SB377 - Establishes provisions relating to health insurance. (BDR 57-1083)

S.B. 377 - *SB377* SENATE BILL NO. 377–SENATOR STEINBECK MARCH 17, 2025 ____________ Referred to Committee on Commerce and Labor SUMMARY—Establishes provisions relating to health insurance. (BDR 57-1083) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. CONTAINS UNFUNDED MANDATE (§ 13) (NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT) ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to insurance; requiring certain policies of health insurance to include coverage for certain alternatives to opioids; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires public and private policies of insurance regulated under 1 Nevada law and employers who provide such insurance for their employees to 2 include coverage for drugs to: (1) support safe withdrawal from substance use 3 disorder; and (2) provide medication-assisted treatment for opioid use disorder. 4 (NRS 287.010, 287.04335, 422.4025, 608.1555, 689A.0459, 689B.0319, 5 689C.1665, 695A.1874, 695B.19197, 695C.050, 695C.1699, 695G.1719) Sections 6 2, 4-10 and 12-15 of this bill require certain public and private policies of health 7 insurance to cover drugs that are alternatives to opioids for purposes for which 8 opioids are commonly used. Sections 1, 2, 4-10, 12-14 and 16 of this bill: (1) 9 prohibit certain insurers from imposing certain other conditions on covered opioid 10 alternatives that are not imposed on opioids; and (2) require such an insurer to 11 exempt an insured from medical management techniques that would otherwise 12 apply to an alternative to an opioid if the provider of health care prescribing or 13 administering the alternative confirms that the alternative is an appropriate 14 treatment for the patient. Section 3 of this bill authorizes the Commissioner of 15 Insurance to require certain policies of health insurance issued by a domestic 16 insurer to a person who resides in another state to include the coverage required by 17 section 2. Section 11 of this bill authorizes the Commissioner to suspend or revoke 18 the certification of a health maintenance organization that fails to comply with the 19 requirements of section 9. The Commissioner would also be authorized to take 20 such actions against other health insurers who fail to comply with the requirements 21 of sections 2, 4-10 and 12. (NRS 680A.200) 22 – 2 – - *SB377* 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 1 follows: 2 687B.225 1. Except as otherwise provided in NRS 3 689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 4 689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 5 689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374, 6 689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 7 695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 8 695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 9 695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 10 695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751, 11 695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 12 695G.1719 and 695G.177, and sections 2, 4, 5, 7, 8, 9 and 12 of 13 this act, any contract for group, blanket or individual health 14 insurance or any contract by a nonprofit hospital, medical or dental 15 service corporation or organization for dental care which provides 16 for payment of a certain part of medical or dental care may require 17 the insured or member to obtain prior authorization for that care 18 from the insurer or organization. The insurer or organization shall: 19 (a) File its procedure for obtaining approval of care pursuant to 20 this section for approval by the Commissioner; and 21 (b) Unless a shorter time period is prescribed by a specific 22 statute, including, without limitation, NRS 689A.0446, 689B.0361, 23 689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, 24 respond to any request for approval by the insured or member 25 pursuant to this section within 20 days after it receives the request. 26 2. The procedure for prior authorization may not discriminate 27 among persons licensed to provide the covered care. 28 Sec. 2. Chapter 689A of NRS is hereby amended by adding 29 thereto a new section to read as follows: 30 1. An insurer that offers or issues a policy of health 31 insurance shall include in the policy coverage for at least one 32 alternative to an opioid that is effective for each purpose for 33 which: 34 (a) An opioid is commonly used; and 35 (b) A non-opioid alternative is available. 36 2. An insurer shall not: 37 (a) Require prior authorization for an alternative to an opioid 38 if prior authorization would not be required for an opioid under 39 the same circumstances; or 40 – 3 – - *SB377* (b) Impose other requirements on an alternative to an opioid 1 that would not be imposed on an opioid used under the same 2 circumstances. 3 3. An insurer shall exempt an insured from any medical 4 management techniques that would otherwise apply to the benefits 5 described in subsection 1 if the provider of health care who 6 prescribes or administers an alternative to an opioid confirms that, 7 in the professional judgment of the provider of health care, the 8 alternative to an opioid is appropriate for the treatment of the 9 patient. 10 4. A policy of health insurance subject to the provisions of 11 this chapter that is delivered, issued for delivery or renewed on or 12 after January 1, 2026, has the legal effect of including the 13 coverage required by subsection 1, and any provision of the policy 14 that conflict with the provisions of this section is void. 15 5. As used in this section: 16 (a) “Medical management technique” means a practice which 17 is used to control the cost or utilization of health care services or 18 prescription drug use. The term includes, without limitation, the 19 use of step therapy, prior authorization or categorizing drugs and 20 devices based on cost, type or method of administration. 21 (b) “Provider of health care” has the meaning ascribed to it in 22 NRS 629.031. 23 Sec. 3. NRS 689A.330 is hereby amended to read as follows: 24 689A.330 If any policy is issued by a domestic insurer for 25 delivery to a person residing in another state, and if the insurance 26 commissioner or corresponding public officer of that other state has 27 informed the Commissioner that the policy is not subject to approval 28 or disapproval by that officer, the Commissioner may by ruling 29 require that the policy meet the standards set forth in NRS 689A.030 30 to 689A.320, inclusive [.] , and section 2 of this act. 31 Sec. 4. Chapter 689B of NRS is hereby amended by adding 32 thereto a new section to read as follows: 33 1. An insurer that offers or issues a policy of group health 34 insurance shall include in the policy coverage for at least one 35 alternative to an opioid that is effective for each purpose for 36 which: 37 (a) An opioid is commonly used; and 38 (b) A non-opioid alternative is available. 39 2. An insurer shall not: 40 (a) Require prior authorization for an alternative to an opioid 41 if prior authorization would not be required for an opioid under 42 the same circumstances; or 43 – 4 – - *SB377* (b) Impose other requirements on an alternative to an opioid 1 that would not be imposed on an opioid used under the same 2 circumstances. 3 3. An insurer shall exempt an insured from any medical 4 management techniques that would otherwise apply to the benefits 5 described in subsection 1 if the provider of health care who 6 prescribes or administers an alternative to an opioid confirms that, 7 in the professional judgment of the provider of health care, the 8 alternative to an opioid is appropriate for the treatment of the 9 patient. 10 4. A policy of group health insurance subject to the 11 provisions of this chapter that is delivered, issued for delivery or 12 renewed on or after January 1, 2026, has the legal effect of 13 including the coverage required by subsection 1, and any 14 provisions of the policy that conflict with the provisions of this 15 section is void. 16 5. As used in this section: 17 (a) “Medical management technique” means a practice which 18 is used to control the cost or utilization of health care services or 19 prescription drug use. The term includes, without limitation, the 20 use of step therapy, prior authorization or categorizing drugs and 21 devices based on cost, type or method of administration. 22 (b) “Provider of health care” has the meaning ascribed to it in 23 NRS 629.031. 24 Sec. 5. Chapter 689C of NRS is hereby amended by adding 25 thereto a new section to read as follows: 26 1. A carrier that offers or issues a health benefit plan shall 27 include in the plan coverage for at least one alternative to an 28 opioid that is effective for each purpose for which: 29 (a) An opioid is commonly used; and 30 (b) A non-opioid alternative is available. 31 2. A carrier shall not: 32 (a) Require prior authorization for an alternative to an opioid 33 if prior authorization would not be required for an opioid under 34 the same circumstances; or 35 (b) Impose other requirements on an alternative to an opioid 36 that would not be imposed on an opioid used under the same 37 circumstances. 38 3. A carrier shall exempt an insured from any medical 39 management techniques that would otherwise apply to the benefits 40 described in subsection 1 if the provider of health care who 41 prescribes or administers an alternative to an opioid confirms that, 42 in the professional judgment of the provider of health care, the 43 alternative to an opioid is appropriate for the treatment of the 44 patient. 45 – 5 – - *SB377* 4. A health benefit plan subject to the provisions of this 1 chapter that is delivered, issued for delivery or renewed on or after 2 January 1, 2026, has the legal effect of including the coverage 3 required by subsection 1, and any provisions of the plan that 4 conflict with the provisions of this section is void. 5 5. As used in this section: 6 (a) “Medical management technique” means a practice which 7 is used to control the cost or utilization of health care services or 8 prescription drug use. The term includes, without limitation, the 9 use of step therapy, prior authorization or categorizing drugs and 10 devices based on cost, type or method of administration. 11 (b) “Provider of health care” has the meaning ascribed to it in 12 NRS 629.031. 13 Sec. 6. NRS 689C.425 is hereby amended to read as follows: 14 689C.425 A voluntary purchasing group and any contract 15 issued to such a group pursuant to NRS 689C.360 to 689C.600, 16 inclusive, are subject to the provisions of NRS 689C.015 to 17 689C.355, inclusive, and section 5 of this act, to the extent 18 applicable and not in conflict with the express provisions of NRS 19 687B.408 and 689C.360 to 689C.600, inclusive. 20 Sec. 7. Chapter 695A of NRS is hereby amended by adding 21 thereto a new section to read as follows: 22 1. A society that offers or issues a benefit contract shall 23 include in the contract coverage for at least one alternative to an 24 opioid that is effective for each purpose for which: 25 (a) An opioid is commonly used; and 26 (b) A non-opioid alternative is available. 27 2. A society shall not: 28 (a) Require prior authorization for an alternative to an opioid 29 if prior authorization would not be required for an opioid under 30 the same circumstances; or 31 (b) Impose other requirements on an alternative to an opioid 32 that would not be imposed on an opioid used under the same 33 circumstances. 34 3. A society shall exempt an insured from any medical 35 management techniques that would otherwise apply to the benefits 36 described in subsection 1 if the provider of health care who 37 prescribes or administers an alternative to an opioid confirms that, 38 in the professional judgment of the provider of health care, the 39 alternative to an opioid is appropriate for the treatment of the 40 patient. 41 4. A benefit contract subject to the provisions of this chapter 42 that is delivered, issued for delivery or renewed on or after 43 January 1, 2026, has the legal effect of including the coverage 44 – 6 – - *SB377* required by subsection 1, and any provisions of the contract that 1 conflict with the provisions of this section is void. 2 5. As used in this section: 3 (a) “Medical management technique” means a practice which 4 is used to control the cost or utilization of health care services or 5 prescription drug use. The term includes, without limitation, the 6 use of step therapy, prior authorization or categorizing drugs and 7 devices based on cost, type or method of administration. 8 (b) “Provider of health care” has the meaning ascribed to it in 9 NRS 629.031. 10 Sec. 8. Chapter 695B of NRS is hereby amended by adding 11 thereto a new section to read as follows: 12 1. A hospital or medical services corporation that offers or 13 issues a policy of health insurance shall include in the policy 14 coverage for at least one alternative to an opioid that is effective 15 for each purpose for which: 16 (a) An opioid is commonly used; and 17 (b) A non-opioid alternative is available. 18 2. A hospital or medical services corporation shall not: 19 (a) Require prior authorization for an alternative to an opioid 20 if prior authorization would not be required for an opioid under 21 the same circumstances; or 22 (b) Impose other requirements on an alternative to an opioid 23 that would not be imposed on an opioid used under the same 24 circumstances. 25 3. A hospital or medical services corporation shall exempt an 26 insured from any medical management techniques that would 27 otherwise apply to the benefits described in subsection 1 if the 28 provider of health care who prescribes or administers an 29 alternative to an opioid confirms that, in the professional 30 judgment of the provider of health care, the alternative to an 31 opioid is appropriate for the treatment of the patient. 32 4. A policy of health insurance subject to the provisions of 33 this chapter th [Text truncated for display. Full text available on LegiScan.]