Revises provisions relating to health insurance coverage for biomarker testing. (BDR 57-913)

A.B. 382

- *AB382*

ASSEMBLY BILL NO. 382–ASSEMBLYMEMBERS FLANAGAN; DALIA,
DICKMAN, EDGEWORTH, GONZÁLEZ, GOULDING, GRAY,
JACKSON, KARRIS, KASAMA, LA RUE HATCH, NGUYEN
AND ORENTLICHER

MARCH 10, 2025
____________

JOINT SPONSORS: SENATORS NGUYEN, OHRENSCHALL AND PAZINA
____________

Referred to Committee on Commerce and Labor

SUMMARY—Revises provisions relating to health insurance
coverage for biomarker testing. (BDR 57-913)

FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.

CONTAINS UNFUNDED MANDATE (§ 2 & NRS 287.010)
(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; expanding the scope of required
insurance coverage for biomarker testing; and providing
other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires certain public and private health plans, including 1
Medicaid and health plans for state and local employees to provide coverage, in 2
certain circumstances, for medically necessary biomarker testing for the diagnosis, 3
treatment, appropriate management and ongoing monitorin g of cancer when such 4
biomarker testing is supported by medical evidence. (NRS 287.010, 287.04335, 5
422.272364, 689A.0446, 689B.0361, 695C.050, 689C.1688, 695A.1859, 6
695B.19087, 695C.16932, 695G.1703) This bill removes the limitations that such 7
coverage is only required if the biomarker testing is: (1) medically necessary; and 8
(2) for the diagnosis, treatment, appropriate management and ongoing monitoring 9
of cancer. This bill thus requires public and private health plans to cover any 10
biomarker testing for th e diagnosis, treatment, appropriate management and 11
ongoing management of a medical condition or disease when such biomarker 12
testing is supported by medical evidence, regardless of whether the biomarker 13
testing is determined to be medically necessary. 14

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- *AB382*
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. NRS 689A.0446 is hereby amended to read as 1
follows: 2
689A.0446 1. Subject to the limitations prescribed by 3
subsection 4, an insurer that issues a policy of health insurance shall 4
include in the policy coverage for [medically necessary] biomarker 5
testing for the diagnosis, treatment, appropriate management and 6
ongoing monitoring of [cancer] a medical condition or disease 7
when such biomarker testing is supported by medical and scientific 8
evidence. Such evidence includes, without limitation: 9
(a) The labeled indications for a biomarker test or medication 10
that has been approved or cleared by the United States Food and 11
Drug Administration; 12
(b) The indicated tests for a drug that has been approved by the 13
United States Food and Drug Administra tion or the warnings and 14
precautions included on the label of such a drug; 15
(c) A national coverage determination or local coverage 16
determination, as those terms are defined in 42 C.F.R. § 400.202; or 17
(d) Nationally recognized clinical practice guidelines or 18
consensus statements. 19
2. An insurer shall: 20
(a) Provide the coverage required by subsection 1 in a manner 21
that limits disruptions in care and the need for multiple specimens; 22
(b) Establish a clear and readily accessible process for an 23
insured or provider of health care to: 24
(1) Request an exception to a policy excluding coverage for 25
biomarker testing for the diagnosis, treatment, management or 26
ongoing monitoring of [cancer;] a medical condition or disease; or 27
(2) Appeal a denial of coverage for su ch biomarker testing; 28
and 29
(c) Make the process described in paragraph (b) available on an 30
Internet website maintained by the insurer. 31
3. If an insurer requires an insured to obtain prior authorization 32
for a biomarker test described in subsection 1, the insurer shall 33
respond to a request for such prior authorization: 34
(a) Within 24 hours after receiving an urgent request; or 35
(b) Within 72 hours after receiving any other request. 36
4. The provisions of this section do not require an insurer to 37
provide coverage of biomarker testing: 38
(a) For screening purposes; 39
(b) Conducted by a provider of health care for whom the 40
biomarker testing is not within his or her scope of practice, training 41
and experience; or 42

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- *AB382*
(c) Conducted by a provider of health care or a facility that does 1
not participate in the network plan of the insurer . [; or 2
(d) That has not been determined to be medically necessary by a 3
provider of health care for whom such a determination is within his 4
or her scope of practice, training and experience.] 5
5. A policy of health insurance subject to the provisions of this 6
chapter that is delivered, issued for delivery or renewed on or after 7
[October] January 1, [2023,] 2026, has the legal effect of including 8
the coverage required by this section, an d any provision of the 9
policy or renewal which is in conflict with the provisions of this 10
section is void. 11
6. As used in this section: 12
(a) “Biomarker” means a characteristic that is objectively 13
measured and evaluated as an indicator of a normal biologic al 14
process, a pathogenic process or a pharmacological response to a 15
specific therapeutic intervention and includes, without limitation: 16
(1) An interaction between a gene and a drug that is being 17
used by or considered for use by the patient; 18
(2) A mutation or characteristic of a gene; and 19
(3) The expression of a protein. 20
(b) “Biomarker testing” means the analysis of the tissue, blood 21
or other biospecimen of a patient for the presentation of a biomarker 22
and includes, without limitation, single -analyte tests, multiplex 23
panel tests and whole genome, whole exome and whole 24
transcriptome sequencing. 25
(c) “Consensus statement” means a statement aimed at a specific 26
clinical circumstance that is: 27
(1) Made for the purpose of optimizing the outcomes of 28
clinical care; 29
(2) Made by an independent, multidisciplinary panel of 30
experts that has established a policy to avoid conflicts of interest; 31
(3) Based on scientific evidence; and 32
(4) Made using a transparent methodology and reporting 33
procedure. 34
(d) [“Medically necessary” means health care services or 35
products that a prudent provider of health care would provide to a 36
patient to prevent, diagnose or treat an illness, injury or disease, or 37
any symptoms thereof, that are necessary and: 38
(1) Provided in accordance with generally accepted standards 39
of medical practice; 40
(2) Not primarily provided for the convenience of the patient 41
or provider of health care; and 42
(3) Significant in guiding and informing the provider of 43
health care in providing the most appropriate course of treatment for 44

– 4 –

- *AB382*
the patient in order to prevent, delay or lessen the magnitude of an 1
adverse health outcome. 2
(e)] “Nationally recognized clinical practice guidelines” means 3
evidence-based guidelines establishing standards of care that 4
include, without limitation, recommendations intended to optimize 5
care of patients and are: 6
(1) Informed by a systemic review of evidence and an 7
assessment of the risks and benefits of alternative options for care; 8
and 9
(2) Developed using a transparent m ethodology and 10
reporting procedure by an independent organization or society of 11
medical professionals that has established a policy to avoid conflicts 12
of interest. 13
[(f)] (e) “Network plan” means a policy of health insurance 14
offered by an insurer under whi ch the financing and delivery of 15
medical care, including items and services paid for as medical care, 16
are provided, in whole or in part, through a defined set of providers 17
under contract with the insurer. The term does not include an 18
arrangement for the financing of premiums. 19
[(g)] (f) “Provider of health care” has the meaning ascribed to it 20
in NRS 629.031. 21
Sec. 2. NRS 689B.0361 is hereby amended to read as follows: 22
689B.0361 1. Subject to the limitations prescribed by 23
subsection 4, an insurer that issues a policy of group health 24
insurance shall include in the policy coverage for [medically 25
necessary] biomarker testing for the diagnosis, treatment, 26
appropriate management and ongoi ng monitoring of [cancer] a 27
medical condition or disease when such biomarker testing is 28
supported by medical and scientific evidence. Such evidence 29
includes, without limitation: 30
(a) The labeled indications for a biomarker test or medication 31
that has been approved or cleared by the United States Food and 32
Drug Administration; 33
(b) The indicated tests for a drug that has been approved by the 34
United States Food and Drug Administration or the warnings and 35
precautions included on the label of such a drug; 36
(c) A national coverage determination or local coverage 37
determination, as those terms are defined in 42 C.F.R. § 400.202; or 38
(d) Nationally recognized clinical practice guidelines or 39
consensus statements. 40
2. An insurer shall: 41
(a) Provide the coverage requir ed by subsection 1 in a manner 42
that limits disruptions in care and the need for multiple specimens; 43
(b) Establish a clear and readily accessible process for an 44
insured or provider of health care to: 45

– 5 –

- *AB382*
(1) Request an exception to a policy excluding coverage for 1
biomarker testing for the diagnosis, treatment, management or 2
ongoing monitoring of [cancer;] a medical condition or disease; or 3
(2) Appeal a denial of coverage for such biomarker testing; 4
and 5
(c) Make the process described in paragraph (b) available on an 6
Internet website maintained by the insurer. 7
3. If an insurer requires an insured to obtain prior authorization 8
for a biomarker test described in subsection 1, the insurer shall 9
respond to a request for such prior authorization: 10
(a) Within 24 hours after receiving an urgent request; or 11
(b) Within 72 hours after receiving any other request. 12
4. The provisions of this section do not require an insurer to 13
provide coverage of biomarker testing: 14
(a) For screening purposes; 15
(b) Conducted by a provider of health care for whom the 16
biomarker testing is not within his or her scope of practice, training 17
and experience; or 18
(c) Conducted by a provider of health care or a facility that does 19
not participate in the network plan of the insurer . [; or 20
(d) That has not been determined to be medically necessary by a 21
provider of health care for whom such a determination is within his 22
or her scope of practice, training and experience.] 23
5. A policy of group health insurance subject to the provisions 24
of this chapter that is delivered, issued for delivery or renewed on or 25
after [October] January 1, [2023,] 2026, has the legal effect of 26
including the coverage required by this section, and any provision of 27
the policy or renewal which is in conflict with the provisions of this 28
section is void. 29
6. As used in this section: 30
(a) “Biomarker” means a characteristic that is objectively 31
measured and evaluated as an indicator of a normal biological 32
process, a pat hogenic process or a pharmacological response to a 33
specific therapeutic intervention and includes, without limitation: 34
(1) An interaction between a gene and a drug that is being 35
used by or considered for use by the patient; 36
(2) A mutation or characteristic of a gene; and 37
(3) The expression of a protein. 38
(b) “Biomarker testing” means the analysis of the tissue, blood 39
or other biospecimen of a patient for the presentation of a biomarker 40
and includes, without limitation, single -analyte tests, multiplex 41
panel tests and whole genome, whole exome and whole 42
transcriptome sequencing. 43
(c) “Consensus statement” means a statement aimed at a specific 44
clinical circumstance that is: 45

– 6 –

- *AB382*
(1) Made for the purpose of optimizing the outcomes of 1
clinical care; 2
(2) Made by an independent, multidisciplinary panel of 3
experts that has established a policy to avoid conflicts of interest; 4
(3) Based on scientific evidence; and 5
(4) Made using a transparent methodology and reporting 6
procedure. 7
(d) [“Medically nec essary” means health care services or 8
products that a prudent provider of health care would provide to a 9
patient to prevent, diagnose or treat an illness, injury or disease, or 10
any symptoms thereof, that are necessary and: 11
(1) Provided in accordance with generally accepted standards 12
of medical practice; 13
(2) Not primarily provided for the convenience of the patient 14
or provider of health care; and 15
(3) Significant in guiding and informing the provider of 16
health care in providing the most appropriate course of treatment for 17
the patient in order to prevent, delay or lessen the magnitude of an 18
adverse health outcome. 19
(e)] “Nationally recognized clinical practice guidelines” means 20
evidence-based guidelines establishing standards of care that 21
include, without limitation, recommendations intended to optimize 22
care of patients and are: 23
(1) Informed by a systemic review of evidence and an 24
assessment of the risks and benefits of alternative options for care; 25
and 26
(2) Developed using a transparent methodology and 27
reporting procedure by an independent organization or society of 28
medical professionals that has established a policy to avoid conflicts 29
of interest. 30
[(f)] (e) “Network plan” means a policy of group health 31
insurance offered by an insurer under which the f inancing and 32
delivery of medical care, including items and services paid for as 33
medical care, are provided, in whole or in part, through a defined set 34
of providers under contract with the insurer. The term does not 35
include an arrangement for the financing of premiums. 36
[(g)] (f) “Provider of health care” has the meaning ascribed to it 37
in NRS 629.031. 38
Sec. 3. NRS 689C.1688 is hereby amended to read as follows: 39
689C.1688 1. Subject to the limitations prescribed by 40
subsection 4, a carrier that issues a health benefit plan shall include 41
in the plan coverage for [medically necessary] biomarker testing for 42
the diagnosis, treatment, appropriate management and ongoing 43
monitoring of [cancer] a medical condition or disease when such 44

– 7 –

- *AB382*
biomarker testing is supported by medical and scientific evidence. 1
Such evidence includes, without limitation: 2
(a) The labeled indications for a biomarker test or medication 3
that has been approved or clea red by the United States Food and 4
Drug Administration; 5
(b) The indicated tests for a drug that has been approved by the 6
United States Food and Drug Administration or the warnings and 7
precautions included on the label of such a drug; 8
(c) A national coverage determination or local coverage 9
determination, as those terms are defined in 42 C.F.R. § 400.202; or 10
(d) Nationally recognized clinical practice guidelines or 11
consensus statements. 12
2. A carrier shall: 13
(a) Provide the coverage required by subse ction 1 in a manner 14
that limits disruptions in care and the need for multiple specimens; 15
(b) Establish a clear and readily accessible process for an 16
insured or provider of health care to: 17
(1) Request an exception to a policy excluding coverage for 18
biomarker testing for the diagnosis, treatment, management or 19
ongoing monitoring of [cancer;] a medical condition or disease; or 20
(2) Appeal a denial of coverage for such biomarker testing; 21
and 22
(c) Make the process described in paragraph (b) available on an 23
Internet website maintained by the carrier. 24
3. If a carrier requires an insured to obtain prior authorization 25
for a biomarker test described in subsection 1, the carrier shall 26
respond to a request for such prior authorization: 27
(a) Within 24 hours after receiving an urgent request; or 28
(b) Within 72 hours after receiving any other request. 29
4. The provisions of this section do not require a carrier to 30
provide coverage of biomarker testing: 31
(a) For screening purposes; 32
(b) Conducted by a provider of health care for whom the 33
biomarker testing is not within his or her scope of practice, training 34
and experience; or 35
(c) Conducted by a provider of health care or a facility that is 36
not in the applicable network plan of the carrier . [; or 37
(d) That has not been determined to be medically necessary by a 38
provider of health care for whom such a determination is within his 39
or her scope of practice, training and experience.] 40
5. A health benefit plan subject to the provisions of this chapter 41
that is delivered, issued for delivery or renewed on or after 42
[October] January 1, [2023,] 2026, has the legal effect of including 43
the coverage required by this section, and any provision of the plan 44

– 8 –

- *AB382*
or renewal which is in conflict with the provisions of this section is 1
void. 2
6. As used in this section: 3
(a) “Biomarker” means a characteristic that is objectively 4
measured and evaluated as an indicator of a normal biological 5
process, a pathogenic process or a pha rmacological response to a 6
specific therapeutic intervention and includes, without limitation: 7
(1) An interaction between a gene and a drug that is being 8
used by or considered for use by the patient; 9
(2) A mutation or characteristic of a gene; and 10
(3) The expression of a protein. 11
(b) “Biomarker testing” means the analysis of the tissue, blood 12
or other biospecimen of a patient for the presentation of a biomarker 13
and includes, without limitation, single -analyte tests, multiplex 14
panel tests and whole g enome, whole exome and whole 15
transcriptome sequencing. 16
(c) “Consensus statement” means a statement aimed at a specific 17
clinical circumstance that is: 18
(1) Made for the purpose of optimizing the outcomes of 19
clinical care; 20
(2) Made by an independent, mul tidisciplinary panel of 21
experts that has established a policy to avoid conflicts of interest; 22
(3) Based on scientific evidence; and 23
(4) Made using a transparent methodology and reporting 24
procedure. 25
(d) [“Medically necessary” means health care services or 26
products that a prudent provider of health care would provide to a 27
patient to prevent, diagnose or treat an illness, injury or disease, or 28
any symptoms thereof, that are necessary and: 29
(1) Provided in accordance with generally accepted standards 30
of medical practice; 31
(2) Not primarily provided for the convenience of the patient 32
or provider of health care; and 33
(3) Significant in guiding and informing the provider of 34
health care in providing the most appropriate course of treatment for 35
the patient in order to prevent, delay or lessen the magnitude of an 36
adverse health outcome. 37
(e)] “Nationally recognized clinical practice guidelines” means 38
evidence-based guidelines establishing standards of care that 39
include, without limitation, recommendations int ended to optimize 40
care of patients and are: 41
(1) Informed by a systemic review of evidence and an 42
assessment of the risks and benefits of alternative options for care; 43
and 44

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- *AB382*
(2) Developed using a transparent methodology and 1
reporting procedure by an indep endent organization or society of 2
medical professionals that has established a policy to avoid conflicts 3
of interest. 4
[(f)] (e) “Provider of health care” has the meaning ascribed to it 5
in NRS 629.031. 6
Sec. 4. NRS 695A.1859 is hereby amended to read as follows: 7
695A.1859 1. Subject to the limitations prescribed by 8
subsection 4, a society that issues a benefit contract shall include in 9
the contract coverage for [medically necessary ] biomarker testing 10
for the diagnosis, treatment, appropriate management and ongoing 11
monitoring of [cancer] a medical condition or disease when such 12
biomarker testing is supported by medical and scientific evidence. 13
Such evidence includes, without limitation: 14
(a) The labeled indications for a biomarker test or medication 15
that has been approved or cleared by the United States Food and 16
Drug Administration; 17
(b) The indicated tests for a drug that has been approved by the 18
United States Food and Drug Administra tion or the warnings and 19
precautions included on the label of such a drug; 20
(c) A national coverage determination or local coverage 21
determination, as those terms are defined in 42 C.F.R. § 400.202; or 22
(d) Nationally recognized clinical practice guidelines or 23
consensus statements. 24
2. A society shall: 25
(a) Provide the coverage required by subsection 1 in a manner 26
that limits disruptions in care and the need for multiple specimens; 27
(b) Establish a clear and readily accessible process for an 28
insured or provider of health care to: 29
(1) Request an exception to a policy excluding coverage for 30
biomarker testing for the diagnosis, treatment, management or 31
ongoing monitoring of [cancer;] a medical condition or disease; or 32
(2) Appeal a denial of coverage for suc h biomarker testing; 33
and 34
(c) Make the process described in paragraph (b) available on an 35
Internet website maintained by the society. 36
3. If a society requires an insured to obtain prior authorization 37
for a biomarker test described in subsection 1, the so ciety shall 38
respond to a request for such prior authorization: 39
(a) Within 24 hours after receiving an urgent request; or 40
(b) Within 72 hours after receiving any other request. 41
4. The provisions of this section do not require a society to 42
provide coverage of biomarker testing: 43
(a) For screening purposes; 44

– 10 –

- *AB382*
(b) Conducted by a provider of health care for whom the 1
biomarker testing is not within his or her scope of practice, training 2
and experience; or 3
(c) Conducted by a provider of health care or a facility that does 4
not participate in the network plan of the society . [; or 5
(d) That has not been determined to be medically necessary by a 6
provider of health care for whom such a determination is within his 7
or her scope of practice, training and experience.] 8
5. A benefit contract subject to the provisions of this chapter 9
that is delivered, issued for delivery or renewed on or after 10
[October] January 1, [2023,] 2026, has the legal effect of including 11
the coverage required by this section, and any prov ision of the 12
benefit contract or renewal which is in conflict with the provisions 13
of this section is void. 14
6. As used in this section: 15
(a) “Biomarker” means a characteristic that is objectively 16
measured and evaluated as an indicator of a normal biological 17
process, a pathogenic process or a pharmacological response to a 18
specific therapeutic intervention and includes, without limitation: 19
(1) An interaction between a gene and a drug that is being 20
used by or considered for use by the patient; 21
(2) A gene mutation or characteristic; and 22
(3) The expression of a protein. 23
(b) “Biomarker testing” means the analysis of the tissue, blood 24
or other biospecimen of a patient for the presentation of a biomarker 25
and includes, without limitation, single -analyte tests, multiplex 26
panel tests and whole genome, whole exome and whole 27
transcriptome sequencing. 28
(c) “Consensus statement” means a statement aimed at a specific 29
clinical circumstance that is: 30
(1) Made for the purpose of optimizing the outcomes of 31
clinical care; 32
(2) Made by an independent, multidisciplinary panel of 33
experts that has established a policy to avoid conflicts of interest; 34
(3) Based on scientific evidence; and 35
(4) Made using a transparent methodology and reporting 36
procedure. 37
(d) [“Medically necessary” means health care services or 38
products that a prudent provider of health care would provide to a 39
patient to prevent, diagnose or treat an illness, injury or disease, or 40
any symptoms thereof, that are necessary and: 41
(1) Provided in accordance with generally accepted standards 42
of medical practice; 43
(2) Not primarily provided for the convenience of the patient 44
or provider of health care; and 45

– 11 –

- *AB382*
(3) Significant in guiding and informing the provider of 1
health care in providing the most appropriate course of treatment for 2
the patient in order to prevent, delay or lessen the magnitude of an 3
adverse health outcome. 4
(e)] “Nationally recognized clinical practice guidelines” means 5
evidence-based guidelines establishing standards of care that 6
include, without limitation, recommendations intended to optimize 7
care of patients and are: 8
(1) Informed by a systemic review of evidence and an 9
assessment of the risks and benefits of alternative options for care; 10
and 11
(2) Developed using a transparent methodology and 12
reporting procedure by an independent organization or society of 13
medical professionals that has established a policy to avoid conflicts 14
of interest. 15
[(f)] (e) “Network plan” means a benefit contract offered by a 16
society under which the fi nancing and delivery of medical care, 17
including items and services paid for as medical care, are provided, 18
in whole or in part, through a defined set of providers under contract 19
with the society. The term does not include an arrangement for the 20
financing of premiums. 21
[(g)] (f) “Provider of health care” has the meaning ascribed to it 22
in NRS 629.031. 23
Sec. 5. NRS 695B.19087 is hereby amended to read as 24
follows: 25
695B.19087 1. Subject to the limitations prescribed by 26
subsection 4, a hospital or medical service corporation that issues a 27
policy of health insurance shall include in the policy coverage for 28
[medically necessary] biomarker testing for the diagnosis, treatment, 29
appropriate management and ongoing monitoring of [cancer] a 30
medical condition or disease when such biomarker testing is 31
supported by medical and scientific evidence. Such evidence 32
includes, without limitation: 33
(a) The labeled indications for a biomarker test or medication 34
that has been approved or cleared by the United States Food and 35
Drug Administration; 36
(b) The indicated tests for a drug that has been approved by the 37
United States Food and Drug Administration or the warnings and 38
precautions included on the label of such a drug; 39
(c) A national coverage determination or local coverage 40
determination, as those terms are defined in 42 C.F.R. § 400.202; or 41
(d) Nationally recognized clinical practice guidelines or 42
consensus statements. 43
2. A hospital or medical service corporation shall: 44

– 12 –

- *AB382*
(a) Provide the coverage required by subsection 1 in a manner 1
that limits disruptions in care and the need for multiple specimens; 2
(b) Establish a clear and readily accessible process for an 3
insured or provider of health care to: 4
(1) Request an exception to a policy excluding coverage for 5
biomarker testing for the diagnosis, treatment, management or 6
ongoing monitoring of [cancer;] a medical condition or disease; or 7
(2) Appeal a denial of coverage for such biomarker testing; 8
and 9
(c) Make the process described in paragraph (b) available on an 10
Internet website maintained by the hospital or medical service 11
corporation. 12
3. If a hospital or medical service corporation requires an 13
insured to obtain prior authorization for a biomarke r test described 14
in subsection 1, the hospital or medical service corporation shall 15
respond to a request for such prior authorization: 16
(a) Within 24 hours after receiving an urgent request; or 17
(b) Within 72 hours after receiving any other request. 18
4. The provisions of this section do not require a hospital or 19
medical service corporation to provide coverage of biomarker 20
testing: 21
(a) For screening purposes; 22
(b) Conducted by a provider of health care for whom the 23
biomarker testing is not within his or h er scope of practice, training 24
and experience; or 25
(c) Conducted by a provider of health care or a facility that does 26
not participate in the network plan of the hospital or medical service 27
corporation . [; or 28
(d) That has not been determined to be medically necessary by a 29
provider of health care for whom such a determination is within his 30
or her scope of practice, training and experience.] 31
5. A policy of health insurance subject to the provisions of this 32
chapter that is delivered, issued for delivery or renewed on or after 33
[October] January 1, [2023,] 2026, has the legal effect of including 34
the coverage required by this section, and any provision of the 35
policy or renewal which is in conflict with the provisions of this 36
section is void. 37
6. As used in this section: 38
(a) “Biomarker” means a characteristic that is objectively 39
measured and evaluated as an indicator of a normal biological 40
process, a pathogenic process or a pharmacological response to a 41
specific therapeutic intervention and includes, without limitation: 42
(1) An interaction between a gene and a drug that is being 43
used by or considered for use by the patient; 44
(2) A mutation or characteristic of a gene; and 45

– 13 –

- *AB382*
(3) The expression of a protein. 1
(b) “Biomarker testing” means the analysis of the t issue, blood 2
or other biospecimen of a patient for the presentation of a biomarker 3
and includes, without limitation, single -analyte tests, multiplex 4
panel tests and whole genome, whole exome and whole 5
transcriptome sequencing. 6
(c) “Consensus statement” means a statement aimed at a specific 7
clinical circumstance that is: 8
(1) Made for the purpose of optimizing the outcomes of 9
clinical care; 10
(2) Made by an independent, multidisciplinary panel of 11
experts that has established a policy to avoid conflicts of interest; 12
(3) Based on scientific evidence; and 13
(4) Made using a transparent methodology and reporting 14
procedure. 15
(d) [“Medically necessary” means health care services or 16
products that a prudent provider of health care would provide to a 17
patient to prevent, diagnose or treat an illness, injury or disease, or 18
any symptoms thereof, that are necessary and: 19
(1) Provided in accordance with generally accepted standards 20
of medical practice; 21
(2) Not primarily provided for the convenience of the patient 22
or provider of health care; and 23
(3) Significant in guiding and informing the provider of 24
health care in providing the most appropriate course of treatment for 25
the patient in order to prevent, delay or lessen the magnitude of an 26
adverse health outcome. 27
(e)] “Nationally recognized clinical practice guidelines” means 28
evidence-based guidelines establishing standards of care that 29
include, without limitation, recommendations intended to optimize 30
care of patients and are: 31
(1) Informed by a systemic review of evidence and an 32
assessment of the risks and benefits of alternative options for care; 33
and 34
(2) Developed using a transparent methodology and 35
reporting procedure by an independent organization or society of 36
medical professionals that has established a policy to avoid conflicts 37
of interest. 38
[(f)] (e) “Network plan” means a policy of health insurance 39
offered by a hospital or medical service corporation under which the 40
financing and delivery of medical care, including items and services 41
paid for as medical care, are provided, in whole or in part, through a 42
defined set of providers under contract with the hospital or medical 43
service corporation. The term does not include an arrangement for 44
the financing of premiums. 45

– 14 –

- *AB382*
[(g)] (f) “Provider of health care” has the meaning ascribed to it 1
in NRS 629.031. 2
Sec. 6. NRS 695C.16932 is hereby amended to read as 3
follows: 4
695C.16932 1. Subject to the limitations prescribed by 5
subsection 4, a health maintenance organization that issues a health 6
care plan shall include in the plan coverage for [medically 7
necessary] biomarker testing for the diagnosis, treatment, 8
appropriate management and ongoing monitoring of [cancer] a 9
medical condition or disease when such biomarker testing is 10
supported by medical and scientific evidence. Such evidence 11
includes, without limitation: 12
(a) The labeled indications for a biomarker test or medication 13
that has been approved or cleared by the United States Food and 14
Drug Administration; 15
(b) The indicated tests for a drug that has been approved by the 16
United States Food and Drug Administration or the warnings and 17
precautions included on the label of such a drug; 18
(c) A national coverage determination or local coverage 19
determination, as those terms are defined in 42 C.F.R. § 400.202; or 20
(d) Nationally recognized clinical practice guidelines or 21
consensus statements. 22
2. A health maintenance organization shall: 23
(a) Provide the coverage required by subsection 1 in a manner 24
that limits disruptions in care and the need for multiple specimens; 25
(b) Establish a clear and readily accessible process for an 26
enrollee or provider of health care to: 27
(1) Request an exception to a policy excluding coverage for 28
biomarker testing for the diagnosis, treatment, management or 29
ongoing monitoring of [cancer;] a medical condition or disease; or 30
(2) Appeal a denial of coverage for such biomarker testing; 31
and 32
(c) Make the process described in paragraph (b) available on an 33
Internet website maintained by the health maintenance organization. 34
3. If a health maintenance organization requires an enrollee to 35
obtain prior authorization for a biomarker test described in 36
subsection 1, the health maintenance organization shall respond to a 37
request for such prior authorization: 38
(a) Within 24 hours after receiving an urgent request; or 39
(b) Within 72 hours after receiving any other request. 40
4. The provisions of this sec tion do not require a health 41
maintenance organization to provide coverage of biomarker testing: 42
(a) For screening purposes; 43

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(b) Conducted by a provider of health care for whom the 1
biomarker testing is not within his or her scope of practice, training 2
and experience; or 3
(c) Conducted by a provider of health care or a facility that does 4
not participate in the network plan of the health maintenance 5
organization . [; or 6
(d) That has not been determined to be medically necessary by a 7
provider of health care for whom such a determination is within his 8
or her scope of practice, training and experience.] 9
5. A health care plan subject to the provisions of this chapter 10
that is delivered, issued for delivery or renewed on or after 11
[October] January 1, [2023,] 2026, has the legal effect of including 12
the coverage required by this section, and any provision of the plan 13
or renewal which is in conflict with the provisions of this section is 14
void. 15
6. As used in this section: 16
(a) “Biomarker” means a characteristic th at is objectively 17
measured and evaluated as an indicator of a normal biological 18
process, a pathogenic process or a pharmacological response to a 19
specific therapeutic intervention and includes, without limitation: 20
(1) An interaction between a gene and a d rug that is being 21
used by or considered for use by the patient; 22
(2) A mutation or characteristic of a gene; and 23
(3) The expression of a protein. 24
(b) “Biomarker testing” means the analysis of the tissue, blood 25
or other biospecimen of a patient for the presentation of a biomarker 26
and includes, without limitation, single -analyte tests, multiplex 27
panel tests and whole genome, whole exome and whole 28
transcriptome sequencing. 29
(c) “Consensus statement” means a statement aimed at a specific 30
clinical circumstance that is: 31
(1) Made for the purpose of optimizing the outcomes of 32
clinical care; 33
(2) Made by an independent, multidisciplinary panel of 34
experts that has established a policy to avoid conflicts of interest; 35
(3) Based on scientific evidence; and 36
(4) Made using a transparent methodology and reporting 37
procedure. 38
(d) [“Medically necessary” means health care services or 39
products that a prudent provider of health care would provide to a 40
patient to prevent, diagnose or treat an illness, injury or disease , or 41
any symptoms thereof, that are necessary and: 42
(1) Provided in accordance with generally accepted standards 43
of medical practice; 44

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(2) Not primarily provided for the convenience of the patient 1
or provider of health care; and 2
(3) Significant in guid ing and informing the provider of 3
health care in providing the most appropriate course of treatment for 4
the patient in order to prevent, delay or lessen the magnitude of an 5
adverse health outcome. 6
(e)] “Nationally recognized clinical practice guidelines” means 7
evidence-based guidelines establishing standards of care that 8
include, without limitation, recommendations intended to optimize 9
care of patients and are: 10
(1) Informed by a systemic review of evidence and an 11
assessment of the risks and benefits of a lternative options for care; 12
and 13
(2) Developed using a transparent methodology and 14
reporting procedure by an independent organization or society of 15
medical professionals that has established a policy to avoid conflicts 16
of interest. 17
[(f)] (e) “Network plan” means a health care plan offered by a 18
health maintenance organization under which the financing and 19
delivery of medical care, including items and services paid for as 20
medical care, are provided, in whole or in part, through a defined set 21
of providers u nder contract with the health maintenance 22
organization. The term does not include an arrangement for the 23
financing of premiums. 24
[(g)] (f) “Provider of health care” has the meaning ascribed to it 25
in NRS 629.031. 26
Sec. 7. NRS 695G.1703 is hereby amended to read as follows: 27
695G.1703 1. Subject to the limitations prescribed by 28
subsection 4, a managed care organization that issues a health care 29
plan shall include in the plan coverage for [medically necessary ] 30
biomarker tes ting for the diagnosis, treatment, appropriate 31
management and ongoing monitoring of [cancer] a medical 32
condition or disease when such biomarker testing is supported by 33
medical and scientific evidence. Such evidence includes, without 34
limitation: 35
(a) The la beled indications for a biomarker test or medication 36
that has been approved or cleared by the United States Food and 37
Drug Administration; 38
(b) The indicated tests for a drug that has been approved by the 39
United States Food and Drug Administration or the wa rnings and 40
precautions included on the label of such a drug; 41
(c) A national coverage determination or local coverage 42
determination, as those terms are defined in 42 C.F.R. § 400.202; or 43
(d) Nationally recognized clinical practice guidelines or 44
consensus statements. 45

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2. A managed care organization shall: 1
(a) Provide the coverage required by subsection 1 in a manner 2
that limits disruptions in care and the need for multiple specimens; 3
(b) Establish a clear and readily accessible process for an 4
insured or provider of health care to: 5
(1) Request an exception to a policy excluding coverage for 6
biomarker testing for the diagnosis, treatment, management or 7
ongoing monitoring of [cancer;] a medical condition or disease; or 8
(2) Appeal a denial of coverage for such biomarker testing; 9
and 10
(c) Make the process described in paragraph (b) available on an 11
Internet website maintained by the managed care organization. 12
3. If a managed care organization requires an insured to obtain 13
prior authorization for a biomarker test described in subsection 1, 14
the managed care organization shall respond to a request for such 15
prior authorization: 16
(a) Within 24 hours after receiving an urgent request; or 17
(b) Within 72 hours after receiving any other request. 18
4. The provisions of this section do not require a managed care 19
organization to provide coverage of biomarker testing: 20
(a) For screening purposes; 21
(b) Conducted by a provider of health care for whom the 22
biomarker testing is not within his or her scope of practice, training 23
and experience; or 24
(c) Conducted by a provider of health care or a facility that does 25
not participate in the network plan of the managed care organization 26
. [; or 27
(d) That has not been determined to be medically necessary by a 28
provider of health care for whom such a determination is within his 29
or her scope of practice, training and experience.] 30
5. A health care plan subject to the provisions of this chapter 31
that is delivered, issued for delivery or renewed on or after 32
[October] January 1, [2023,] 2026, has the legal effect of including 33
the coverage required by this section, and any provision of the plan 34
or renewal which is in conflict with the provisions of this section is 35
void. 36
6. As used in this section: 37
(a) “Biomarker” means a characteristic that is objectively 38
measured and evaluated as an indicator of a normal biological 39
process, a pathogenic process or a pharmacological response to a 40
specific therapeutic intervention and includes, without limitation: 41
(1) An interaction between a gene and a drug that is being 42
used by or considered for use by the patient; 43
(2) A mutation or characteristic of a gene; and 44
(3) The expression of a protein. 45

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(b) “Biomarker testing” means the analysi s of the tissue, blood 1
or other biospecimen of a patient for the presentation of a biomarker 2
and includes, without limitation, single -analyte tests, multiplex 3
panel tests and whole genome, whole exome and whole 4
transcriptome sequencing. 5
(c) “Consensus statement” means a statement aimed at a specific 6
clinical circumstance that is: 7
(1) Made for the purpose of optimizing the outcomes of 8
clinical care; 9
(2) Made by an independent, multidisciplinary panel of 10
experts that has established a policy to avoid conflicts of interest; 11
(3) Based on scientific evidence; and 12
(4) Made using a transparent methodology and reporting 13
procedure. 14
(d) [“Medically necessary” means health care services or 15
products that a prudent provider of health care would provide to a 16
patient to prevent, diagnose or treat an illness, injury or disease, or 17
any symptoms thereof, that are necessary and: 18
(1) Provided in accordance with generally accepted standards 19
of medical practice; 20
(2) Not primarily provided for the convenience of the p atient 21
or provider of health care; and 22
(3) Significant in guiding and informing the provider of 23
health care in providing the most appropriate course of treatment for 24
the patient in order to prevent, delay or lessen the magnitude of an 25
adverse health outcome. 26
(e)] “Nationally recognized clinical practice guidelines” means 27
evidence-based guidelines establishing standards of care that 28
include, without limitation, recommendations intended to optimize 29
care of patients and are: 30
(1) Informed by a systemic rev iew of evidence and an 31
assessment of the risks and benefits of alternative options for care; 32
and 33
(2) Developed using a transparent methodology and 34
reporting procedure by an independent organization or society of 35
medical professionals that has established a policy to avoid conflicts 36
of interest. 37
[(f)] (e) “Network plan” means a health care plan offered by a 38
managed care organization under which the financing and delivery 39
of medical care, including items and services paid for as medical 40
care, are provided, in whole or in part, through a defined set of 41
providers under contract with the managed care organization. The 42
term does not include an arrangement for the financing of 43
premiums. 44

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[(g)] (f) “Provider of health care” has the meaning ascribed to it 1
in NRS 629.031. 2
Sec. 8. NRS 422.272364 is hereby amended to read as 3
follows: 4
422.272364 1. Subject to the limitations prescribed by 5
subsection 4, the Director shall include in the State Plan for 6
Medicaid a requirement that the State pay the nonfederal share of 7
expenditures incurred for [medically necessary ] biomarker testing 8
for the diagnosis, t reatment, appropriate management and ongoing 9
monitoring of [cancer] a medical condition or disease when such 10
biomarker testing is supported by medical and scientific evidence. 11
Such evidence includes, without limitation: 12
(a) The labeled indications for a b iomarker test or medication 13
that has been approved or cleared by the United States Food and 14
Drug Administration; 15
(b) The indicated tests for a drug that has been approved by the 16
United States Food and Drug Administration or the warnings and 17
precautions included on the label of such a drug; 18
(c) A national coverage determination or local coverage 19
determination, as those terms are defined in 42 C.F.R. § 400.202; or 20
(d) Nationally recognized clinical practice guidelines or 21
consensus statements. 22
2. The Director shall: 23
(a) Ensure that the coverage required by subsection 1 is 24
provided in a manner that limits disruptions in care and the need for 25
multiple specimens; 26
(b) Include in the State Plan for Medicaid a clear and readily 27
accessible process for a recipie nt of Medicaid or provider of health 28
care to: 29
(1) Request an exception to a policy excluding coverage for 30
biomarker testing for the diagnosis, treatment, management or 31
ongoing monitoring of [cancer;] a medical condition or disease; or 32
(2) Appeal a den ial of coverage for such biomarker testing; 33
and 34
(c) Make the process described in paragraph (b) available on an 35
Internet website maintained by the Department. 36
3. If the State Plan for Medicaid requires a recipient of 37
Medicaid to obtain prior authorization for a biomarker test described 38
in subsection 1, the State Plan must require a response to a request 39
for such prior authorization: 40
(a) Within 24 hours after receiving an urgent request; or 41
(b) Within 72 hours after receiving any other request. 42
4. The provisions of this section do not require the State Plan 43
for Medicaid to include coverage of biomarker testing: 44
(a) For screening purposes; or 45

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(b) Conducted by a provider of health care for whom the 1
biomarker testing is not within his or her scope of practice, training 2
and experience . [; or 3
(c) That has not been determined to be medically necessary by a 4
provider of health care for whom such a determination is within his 5
or her scope of practice, training and experience.] 6
5. As used in this section: 7
(a) “Biomarker” means a characteristic that is objectively 8
measured and evaluated as an indicator of a normal biological 9
process, a pathogenic process or a pharmacological response to a 10
specific therapeutic intervention and includes, without limitation: 11
(1) An interaction between a gene and a drug that is being 12
used by or considered for use by the patient; 13
(2) A mutation or characteristic of a gene; and 14
(3) The expression of a protein. 15
(b) “Biomarker testing” means the analysis of the tissue, blo od 16
or other biospecimen of a patient for the presentation of a biomarker 17
and includes, without limitation, single -analyte tests, multiplex 18
panel tests and whole genome, whole exome and whole 19
transcriptome sequencing. 20
(c) “Consensus statement” means a statement aimed at a specific 21
clinical circumstance that is: 22
(1) Made for the purpose of optimizing the outcomes of 23
clinical care; 24
(2) Made by an independent, multidisciplinary panel of 25
experts that has established a policy to avoid conflicts of interest; 26
(3) Based on scientific evidence; and 27
(4) Made using a transparent methodology and reporting 28
procedure. 29
(d) [“Medically necessary” means health care services or 30
products that a prudent provider of health care would provide to a 31
patient to prevent, dia gnose or treat an illness, injury or disease, or 32
any symptoms thereof, that are necessary and: 33
(1) Provided in accordance with generally accepted standards 34
of medical practice; 35
(2) Not primarily provided for the convenience of the patient 36
or provider of health care; and 37
(3) Significant in guiding and informing the provider of 38
health care in providing the most appropriate course of treatment for 39
the patient in order to prevent, delay or lessen the magnitude of an 40
adverse health outcome. 41
(e)] “Nationally recognized clinical practice guidelines” means 42
evidence-based guidelines establishing standards of care that 43
include, without limitation, recommendations intended to optimize 44
care of patients and are: 45

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(1) Informed by a systemic review of evidence and an 1
assessment of the risks and benefits of alternative options for care; 2
and 3
(2) Developed using a transparent methodology and 4
reporting procedure by an independent organization or society of 5
medical professionals that has established a policy to avoid conflicts 6
of interest. 7
[(f)] (e) “Provider of health care” has the meaning ascribed to it 8
in NRS 629.031. 9
Sec. 9. The provisions of NRS 354.599 do not apply to any 10
additional expenses of a local government that are related to the 11
provisions of this act. 12
Sec. 10. 1. This section becomes effective upon passage and 13
approval. 14
2. Sections 1 to 9, inclusive, of this act become effective: 15
(a) Upon passage and approval for the purpose of adopt ing any 16
regulations and performing any other preparatory administrative 17
tasks that are necessary to carry out the provisions of this act; and 18
(b) On January 1, 2026, for all other purposes. 19

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