EXEMPT
(Reprinted with amendments adopted on April 21, 2025)
FIRST REPRINT A.B. 204
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ASSEMBLY BILL NO. 204–ASSEMBLYMEMBER CARTER
PREFILED FEBRUARY 3, 2025
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Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions relating to medical debt.
(BDR 52-135)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: No.
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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to medical debt; prohibiting collection agencies
and certain entities that provide health care from reporting
medical debt to a consumer reporting agency in certain
circumstances; prohibiting certain actions by certain
entities that provide health care and collection agencies to
collect a medical debt; providing requirements for
engaging in extraordinary collection actions to collect a
medical debt; authorizing the Commissioner of Financial
Institutions to institute legal proceedings against violators;
and providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law provides requirements governing the collection of medical debt by 1
a collection agency, including a requirement to provide certain notice to a medical 2
debtor before taking action to collect and prohibiting certain actions to collect a 3
medical debt. (NRS 649.366, 649.368) Section 13 of this bill prohibits a health care 4
entity, which includes a medical facility, provider of health care or provider of 5
emergency medical services, or a collection agency from reporting a medical debt 6
to a consumer reporting agency unless the health care entity or collection agency 7
issued an offer to the consumer to enter into a payment plan to satisfy the medical 8
debt. Section 13: (1) establishes a procedure for the issuance of such an offer; (2) 9
prohibits a health care entity or collection agency from reporting medical debt to a 10
consumer reporting agency if the consumer enters into a payment plan and 11
complies with the terms and conditions of the plan; (3) provides that any portion of 12
the medical debt that is reported to a consumer reporting agency in violation of 13
section 13 shall be void; and (4) requires the Commissioner of Financial 14
Institutions to adopt regulations to carry out the provisions of section 13. Sections 15
14 and 19 of this bill prohibit a health care entity or collection agency from 16
engaging in certain actions, or threatening to engage in certain actions, to collect a 17
medical debt, including: (1) causing the arrest of a consumer; (2) obtaining a lien or 18
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foreclosing on real property of a consumer that includes the consumer’s primary 19
residence; (3) garnishing the wages of a consumer or any refund of federal income 20
taxes due to a consumer; or (4) garnishing, attaching or seizing the bank account of 21
a consumer. 22
Section 15 of this bill prohibits a health care entity or collection agency from 23
engaging in extraordinary collection actions until at least 180 days after the first bill 24
for a medical debt is sent to a consumer and requires a notice that includes certain 25
information to be sent to the consumer at least 30 days before any extraordinary 26
collection action is taken. Section 6 of this bill defines the term “extraordinary 27
collection action” to mean: (1) selling a medical debt to a collection agency; (2) 28
deferring, denying or requiring payment before providing medically necessary care; 29
or (3) any action that requires a legal or judicial process except for placing a lien on 30
third party settlements. Section 15 prohibits a health care entity or collection 31
agency from engaging in extraordinary collection actions during a state of 32
emergency, declaration of disaster or public health emergency or other health event 33
with respect to the geographic area in which a consumer resides. 34
Section 16 of this bill provides additional requirements for the collection of 35
medical debts incurred for medical services, products or devices provided by a 36
medical facility, including: (1) a prohibition on engaging in extraordinary collection 37
actions unless such actions are described in the billing and collection policy of the 38
medical facility; (2) a requirement to reverse any extraordinary collection actions if 39
it is determined that the consumer is eligible for financial assistance that eliminates 40
or would have eliminated the debt; and (3) requiring a consumer to be refunded 41
within 60 days if, after the application of any financial assistance, a consumer had 42
paid an amount in excess of the amount of the medical debt. 43
Section 17 of this bill provides that the protections provided by sections 13-16 44
cannot be waived. 45
Section 18 of this bill authorizes the Commissioner of Financial Institutions to 46
institute legal proceedings against a person who has willfully violated, is violating 47
or is about to violate the provisions of sections 2-18 of this bill. Section 18 48
authorizes a district court to grant certain remedies in such a proceeding. 49
Sections 3-12 define terms related to the collection of medical debts and 50
section 2 makes those terms applicable to sections 13-18. 51
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 597 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2 to 18, inclusive, of this 2
act. 3
Sec. 2. As used in sections 2 to 18, inclusive, of this act, 4
unless the context otherwise requires, the words and terms defined 5
in sections 3 to 12, inclusive, of this act have the meanings 6
ascribed to them in those sections. 7
Sec. 3. “Collection agency” includes: 8
1. A collection agency, as defined in NRS 649.020. 9
2. A collection agent, as defined in NRS 649.025. 10
Sec. 4. “Consumer” means a natural person. 11
Sec. 5. “Consumer reporting agency” has the meaning 12
ascribed to it in NRS 686A.640. 13
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Sec. 5.5. 1. “Cosmetic surgery” means a surgical 1
procedure that: 2
(a) Does not meaningfully promote the proper function of the 3
body; 4
(b) Does not prevent or treat illness or disease; and 5
(c) Is primarily directed at improving or preserving the 6
appearance of a person. 7
2. This term does not include reconstructive surgery when 8
such service is incidental to or follows surgery resulting from the 9
diagnosis, prevention, treatment, cure or relief from a physical, 10
dental, behavioral or substance use disorder, mental health 11
condition, illness, injury or disease. 12
Sec. 6. “Extraordinary collection action” means: 13
1. Selling or transferring, with or without compensation, the 14
medical debt of a consumer to a collection agency; 15
2. Deferring, denying or requiring payment before providing 16
medically necessary care; or 17
3. Any action that requires a legal or judicial process, 18
including, without limitation, placing a lien, except for a lien on a 19
third party settlement, or commencing a civil action. 20
Sec. 7. “Financial assistance policy” means a written 21
financial assistance policy of a health care entity which includes: 22
1. Eligibility criteria for financial assistance, including, 23
without limitation, when such assistance includes free or 24
discounted care. 25
2. The basis for calculating amounts charged to patients. 26
3. The method for applying for financial assistance. 27
4. The billing and collections policy, including, without 28
limitation, the actions the health care entity may take in the event 29
of nonpayment. 30
5. Measures to widely publicize the policy within the 31
community to be served by the health care entity. 32
Sec. 8. “Health care entity” means: 33
1. A medical facility; 34
2. A provider of emergency medical services; or 35
3. A provider of health care. 36
Sec. 9. 1. “Medical debt” means a debt owed by a 37
consumer to a health care entity or its agent or assignee for the 38
provision of medical services, products or devices. The term 39
includes, without limitation, medical bills that are not past due or 40
have been paid. 41
2. The term does not include: 42
(a) Debt charged to a credit card, as defined in NRS 97A.050, 43
unless the credit card is issued for the sole purpose of purchasing 44
medical services, products or devices; or 45
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(b) An open-end or closed-end extension of credit made by a 1
financial institution to a borrower, unless the open-end or closed-2
end extension of credit is for the sole purpose of purchasing 3
medical services, products or devices. 4
Sec. 10. “Medical facility” has the meaning ascribed to it in 5
NRS 449.0151. 6
Sec. 10.5. “Medical services, products or devices” means any 7
service, treatment, drug, medication, product or device, excluding 8
cosmetic surgery, that is charged to a consumer by a health care 9
entity. 10
Sec. 11. “Provider of emergency medical services” has the 11
meaning ascribed to it in NRS 649.041. 12
Sec. 12. “Provider of health care” has the meaning ascribed 13
to it in NRS 629.031. 14
Sec. 13. 1. A health care entity or collection agency shall 15
not report any information to a consumer reporting agency 16
regarding a medical debt unless the health care entity or collection 17
agency has issued an offer to the consumer to enter into a 18
payment plan to satisfy the medical debt. For such a payment 19
plan, a health care entity or collection agency must: 20
(a) Not more than 30 days after the medical debt was incurred, 21
provide to the consumer an itemized bill of all charges for medical 22
services, products or devices at no additional cost to the consumer; 23
and 24
(b) Not more than 90 days after the medical debt was incurred, 25
provide to the consumer two written offers, provided at least 30 26
days apart, to enter into a payment plan for which the rate of 27
interest during the payment period on the medical debt is fixed at 0 28
percent. 29
2. If the consumer does not respond to the health care entity 30
or collection agency, or otherwise engage with the health care 31
entity or collection agency to satisfy the medical debt or enter into 32
a payment plan to satisfy the medical debt, the health care entity 33
or collection agency may, not earlier than 90 days after the 34
medical debt was incurred, issue to the consumer a final notice 35
informing the consumer that the medical debt will be reported to a 36
consumer reporting agency not earlier than 180 days after the date 37
on which the notice was issued if the debtor does not enter into a 38
payment plan or otherwise satisfy the medical debt. 39
3. If the consumer does not respond to the health care entity 40
or collection agency, or otherwise engage with the health care 41
entity or collection agency to satisfy the medical debt or enter into 42
a payment plan to satisfy the medical debt, within 180 days after 43
the notice was issued pursuant to subsection 2, the health care 44
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entity or collection agency may report the medical debt to a 1
consumer reporting agency. 2
4. If a consumer enters into a payment plan with a health 3
care entity or collection agency: 4
(a) The terms and conditions of any payment plan between a 5
consumer and a health care entity or collection agency must be 6
specific, intelligible and unambiguous; 7
(b) The health care entity or collection agency shall fix the 8
rate of interest on the medical debt at 0 percent so long as the 9
consumer complies with the terms and conditions of the payment 10
plan; and 11
(c) The health care entity or collection agency shall not report 12
any information to a consumer reporting agency regarding the 13
medical debt so long as the consumer complies with the terms and 14
conditions of the payment plan. 15
5. Any portion of a medical debt that is reported to a 16
consumer reporting agency in violation of this section shall be 17
void. 18
6. The Commissioner of Financial Institutions shall adopt 19
regulations to carry out the provisions of this section, including, 20
without limitation, any additional procedures or requirements 21
governing payment plans which the Commissioner determines are 22
necessary or desirable. 23
Sec. 14. A health care entity or collection agency shall not 24
engage in any of the following actions to collect a medical debt: 25
1. Causing or threatening the arrest of a consumer, 26
including, without limitation, an arrest pursuant to NRS 31.470 to 27
31.730, inclusive; 28
2. Obtaining or threatening to obtain a lien against any real 29
property of a consumer which consists, in whole or in part, of the 30
primary residence of the consumer; 31
3. Foreclosing or threatening to foreclose on any real 32
property of a consumer which consists, in whole or in part, of the 33
primary residence of the consumer; 34
4. Garnishing or threatening to garnish the wages of a 35
consumer or any refund of federal income taxes due to a 36
consumer; or 37
5. Garnishing, attaching or seizing, or threatening to garnish, 38
attach or seize, a bank account of a consumer. 39
Sec. 15. 1. A health care entity or collection agency shall 40
not engage in any extraordinary collection action until at least 180 41
days after the first bill for a medical debt has been sent to a 42
consumer. 43
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2. At least 30 days before taking any extraordinary collection 1
action to collect a medical debt, a health care entity or collection 2
agency shall provide to the consumer a notice: 3
(a) Identifying the extraordinary collection action that will be 4
initiated in order to obtain payment; 5
(b) Providing a deadline after which such extraordinary 6
collection action will be initiated, which must be not earlier than 7
30 days after the date of the notice; and 8
(c) If the medical debt was incurred for medical services, 9
products or devices provided by a medical facility, stating whether 10
the medical facility offers financial assistance to eligible 11
consumers and providing a plain-language summary of any 12
financial assistance policy of the medical facility. 13
3. A health care entity or collection agency shall not engage 14
in any extraordinary collection action against a consumer for a 15
medical debt during any period in which, with respect to the 16
geographic area in which the consumer resides, there exists: 17
(a) A state of emergency or declaration of disaster proclaimed 18
pursuant to NRS 414.070; 19
(b) A public health emergency or other health event pursuant 20
to NRS 439.970; or 21
(c) A state of emergency, declaration of disaster or public 22
health emergency as declared pursuant to federal law or the laws 23
of another state. 24
Sec. 16. 1. If a medical debt was incurred for medical 25
services, products or devices provided by a medical facility, the 26
medical facility or a collection agency shall not engage in any 27
extraordinary collection action to recover the medical debt unless 28
such extraordinary collection action is described in the billing and 29
collections policy of the medical facility. 30
2. If a medical facility, or a collection agency acting to collect 31
a medical debt incurred for medical services, products or devices 32
provided by a medical facility, initiates an extraordinary collection 33
action against a consumer to collect a medical debt and the 34
consumer is later found to be eligible under the financial 35
assistance policy of the medical facility for financial assistance 36
that eliminates or would have eliminated the medical debt, the 37
medical facility or collection agency shall reverse any such 38
extraordinary collection action, including, without limitation, 39
removing any lien, attachment or garnishment against the 40
property of the consumer. 41
3. If, after the application of any financial assistance for 42
which a consumer is eligible, the consumer has paid, to a medical 43
facility, a collection agency or both, an amount in excess of the 44
amount of the medical debt, the medical facility or collection 45
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agency shall refund any excess amount to the consumer within 60 1
days. 2
Sec. 17. The protections set forth in sections 13 to 16, 3
inclusive, of this act are for the benefit of consumers and cannot 4
be waived. 5
Sec. 18. If the Commissioner of Financial Institutions has 6
reason to believe that a person has willfully violated, is violating or 7
is about to violate any of the provisions of sections 2 to 18, 8
inclusive, of this act, the Commissioner may institute an 9
appropriate legal proceeding against the person. The district court, 10
upon a showing that the person has willfully violated, is violating 11
or is about to violate any provision of sections 2 to 18, inclusive, of 12
this act may grant any of the following remedies, as appropriate: 13
1. Issue a temporary or permanent injunction. 14
2. Impose a civil penalty not to exceed: 15
(a) For a first violation, $10,000; and 16
(b) For any subsequent violation, $25,000. 17
3. Issue a declaratory judgment. 18
4. Order restitution for the consumer. 19
5. Order the payment of attorney’s fees and costs. 20
6. Order such relief as the court deems just. 21
Sec. 19. NRS 649.368 is hereby amended to read as follows: 22
649.368 A collection agency, or its compliance manager, 23
agents or employees, shall not, for any medical debt: 24
1. Take any confession of judgment or any power of attorney 25
running to the collection agency or to any third person to confess 26
judgment or to appear for the debtor in a judicial proceeding. 27
2. Commence a civil action to collect the medical debt if the 28
amount of the medical debt, excluding interest, late fees, collection 29
costs, attorney’s fees and any other fees or costs, is less than the 30
maximum jurisdictional amount set forth in subsection 1 of NRS 31
73.010. Nothing in this subsection shall be construed to prohibit the 32
commencement of a small claims action in justice court to collect 33
the medical debt. 34
3. Charge or collect a fee of more than 5 percent of the amount 35
of the medical debt, excluding interest, late fees, collection costs, 36
attorney’s fees and any other fees or costs, as a collection fee or as 37
an attorney’s fee for the collection of the medical debt. 38
4. Perform an action prohibited by sections 2 to 18, inclusive, 39
of this act. 40
Sec. 20. 1. The amendatory provisions of this act apply to: 41
(a) Any contract between a health care entity and a collection 42
agency for the purchase, transfer or collection of medical debt 43
entered into before, on or after January 1, 2026, but do not apply to 44
any action taken under such a contract before January 1, 2026. 45
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(b) Medical debt incurred before, on or after January 1, 2026, 1
but do not apply to any action taken to collect a medical debt before 2
January 1, 2026. 3
2. As used in this section: 4
(a) “Collection agency” has the meaning ascribed to it in section 5
3 of this act. 6
(b) “Health care entity” has the meaning ascribed to it in section 7
8 of this act. 8
(c) “Medical debt” has the meaning ascribed to it in section 9 of 9
this act. 10
Sec. 21. This act becomes effective on January 1, 2026. 11
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