SB128 - Makes changes related to health care. (BDR 57-87)

- 83rd Session (2025) Senate Bill No. 128–Senator Neal CHAPTER.......... AN ACT relating to health care; prescribing requirements governing the denial of requests for prior authorization; making certain legislative findings and declarations; encouraging licensed physicians, physician assistants, advanced practice registered nurses and osteopathic physicians to discuss with patients in certain circumstances information relating to stem cell treatment, storage and donation; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law authorizes certain health insurers to require an insured to obtain prior authorization from the insurer before receiving certain care. (NRS 687B.225) Sections 1, 4 and 5 of this bill prohibit certain health insurers, including insurance for public employees, from solely using, employing or relying upon an artificial intelligence system or an automated decision tool to: (1) deny a request for prior authorization for medical or dental care; (2) modify a request for prior authorization for such care submitted by a provider of health care; (3) reduce the scope of services or amount of coverage for such care that is included within a request for prior authorization; or (4) terminate, reduce or modify coverage for previously approved medical or dental care. Sections 1, 4 and 5 also require such health insurers to approve a request for prior authorization for medical or dental care that is covered by the insurer, unless a licensed health care professional with the education, training and expertise necessary to evaluate the condition at issue determines that the care requested is not medically necessary or is experimental or investigational. Sections 6 and 7 of this bill make conforming changes to clarify that certain provisions generally applicable to members of plans of self-insurance for employees of local governments and are applicable to the provisions of sections 4 and 5, respectively. Existing law requires a physician, physician assistant, advanced practice registered nurse or an osteopathic physician to counsel and provide certain information to a patient who is diagnosed with certain conditions. (NRS 630.3737, 632.2383, 633.6947) Sections 9-11 of this bill make certain legislative findings and declarations relating to the use of stem cell therapy, including a declaration encouraging physicians, physician assistants, advanced practice registered nurses and osteopathic physicians to: (1) discuss with a patient, upon diagnosing the patient with arthritis, osteoarthritis or any other condition that is regularly treated using stem cell therapy, the potential use of stem cell therapy to treat the condition; and (2) when acting as providers of primary care during the first encounter with a new patient, inform the patient of options that may be available to the patient for donating, banking or storing stem cells for future use by the patient or a donee. – 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, 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] in a manner consistent with the provisions of this section. 2. An insurer or organization that requires an insured or member to obtain prior authorization for medical or dental care 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.] 3. The procedure for prior authorization may not discriminate among persons licensed to provide the covered care. 4. Except as otherwise provided in subsection 6, an insurer or organization that requires an insured or member to obtain prior authorization for medical or dental care: (a) Shall not solely utilize, employ or rely upon an artificial intelligence system or automated decision tool to: (1) Deny a request for prior authorization for medical or dental care; – 3 – - 83rd Session (2025) (2) Modify a request for medical or dental care submitted by a provider of health care; (3) Reduce the scope of services or the amount of coverage for medical or dental care included within a request for prior authorization; or (4) Terminate, reduce or modify coverage for previously approved medical or dental care. (b) Shall approve, without modification, a request for prior authorization submitted by an insured or member, or by a provider of health care acting within the scope of his or her practice on behalf of an insured or member, for medical or dental care that is covered by the insurer or organization, unless a licensed health care professional who possesses the education, training and expertise necessary to evaluate the specific clinical issues relevant to the request for prior authorization determines that the care requested is not medically necessary or is experimental or investigational after reviewing all available medical documentation, notes of the insured’s or member’s provider of health care, test results and other relevant medical records of the insured or member. 5. The provisions of subsection 4 do not: (a) Prohibit an insurer or organization from utilizing an artificial intelligence system or automated decision tool to automatically approve a request for prior authorization. (b) Affect the obligation of any entity to which the requirements of NRS 695G.150 apply to comply with such requirements. 6. The requirements of subsection 4 do not apply to a managed care organization when providing coverage for recipients of Medicaid or pursuant to the Children’s Health Insurance Program pursuant to a contract with the Department of Health and Human Services entered into pursuant to NRS 422.273. 7. As used in this section: (a) “Artificial intelligence system” means a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations or decisions influencing real or virtual environments. (b) “Automated decision tool” means a computational process derived from machine learning, statistical modeling, data analytics or artificial intelligence that, for any number of inputs, is designed to produce a simple output or recommendation, including, without – 4 – - 83rd Session (2025) limitation, a score, classification or recommendation, that is used to assist or replace human decision-making. (c) “Healing art” means any system, treatment, operation, diagnosis, prescription or practice for the ascertainment, cure, relief, palliation, adjustment or correction of any human disease, ailment, deformity, injury, or unhealthy or abnormal physical or mental condition for the practice of which long periods of specialized education and training and a degree of specialized knowledge of an intellectual and physical nature are required. (d) “Licensed health care professional” means a person who is licensed in any state or territory of the United States to perform any healing art. (e) “Medical or dental care” includes, without limitation, the provision of prescription drugs. (f) “Medically necessary” has the meaning ascribed to it in NRS 695G.055. (g) “Provider of health care” has the meaning ascribed to it in NRS 695G.070. Sec. 2. (Deleted by amendment.) Sec. 3. Chapter 287 of NRS is hereby amended by adding thereto the provisions set forth as sections 4 and 5 of this act. Sec. 4. 1. The governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada that provides health insurance through a plan of self-insurance: (a) Shall not solely utilize, employ or rely upon an artificial intelligence system or automated decision tool to: (1) Deny a request for prior authorization for medical or dental care; (2) Modify a request for medical or dental care submitted by a provider of health care; (3) Reduce the scope of services or the amount of coverage for medical or dental care included within a request for prior authorization; or (4) Terminate, reduce or modify coverage for previously approved medical or dental care. (b) Shall approve, without modification, a request for prior authorization submitted by an insured, or by a provider of health care acting within the scope of his or her practice on behalf of an insured, for medical or dental care that is covered by the plan of self-insurance, unless a licensed health care professional who possesses the education, training and expertise necessary to – 5 – - 83rd Session (2025) evaluate the specific clinical issues relevant to the request for prior authorization determines that the care requested is not medically necessary or is experimental or investigational after reviewing all available medical documentation, notes of the insured’s provider of health care, test results and other relevant medical records of the insured. 2. The provisions of subsection 1 do not prohibit a governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada that provides health insurance through a plan of self-insurance from utilizing an artificial intelligence system or automated decision tool to automatically approve a request for prior authorization. 3. As used in this section: (a) “Artificial intelligence system” has the meaning ascribed to it in NRS 687B.225. (b) “Automated decision tool” has the meaning ascribed to it in NRS 687B.225. (c) “Licensed health care professional” has the meaning ascribed to it in NRS 687B.225. (d) “Medical or dental care” has the meaning ascribed to it in NRS 687B.225. (e) “Medically necessary” has the meaning ascribed to it in NRS 695G.055. (f) “Provider of health care” has the meaning ascribed to it in NRS 695G.070. Sec. 5. 1. If the Board provides health insurance through a plan of self-insurance, the Board: (a) Shall not solely utilize, employ or rely upon an artificial intelligence system or automated decision tool to: (1) Deny a request for prior authorization for medical or dental care; (2) Modify a request for medical or dental care submitted by a provider of health care; (3) Reduce the scope of services or the amount of coverage for medical or dental care included within a request for prior authorization; or (4) Terminate, reduce or modify coverage for previously approved medical or dental care. (b) Shall approve, without modification, a request for prior authorization submitted by an insured, or by a provider of health care acting within the scope of his or her practice on behalf of an insured, for medical or dental care that is covered by the plan of – 6 – - 83rd Session (2025) self-insurance, unless a licensed health care professional who possesses the education, training and expertise necessary to evaluate the specific clinical issues relevant to the request for prior authorization determines that the care requested is not medically necessary or is experimental or investigational after reviewing all available medical documentation, notes of the insured’s provider of health care, test results and other relevant medical records of the insured. 2. The provisions of subsection 1 do not: (a) Prohibit the Board from utilizing an artificial intelligence system or automated decision tool to automatically approve a request for prior authorization. (b) Affect the obligation of the Board to comply with the requirements of NRS 695G.150. 3. As used in this section: (a) “Artificial intelligence system” has the meaning ascribed to it in NRS 687B.225. (b) “Automated decision tool” has the meaning ascribed to it in NRS 687B.225. (c) “Licensed health care professional” has the meaning ascribed to it in NRS 687B.225. (d) “Medical or dental care” has the meaning ascribed to it in NRS 687B.225. (e) “Medically necessary” has the meaning ascribed to it in NRS 695G.055. (f) “Provider of health care” has the meaning ascribed to it in NRS 695G.070. Sec. 6. NRS 287.040 is hereby amended to read as follows: 287.040 The provisions of NRS 287.010 to 287.040, inclusive, and section 4 of this act do not make it compulsory upon any governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada, except as otherwise provided in NRS 287.021 or subsection 4 of NRS 287.023 or in an agreement entered into pursuant to subsection 3 of NRS 287.015, to pay any premiums, contributions or other costs for group insurance, a plan of benefits or medical or hospital services established pursuant to NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or (d) of subsection 1 of NRS 287.025, for coverage under the Public Employees’ Benefits Program, or to make any contributions to a trust fund established pursuant to NRS 287.017, or upon any officer or employee of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental – 7 – - 83rd Session (2025) agency of this State to accept any such coverage or to assign his or her wages or salary in p [Text truncated for display. 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