AB522 - Revises provisions relating to health care. (BDR 57-1135)

EXEMPT (Reprinted with amendments adopted on April 21, 2025) FIRST REPRINT A.B. 522 - *AB522_R1* ASSEMBLY BILL NO. 522–COMMITTEE ON HEALTH AND HUMAN SERVICES MARCH 24, 2025 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to health care. (BDR 57-1135) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§§ 21-24, 27-29, 101, 105 & NRS 287.010) (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; requiring health insurers to allow the covered adult child of an insured to remain covered by the health insurance of the insured until 26 years of age; requiring health insurers to provide coverage for certain preventive health care for children, persons who are pregnant, women and adults; prohibiting insurers from imposing certain costs and taking other actions with respect to certain preventive health care; requiring health insurers to provide coverage for screenings for colorectal cancer; requiring health insurers to provide coverage for maternity and newborn care; prohibiting health insurers and providers of health care from engaging in certain discriminatory actions; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing federal law requires all health insurers to extend coverage for the 1 covered adult child of an insured until such child reaches 26 years of age. (42 2 U.S.C. § 300gg-14) Sections 2, 17, 31, 44, 46, 60, 74, 79, 90, 104 and 106 of this 3 bill align Nevada law with federal law in this manner and require a policy of health 4 insurance that provides coverage for dependent children to continue to make such 5 coverage available until the dependent child reaches 26 years of age. 6 Existing federal law requires all health insurance plans to include coverage, 7 without a higher deductible, copay or coinsurance, for certain preventive health 8 care for women, adults and children based on the recommendations and guidelines 9 – 2 – - *AB522_R1* of certain entities, including the United States Preventive Services Task Force and 10 the Health Resources and Services Administration of the United States Department 11 of Health and Human Services. (42 U.S.C. § 300gg-13; 45 C.F.R. § 147.130) 12 Existing Nevada law generally conforms with federal law in this manner and 13 requires public and private policies of health insurance, including Medicaid, to 14 cover certain preventive health care, including certain screenings, counseling, 15 vaccinations and contraceptive and other family planning drugs and devices. (NRS 16 287.010, 287.04335, 422.27172, 422.27174, 608.1555, 689A.0418, 689A.0419, 17 689B.0378, 689B.03785, 689C.1676, 689C.1678, 695A.1865, 695A.1875, 18 695B.1919, 695B.19195, 695C.1696, 695C.1698, 695G.1715, 695G.1717) 19 Sections 3-5, 11, 18-20, 27, 32-34, 40, 44, 47-49, 57, 61-63, 69, 75-77, 79, 80, 91- 20 93, 101, 104, 106 and 115 of this bill require public and private policies of health 21 insurance, including Medicaid, to include certain additional preventive health care 22 services which are not currently required to be covered under existing law, but have 23 been recommended by the United States Preventive Services Task Force and the 24 Health Resources and Services Administration. Sections 3-5, 11, 18-20, 27, 32-34, 25 40, 44, 47-49, 57, 61-63, 69, 75-77, 79, 80, 91-93, 101, 104, 106, 115 and 117 26 additionally prohibit an insurer from charging a higher deductible or any copay or 27 coinsurance for such preventive health care. 28 Existing law requires certain public and private policies of health insurance to 29 provide coverage for: (1) screening, genetic counseling and testing for harmful 30 mutations in the BRCA gene under certain circumstances; (2) examinations of 31 persons who are pregnant to detect certain diseases; and (3) testing for, treating and 32 preventing sexually transmitted diseases. (NRS 287.010, 287.04335, 422.27173, 33 422.27175, 608.1555, 689A.04049, 689A.0412, 689A.0438, 689B.0314, 34 689B.0315, 689B.0316, 689C.1653, 689C.1673, 689C.1675, 695A.1844, 35 695A.1853, 695A.1856, 695B.1911, 695B.1913, 695B.1926, 695C.17347, 36 695C.1736, 695C.1737, 695G.1707, 695G.1712, 695G.1714) Sections 8, 10, 13, 37 21-23, 36, 37, 39, 52, 53, 55, 66, 68, 70, 83, 85, 86, 96, 97, 99, 114 and 116 of this 38 bill prohibit an insurer from charging a higher deductible or any copay or 39 coinsurance for these services as well. Sections 10, 22, 39, 55, 68, 86, 99 and 114 40 additionally require such policies of health insurance to include coverage for the 41 detection of the human immunodeficiency virus in persons who are pregnant. 42 Existing law requires certain public and private policies of health insurance to 43 include coverage for certain screenings and tests for breast cancer. Existing law 44 also prohibits such policies of health insurance, other than Medicaid, from charging 45 a higher deductible or any copay or coinsurance for such screenings and tests. 46 (NRS 287.0273, 287.04337, 422.27176, 608.1555, 689A.0405, 689B.0374, 47 689C.1674, 695A.1855, 695B.1912, 695C.1735, 695G.1713) Sections 105 and 48 107 of this bill additionally require insurance for government employees to cover 49 certain additional diagnostic imaging if breast cancer is seen or suspected without 50 charging a higher deductible or imposing any copay or coinsurance for such 51 imaging. 52 Existing law requires certain policies of health insurance that provide coverage 53 for the treatment of colorectal cancer to additionally provide coverage for the 54 screening of colorectal cancer. (NRS 689A.04042, 689B.0367, 695B.1907, 55 695C.1731, 695G.168) Sections 7, 24, 35, 50, 65, 82, 95 and 111 of this bill: (1) 56 require all public and private policies of health insurance, including Medicaid, to 57 cover screening for colorectal cancer; and (2) prohibit insurers from charging a 58 higher deductible or any copay or coinsurance for such screenings. 59 Existing federal law requires all policies of health insurance to include 60 coverage for maternity and newborn care. (42 U.S.C. § 18022(b)) Sections 12, 15, 61 29, 41, 42, 51, 56, 64, 71, 78, 81, 94, 100 and 112 of this bill align Nevada law 62 with federal law in this manner and require public and private policies of health 63 insurance to include coverage for such care. 64 – 3 – - *AB522_R1* Existing federal regulations prohibit certain health care entities from 65 discriminating on the basis of race, color, national origin, sex, age or disability. (45 66 C.F.R. §§ 92.101, 92.206, 92.208, 92.209) Existing law prohibits public and private 67 policies of health insurance from discriminating against any person with respect to 68 participation or coverage under the policy on the basis of actual or perceived gender 69 identity or expression. (NRS 287.010, 287.04335, 422.2701, 608.1555, 689A.033, 70 689B.0675, 689C.1975, 689C.425, 695A.198, 695B.3167, 695C.050, 695C.204, 71 695G.415) Sections 6, 28, 43, 58, 72, 87, 102 and 113 of this bill additionally 72 prohibit public and private policies of health insurance, including Medicaid, from 73 discriminating against any person on the basis of actual or perceived race, color, 74 national origin, sex, age or disability. Section 119 of this bill similarly prohibits a 75 provider of health care from discriminating against a person on the basis of those 76 characteristics, as well as gender identity or expression. Section 119 also authorizes 77 a board, agency or other entity in this State that licenses, certifies or regulates a 78 provider of health care to: (1) adopt regulations prescribing the types of 79 discrimination that are prohibited; and (2) discipline a provider of health care that 80 violates section 119. 81 Existing law prohibits an insurer that offers or issues a policy of group health 82 insurance from penalizing a provider of health care who provides the following 83 benefits that such an insurer is required to cover: (1) certain counseling and 84 screenings; (2) smoking cessation programs; (3) certain federally recommended 85 vaccinations; (4) federally recommended well-woman preventative visits; and (5) 86 care in a hospital for a prescribed length of time after a birth. (NRS 689B.03785, 87 689B.520) Sections 27 and 29 remove that prohibition, thereby authorizing such an 88 insurer to penalize a provider of health care for providing such benefits and the 89 additional benefits added by those sections. Section 104 exempts health plans for 90 retirees from local government employment from: (1) the requirements of this bill; 91 and (2) certain provisions of existing law requiring group health insurance plans to 92 provide certain coverage and prohibiting such plans from engaging in certain 93 discrimination. (NRS 689B.0314, 689B.0315, 689B.0316, 689B.0367 and 94 689B.0675) 95 Section 88 of this bill authorizes the Commissioner of Insurance to suspend or 96 revoke the certificate of a health maintenance organization that fails to provide the 97 coverage required by sections 74-78. The Commissioner would also be authorized 98 to take such action against other private health insurers who fail to provide the 99 coverage required by this bill. (NRS 680A.200) Section 103 of this bill requires 100 the Director of the Department of Health and Human Services to administer the 101 provisions of sections 109-112 in the same manner as other provisions relating to 102 Medicaid. 103 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 the provisions set forth as sections 2 to 5, inclusive, 2 of this act. 3 Sec. 2. 1. An insurer that offers or issues a policy of health 4 insurance which provides coverage for dependent children shall 5 continue to make such coverage available for an adult child of an 6 insured until such child reaches 26 years of age. 7 – 4 – - *AB522_R1* 2. Nothing in this section shall be construed as requiring an 1 insurer to make coverage available for a dependent of an adult 2 child of an insured. 3 Sec. 3. 1. An insurer that offers or issues a policy of health 4 insurance shall include in the policy coverage for: 5 (a) Screening for anxiety for insureds who are at least 8 but 6 not more than 18 years of age; 7 (b) Assessments relating to height, weight, body mass index 8 and medical history for insureds who are less than 18 years of 9 age; 10 (c) Comprehensive and intensive behavioral interventions for 11 insureds who are at least 12 but not more than 18 years of age and 12 have a body mass index in the 95th percentile or greater for 13 persons of the same age and sex; 14 (d) The application of fluoride varnish to the primary teeth for 15 insureds who are less than 5 years of age; 16 (e) Oral fluoride supplements for insureds who are at least 6 17 months of age but less than 5 years of age and whose supply of 18 water is deficient in fluoride; 19 (f) Counseling and education pertaining to the minimization of 20 exposure to ultraviolet radiation for insureds who are less than 25 21 years of age and the parents or legal guardians of insureds who 22 are less than 18 years of age for the purpose of minimizing the 23 risk of skin cancer in those persons; 24 (g) Brief behavioral counseling and interventions to prevent 25 tobacco use for insureds who are less than 18 years of age; and 26 (h) At least one screening for the detection of amblyopia or the 27 risk factors of amblyopia for insureds who are at least 3 but not 28 more than 5 years of age. 29 2. An insurer must ensure that the benefits required by 30 subsection 1 are made available to an insured through a provider 31 of health care who participates in the network plan of the insurer. 32 3. Except as otherwise provided in subsection 5, an insurer 33 that offers or issues a policy of health insurance shall not: 34 (a) Require an insured to pay a higher deductible, any 35 copayment or coinsurance or require a longer waiting period or 36 other condition to obtain any benefit provided in the policy of 37 health insurance pursuant to subsection 1; 38 (b) Refuse to issue a policy of health insurance or cancel a 39 policy of health insurance solely because the person applying for 40 or covered by the policy uses or may use any such benefit; 41 (c) Offer or pay any type of material inducement or financial 42 incentive to an insured to discourage the insured from obtaining 43 any such benefit; 44 – 5 – - *AB522_R1* (d) Penalize a provider of health care who provides any such 1 benefit to an insured, including, without limitation, reducing the 2 reimbursement of the provider of health care; 3 (e) Offer or pay any type of material inducement, bonus or 4 other financial incentive to a provider of health care to deny, 5 reduce, withhold, limit or delay access to any such benefit to an 6 insured; or 7 (f) Impose any other restrictions or delays on the access of an 8 insured to any such benefit. 9 4. A policy of health insurance subject to the provisions of 10 this chapter that is delivered, issued for delivery or renewed on or 11 after October 1, 2025, has the legal effect of including the 12 coverage required by subsection 1, and any provision of the policy 13 or the renewal which is in conflict with this section is void. 14 5. Except as otherwise provided in this section and federal 15 law, an insurer may use medical management techniques, 16 including, without limitation, any available clinical evidence, to 17 determine the frequency of or treatment relating to any benefit 18 required by this section or the type of provider of health care to 19 use for such treatment. 20 6. As used in this section: 21 (a) “Medical management technique” means a practice which 22 is used to control the cost or utilization of health care services or 23 prescription drug use. The term includes, without limitation, the 24 use of step therapy, prior authorization or categorizing drugs and 25 devices based on cost, type or method of administration. 26 (b) “Network plan” means a policy of health insurance offered 27 by an insurer under which the financing and delivery of medical 28 care, including items and services paid for as medical care, are 29 [Text truncated for display. Full text available on LegiScan.]