A.B. 349
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ASSEMBLY BILL NO. 349–ASSEMBLYMEMBER ORENTLICHER
MARCH 3, 2025
____________
Referred to Committee on Health and Human Services
SUMMARY—Makes revisions relating to health care.
(BDR 23-343)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§§ 8, 14, 18)
(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 health care; establishing maximum rates that
hospitals, independent centers for emergency medical
care and surgical centers for ambulatory patients may
charge for certain goods and services provided to patients
covered by certain insurance for public employees;
requiring hospitals to publish certain information relating
to pricing; authorizing the imposition of certain
administrative penalties and sanctions; and providing
other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law creates the Public Employees’ Benefits Program to provide group 1
life, accident or health insurance to certain public employees, state officers and 2
members of the Legislature in this State. (NRS 287.043) Existing law also 3
prescribes a procedure to determine the amount that a third party which provides 4
health coverage to a person, including the Public Employees’ Benefits Program, is 5
required to pay to an out-of-network hospital, independent center for emergency 6
medical care or other provider of health care for medically necessary emergency 7
services rendered to that person. (NRS 439B.700-439B.760) Section 5 of this bill 8
establishes maximum rates that hospitals, independent centers for emergency 9
medical care and surgical centers for ambulatory patients may charge for goods and 10
services when provided to a patient who is covered by the Program or a local 11
government employer that elects to be subject to those maximum rates. Those 12
maximum rates differ depending on whether the facility is an in-network facility or 13
an out-of-network facility. Section 5 authorizes the Division of Health Care 14
Financing and Policy of the Department of Health and Human Services to increase 15
those maximum rates if: (1) the Division determines that health care facilities in 16
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this State are experiencing financial hardship due to a decrease in the rates of 17
reimbursement provided under Medicaid; and (2) the Interim Finance Committee 18
approves the increase. Section 11 of this bill authorizes the Interim Finance 19
Committee to consider such an increase during a regular or special session of the 20
Legislature. Section 9 of this bill prescribes the manner in which a local 21
government employer may opt in to the provisions of section 5. 22
Section 19 of this bill requires the Board and each participating local 23
government employer to consider the change in rates as a result of implementing 24
section 5 when assessing the cost of premiums of contributions for the Program. 25
Sections 3 and 4 of this bill define necessary terms, and section 2 of this bill 26
establishes the applicability of those definitions. Section 6 of this bill requires the 27
Division to annually submit to the Legislature a report concerning the impacts of 28
the maximum rates established by section 5. 29
Section 7 of this bill requires the Division to adopt certain regulations to 30
implement sections 2-8 of this bill, including regulations prescribing civil penalties 31
to be imposed against a health care facility that charges the Program or a 32
participating local government employer an amount that exceeds the maximum 33
rates prescribed by section 5. Sections 8 and 14 of this bill provide for the 34
imposition of disciplinary action against a health care facility for such a violation. 35
Section 8 also authorizes: (1) the Division or Attorney General to maintain a suit 36
for an injunction against such a violation; and (2) any person or entity injured by 37
such a violation to maintain a suit for damages and attorney’s fees and costs. 38
Section 10 of this bill applies the definitions in existing law relating to the 39
Program to the provisions of sections 2-8. Sections 13 and 16 of this bill make 40
conforming changes to clarify the application of existing provisions concerning the 41
rates that a health care facility, including a county hospital, may charge for certain 42
services. Sections 17 and 18 of this bill make conforming changes to clarify the 43
applicability of certain provisions of existing law relating to the Program. (NRS 44
687B.409, 689B.065) 45
Existing federal regulations require a hospital to publish: (1) a list of standard 46
charges for all items and services provided by the hospital; and (2) a consumer-47
friendly list of standard charges for a limited set of shoppable services, which are 48
services provided by a hospital that can be scheduled by a consumer in advance. 49
(45 C.F.R. §§ 180.20, 180.40-180.60) Section 12 of this bill requires each hospital 50
in this State to comply with those federal requirements, and sections 12, 14 and 15 51
authorize the imposition of disciplinary action against a hospital that fails to 52
comply with those requirements. 53
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 287 of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2 to 8, inclusive, of this 2
act. 3
Sec. 2. As used in sections 2 to 8, inclusive, of this act, unless 4
the context otherwise requires, the words and terms defined in 5
sections 3 and 4 of this act have the meanings ascribed to them in 6
those sections. 7
Sec. 3. “Division” means the Division of Health Care 8
Financing and Policy of the Department of Health and Human 9
Services. 10
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Sec. 4. “Health care facility” means: 1
1. A hospital, as defined in NRS 449.012, other than a 2
hospital which has been certified as a critical access hospital by 3
the United States Secretary of Health and Human Services 4
pursuant to 42 U.S.C. § 1395i-4(e). 5
2. An independent center for emergency medical care, as 6
defined in NRS 449.013. 7
3. A surgical center for ambulatory patients, as defined in 8
NRS 449.019. 9
Sec. 5. 1. Notwithstanding any other provision of law 10
except for subsection 3 to the contrary, any contract for goods and 11
services between the Board or an opt-in local government and a 12
health care facility must establish a rate of reimbursement for 13
inpatient and outpatient services provided by an in-network facility 14
that does not exceed the lesser of: 15
(a) The billed charge for the service; 16
(b) The rate of reimbursement prescribed for the services in a 17
contract between the Board or the opt-in local government, as 18
applicable, and the health care facility for the 2024 plan year; or 19
(c) One hundred and seventy-five percent of the rate of 20
reimbursement provided by Medicare for the same or similar 21
services on the date on which the service is provided. 22
2. Notwithstanding any other provision of law except for 23
subsection 3 to the contrary, an out-of-network facility shall not 24
charge the Program or an opt-in local government an amount for 25
inpatient or outpatient services provided by the health care facility 26
that exceed the lesser of: 27
(a) The billed charge for the service; 28
(b) The rate of reimbursement prescribed for the services in a 29
contract between the Board or the opt-in local government, as 30
applicable, and the health care facility for the 2024 plan year; or 31
(c) One hundred and sixty percent of the rate of 32
reimbursement provided by Medicare for the same or similar 33
services on the date on which the service is provided. 34
3. The Division, with the approval of the Interim Finance 35
Committee, may increase the maximum rates of reimbursement 36
prescribed by subsections 1 and 2 if the Division determines that 37
health care facilities in this State are experiencing financial 38
hardship due to a decrease in the rates of reimbursement provided 39
under Medicaid. 40
4. Nothing in this section prohibits the Board or an opt-in 41
local government from reimbursing a health care facility through 42
a payment model other than fee-for-service as long as: 43
(a) The payments incentivize higher quality or improved health 44
outcomes; and 45
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(b) The rates of reimbursement paid under the payment model 1
comply with the requirements of this section. 2
5. As used in this section: 3
(a) “In-network facility” means a health care facility that has 4
entered into a contract with the Program or an opt-in local 5
government to provide care to persons covered by the Program or 6
opt-in local government. 7
(b) “Opt-in local government” means a governing body of a 8
county, school district, municipal corporation, political 9
subdivision, public corporation or other local governmental 10
agency of the State of Nevada that provides health coverage 11
pursuant to NRS 287.010 or any issuer of a policy of health 12
insurance purchased pursuant to NRS 287.010 that elects 13
pursuant to NRS 287.012 to pay the rates prescribed by this 14
section to health care facilities. 15
(c) “Out-of-network facility” means a health care facility that 16
has not entered into a contract with the Program or an opt-in local 17
government to provide care to persons covered by the Program or 18
opt-in local government. 19
Sec. 6. On or before July 30 of each even-numbered year, 20
the Division shall: 21
1. Review and study the impacts of the provisions of section 5 22
of this act; 23
2. Compile a report with a summary of such information and 24
any recommendations relating to the provisions of section 5 of this 25
act; and 26
3. Submit the report compiled pursuant to subsection 2 to the 27
Director of the Legislative Counsel Bureau for transmittal to the 28
Joint Interim Standing Committee on Health and Human 29
Services. 30
Sec. 7. The Division shall adopt any regulations necessary to 31
carry out the provisions of sections 2 to 8, inclusive, of this act, 32
including, without limitation, regulations prescribing civil 33
penalties that may be imposed against a health care facility that 34
charges a rate that exceeds the maximum amounts prescribed by 35
section 5 of this act for services to which the provisions of that 36
section apply. 37
Sec. 8. 1. The Division may report any failure by a health 38
care facility to comply with the provisions of sections 2 to 8, 39
inclusive, of this act to the Division of Public and Behavioral 40
Health of the Department of Health and Human Services for the 41
initiation of disciplinary proceedings. 42
2. The Division or the Attorney General may maintain in any 43
court of competent jurisdiction a suit to enjoin any person from 44
charging rates that exceed the maximum amounts prescribed by 45
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section 5 of this act for services to which the provisions of that 1
section apply. Such an injunction: 2
(a) May be issued without proof of actual damage sustained by 3
any person as a preventive or punitive measure. 4
(b) Does not relieve any person or business entity from any 5
other legal action. 6
3. Any person or entity injured by the failure of a health care 7
facility to charge rates in accordance with the provisions of section 8
5 of this act for services to which that section applies may 9
maintain in any court of competent jurisdiction a suit to recover: 10
(a) Damages resulting from such failure; and 11
(b) Attorney’s fees and costs. 12
Sec. 9. NRS 287.012 is hereby amended to read as follows: 13
287.012 1. A governing body of a county, school district, 14
municipal corporation, political subdivision, public corporation or 15
other local governmental agency of the State of Nevada that 16
provides coverage of prescription drugs pursuant to NRS 287.010 or 17
any issuer of a policy of health insurance purchased pursuant to 18
NRS 287.010 may use the list of preferred prescription drugs 19
developed by the Department of Health and Human Services 20
pursuant to subsection 1 of NRS 422.4025 as its formulary and 21
obtain prescription drugs through the purchasing agreements 22
negotiated by the Department pursuant to that section by notifying 23
the Department in the form prescribed by the Department. 24
2. A governing body of a county, school district, municipal 25
corporation, political subdivision, public corporation or other 26
local governmental agency of the State of Nevada that provides 27
health coverage pursuant to NRS 287.010 or any issuer of a policy 28
of health insurance purchased pursuant to NRS 287.010 may elect 29
to pay rates established by section 5 of this act to health care 30
facilities for goods and services described in that section by 31
notifying the Division of Health Care Financing and Policy of the 32
Department in the form prescribed by the Department. 33
3. As used in this section, “health care facility” has the 34
meaning ascribed to it in section 4 of this act. 35
Sec. 10. NRS 287.0402 is hereby amended to read as follows: 36
287.0402 As used in NRS 287.0402 to 287.049, inclusive, and 37
sections 2 to 8, inclusive, of this act, unless the context otherwise 38
requires, the words and terms defined in NRS 287.0404 to 39
287.04064, inclusive, have the meanings ascribed to them in those 40
sections. 41
Sec. 11. NRS 218E.405 is hereby amended to read as follows: 42
218E.405 1. Except as otherwise provided in subsection 2, 43
the Interim Finance Committee may exercise the powers conferred 44
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upon it by law only when the Legislature is not in a regular or 1
special session. 2
2. During a regular or special session, the Interim Finance 3
Committee may also perform the duties imposed on it by NRS 4
228.1111, subsection 5 of NRS 284.115, NRS 285.070, subsection 2 5
of NRS 321.335, NRS 322.007, subsection 2 of NRS 323.020, NRS 6
323.050, subsection 1 of NRS 323.100, subsection 3 of 7
NRS 341.126, NRS 341.142, paragraph (f) of subsection 1 of NRS 8
341.145, subsection 3 of NRS 349.073, NRS 353.220, 353.224, 9
353.2705 to 353.2771, inclusive, 353.288, 353.335, 353.3375, 10
353C.224, 353C.226, paragraph (b) of subsection 4 of NRS 11
407.0762, NRS 428.375, 433.732, 439.4905, 439.620, 439.630, 12
445B.830, subsection 1 of NRS 445C.320 and NRS 538.650 [.] and 13
section 5 of this act. In performing those duties, the Senate Standing 14
Committee on Finance and the Assembly Standing Committee on 15
Ways and Means may meet separately and transmit the results of 16
their respective votes to the Chair of the Interim Finance Committee 17
to determine the action of the Interim Finance Committee as a 18
whole. 19
3. The Chair of the Interim Finance Committee may appoint a 20
subcommittee consisting of six members of the Committee to 21
review and make recommendations to the Committee on matters of 22
the State Public Works Division of the Department of 23
Administration that require prior approval of the Interim Finance 24
Committee pursuant to subsection 3 of NRS 341.126, NRS 341.142 25
and paragraph (f) of subsection 1 of NRS 341.145. If the Chair 26
appoints such a subcommittee: 27
(a) The Chair shall designate one of the members of the 28
subcommittee to serve as the chair of the subcommittee; 29
(b) The subcommittee shall meet throughout the year at the 30
times and places specified by the call of the chair of the 31
subcommittee; and 32
(c) The Director or the Director’s designee shall act as the 33
nonvoting recording secretary of the subcommittee. 34
Sec. 12. NRS 439B.400 is hereby amended to read as follows: 35
439B.400 1. Each hospital in this State shall [maintain] : 36
(a) Maintain and use a uniform list of billed charges for that 37
hospital for units of service or goods provided to all inpatients. A 38
hospital may not use a billed charge for an inpatient that is different 39
than the billed charge used for another inpatient for the same service 40
or goods provided. This section does not restrict the ability of a 41
hospital or other person to negotiate a discounted rate from the 42
hospital’s billed charges or to contract for a different rate or 43
mechanism for payment of the hospital. 44
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(b) Comply with the provisions of 45 C.F.R. §§ 180.40, 180.50 1
and 180.60 regarding the publication of: 2
(1) A list of standard charges for all items and services; and 3
(2) A consumer-friendly list of standard charges for a 4
limited set of shoppable services. 5
(c) On or before February 1 of each year, provide the 6
Department the most current version of each list described in 7
paragraph (b). 8
2. If an allegation of a violation of the provisions of 9
subsection 1 is made against a hospital, the Division of Public and 10
Behavioral Health of the Department shall conduct an 11
investigation of the alleged violation. Such a violation constitutes 12
grounds for the denial, suspension or revocation of such a license, 13
or for the imposition of any sanction prescribed by NRS 449.163. 14
Sec. 13. NRS 439B.742 is hereby amended to read as follows: 15
439B.742 The provisions of NRS 439B.745 and 439B.748 do 16
not apply to: 17
1. A hospital which has been certified as a critical access 18
hospital by the Secretary of Health and Human Services pursuant to 19
42 U.S.C. § 1395i-4(e) or any medically necessary emergency 20
services provided at such a hospital; 21
2. A person who is covered by a policy of health insurance that 22
was sold outside this State; [or] 23
3. Any health care services provided more than 24 hours after 24
notification is provided pursuant to NRS 439B.745 that a person has 25
been stabilized [.] ; or 26
4. Any goods or services for which maximum rates have been 27
established by section 8 of this act. 28
Sec. 14. NRS 449.160 is hereby amended to read as follows: 29
449.160 1. The Division may deny an application for a 30
license or may suspend or revoke any license issued under the 31
provisions of NRS 449.029 to 449.2428, inclusive, upon any of the 32
following grounds: 33
(a) Violation by the applicant or the licensee of any of the 34
provisions of NRS 439B.400, 439B.410, 449.029 to 449.245, 35
inclusive, or 449A.100 to 449A.124, inclusive, and 449A.270 to 36
449A.286, inclusive, or of any other law of this State or of the 37
standards, rules and regulations adopted thereunder. 38
(b) Aiding, abetting or permitting the commission of any illegal 39
act. 40
(c) Conduct inimical to the public health, morals, welfare and 41
safety of the people of the State of Nevada in the maintenance and 42
operation of the premises for which a license is issued. 43
(d) Conduct or practice detrimental to the health or safety of the 44
occupants or employees of the facility. 45
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(e) Failure of the applicant to obtain written approval from the 1
Director of the Department of Health and Human Services as 2
required by NRS 439A.100 or 439A.102 or as provided in any 3
regulation adopted pursuant to NRS 449.001 to 449.430, inclusive, 4
and 449.435 to 449.531, inclusive, and chapter 449A of NRS if such 5
approval is required, including, without limitation, the closure or 6
conversion of any hospital in a county whose population is 100,000 7
or more that is owned by the licensee without approval pursuant to 8
NRS 439A.102. 9
(f) Failure to comply with the provisions of NRS 441A.315 and 10
any regulations adopted pursuant thereto or NRS 449.2486. 11
(g) Violation of the provisions of NRS 458.112. 12
(h) Failure to comply with the provisions of NRS 449A.170 to 13
449A.192, inclusive, and any regulation adopted pursuant thereto. 14
(i) Violation of the provisions of NRS 629.260. 15
(j) Failure to comply with the provisions of sections 2 to 8, 16
inclusive, of this act or any regulations adopted pursuant thereto. 17
2. In addition to the provisions of subsection 1, the Division 18
may revoke a license to operate a facility for the dependent if, with 19
respect to that facility, the licensee that operates the facility, or an 20
agent or employee of the licensee: 21
(a) Is convicted of violating any of the provisions of 22
NRS 202.470; 23
(b) Is ordered to but fails to abate a nuisance pursuant to NRS 24
244.360, 244.3603 or 268.4124; or 25
(c) Is ordered by the appropriate governmental agency to correct 26
a violation of a building, safety or health code or regulation but fails 27
to correct the violation. 28
3. The Division shall maintain a log of any complaints that it 29
receives relating to activities for which the Division may revoke the 30
license to operate a facility for the dependent pursuant to subsection 31
2. The Division shall provide to a facility for the care of adults 32
during the day: 33
(a) A summary of a complaint against the facility if the 34
investigation of the complaint by the Division either substantiates 35
the complaint or is inconclusive; 36
(b) A report of any investigation conducted with respect to the 37
complaint; and 38
(c) A report of any disciplinary action taken against the facility. 39
The facility shall make the information available to the public 40
pursuant to NRS 449.2486. 41
4. On or before February 1 of each odd-numbered year, the 42
Division shall submit to the Director of the Legislative Counsel 43
Bureau a written report setting forth, for the previous biennium: 44
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(a) Any complaints included in the log maintained by the 1
Division pursuant to subsection 3; and 2
(b) Any disciplinary actions taken by the Division pursuant to 3
subsection 2. 4
Sec. 15. NRS 449.163 is hereby amended to read as follows: 5
449.163 1. In addition to the payment of the amount required 6
by NRS 449.0308, if a medical facility, facility for the dependent or 7
facility which is required by the regulations adopted by the Board 8
pursuant to NRS 449.0303 to be licensed violates any provision 9
related to its licensure, including any provision of NRS 439B.400, 10
439B.410 or 449.029 to 449.2428, inclusive, or any condition, 11
standard or regulation adopted by the Board, the Division, in 12
accordance with the regulations adopted pursuant to NRS 449.165, 13
may: 14
(a) Prohibit the facility from admitting any patient until it 15
determines that the facility has corrected the violation; 16
(b) Limit the occupancy of the facility to the number of beds 17
occupied when the violation occurred, until it determines that the 18
facility has corrected the violation; 19
(c) If the license of the facility limits the occupancy of the 20
facility and the facility has exceeded the approved occupancy, 21
require the facility, at its own expense, to move patients to another 22
facility that is licensed; 23
(d) Except where a greater penalty is authorized by subsection 2, 24
impose an administrative penalty of not more than $5,000 per day 25
for each violation, together with interest thereon at a rate not to 26
exceed 10 percent per annum; and 27
(e) Appoint temporary management to oversee the operation of 28
the facility and to ensure the health and safety of the patients of the 29
facility, until: 30
(1) It determines that the facility has corrected the violation 31
and has management which is capable of ensuring continued 32
compliance with the applicable statutes, conditions, standards and 33
regulations; or 34
(2) Improvements are made to correct the violation. 35
2. If an off-campus location of a hospital fails to obtain a 36
national provider identifier that is distinct from the national provider 37
identifier used by the main campus and any other off-campus 38
location of the hospital in violation of NRS 449.1818, the Division 39
may impose against the hospital an administrative penalty of not 40
more than $10,000 for each day of such failure, together with 41
interest thereon at a rate not to exceed 10 percent per annum, in 42
addition to any other action authorized by this chapter. 43
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3. If the facility fails to pay any administrative penalty imposed 1
pursuant to paragraph (d) of subsection 1 or subsection 2, the 2
Division may: 3
(a) Suspend the license of the facility until the administrative 4
penalty is paid; and 5
(b) Collect court costs, reasonable attorney’s fees and other 6
costs incurred to collect the administrative penalty. 7
4. The Division may require any facility that violates any 8
provision of NRS 439B.400, 439B.410 or 449.029 to 449.2428, 9
inclusive, or any condition, standard or regulation adopted by the 10
Board to make any improvements necessary to correct the violation. 11
5. Any money collected as administrative penalties pursuant to 12
paragraph (d) of subsection 1 or subsection 2 must be accounted for 13
separately and used to administer and carry out the provisions of 14
NRS 449.001 to 449.430, inclusive, 449.435 to 449.531, inclusive, 15
and chapter 449A of NRS to protect the health, safety, well-being 16
and property of the patients and residents of facilities in accordance 17
with applicable state and federal standards or for any other purpose 18
authorized by the Legislature. 19
Sec. 16. NRS 450.410 is hereby amended to read as follows: 20
450.410 1. Supervising boards of county hospitals may: 21
(a) Provide for treatment to sick or injured persons and require 22
the payment of reasonable charges therefor. 23
(b) Contract for the provision of such treatment on a periodic 24
prepaid basis with any person authorized by the Commissioner of 25
Insurance pursuant to title 57 of NRS to arrange for or provide 26
health care services on a periodic prepaid basis. 27
The treatment of such persons must not be permitted to interfere 28
with the treatment of purely charitable cases. 29
2. [Every] Except where different rates are required by 30
section 5 of this act, every person treated by a county hospital and 31
required to pay charges for hospitalization, shall pay the charges 32
fixed by the supervising board therefor . [,which] Any charges [,] 33
for hospitalization, when paid, must be paid forthwith into the 34
county treasury and deposited to the credit of the hospital fund. 35
3. Every person treated by a county hospital and required to 36
pay charges to the hospital has the right to the services of a 37
physician or surgeon of the person’s own choice, and has the right to 38
employ such special nurses as may be necessary, but the cost of the 39
physician, surgeon or nurses must not become a claim against the 40
county. 41
4. Supervising boards shall fix and determine reasonable 42
charges to be paid by sick and injured persons treated by county 43
hospitals, which charges must include the board and lodging of the 44
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person and the customary use of hospital facilities by the person 1
admitted. 2
Sec. 17. NRS 687B.409 is hereby amended to read as follows: 3
687B.409 1. Every payment made pursuant to a policy of 4
health insurance to pay for treatment relating solely to mental health 5
or an alcohol or substance use disorder must be made directly to the 6
provider of health care that provides the treatment if the provider: 7
(a) Is an out-of-network provider; and 8
(b) Has obtained and delivered to the insurer or an authorized 9
representative of the insurer, including, without limitation, a third-10
party administrator, a written assignment of benefits pursuant to 11
which the insured has assigned to the provider the insured’s benefits 12
under the policy of health insurance with regard to the treatment. 13
2. An out-of-network provider that receives payment pursuant 14
to subsection 1: 15
(a) Shall, if a person paid the provider directly for the treatment 16
described in subsection 1, refund to the person the amount that the 17
person paid directly to the provider for the treatment, less any 18
applicable deductible, copayment or coinsurance, not later than 45 19
days after the provider receives payment pursuant to subsection 1; 20
and 21
(b) Must indemnify and hold harmless the insurer against any 22
claim made against the insurer by the person who receives the 23
treatment described in subsection 1 for any amount paid by the 24
insurer to the provider in compliance with this section. 25
3. An assignment of benefits described in paragraph (b) of 26
subsection 1 is irrevocable for the period: 27
(a) Beginning on the date the insured gives to the out-of-28
network provider the assignment of benefits; and 29
(b) Ending on the later of: 30
(1) The date on which the out-of-network provider receives 31
from the insurer the final payment for the treatment; or 32
(2) The date of the final resolution, including, without 33
limitation, by settlement or trial, of all claims relating to all 34
payments which relate to the treatment. 35
4. Nothing in this section shall be construed to require an 36
insurer to make a payment to an out-of-network provider: 37
(a) Who is not authorized by law to provide the treatment; 38
(b) Who provides the treatment in violation of any law; or 39
(c) In an amount which exceeds the amount required by the 40
policy of health insurance to be paid for out-of-network treatment. 41
5. As used in this section: 42
(a) “Health care services” means services for the diagnosis, 43
prevention, treatment, care or relief of a health condition, illness, 44
injury or disease. 45
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(b) “Insured” means a person who receives benefits pursuant to 1
a policy of health insurance. 2
(c) “Insurer” means a person, including, without limitation, a 3
governmental entity, who issues or otherwise provides a policy of 4
health insurance. 5
(d) “Network plan” has the meaning ascribed to it in 6
NRS 689B.570. 7
(e) “Out-of-network provider” means a provider of health care 8
who: 9
(1) Provides health care services; 10
(2) Is paid, pursuant to a policy of health insurance, for 11
providing the health care services; and 12
(3) Is not under contract to provide the health care services as 13
part of any network plan associated with the policy of health 14
insurance. 15
(f) “Policy of health insurance” includes, without limitation, a 16
policy, contract, certificate, plan or agreement, as applicable, issued 17
pursuant to or otherwise governed by NRS 287.0402 to 287.049, 18
inclusive, and sections 2 to 8, inclusive, of this act or chapter 608, 19
689A, 689B, 689C, 695A, 695B, 695C, 695F or 695G of NRS for 20
the provision of, delivery of, arrangement for, payment for or 21
reimbursement for any of the costs of health care services. 22
(g) “Provider of health care” has the meaning ascribed to it in 23
NRS 695G.070. 24
Sec. 18. NRS 689B.065 is hereby amended to read as follows: 25
689B.065 1. A policy of group health insurance issued to 26
replace any discontinued policy or coverage for group health 27
insurance must: 28
(a) Provide coverage for all persons who were covered under the 29
previous policy or coverage on the date it was discontinued; and 30
(b) Except as otherwise provided in subsection 2, provide 31
benefits which are at least as extensive as the benefits provided by 32
the previous policy or coverage, except that benefits may be reduced 33
or excluded to the extent that such a reduction or exclusion was 34
permissible under the terms of the previous policy or coverage, 35
if that replacement policy is issued within 60 days after the date 36
on which the previous policy or coverage was discontinued. 37
2. If an employer obtains a replacement policy pursuant to 38
subsection 1 to cover the employees of the employer, any benefits 39
provided by the previous policy or coverage may be reduced if 40
notice of the reduction is given to the employees of the employer 41
pursuant to NRS 608.1577. 42
3. Any insurer which issues a replacement policy pursuant to 43
subsection 1 may submit a written request to the insurer who 44
provided the previous policy or coverage for a statement of benefits 45
– 13 –
- *AB349*
which were provided under that policy or coverage. Upon receiving 1
such a request, the insurer who provided the previous policy or 2
coverage shall give a written statement to the insurer providing the 3
replacement policy which indicates what benefits were provided and 4
what exclusions or reductions were in effect under the previous 5
policy or coverage. 6
4. The provisions of this section: 7
(a) Apply to a self-insured employer who provides health 8
benefits to the employees of the employer and replaces those 9
benefits with a policy of group health insurance. 10
(b) Do not apply to the Public Employees’ Benefits Program 11
established pursuant to NRS 287.0402 to 287.049, inclusive [.] , and 12
sections 2 to 8, inclusive, of this act. 13
Sec. 19. 1. The Board of the Public Employees’ Benefits 14
Program and an opt-in local government shall take into account the 15
change in the rates of reimbursement provided for the services of 16
health care facilities resulting from the provisions of section 5 of 17
this act when assessing the cost of premiums or contributions for the 18
Program or the plan of health insurance offered by the opt-in local 19
government, as applicable. 20
2. As used in this section: 21
(a) “Health care facility” has the meaning ascribed to it in 22
section 4 of this act. 23
(b) “Opt-in local government” has the meaning ascribed to it in 24
section 5 of this act. 25
Sec. 20. The provisions of subsection 1 of NRS 218D.380 do 26
not apply to any provision of this act which adds or revises a 27
requirement to submit a report to the Legislature. 28
Sec. 21. The provisions of NRS 354.599 do not apply to any 29
additional expenses of a local government that are related to the 30
provisions of this act. 31
Sec. 22. 1. This section becomes effective upon passage and 32
approval. 33
2. Sections 1 to 21 of this act become effective: 34
(a) Upon passage and approval for the purpose of adopting any 35
regulations and performing any other preparatory administrative 36
tasks that are necessary to carry out the provisions of this act; and 37
(b) On January 1, 2026, for all other purposes. 38
H