S.B. 9
- *SB9*
SENATE BILL NO. 9–COMMITTEE ON COMMERCE AND LABOR
(ON BEHALF OF THE DIVISION OF HEALTH CARE
FINANCING AND POLICY OF THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES)
PREFILED OCTOBER 29, 2024
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions relating to Medicaid.
(BDR 57-290)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: No.
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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to insurance; revising provisions governing
certain duties of insurers and certain other providers of
health coverage with regard to coverage and claims for
persons who are eligible for or provided medical
assistance under Medicaid; and providing other matters
properly relating thereto.
Legislative Counsel’s Digest:
Under existing law, if a state agency is assigned any rights of a person who is 1
eligible for medical assistance under Medicaid, insurers and certain other providers 2
of health coverage are subject to certain requirements. Among other requirements, 3
existing law requires the insurer or other provider to: (1) respond to any inquiry by 4
the state agency regarding a claim for payment for the provision of any medical 5
item or service not later than 3 years after the date of the provision of the medical 6
item or service; and (2) agree not to deny a claim submitted by the state agency for 7
certain reasons. (NRS 689A.430, 689B.300, 695A.151, 695B.340, 695C.163, 8
695F.440) 9
Section 202 of the federal Consolidated Appropriations Act, 2022, Pub. L. No. 10
117-103, revised certain requirements for a state plan for medical assistance 11
concerning the liability of third parties for payment of a claim for a health care item 12
or service. (42 U.S.C. § 1396a) Sections 1-6 of this bill revise existing law to 13
comply with those requirements. Sections 1-6 require insurers and certain other 14
providers of health coverage that the state agency reasonably believes cover the 15
person who is eligible for medical assistance under Medicaid to respond to an 16
inquiry regarding a claim for payment for the provision of any medical item or 17
service not later than 60 days after receiving the inquiry. Sections 1-6 also require 18
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insurers and certain other providers of health coverage to agree not to deny a claim 19
submitted by the state agency solely on the basis of lack of prior authorization if the 20
state agency authorized the medical item or service. 21
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 689A.430 is hereby amended to read as 1
follows: 2
689A.430 1. An insurer shall not, when considering 3
eligibility for coverage or making payments under a policy of health 4
insurance, consider the availability of, or eligibility of a person for, 5
medical assistance under Medicaid. 6
2. To the extent that payment has been made by Medicaid for 7
health care, an insurer: 8
(a) Shall treat Medicaid as having a valid and enforceable 9
assignment of an insured’s benefits regardless of any exclusion of 10
Medicaid or the absence of a written assignment; and 11
(b) May, as otherwise allowed by the policy, evidence of 12
coverage or contract and applicable law or regulation concerning 13
subrogation, seek to enforce any right of a recipient of Medicaid to 14
reimbursement against any other liable party if: 15
(1) It is so authorized pursuant to a contract with Medicaid 16
for managed care; or 17
(2) It has reimbursed Medicaid in full for the health care 18
provided by Medicaid to its insured. 19
3. If a state agency is assigned any rights of a person who is: 20
(a) Eligible for medical assistance under Medicaid; and 21
(b) Covered by a policy of health insurance, 22
the insurer that issued the policy shall not impose any 23
requirements upon the state agency except requirements it imposes 24
upon the agents or assignees of other persons covered by the policy. 25
4. If a state agency is assigned any rights of an insured who is 26
eligible for medical assistance under Medicaid, an insurer shall: 27
(a) Upon request of the state agency, provide to the state agency 28
information regarding the insured to determine: 29
(1) Any period during which the insured or the insured’s 30
spouse or dependent may be or may have been covered by the 31
insurer; and 32
(2) The nature of the coverage that is or was provided by the 33
insurer, including, without limitation, the name and address of the 34
insured and the identifying number of the policy, evidence of 35
coverage or contract; 36
(b) [Respond to] Not later than 60 days after receiving any 37
inquiry by the state agency regarding a claim for payment for the 38
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provision of any medical item or service to the person who is 1
eligible for medical assistance under Medicaid and who the state 2
agency reasonably believes is covered by the insurer that is 3
submitted not later than 3 years after the date of the provision of the 4
medical item or service [;] , respond to such inquiry; and 5
(c) Agree not to deny a claim submitted by the state agency 6
solely on the basis of [the] : 7
(1) Lack of prior authorization if the state agency 8
authorized the medical item or service; or 9
(2) The date of submission of the claim, the type or format of 10
the claim form or failure to present proper documentation at the 11
point of sale that is the basis for the claim if: 12
[(1)] (I) The claim is submitted by the state agency not later 13
than 3 years after the date of the provision of the medical item or 14
service; and 15
[(2)] (II) Any action by the state agency to enforce its rights 16
with respect to such claim is commenced not later than 6 years after 17
the submission of the claim. 18
5. As used in this section, “insurer” includes, without 19
limitation, a self-insured plan, group health plan as defined in 20
section 607(1) of the Employee Retirement Income Security Act of 21
1974, 29 U.S.C. § 1167(1), service benefit plan or other 22
organization that has issued a policy of health insurance or any other 23
party described in section 1902(a)(25)(A), (G) or (I) of the Social 24
Security Act, 42 U.S.C. § 1396a(a)(25)(A), (G) or (I), as being 25
legally responsible for payment of a claim for a health care item or 26
service. 27
Sec. 2. NRS 689B.300 is hereby amended to read as follows: 28
689B.300 1. An insurer shall not, when considering 29
eligibility for coverage or making payments under a group health 30
policy, consider the availability of, or eligibility of a person for, 31
medical assistance under Medicaid. 32
2. To the extent that payment has been made by Medicaid for 33
health care, an insurer: 34
(a) Shall treat Medicaid as having a valid and enforceable 35
assignment of an insured’s benefits regardless of any exclusion of 36
Medicaid or the absence of a written assignment; and 37
(b) May, as otherwise allowed by the policy, evidence of 38
coverage or contract and applicable law or regulation concerning 39
subrogation, seek to enforce any rights of a recipient of Medicaid to 40
reimbursement against any other liable party if: 41
(1) It is so authorized pursuant to a contract with Medicaid 42
for managed care; or 43
(2) It has reimbursed Medicaid in full for the health care 44
provided by Medicaid to its insured. 45
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3. If a state agency is assigned any rights of a person who is: 1
(a) Eligible for medical assistance under Medicaid; and 2
(b) Covered by a group health policy, 3
the insurer that issued the policy shall not impose any 4
requirements upon the state agency except requirements it imposes 5
upon the agents or assignees of other persons covered by the policy. 6
4. If a state agency is assigned any rights of an insured who is 7
eligible for medical assistance under Medicaid, an insurer shall: 8
(a) Upon request of the state agency, provide to the state agency 9
information regarding the insured to determine: 10
(1) Any period during which the insured or the spouse or 11
dependent of the insured may be or may have been covered by the 12
insurer; and 13
(2) The nature of the coverage that is or was provided by the 14
insurer, including, without limitation, the name and address of the 15
insured and the identifying number of the policy; 16
(b) [Respond to] Not later than 60 days after receiving any 17
inquiry by the state agency regarding a claim for payment for the 18
provision of any medical item or service to the person who is 19
eligible for medical assistance under Medicaid and who the state 20
agency reasonably believes is covered by the insurer that is 21
submitted not later than 3 years after the date of the provision of the 22
medical item or service [;] , respond to such inquiry; and 23
(c) Agree not to deny a claim submitted by the state agency 24
solely on the basis of [the] : 25
(1) Lack of prior authorization if the state agency 26
authorized the medical item or service; or 27
(2) The date of submission of the claim, the type or format of 28
the claim form or failure to present proper documentation at the 29
point of sale that is the basis for the claim if: 30
[(1)] (I) The claim is submitted by the state agency not later 31
than 3 years after the date of the provision of the medical item or 32
service; and 33
[(2)] (II) Any action by the state agency to enforce its rights 34
with respect to such claim is commenced not later than 6 years after 35
the submission of the claim. 36
5. As used in this section, “insurer” includes, without 37
limitation, a self-insured plan, group health plan as defined in 38
section 607(1) of the Employee Retirement Income Security Act of 39
1974, 29 U.S.C. § 1167(1), service benefit plan or other 40
organization that has issued a group health policy or any other party 41
described in section 1902(a)(25)(A), (G) or (I) of the Social Security 42
Act, 42 U.S.C. § 1396a(a)(25)(A), (G) or (I), as being legally 43
responsible for payment of a claim for a health care item or service. 44
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Sec. 3. NRS 695A.151 is hereby amended to read as follows: 1
695A.151 1. A society shall not, when considering eligibility 2
for coverage or making payments under a certificate for health 3
benefits, consider the availability of, or eligibility of a person for, 4
medical assistance under Medicaid. 5
2. To the extent that payment has been made by Medicaid for 6
health care, a society: 7
(a) Shall treat Medicaid as having a valid and enforceable 8
assignment of an insured’s benefits regardless of any exclusion of 9
Medicaid or the absence of a written assignment; and 10
(b) May, as otherwise allowed by its certificate for health 11
benefits, evidence of coverage or contract and applicable law or 12
regulation concerning subrogation, seek to enforce any 13
reimbursement rights of a recipient of Medicaid against any other 14
liable party if: 15
(1) It is so authorized pursuant to a contract with Medicaid 16
for managed care; or 17
(2) It has reimbursed Medicaid in full for the health care 18
provided by Medicaid to its insured. 19
3. If a state agency is assigned any rights of a person who is: 20
(a) Eligible for medical assistance under Medicaid; and 21
(b) Covered by a certificate for health benefits, 22
the society that issued the health policy shall not impose any 23
requirements upon the state agency except requirements it imposes 24
upon the agents or assignees of other persons covered by the 25
certificate. 26
4. If a state agency is assigned any rights of an insured who is 27
eligible for medical assistance under Medicaid, a society that issues 28
a certificate for health benefits, evidence of coverage or contract 29
shall: 30
(a) Upon request of the state agency, provide to the state agency 31
information regarding the insured to determine: 32
(1) Any period during which the insured, a spouse or 33
dependent of the insured may be or may have been covered by the 34
society; and 35
(2) The nature of the coverage that is or was provided by the 36
society, including, without limitation, the name and address of the 37
insured and the identifying number of the certificate for health 38
benefits, evidence of coverage or contract; 39
(b) [Respond to] Not later than 60 days after receiving any 40
inquiry by the state agency regarding a claim for payment for the 41
provision of any medical item or service to the person who is 42
eligible for medical assistance under Medicaid and who the state 43
agency reasonably believes is covered by the society that is 44
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submitted not later than 3 years after the date of the provision of the 1
medical item or service [;] , respond to such inquiry; and 2
(c) Agree not to deny a claim submitted by the state agency 3
solely on the basis of [the] : 4
(1) Lack of prior authorization if the state agency 5
authorized the medical item or service; or 6
(2) The date of submission of the claim, the type or format of 7
the claim form or failure to present proper documentation at the 8
point of sale that is the basis for the claim if: 9
[(1)] (I) The claim is submitted by the state agency not later 10
than 3 years after the date of the provision of the medical item or 11
service; and 12
[(2)] (II) Any action by the state agency to enforce its rights 13
with respect to such claim is commenced not later than 6 years after 14
the submission of the claim. 15
Sec. 4. NRS 695B.340 is hereby amended to read as follows: 16
695B.340 1. A corporation shall not, when considering 17
eligibility for coverage or making payments under a contract, 18
consider the availability of, or any eligibility of a person for, 19
medical assistance under Medicaid. 20
2. To the extent that payment has been made by Medicaid for 21
health care, a corporation: 22
(a) Shall treat Medicaid as having a valid and enforceable 23
assignment of benefits of a subscriber or policyholder or claimant 24
under the subscriber or policyholder regardless of any exclusion of 25
Medicaid or the absence of a written assignment; and 26
(b) May, as otherwise allowed by the policy, evidence of 27
coverage or contract and applicable law or regulation concerning 28
subrogation, seek to enforce any rights of a recipient of Medicaid 29
against any other liable party if: 30
(1) It is so authorized pursuant to a contract with Medicaid 31
for managed care; or 32
(2) It has reimbursed Medicaid in full for the health care 33
provided by Medicaid to its subscriber or policyholder. 34
3. If a state agency is assigned any rights of a person who is: 35
(a) Eligible for medical assistance under Medicaid; and 36
(b) Covered by a contract, 37
the corporation that issued the contract shall not impose any 38
requirements upon the state agency except requirements it imposes 39
upon the agents or assignees of other persons covered by the same 40
contract. 41
4. If a state agency is assigned any rights of a subscriber or 42
policyholder who is eligible for medical assistance under Medicaid, 43
a corporation shall: 44
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(a) Upon request of the state agency, provide to the state agency 1
information regarding the subscriber or policyholder to determine: 2
(1) Any period during which the subscriber or policyholder, 3
the spouse or a dependent of the subscriber or policyholder may be 4
or may have been covered by a contract; and 5
(2) The nature of the coverage that is or was provided by the 6
corporation, including, without limitation, the name and address of 7
the subscriber or policyholder and the identifying number of the 8
contract; 9
(b) [Respond to] Not later than 60 days after receiving any 10
inquiry by the state agency regarding a claim for payment for the 11
provision of any medical item or service to the person who is 12
eligible for medical assistance under Medicaid and who the state 13
agency reasonably believes is covered by a contract that is 14
submitted not later than 3 years after the date of the provision of the 15
medical item or service [;] , respond to such inquiry; and 16
(c) Agree not to deny a claim submitted by the state agency 17
solely on the basis of [the] : 18
(1) Lack of prior authorization if the state agency 19
authorized the medical item or service; or 20
(2) The date of submission of the claim, the type or format of 21
the claim form or failure to present proper documentation at the 22
point of sale that is the basis for the claim if: 23
[(1)] (I) The claim is submitted by the state agency not later 24
than 3 years after the date of the provision of the medical item or 25
service; and 26
[(2)] (II) Any action by the state agency to enforce its rights 27
with respect to such claim is commenced not later than 6 years after 28
the submission of the claim. 29
Sec. 5. NRS 695C.163 is hereby amended to read as follows: 30
695C.163 1. A health maintenance organization shall not, 31
when considering eligibility for coverage or making payments under 32
a health care plan, consider the availability of, or eligibility of a 33
person for, medical assistance under Medicaid. 34
2. To the extent that payment has been made by Medicaid for 35
health care, a health maintenance organization: 36
(a) Shall treat Medicaid as having a valid and enforceable 37
assignment of benefits due an enrollee or claimant under the 38
enrollee regardless of any exclusion of Medicaid or the absence of a 39
written assignment; and 40
(b) May, as otherwise allowed by its plan, evidence of coverage 41
or contract and applicable law or regulation concerning subrogation, 42
seek to enforce any rights of a recipient of Medicaid to 43
reimbursement against any other liable party if: 44
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(1) It is so authorized pursuant to a contract with Medicaid 1
for managed care; or 2
(2) It has reimbursed Medicaid in full for the health care 3
provided by Medicaid to its enrollee. 4
3. If a state agency is assigned any rights of a person who is: 5
(a) Eligible for medical assistance under Medicaid; and 6
(b) Covered by a health care plan, 7
the organization responsible for the health care plan shall not 8
impose any requirements upon the state agency except requirements 9
it imposes upon the agents or assignees of other persons covered by 10
the same plan. 11
4. If a state agency is assigned any rights of an enrollee who is 12
eligible for medical assistance under Medicaid, a health 13
maintenance organization shall: 14
(a) Upon request of the state agency, provide to the state agency 15
information regarding the enrollee to determine: 16
(1) Any period during which the enrollee, the spouse or a 17
dependent of the enrollee may be or may have been covered by the 18
health care plan; and 19
(2) The nature of the coverage that is or was provided by the 20
organization, including, without limitation, the name and address of 21
the enrollee and the identifying number of the health care plan; 22
(b) [Respond to] Not later than 60 days after receiving any 23
inquiry by the state agency regarding a claim for payment for the 24
provision of any medical item or service to the person who is 25
eligible for assistance under Medicaid and who the state agency 26
reasonably believes is covered by the health care plan that is 27
submitted not later than 3 years after the date of the provision of the 28
medical item or service [;] , respond to such inquiry; and 29
(c) Agree not to deny a claim submitted by the state agency 30
solely on the basis of [the] : 31
(1) Lack of prior authorization if the state agency 32
authorized the medical item or service; or 33
(2) The date of submission of the claim, the type or format of 34
the claim form or failure to present proper documentation at the 35
point of sale that is the basis for the claim if: 36
[(1)] (I) The claim is submitted by the state agency not later 37
than 3 years after the date of the provision of the medical item or 38
service; and 39
[(2)] (II) Any action by the state agency to enforce its rights 40
with respect to such claim is commenced not later than 6 years after 41
the submission of the claim. 42
Sec. 6. NRS 695F.440 is hereby amended to read as follows: 43
695F.440 1. An organization shall not, when considering 44
eligibility for coverage or making payments under any evidence of 45
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coverage, consider the availability of, or eligibility of a person for, 1
medical assistance under Medicaid. 2
2. To the extent that payment has been made by Medicaid for 3
health care, a prepaid limited health service organization: 4
(a) Shall treat Medicaid as having a valid and enforceable 5
assignment of benefits due a subscriber or claimant under the 6
subscriber regardless of any exclusion of Medicaid or the absence of 7
a written assignment; and 8
(b) May, as otherwise allowed by its evidence of coverage or 9
contract and applicable law or regulation concerning subrogation, 10
seek to enforce any rights of a recipient of Medicaid against any 11
other liable party if: 12
(1) It is so authorized pursuant to a contract with Medicaid 13
for managed care; or 14
(2) It has reimbursed Medicaid in full for the health care 15
provided by Medicaid to its subscriber. 16
3. If a state agency is assigned any rights of a person who is: 17
(a) Eligible for medical assistance under Medicaid; and 18
(b) Covered by any evidence of coverage, 19
the prepaid limited health service organization that issued the 20
evidence of coverage shall not impose any requirements upon the 21
state agency except requirements it imposes upon the agents or 22
assignees of other persons covered by any evidence of coverage. 23
4. If a state agency is assigned any rights of a subscriber who is 24
eligible for medical assistance under Medicaid, a prepaid limited 25
health service organization shall: 26
(a) Upon request of the state agency, provide to the state agency 27
information regarding the subscriber to determine: 28
(1) Any period during which the subscriber, the spouse or a 29
dependent of the subscriber may be or may have been covered by 30
the organization; and 31
(2) The nature of the coverage that is or was provided by the 32
organization, including, without limitation, the name and address of 33
the subscriber and the identifying number of the evidence of 34
coverage; 35
(b) [Respond to] Not later than 60 days after receiving any 36
inquiry by the state agency regarding a claim for payment for the 37
provision of any medical item or service to the person who is 38
eligible for medical assistance under Medicaid and who the state 39
agency reasonably believes is covered by the organization that is 40
submitted not later than 3 years after the date of the provision of the 41
medical item or service [;] , respond to such inquiry; and 42
(c) Agree not to deny a claim submitted by the state agency 43
solely on the basis of [the] : 44
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(1) Lack of prior authorization if the state agency 1
authorized the medical item or service; or 2
(2) The date of submission of the claim, the type or format of 3
the claim form or failure to present proper documentation at the 4
point of sale that is the basis for the claim if: 5
[(1)] (I) The claim is submitted by the state agency not later 6
than 3 years after the date of the provision of the medical item or 7
service; and 8
[(2)] (II) Any action by the state agency to enforce its rights 9
with respect to such claim is commenced not later than 6 years after 10
the submission of the claim. 11
Sec. 7. This act becomes effective upon passage and approval. 12
H