A.B. 399
- *AB399*
ASSEMBLY BILL NO. 399–ASSEMBLYMEMBER EDGEWORTH
MARCH 11, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Requires certain health insurance to cover certain
health care related to severe obesity. (BDR 57-657)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§ 13)
(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 that certain policies of
health insurance include coverage for certain health care
to treat and care for diseases and conditions caused by
severe obesity; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing law requires public and private policies of insurance regulated under 1
Nevada law to include certain coverage. (NRS 287.010, 287.04335, 422.27172-2
422.272428, 689A.04033-689A.0465, 689B.0303-689B.0379, 689C.1652-3
689C.169, 689C.194, 689C.1945, 689C.195, 689C.425, 695A.184-695A.1875, 4
695A.265, 695B.1901-695B.1948, 695C.050, 695C.1691-695C.176, 695G.162-5
695G.177) Existing law also requires employers to provide certain benefits for 6
health care to employees, including the coverage required of health insurers, if the 7
employer provides health benefits for its employees. (NRS 608.1555) 8
Sections 1, 3-9, 11 and 13-15 of this bill require that certain public and private 9
policies of health insurance and health plans, including Medicaid, include 10
medically necessary treatment and care, including bariatric surgery, for diseases 11
and conditions caused by severe obesity under certain circumstances and with 12
certain restrictions. Sections 1, 3-9, 11 and 13-15 exclude from this required 13
coverage drugs for weight loss. Section 2 of this bill authorizes the Commissioner 14
of Insurance to require that certain policies of health insurance issued by a domestic 15
insurer to a person who resides in another state include the coverage required by 16
section 1. Section 10 of this bill authorizes the Commissioner to suspend or revoke 17
the certificate of a health maintenance organization that fails to comply with the 18
requirements of section 8. The Commissioner would also be authorized to take 19
such actions against other health insurers who fail to comply with the requirements 20
of sections 1, 3-7, 9 and 11. (NRS 680A.200) Section 12 of this bill requires the 21
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Director of the Department of Health and Human Services to administer section 15 22
in the same manner as other provisions governing Medicaid. 23
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 689A of NRS is hereby amended by 1
adding thereto a new section to read as follows: 2
1. Subject to the limitations authorized by this section, an 3
insurer that offers or issues a policy of health insurance shall 4
include in the policy coverage for medically necessary treatment 5
and care for diseases and conditions caused by severe obesity, 6
including, without limitation: 7
(a) Medically necessary bariatric surgery for an insured who is 8
18 years of age or older; and 9
(b) Related preoperative and postoperative services, including, 10
without limitation, psychological screening, counseling, behavior 11
modification, physical therapy and nutritional education. 12
2. As conditions of providing coverage for bariatric surgery 13
pursuant to subsection 1, an insurer may require: 14
(a) An insured to successfully complete a preoperative period 15
of not more than 3 months that includes services recommended by 16
the American Society for Metabolic and Bariatric Surgery, or its 17
successor organization; and 18
(b) That the bariatric surgery be performed in a medical 19
facility that holds Metabolic and Bariatric Surgery Accreditation 20
issued by the American College of Surgeons, or its successor 21
organization. 22
3. An insurer may limit coverage for bariatric surgery and 23
related preoperative and postoperative services to not more than 24
one such surgery per lifetime. 25
4. An insurer may require the physician seeking coverage for 26
bariatric surgery pursuant to subsection 1 to provide a written 27
statement to the insurer that the treatment prescribed is medically 28
necessary and will be provided in accordance with the American 29
Society for Metabolic and Bariatric Surgery, or its successor 30
organization, or the American College of Surgeons, or its 31
successor organization. 32
5. This section does not require a policy of health insurance 33
to include coverage for any drug that is injected to lower glucose 34
levels or any other drug prescribed for weight loss. 35
6. A policy of health insurance subject to the provisions of 36
this chapter which is delivered, issued for delivery or renewed on 37
or after January 1, 2026, has the legal effect of including the 38
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coverage required by this section and any provision of the policy 1
which is in conflict with this section is void. 2
7. As used in this section: 3
(a) “Medical facility” has the meaning ascribed to it in 4
NRS 449.0151. 5
(b) “Medically necessary” means health care services or 6
products that a prudent physician would provide to a patient to 7
prevent, diagnose or treat an illness, injury or disease or any 8
symptom thereof, that are necessary and: 9
(1) Provided in accordance with generally accepted 10
standards of medical practice; 11
(2) Clinically appropriate with regard to type, frequency, 12
extent, location and duration; 13
(3) Not primarily provided for the convenience of the 14
patient, physician or other provider of health care; 15
(4) Required to improve a specific health condition of an 16
insured or to preserve the existing state of health of the insured; 17
and 18
(5) The most clinically appropriate level of health care that 19
may be safely provided to the insured. 20
(c) “Provider of health care” has the meaning ascribed to it in 21
NRS 629.031. 22
(d) “Severe obesity” means: 23
(1) A body mass index of 40 or higher; or 24
(2) A body mass index of 35 or higher with an associated 25
comorbidity, which may include, without limitation, hypertension, 26
cardiopulmonary conditions, sleep apnea or diabetes. 27
Sec. 2. NRS 689A.330 is hereby amended to read as follows: 28
689A.330 If any policy is issued by a domestic insurer for 29
delivery to a person residing in another state, and if the insurance 30
commissioner or corresponding public officer of that other state has 31
informed the Commissioner that the policy is not subject to approval 32
or disapproval by that officer, the Commissioner may by ruling 33
require that the policy meet the standards set forth in NRS 689A.030 34
to 689A.320, inclusive [.] , and section 1 of this act. 35
Sec. 3. Chapter 689B of NRS is hereby amended by adding 36
thereto a new section to read as follows: 37
1. Subject to the limitations authorized by this section, an 38
insurer that offers or issues a policy of group health insurance 39
shall include in the policy coverage for medically necessary 40
treatment and care for diseases and conditions caused by severe 41
obesity, including, without limitation: 42
(a) Medically necessary bariatric surgery for an insured who is 43
18 years of age or older; and 44
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(b) Related preoperative and postoperative services, including, 1
without limitation, psychological screening, counseling, behavior 2
modification, physical therapy and nutritional education. 3
2. As conditions of providing coverage for bariatric surgery 4
pursuant to subsection 1, an insurer may require: 5
(a) An insured to successfully complete a preoperative period 6
of not more than 3 months that includes services recommended by 7
the American Society for Metabolic and Bariatric Surgery, or its 8
successor organization; and 9
(b) That the bariatric surgery be performed in a medical 10
facility that holds Metabolic and Bariatric Surgery Accreditation 11
issued by the American College of Surgeons, or its successor 12
organization. 13
3. An insurer may limit coverage for bariatric surgery and 14
related preoperative and postoperative services to not more than 15
one such surgery per lifetime. 16
4. An insurer may require the physician seeking coverage for 17
bariatric surgery pursuant to subsection 1 to provide a written 18
statement to the insurer that the treatment is medically necessary 19
and will be provided in accordance with the American Society for 20
Metabolic and Bariatric Surgery, or its successor organization, or 21
the American College of Surgeons, or its successor organization. 22
5. This section does not require a policy of group health 23
insurance to include coverage for any drug that is injected to 24
lower glucose levels or any other drug prescribed for weight loss. 25
6. A policy of group health insurance subject to the 26
provisions of this chapter which is delivered, issued for delivery or 27
renewed on or after January 1, 2026, has the legal effect of 28
including the coverage required by this section and any provision 29
of the policy which is in conflict with this section is void. 30
7. As used in this section: 31
(a) “Medical facility” has the meaning ascribed to it in 32
NRS 449.0151. 33
(b) “Medically necessary” means health care services or 34
products that a prudent physician would provide to a patient to 35
prevent, diagnose or treat an illness, injury or disease or any 36
symptom thereof, that are necessary and: 37
(1) Provided in accordance with generally accepted 38
standards of medical practice; 39
(2) Clinically appropriate with regard to type, frequency, 40
extent, location and duration; 41
(3) Not primarily provided for the convenience of the 42
patient, physician or other provider of health care; 43
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(4) Required to improve a specific health condition of an 1
insured or to preserve the existing state of health of the insured; 2
and 3
(5) The most clinically appropriate level of health care that 4
may be safely provided to the insured. 5
(c) “Provider of health care” has the meaning ascribed to it in 6
NRS 629.031. 7
(d) “Severe obesity” means: 8
(1) A body mass index of 40 or higher; or 9
(2) A body mass index of 35 or higher with an associated 10
comorbidity, which may include, without limitation, hypertension, 11
cardiopulmonary conditions, sleep apnea or diabetes. 12
Sec. 4. Chapter 689C of NRS is hereby amended by adding 13
thereto a new section to read as follows: 14
1. Subject to the limitations authorized by this section, a 15
carrier that offers or issues a health benefit plan shall include in 16
the plan coverage for medically necessary treatment and care for 17
diseases and conditions caused by severe obesity, including, 18
without limitation: 19
(a) Medically necessary bariatric surgery for an insured who is 20
18 years of age or older; and 21
(b) Related preoperative and postoperative services, including, 22
without limitation, psychological screening, counseling, behavior 23
modification, physical therapy and nutritional education. 24
2. As conditions of providing coverage for bariatric surgery 25
pursuant to subsection 1, a carrier may require: 26
(a) An insured to successfully complete a preoperative period 27
of not more than 3 months that includes services recommended by 28
the American Society for Metabolic and Bariatric Surgery, or its 29
successor organization; and 30
(b) That the bariatric surgery be performed in a medical 31
facility that holds Metabolic and Bariatric Surgery Accreditation 32
issued by the American College of Surgeons, or its successor 33
organization. 34
3. A carrier may limit coverage for bariatric surgery and 35
related preoperative and postoperative services to not more than 36
one such surgery per lifetime. 37
4. A carrier may require the physician seeking coverage for 38
bariatric surgery pursuant to subsection 1 to provide a written 39
statement to the carrier that the treatment prescribed is medically 40
necessary and will be provided in accordance with the American 41
Society for Metabolic and Bariatric Surgery, or its successor 42
organization, or the American College of Surgeons, or its 43
successor organization. 44
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5. This section does not require a health benefit plan to 1
include coverage for any drug that is injected to lower glucose 2
levels or any other drug prescribed for weight loss. 3
6. A health benefit plan subject to the provisions of this 4
chapter which is delivered, issued for delivery or renewed on or 5
after January 1, 2026, has the legal effect of including the 6
coverage required by this section and any provision of the plan 7
which is in conflict with this section is void. 8
7. As used in this section: 9
(a) “Medical facility” has the meaning ascribed to it in 10
NRS 449.0151. 11
(b) “Medically necessary” means health care services or 12
products that a prudent physician would provide to a patient to 13
prevent, diagnose or treat an illness, injury or disease or any 14
symptom thereof, that are necessary and: 15
(1) Provided in accordance with generally accepted 16
standards of medical practice; 17
(2) Clinically appropriate with regard to type, frequency, 18
extent, location and duration; 19
(3) Not primarily provided for the convenience of the 20
patient, physician or other provider of health care; 21
(4) Required to improve a specific health condition of an 22
insured or to preserve the existing state of health of the insured; 23
and 24
(5) The most clinically appropriate level of health care that 25
may be safely provided to the insured. 26
(c) “Provider of health care” has the meaning ascribed to it in 27
NRS 629.031. 28
(d) “Severe obesity” means: 29
(1) A body mass index of 40 or higher; or 30
(2) A body mass index of 35 or higher with an associated 31
comorbidity, which may include, without limitation, hypertension, 32
cardiopulmonary conditions, sleep apnea or diabetes. 33
Sec. 5. NRS 689C.425 is hereby amended to read as follows: 34
689C.425 A voluntary purchasing group and any contract 35
issued to such a group pursuant to NRS 689C.360 to 689C.600, 36
inclusive, are subject to the provisions of NRS 689C.015 to 37
689C.355, inclusive, and section 4 of this act to the extent 38
applicable and not in conflict with the express provisions of NRS 39
687B.408 and 689C.360 to 689C.600, inclusive. 40
Sec. 6. Chapter 695A of NRS is hereby amended by adding 41
thereto a new section to read as follows: 42
1. Subject to the limitations authorized by this section, a 43
society that offers or issues a benefit contract shall include in the 44
contract coverage for medically necessary treatment and care for 45
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diseases and conditions caused by severe obesity, including, 1
without limitation: 2
(a) Medically necessary bariatric surgery for an insured who is 3
18 years of age or older; and 4
(b) Related preoperative and postoperative services, including, 5
without limitation, psychological screening, counseling, behavior 6
modification, physical therapy and nutritional education. 7
2. As conditions of providing coverage for bariatric surgery 8
pursuant to subsection 1, a society may require: 9
(a) An insured to successfully complete a preoperative period 10
of not more than 3 months that includes services recommended by 11
the American Society for Metabolic and Bariatric Surgery, or its 12
successor organization; and 13
(b) That the bariatric surgery be performed in a medical 14
facility that holds Metabolic and Bariatric Surgery Accreditation 15
issued by the American College of Surgeons, or its successor 16
organization. 17
3. A society may limit coverage for bariatric surgery and 18
related preoperative and postoperative services to not more than 19
one such surgery per lifetime. 20
4. A society may require the physician seeking coverage for 21
bariatric surgery pursuant to subsection 1 to provide a written 22
statement to the society that the treatment is medically necessary 23
and will be provided in accordance with the American Society for 24
Metabolic and Bariatric Surgery, or its successor organization, or 25
the American College of Surgeons, or its successor organization. 26
5. This section does not require a benefit contract to include 27
coverage for any drug that is injected to lower glucose levels or 28
any other drug prescribed for weight loss. 29
6. A benefit contract subject to the provisions of this chapter 30
which is delivered, issued for delivery or renewed on or after 31
January 1, 2026, has the legal effect of including the coverage 32
required by this section and any provision of the contract which is 33
in conflict with this section is void. 34
7. As used in this section: 35
(a) “Medical facility” has the meaning ascribed to it in 36
NRS 449.0151. 37
(b) “Medically necessary” means health care services or 38
products that a prudent physician would provide to a patient to 39
prevent, diagnose or treat an illness, injury or disease or any 40
symptom thereof, that are necessary and: 41
(1) Provided in accordance with generally accepted 42
standards of medical practice; 43
(2) Clinically appropriate with regard to type, frequency, 44
extent, location and duration; 45
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(3) Not primarily provided for the convenience of the 1
patient, physician or other provider of health care; 2
(4) Required to improve a specific health condition of an 3
insured or to preserve the existing state of health of the insured; 4
and 5
(5) The most clinically appropriate level of health care that 6
may be safely provided to the insured. 7
(c) “Provider of health care” has the meaning ascribed to it in 8
NRS 629.031. 9
(d) “Severe obesity” means: 10
(1) A body mass index of 40 or higher; or 11
(2) A body mass index of 35 or higher with an associated 12
comorbidity, which may include, without limitation, hypertension, 13
cardiopulmonary conditions, sleep apnea or diabetes. 14
Sec. 7. Chapter 695B of NRS is hereby amended by adding 15
thereto a new section to read as follows: 16
1. Subject to the limitations authorized by this section, a 17
hospital or medical services corporation that offers or issues a 18
policy of health insurance shall include in the policy coverage for 19
medically necessary treatment and care for diseases and 20
conditions caused by severe obesity, including, without limitation: 21
(a) Medically necessary bariatric surgery for an insured who is 22
18 years of age or older; and 23
(b) Related preoperative and postoperative services, including, 24
without limitation, psychological screening, counseling, behavior 25
modification, physical therapy and nutritional education. 26
2. As conditions of providing coverage for bariatric surgery 27
pursuant to subsection 1, a hospital or medical services 28
corporation may require: 29
(a) An insured to successfully complete a preoperative period 30
of not more than 3 months that includes services recommended by 31
the American Society for Metabolic and Bariatric Surgery, or its 32
successor organization; and 33
(b) That the bariatric surgery be performed in a medical 34
facility that holds Metabolic and Bariatric Surgery Accreditation 35
issued by the American College of Surgeons, or its successor 36
organization. 37
3. A hospital or medical services corporation may limit 38
coverage for bariatric surgery and related preoperative and 39
postoperative services to not more than one such surgery per 40
lifetime. 41
4. A hospital or medical services corporation may require the 42
physician seeking coverage for bariatric surgery pursuant to 43
subsection 1 to provide a written statement to the hospital or 44
medical services corporation that the treatment is medically 45
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necessary and will be provided in accordance with the American 1
Society for Metabolic and Bariatric Surgery, or its successor 2
organization, or the American College of Surgeons, or its 3
successor organization. 4
5. This section does not require a policy of health insurance 5
to include coverage for any drug that is injected to lower glucose 6
levels or any other drug prescribed for weight loss. 7
6. A policy of health insurance subject to the provisions of 8
this chapter which is delivered, issued for delivery or renewed on 9
or after January 1, 2026, has the legal effect of including the 10
coverage required by this section and any provision of the policy 11
which is in conflict with this section is void. 12
7. As used in this section: 13
(a) “Medical facility” has the meaning ascribed to it in 14
NRS 449.0151. 15
(b) “Medically necessary” means health care services or 16
products that a prudent physician would provide to a patient to 17
prevent, diagnose or treat an illness, injury or disease or any 18
symptom thereof, that are necessary and: 19
(1) Provided in accordance with generally accepted 20
standards of medical practice; 21
(2) Clinically appropriate with regard to type, frequency, 22
extent, location and duration; 23
(3) Not primarily provided for the convenience of the 24
patient, physician or other provider of health care; 25
(4) Required to improve a specific health condition of an 26
insured or to preserve the existing state of health of the insured; 27
and 28
(5) The most clinically appropriate level of health care that 29
may be safely provided to the insured. 30
(c) “Provider of health care” has the meaning ascribed to it in 31
NRS 629.031. 32
(d) “Severe obesity” means: 33
(1) A body mass index of 40 or higher; or 34
(2) A body mass index of 35 or higher with an associated 35
comorbidity, which may include, without limitation, hypertension, 36
cardiopulmonary conditions, sleep apnea or diabetes. 37
Sec. 8. Chapter 695C of NRS is hereby amended by adding 38
thereto a new section to read as follows: 39
1. Subject to the limitations authorized by this section, a 40
health maintenance organization that offers or issues a health 41
care plan shall include in the plan coverage for medically 42
necessary treatment and care for diseases and conditions caused 43
by severe obesity, including, without limitation: 44
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(a) Medically necessary bariatric surgery for an enrollee who 1
is 18 years of age or older; and 2
(b) Related preoperative and postoperative services, including, 3
without limitation, psychological screening, counseling, behavior 4
modification, physical therapy and nutritional education. 5
2. As conditions of providing coverage for bariatric surgery 6
pursuant to subsection 1, a health maintenance organization may 7
require: 8
(a) An enrollee to successfully complete a preoperative period 9
of not more than 3 months that includes services recommended by 10
the American Society for Metabolic and Bariatric Surgery, or its 11
successor organization; and 12
(b) That the bariatric surgery be performed in a medical 13
facility that holds Metabolic and Bariatric Surgery Accreditation 14
issued by the American College of Surgeons, or its successor 15
organization. 16
3. A health maintenance organization may limit coverage for 17
bariatric surgery and related preoperative and postoperative 18
services to not more than one such surgery per lifetime. 19
4. A health maintenance organization may require the 20
physician seeking coverage for bariatric surgery pursuant to 21
subsection 1 to provide a written statement to the health 22
maintenance organization that the treatment is medically 23
necessary and will be provided in accordance with the American 24
Society for Metabolic and Bariatric Surgery, or its successor 25
organization, or the American College of Surgeons, or its 26
successor organization. 27
5. This section does not require a health care plan to include 28
coverage for any drug that is injected to lower glucose levels or 29
any other drug prescribed for weight loss. 30
6. A health care plan subject to the provisions of this chapter 31
which is delivered, issued for delivery or renewed on or after 32
January 1, 2026, has the legal effect of including the coverage 33
required by this section and any provision of the plan which is in 34
conflict with this section is void. 35
7. As used in this section: 36
(a) “Medical facility” has the meaning ascribed to it in 37
NRS 449.0151. 38
(b) “Medically necessary” means health care services or 39
products that a prudent physician would provide to a patient to 40
prevent, diagnose or treat an illness, injury or disease or any 41
symptom thereof, that are necessary and: 42
(1) Provided in accordance with generally accepted 43
standards of medical practice; 44
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(2) Clinically appropriate with regard to type, frequency, 1
extent, location and duration; 2
(3) Not primarily provided for the convenience of the 3
patient, physician or other provider of health care; 4
(4) Required to improve a specific health condition of an 5
enrollee or to preserve the existing state of health of the enrollee; 6
and 7
(5) The most clinically appropriate level of health care that 8
may be safely provided to the enrollee. 9
(c) “Provider of health care” has the meaning ascribed to it in 10
NRS 629.031. 11
(d) “Severe obesity” means: 12
(1) A body mass index of 40 or higher; or 13
(2) A body mass index of 35 or higher with an associated 14
comorbidity, which may include, without limitation, hypertension, 15
cardiopulmonary conditions, sleep apnea or diabetes. 16
Sec. 9. NRS 695C.050 is hereby amended to read as follows: 17
695C.050 1. Except as otherwise provided in this chapter or 18
in specific provisions of this title, the provisions of this title are not 19
applicable to any health maintenance organization granted a 20
certificate of authority under this chapter. This provision does not 21
apply to an insurer licensed and regulated pursuant to this title 22
except with respect to its activities as a health maintenance 23
organization authorized and regulated pursuant to this chapter. 24
2. Solicitation of enrollees by a health maintenance 25
organization granted a certificate of authority, or its representatives, 26
must not be construed to violate any provision of law relating to 27
solicitation or advertising by practitioners of a healing art. 28
3. Any health maintenance organization authorized under this 29
chapter shall not be deemed to be practicing medicine and is exempt 30
from the provisions of chapter 630 of NRS. 31
4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 32
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 33
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 34
695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, 35
inclusive, and 695C.265 do not apply to a health maintenance 36
organization that provides health care services through managed 37
care to recipients of Medicaid under the State Plan for Medicaid or 38
insurance pursuant to the Children’s Health Insurance Program 39
pursuant to a contract with the Division of Health Care Financing 40
and Policy of the Department of Health and Human Services. This 41
subsection does not exempt a health maintenance organization from 42
any provision of this chapter for services provided pursuant to any 43
other contract. 44
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5. The provisions of NRS 695C.16932 to 695C.1699, 1
inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 2
695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, 3
inclusive, and section 8 of this act, 695C.1757 and 695C.204 apply 4
to a health maintenance organization that provides health care 5
services through managed care to recipients of Medicaid under the 6
State Plan for Medicaid. 7
6. The provisions of NRS 695C.17095 do not apply to a health 8
maintenance organization that provides health care services to 9
members of the Public Employees’ Benefits Program. This 10
subsection does not exempt a health maintenance organization from 11
any provision of this chapter for services provided pursuant to any 12
other contract. 13
7. The provisions of NRS 695C.1735 do not apply to a health 14
maintenance organization that provides health care services to: 15
(a) The officers and employees, and the dependents of officers 16
and employees, of the governing body of any county, school district, 17
municipal corporation, political subdivision, public corporation or 18
other local governmental agency of this State; or 19
(b) Members of the Public Employees’ Benefits Program. 20
This subsection does not exempt a health maintenance 21
organization from any provision of this chapter for services 22
provided pursuant to any other contract. 23
Sec. 10. NRS 695C.330 is hereby amended to read as follows: 24
695C.330 1. The Commissioner may suspend or revoke any 25
certificate of authority issued to a health maintenance organization 26
pursuant to the provisions of this chapter if the Commissioner finds 27
that any of the following conditions exist: 28
(a) The health maintenance organization is operating 29
significantly in contravention of its basic organizational document, 30
its health care plan or in a manner contrary to that described in and 31
reasonably inferred from any other information submitted pursuant 32
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments 33
to those submissions have been filed with and approved by the 34
Commissioner; 35
(b) The health maintenance organization issues evidence of 36
coverage or uses a schedule of charges for health care services 37
which do not comply with the requirements of NRS 695C.1691 to 38
695C.200, inclusive, and section 8 of this act, 695C.204 or 39
695C.207; 40
(c) The health care plan does not furnish comprehensive health 41
care services as provided for in NRS 695C.060; 42
(d) The Commissioner certifies that the health maintenance 43
organization: 44
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(1) Does not meet the requirements of subsection 1 of 1
NRS 695C.080; or 2
(2) Is unable to fulfill its obligations to furnish health care 3
services as required under its health care plan; 4
(e) The health maintenance organization is no longer financially 5
responsible and may reasonably be expected to be unable to meet its 6
obligations to enrollees or prospective enrollees; 7
(f) The health maintenance organization has failed to put into 8
effect a mechanism affording the enrollees an opportunity to 9
participate in matters relating to the content of programs pursuant to 10
NRS 695C.110; 11
(g) The health maintenance organization has failed to put into 12
effect the system required by NRS 695C.260 for: 13
(1) Resolving complaints in a manner reasonably to dispose 14
of valid complaints; and 15
(2) Conducting external reviews of adverse determinations 16
that comply with the provisions of NRS 695G.241 to 695G.310, 17
inclusive; 18
(h) The health maintenance organization or any person on its 19
behalf has advertised or merchandised its services in an untrue, 20
misrepresentative, misleading, deceptive or unfair manner; 21
(i) The continued operation of the health maintenance 22
organization would be hazardous to its enrollees or creditors or to 23
the general public; 24
(j) The health maintenance organization fails to provide the 25
coverage required by NRS 695C.1691; or 26
(k) The health maintenance organization has otherwise failed to 27
comply substantially with the provisions of this chapter. 28
2. A certificate of authority must be suspended or revoked only 29
after compliance with the requirements of NRS 695C.340. 30
3. If the certificate of authority of a health maintenance 31
organization is suspended, the health maintenance organization shall 32
not, during the period of that suspension, enroll any additional 33
groups or new individual contracts, unless those groups or persons 34
were contracted for before the date of suspension. 35
4. If the certificate of authority of a health maintenance 36
organization is revoked, the organization shall proceed, immediately 37
following the effective date of the order of revocation, to wind up its 38
affairs and shall conduct no further business except as may be 39
essential to the orderly conclusion of the affairs of the organization. 40
It shall engage in no further advertising or solicitation of any kind. 41
The Commissioner may, by written order, permit such further 42
operation of the organization as the Commissioner may find to be in 43
the best interest of enrollees to the end that enrollees are afforded 44
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the greatest practical opportunity to obtain continuing coverage for 1
health care. 2
Sec. 11. Chapter 695G of NRS is hereby amended by adding 3
thereto a new section to read as follows: 4
1. Subject to the limitations authorized by this section, a 5
managed care organization that offers or issues a health care plan 6
shall include in the plan coverage for medically necessary 7
treatment and care for diseases and conditions caused by severe 8
obesity, including, without limitation: 9
(a) Medically necessary bariatric surgery for an insured who is 10
18 years of age or older; and 11
(b) Related preoperative and postoperative services, including, 12
without limitation, psychological screening, counseling, behavior 13
modification, physical therapy and nutritional education. 14
2. As conditions of providing coverage for a bariatric surgery 15
pursuant to subsection 1, a managed care organization may 16
require: 17
(a) An insured to successfully complete a preoperative period 18
of not more than 3 months that includes services recommended by 19
the American Society for Metabolic and Bariatric Surgery, or its 20
successor organization; and 21
(b) That the bariatric surgery be performed in a medical 22
facility that holds Metabolic and Bariatric Surgery Accreditation 23
issued by American College of Surgeons, or its successor 24
organization. 25
3. A managed care organization may limit coverage for 26
bariatric surgery and related preoperative and postoperative 27
services to not more than one such surgery per lifetime. 28
4. A managed care organization shall require the physician 29
seeking coverage for bariatric surgery pursuant to subsection 1 to 30
provide a written statement to the managed care organization that 31
the treatment is medically necessary and will be provided in 32
accordance with the American Society for Metabolic and Bariatric 33
Surgery, or its successor organization, or the American College of 34
Surgeons, or its successor organization. 35
5. This section does not require a health care plan to include 36
coverage for any drug that is injected to lower glucose levels or 37
any other drug prescribed for weight loss. 38
6. A health care plan subject to the provisions of this chapter 39
which is delivered, issued for delivery or renewed on or after 40
January 1, 2026, has the legal effect of including the coverage 41
required by this section and any provision of the plan which is in 42
conflict with this section is void. 43
7. As used in this section: 44
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(a) “Medical facility” has the meaning ascribed to it in 1
NRS 449.0151. 2
(b) “Provider of health care” has the meaning ascribed to it in 3
NRS 629.031. 4
(c) “Severe obesity” means: 5
(1) A body mass index of 40 or higher; or 6
(2) A body mass index of 35 or higher with an associated 7
comorbidity, which may include, without limitation, hypertension, 8
cardiopulmonary conditions, sleep apnea or diabetes. 9
Sec. 12. NRS 232.320 is hereby amended to read as follows: 10
232.320 1. The Director: 11
(a) Shall appoint, with the consent of the Governor, 12
administrators of the divisions of the Department, who are 13
respectively designated as follows: 14
(1) The Administrator of the Aging and Disability Services 15
Division; 16
(2) The Administrator of the Division of Welfare and 17
Supportive Services; 18
(3) The Administrator of the Division of Child and Family 19
Services; 20
(4) The Administrator of the Division of Health Care 21
Financing and Policy; and 22
(5) The Administrator of the Division of Public and 23
Behavioral Health. 24
(b) Shall administer, through the divisions of the Department, 25
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 26
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 27
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 28
section 15 of this act, 422.580, 432.010 to 432.133, inclusive, 29
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 30
and 445A.010 to 445A.055, inclusive, and all other provisions of 31
law relating to the functions of the divisions of the Department, but 32
is not responsible for the clinical activities of the Division of Public 33
and Behavioral Health or the professional line activities of the other 34
divisions. 35
(c) Shall administer any state program for persons with 36
developmental disabilities established pursuant to the 37
Developmental Disabilities Assistance and Bill of Rights Act of 38
2000, 42 U.S.C. §§ 15001 et seq. 39
(d) Shall, after considering advice from agencies of local 40
governments and nonprofit organizations which provide social 41
services, adopt a master plan for the provision of human services in 42
this State. The Director shall revise the plan biennially and deliver a 43
copy of the plan to the Governor and the Legislature at the 44
beginning of each regular session. The plan must: 45
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(1) Identify and assess the plans and programs of the 1
Department for the provision of human services, and any 2
duplication of those services by federal, state and local agencies; 3
(2) Set forth priorities for the provision of those services; 4
(3) Provide for communication and the coordination of those 5
services among nonprofit organizations, agencies of local 6
government, the State and the Federal Government; 7
(4) Identify the sources of funding for services provided by 8
the Department and the allocation of that funding; 9
(5) Set forth sufficient information to assist the Department 10
in providing those services and in the planning and budgeting for the 11
future provision of those services; and 12
(6) Contain any other information necessary for the 13
Department to communicate effectively with the Federal 14
Government concerning demographic trends, formulas for the 15
distribution of federal money and any need for the modification of 16
programs administered by the Department. 17
(e) May, by regulation, require nonprofit organizations and state 18
and local governmental agencies to provide information regarding 19
the programs of those organizations and agencies, excluding 20
detailed information relating to their budgets and payrolls, which the 21
Director deems necessary for the performance of the duties imposed 22
upon him or her pursuant to this section. 23
(f) Has such other powers and duties as are provided by law. 24
2. Notwithstanding any other provision of law, the Director, or 25
the Director’s designee, is responsible for appointing and removing 26
subordinate officers and employees of the Department. 27
Sec. 13. NRS 287.010 is hereby amended to read as follows: 28
287.010 1. The governing body of any county, school 29
district, municipal corporation, political subdivision, public 30
corporation or other local governmental agency of the State of 31
Nevada may: 32
(a) Adopt and carry into effect a system of group life, accident 33
or health insurance, or any combination thereof, for the benefit of its 34
officers and employees, and the dependents of officers and 35
employees who elect to accept the insurance and who, where 36
necessary, have authorized the governing body to make deductions 37
from their compensation for the payment of premiums on the 38
insurance. 39
(b) Purchase group policies of life, accident or health insurance, 40
or any combination thereof, for the benefit of such officers and 41
employees, and the dependents of such officers and employees, as 42
have authorized the purchase, from insurance companies authorized 43
to transact the business of such insurance in the State of Nevada, 44
and, where necessary, deduct from the compensation of officers and 45
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- *AB399*
employees the premiums upon insurance and pay the deductions 1
upon the premiums. 2
(c) Provide group life, accident or health coverage through a 3
self-insurance reserve fund and, where necessary, deduct 4
contributions to the maintenance of the fund from the compensation 5
of officers and employees and pay the deductions into the fund. The 6
money accumulated for this purpose through deductions from the 7
compensation of officers and employees and contributions of the 8
governing body must be maintained as an internal service fund as 9
defined by NRS 354.543. The money must be deposited in a state or 10
national bank or credit union authorized to transact business in the 11
State of Nevada. Any independent administrator of a fund created 12
under this section is subject to the licensing requirements of chapter 13
683A of NRS, and must be a resident of this State. Any contract 14
with an independent administrator must be approved by the 15
Commissioner of Insurance as to the reasonableness of 16
administrative charges in relation to contributions collected and 17
benefits provided. The provisions of NRS 439.581 to 439.597, 18
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 19
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs 20
(b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 21
and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, and 22
section 3 of this act, 689B.0375 to 689B.050, inclusive, 689B.0675, 23
689B.265, 689B.287 and 689B.500 apply to coverage provided 24
pursuant to this paragraph, except that the provisions of NRS 25
689B.0378, 689B.03785 and 689B.500 only apply to coverage for 26
active officers and employees of the governing body, or the 27
dependents of such officers and employees. 28
(d) Defray part or all of the cost of maintenance of a self-29
insurance fund or of the premiums upon insurance. The money for 30
contributions must be budgeted for in accordance with the laws 31
governing the county, school district, municipal corporation, 32
political subdivision, public corporation or other local governmental 33
agency of the State of Nevada. 34
2. If a school district offers group insurance to its officers and 35
employees pursuant to this section, members of the board of trustees 36
of the school district must not be excluded from participating in the 37
group insurance. If the amount of the deductions from compensation 38
required to pay for the group insurance exceeds the compensation to 39
which a trustee is entitled, the difference must be paid by the trustee. 40
3. In any county in which a legal services organization exists, 41
the governing body of the county, or of any school district, 42
municipal corporation, political subdivision, public corporation or 43
other local governmental agency of the State of Nevada in the 44
county, may enter into a contract with the legal services 45
– 18 –
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organization pursuant to which the officers and employees of the 1
legal services organization, and the dependents of those officers and 2
employees, are eligible for any life, accident or health insurance 3
provided pursuant to this section to the officers and employees, and 4
the dependents of the officers and employees, of the county, school 5
district, municipal corporation, political subdivision, public 6
corporation or other local governmental agency. 7
4. If a contract is entered into pursuant to subsection 3, the 8
officers and employees of the legal services organization: 9
(a) Shall be deemed, solely for the purposes of this section, to be 10
officers and employees of the county, school district, municipal 11
corporation, political subdivision, public corporation or other local 12
governmental agency with which the legal services organization has 13
contracted; and 14
(b) Must be required by the contract to pay the premiums or 15
contributions for all insurance which they elect to accept or of which 16
they authorize the purchase. 17
5. A contract that is entered into pursuant to subsection 3: 18
(a) Must be submitted to the Commissioner of Insurance for 19
approval not less than 30 days before the date on which the contract 20
is to become effective. 21
(b) Does not become effective unless approved by the 22
Commissioner. 23
(c) Shall be deemed to be approved if not disapproved by the 24
Commissioner within 30 days after its submission. 25
6. As used in this section, “legal services organization” means 26
an organization that operates a program for legal aid and receives 27
money pursuant to NRS 19.031. 28
Sec. 14. NRS 287.04335 is hereby amended to read as 29
follows: 30
287.04335 If the Board provides health insurance through a 31
plan of self-insurance, it shall comply with the provisions of NRS 32
439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 33
687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 34
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 35
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 36
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 37
695G.174, inclusive, and section 11 of this act, 695G.176, 38
695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 39
695G.310, inclusive, 695G.405 and 695G.415, in the same manner 40
as an insurer that is licensed pursuant to title 57 of NRS is required 41
to comply with those provisions. 42
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Sec. 15. Chapter 422 of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. To the extent that federal financial participation is 3
available and subject to the limitations authorized by this section, 4
the director shall include under Medicaid coverage for medically 5
necessary treatment and care for diseases and conditions caused 6
by severe obesity, including, without limitation: 7
(a) Medically necessary bariatric surgery for a person who is 8
18 years of age or older; and 9
(b) Related preoperative and postoperative services, including, 10
without limitation, psychological screening, counseling, behavior 11
modification, physical therapy and nutritional education. 12
2. As a condition of providing coverage for a bariatric 13
surgery, the Director may require: 14
(a) A person to successfully complete a preoperative period of 15
not more than 3 months that includes services recommended by 16
the American Society for Metabolic and Bariatric Surgery, or its 17
successor organization; and 18
(b) That the bariatric surgery be performed in a medical 19
facility that holds Metabolic and Bariatric Surgery Accreditation 20
issued by the American College of Surgeons, or its successor 21
organization. 22
3. The Director may limit coverage for bariatric surgery and 23
related preoperative and postoperative services to not more than 24
one such surgery per lifetime. 25
4. The Director may require the physician seeking coverage 26
for bariatric surgery pursuant to subsection 1 to provide a written 27
statement to the Director that the treatment is medically necessary 28
and will be provided in accordance with the American Society for 29
Metabolic and Bariatric Surgery, or its successor organization, or 30
the American College of Surgeons, or its successor organization. 31
5. This section does not require Medicaid to include coverage 32
for any drug that is injected to lower glucose levels or any other 33
drug prescribed for weight loss. 34
6. The Department shall: 35
(a) Apply to the Secretary of Health and Human Services for 36
any waiver of federal law or apply for any amendment of the State 37
Plan for Medicaid that is necessary for the Department to receive 38
federal funding to provide the coverage described in subsection 1. 39
(b) Fully cooperate in good faith with the Federal Government 40
during the application process to satisfy the requirement of the 41
Federal Government for obtaining a waiver or amendment 42
pursuant to paragraph (a). 43
7. As used in this section: 44
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- *AB399*
(a) “Medical facility” has the meaning ascribed to it in 1
NRS 449.0151. 2
(b) “Medically necessary” means health care services or 3
products that a prudent physician would provide to a patient to 4
prevent, diagnose or treat an illness, injury or disease or any 5
symptom thereof, that are necessary and: 6
(1) Provided in accordance with generally accepted 7
standards of medical practice; 8
(2) Clinically appropriate with regard to type, frequency, 9
extent, location and duration; 10
(3) Not primarily provided for the convenience of the 11
patient, physician or other provider of health care; 12
(4) Required to improve a specific health condition of a 13
patient or to preserve the existing state of health of the patient; 14
and 15
(5) The most clinically appropriate level of health care that 16
may be safely provided to the patient. 17
(c) “Provider of health care” has the meaning ascribed to it in 18
NRS 629.031. 19
(d) “Severe obesity” means: 20
(1) A body mass index of 40 or higher; or 21
(2) A body mass index of 35 or higher with an associated 22
comorbidity, which may include, without limitation, hypertension, 23
cardiopulmonary conditions, sleep apnea or diabetes. 24
Sec. 16. The provisions of NRS 354.599 do not apply to any 25
additional expenses of a local government that are related to the 26
provisions of this act. 27
Sec. 17. 1. This section becomes effective upon passage and 28
approval. 29
2. Sections 1 to 16, inclusive, of this act become effective: 30
(a) Upon passage and approval for the purpose of adopting any 31
regulations and performing any other preparatory administrative 32
tasks that are necessary to carry out the provisions of this act; and 33
(b) On January 1, 2026, for all other purposes. 34
H