NevadaSB49583rd Regular Session (2025)SenateWALLET

AN ACT relating to health care; revising requirements governing the electronic maintenance, transmittal and exchange of health information; making revisions relating to emergency medical care; prescribing certain requirements to expedite the credentialing and privileging of providers of health care; authorizing paramedics to serve as employees or volunteers in hospitals under certain circumstances; imposing certain requirements governing prior authorization for medical care and payment of health insurance claims; making various revisions relating to Medicaid; creating and prescribing the duties of the Office of Mental Health in the Department of Health and Human Services or the Nevada Health Authority, if it is created; prohibiting noncompetition covenants governing certain providers of health care; requiring the prioritization of certain applications for licensure as a physician or osteopathic physician; requiring certain providers of health care to provide certain data to the Department; requiring certain reports of the Board of Medical Examiners and the State Board of Osteopathic Medicine to include certain information; authorizing the establishment of an alternative pathway to licensure as a dental hygienist; establishing provisions to incentivize the provision of psychological services to rural patients; requiring the Patient Protection Commission to study academic medical centers; making appropriations; providing a penalty; and providing other matters properly relating thereto.

Sponsored By: Senate Committee on Health and Human Services

Failed

BDR 40-1037

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Bill Overview

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60 provisions identified: 36 benefits, 13 costs, 11 mixed.

Care approvals carry across plan changes

Beginning January 1, 2028, the law provides care-continuity protections when health benefits end or patients change plans. New carriers must honor applicable earlier approvals for the first 90 days, unless the new policy clearly excludes the care. Medicaid and CHIP must also honor qualifying approvals during the first 90 days of enrollment. Those approvals must have been issued within the previous 12 months, and the program must not clearly exclude the care. Carriers must preserve approvals for the same care when patients switch policies within that carrier. For identical care already approved, new approval procedures, exclusions, or limits generally wait until the next coverage period.

Easier initial Medicaid decisions near home

The state must help hospitals and qualified community groups make initial Medicaid eligibility decisions. This process can help people seeking Medicaid get an earlier decision. The state must audit those decisions for accuracy and legal compliance. An initial decision does not guarantee final Medicaid eligibility.

Emergency centers must offer urgent-care prices

Independent emergency centers must offer urgent care during all operating hours through a separate unit or severity-based routing system. When urgent care can treat or manage a patient's condition, the center must explain that option. It cannot charge more than the amount customarily charged by an urgent-care center. It also cannot impose a longer wait than emergency services for a patient with the same condition.

Emergency Medicaid care needs no preapproval

The state and Medicaid managed care plans cannot require prior approval for emergency services covered by Medicaid or CHIP. This includes covered ambulance trips to a hospital or other medical facility.

Faster care approvals and clearer appeals

Beginning January 1, 2028, new care-approval rules cover health insurers, Medicaid, CHIP, state employee coverage, and covered review contractors. Decisions generally are due within 2 business days; allowed longer deadlines cannot exceed 7 calendar days, and shorter deadlines control. Missed response deadlines mean approval. Delay notices must explain the reasons, needed steps, and expected timeline, with written notice to patients and electronic notice to providers. Denial notices must explain the decision, missing records, and appeal instructions; appeals must be resolved clearly within a reasonable time. For Medicaid and CHIP, requests submitted after the state rejects an operating-rule revision have a 2-business-day deadline.

Faster care approvals and emergency access

Beginning January 1, 2028, carriers must use a state-approved process to keep requiring prior approval under newly issued or renewed policies. They must approve, deny, or give notice of delay within 2 business days, unless a shorter legal deadline applies. Operating rules may allow more time, but never beyond 7 calendar days; missing the applicable deadline means approval. After the Commissioner rejects an operating-rule revision following a public hearing and gives notice, the 2-business-day deadline applies. Covered emergency services need no prior approval; older policies generally qualify at renewal, and earlier Medicaid medical or dental requests are excluded.

High-approval providers can skip care preapproval

Beginning January 1, 2028, qualifying providers receive exemptions from prior approval for eligible covered care, subject to statutory exceptions. For carrier coverage, an in-network provider needs at least 95% approval for the specific service during the previous 24 months. Additional requirements set by regulation also apply. Carriers must review eligibility annually and publish exempt providers, specialties, and services. Exemptions can be revoked when eligibility ends, with appeal rights; audits and authorized penalties also require notice and an appeal opportunity. Medicaid and CHIP must grant qualifying exemptions except where the law specifies exceptions.

More places for temporary Medicaid eligibility

The state must help hospital staff make temporary Medicaid eligibility decisions while full eligibility is reviewed. It must seek federal approval for certified staff at qualified community groups to make these decisions too. The state must provide training, certification, and regular audits. Certifications expire after one year to the extent federal authorities allow.

Stronger protection for approved medical care

Beginning January 1, 2028, health carriers generally must honor approved care and cannot delay or deny its payment. Similar protections apply to state Medicaid and Medicaid managed care approvals. Exceptions cover fraud, material misrepresentation, clerical errors, or no coverage on the care date. A lower billing code or reduced payment needs clear, documented support consistent with applicable care standards. The payer must give the provider written notice and supporting documents.

Patients can compare emergency center charges

The state must publish information that helps people compare independent emergency centers' charges and quality of care. The information includes discharge data, quality measures, potentially preventable readmissions, and charges for the top 50 treatments. Published information must protect patient identities. The Office for Consumer Health Assistance website must link to the center charge and quality information.

Patients get free electronic health records

Record holders must securely send requested electronic records to patients or their chosen covered entities within seven business days, without charge. Sending records to another person or entity requires the patient's written permission. For other electronic deliveries, fees generally cannot exceed $40 or the legal per-page amount, whichever is less. Non-government record holders may charge a $5 minimum when that calculation is lower. Their listed extra fees are $5 for a no-records confirmation or certificate, $20 per printed film sheet, and $25 for radiologic images in another form.

Clearer emergency-center information and hospital bills

The state must collect emergency-center operating and patient-outcome information and share specified information online and upon request. It must build public awareness of that information and include the program in its status report. Hospitals and independent emergency centers must use the state's discharge form and report patient information monthly. Reporting must be electronic unless the Director grants a financial-hardship exemption. Insurers and other payers must accept the form as the bill, not as proof that payment is guaranteed.

Health plans must offer online approvals

Beginning January 1, 2028, insurers and covered approval entities must use electronic systems to receive and process care requests. Carrier systems must let providers submit requests, track progress, and receive updates. The state must provide an electronic system for Medicaid and CHIP medical and dental approval requests, following industry and federal standards. Carriers generally must adopt finalized operating-rule changes within 2 years unless the Insurance Commissioner finds them unsuitable for Nevada. That review requires a public hearing within 6 months and notice within 30 days after the hearing.

Insurance protections extend to employer benefits

Employers providing health care benefits must provide the benefits required by the specified state insurance provisions. They must also pay providers in the same manner required of an insurance policy. This incorporates the law's specified care-approval, credentialing, and related insurance requirements.

Patients get notice of automated reviews

Beginning January 1, 2028, insurers and covered review entities using artificial intelligence or automated tools must notify each insured. The notice must describe the tool as required by the law. Carriers must also post an easy-to-find public explanation of its use, operation, and information sources. These disclosures do not guarantee care approval.

Public employee plans gain insurance safeguards

The state public employee benefits board's self-insured plans must follow specified insurance rules, including approval and claims requirements. Listed coverage rules also apply to active local government officers, employees, and dependents in self-insured reserve-fund plans. The state board may hire health carriers only when they meet regulatory standards. For prescription coverage, the board or its contractor may use the state's preferred drug list and negotiated purchasing agreements. It must first notify the Department in the required form; the law promises no specific premium or drug-cost savings.

Patient-care providers gain freedom from noncompetes

Noncompete agreements cannot apply to health care providers whose main duties involve clinical patient care. This protection excludes providers employed or contracted mainly for administrative work. If a court finds a noncompete applies to a covered provider, it must award that employee or contractor reasonable attorney fees and costs.

Health practices get electronic records relief

Qualifying solo and group practices are exempt from general electronic health information rules. The entire practice must have served fewer than 500 patients last year and reasonably expect fewer than 500 this year. Exempt providers must still send electronic records to patients or, at patients’ request, to another person or organization. Eligible providers can also apply to Nevada’s health department for an infrastructure waiver. The department must grant it when needed systems are missing and obtaining them is not reasonably practical, including costs that threaten continued operation.

Faster checks for providers joining networks

Beginning January 1, 2026, Medicaid, CHIP, and carrier-network credential checks must use the CAQH Provider Data Portal or its successor. Verification must use an NCQA-certified organization, unless the carrier or delegate itself holds that certification. At least 95% of complete requests must be processed within 60 days after all needed information arrives. A complete portal request requires finished fields, electronic confirmation, and access for the reviewing entity. Hospital privilege requests and additional insurer credentialing deadlines begin January 1, 2027, with the same 95% and 60-day standard. Delay reporting, annual data publication, carrier audits, and a February 1 report on carrier approval and denial times support oversight. Delegated medical facilities must follow applicable standards, excluding ERISA and local-government self-insurance arrangements. The medical board must also offer hospitals and qualifying verification groups electronic access to board data when providers authorize sharing.

Faster reviews for health care providers

Medical boards must prioritize physician applications for underserved Nevada areas, populations, or shortage specialties; priority does not guarantee a license. Hospitals must process at least 95% of complete staff-privilege requests within 60 days after receiving all needed information. They must identify missing information within 15 days, report overdue processing immediately, and file annual reports by February 1. Medicaid and CHIP credential submissions must be accepted through the CAQH Provider Data Portal or its successor. The state or its delegate must use an NCQA-certified credentials verifier, but this rule alone sets no approval deadline.

Health record exchanges gain stronger oversight

Qualifying health information exchanges may create, authenticate, and store health records. Covered providers remain subject to the applicable record-maintenance and exchange rules. The Department must alert licensing bodies when covered providers or insurers violate those rules without an exemption or waiver. Exempt high-level providers still face notices when they fail to furnish electronic records as required.

Licensing protection for existing emergency centers

Beginning January 1, 2026, the state must license otherwise qualified independent emergency centers within five miles of another center or hospital emergency department. This protection covers centers operating when the law was enacted. Proposed centers qualify if, by January 1, 2025, they had acquired land and obtained or were obtaining construction approvals. They must also have begun seeking any applicable additional state approval by that date. All other licensing requirements still apply.

New office coordinates mental health care

The law creates an Office of Mental Health in Nevada's health department, or the Nevada Health Authority if created. A Governor-appointed director must have behavioral-health experience and avoid the specified conflicts of interest. The office coordinates services, workforce development, access efforts, and assessments of state programs. It supports mental-health providers joining Medicaid and statewide children's mental-health services and planning. Its work includes rural and underserved communities.

New office coordinates mental health services

The law creates an Office of Mental Health in the Department of Health and Human Services. The Director must appoint its Executive Director. The Office works to improve access and effectiveness, including children's mental and behavioral health services. It must report to lawmakers every two years. The law provides for transfer to the Nevada Health Authority contingent on enactment of Senate Bill 494.

Osteopathic providers get streamlined approval tools

The osteopathic medicine board must prioritize first-time license applicants planning to serve the most critical provider shortages. Priorities cover geographic areas, populations, and specialties identified by the required state assessment. The board must monitor processing times and update priorities annually with the state health department. It must also provide electronic record access for hospitals and specified credentialing groups reviewing osteopathic physicians, physician assistants, and anesthesiologist assistants. Providers must authorize access for credential checks or granting hospital work privileges.

Paramedics gain regulated hospital work roles

The State Board of Health must adopt rules allowing paramedics to work or volunteer in hospitals. Roles may include emergency departments, intensive care, and other acute or specialty care areas. Rules must cover duties, training, certification, oversight, and regular evaluations, with work matched to training and experience. Hospitals using paramedics must adopt written policies covering supervision, safety, legal compliance, and outcome records. By February 1 each year, they must report roles, patient outcomes, challenges, best practices, and policy changes.

Physician licenses prioritized for care shortages

Nevada's medical board must prioritize initial physician-license applications aimed at the most critical provider shortages. Priorities cover identified geographic areas, populations, and medical specialties. The board must track processing times and update priorities annually with the health department using the required shortage assessment.

Prompt Medicaid payments for care providers

Medicaid and CHIP must follow the specified prompt-payment rules applying to private insurers and the state employee benefits program. After prior approval, claims must be paid within 30 days, with separate timelines when additional records are requested. Late payments earn interest at Nevada's largest bank's prime rate, measured on January 1 or July 1, plus 6%. Interest runs from 30 days after approval until payment. Medicaid must also follow federal timely-payment requirements.

Psychologists earn recognition for rural care

The psychology board must encourage continuing education about rural patients' mental health needs. Psychologists providing at least 200 hours of telehealth care to rural Nevada patients receive a certificate of distinction. With their consent, the board may list them online as a Committed Rural Service Provider. The program provides recognition, not cash, and does not require psychologists to offer this care.

State funding supports Medicaid program changes

Effective July 1, 2025, the law provides state agency funding for specified Medicaid and children’s health insurance program changes. It appropriates $291,296 from Nevada’s General Fund and authorizes another $1.149153 million in spending for fiscal year 2026–2027. The funding supports administration of changes involving value-based payments, temporary eligibility while applications are reviewed, and claim oversight—not direct household payments. Remaining appropriated funds cannot be committed after June 30, 2027, or spent after September 17, 2027. Those remaining funds must return to the General Fund by September 17, 2027.

State funds academic medical center study

Beginning July 1, 2025, the Patient Protection Commission receives $200,000 to study Nevada's academic medical centers during 2025–2026. The study must cover workforce, locations, funding, statewide coordination, training, partnerships, and governance. The Commission must consult health care, academic, and economics experts and Nevada community representatives. Its report is due November 6, 2026, and unspent funds are subject to reversion by September 17, 2027. The money funds a study, not new medical centers or direct household benefits.

Yearly checks on health plan compliance

The Insurance Commissioner must audit every Nevada health carrier annually and publish a compliance report on approval and related insurance rules. The Commissioner must investigate provider complaints and hold a yearly public meeting with the health department. Public input must guide regulations or recommended law changes. The Commissioner can audit approval reports and require independent audits after repeated reporting failures or suspected inaccuracies. New qualification standards cover insurers, administrators, review organizations, and review agents, with separate compliance criteria for state employee plan carriers.

Psychologists get credit for rural-care training

The psychology board must tell licensees about rural mental-health continuing education offered by the American Psychological Association's Committee on Rural Health. The board must count that training toward psychologists' required continuing education.

Ambulance operators lose record-rule penalties

The law removes corrective-action authority and administrative penalties for specified electronic health-information violations by ambulance operators. The repeal also covers air ambulance and fire-agency vehicle permit holders. The repealed rule did not allow permit suspension or revocation for those violations.

Emergency centers avoid certain licensing costs

Nevada cannot charge a fee to issue an independent emergency center's operating license. Hospital-owned, operated, or affiliated centers also avoid license renewal fees. The state cannot collect its actual enforcement costs for issuing or renewing those hospital-affiliated centers' licenses. The law does not require centers to pass these savings to patients.

Quality-based Medicaid payments for emergency centers

Medicaid must include quality-based payments for care at independent emergency centers to the extent money is available. Higher reimbursement goes to centers providing high-quality care at an appropriate level. The payment system also depends on federal legal authority. The law does not set payment rates or provide cash payments to patients.

Care administrators face added discipline grounds

The long-term care administrator board can discipline licensees who help others violate the act's covered facility rules. This applies to violations involving skilled nursing facilities, intermediate care facilities, and group residential facilities.

Pharmacists must follow more record rules

Pharmacists lose their exemption from the applicable health-record requirements. The specified record-retention and record-destruction provisions remain excluded from this change.

Alternative-path hygienists face preventive-agent limits

Dental hygienists trained through the alternative pathway cannot prescribe or dispense preventive agents under the dental hygienist prescribing authority. This restriction ends if they later graduate from the standard dental hygiene program specified in state law.

Health professionals must submit renewal data

Covered health professionals must electronically submit the state health director's data request to renew their licenses, registrations, or certificates. The requirement also applies to physician biennial registration. It covers physicians, dentists, nurses, and professionals licensed under the other listed health-profession laws. Licensing boards must include the request in electronic renewal applications. The information is confidential except for allowed uses needed to administer the requirement.

Hospital sites need separate billing numbers

Qualifying hospital sites more than 250 yards from the main campus must use distinct national provider numbers on claims. This covers integrated outpatient surgery, urgent care, and emergency-room sites. Claims may also show the main-campus number if each number's location is clear. Independent emergency centers must put their own provider number on every claim for care delivered there. These rules do not set new patient charges or payment rates.

Medicaid approval exemptions face quality checks

The state must set quality standards for its Gold Card approval-exemption holders and Medicaid managed care entities. Holders falling below the required average quality rating must receive a review. The state may suspend or revoke an exemption when the holder takes insufficient steps to improve care. It may require approval for a specific good or service to address fraud, abuse, or cost-control risks. It cannot impose that requirement on an entire class of goods or services.

Medicaid providers face stronger state reviews

State officials can review certain sealed records when screening people seeking to provide Medicaid services or own or manage providers. The state must also follow a prescribed process to review whether Medicaid claims are proper. After review, it can deny claims, recover payments already made, or take other specified actions. These rules do not directly change household Medicaid eligibility or benefit amounts.

New emergency centers face location limits

The law broadens the independent emergency-center definition beyond facilities offering only limited emergency treatment. Covered centers must be structurally separate from a hospital and treat medical emergencies. Hospital-owned, operated, or affiliated centers qualify when located more than 250 yards from the hospital. Nevada cannot license a new center within five miles of another independent center or a hospital emergency department. Exceptions protect centers already licensed or taking specified steps toward opening by January 1, 2025.

Providers must report data to renew

Covered health care providers must complete the Director's electronic workforce data request to renew their credentials. The request covers provider demographics and practices. It applies across the listed medical, dental, nursing, vision, behavioral health, social work, and related licensing boards. The law specifies no new fee for this task.

Providers must send approval requests online

Hospitals and outpatient surgery centers must send applicable care-approval requests through the required electronic systems. Providers must also use them if privately insured patients generated at least 10% of gross revenue in the previous calendar year. The revenue test excludes the specified Medicaid and CHIP managed care coverage. These submission rules exclude ERISA employee plans and local-government self-insurance reserve funds. Provider violations count as unprofessional conduct and can lead to licensing discipline.

Tighter checks on Medicaid provider payments

Medicaid providers must keep and provide documents that let the state verify claims. The state may deny claims or recover payments it cannot verify. Health agencies may inspect sealed records involving Medicare, Medicaid, or licensed professional services during specified Medicaid suitability reviews. They may consider the underlying events or convictions when refusing or ending contracts for providers, owners, or managers.

Dental applicants need remote care training

Dentistry, dental hygiene, and dental therapy license applicants planning to provide teledentistry must show proof of related training. They need at least 2 hours of continuing education on teledentistry. A teledentistry course completed as a graduation requirement at an accredited school also qualifies.

Insurance companies face added approval standards

Health insurers and utilization review agents must meet the new regulatory requirements to receive state authorization or registration. The commissioner can refuse administrator registration when the applicant or required affidavit signer fails those requirements. Independent review organizations must meet approval standards and submit supporting documents for initial approval or reapproval. An unaccredited review organization can be approved only when no acceptable nationally recognized private accreditor offers accreditation. Insurers not otherwise authorized in Nevada need a reinsurer certificate of authority to reinsure a Nevada domestic insurer.

Insurance approval protections have coverage limits

Specified approval and claims rules also cover administrators and review organizations handling those tasks. Relevant rules extend to nonprofit hospital, medical, and dental service corporations unless they conflict with those corporations' governing laws. The administrator and review-organization inclusion excludes work for local government self-insurance reserve funds. Specified commercial approval rules also exclude organizations' contracted Medicaid or CHIP work. That exception does not remove the separate Medicaid protections described elsewhere in the law.

Health record exchanges face certification rules

Health information exchanges must get state certification before operating in Nevada. Certification rules must address financial and operating stability, privacy, security, patient consent, and the ability to share information across systems. The state health director can deny, suspend, or revoke certification and fine exchanges operating without it.

Health records follow separate legal rules

Nevada's general privacy and information-security laws do not apply to health information handled according to the specified health-information rules. The state's electronic-transactions and digital-signature laws also do not apply to records governed by those health-information rules. These exclusions change the legal framework, not the separate health-information requirements.

Stronger health record rules, small-practice exemptions

Covered facilities and providers must follow state rules for electronic health records, with legal exceptions and waivers. The rules cover access, privacy, security, consent, corrections, breach notices, system compatibility, electronic prescription approvals, and audits. Solo or small group practices with fewer than 500 patients in the prior year are exempt from broader requirements. Exempt providers must still send records electronically when patients ask. Rules cannot require a health information exchange, accept joining one alone as compliance, or allow fee-based services that violate record-access protections.

Emergency centers face new operating rules

Structurally separate emergency facilities need independent emergency-center licenses, including facilities owned or operated by hospitals. Beginning January 1, 2026, covered centers must provide urgent care throughout operating hours; centers licensed at enactment are exempt. Hospital-affiliated centers may operate without a separate license from January 1 through July 1, 2026. Covered facility violations can lead to license denial, suspension, revocation, or prosecution. The Division may also impose up to $5,000 per day for each violation.

Facility rules cover hospice, exempt others

Qualifying hospice programs count as medical facilities under the specified Nevada facility rules. Qualifying religious healing facilities, foster homes, and federally operated and maintained facilities are exempt from specified facility requirements. Religious healing facilities must serve people who rely solely on prayer for healing as part of their religion. Applicable sanitation and safety rules still apply to those religious facilities.

Medicaid carriers must bid for Public Option

Medicaid and CHIP managed care carriers must submit a good-faith Public Option administrator bid to continue Medicaid managed care participation. This applies when the state requests bids, and proposals must meet applicable standards. The Director must favor bids that align networks and include specified safety-net and rural providers. Favored bids must also support the workforce, value-based payment, and culturally competent care that reduces disparities. This does not create a direct household payment.

Medicaid claim reviews with hearing protections

Medicaid providers must keep claim-supporting records for the period set by regulation and share them when the state requests them. The state can deny or recover payments it cannot verify. Suspected unnecessary, excessive, or improper services require review and supporting records. Within 60 days after receiving those records, the state must resolve the claims and can require advance approval for future services. Providers generally receive a hearing opportunity, but failure to submit requested records can allow action without one.

Some Medicaid requirements start in 2029

The Department does not have to implement three specified Medicaid requirements until January 1, 2029. From January 1, 2028, through January 1, 2029, it may collect provider data needed to prepare. These are subsections 9, 10, and 11 of section 56. The supplied provisions do not describe what those requirements do.

New dental hygienist pathway with limits

Nevada’s dental board can create supervised training instead of requiring graduation from an accredited dental hygiene program. Applicants must start during a two-year period when the state workforce assessment identifies a dental hygienist shortage. Required classes include two semesters each of biology with labs, chemistry with labs, and anatomy and physiology. Applicants also need one semester each of microbiology and college-level math, plus comparable education and dentist-supervised clinical training. They must pass the supervising dentist’s competency exam, a written exam, and a board-approved clinical exam. Board rules must set their allowed duties, limit practice locations, and specify what they tell patients about their training. Graduates cannot prescribe or dispense preventive agents unless they later graduate from an accredited dental hygiene program.

Paramedics gain hospital roles with training

Hospitals can use paramedics as employees or volunteers after the paramedics meet required qualifications and training standards. Hospitals must first develop and put the required comprehensive policies in place. Paramedics cannot work in an area requiring extra training until they complete that training.

Sponsors & Cosponsors

Sponsor

Senate Committee on Health and Human Services
Affiliation unavailable

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 13 • No: 8

Senate vote • 6/2/2025

Final Passage - Senate (1st Reprint)