SB47 - Provides for a study of certain issues relating to insurance. (BDR 57-405)

EXEMPT (Reprinted with amendments adopted on April 16, 2025) FIRST REPRINT S.B. 47 - *SB47_R1* SENATE BILL NO. 47–COMMITTEE ON COMMERCE AND LABOR (ON BEHALF OF THE WASHOE REGIONAL BEHAVIORAL HEALTH POLICY BOARD) PREFILED NOVEMBER 19, 2024 ____________ Referred to Committee on Commerce and Labor SUMMARY—Provides for a study of certain issues relating to insurance. (BDR 57-405) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to insurance; providing for a study of certain issues relating to coverage for behavioral health care; requiring the submission of certain information for the purposes of that study; providing for the confidentiality of such information; and providing other matters properly relating thereto. Legislative Counsel’s Digest: The federal Paul Wellstone and Pete Domenici Mental Health Parity and 1 Addiction Equity Act of 2008 prohibits certain health insurers from imposing terms 2 on benefits for mental health or substance use disorder that are less favorable than 3 the terms imposed on medical and surgical benefits. (42 U.S.C. § 300gg-26) 4 Existing state law requires certain health insurers to: (1) comply with the Act; and 5 (2) provide to the Commissioner of Insurance certain data necessary to evaluate 6 compliance with the Act. (NRS 687B.404) 7 Section 7 of this bill requires the Commissioner to apply for gifts, grants and 8 donations to support a study of the degree to which public and private insurance 9 plans in this State achieve parity between coverage for behavioral health care and 10 coverage for other medical care. To the extent that the Commissioner obtains 11 sufficient money, section 7 requires the Commissioner to enter into a contract with 12 a qualified person or entity to conduct the study. Section 8 of this bill requires 13 public and private health insurers in this State and certain other persons or entities 14 to submit data to the Commissioner or the contractor as necessary to conduct the 15 study. Section 9 of this bill authorizes the Commissioner to issue a subpoena for 16 the production of such data if a person or entity fails to comply with section 8. 17 Sections 8 and 11 of this bill provide for the confidentiality of any personally 18 identifiable information, proprietary financial information, trade secret or other 19 – 2 – - *SB47_R1* confidential information that is submitted to the Commissioner pursuant to section 20 8. Section 10 of this bill requires: (1) the Commissioner to submit an annual report 21 to the Legislature concerning the progress of the efforts to fund and conduct the 22 study; and (2) the contractor who conducts the study to report the results to the 23 Commissioner, the Governor and the Legislature upon completion of the study. 24 Sections 3-6 of this bill define certain terms used in sections 3-10. Section 2 of this 25 bill establishes the applicability of those definitions. 26 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 679B of NRS is hereby amended by adding 1 thereto the provisions set forth as sections 2 to 10, inclusive, of this 2 act. 3 Sec. 2. As used in sections 2 to 10, inclusive, of this act, 4 unless the context otherwise requires, the words and terms defined 5 in sections 3 to 6, inclusive, of this act have the meanings ascribed 6 to them in those sections. 7 Sec. 3. “Behavioral health care” means care for a mental 8 illness, other mental health condition, intellectual disability, 9 developmental disability or substance use disorder. 10 Sec. 4. “Developmental disability” has the meaning ascribed 11 to it in NRS 435.007. 12 Sec. 5. “Health insurer” means any insurer, governmental 13 entity or other organization providing health coverage or benefits 14 in accordance with state or federal law. 15 Sec. 6. “Intellectual disability” has the meaning ascribed to 16 it in NRS 435.007. 17 Sec. 7. 1. The Commissioner shall: 18 (a) Apply for gifts, grants and donations to support the study 19 described in paragraph (b); and 20 (b) To the extent money is available pursuant to paragraph (a), 21 enter into a contract with a qualified person or entity to study the 22 degree to which public and private insurance plans in this State 23 achieve parity between: 24 (1) Coverage for behavioral health care; and 25 (2) Coverage for other medical care. 26 2. The Commissioner may collaborate or enter into a contract 27 with any person or entity to assist in applying for gifts, grants and 28 donations pursuant to paragraph (a) of subsection 1. 29 3. The Commissioner and the person or entity with whom the 30 Commissioner enters into a contract pursuant to subsection 1 may 31 enter into a contract or otherwise collaborate with a non-profit 32 organization that specializes in data analytics relating to health 33 – 3 – - *SB47_R1* insurance as necessary to conduct the study pursuant to 1 subsection 1. 2 4. The study conducted pursuant to subsection 1 must 3 include, without limitation: 4 (a) An analysis of the degree to which health insurers in this 5 State comply with the Paul Wellstone and Pete Domenici Mental 6 Health Parity and Addiction Equity Act of 2008, Public Law 110- 7 343, Division C, Title V, Subtitle B; 8 (b) A comparison of the terms under which health insurers in 9 this State cover behavioral health care to the terms under which 10 such health insurers cover other forms of medical care, including, 11 without limitation: 12 (1) The adequacy of networks; 13 (2) Rates of reimbursement; 14 (3) Incentives offered by insurers to providers of health 15 care; 16 (4) Rates of denial of coverage; 17 (5) Prior authorization; and 18 (6) Step therapy; and 19 (c) An investigation into: 20 (1) The adequacy of the workforce providing behavioral 21 health care in this State; 22 (2) The potential and, if applicable, actual outcomes of 23 having an inadequate workforce providing behavioral health care, 24 including, without limitation: 25 (I) Increased rates of substance use disorder, suicidal 26 ideation and suicide; and 27 (II) Direct and indirect monetary costs to the State 28 Government, local governments and other persons and entities in 29 this State; 30 (3) The emergency and inpatient care provided to treat 31 behavioral health conditions or related health conditions that are 32 preventable or better treated in an outpatient setting; 33 (4) Rates of unemployment or loss of personal income 34 related to persons suffering from behavioral health conditions; 35 and 36 (5) The cost to the State of claims for disability due to 37 behavioral health conditions. 38 5. The study conducted pursuant to subsection 1 may include 39 a market survey that compares any or all of the metrics described 40 in subsection 4 to the same metrics in other states. If conducted, 41 the market survey must include, without limitation: 42 (a) A comparison to metrics in states that have achieved 43 greater parity between coverage for behavioral health care and 44 coverage for other medical care; and 45 – 4 – - *SB47_R1* (b) Consideration for the limited pool of health insurers in this 1 State. 2 6. As used in this section, “network” means a defined set of 3 providers of health care who are under contract with a health 4 insurer to provide health care services. 5 Sec. 8. 1. Notwithstanding any other provision of law and 6 except as otherwise provided in subsection 2, upon a request made 7 to obtain information for the purposes of the study conducted 8 pursuant to section 7 of this act, the following persons and entities 9 shall submit information to the Commissioner or the person or 10 entity with whom the Commissioner enters into a contract 11 pursuant to subsection 1 of section 7 of this act: 12 (a) Health insurers that offer or issue policies of health 13 insurance in this State, including, without limitation, the Public 14 Employees’ Benefits Program; 15 (b) Except where federal law prohibits the Commissioner from 16 requiring the submission of such information, a self-funded 17 multiple employer welfare arrangement that: 18 (1) Has been issued a certificate of authority by the 19 Commissioner; and 20 (2) Provides health coverage or benefits to residents of this 21 State; 22 (c) The Department of Health and Human Services and each 23 division and office thereof; 24 (d) The Division; and 25 (e) Any public body established by the Commissioner. 26 2. Except as otherwise provided in paragraph (b) of 27 subsection 1, a provider of health coverage for federal employees, 28 a provider of health coverage that is subject to the Employee 29 Retirement Income Security Act of 1974 or the administrator of a 30 Taft-Hartley trust formed pursuant to 29 U.S.C. § 186(c)(5) is not 31 required to but may submit information to the Commissioner or 32 the person or entity with whom the Commissioner enters into a 33 contract pursuant to subsection 1 of section 7 of this act for the 34 purposes of the study conducted pursuant to that section. 35 3. The Commissioner or the person or entity with whom the 36 Commissioner enters into a contract pursuant to subsection 1 of 37 section 7 of this act may submit a request pursuant to NRS 38 439B.850 to obtain data from the all-payer claims database 39 established pursuant to NRS 439B.835, including, without 40 limitation, data that has not been de-identified or that includes 41 proprietary financial information. The Department of Health and 42 Human Services shall release such data upon the submission of 43 such a request. The Commissioner and the person or entity shall 44 – 5 – - *SB47_R1* comply with the provisions of subsection 4 of this section and 1 subsection 5 of NRS 439B.855 with respect to any such data. 2 4. Any personally identifiable information, proprietary 3 financial information, trade secret or information deemed 4 confidential by law that is provided pursuant to this section to the 5 Commissioner or any person or entity with whom the 6 Commissioner enters into a contract is confidential. Such 7 information must not be included in a report compiled pursuant to 8 section 10 of this act or otherwise disclosed to any other person or 9 entity. 10 5. As used in this section, “multiple employer welfare 11 arrangement” has the meaning ascribed to it in 29 U.S.C. § 12 1002(40). 13 Sec. 9. 1. If a person or entity fails to comply with the 14 provisions of subsection 1 or 3 of section 8 of this act, the 15 Commissioner may issue a subpoena to compel the person or 16 entity to comply with those requirements. 17 2. A subpoena issued pursuant to this section shall have the 18 same force and effect and shall be served in the same manner as if 19 issued from a court of record. 20 3. If any person or entity fails to obey a subpoena issued 21 pursuant to this section, the Commissioner may file a written 22 report thereof and proof of service of the subpoena in any court of 23 competent jurisdiction, for such action as the court may 24 determine. 25 Sec. 10. 1. On or before January 31 of each year, the 26 Commissioner shall: 27 (a) Compile a report describing the progress made toward the 28 objectives described in subsection 1 of section 7 of this act during 29 the immediately preceding calendar year; and 30 (b) Submit the report to the Director of the Legislative Counsel 31 Bureau for transmittal to: 32 (1) In an odd-numbered year, the next regular session of 33 the Legislature; and 34 (2) In an even-numbered year, the Joint Interim Standing 35 Committee on Health and Human Services. 36 2. Upon completion of the study conducted pursuant to 37 section 7 of this act, the person or entity with whom the 38 Commissioner enters into a contract pursuant subsection 1 of that 39 section shall compile and submit to the Commissioner, the 40 Governor and the Director of the Legislative Counsel Bureau for 41 transmittal to the Legislature a report that includes, without 42 limitation: 43 (a) The results of the study; 44 – 6 – - *SB47_R1* (b) Recommendations to improve the reporting of data by 1 health insurers and the analysis of such data to ensure compliance 2 with the Paul Wellstone and Pete Domenici Mental Health Parity 3 and Addiction Equity Act of 2008, Public Law 110-343, Division 4 C, Title V, Subtitle B; 5 (c) Recommendations for policies to improve the degree to 6 which public and private insurance plans in this State achieve 7 parity between: 8 (1) Coverage for behavioral health care; and 9 (2) Coverage for other medical care; 10 (d) Recommendations for improving the development and 11 retention of the workforce providing behavioral health care in this 12 State; and 13 (e) Recommendations for policies to increase access to 14 behavioral health care in this State. 15 Sec. 11. NRS 239.010 is hereby amended to read as follows: 16 239.010 1. Except as otherwise provided in this section and 17 NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 18 49.293, 62D.420, 62D.440, 62E.516, 62E.620, 62H.025, 62H.030, 19 62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 20 80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 21 87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 22 88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A.270, 23 116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 24 119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 25 120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 26 127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 27 130.712, 136.050, 159.044, 159A.044, 164.041, 172.075, 172.245, 28 176.01334, 176.01385, 176.015, 176.0625, 176.09129, 176.156, 29 176A.630, 178.39801, 178.4715, 178.5691, 178.5717, 179.495, 30 179A.070, 179A.165, 179D.160, 180.600, 200.3771, 200.3772, 31 200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 32 209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 33 213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 34 218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 218G.615, 35 224.240, 226.462, 226.796, 228.270, 228.450, 228 [Text truncated for display. 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