SB246 - Revises provisions relating to health insurance coverage for gynecological or obstetrical services. (BDR 57-205)

- 83rd Session (2025) Senate Bill No. 246–Senators Lange, Cruz-Crawford, Pazina, Taylor; Daly, Flores, Nguyen and Scheible CHAPTER.......... AN ACT relating to insurance; requiring certain health plans to authorize a woman covered by such a plan to obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician; requiring such health plans to authorize a woman covered by such a plan to designate an obstetrician or gynecologist as her primary care physician under certain circumstances; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires certain public and private health insurance plans to include a provision authorizing a woman covered by such a plan to obtain covered gynecological or obstetrical services without first receiving authorization from the insurer or a referral from her primary care physician. (NRS 287.010, 687B.225, 689A.0413, 689B.031, 695B.1914, 695C.1713) Sections 1-6, 8 and 9 of this bill apply this requirement to: (1) health plans that provide medical care to certain private-sector employees of small employers and their dependents; (2) benefit contracts issued by fraternal benefit societies; (3) managed care organizations; (4) the Public Employees’ Benefits Program; and (5) Medicaid. Sections 1.3-6, 8 and 9 require all public and private health insurance plans which are subject to this requirement to additionally authorize a woman covered by the plan to designate as her primary care physician an obstetrician or gynecologist who meets certain criteria. Section 7 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 9 in the same manner as other requirements governing Medicaid. 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, – 2 – - 83rd Session (2025) 695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 695G.1719 and 695G.177, and sections 2, 4 and 6 of this act, 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 insurer or organization 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. The procedure for prior authorization may not discriminate among persons licensed to provide the covered care. Sec. 1.3. NRS 689A.0413 is hereby amended to read as follows: 689A.0413 1. A policy of health insurance must include a provision authorizing a woman covered by the policy to [obtain] : (a) Obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician. (b) Designate as her primary care physician an obstetrician or gynecologist who: (1) Participates in the network plan of the insurer; (2) Satisfies the criteria established by the insurer for designation as a primary care provider under the policy of health insurance; and (3) Agrees to abide by all terms and conditions imposed by the insurer on other primary care physicians generally. 2. [The provisions of this section do not authorize a woman covered by a policy of health insurance to designate an obstetrician or gynecologist as her primary care physician. 3.] A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October] January 1, [1999,] 2026, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void. [4.] 3. As used in this section [, “primary] : (a) “Network plan” means a policy of health insurance offered by an insurer under which the financing and delivery of medical – 3 – - 83rd Session (2025) care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums. (b) “Primary care physician” has the meaning ascribed to it in NRS 695G.060. Sec. 1.7. NRS 689B.031 is hereby amended to read as follows: 689B.031 1. A policy of group health insurance must include a provision authorizing a woman covered by the policy to [obtain] : (a) Obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician. (b) Designate as her primary care physician an obstetrician or gynecologist who: (1) Participates in the network plan of the insurer; (2) Satisfies the criteria established by the insurer for designation as a primary care provider under the policy of group health insurance; and (3) Agrees to abide by all terms and conditions imposed by the insurer on other primary care physicians generally. 2. [The provisions of this section do not authorize a woman covered by a policy of group health insurance to designate an obstetrician or gynecologist as her primary care physician. 3.] A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October] January 1, [1999,] 2026, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void. [4.] 3. As used in this section [, “primary] : (a) “Network plan” means a policy of group health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums. (b) “Primary care physician” has the meaning ascribed to it in NRS 695G.060. Sec. 2. Chapter 689C of NRS is hereby amended by adding thereto a new section to read as follows: 1. A carrier that offers or issues a health benefit plan shall include in the plan a provision authorizing a woman covered by the plan to: – 4 – - 83rd Session (2025) (a) Obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician. (b) Designate as her primary care physician an obstetrician or gynecologist who: (1) Participates in the network plan of the carrier; (2) Satisfies the criteria established by the carrier for designation as a primary care provider under the health benefit plan; and (3) Agrees to abide by all terms and conditions imposed by the carrier on other primary care physicians generally. 2. A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage required by this section, and any provision of the plan or renewal of the plan which is in conflict with this section is void. 3. As used in this section, “primary care physician” has the meaning ascribed to it in NRS 695G.060. Sec. 3. NRS 689C.425 is hereby amended to read as follows: 689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, and section 2 of this act to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive. Sec. 4. Chapter 695A of NRS is hereby amended by adding thereto a new section to read as follows: 1. A society that offers or issues a benefit contract shall include in the contract a provision authorizing a woman covered by the plan to: (a) Obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician. (b) Designate as her primary care physician an obstetrician or gynecologist who: (1) Participates in the network plan of the society; (2) Satisfies the criteria established by the society for designation as a primary care provider under the benefit contract; and (3) Agrees to abide by all terms and conditions imposed by the society on other primary care physicians generally. 2. A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after – 5 – - 83rd Session (2025) January 1, 2026, has the legal effect of including the coverage required by this section, and any provision of the benefit contract or renewal of the benefit contract which is in conflict with this section is void. 3. As used in this section: (a) “Network plan” means a benefit contract offered by a society under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the society. The term does not include an arrangement for the financing of premiums. (b) “Primary care physician” has the meaning ascribed to it in NRS 695G.060. Sec. 4.5. NRS 695B.1914 is hereby amended to read as follows: 695B.1914 1. A contract for hospital or medical service must include a provision authorizing a woman covered by the contract to [obtain] : (a) Obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician. (b) Designate as her primary care physician an obstetrician or gynecologist who: (1) Participates in the network plan of the hospital or medical services corporation; (2) Satisfies the criteria established by the hospital or medical services corporation for designation as a primary care provider under the contract; and (3) Agrees to abide by all terms and conditions imposed by the hospital or medical services corporation on other primary care physicians generally. 2. [The provisions of this section do not authorize a woman covered by a contract for hospital or medical service to designate an obstetrician or gynecologist as her primary care physician. 3.] A contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after [October] January 1, [1999,] 2026, has the legal effect of including the coverage required by this section, and any provision of the contract or the renewal which is in conflict with this section is void. [4.] 3. As used in this section [, “primary] : (a) “Network plan” means a policy of health insurance offered by a hospital or medical services corporation under which the financing and delivery of medical care, including items and – 6 – - 83rd Session (2025) services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the hospital or medical services corporation. The term does not include an arrangement for the financing of premiums. (b) “Primary care physician” has the meaning ascribed to it in NRS 695G.060. Sec. 5. NRS 695C.050 is hereby amended to read as follows: 695C.050 1. Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a health maintenance organization authorized and regulated pursuant to this chapter. 2. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art. 3. Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS. 4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.1712, inclusive, 695C.1717 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.1759, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services. This subsection does not exempt a health maintenance organization from any provision of this chapter for services provided pursuant to any other contract. 5. The provisions of NRS 695C.16932 to 695C.1699, inclusive, 695C.1701, 695C.1708, 695C.1713, 695C.1728, 695C.1731, 695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, inclusive, 695C.1757 and 695C.204 apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid. 6. The provisions of NRS 695C.17095 do not apply to a health maintenance organization th [Text truncated for display. Full text available on LegiScan.]