AB399 - Requires certain health insurance to cover certain health care related to severe obesity. (BDR 57-657)

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 – 2 – - *AB399* 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 – 3 – - *AB399* 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 – 4 – - *AB399* (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 – 5 – - *AB399* (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 – 6 – - *AB399* 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 s [Text truncated for display. Full text available on LegiScan.]