AB169 - Revises provisions relating to health insurance. (BDR 57-735)

- 83rd Session (2025) Assembly Bill No. 169–Assemblymember Yeager CHAPTER.......... AN ACT relating to insurance; establishing the applicability of provisions requiring policies of health insurance to include certain coverage; requiring that certain health insurance policies and health plans include coverage for certain forms of speech-language pathology as treatment for stuttering for persons who are less than 26 years of age; prohibiting certain limitations on such coverage; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires public and private policies of health insurance and health plans regulated under Nevada law to include certain coverage. (NRS 287.010, 287.04335, 422.27172-422.272428, 689A.04033-689A.0465, 689B.0303- 689B.0379, 689C.1652-689C.169, 689C.194, 689C.1945, 689C.195, 689C.425, 695A.184-695A.1875, 695A.265, 695B.1901-695B.1948, 695C.050, 695C.1691- 695C.176, 695G.162-695G.177) Existing law also requires employers to provide certain benefits for health care to employees, including the coverage required of health insurers, if the employer provides health benefits for its employees. (NRS 608.1555) Sections 2.3 and 4.3 of this bill provide that certain provisions requiring a policy of individual or group health insurance to include certain coverage are inapplicable to a policy that only provides coverage for a specified disease or illness or that only provides a limited benefit. Sections 2.7, 4.7-10, 12, 12.5, 14 and 16 of this bill require that certain public and private policies of health insurance and health plans, including Medicaid but excluding the Public Employees’ Benefits Program, include coverage for habilitative and rehabilitative speech-language pathology as a treatment for stuttering for persons who are less than 26 years of age. Sections 1, 2.7, 4.7-10, 12, 14 and 16 of this bill additionally prohibit an insurer from imposing a maximum annual limit on the coverage, limiting coverage based on the cause of the stuttering or imposing medical management techniques on those benefits. Section 13 of this bill makes a conforming change to require the Director of the Department of Health and Human Services to administer the provisions of section 16 in the same manner as other provisions relating to Medicaid. Section 3 of this bill authorizes the Commissioner of Insurance to require that certain policies of health insurance issued by a domestic insurer to a person who resides in another state include the coverage required by sections 2.3 and 2.7. Section 11 of this bill authorizes the Commissioner to suspend or revoke the certificate of a health maintenance organization that fails to comply with the requirements of section 9. The Commissioner would also be authorized to take such action against other health insurers who fail to comply with the requirements of sections 2.7, 4.7-8 or 12. (NRS 680A.200) – 2 – - 83rd Session (2025) EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. 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 follows: 687B.225 1. Except as otherwise provided in NRS 689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 695G.1719 , [and] 695G.177, and sections 2.7, 4.7, 5, 7, 8, 9 and 12 of this act, any contract for group, blanket or individual health insurance or any contract by a nonprofit hospital, medical or dental service corporation or organization for dental care which provides for payment of a certain part of medical or dental care may require the insured or member to obtain prior authorization for that care from the insurer or organization. The insurer or organization shall: (a) File its procedure for obtaining approval of care pursuant to this section for approval by the Commissioner; and (b) Unless a shorter time period is prescribed by a specific statute, including, without limitation, NRS 689A.0446, 689B.0361, 689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, respond to any request for approval by the insured or member pursuant to this section within 20 days after it receives the request. 2. The procedure for prior authorization may not discriminate among persons licensed to provide the covered care. Sec. 2. Chapter 689A of NRS is hereby amended by adding thereto the provisions set forth as sections 2.3 and 2.7 of this act. Sec. 2.3. 1. The provisions of NRS 689A.04033 to 689A.0465, inclusive, and section 2.7 of this act must not be construed to require a policy that provides coverage only for a specified disease or illness or other limited benefit to provide the coverage set forth in those sections. 2. The Division shall not interpret the term “policy of health insurance,” for the purposes of NRS 689A.04033 to 689A.0465, – 3 – - 83rd Session (2025) inclusive, and section 2.7 of this act, in a manner contrary to the provisions of subsection 1. Sec. 2.7. 1. An insurer that offers or issues a policy of health insurance shall include in the policy coverage for habilitative speech-language pathology and rehabilitative speech- language pathology as a treatment for stuttering for insureds who are less than 26 years of age. 2. An insurer shall not: (a) Set a maximum annual limit on the benefits described in subsection 1, including, without limitation, a limit on the number of annual visits to a speech-language pathologist; (b) Limit the benefits described in subsection 1 based on the cause of the stuttering; or (c) Subject the benefits described in subsection 1 to medical management techniques. 3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void. 4. As used in this section: (a) “Habilitative speech-language pathology” means services that constitute the practice of speech-language pathology which help a person keep, learn or improve skills and functioning for daily living. (b) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs. The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration. (c) “Practice of speech-language pathology” has the meaning ascribed to it in NRS 637B.060. (d) “Rehabilitative speech-language pathology” means services that constitute the practice of speech-language pathology which help a person restore or improve skills and functioning for daily living that have been lost or impaired. Sec. 3. NRS 689A.330 is hereby amended to read as follows: 689A.330 If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public officer of that other state has informed the Commissioner that the policy is not subject to approval or disapproval by that officer, the Commissioner may by ruling – 4 – - 83rd Session (2025) require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and sections 2.3 and 2.7 of this act. Sec. 4. Chapter 689B of NRS is hereby amended by adding thereto the provisions set forth as sections 4.3 and 4.7 of this act. Sec. 4.3. 1. The provisions of NRS 689B.0303 to 689B.0379, inclusive, and section 4.7 of this act must not be construed to require a policy that provides coverage only for a specified disease or illness or other limited benefit to provide the coverage set forth in those sections. 2. The Division shall not interpret the term “policy of group health insurance,” for the purposes of NRS 689B.0303 to 689B.0379, inclusive, and section 4.7 of this act, in a manner contrary to the provisions of subsection 1. Sec. 4.7. 1. An insurer that offers or issues a policy of group health insurance shall include in the policy coverage for habilitative speech-language pathology and rehabilitative speech- language pathology as a treatment for stuttering for insureds who are less than 26 years of age. 2. An insurer shall not: (a) Set a maximum annual limit on the benefits described in subsection 1, including, without limitation, a limit on the number of annual visits to a speech-language pathologist; (b) Limit the benefits described in subsection 1 based on the cause of the stuttering; or (c) Subject the benefits described in subsection 1 to medical management techniques. 3. A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void. 4. As used in this section: (a) “Habilitative speech-language pathology” means services that constitute the practice of speech-language pathology which help a person keep, learn or improve skills and functioning for daily living. (b) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs. The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration. – 5 – - 83rd Session (2025) (c) “Practice of speech-language pathology” has the meaning ascribed to it in NRS 637B.060. (d) “Rehabilitative speech-language pathology” means services that constitute the practice of speech-language pathology which help a person restore or improve skills and functioning for daily living that have been lost or impaired. Sec. 5. Chapter 689C of NRS is hereby amended by adding thereto a new section to read as follows: 1. A carrier that offers or issues a health benefit plan shall include in the plan coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as a treatment for stuttering for insureds who are less than 26 years of age. 2. A carrier shall not: (a) Set a maximum annual limit on the benefits described in subsection 1, including, without limitation, a limit on the number of annual visits to a speech-language pathologist; (b) Limit the benefits described in subsection 1 based on the cause of the stuttering; or (c) Subject the benefits described in subsection 1 to medical management techniques. 3. A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void. 4. As used in this section: (a) “Habilitative speech-language pathology” means services that constitute the practice of speech-language pathology which help a person keep, learn or improve skills and functioning for daily living. (b) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs. The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration. (c) “Practice of speech-language pathology” has the meaning ascribed to it in NRS 637B.060. (d) “Rehabilitative speech-language pathology” means services that constitute the practice of speech-language pathology which help a person restore or improve skills and functioning for daily living that have been lost or impaired. – 6 – - 83rd Session (2025) Sec. 6. NRS 689C.425 is hereby amended to read as follows: 689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, and section 5 of this act to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive. Sec. 7. Chapter 695A of NRS is hereby amended by adding thereto a new section to read as follows: 1. A society that offers or issues a benefit contract shall include in the contract coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as a treatment for stuttering for insureds who are less than 26 years of age. 2. A society shall not: (a) Set a maximum annual limit on the benefits described in subsection 1, including, without limitation, a limit on the number of annual visits to a speech-language pathologist; (b) Limit the benefits described in subsection 1 based on the cause of the stuttering; or (c) Subject the benefits described in subsection 1 to medical management techniques. 3. A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage required by subsection 1, and any provision of the contract that conflicts with the provisions of this section is void. 4. As used in this section: (a) “Habilitative speech-language pathology” means services that constitute the practice of speech-language pathology which help a person keep, learn or improve skills and functioning for daily living. (b) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs. The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration. (c) “Practice of speech-language pathology” has the meaning ascribed to it in NRS 637B.060. (d) “Rehabilitative speech-language pathology” means services that constitute the practice of speech-language pa [Text truncated for display. Full text available on LegiScan.]