; 43
(d) Psychiatrists; 44
(e) Psychologists; 45
– 10 –
- *SB163_R2*
(f) Gynecologists; 1
(g) Speech-language pathologists; 2
(h) Primary care physicians; 3
(i) Advanced practice registered nurses; 4
(j) Physician assistants; and 5
(k) Any other providers of medically necessary services for the 6
treatment of gender dysphoria or gender incongruence. 7
2. This section does not require a health benefit plan to 8
include coverage for cosmetic surgery performed by a plastic 9
surgeon or reconstructive surgeon that is not medically necessary. 10
3. A carrier that issues a health benefit plan shall not 11
categorically refuse to cover medically necessary gender-affirming 12
treatments or procedures or revisions to prior treatments if the 13
plan provides coverage for any such services, procedures or 14
revisions for purposes other than gender transition or affirmation. 15
4. A carrier that issues a health benefit plan may prescribe 16
requirements that must be satisfied before the carrier covers 17
surgical treatment of conditions relating to gender dysphoria or 18
gender incongruence for an insured who is less than 18 years of 19
age. Such requirements may include, without limitation, 20
requirements that: 21
(a) The treatment must be recommended by a psychologist, 22
psychiatrist or other mental health professional; 23
(b) The treatment must be recommended by a physician; 24
(c) The insured must provide a written expression of the desire 25
of the insured to undergo the treatment; 26
(d) A written plan for treatment that covers at least 1 year must 27
be developed and approved by at least two providers of health 28
care; and 29
(e) Parental consent is provided for the insured unless the 30
insured is expressly authorized by law to consent on his or her 31
own behalf. 32
5. When determining whether treatment is medically 33
necessary for the purposes of this section, a carrier must consider 34
the most recent Standards of Care published by the World 35
Professional Association for Transgender Health, or its successor 36
organization. 37
6. A carrier shall make a reasonable effort to ensure that the 38
benefits required by subsection 1 are made available to an insured 39
through a provider of health care who participates in the network 40
plan of the carrier. If, after a reasonable effort, the carrier is 41
unable to make such benefits available through such a provider of 42
health care, the carrier may treat the treatment that the carrier is 43
unable to make available through such a provider of health care 44
in the same manner as other services provided by a provider of 45
– 11 –
- *SB163_R2*
health care who does not participate in the network plan of the 1
carrier. 2
7. If an insured appeals the denial of a claim or coverage 3
under this section on the grounds that the treatment requested by 4
the insured is not medically necessary, the carrier must consult 5
with a provider of health care who has experience in prescribing 6
or delivering gender-affirming treatment concerning the medical 7
necessity of the treatment requested by the insured when 8
considering the appeal 9
8. A health benefit plan subject to the provisions of this 10
chapter that is delivered, issued for delivery or renewed on or after 11
July 1, 2023, has the legal effect of including the coverage 12
required by subsection 1, and any provision of the plan or renewal 13
which is in conflict with the provisions of this section is void. 14
9. As used in this section: 15
(a) “Cosmetic surgery”: 16
(1) Means a surgical procedure that: 17
(I) Does not meaningfully promote the proper function 18
of the body; 19
(II) Does not prevent or treat illness or disease; and 20
(III) Is primarily directed at improving the appearance 21
of a person. 22
(2) Includes, without limitation, cosmetic surgery directed 23
at preserving beauty. 24
(b) “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
– 12 –
- *SB163_R2*
(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
(c) “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
(d) “Network plan” means a health benefit plan offered by a 22
carrier under which the financing and delivery of medical care, 23
including items and services paid for as medical care, are 24
provided, in whole or in part, through a defined set of providers 25
under contract with the carrier. The term does not include an 26
arrangement for the financing of premiums. 27
(e) “Provider of health care” has the meaning ascribed to it in 28
NRS 629.031. 29
Sec. 4.6. A carrier that issues a health benefit plan shall not 30
discriminate against any person with respect to participation or 31
coverage under the plan on the basis of actual or perceived gender 32
identity or expression. Prohibited discrimination includes, without 33
limitation: 34
1. Denying, cancelling, limiting or refusing to issue or renew 35
a health benefit plan on the basis of the actual or perceived gender 36
identity or expression of a person or a family member of the 37
person; 38
2. Imposing a payment or premium that is based on the 39
actual or perceived gender identity or expression of an insured or 40
a family member of the insured; 41
3. Designating the actual or perceived gender identity or 42
expression of a person or a family member of the person as 43
grounds to deny, cancel or limit participation or coverage; and 44
– 13 –
- *SB163_R2*
4. Denying, cancelling or limiting participation or coverage 1
on the basis of actual or perceived gender identity or expression, 2
including, without limitation, by limiting or denying coverage for 3
health care services that are: 4
(a) Related to gender transition, provided that there is 5
coverage under the plan for the services when the services are not 6
related to gender transition; or 7
(b) Ordinarily or exclusively available to persons of any sex. 8
Sec. 5. NRS 689C.425 is hereby amended to read as follows: 9
689C.425 A voluntary purchasing group and any contract 10
issued to such a group pursuant to NRS 689C.360 to 689C.600, 11
inclusive, are subject to the provisions of NRS 689C.015 to 12
689C.355, inclusive, and sections 4 and 4.6 of this act, to the extent 13
applicable and not in conflict with the express provisions of NRS 14
687B.408 and 689C.360 to 689C.600, inclusive. 15
Sec. 5.8. Chapter 695A of NRS is hereby amended by adding 16
thereto the provisions set forth as sections 6 and 6.6 of this act. 17
Sec. 6. 1. Except as otherwise provided in this section, a 18
society that issues a benefit contract shall include in the benefit 19
contract coverage for the medically necessary treatment of 20
conditions relating to gender dysphoria and gender incongruence. 21
Such coverage must include coverage of medically necessary 22
psychosocial and surgical intervention and any other medically 23
necessary treatment for such disorders provided by: 24
(a) Endocrinologists; 25
(b) Pediatric endocrinologists; 26
(c) Social workers; 27
(d) Psychiatrists; 28
(e) Psychologists; 29
(f) Gynecologists; 30
(g) Speech-language pathologists; 31
(h) Primary care physicians; 32
(i) Advanced practice registered nurses; 33
(j) Physician assistants; and 34
(k) Any other providers of medically necessary services for the 35
treatment of gender dysphoria or gender incongruence. 36
2. This section does not require a benefit contract to include 37
coverage for cosmetic surgery performed by a plastic surgeon or 38
reconstructive surgeon that is not medically necessary. 39
3. A society that issues a benefit contract shall not 40
categorically refuse to cover medically necessary gender-affirming 41
treatments or procedures or revisions to prior treatments if the 42
contract provides coverage for any such services, procedures or 43
revisions for purposes other than gender transition or affirmation. 44
– 14 –
- *SB163_R2*
4. A society that issues a benefit contract may prescribe 1
requirements that must be satisfied before the society covers 2
surgical treatment of conditions relating to gender dysphoria or 3
gender incongruence for an insured who is less than 18 years of 4
age. Such requirements may include, without limitation, 5
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; 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 13
care; and 14
(e) Parental consent is provided for the insured unless the 15
insured is expressly authorized by law to consent on his or her 16
own behalf. 17
5. When determining whether treatment is medically 18
necessary for the purposes of this section, a society must consider 19
the most recent Standards of Care published by the World 20
Professional Association for Transgender Health, or its successor 21
organization. 22
6. A society shall make a reasonable effort to ensure that the 23
benefits required by subsection 1 are made available to an insured 24
through a provider of health care who participates in the network 25
plan of the society. If, after a reasonable effort, the society is 26
unable to make such benefits available through such a provider of 27
health care, the society may treat the treatment that the society is 28
unable to make available through such a provider of health care 29
in the same manner as other services provided by a provider of 30
health care who does not participate in the network plan of the 31
society. 32
7. If an insured appeals the denial of a claim or coverage 33
under this section on the grounds that the treatment requested by 34
the insured is not medically necessary, the society must consult 35
with a provider of health care who has experience in prescribing 36
or delivering gender-affirming treatment concerning the medical 37
necessity of the treatment requested by the insured when 38
considering the appeal. 39
8. A benefit contract subject to the provisions of this chapter 40
that is delivered, issued for delivery or renewed on or after July 1, 41
2023, has the legal effect of including the coverage required by 42
subsection 1, and any provision of the benefit contract or renewal 43
which is in conflict with the provisions of this section is void. 44
9. As used in this section: 45
– 15 –
- *SB163_R2*
(a) “Cosmetic surgery”: 1
(1) Means a surgical procedure that: 2
(I) Does not meaningfully promote the proper function 3
of the body; 4
(II) Does not prevent or treat illness or disease; and 5
(III) Is primarily directed at improving the appearance 6
of a person. 7
(2) Includes, without limitation, cosmetic surgery directed 8
at preserving beauty. 9
(b) “Gender dysphoria” means distress or impairment in 10
social, occupational or other areas of functioning caused by a 11
marked difference between the gender identity or expression of a 12
person and the sex assigned to the person at birth which lasts at 13
least 6 months and is shown by at least two of the following: 14
(1) A marked difference between gender identity or 15
expression and primary or secondary sex characteristics or 16
anticipated secondary sex characteristics in young adolescents. 17
(2) A strong desire to be rid of primary or secondary sex 18
characteristics because of a marked difference between such sex 19
characteristics and gender identity or expression or a desire to 20
prevent the development of anticipated secondary sex 21
characteristics in young adolescents. 22
(3) A strong desire for the primary or secondary sex 23
characteristics of the gender opposite from the sex assigned at 24
birth. 25
(4) A strong desire to be of the opposite gender or a gender 26
different from the sex assigned at birth. 27
(5) A strong desire to be treated as the opposite gender or a 28
gender different from the sex assigned at birth. 29
(6) A strong conviction of experiencing typical feelings and 30
reactions of the opposite gender or a gender different from the sex 31
assigned at birth. 32
(c) “Medically necessary” means health care services or 33
products that a prudent provider of health care would provide to a 34
patient to prevent, diagnose or treat an illness, injury or disease, or 35
any symptoms thereof, that are necessary and: 36
(1) Provided in accordance with generally accepted 37
standards of medical practice; 38
(2) Clinically appropriate with regard to type, frequency, 39
extent, location and duration; 40
(3) Not provided primarily for the convenience of the 41
patient or provider of health care; 42
(4) Required to improve a specific health condition of a 43
patient or to preserve the existing state of health of the patient; 44
and 45
– 16 –
- *SB163_R2*
(5) The most clinically appropriate level of health care that 1
may be safely provided to the patient. 2
A provider of health care prescribing, ordering, recommending 3
or approving a health care service or product does not, by itself, 4
make that health care service or product medically necessary. 5
(d) “Network plan” means a benefit contract offered by a 6
society under which the financing and delivery of medical care, 7
including items and services paid for as medical care, are 8
provided, in whole or in part, through a defined set of providers 9
under contract with the society. The term does not include an 10
arrangement for the financing of premiums. 11
(e) “Provider of health care” has the meaning ascribed to it in 12
NRS 629.031. 13
Sec. 6.6. A society that issues a benefit contract shall not 14
discriminate against any person with respect to participation or 15
coverage under the contract on the basis of actual or perceived 16
gender identity or expression. Prohibited discrimination includes, 17
without limitation: 18
1. Denying, cancelling, limiting or refusing to issue or renew 19
a benefit contract on the basis of the actual or perceived gender 20
identity or expression of a person or a family member of the 21
person; 22
2. Imposing a payment or premium that is based on the 23
actual or perceived gender identity or expression of an insured or 24
a family member of the insured; 25
3. Designating the actual or perceived gender identity or 26
expression of a person or a family member of the person as 27
grounds to deny, cancel or limit participation or coverage; and 28
4. Denying, cancelling or limiting participation or coverage 29
on the basis of actual or perceived gender identity or expression, 30
including, without limitation, by limiting or denying coverage for 31
health care services that are: 32
(a) Related to gender transition, provided that there is 33
coverage under the contract for the services when the services are 34
not related to gender transition; or 35
(b) Ordinarily or exclusively available to persons of any sex. 36
Sec. 6.8. Chapter 695B of NRS is hereby amended by adding 37
thereto the provisions set forth as sections 7 and 7.6 of this act. 38
Sec. 7. 1. Except as otherwise provided in this section, a 39
hospital or medical services corporation that issues a policy of 40
health insurance shall include in the policy coverage for the 41
medically necessary treatment of conditions relating to gender 42
dysphoria and gender incongruence. Such coverage must include 43
coverage of medically necessary psychosocial and surgical 44
– 17 –
- *SB163_R2*
intervention and any other medically necessary treatment for such 1
disorders provided by: 2
(a) Endocrinologists; 3
(b) Pediatric endocrinologists; 4
(c) Social workers; 5
(d) Psychiatrists; 6
(e) Psychologists; 7
(f) Gynecologists; 8
(g) Speech-language pathologists; 9
(h) Primary care physicians; 10
(i) Advanced practice registered nurses; 11
(j) Physician assistants; and 12
(k) Any other providers of medically necessary services for the 13
treatment of gender dysphoria or gender incongruence. 14
2. This section does not require a policy of health insurance 15
to include coverage for cosmetic surgery performed by a plastic 16
surgeon or reconstructive surgeon that is not medically necessary. 17
3. A hospital or medical services corporation that issues a 18
policy of health insurance shall not categorically refuse to cover 19
medically necessary gender-affirming treatments or procedures or 20
revisions to prior treatments if the policy provides coverage for any 21
such services, procedures or revisions for purposes other than 22
gender transition or affirmation. 23
4. A hospital or medical services corporation that issues a 24
policy of health insurance may prescribe requirements that must 25
be satisfied before the hospital or medical services corporation 26
covers surgical treatment of conditions relating to gender 27
dysphoria or gender incongruence for an insured who is less than 28
18 years of age. Such requirements may include, without 29
limitation, requirements that: 30
(a) The treatment must be recommended by a psychologist, 31
psychiatrist or other mental health professional; 32
(b) The treatment must be recommended by a physician; 33
(c) The insured must provide a written expression of the desire 34
of the insured to undergo the treatment; 35
(d) A written plan for treatment that covers at least 1 year must 36
be developed and approved by at least two providers of health 37
care; and 38
(e) Parental consent is provided for the insured unless the 39
insured is expressly authorized by law to consent on his or her 40
own behalf. 41
5. When determining whether treatment is medically 42
necessary for the purposes of this section, a hospital or medical 43
services corporation must consider the most recent Standards of 44
– 18 –
- *SB163_R2*
Care published by the World Professional Association for 1
Transgender Health, or its successor organization. 2
6. A hospital or medical services corporation shall make a 3
reasonable effort to ensure that the benefits required by subsection 4
1 are made available to an insured through a provider of health 5
care who participates in the network plan of the hospital or 6
medical services corporation. If, after a reasonable effort, the 7
hospital or medical services corporation is unable to make such 8
benefits available through such a provider of health care, the 9
hospital or medical services corporation may treat the treatment 10
that the hospital or medical services corporation is unable to make 11
available through such a provider of health care in the same 12
manner as other services provided by a provider of health care 13
who does not participate in the network plan of the hospital or 14
medical services corporation. 15
7. If an insured appeals the denial of a claim or coverage 16
under this section on the grounds that the treatment requested by 17
the insured is not medically necessary, the hospital or medical 18
services corporation must consult with a provider of health care 19
who has experience in prescribing or delivering gender-affirming 20
treatment concerning the medical necessity of the treatment 21
requested by the insured when considering the appeal. 22
8. A policy of health insurance subject to the provisions of 23
this chapter that is delivered, issued for delivery or renewed on or 24
after July 1, 2023, has the legal effect of including the coverage 25
required by subsection 1, and any provision of the policy or 26
renewal which is in conflict with the provisions of this section is 27
void. 28
9. As used in this section: 29
(a) “Cosmetic surgery”: 30
(1) Means a surgical procedure that: 31
(I) Does not meaningfully promote the proper function 32
of the body; 33
(II) Does not prevent or treat illness or disease; and 34
(III) Is primarily directed at improving the appearance 35
of a person. 36
(2) Includes, without limitation, cosmetic surgery directed 37
at preserving beauty. 38
(b) “Gender dysphoria” means distress or impairment in 39
social, occupational or other areas of functioning caused by a 40
marked difference between the gender identity or expression of a 41
person and the sex assigned to the person at birth which lasts at 42
least 6 months and is shown by at least two of the following: 43
– 19 –
- *SB163_R2*
(1) A marked difference between gender identity or 1
expression and primary or secondary sex characteristics or 2
anticipated secondary sex characteristics in young adolescents. 3
(2) A strong desire to be rid of primary or secondary sex 4
characteristics because of a marked difference between such sex 5
characteristics and gender identity or expression or a desire to 6
prevent the development of anticipated secondary sex 7
characteristics in young adolescents. 8
(3) A strong desire for the primary or secondary sex 9
characteristics of the gender opposite from the sex assigned at 10
birth. 11
(4) A strong desire to be of the opposite gender or a gender 12
different from the sex assigned at birth. 13
(5) A strong desire to be treated as the opposite gender or a 14
gender different from the sex assigned at birth. 15
(6) A strong conviction of experiencing typical feelings and 16
reactions of the opposite gender or a gender different from the sex 17
assigned at birth. 18
(c) “Medically necessary” means health care services or 19
products that a prudent provider of health care would provide to a 20
patient to prevent, diagnose or treat an illness, injury or disease, or 21
any symptoms thereof, that are necessary and: 22
(1) Provided in accordance with generally accepted 23
standards of medical practice; 24
(2) Clinically appropriate with regard to type, frequency, 25
extent, location and duration; 26
(3) Not provided primarily for the convenience of the 27
patient or provider of health care; 28
(4) Required to improve a specific health condition of a 29
patient or to preserve the existing state of health of the patient; 30
and 31
(5) The most clinically appropriate level of health care that 32
may be safely provided to the patient. 33
A provider of health care prescribing, ordering, recommending 34
or approving a health care service or product does not, by itself, 35
make that health care service or product medically necessary. 36
(d) “Network plan” means a policy of health insurance offered 37
by a hospital or medical services corporation under which the 38
financing and delivery of medical care, including items and 39
services paid for as medical care, are provided, in whole or in part, 40
through a defined set of providers under contract with the hospital 41
or medical services corporation. The term does not include an 42
arrangement for the financing of premiums. 43
(e) “Provider of health care” has the meaning ascribed to it in 44
NRS 629.031. 45
– 20 –
- *SB163_R2*
Sec. 7.6. A hospital or medical services corporation that 1
issues a policy of health insurance shall not discriminate against 2
any person with respect to participation or coverage under the 3
policy on the basis of actual or perceived gender identity or 4
expression. Prohibited discrimination includes, without limitation: 5
1. Denying, cancelling, limiting or refusing to issue or renew 6
a policy of health insurance on the basis of the actual or perceived 7
gender identity or expression of a person or a family member of 8
the person; 9
2. Imposing a payment or premium that is based on the 10
actual or perceived gender identity or expression of an insured or 11
a family member of the insured; 12
3. Designating the actual or perceived gender identity or 13
expression of a person or a family member of the person as 14
grounds to deny, cancel or limit participation or coverage; and 15
4. Denying, cancelling or limiting participation or coverage 16
on the basis of actual or perceived gender identity or expression, 17
including, without limitation, by limiting or denying coverage for 18
health care services that are: 19
(a) Related to gender transition, provided that there is 20
coverage under the policy for the services when the services are 21
not related to gender transition; or 22
(b) Ordinarily or exclusively available to persons of any sex. 23
Sec. 7.8. Chapter 695C of NRS is hereby amended by adding 24
thereto the provisions set forth as sections 8 and 8.6 of this act. 25
Sec. 8. 1. Except as otherwise provided in this section, a 26
health maintenance organization that issues a health care plan 27
shall include in the health care plan coverage for the medically 28
necessary treatment of conditions relating to gender dysphoria and 29
gender incongruence. Such coverage must include coverage of 30
medically necessary psychosocial and surgical intervention and 31
any other medically necessary treatment for such disorders 32
provided by: 33
(a) Endocrinologists; 34
(b) Pediatric endocrinologists; 35
(c) Social workers; 36
(d) Psychiatrists; 37
(e) Psychologists; 38
(f) Gynecologists; 39
(g) Speech-language pathologists; 40
(h) Primary care physicians; 41
(i) Advanced practice registered nurses; 42
(j) Physician assistants; and 43
(k) Any other providers of medically necessary services for the 44
treatment of gender dysphoria or gender incongruence. 45
– 21 –
- *SB163_R2*
2. This section does not require a health care plan to include 1
coverage for cosmetic surgery performed by a plastic surgeon or 2
reconstructive surgeon that is not medically necessary. 3
3. A health maintenance organization that issues a health 4
care plan shall not categorically refuse to cover medically 5
necessary gender-affirming treatments or procedures or revisions 6
to prior treatments if the plan provides coverage for any such 7
services, procedures or revisions for purposes other than gender 8
transition or affirmation. 9
4. A health maintenance organization that issues a health 10
care plan may prescribe requirements that must be satisfied before 11
the health maintenance organization covers surgical treatment of 12
conditions relating to gender dysphoria or gender incongruence 13
for an enrollee who is less than 18 years of age. Such 14
requirements may include, without limitation, requirements that: 15
(a) The treatment must be recommended by a psychologist, 16
psychiatrist or other mental health professional; 17
(b) The treatment must be recommended by a physician; 18
(c) The enrollee must provide a written expression of the desire 19
of the enrollee to undergo the treatment; 20
(d) A written plan for treatment that covers at least 1 year must 21
be developed and approved by at least two providers of health 22
care; and 23
(e) Parental consent is provided for the enrollee unless the 24
enrollee is expressly authorized by law to consent on his or her 25
own behalf. 26
5. When determining whether treatment is medically 27
necessary for the purposes of this section, a health maintenance 28
organization must consider the most recent Standards of Care 29
prescribed by the World Professional Association for Transgender 30
Health, or its successor organization. 31
6. A health maintenance organization shall make a 32
reasonable effort to ensure that the benefits required by subsection 33
1 are made available to an enrollee through a provider of 34
health care who participates in the network plan of the health 35
maintenance organization. If, after a reasonable effort, the health 36
maintenance organization is unable to make such benefits 37
available through such a provider of health care, the health 38
maintenance organization may treat the treatment that the health 39
maintenance organization is unable to make available through 40
such a provider of health care in the same manner as other 41
services provided by a provider of health care who does not 42
participate in the network plan of the health maintenance 43
organization. 44
– 22 –
- *SB163_R2*
7. If an enrollee appeals the denial of a claim or coverage 1
under this section on the grounds that the treatment requested by 2
the enrollee is not medically necessary, the health maintenance 3
organization must consult with a provider of health care who has 4
experience in prescribing or delivering gender-affirming treatment 5
concerning the medical necessity of the treatment requested by the 6
enrollee when considering the appeal. 7
8. A health care plan subject to the provisions of this chapter 8
that is delivered, issued for delivery or renewed on or after July 1, 9
2023, has the legal effect of including the coverage required by 10
subsection 1, and any provision of the plan or renewal which is in 11
conflict with the provisions of this section is void. 12
9. As used in this section: 13
(a) “Cosmetic surgery”: 14
(1) Means a surgical procedure that: 15
(I) Does not meaningfully promote the proper function 16
of the body; 17
(II) Does not prevent or treat illness or disease; and 18
(III) Is primarily directed at improving the appearance 19
of a person. 20
(2) Includes, without limitation, cosmetic surgery directed 21
at preserving beauty. 22
(b) “Gender dysphoria” means distress or impairment in 23
social, occupational or other areas of functioning caused by a 24
marked difference between the gender identity or expression of a 25
person and the sex assigned to the person at birth which lasts at 26
least 6 months and is shown by at least two of the following: 27
(1) A marked difference between gender identity or 28
expression and primary or secondary sex characteristics or 29
anticipated secondary sex characteristics in young adolescents. 30
(2) A strong desire to be rid of primary or secondary sex 31
characteristics because of a marked difference between such sex 32
characteristics and gender identity or expression or a desire to 33
prevent the development of anticipated secondary sex 34
characteristics in young adolescents. 35
(3) A strong desire for the primary or secondary sex 36
characteristics of the gender opposite from the sex assigned at 37
birth. 38
(4) A strong desire to be of the opposite gender or a gender 39
different from the sex assigned at birth. 40
(5) A strong desire to be treated as the opposite gender or a 41
gender different from the sex assigned at birth. 42
(6) A strong conviction of experiencing typical feelings and 43
reactions of the opposite gender or a gender different from the sex 44
assigned at birth. 45
– 23 –
- *SB163_R2*
(c) “Medically necessary” means health care services or 1
products that a prudent provider of health care would provide to a 2
patient to prevent, diagnose or treat an illness, injury or disease, or 3
any symptoms thereof, that are necessary and: 4
(1) Provided in accordance with generally accepted 5
standards of medical practice; 6
(2) Clinically appropriate with regard to type, frequency, 7
extent, location and duration; 8
(3) Not provided primarily for the convenience of the 9
patient or provider of health care; 10
(4) Required to improve a specific health condition of a 11
patient or to preserve the existing state of health of the patient; 12
and 13
(5) The most clinically appropriate level of health care that 14
may be safely provided to the patient. 15
A provider of health care prescribing, ordering, recommending 16
or approving a health care service or product does not, by itself, 17
make that health care service or product medically necessary. 18
(d) “Network plan” means a health care plan offered by a 19
health maintenance organization under which the financing and 20
delivery of medical care, including items and services paid for as 21
medical care, are provided, in whole or in part, through a defined 22
set of providers under contract with the health maintenance 23
organization. The term does not include an arrangement for the 24
financing of premiums. 25
(e) “Provider of health care” has the meaning ascribed to it in 26
NRS 629.031. 27
Sec. 8.6. A health maintenance organization that issues a 28
health care plan shall not discriminate against any person with 29
respect to participation or coverage under the plan on the basis of 30
actual or perceived gender identity or expression. Prohibited 31
discrimination includes, without limitation: 32
1. Denying, cancelling, limiting or refusing to issue or renew 33
a health care plan on the basis of the actual or perceived gender 34
identity or expression of a person or a family member of the 35
person; 36
2. Imposing a payment or premium that is based on the 37
actual or perceived gender identity or expression of an enrollee or 38
a family member of the enrollee; 39
3. Designating the actual or perceived gender identity or 40
expression of a person or a family member of the person as 41
grounds to deny, cancel or limit participation or coverage; and 42
4. Denying, cancelling or limiting participation or coverage 43
on the basis of actual or perceived gender identity or expression, 44
– 24 –
- *SB163_R2*
including, without limitation, by limiting or denying coverage for 1
health care services that are: 2
(a) Related to gender transition, provided that there is 3
coverage under the plan for the services when the services are not 4
related to gender transition; or 5
(b) Ordinarily or exclusively available to persons of any sex. 6
Sec. 9. NRS 695C.050 is hereby amended to read as follows: 7
695C.050 1. Except as otherwise provided in this chapter or 8
in specific provisions of this title, the provisions of this title are not 9
applicable to any health maintenance organization granted a 10
certificate of authority under this chapter. This provision does not 11
apply to an insurer licensed and regulated pursuant to this title 12
except with respect to its activities as a health maintenance 13
organization authorized and regulated pursuant to this chapter. 14
2. Solicitation of enrollees by a health maintenance 15
organization granted a certificate of authority, or its representatives, 16
must not be construed to violate any provision of law relating to 17
solicitation or advertising by practitioners of a healing art. 18
3. Any health maintenance organization authorized under this 19
chapter shall not be deemed to be practicing medicine and is exempt 20
from the provisions of chapter 630 of NRS. 21
4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 22
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 23
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 24
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 25
inclusive, and 695C.265 do not apply to a health maintenance 26
organization that provides health care services through managed 27
care to recipients of Medicaid under the State Plan for Medicaid or 28
insurance pursuant to the Children’s Health Insurance Program 29
pursuant to a contract with the Division of Health Care Financing 30
and Policy of the Department of Health and Human Services. This 31
subsection does not exempt a health maintenance organization from 32
any provision of this chapter for services provided pursuant to any 33
other contract. 34
5. The provisions of NRS 695C.1694 to 695C.1698, inclusive, 35
695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17333, 36
695C.17345, 695C.17347, 695C.1735, 695C.1737, 695C.1743, 37
695C.1745 and 695C.1757 and sections 8 and 8.6 of this act apply 38
to a health maintenance organization that provides health care 39
services through managed care to recipients of Medicaid under the 40
State Plan for Medicaid. 41
Sec. 10. NRS 695C.330 is hereby amended to read as follows: 42
695C.330 1. The Commissioner may suspend or revoke any 43
certificate of authority issued to a health maintenance organization 44
– 25 –
- *SB163_R2*
pursuant to the provisions of this chapter if the Commissioner finds 1
that any of the following conditions exist: 2
(a) The health maintenance organization is operating 3
significantly in contravention of its basic organizational document, 4
its health care plan or in a manner contrary to that described in and 5
reasonably inferred from any other information submitted pursuant 6
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 7
to those submissions have been filed with and approved by the 8
Commissioner; 9
(b) The health maintenance organization issues evidence of 10
coverage or uses a schedule of charges for health care services 11
which do not comply with the requirements of NRS 695C.1691 to 12
695C.200, inclusive, or 695C.207 [;] or sections 8 and 8.6 of this 13
act; 14
(c) The health care plan does not furnish comprehensive health 15
care services as provided for in NRS 695C.060; 16
(d) The Commissioner certifies that the health maintenance 17
organization: 18
(1) Does not meet the requirements of subsection 1 of NRS 19
695C.080; or 20
(2) Is unable to fulfill its obligations to furnish health care 21
services as required under its health care plan; 22
(e) The health maintenance organization is no longer financially 23
responsible and may reasonably be expected to be unable to meet its 24
obligations to enrollees or prospective enrollees; 25
(f) The health maintenance organization has failed to put into 26
effect a mechanism affording the enrollees an opportunity to 27
participate in matters relating to the content of programs pursuant to 28
NRS 695C.110; 29
(g) The health maintenance organization has failed to put into 30
effect the system required by NRS 695C.260 for: 31
(1) Resolving complaints in a manner reasonably to dispose 32
of valid complaints; and 33
(2) Conducting external reviews of adverse determinations 34
that comply with the provisions of NRS 695G.241 to 695G.310, 35
inclusive; 36
(h) The health maintenance organization or any person on its 37
behalf has advertised or merchandised its services in an untrue, 38
misrepresentative, misleading, deceptive or unfair manner; 39
(i) The continued operation of the health maintenance 40
organization would be hazardous to its enrollees or creditors or to 41
the general public; 42
(j) The health maintenance organization fails to provide the 43
coverage required by NRS 695C.1691; or 44
– 26 –
- *SB163_R2*
(k) The health maintenance organization has otherwise failed to 1
comply substantially with the provisions of this chapter. 2
2. A certificate of authority must be suspended or revoked only 3
after compliance with the requirements of NRS 695C.340. 4
3. If the certificate of authority of a health maintenance 5
organization is suspended, the health maintenance organization shall 6
not, during the period of that suspension, enroll any additional 7
groups or new individual contracts, unless those groups or persons 8
were contracted for before the date of suspension. 9
4. If the certificate of authority of a health maintenance 10
organization is revoked, the organization shall proceed, immediately 11
following the effective date of the order of revocation, to wind up its 12
affairs and shall conduct no further business except as may be 13
essential to the orderly conclusion of the affairs of the organization. 14
It shall engage in no further advertising or solicitation of any kind. 15
The Commissioner may, by written order, permit such further 16
operation of the organization as the Commissioner may find to be in 17
the best interest of enrollees to the end that enrollees are afforded 18
the greatest practical opportunity to obtain continuing coverage for 19
health care. 20
Sec. 10.8. Chapter 695G of NRS is hereby amended by adding 21
thereto the provisions set forth as sections 11 and 11.6 of this act. 22
Sec. 11. 1. Except as otherwise provided in this section, a 23
managed care organization that issues a health care plan shall 24
include in the health care plan coverage for the medically 25
necessary treatment of conditions relating to gender dysphoria and 26
gender incongruence. Such coverage must include coverage of 27
medically necessary psychosocial and surgical intervention and 28
any other medically necessary treatment for such disorders 29
provided by: 30
(a) Endocrinologists; 31
(b) Pediatric endocrinologists; 32
(c) Social workers; 33
(d) Psychiatrists; 34
(e) Psychologists; 35
(f) Gynecologists; 36
(g) Speech-language pathologists; 37
(h) Primary care physicians; 38
(i) Advanced practice registered nurses; 39
(j) Physician assistants; and 40
(k) Any other providers of medically necessary services for the 41
treatment of gender dysphoria or gender incongruence. 42
2. This section does not require a health care plan to include 43
coverage for cosmetic surgery performed by a plastic surgeon or 44
reconstructive surgeon that is not medically necessary. 45
– 27 –
- *SB163_R2*
3. A managed care organization that issues a health care 1
plan shall not categorically refuse to cover medically necessary 2
gender-affirming treatments or procedures or revisions to prior 3
treatments if the plan provides coverage for any such services, 4
procedures or revisions for purposes other than gender transition 5
or affirmation. 6
4. A managed care organization that issues a health care 7
plan may prescribe requirements that must be satisfied before the 8
managed care organization covers surgical treatment of 9
conditions relating to gender dysphoria or gender incongruence 10
for an insured who is less than 18 years of age. Such requirements 11
may include, without limitation, requirements that: 12
(a) The treatment must be recommended by a psychologist, 13
psychiatrist or other mental health professional; 14
(b) The treatment must be recommended by a physician; 15
(c) The insured must provide a written expression of the desire 16
of the insured to undergo the treatment; 17
(d) A written plan for treatment that covers at least 1 year must 18
be developed and approved by at least two providers of health 19
care; and 20
(e) Parental consent is provided for the insured unless the 21
insured is expressly authorized by law to consent on his or her 22
own behalf. 23
5. When determining whether treatment is medically 24
necessary for the purposes of this section, a managed care 25
organization must consider the most recent Standards of Care 26
prescribed by the World Professional Association for Transgender 27
Health, or its successor organization. 28
6. A managed care organization shall make a reasonable 29
effort to ensure that the benefits required by subsection 1 are 30
made available to an insured through a provider of health care 31
who participates in the network plan of the managed 32
care organization. If, after a reasonable effort, the managed care 33
organization is unable to make such benefits available through 34
such a provider of health care, the managed care organization 35
may treat the treatment that the managed care organization is 36
unable to make available through such a provider of health care 37
in the same manner as other services provided by a provider of 38
health care who does not participate in the network plan of the 39
managed care organization. 40
7. If an insured appeals the denial of a claim or coverage 41
under this section on the grounds that the treatment requested by 42
the insured is not medically necessary, the managed care 43
organization must consult with a provider of health care who has 44
experience in prescribing or delivering gender-affirming treatment 45
– 28 –
- *SB163_R2*
concerning the medical necessity of the treatment requested by the 1
insured when considering the appeal. 2
8. Evidence of coverage subject to the provisions of this 3
chapter that is delivered, issued for delivery or renewed on or after 4
July 1, 2023, has the legal effect of including the coverage 5
required by subsection 1, and any provision of the plan or renewal 6
which is in conflict with the provisions of this section is void. 7
9. As used in this section: 8
(a) “Cosmetic surgery”: 9
(1) Means a surgical procedure that: 10
(I) Does not meaningfully promote the proper function 11
of the body; 12
(II) Does not prevent or treat illness or disease; and 13
(III) Is primarily directed at improving the appearance 14
of a person. 15
(2) Includes, without limitation, cosmetic surgery directed 16
at preserving beauty. 17
(b) “Gender dysphoria” means distress or impairment in 18
social, occupational or other areas of functioning caused by a 19
marked difference between the gender identity or expression of a 20
person and the sex assigned to the person at birth which lasts at 21
least 6 months and is shown by at least two of the following: 22
(1) A marked difference between gender identity or 23
expression and primary or secondary sex characteristics or 24
anticipated secondary sex characteristics in young adolescents. 25
(2) A strong desire to be rid of primary or secondary sex 26
characteristics because of a marked difference between such sex 27
characteristics and gender identity or expression or a desire to 28
prevent the development of anticipated secondary sex 29
characteristics in young adolescents. 30
(3) A strong desire for the primary or secondary sex 31
characteristics of the gender opposite from the sex assigned at 32
birth. 33
(4) A strong desire to be of the opposite gender or a gender 34
different from the sex assigned at birth. 35
(5) A strong desire to be treated as the opposite gender or a 36
gender different from the sex assigned at birth. 37
(6) A strong conviction of experiencing typical feelings and 38
reactions of the opposite gender or a gender different from the sex 39
assigned at birth. 40
(c) “Medically necessary” means health care services or 41
products that a prudent provider of health care would provide to a 42
patient to prevent, diagnose or treat an illness, injury or disease, or 43
any symptoms thereof, that are necessary and: 44
– 29 –
- *SB163_R2*
(1) Provided in accordance with generally accepted 1
standards of medical practice; 2
(2) Clinically appropriate with regard to type, frequency, 3
extent, location and duration; 4
(3) Not provided primarily for the convenience of the 5
patient or provider of health care; 6
(4) Required to improve a specific health condition of a 7
patient or to preserve the existing state of health of the patient; 8
and 9
(5) The most clinically appropriate level of health care that 10
may be safely provided to the patient. 11
A provider of health care prescribing, ordering, recommending 12
or approving a health care service or product does not, by itself, 13
make that health care service or product medically necessary. 14
(d) “Network plan” means a health care plan offered by a 15
managed care organization under which the financing and 16
delivery of medical care, including items and services paid for as 17
medical care, are provided, in whole or in part, through a defined 18
set of providers under contract with the managed care 19
organization. The term does not include an arrangement for the 20
financing of premiums. 21
(e) “Provider of health care” has the meaning ascribed to it in 22
NRS 629.031. 23
Sec. 11.6. A managed care organization that issues a health 24
care plan shall not discriminate against any person with respect to 25
participation or coverage under the plan on the basis of actual or 26
perceived gender identity or expression. Prohibited discrimination 27
includes, without limitation: 28
1. Denying, cancelling, limiting or refusing to issue or renew 29
a health care plan on the basis of the actual or perceived gender 30
identity or expression of a person or a family member of the 31
person; 32
2. Imposing a payment or premium that is based on the 33
actual or perceived gender identity or expression of an insured or 34
a family member of the insured; 35
3. Designating the actual or perceived gender identity or 36
expression of a person or a family member of the person as 37
grounds to deny, cancel or limit participation or coverage; and 38
4. Denying, cancelling or limiting participation or coverage 39
on the basis of actual or perceived gender identity or expression, 40
including, without limitation, by limiting or denying coverage for 41
health care services that are: 42
(a) Related to gender transition, provided that there is 43
coverage under the plan for the services when the services are not 44
related to gender transition; or 45
– 30 –
- *SB163_R2*
(b) Ordinarily or exclusively available to persons of any sex. 1
Sec. 12. NRS 232.320 is hereby amended to read as follows: 2
232.320 1. The Director: 3
(a) Shall appoint, with the consent of the Governor, 4
administrators of the divisions of the Department, who are 5
respectively designated as follows: 6
(1) The Administrator of the Aging and Disability Services 7
Division; 8
(2) The Administrator of the Division of Welfare and 9
Supportive Services; 10
(3) The Administrator of the Division of Child and Family 11
Services; 12
(4) The Administrator of the Division of Health Care 13
Financing and Policy; and 14
(5) The Administrator of the Division of Public and 15
Behavioral Health. 16
(b) Shall administer, through the divisions of the Department, 17
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 18
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 19
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 20
sections 15 and 15.6 of this act, 422.580, 432.010 to 432.133, 21
inclusive, 432B.6201 to 432B.626, inclusive, 444.002 to 444.430, 22
inclusive, and 445A.010 to 445A.055, inclusive, and all other 23
provisions of law relating to the functions of the divisions of the 24
Department, but is not responsible for the clinical activities of the 25
Division of Public and Behavioral Health or the professional line 26
activities of the other divisions. 27
(c) Shall administer any state program for persons with 28
developmental disabilities established pursuant to the 29
Developmental Disabilities Assistance and Bill of Rights Act of 30
2000, 42 U.S.C. §§ 15001 et seq. 31
(d) Shall, after considering advice from agencies of local 32
governments and nonprofit organizations which provide social 33
services, adopt a master plan for the provision of human services in 34
this State. The Director shall revise the plan biennially and deliver a 35
copy of the plan to the Governor and the Legislature at the 36
beginning of each regular session. The plan must: 37
(1) Identify and assess the plans and programs of the 38
Department for the provision of human services, and any 39
duplication of those services by federal, state and local agencies; 40
(2) Set forth priorities for the provision of those services; 41
(3) Provide for communication and the coordination of those 42
services among nonprofit organizations, agencies of local 43
government, the State and the Federal Government; 44
– 31 –
- *SB163_R2*
(4) Identify the sources of funding for services provided by 1
the Department and the allocation of that funding; 2
(5) Set forth sufficient information to assist the Department 3
in providing those services and in the planning and budgeting for the 4
future provision of those services; and 5
(6) Contain any other information necessary for the 6
Department to communicate effectively with the Federal 7
Government concerning demographic trends, formulas for the 8
distribution of federal money and any need for the modification of 9
programs administered by the Department. 10
(e) May, by regulation, require nonprofit organizations and state 11
and local governmental agencies to provide information regarding 12
the programs of those organizations and agencies, excluding 13
detailed information relating to their budgets and payrolls, which the 14
Director deems necessary for the performance of the duties imposed 15
upon him or her pursuant to this section. 16
(f) Has such other powers and duties as are provided by law. 17
2. Notwithstanding any other provision of law, the Director, or 18
the Director’s designee, is responsible for appointing and removing 19
subordinate officers and employees of the Department. 20
Sec. 13. NRS 287.010 is hereby amended to read as follows: 21
287.010 1. The governing body of any county, school 22
district, municipal corporation, political subdivision, public 23
corporation or other local governmental agency of the State of 24
Nevada may: 25
(a) Adopt and carry into effect a system of group life, accident 26
or health insurance, or any combination thereof, for the benefit of its 27
officers and employees, and the dependents of officers and 28
employees who elect to accept the insurance and who, where 29
necessary, have authorized the governing body to make deductions 30
from their compensation for the payment of premiums on the 31
insurance. 32
(b) Purchase group policies of life, accident or health insurance, 33
or any combination thereof, for the benefit of such officers and 34
employees, and the dependents of such officers and employees, as 35
have authorized the purchase, from insurance companies authorized 36
to transact the business of such insurance in the State of Nevada, 37
and, where necessary, deduct from the compensation of officers and 38
employees the premiums upon insurance and pay the deductions 39
upon the premiums. 40
(c) Provide group life, accident or health coverage through a 41
self-insurance reserve fund and, where necessary, deduct 42
contributions to the maintenance of the fund from the compensation 43
of officers and employees and pay the deductions into the fund. The 44
money accumulated for this purpose through deductions from 45
– 32 –
- *SB163_R2*
the compensation of officers and employees and contributions of the 1
governing body must be maintained as an internal service fund as 2
defined by NRS 354.543. The money must be deposited in a state or 3
national bank or credit union authorized to transact business in the 4
State of Nevada. Any independent administrator of a fund created 5
under this section is subject to the licensing requirements of chapter 6
683A of NRS, and must be a resident of this State. Any contract 7
with an independent administrator must be approved by the 8
Commissioner of Insurance as to the reasonableness of 9
administrative charges in relation to contributions collected and 10
benefits provided. The provisions of NRS 686A.135, 687B.352, 11
687B.408, 687B.723, 687B.725, 689B.030 to 689B.050, inclusive, 12
and sections 3 and 3.6 of this act, 689B.265, 689B.287 and 13
689B.500 apply to coverage provided pursuant to this paragraph, 14
except that the provisions of NRS 689B.0378, 689B.03785 and 15
689B.500 only apply to coverage for active officers and employees 16
of the governing body, or the dependents of such officers and 17
employees. 18
(d) Defray part or all of the cost of maintenance of a self-19
insurance fund or of the premiums upon insurance. The money for 20
contributions must be budgeted for in accordance with the laws 21
governing the county, school district, municipal corporation, 22
political subdivision, public corporation or other local governmental 23
agency of the State of Nevada. 24
2. If a school district offers group insurance to its officers and 25
employees pursuant to this section, members of the board of trustees 26
of the school district must not be excluded from participating in the 27
group insurance. If the amount of the deductions from compensation 28
required to pay for the group insurance exceeds the compensation to 29
which a trustee is entitled, the difference must be paid by the trustee. 30
3. In any county in which a legal services organization exists, 31
the governing body of the county, or of any school district, 32
municipal corporation, political subdivision, public corporation or 33
other local governmental agency of the State of Nevada in the 34
county, may enter into a contract with the legal services 35
organization pursuant to which the officers and employees of the 36
legal services organization, and the dependents of those officers and 37
employees, are eligible for any life, accident or health insurance 38
provided pursuant to this section to the officers and employees, and 39
the dependents of the officers and employees, of the county, school 40
district, municipal corporation, political subdivision, public 41
corporation or other local governmental agency. 42
4. If a contract is entered into pursuant to subsection 3, the 43
officers and employees of the legal services organization: 44
– 33 –
- *SB163_R2*
(a) Shall be deemed, solely for the purposes of this section, to be 1
officers and employees of the county, school district, municipal 2
corporation, political subdivision, public corporation or other local 3
governmental agency with which the legal services organization has 4
contracted; and 5
(b) Must be required by the contract to pay the premiums or 6
contributions for all insurance which they elect to accept or of which 7
they authorize the purchase. 8
5. A contract that is entered into pursuant to subsection 3: 9
(a) Must be submitted to the Commissioner of Insurance for 10
approval not less than 30 days before the date on which the contract 11
is to become effective. 12
(b) Does not become effective unless approved by the 13
Commissioner. 14
(c) Shall be deemed to be approved if not disapproved by the 15
Commissioner within 30 days after its submission. 16
6. As used in this section, “legal services organization” means 17
an organization that operates a program for legal aid and receives 18
money pursuant to NRS 19.031. 19
Sec. 14. NRS 287.04335 is hereby amended to read as 20
follows: 21
287.04335 If the Board provides health insurance through a 22
plan of self-insurance, it shall comply with the provisions of NRS 23
686A.135, 687B.352, 687B.409, 687B.723, 687B.725, 689B.0353, 24
689B.255, 695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 25
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 26
695G.1675, 695G.170 to 695G.174, inclusive, and sections 11 and 27
11.6 of this act, 695G.176, 695G.177, 695G.200 to 695G.230, 28
inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, in the 29
same manner as an insurer that is licensed pursuant to title 57 of 30
NRS is required to comply with those provisions. 31
Sec. 14.8. Chapter 422 of NRS is hereby amended by adding 32
thereto the provisions set forth as sections 15 and 15.6 of this act. 33
Sec. 15. 1. Except as otherwise provided in this section, the 34
Director shall include in the State Plan for Medicaid a 35
requirement that the State, to the extent authorized by federal law, 36
must pay the nonfederal share of expenditures incurred for the 37
medically necessary treatment of conditions relating to gender 38
dysphoria and gender incongruence. Such treatment includes 39
medically necessary psychosocial and surgical intervention and 40
any other medically necessary treatment for such disorders 41
provided by: 42
(a) Endocrinologists; 43
(b) Pediatric endocrinologists; 44
(c) Social workers; 45
– 34 –
- *SB163_R2*
(d) Psychiatrists; 1
(e) Psychologists; 2
(f) Gynecologists; 3
(g) Speech-language pathologists; 4
(h) Primary care physicians; 5
(i) Advanced practice registered nurses; 6
(j) Physician assistants; and 7
(k) Any other providers of medically necessary services for the 8
treatment of gender dysphoria or gender incongruence. 9
2. This section does not require the Director to include in the 10
State Plan for Medicaid coverage for cosmetic surgery performed 11
by a plastic surgeon or reconstructive surgeon that is not 12
medically necessary. 13
3. The Department shall not categorically refuse to cover any 14
medically necessary gender-affirming treatments or procedures or 15
revisions to prior treatments if the State Plan for Medicaid 16
provides coverage for any such services, procedures or revisions 17
for purposes other than gender transition or affirmation. 18
4. When determining whether treatment is medically 19
necessary for the purposes of this section, the Department must 20
consider the most recent Standards of Care published by the 21
World Professional Association for Transgender Health, or its 22
successor organization. 23
5. If a person appeals the denial of a payment or coverage 24
under this section on the grounds that the treatment requested by 25
the person is not medically necessary, the Division must consult 26
with a provider of health care who has experience in prescribing 27
or delivering gender-affirming treatment concerning the medical 28
necessity of the treatment requested by the person when 29
considering the appeal. 30
6. As used in this section: 31
(a) “Cosmetic surgery”: 32
(1) Means a surgical procedure that: 33
(I) Does not meaningfully promote the proper function 34
of the body; 35
(II) Does not prevent or treat illness or disease; and 36
(III) Is primarily directed at improving the appearance 37
of a person. 38
(2) Includes, without limitation, cosmetic surgery directed 39
at preserving beauty. 40
(b) “Gender dysphoria” means distress or impairment in 41
social, occupational or other areas of functioning caused by a 42
marked difference between the gender identity or expression of a 43
person and the sex assigned to the person at birth which lasts at 44
least 6 months and is shown by at least two of the following: 45
– 35 –
- *SB163_R2*
(1) A marked difference between gender identity or 1
expression and primary or secondary sex characteristics or 2
anticipated secondary sex characteristics in young adolescents. 3
(2) A strong desire to be rid of primary or secondary sex 4
characteristics because of a marked difference between such sex 5
characteristics and gender identity or expression or a desire to 6
prevent the development of anticipated secondary sex 7
characteristics in young adolescents. 8
(3) A strong desire for the primary or secondary sex 9
characteristics of the gender opposite from the sex assigned at 10
birth. 11
(4) A strong desire to be of the opposite gender or a gender 12
different from the sex assigned at birth. 13
(5) A strong desire to be treated as the opposite gender or a 14
gender different from the sex assigned at birth. 15
(6) A strong conviction of experiencing typical feelings and 16
reactions of the opposite gender or a gender different from the sex 17
assigned at birth. 18
(c) “Medically necessary” means health care services or 19
products that a prudent provider of health care would provide to a 20
patient to prevent, diagnose or treat an illness, injury or disease, or 21
any symptoms thereof, that are necessary and: 22
(1) Provided in accordance with generally accepted 23
standards of medical practice; 24
(2) Clinically appropriate with regard to type, frequency, 25
extent, location and duration; 26
(3) Not provided primarily for the convenience of the 27
patient or provider of health care; 28
(4) Required to improve a specific health condition of a 29
patient or to preserve the existing state of health of the patient; 30
and 31
(5) The most clinically appropriate level of health care that 32
may be safely provided to the patient. 33
A provider of health care prescribing, ordering, recommending 34
or approving a health care service or product does not, by itself, 35
make that health care service or product medically necessary. 36
(d) “Provider of health care” has the meaning ascribed to it in 37
NRS 629.031. 38
Sec. 15.6. The Department shall not discriminate against any 39
person with respect to participation or coverage under Medicaid 40
on the basis of actual or perceived gender identity or expression. 41
Prohibited discrimination includes, without limitation: 42
1. Denying, cancelling, limiting or refusing to issue a 43
payment or coverage on the basis of the actual or perceived gender 44
– 36 –
- *SB163_R2*
identity or expression of a person or a family member of the 1
person; 2
2. Imposing a payment that is based on the actual or 3
perceived gender identity or expression of a recipient of Medicaid 4
or a family member of the recipient; 5
3. Designating the actual or perceived gender identity or 6
expression of a person or a family member of the person as 7
grounds to deny, cancel or limit participation or coverage; and 8
4. Denying, cancelling or limiting participation or coverage 9
on the basis of actual or perceived gender identity or expression, 10
including, without limitation, by limiting or denying payment or 11
coverage for health care services that are: 12
(a) Related to gender transition, provided that there is 13
coverage under Medicaid for the services when the services are 14
not related to gender transition; or 15
(b) Ordinarily or exclusively available to persons of any sex. 16
Sec. 16. 1. There is hereby appropriated from the State 17
General Fund to the Division of Health Care Financing and Policy 18
of the Department of Health and Human Services for the costs of 19
providing coverage under Medicaid for the treatment of conditions 20
relating to gender dysphoria and gender incongruence required by 21
section 15 of this act the following sums: 22
For the Fiscal Year 2023-2024 .................................. $162,926 23
For the Fiscal Year 2024-2025 .................................. $182,654 24
2. Any balance of the sums appropriated by subsection 1 25
remaining at the end of the respective fiscal years must not be 26
committed for expenditure after June 30 of the respective fiscal 27
years by the entity to which the appropriation is made or any entity 28
to which money from the appropriation is granted or otherwise 29
transferred in any manner, and any portion of the appropriated 30
money remaining must not be spent for any purpose after 31
September 20, 2024, and September 19, 2025, respectively, by 32
either the entity to which the money was appropriated or the entity 33
to which the money was subsequently granted or transferred, and 34
must be reverted to the State General Fund on or before 35
September 20, 2024, and September 19, 2025, respectively. 36
3. Expenditure of $1,239,172 not appropriated from the State 37
General Fund or the State Highway Fund is hereby authorized 38
during Fiscal Year 2023-2024 by the Division of Health Care 39
Financing and Policy of the Department of Health and Human 40
Services for the same purposes as set forth in subsection 1. 41
4. Expenditure of $1,076,246 not appropriated from the State 42
General Fund or the State Highway Fund is hereby authorized 43
during Fiscal Year 2024-2025 by the Division of Health Care 44
– 37 –
- *SB163_R2*
Financing and Policy of the Department of Health and Human 1
Services for the same purposes as set forth in subsection 1. 2
Sec. 17. 1. There is hereby appropriated from the State 3
General Fund to the Division of Health Care Financing and Policy 4
of the Department of Health and Human Services the sum of 5
$19,500 for the costs of information system upgrades and actuarial 6
rate setting associated with carrying out the provisions of this act. 7
2. Any remaining balance of the appropriation made by 8
subsection 1 must not be committed for expenditure after June 30, 9
2024, by the entity to which the appropriation is made or any entity 10
to which money from the appropriation is granted or otherwise 11
transferred in any manner, and any portion of the appropriated 12
money remaining must not be spent for any purpose after 13
September 20, 2024, by either the entity to which the money was 14
appropriated or the entity to which the money was subsequently 15
granted or transferred, and must be reverted to the State General 16
Fund on or before September 20, 2024. 17
3. Expenditure of $48,000 not appropriated from the State 18
General Fund or the State Highway Fund is hereby authorized 19
during Fiscal Year 2023-2024 by the Division of Health Care 20
Financing and Policy of the Department of Health and Human 21
Services for the same purposes as set forth in subsection 1. 22
Sec. 18. The provisions of NRS 354.599 do not apply to any 23
additional expenses of a local government that are related to the 24
provisions of this act. 25
Sec. 19. This act becomes effective on July 1, 2023. 26
H