S.B. 97
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SENATE BILL NO. 97–COMMITTEE ON COMMERCE AND LABOR
(ON BEHALF OF THE JOINT INTERIM STANDING COMMITTEE
ON HEALTH AND HUMAN SERVICES)
PREFILED JANUARY 14, 2025
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Referred to Committee on Commerce and Labor
SUMMARY—Makes revisions to the Silver State Health Insurance
Exchange. (BDR 57-346)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Contains Appropriation not included
in Executive Budget.
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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 health insurance; requiring the Executive
Director of the Silver State Health Insurance Exchange to
apply for a federal waiver to allow certain persons to
access health plans offered on the Exchange; expanding
the number of voting members of the Board of Directors
of the Exchange; making an appropriation; and providing
other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law establishes the Silver State Health Insurance Exchange to facilitate 1
the purchase of subsidized health plans by certain small employers and natural 2
persons who are citizens of the United States or otherwise lawfully present in the 3
United States. (Chapter 695I of NRS) Section 1 of this bill requires the Executive 4
Director of the Exchange, in collaboration with the Director of the Department of 5
Health and Human Services, the Director of the Department of Business and 6
Industry and the Commissioner of Insurance, to: (1) apply for a federal waiver to 7
authorize any natural person to purchase a qualified health plan on the Exchange, 8
regardless of his or her immigration status, if the natural person otherwise qualifies 9
to purchase such a plan on the Exchange; and (2) conduct, or contract with an 10
independent actuary to conduct, an actuarial analysis before applying for the waiver 11
to ensure that such waiver will comply with certain federal requirements. (42 12
U.S.C. § 18052(b)) Section 2 of this bill makes a conforming change to indicate 13
that the waiver, if approved, would authorize natural persons who are not lawfully 14
present in the United States to purchase qualified health plans. Section 4 of this bill 15
makes an appropriation of $1,000,000 to the Exchange for the costs of the actuarial 16
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analysis and other administrative tasks related to applying for and implementing the 17
waiver. 18
Existing law creates the Board of Directors of the Exchange which consists of: 19
(1) five voting members appointed by the Governor; (2) one voting member 20
appointed by the Majority Leader of the Senate; (3) one voting member appointed 21
by the Speaker of the Assembly; and (4) three ex officio, nonvoting members. 22
(NRS 695I.300) Section 3 of this bill: (1) requires the Majority Leader of the 23
Senate and the Speaker of the Assembly to each appoint one additional voting 24
member to the Board; and (2) makes a conforming change to the number of 25
members of the Board who must have certain expertise or experience to reflect the 26
increased number of members of the Board. Section 5 of this bill prescribes the 27
length of the initial terms of the new members added to the Board by section 3 to 28
ensure that the terms of the voting members of the Board are staggered. 29
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 695I of NRS is hereby amended by adding 1
thereto a new section to read as follows: 2
1. The Legislature hereby finds and declares that it is the 3
public policy of this State that each natural person who otherwise 4
qualifies to purchase a qualified health plan on the Exchange, 5
regardless of his or her immigration or citizenship status, is 6
eligible to receive the benefits of purchasing a qualified health 7
plan on the Exchange. 8
2. The Executive Director, in collaboration with the Director 9
of the Department of Health and Human Services, the Director of 10
the Department of Business and Industry and the Commissioner, 11
shall: 12
(a) Conduct, or enter into a contract with an independent 13
actuary to conduct, an actuarial analysis to determine whether a 14
waiver described in paragraph (b) will meet the requirements of 42 15
U.S.C. § 18052(b); and 16
(b) If the actuarial analysis conducted pursuant to paragraph 17
(a) determines that the waiver will meet the requirements of 42 18
U.S.C. § 18052(b), apply to the Secretary of Health and Human 19
Services for a waiver pursuant to 42 U.S.C. § 18052 to authorize 20
any natural person to purchase a qualified health plan on the 21
Exchange, regardless of his or her immigration status, if the 22
natural person would otherwise be a qualified individual. 23
Sec. 2. NRS 695I.210 is hereby amended to read as follows: 24
695I.210 1. The Exchange shall: 25
(a) Create and administer a health insurance exchange; 26
(b) Facilitate the purchase and sale of qualified health plans 27
consistent with established patterns of care within the State; 28
(c) Provide for the establishment of a program to assist qualified 29
small employers in Nevada in facilitating the enrollment of their 30
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employees in qualified health plans offered in the small group 1
market; 2
(d) Except as otherwise authorized by a waiver obtained 3
pursuant to NRS 695I.505 [,] or section 1 of this act, make only 4
qualified health plans available to qualified individuals and qualified 5
small employers; and 6
(e) Unless the Federal Act is repealed or is held to be 7
unconstitutional or otherwise invalid or unlawful, perform all duties 8
that are required of the Exchange to implement the requirements of 9
the Federal Act. 10
2. The Exchange may: 11
(a) Enter into contracts with any person, including, without 12
limitation, a local government, a political subdivision of a local 13
government and a governmental agency, to assist in carrying out the 14
duties and powers of the Exchange or the Board; and 15
(b) Apply for and accept any gift, donation, bequest, grant or 16
other source of money to carry out the duties and powers of the 17
Exchange or the Board. 18
3. The Exchange is subject to the provisions of chapter 333 of 19
NRS. 20
Sec. 3. NRS 695I.300 is hereby amended to read as follows: 21
695I.300 1. The governing authority of the Exchange is the 22
Board, consisting of [seven] nine voting members and three ex 23
officio nonvoting members. 24
2. Subject to the provisions of subsections 3 to 6, inclusive: 25
(a) The Governor shall appoint five voting members of the 26
Board; 27
(b) The Senate Majority Leader shall appoint [one] two voting 28
[member] members of the Board; and 29
(c) The Speaker of the Assembly shall appoint [one] two voting 30
[member] members of the Board. 31
3. Each voting member of the Board must have: 32
(a) Expertise in the sale or marketing of individual or small 33
employer health insurance; 34
(b) Expertise in health care administration, health care 35
financing, health information technology or health insurance; 36
(c) Expertise in the administration of health care delivery 37
systems; 38
(d) Experience as a consumer who would benefit from services 39
provided by the Exchange; or 40
(e) Experience as a consumer advocate, including, without 41
limitation, experience in consumer outreach and education for those 42
who would benefit from services provided by the Exchange. 43
4. When making an appointment pursuant to subsection 2, the 44
Governor, the Majority Leader and the Speaker of the Assembly 45
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shall consider the collective expertise and experience of the voting 1
members of the Board and shall attempt to make each appointment 2
so that: 3
(a) The areas of expertise and experience described in 4
subsection 3 are collectively represented by the voting members of 5
the Board; and 6
(b) The voting members of the Board represent a range and 7
diversity of skills, knowledge, experience and geographic and 8
stakeholder perspectives. 9
5. When making an appointment pursuant to subsection 2, the 10
Governor, the Majority Leader and the Speaker of the Assembly 11
shall, as vacancies on the Board occur, ensure that not more than 12
[two] three voting members of the Board represent any particular 13
area of expertise or experience described in paragraph (a), (b), (c), 14
(d) or (e) of subsection 3. 15
6. A voting member of the Board may not be a Legislator or 16
hold any elective office in State Government. 17
7. The following are ex officio nonvoting members of the 18
Board who shall assist the voting members of the Board by 19
providing advice and expertise: 20
(a) The Director of the Department of Health and Human 21
Services, or his or her designee; 22
(b) The Director of the Department of Business and Industry, or 23
his or her designee; and 24
(c) The Director of the Office of Finance, or his or her designee. 25
Sec. 4. 1. There is hereby appropriated from the State 26
General Fund to the Silver State Health Insurance Exchange the sum 27
of $1,000,000 to pay the costs of: 28
(a) The actuarial analysis required by paragraph (a) of 29
subsection 2 of section 1 of this act; and 30
(b) Any other administrative activities related to the application 31
for and implementation of the waiver described in paragraph (b) of 32
subsection 2 of section 1 of this act. 33
2. Any remaining balance of the appropriation made by 34
subsection 1 must not be committed for expenditure after June 30, 35
2027, by the entity to which the appropriation is made or any entity 36
to which money from the appropriation is granted or otherwise 37
transferred in any manner, and any portion of the appropriated 38
money remaining must not be spent for any purpose after 39
September 17, 2027, by either the entity to which the money was 40
appropriated or the entity to which the money was subsequently 41
granted or transferred, and must be reverted to the State General 42
Fund on or before September 17, 2027. 43
Sec. 5. 1. The Speaker of the Assembly shall appoint the 44
additional voting member of the Board of Directors of the Silver 45
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State Health Insurance Exchange pursuant to paragraph (c) of 1
subsection 2 of NRS 695I.300, as amended by section 3 of this 2
act, to an initial term commencing on July 1, 2025, and expiring on 3
June 30, 2027. 4
2. The Senate Majority Leader shall appoint the additional 5
voting member of the Board of Directors of the Silver State Health 6
Insurance Exchange pursuant to paragraph (b) of subsection 2 of 7
NRS 695I.300, as amended by section 3 of this act, to an initial term 8
commencing on July 1, 2025, and expiring on June 30, 2028. 9
Sec. 6. 1. This section and sections 4 and 5 of this act 10
become effective upon passage and approval. 11
2. Section 3 of this act becomes effective on July 1, 2025. 12
3. Sections 1 and 2 of this act become effective: 13
(a) Upon passage and approval for the purpose of conducting the 14
actuarial analysis required by paragraph (a) of subsection 2 of 15
section 1 of this act, preparing and submitting the application for the 16
federal waiver described in paragraph (b) of subsection 2 of section 17
1 of this act and performing any other preparatory administrative 18
tasks that are necessary to carry out the provisions of this act; and 19
(b) On January 1, 2028, for all other purposes. 20
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