NevadaAB20283rd Regular Session (2025)House

AN ACT relating to insurance; revising certain definitions for the purposes of certain coverage for health care services; revising provisions governing the circumstances under which a managed care organization is not required to authorize coverage of a health care service; revising the applicability of certain provisions requiring certain insurers to establish a system of procedures for resolving complaints of insured persons and providing for the external review of an adverse determination to include certain insurers that issue policies or certificates that provide only dental coverage; revising the information which a health carrier is required to provide in a notice of an adverse determination; authorizing a dentist of a covered person to submit to the Office for Consumer Health Assistance in the Department of Health and Human Services a request for an external review of an adverse determination; requiring an independent review organization to notify the dentist of a covered person and a health carrier of certain information and the determination and reasons of the independent review organization; requiring a decision of an independent review organization to be based, in part, on certain documentary evidence, including any recommendation of the dentist of the insured; and providing other matters properly relating thereto.

Sponsored By: Tracy Brown-May (Democratic)

Signed by Governor

BDR 57-573

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 4 benefits, 1 costs, 0 mixed.

If review overturns denial, insurer pays

When the independent review overturns your insurer’s denial, the insurer must approve and cover the service right away. If the insurer failed to send records on time and the reviewer reverses the denial for that reason, the reviewer must promptly tell you, the insurer, and the state office and explain why.

Dental plans get full appeal rights

Dental-only insurance now uses the same complaint and external review rules as medical plans. Your dentist can file an external review for you within 4 months of a denial. Denial letters must say that a dentist, not just a doctor, can certify urgency for a faster review. Dentists count as your treating provider and as clinical peers in the review. The review organization must notify your dentist of needed info and send any dentist records to the insurer within 1 business day.

Faster, fairer external reviews of denials

After you ask for external review, your insurer must do a first check in 5 business days and tell you and the state office the result within 1 business day. If the insurer says your request is ineligible, the Office for Consumer Health Assistance can still decide it is eligible and send it to review. If eligible, the Office assigns a qualified review organization at random, tells you and the insurer, and gives you 5 business days to add more records. The insurer must quickly send all records it used to deny care; if it fails, the reviewer may reverse the denial. The reviewer picks expert clinicians, gets their opinions (for standard cases, within 20 days), and decides by majority. Decisions must be based on your records, evidence-based medicine, peer‑reviewed research, expert opinions, and your plan’s benefit terms.

Faster appeals for experimental denials

If your plan says a treatment is experimental or investigational, you have 4 months from the denial to ask for external review. You can make an oral expedited request when your doctor or dentist certifies in writing that delay would make the treatment less effective. The Office for Consumer Health Assistance must tell the insurer right away when you request an expedited review.

Denials must come from qualified clinicians

A managed care plan may deny a service only if a Nevada-licensed doctor or dentist makes the decision. That clinician must have the right training for your condition and must review your records. This can make some denials more likely to stand.

Sponsors & Cosponsors

Sponsor

  • Tracy Brown-May

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 62 • No: 0

Senate vote • 5/19/2025

Final Passage - Senate (1st Reprint)

Yes: 20 • No: 0

House vote • 4/22/2025

Final Passage - Assembly (1st Reprint)

Yes: 42 • No: 0

Actions Timeline

  1. Chapter 23.

    5/27/2025legislature
  2. Approved by the Governor.

    5/26/2025legislature
  3. Enrolled and delivered to Governor.

    5/23/2025legislature
  4. In Assembly. To enrollment.

    5/20/2025House
  5. Read third time. Passed. Title approved. (Yeas: 20, Nays: None, Excused: 1.) To Assembly.

    5/19/2025Senate
  6. Read second time.

    5/16/2025Senate
  7. From committee: Do pass.

    5/15/2025Senate
  8. Read first time. Referred to Committee on Commerce and Labor. To committee.

    4/29/2025Senate
  9. In Senate.

    4/28/2025Senate
  10. To Senate.

    4/25/2025House
  11. From printer. To engrossment. Engrossed. First reprint.

    4/25/2025House
  12. To printer.

    4/22/2025House
  13. Read third time. Passed, as amended. Title approved. (Yeas: 42, Nays: None.)

    4/22/2025House
  14. Dispensed with reprinting.

    4/21/2025House
  15. Read second time. Amended. (Amend. No. 42.)

    4/21/2025House
  16. Placed on Second Reading File.

    4/21/2025House
  17. From committee: Amend, and do pass as amended.

    4/21/2025House
  18. From printer. To committee.

    2/5/2025House
  19. To printer.

    2/4/2025House
  20. Read first time.

    2/4/2025House
  21. Referred to Committee on Commerce and Labor.

    2/3/2025House
  22. Prefiled.

    2/3/2025House

Bill Text

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