SB217 - Makes revisions relating to reproductive health care. (BDR 40-24)

- 83rd Session (2025) Senate Bill No. 217–Senators Cannizzaro, Nguyen, Scheible, Pazina, Dondero Loop; Cruz-Crawford, Daly, Doñate, Flores, Lange, Neal, Ohrenschall and Taylor CHAPTER.......... AN ACT relating to health care; prohibiting a governmental entity from substantially burdening certain activity relating to assisted reproduction under certain circumstances; authorizing a person whose engagement in such activity has been so burdened to assert the violation as a claim or defense in a judicial proceeding; authorizing a court to award damages against a governmental entity that substantially burdens such activity in certain circumstances; providing certain immunity from civil and criminal liability and administrative sanctions for certain persons and entities involved in the provision of assisted reproduction; providing that a fertilized egg or human embryo that exists before implantation in a human uterus is not a person for legal purposes; requiring certain health insurers to authorize a pregnant person to enroll in a health plan during a specified period; requiring certain public and private health insurers to provide certain coverage for the treatment of infertility and fertility preservation; providing a penalty; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law prescribes certain rights for a patient of a medical facility or a facility for the dependent. (NRS 449A.100-449A.124) Sections 2-9 of this bill establish certain rights related to assisted reproduction. Sections 3-6 define certain terms relating to assisted reproduction. Section 7 applies the provisions of sections 2-9 to certain state laws and all local laws and ordinances and the implementation of those laws and ordinances, regardless of when those laws or ordinances were enacted. Section 8 generally prohibits a governmental entity from enacting or implementing any limitation or requirement that singles out assisted reproduction and substantially burdens: (1) the access of a person to assisted reproduction, any drug or device related to assisted reproduction or information related to assisted reproduction; (2) the ability of a provider of health care to provide assisted reproduction, any drug or device related to assisted reproduction or information related to assisted reproduction within his or her scope of practice, training and experience; (3) the ability of a third party to provide insurance coverage of assisted reproduction or drugs or devices related to assisted reproduction; or (4) the ability of a person to control the use or disposition of his or her reproductive genetic material. Section 8 creates an exception to such prohibitions if the governmental entity demonstrates by clear and convincing evidence that the burden, as applied to the person, provider of health care or third party who is subject to the burden: (1) furthers a compelling interest; and (2) is the least restrictive means of furthering that interest. Section 8 authorizes a person, provider of health care or third party whose ability to access, provide or cover assisted reproduction, drugs or devices related to – 2 – - 83rd Session (2025) assisted reproduction or information related to assisted reproduction, or a person whose ability to control the use or disposition of his or her reproductive genetic material, is burdened to bring or defend an action in court and obtain appropriate relief. Section 8 requires a court to award costs and attorney’s fees to a person or entity who prevails on such a claim. Section 8 additionally authorizes the Attorney General to bring an action to enjoin any limitation or requirement that violates section 8. Section 9 provides that a person or entity is not subject to civil or criminal liability or administrative sanctions solely because the person or entity provides or receives goods or services related to assisted reproduction. Section 9 also provides that the manufacturer of certain goods used to facilitate assisted reproduction is not subject to civil or criminal liability or administrative sanctions solely because of the death of or damage to an embryo. Under section 9, a person or entity is not immune from civil or criminal liability or administrative sanctions for acts or omissions that independently create liability or grounds for administrative sanctions, including, without limitation, negligence or providing services outside the scope of practice, training or experience of the person or entity. Section 10 of this bill provides that a fertilized egg or human embryo that exists before implantation in the uterus of a human body is not a human being for any purpose under Nevada law. Existing law prescribes certain requirements governing the availability of health insurance plans in this State. (NRS 687B.480, 689A.430-689A.460, 689B.300-689B.330, 695A.151-695A.157, 695B.340-695B.370, 695C.163- 695C.169, 695F.440-695F.470) Sections 12, 13, 15, 20, 24, 27-29, 32, 36, 42 and 45 of this bill require a health insurer, including public and private employers who provide insurance for their employees but excluding certain group plans, to provide a special enrollment period to a person determined by a qualified provider of health care to be pregnant, during which the pregnant person must be allowed to enroll in a health care plan outside of the period of open enrollment. Sections 38, 38.5, 45.2 and 45.6 of this bill provide that until January 1, 2027, the requirements of sections 36 and 45 to provide such a special enrollment period do not apply to Medicaid managed care plans. Section 17 of this bill provides for the enforcement of section 15, which governs private employers who provide health benefits to employees through a self-insured plan. Section 18 of this bill establishes civil and criminal penalties for a violation of section 15, which are the same as the penalties for violations of other laws governing benefits provided by private employers. Sections 21, 26, 34 and 39 of this bill make conforming changes to indicate the applicability of certain definitions to sections 20, 24, 32 and 36, respectively. Existing law requires public and private policies of health insurance regulated under Nevada law to include certain coverage. (NRS 287.010, 287.04335, 422.2717-422.272428, 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 through a self- insured plan. (NRS 608.1555) Sections 12, 23, 31, 37 and 44 of this bill require certain health care plans for groups of more than 50 employees or members, including health plans for employees of local governments, to include certain coverage for: (1) the treatment of infertility; and (2) the preservation of fertility where the insured has a medical condition or requires medical treatment that may cause infertility under certain circumstances. Sections 13.5, 14, 38.7, 45.65, 45.8, 45.9 and 47 of this bill impose similar requirements on the Public Employees’ Benefits Program and Medicaid, beginning on July 1, 2027. Sections 38 and 45.2 – 3 – - 83rd Session (2025) exempt Medicaid managed care plans from those requirements before that date. Section 16 of this bill exempts private employers who provide benefits for health care for less than 51 employees through a self-insured plan from the requirements to cover services for the treatment or preservation of fertility. Sections 12, 13.5, 14, 19, 23, 31, 37, 38.7, 44, 45.65, 45.8 and 45.9 of this bill prohibit an insurer, including Medicaid, from imposing conditions, including cost-sharing, prior authorizations and waiting periods, on infertility treatment or fertility preservation if such conditions are not required for similar benefits that are not related to fertility. Section 11 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 14 in the same manner as other provisions relating to Medicaid. Sections 25, 33 and 40 of this bill make conforming changes to clarify the applicability of provisions indicating that certain insurers are not required to cover fertility drugs. Section 43.5 of this bill defines the term “small employer” for the purpose of section 44 and other provisions governing managed care. Section 45.1 of this bill establishes the applicability of that definition, and section 45.7 of this bill removes a duplicative definition. Section 41 of this bill authorizes the Commissioner of Insurance to suspend or revoke the certificate of a health maintenance organization that fails to provide the coverage required by section 37. The Commissioner is also authorized to take such action against other health insurers who fail to provide the coverage required by sections 23 and 44. (NRS 680A.200) 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. Chapter 449A of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 9, inclusive, of this act. Sec. 2. As used in sections 2 to 9, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 6, inclusive, of this act have the meanings ascribed to them in those sections. Sec. 3. “Assisted reproduction” has the meaning ascribed to it in NRS 126.510. Sec. 4. “Gamete” has the meaning ascribed to it in NRS 126.560. Sec. 5. “Governmental entity” means the State of Nevada or any of its agencies or political subdivisions. Sec. 6. “Third party” means any insurer, governmental entity or other organization providing health coverage or benefits in accordance with state or federal law. Sec. 7. 1. Except as otherwise provided in this section, the provisions of sections 2 to 9, inclusive, of this act apply to all state and local laws and ordinances and the implementation of those – 4 – - 83rd Session (2025) laws and ordinances, whether statutory or otherwise, and whether enacted before, on or after July 1, 2025. 2. State laws that are enacted on or after July 1, 2025, are subject to the provisions of sections 2 to 9, inclusive, of this act unless the law explicitly excludes such application by reference to this section. 3. The provisions of sections 2 to 9, inclusive, of this act do not authorize a governmental entity to burden: (a) The access of any person to assisted reproduction, any drug or device related to assisted reproduction or information related to assisted reproduction; (b) The ability of a provider of health care to provide assisted reproduction or information related to assisted reproduction or to provide, administer, dispense or prescribe any drug or device related to assisted reproduction within the scope of practice, training and experience of the provider of health care; (c) The ability of a third party to provide coverage of assisted reproduction or drugs or devices related to assisted reproduction; or (d) The ability of a person to control the use or disposition of his or her gametes or other reproductive genetic material. Sec. 8. 1. Except as otherwise provided in this section, a governmental entity shall not enact or implement any limitation or requirement that: (a) Expressly, effectively, implicitly or, as implemented, singles out assisted reproduction or any drug or device related to assisted reproduction and substantially burdens: (1) The access of a person to assisted reproduction, any drug or device related to assisted reproduction or information related to assisted reproduction; (2) The ability of a provider of health care to: (I) Provide assisted reproduction or information related to assisted reproduction within the scope of practice, training and experience of the provider of health care; or (II) Provide, administer, dispense or prescribe any drug or device related to assisted reproduction within the scope of practice, training and experience of the provider of health care; or (3) The ability of a third party to provide coverage of assisted reproduction or drugs or devices related to assisted reproduction. (b) Expressly, effectively, implicitly or, as implemented, substantially burdens the ability of a person to control the use or – 5 – - 83rd Session (2025) disposition of his or her gametes or other reproductive genetic material. 2. A governmental entity may enact a requirement or limitation described in subsection 1 if the governmental entity demonstrates by clear and convincing evidence that the burden imposed by the requirement or limitation described in subsection 1, as applied to the person, provider of health care or third party who is subject to the burden: (a) Furthers a compelling interest; and (b) Is the least restrictive means of furthering that interest. 3. Notwithstanding any provision of NRS 41.0305 to 41.039, inclusive, but subject to the limitation on an award for damages set forth in NRS 41.035 when applicable, a person, provider of health care or third party who has been substantially burdened in violation of this section may assert that violation as a claim or defense in a judicial proceeding and obtain appropriate relief. A court shall award costs and attorney’s fees to a person, provider of health care or third party who prevails on such a claim or defense pursuant to this section. 4. The Attorney General may bring an action in any court of competent jurisdiction in the name of the State of Nevada on his or her own complaint or on the complaint of any person or entity to enjoin any violation or proposed violation of the provisions of this section. 5. A court may find that a person, provider of health care or third party is a vexatious litigant if the person, provider of health care or third party makes a claim within the scope of sections 2 to 9, inclusive, of this act which is without merit, fraudulent or otherwise intended to harass or annoy a person or entity. If a court finds that a person, provider of health care or third party is a vexatious litigant pursuant to this subsection, the court may deny standing to that person, provider of health care or third party to bring further claims which allege a violation of this section. Sec. 9. 1. Except as [Text truncated for display. Full text available on LegiScan.]