Nevada AB 463: Revises provisions governing child care facilities and certain child care programs. (BDR 38-1083)

Bill Text

- 83rd Session (2025)
Assembly Bill No. 463–Assemblymember Backus

CHAPTER..........

AN ACT relating to insurance; requiring certain health insurers to
respond to requests for prior authorization for medical or
dental care within a certain amount of time; prohibiting
certain insurers from requiring prior authorization for certain
types of medical care; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing law authorizes certain health insurers to require prior authorization
before an insured may receive coverage for medical and dental care in certain
circumstances. If an insurer requires prior authorization, existing law requires the
insurer to: (1) file its procedure for obtaining prior authorization with the
Commissioner of Insurance for approval; and (2) respond to a request for prior
authorization within 20 days after receiving the request. (NRS 687B.225) Sections
27 and 45 of this bill require private insurers and insurers providing coverage for
recipients of Medicaid and the Children’s Health Insurance Program, respectively,
to respond to a request for prior authorization within 2 business days after receiving
the request, unless certain nationally recognized operating rules governing prior
authorization would allow the insurer to have additional time to respond to the
particular request. In such a case, sections 27 and 45 authorize an insurer to
respond to the request within the period of time prescribed by the operating rules,
unless doing so would result in the insurer responding to the request more than 7
calendar days after receiving the request.
Sections 19 and 48 of this bill prohibit insurers from requiring an insured to
obtain prior authorization for: (1) certain preventive care services; (2) hospice care
provided to pediatric patients; and (3) care provided to treat neonatal abstinence
syndrome. Section 19 additionally prohibits insurers, other than those covering
recipients of Medicaid or the Children’s Health Insurance Program, from requiring
prior authorization for: (1) outpatient services for the treatment of substance use
disorder; and (2) the prescription of test strips for measuring blood glucose in
persons with diabetes. Section 27 makes conforming changes to clarify that a
private insurer may not require prior authorization where prohibited by section 19.
Sections 4-15 and 35-42 of this bill define certain terms relating to the process
of obtaining and processing requests for prior authorization, and sections 2 and 34
of this bill establish the applicability of those definitions. Section 23 of this bill
provides that if a private insurer violates any provision of section 19 or 27 with
respect to a particular request for prior authorization, that the request is deemed
approved.
Section 28 of this bill requires a nonprofit hospital and medical or dental
service corporation to comply with sections 2-26 of this bill. Section 29 of this bill
requires the Director of the Department to administer the provisions of sections 33-
52 of this bill in the same manner as other provisions governing Medicaid. Section
56 of this bill requires plans of self-insurance for private employers, respectively, to
comply with the requirements of sections 19 and 27 to the extent applicable.
Section 15.5 of this bill provides that a health maintenance organization or other
managed care organization that provides services to recipients of Medicaid or the
Children’s Health Insurance Program or members of the Public Employees’
Benefits Program, or a utilization review organization that conducts utilization
reviews for such entities, is not subject to sections 2-27.

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- 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. Chapter 687B of NRS is hereby amended by adding
thereto the provisions set forth as sections 2 to 26, inclusive, of this
act.
Sec. 2. As used in NRS 687B.225 and sections 2 to 26,
inclusive, of this act, unless the context otherwise requires, the
words and terms defined in sections 3 to 16, inclusive, of this act
have the meanings ascribed to them in those sections.
Secs. 3-6. (Deleted by amendment.)
Sec. 7. “Health carrier” has the meaning ascribed to it in
NRS 695G.024, and includes, without limitation, an organization
for dental care. The term additionally includes a utilization review
organization, as defined in NRS 695G.085, while acting in its
capacity as a utilization review organization for a health carrier.
Sec. 8. (Deleted by amendment.)
Sec. 9. “Insured” means a policyholder, subscriber, enrollee
or other person covered by a health carrier.
Sec. 10. (Deleted by amendment.)
Sec. 11. “Medically necessary” has the meaning ascribed to
it in NRS 695G.055.
Secs. 12 and 13. (Deleted by amendment.)
Sec. 14. “Prior authorization” means:
1. Any process by which a