SB344 - Requires certain health insurance to cover certain screenings for certain genetic disorders. (BDR 57-1104)

- 83rd Session (2025) Senate Bill No. 344–Senators Cannizzaro, Nguyen, Pazina, Scheible, Dondero Loop; Cruz-Crawford, Daly, Doñate, Flores, Lange and Taylor CHAPTER.......... AN ACT relating to insurance; requiring certain health insurance to cover certain screenings for genetic disorders in a fetus or the parents of a fetus; making an appropriation; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires certain public and private insurers, including Medicaid and health plans for public and private employees, to provide coverage for medically necessary biomarker testing for the diagnosis, treatment, appropriate management and ongoing monitoring of cancer when such biomarker testing is supported by medical and scientific evidence. (NRS 287.010, 287.04335, 422.272364, 608.1555, 689A.0446, 689B.0361, 689C.1688, 689C.425, 695A.1859, 695B.19087, 695C.050, 695C.16932, 695G.1703) Existing law also requires such health insurance to cover the examination of a pregnant woman for the discovery of certain sexually transmitted diseases. (NRS 287.010, 287.04335, 422.27173, 608.1555, 689A.0412, 689B.0315, 689C.1675, 689C.925, 695A.1856, 695B.1913, 695C.050, 695C.1737, 695G.1714) Sections 4-10, 12 and 14-16 of this bill require such insurers that issue group health care plans, as well as fraternal benefit societies and Medicaid, to cover certain screenings of the blood of a person who is pregnant to detect chromosomal abnormalities in the fetus. Sections 1, 4-10, 12 and 14-16 prohibit such insurers from requiring prior authorization for such screenings. Section 11 of this bill authorizes the Commissioner to suspend or revoke the certificate of a health maintenance organization that fails to comply with the requirements of section 9. The Commissioner would also be authorized to take such action against other private health insurers who fail to comply with the requirements of section 4-8, 10 or 12. (NRS 680A.200) Section 13 of this bill requires the Director of the Department of Health and Human Services to administer the provisions of section 16 in the same manner as the provisions of existing law governing Medicaid. Section 16.5 of this bill makes an appropriation to the Division of Health Care Financing and Policy of the Department of Health and Human Services for the costs associated with the Medicaid coverage required by section 16. 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, – 2 – - 83rd Session (2025) 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, and sections 4, 5, 7, 8, 9 and 12 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. Secs. 2 and 3. (Deleted by amendment.) Sec. 4. Chapter 689B of NRS is hereby amended by adding thereto a new section to read as follows: 1. An insurer that offers or issues a policy of group health insurance shall include in the policy coverage for noninvasive prenatal screening at any time during pregnancy. Such coverage must be provided without prior authorization. 2. A policy of group health insurance 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 subsection 1, and any provision of the policy that conflicts with the provisions of this section is void. 3. As used in this section, “noninvasive prenatal screening” means drawing blood from a person who is pregnant to perform laboratory analysis on the deoxyribonucleic acid circulating in the maternal blood stream for the purpose of detecting chromosomal abnormalities in the fetus. – 3 – - 83rd Session (2025) Sec. 5. 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 coverage for noninvasive prenatal screening at any time during pregnancy. Such coverage must be provided without prior authorization. 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 subsection 1, and any provision of the plan that conflicts with the provisions of this section is void. 3. As used in this section, “noninvasive prenatal screening” means drawing blood from a person who is pregnant to perform laboratory analysis on the deoxyribonucleic acid circulating in the maternal blood stream for the purpose of detecting chromosomal abnormalities in the fetus. Sec. 6. 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 5 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. 7. 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 coverage for noninvasive prenatal screening at any time during pregnancy. Such coverage must be provided without prior authorization. 2. A benefit contract 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 subsection 1, and any provision of the contract that conflicts with the provisions of this section is void. 3. As used in this section, “noninvasive prenatal screening” means drawing blood from a person who is pregnant to perform laboratory analysis on the deoxyribonucleic acid circulating in the maternal blood stream for the purpose of detecting chromosomal abnormalities in the fetus. Sec. 8. Chapter 695B of NRS is hereby amended by adding thereto a new section to read as follows: 1. A hospital or medical services corporation that offers or issues a policy of group health insurance shall include in the – 4 – - 83rd Session (2025) policy coverage for noninvasive prenatal screening at any time during pregnancy. Such coverage must be provided without prior authorization. 2. A policy of group health insurance 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 subsection 1, and any provision of the policy that conflicts with the provisions of this section is void. 3. As used in this section, “noninvasive prenatal screening” means drawing blood from a person who is pregnant to perform laboratory analysis on the deoxyribonucleic acid circulating in the maternal blood stream for the purpose of detecting chromosomal abnormalities in the fetus. Sec. 9. Chapter 695C of NRS is hereby amended by adding thereto a new section to read as follows: 1. A health maintenance organization that offers or issues a group health care plan or a plan that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid shall include in the plan coverage for noninvasive prenatal screening at any time during pregnancy. Such coverage must be provided without prior authorization. 2. A health care plan subject to the provisions of this section that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void. 3. As used in this section, “noninvasive prenatal screening” means drawing blood from a person who is pregnant to perform laboratory analysis on the deoxyribonucleic acid circulating in the maternal blood stream for the purpose of detecting chromosomal abnormalities in the fetus. Sec. 10. 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, – 5 – - 83rd Session (2025) 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.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.1728, 695C.1731, 695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745, inclusive, and section 9 of this act, 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 that provides health care services to members of the Public Employees’ Benefits Program. This subsection does not exempt a health maintenance organization from any provision of this chapter for services provided pursuant to any other contract. 7. The provisions of NRS 695C.1735 do not apply to a health maintenance organization that provides health care services to: (a) The officers and employees, and the dependents of officers and employees, of the governing body of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of this State; or (b) Members of the Public Employees’ Benefits Program.  This subsection does not exempt a health maintenance organization from any provision of this chapter for services provided pursuant to any other contract. – 6 – - 83rd Session (2025) Sec. 11. NRS 695C.330 is hereby amended to read as follows: 695C.330 1. The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuant to the provisions of this chapter if the Commissioner finds that any of the following conditions exist: (a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner; (b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of NRS 695C.1691 to 695C.200, inclusive, and section 9 of this act, 695C.204 or 695C.207; (c) The health care plan does not furnish comprehensive health care services as provided for in NRS 695C.060; (d) The Commissioner certifies that the health maintenance organization: (1) Does not meet the requirements of subsection 1 of NRS 695C.080; or (2) Is unable to fulfill its obligations to furnish health care services as required under its health care plan; (e) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees; (f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to participate in matters relating to the content of programs pursuant to NRS 695C.110; (g) The health maintenance organization has failed to put into effect the system required by NRS 695C.260 for: (1) Resolving complaints in a manner reasonably to dispose of valid complaints; [Text truncated for display. 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