S.B. 128
- *SB128*
SENATE BILL NO. 128–SENATOR NEAL
PREFILED JANUARY 29, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Makes changes related to health care. (BDR 57-87)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§ 4)
(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; prescribing requirements governing
the denial of requests for prior authorization; requiring, in
certain circumstances, licensed physicians, physician
assistants, advanced practice registered nurses and
osteopathic physicians to discuss with patients certain
information relating to stem cell treatment, storage and
donation; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Existing law authorizes certain health insurers to require an insured to obtain 1
prior authorization from the insurer before receiving certain care. (NRS 687B.225) 2
Sections 1, 4, 5 and 8 of this bill prohibit certain health insurers, including 3
Medicaid, the Children’s Health Insurance Program and insurance for public 4
employees, from using an artificial intelligence system or an automated decision 5
tool to: (1) deny a request for prior authorization; (2) modify a request for prior 6
authorization submitted by a provider of health care; (3) reduce the scope of 7
services or amount of coverage for care that is included within a request for prior 8
authorization; or (4) terminate, reduce or modify coverage for previously approved 9
care. Sections 1, 4, 5 and 8 also prohibit such health insurers from denying or 10
modifying a request for prior authorization on the grounds that the care requested is 11
not medically necessary or is experimental or investigational, unless a licensed 12
health care professional with the education, training and expertise necessary to 13
evaluate the condition at issue first makes such a determination. Section 2 of this 14
bill makes a conforming change to require the Director of the Department of Health 15
and Human Services to administer the requirements set forth in section 8 in the 16
same manner as other requirements governing Medicaid and the Children’s Health 17
Insurance Program. Sections 6 and 7 of this bill make conforming changes to 18
clarify that certain provisions generally applicable to members of plans of 19
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self-insurance for employees of local governments and are applicable to the 20
provisions of sections 4 and 5, respectively. 21
Existing law requires a physician, physician assistant, advanced practice 22
registered nurse or an osteopathic physician to counsel and provide certain 23
information to a patient who is diagnosed with certain conditions. (NRS 630.3737, 24
632.2383, 633.6947) Sections 9-11 of this bill require a physician, physician 25
assistant, advanced practice registered nurse or an osteopathic physician to: (1) 26
discuss with a patient, upon diagnosing the patient with arthritis, osteoarthritis or 27
any other condition that is regularly treated using stem cell therapy, the potential 28
use of stem cell therapy to treat the condition; and (2) when acting as a provider of 29
primary care during the first encounter with a new patient, inform the patient of 30
options that may be available to the patient for donating, banking or storing stem 31
cells for future use by the patient or a donee. 32
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 687B.225 is hereby amended to read as 1
follows: 2
687B.225 1. Except as otherwise provided in NRS 3
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 4
689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 5
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 6
689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 7
695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 8
695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 9
695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 10
695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 11
695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 12
695G.1719 and 695G.177, any contract for group, blanket or 13
individual health insurance or any contract by a nonprofit hospital, 14
medical or dental service corporation or organization for dental care 15
which provides for payment of a certain part of medical or dental 16
care may require the insured or member to obtain prior authorization 17
for that care from the insurer or organization [. The] in a manner 18
consistent with the provisions of this section. 19
2. An insurer or organization that requires an insured or 20
member to obtain prior authorization for medical or dental care 21
shall: 22
(a) File its procedure for obtaining approval of care pursuant to 23
this section for approval by the Commissioner; and 24
(b) Unless a shorter time period is prescribed by a specific 25
statute, including, without limitation, NRS 689A.0446, 689B.0361, 26
689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, 27
respond to any request for approval by the insured or member 28
pursuant to this section within 20 days after it receives the request. 29
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[2.] 3. The procedure for prior authorization may not 1
discriminate among persons licensed to provide the covered care. 2
4. An insurer or organization that requires an insured or 3
member to obtain prior authorization for medical or dental care 4
shall not: 5
(a) Utilize or employ an artificial intelligence system or 6
automated decision tool to: 7
(1) Deny a request for prior authorization for medical or 8
dental care; 9
(2) Modify a request for medical or dental care submitted 10
by a provider of health care; 11
(3) Reduce the scope of services or the amount of coverage 12
for medical or dental care included within a request for prior 13
authorization; or 14
(4) Terminate, reduce or modify coverage for previously 15
approved medical or dental care. 16
(b) Deny or modify a request for prior authorization submitted 17
by an insured or member, or by a provider of health care on behalf 18
of an insured or member, on the grounds that the care requested is 19
not medically necessary or is experimental or investigational, 20
unless a licensed health care professional who possesses the 21
education, training and expertise necessary to evaluate the specific 22
clinical issues relevant to the request for prior authorization first 23
determines that the care requested is not medically necessary or is 24
experimental or investigational after reviewing all available 25
medical documentation, notes of the insured’s or member’s 26
provider of health care, test results and other relevant medical 27
records of the insured or member. 28
5. The provisions of subsection 4 do not prohibit an insurer 29
or organization from utilizing an artificial intelligence system or 30
automated decision tool to automatically approve a request for 31
prior authorization. 32
6. As used in this section: 33
(a) “Artificial intelligence system” means a machine-based 34
system that can, for a given set of human-defined objectives, make 35
predictions, recommendations or decisions influencing real or 36
virtual environments. 37
(b) “Automated decision tool” means an automated or 38
computerized system that is specifically developed or modified to 39
make, or to be a controlling factor in making, consequential 40
decisions. 41
(c) “Healing art” means any system, treatment, operation, 42
diagnosis, prescription or practice for the ascertainment, cure, 43
relief, palliation, adjustment or correction of any human disease, 44
ailment, deformity, injury, or unhealthy or abnormal physical or 45
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mental condition for the practice of which long periods of 1
specialized education and training and a degree of specialized 2
knowledge of an intellectual and physical nature are required. 3
(d) “Licensed health care professional” means a person who is 4
licensed in any state or territory of the United States to perform 5
any healing art. 6
(e) “Medical or dental care” includes, without limitation, the 7
provision of prescription drugs. 8
(f) “Medically necessary” has the meaning ascribed to it in 9
NRS 695G.055. 10
(g) “Provider of health care” has the meaning ascribed to it in 11
NRS 695G.070. 12
Sec. 2. NRS 232.320 is hereby amended to read as follows: 13
232.320 1. The Director: 14
(a) Shall appoint, with the consent of the Governor, 15
administrators of the divisions of the Department, who are 16
respectively designated as follows: 17
(1) The Administrator of the Aging and Disability Services 18
Division; 19
(2) The Administrator of the Division of Welfare and 20
Supportive Services; 21
(3) The Administrator of the Division of Child and Family 22
Services; 23
(4) The Administrator of the Division of Health Care 24
Financing and Policy; and 25
(5) The Administrator of the Division of Public and 26
Behavioral Health. 27
(b) Shall administer, through the divisions of the Department, 28
the provisions of chapters 63, 424, 425, 427A, 432A to 442, 29
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS 30
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and 31
section 8 of this act, 422.580, 432.010 to 432.133, inclusive, 32
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive, 33
and 445A.010 to 445A.055, inclusive, and all other provisions of 34
law relating to the functions of the divisions of the Department, but 35
is not responsible for the clinical activities of the Division of Public 36
and Behavioral Health or the professional line activities of the other 37
divisions. 38
(c) Shall administer any state program for persons with 39
developmental disabilities established pursuant to the 40
Developmental Disabilities Assistance and Bill of Rights Act of 41
2000, 42 U.S.C. §§ 15001 et seq. 42
(d) Shall, after considering advice from agencies of local 43
governments and nonprofit organizations which provide social 44
services, adopt a master plan for the provision of human services in 45
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this State. The Director shall revise the plan biennially and deliver a 1
copy of the plan to the Governor and the Legislature at the 2
beginning of each regular session. The plan must: 3
(1) Identify and assess the plans and programs of the 4
Department for the provision of human services, and any 5
duplication of those services by federal, state and local agencies; 6
(2) Set forth priorities for the provision of those services; 7
(3) Provide for communication and the coordination of those 8
services among nonprofit organizations, agencies of local 9
government, the State and the Federal Government; 10
(4) Identify the sources of funding for services provided by 11
the Department and the allocation of that funding; 12
(5) Set forth sufficient information to assist the Department 13
in providing those services and in the planning and budgeting for the 14
future provision of those services; and 15
(6) Contain any other information necessary for the 16
Department to communicate effectively with the Federal 17
Government concerning demographic trends, formulas for the 18
distribution of federal money and any need for the modification of 19
programs administered by the Department. 20
(e) May, by regulation, require nonprofit organizations and state 21
and local governmental agencies to provide information regarding 22
the programs of those organizations and agencies, excluding 23
detailed information relating to their budgets and payrolls, which the 24
Director deems necessary for the performance of the duties imposed 25
upon him or her pursuant to this section. 26
(f) Has such other powers and duties as are provided by law. 27
2. Notwithstanding any other provision of law, the Director, or 28
the Director’s designee, is responsible for appointing and removing 29
subordinate officers and employees of the Department. 30
Sec. 3. Chapter 287 of NRS is hereby amended by adding 31
thereto the provisions set forth as sections 4 and 5 of this act. 32
Sec. 4. 1. The governing body of any county, school 33
district, municipal corporation, political subdivision, public 34
corporation or other local governmental agency of the State of 35
Nevada that provides health insurance through a plan of self-36
insurance shall not: 37
(a) Utilize or employ an artificial intelligence system or 38
automated decision tool to: 39
(1) Deny a request for prior authorization for medical or 40
dental care; 41
(2) Modify a request for medical or dental care submitted 42
by a provider of health care; 43
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(3) Reduce the scope of services or the amount of coverage 1
for medical or dental care included within a request for prior 2
authorization; or 3
(4) Terminate, reduce or modify coverage for previously 4
approved medical or dental care. 5
(b) Deny or modify a request for prior authorization submitted 6
by an insured, or by a provider of health care on behalf of an 7
insured, on the grounds that the care requested is not medically 8
necessary or is experimental or investigational, unless a licensed 9
health care professional who possesses the education, training and 10
expertise necessary to evaluate the specific clinical issues relevant 11
to the request for prior authorization first determines that the care 12
requested is not medically necessary or is experimental or 13
investigational after reviewing all available medical 14
documentation, notes of the insured’s provider of health care, test 15
results and other relevant medical records of the insured. 16
2. The provisions of subsection 1 do not prohibit a governing 17
body of any county, school district, municipal corporation, 18
political subdivision, public corporation or other local 19
governmental agency of the State of Nevada that provides health 20
insurance through a plan of self-insurance from utilizing an 21
artificial intelligence system or automated decision tool to 22
automatically approve a request for prior authorization. 23
3. As used in this section: 24
(a) “Artificial intelligence system” has the meaning ascribed to 25
it in NRS 687B.225. 26
(b) “Automated decision tool” has the meaning ascribed to it 27
in NRS 687B.225. 28
(c) “Licensed health care professional” has the meaning 29
ascribed to it in NRS 687B.225. 30
(d) “Medical or dental care” has the meaning ascribed to it in 31
NRS 687B.225. 32
(e) “Medically necessary” has the meaning ascribed to it in 33
NRS 695G.055. 34
(f) “Provider of health care” has the meaning ascribed to it in 35
NRS 695G.070. 36
Sec. 5. 1. If the Board provides health insurance through a 37
plan of self-insurance, the Board shall not: 38
(a) Utilize or employ an artificial intelligence system or 39
automated decision tool to: 40
(1) Deny a request for prior authorization for medical or 41
dental care; 42
(2) Modify a request for medical or dental care submitted 43
by a provider of health care; 44
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(3) Reduce the scope of services or the amount of coverage 1
for medical or dental care included within a request for prior 2
authorization; or 3
(4) Terminate, reduce or modify coverage for previously 4
approved medical or dental care. 5
(b) Deny or modify a request for prior authorization submitted 6
by an insured, or by a provider of health care on behalf of an 7
insured, on the grounds that the care requested is not medically 8
necessary or is experimental or investigational, unless a licensed 9
health care professional who possesses the education, training and 10
expertise necessary to evaluate the specific clinical issues relevant 11
to the request for prior authorization first determines that the care 12
requested is not medically necessary or is experimental or 13
investigational after reviewing all available medical 14
documentation, notes of the insured’s provider of health care, test 15
results and other relevant medical records of the insured. 16
2. The provisions of subsection 1 do not prohibit the Board 17
from utilizing an artificial intelligence system or automated 18
decision tool to automatically approve a request for prior 19
authorization. 20
3. As used in this section: 21
(a) “Artificial intelligence system” has the meaning ascribed to 22
it in NRS 687B.225. 23
(b) “Automated decision tool” has the meaning ascribed to it 24
in NRS 687B.225. 25
(c) “Licensed health care professional” has the meaning 26
ascribed to it in NRS 687B.225. 27
(d) “Medical or dental care” has the meaning ascribed to it in 28
NRS 687B.225. 29
(e) “Medically necessary” has the meaning ascribed to it in 30
NRS 695G.055. 31
(f) “Provider of health care” has the meaning ascribed to it in 32
NRS 695G.070. 33
Sec. 6. NRS 287.040 is hereby amended to read as follows: 34
287.040 The provisions of NRS 287.010 to 287.040, inclusive, 35
and section 4 of this act do not make it compulsory upon any 36
governing body of any county, school district, municipal 37
corporation, political subdivision, public corporation or other local 38
governmental agency of the State of Nevada, except as otherwise 39
provided in NRS 287.021 or subsection 4 of NRS 287.023 or in an 40
agreement entered into pursuant to subsection 3 of NRS 287.015, to 41
pay any premiums, contributions or other costs for group insurance, 42
a plan of benefits or medical or hospital services established 43
pursuant to NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or 44
(d) of subsection 1 of NRS 287.025, for coverage under the Public 45
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Employees’ Benefits Program, or to make any contributions to a 1
trust fund established pursuant to NRS 287.017, or upon any officer 2
or employee of any county, school district, municipal corporation, 3
political subdivision, public corporation or other local governmental 4
agency of this State to accept any such coverage or to assign his or 5
her wages or salary in payment of premiums or contributions 6
therefor. 7
Sec. 7. NRS 287.0402 is hereby amended to read as follows: 8
287.0402 As used in NRS 287.0402 to 287.049, inclusive, and 9
section 5 of this act, unless the context otherwise requires, the 10
words and terms defined in NRS 287.0404 to 287.04064, inclusive, 11
have the meanings ascribed to them in those sections. 12
Sec. 8. Chapter 422 of NRS is hereby amended by adding 13
thereto a new section to read as follows: 14
1. The Department, with respect to Medicaid and the 15
Children’s Health Insurance Program, shall not: 16
(a) Utilize or employ an artificial intelligence system or 17
automated decision tool to: 18
(1) Deny a request for prior authorization for medical or 19
dental care; 20
(2) Modify a request for medical or dental care submitted 21
by a provider of health care; 22
(3) Reduce the scope of services or the amount of coverage 23
for medical or dental care included within a request for prior 24
authorization; or 25
(4) Terminate, reduce or modify coverage for previously 26
approved medical or dental care. 27
(b) Deny or modify a request for prior authorization submitted 28
by a recipient of Medicaid or insurance through the Children’s 29
Health Insurance Program, or a provider of health care on behalf 30
of such a recipient, on the grounds that the care requested is not 31
medically necessary or is experimental or investigational, unless a 32
licensed health care professional who possesses the education, 33
training and expertise necessary to evaluate the specific clinical 34
issues relevant to the request for prior authorization first 35
determines that the care requested is not medically necessary or is 36
experimental or investigational after reviewing all available 37
medical documentation, notes of the participant’s provider of 38
health care, test results and other relevant medical records of the 39
participant. 40
2. The provisions of subsection 1 do not prohibit the 41
Department from utilizing an artificial intelligence system or 42
automated decision tool to automatically approve a request for 43
prior authorization. 44
3. As used in this section: 45
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(a) “Artificial intelligence system” has the meaning ascribed to 1
it in NRS 687B.225. 2
(b) “Automated decision tool” has the meaning ascribed to it 3
in NRS 687B.225. 4
(c) “Licensed health care professional” has the meaning 5
ascribed to it in NRS 687B.225. 6
(d) “Medical or dental care” has the meaning ascribed to it in 7
NRS 687B.225. 8
(e) “Medically necessary” has the meaning ascribed to it in 9
NRS 695G.055. 10
(f) “Provider of health care” has the meaning ascribed to it in 11
NRS 695G.070. 12
Sec. 9. Chapter 630 of NRS is hereby amended by adding 13
thereto a new section to read as follows: 14
1. Upon diagnosing a patient with arthritis, osteoarthritis or 15
any other condition that is regularly treated using stem cell 16
therapy, a physician or physician assistant shall discuss with the 17
patient the potential use of stem cell therapy to treat the condition. 18
2. During the first encounter with a new patient, a provider of 19
primary care shall inform the patient of options that may be 20
available to the patient for donating, banking or storing stem cells 21
for future use by the patient or a donee. 22
3. As used in this section: 23
(a) “Provider of health care” has the meaning ascribed to it in 24
NRS 629.031. 25
(b) “Provider of primary care” means a physician, physician 26
assistant or group of providers of health care that includes a 27
physician or physician assistant which: 28
(1) Provides initial and primary health care services to a 29
patient; and 30
(2) Maintains the continuity of care for the patient. 31
(c) “Stem cell therapy” means therapy involving the use of 32
human cells, tissues or cellular or tissue-based products. 33
Sec. 10. Chapter 632 of NRS is hereby amended by adding 34
thereto a new section to read as follows: 35
1. Upon diagnosing a patient with arthritis, osteoarthritis or 36
any other condition that is regularly treated using stem cell 37
therapy, an advanced practice registered nurse shall discuss with 38
the patient the potential use of stem cell therapy to treat the 39
condition. 40
2. During the first encounter with a new patient, a provider of 41
primary care shall inform the patient of options that may be 42
available to the patient for donating, banking or storing stem cells 43
for future use by the patient or a donee. 44
3. As used in this section: 45
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(a) “Provider of health care” has the meaning ascribed to it in 1
NRS 629.031. 2
(b) “Provider of primary care” means an advanced practice 3
registered nurse or a group of providers of health care that 4
includes an advanced practice registered nurse which: 5
(1) Provides initial and primary health care services to a 6
patient; and 7
(2) Maintains the continuity of care for the patient. 8
(c) “Stem cell therapy” means therapy involving the use of 9
human cells, tissues or cellular or tissue-based products. 10
Sec. 11. Chapter 633 of NRS is hereby amended by adding 11
thereto a new section to read as follows: 12
1. Upon diagnosing a patient with arthritis, osteoarthritis or 13
any other condition that is regularly treated using stem cell 14
therapy, an osteopathic physician or physician assistant shall 15
discuss with the patient the potential use of stem cell therapy to 16
treat the condition. 17
2. During the first encounter with a new patient, a provider of 18
primary care shall inform the patient of options that may be 19
available to the patient for donating, banking or storing stem cells 20
for future use by the patient or a donee. 21
3. As used in this section: 22
(a) “Provider of health care” has the meaning ascribed to it in 23
NRS 629.031. 24
(b) “Provider of primary care” means an osteopathic 25
physician, physician assistant or group of providers of health care 26
that includes an osteopathic physician or physician assistant 27
which: 28
(1) Provides initial and primary health care services to a 29
patient; and 30
(2) Maintains the continuity of care for the patient. 31
(c) “Stem cell therapy” means therapy involving the use of 32
human cells, tissues or cellular or tissue-based products. 33
Sec. 12. The provisions of NRS 354.599 do not apply to any 34
additional expenses of a local government that are related to the 35
provisions of this act. 36
Sec. 13. 1. This section becomes effective upon passage and 37
approval. 38
2. Sections 1 to 12, inclusive, of this act become effective: 39
(a) Upon passage and approval for the purpose of adopting any 40
regulations and performing any other preparatory administrative 41
tasks that are necessary to carry out the provisions of this act; and 42
(b) On January 1, 2026, for all other purposes. 43
H