AN ACT relating to insurance; imposing requirements governing prior authorization for medical or dental care; prohibiting an insurer from requiring prior authorization for covered emergency services or denying coverage for covered, medically necessary emergency services; requiring an insurer to publish certain information relating to requests for prior authorization on the Internet; requiring an insurer and the Commissioner of Insurance to compile certain reports; and providing other matters properly relating thereto.
Sponsored By: Duy Nguyen (Democratic), Hanadi Nadeem (Democratic), Toby Yurek (Republican), Tracy Brown-May (Democratic), Venicia Considine (Democratic)
Failed
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 7 benefits, 1 costs, 0 mixed.
Medicaid patients get emergency care protections
Beginning January 1, 2026, Nevada Medicaid and CHIP cannot require advance approval for covered emergency care, including applicable ambulance rides. They cannot deny coverage for covered, medically necessary emergency services. Care is presumed necessary if the provider sends written certification within 72 hours after admission. The state can challenge that presumption only with clear and convincing evidence. Notice may still be required, but cannot be due before the end of the business day immediately following the day after admission or care.
Health plans need approved care authorization rules
Beginning January 1, 2026, health carriers keeping advance-approval requirements must develop compliant procedures and obtain the Insurance Commissioner's approval. This applies to policies issued or renewed after that date. Older policies become subject to the requirements when renewed. The changes do not apply to Medicaid or CHIP approval requests submitted before January 1, 2026; renewals after that date follow the new law.
Medicaid patients gain prescription drug protections
Beginning January 1, 2026, Nevada must manage Medicaid drug approval rules and step therapy, which requires trying other drugs first. The Drug Use Review Board must develop and approve step-therapy rules using medical evidence and best practices, not drug cost. The state must base its rules on the board's recommendations. Step therapy cannot apply to an FDA-approved psychiatric drug when its use is approved or supported by medical evidence, an eligible practitioner prescribes it, and each earlier-step drug is known or reasonably expected to fail. Eligible prescribers include psychiatrists and qualifying psychiatric nurse practitioners or physician assistants; a primary care provider must consult a listed psychiatric practitioner, with the closest participating psychiatric practitioner at least 60 miles from the patient's home.
Medicaid patients get clearer denials and appeals
Beginning January 1, 2026, Medicaid and CHIP care denials require review by a physician, pharmacist, or dentist for dental care. Reviewers need an unrestricted U.S. state or territory license, must work within their licensed field, and should have a similar specialty when practical. The state or plan must immediately send written reasons, identify missing or insufficient records, and explain appeal rights, instructions, and helpful documents. The state must provide an appeal process. Patients can appeal to the state after completing a managed care plan's separate appeal process if the plan upholds the denial.
Medicaid patients get more stable care approvals
Beginning January 1, 2026, Medicaid and CHIP care approvals last 12 months unless federal law sets another period. The state or plan can cancel or tighten approval only for fraud, material misrepresentation, care not covered when provided, or care not provided within 90 business days after the request was received. It must promptly pay complete, properly submitted claims for approved medical or dental care. Exceptions allow denial for late claims, claims failing state or federal submission rules, or approvals obtained through fraud or material misrepresentation. Payment must use the contract rate or the rate ordinarily paid for that care.
Medicaid patients get posted rules and deadlines
Beginning January 1, 2026, Nevada Medicaid and CHIP must post services needing advance approval and the medical rules used for review. Changes cannot take effect until posted, and claims cannot be denied for missing approval that was not required when care occurred. The state or managed care plan must decide and notify the patient and provider within 7 days, unless a shorter legal deadline applies. If more medical information is needed, it must request it within 7 days and decide within 7 days after receipt. These deadlines exclude prescription drugs, personal care services, and services under 42 U.S.C. § 1396n(i) or a § 1396n(c) waiver.
Workers gain employer health benefit protections
Beginning January 1, 2026, employers offering health benefits must provide the same benefits as the insurance policies specified by state law. They must also pay providers in the same manner and follow this law's advance-approval requirements. The law does not require employers to offer health benefits.
Dental patients lose two payment protections
Beginning January 1, 2026, the law repeals two existing protections against refusing payment for previously approved dental care. Those protections covered health carriers, dental care organizations, and their administrators, with exceptions. The effect on a dental claim depends on other applicable protections and coverage terms, including the law's broader approval framework.
Sponsors & Cosponsors
Sponsors
Duy Nguyen
Democratic • House
Hanadi Nadeem
Democratic • House
Toby Yurek
Republican • House
Tracy Brown-May
Democratic • House
Venicia Considine
Democratic • House
Cosponsors
Angela D. Taylor
Democratic • Senate
Cecelia González
Democratic • House
Erica Mosca
Democratic • House
Gregory S. Koenig
Republican • House
Heather Goulding
Democratic • House
Heidi Kasama
Republican • House
Lisa K. Cole
Republican • House
Natha C. Anderson
Democratic • House
Rebecca Edgeworth
Republican • House
Reuben D'Silva
Democratic • House
Venise Karris
Democratic • House
Dina Neal
Democratic • Senate
Edgar Flores
Democratic • Senate
Rochelle T. Nguyen
Democratic • Senate
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
(No further action taken.)
6/3/2025HouseTo committee.
4/24/2025HouseFrom printer. To engrossment. Engrossed. First reprint.
4/24/2025HouseTo printer.
4/21/2025HouseRereferred to Committee on Ways and Means. Exemption effective.
4/21/2025HouseTaken from General File.
4/21/2025HouseRead second time. Amended. (Amend. No. 474.)
4/21/2025HousePlaced on Second Reading File.
4/21/2025HouseFrom committee: Amend, and do pass as amended.
4/21/2025HouseNotice of eligibility for exemption.
3/18/2025HouseFrom printer. To committee.
2/26/2025HouseRead first time. Referred to Committee on Commerce and Labor. To printer.
2/25/2025House
Bill Text
As Introduced
Reprint 1
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