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- 83rd Session (2025)
Senate Bill No. 246–Senators Lange, Cruz-Crawford, Pazina,
Taylor; Daly, Flores, Nguyen and Scheible
CHAPTER..........
AN ACT relating to insurance; requiring certain health plans to
authorize a woman covered by such a plan to obtain covered
gynecological or obstetrical services without first receiving
authorization or a referral from her primary care physician;
requiring such health plans to authorize a woman covered by
such a plan to designate an obstetrician or gynecologist as her
primary care physician under certain circumstances; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires c ertain public and private health insurance plans to
include a provision authorizing a woman covered by such a plan to obtain covered
gynecological or obstetrical services without first receiving authorization from the
insurer or a referral from her primary care physician. (NRS 287.010, 687B.225,
689A.0413, 689B.031, 695B.1914, 695C.1713) Sections 1-6, 8 and 9 of this bill
apply this requirement to: (1) health plans that provide medical care to certain
private-sector employees of small employers and their dependents; (2) benefit
contracts issued by fraternal benefit societies; (3) managed care organizations; (4 )
the Public Employees’ Benefits Program; and (5) Medicaid. Sections 1.3-6, 8 and
9 require all public and private health insurance plans which are subject to this
requirement to additionally authorize a woman covered by the plan to designate as
her primar y care physician an obstetrician or gynecologist who meets certain
criteria.
Section 7 of this bill makes a conforming change to require the Director of the
Department of Health and Human Services to administer the provisions of section
9 in the same manner as other requirements governing Medicaid.
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 687B.225 is hereby amended to read as
follows:
687B.225 1. Except as otherwise provided in NRS
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437,
689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312,
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B.0374,
689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676,
695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912,
695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924,
695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713,
695C.1735, 695C.1737, 695C.1743, 695C.1745, 695C.1751,
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695G.170, 695G.1705, 695G.171, 695G.1 714, 695G.1715,
695G.1719 and 695G.177, and sections 2, 4 and 6 of this act, any
contract for group, blanket or individual health insurance or any
contract by a nonprofit hospital, medical or dental service
corporation or organization for dental care which provides for
payment of a certain part of medical or dental care may require the
insured or member to obtain prior authorization for that care from
the insurer or organization. The insurer or organization shall:
(a) File its procedure for obtaining appro val of care pursuant to
this section for approval by the Commissioner; and
(b) Unless a shorter time period is prescribed by a specific
statute, including, without limitation, NRS 689A.0446, 689B.0361,
689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703,
respond to any request for approval by the insured or member
pursuant to this section within 20 days after it receives the request.
2. The procedure for prior authorization may not discriminate
among persons licensed to provide the covered care.
Sec. 1.3. NRS 689A.0413 is hereby amended to read as
follows:
689A.0413 1. A policy of health insurance must include a
provision authorizing a woman covered by the policy to [obtain] :
(a) Obtain covered gynecological or obstetrical services without
first receiving authorization or a referral from her primary care
physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Participates in the network plan of the insurer;
(2) Satisfies the criteria established by the insurer for
designation as a primary care provider under the policy of health
insurance; and
(3) Agrees to abide by all terms and conditions imposed by
the insurer on other primary care physicians generally.
2. [The provisions of this section do not authorize a woman
covered by a policy of health insurance to designate an obstetrician
or gynecologist as her primary care physician.
3.] A policy subject to the provisions of this chapter that is
delivered, issued for delivery or renewed on or after [October]
January 1, [1999,] 2026, has the legal effect of including the
coverage required by this section, and any provision of the policy or
the renewal which is in conflict with this section is void.
[4.] 3. As used in this section [, “primary] :
(a) “Network plan” means a policy of health insurance offered
by an insurer under which the financing and delivery of medical
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care, including items and services paid for as medical care, are
provided, in whole or in part, through a defined set of providers
under contract with the insurer. The term does not include an
arrangement for the financing of premiums.
(b) “Primary care physician” has the meaning ascribed to it in
NRS 695G.060.
Sec. 1.7. NRS 689B.031 is hereby amended to read as follows:
689B.031 1. A policy of group health insurance must include
a provision authorizing a woman covered by the policy to [obtain] :
(a) Obtain covered gynecological or obstetrical services without
first receiving authorization or a referral from her primary care
physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Participates in the network plan of the insurer;
(2) Satisfies the crite ria established by the insurer for
designation as a primary care provider under the policy of group
health insurance; and
(3) Agrees to abide by all terms and conditions imposed by
the insurer on other primary care physicians generally.
2. [The provisi ons of this section do not authorize a woman
covered by a policy of group health insurance to designate an
obstetrician or gynecologist as her primary care physician.
3.] A policy subject to the provisions of this chapter that is
delivered, issued for de livery or renewed on or after [October]
January 1, [1999,] 2026, has the legal effect of including the
coverage required by this section, and any provision of the policy or
the renewal which is in conflict with this section is void.
[4.] 3. As used in this section [, “primary] :
(a) “Network plan” means a policy of group health insurance
offered by an insurer under which the financing and delivery of
medical care, including items and services paid for as medical
care, are provided, in whole or in part, t hrough a defined set of
providers under contract with the insurer. The term does not
include an arrangement for the financing of premiums.
(b) “Primary care physician” has the meaning ascribed to it in
NRS 695G.060.
Sec. 2. Chapter 689C of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A carrier that offers or issues a health benefit plan shall
include in the plan a provision authorizing a woman covered by
the plan to:
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(a) Obtain covered gynecological or obstetrical services
without first receiving authorization or a referral from her
primary care physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Participates in the network plan of the carrier;
(2) Satisfies the criteria established by the carrier for
designation as a primary care provider under the health benefit
plan; and
(3) Agrees to abide by all terms and conditions imposed by
the carrier on other primary care physicians generally.
2. A health benefit plan subject to the provisions of this
chapter that is delivered, issued for delivery or renewed on or after
January 1, 2026, has the legal effect of including the coverage
required by this section, and any provision of the plan or ren ewal
of the plan which is in conflict with this section is void.
3. As used in this section, “primary care physician” has the
meaning ascribed to it in NRS 695G.060.
Sec. 3. NRS 689C.425 is hereby amended to read as follows:
689C.425 A voluntary purchasing group and any contract
issued to such a group pursuant to NRS 689C.360 to 689C.600,
inclusive, are subject to the provisions of NRS 689C.015 to
689C.355, inclusive, and section 2 of this act to the extent
applicable and not in conflict with the express provisions of NRS
687B.408 and 689C.360 to 689C.600, inclusive.
Sec. 4. Chapter 695A of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A society that offe rs or issues a benefit contract shall
include in the contract a provision authorizing a woman covered
by the plan to:
(a) Obtain covered gynecological or obstetrical services
without first receiving authorization or a referral from her
primary care physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Participates in the network plan of the society;
(2) Satisfies the criteria established by the society for
designation as a primary care provider under the benef it contract;
and
(3) Agrees to abide by all terms and conditions imposed by
the society on other primary care physicians generally.
2. A benefit contract subject to the provisions of this chapter
that is delivered, issued for delivery or renewed on or after
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January 1, 2026, has the legal effect of including the coverage
required by this section, and any provision of the benefit contract
or renewal of the benefit contract which is in conflict with this
section is void.
3. As used in this section:
(a) “Network plan” means a benefit contract offered by a
society under which the financing and delivery of medical care,
including items and services paid for as medical care, are
provided, in whole or in part, through a defined set of providers
under contract with the society. The term does not include an
arrangement for the financing of premiums.
(b) “Primary care physician” has the meaning ascribed to it in
NRS 695G.060.
Sec. 4.5. NRS 695B.1914 is hereby amended to read as
follows:
695B.1914 1. A contract for hospital or medical service must
include a provision authorizing a woman covered by the contract to
[obtain] :
(a) Obtain covered gynecological or obstetrical services without
first receiving authorization or a ref erral from her primary care
physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Participates in the network plan of the hospital or
medical services corporation;
(2) Satisfies the criteria established by the hospital or
medical services corporation for designation as a primary care
provider under the contract; and
(3) Agrees to abide by all terms and conditions imposed by
the hospital or medical services corporation on other primary care
physicians generally.
2. [The provisions of this section do not authorize a woman
covered by a contract for hospital or medical service to designate an
obstetrician or gynecologist as her primary care physician.
3.] A contract subject to the provisions of this ch apter that is
delivered, issued for delivery or renewed on or after [October]
January 1, [1999,] 2026, has the legal effect of including the
coverage required by this section, and any provision of the contract
or the renewal which is in conflict with this section is void.
[4.] 3. As used in this section [, “primary] :
(a) “Network plan” means a policy of health insurance offered
by a hospital or medical services corporation under which the
financing and delivery of medical care, including items and
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services paid for as medical care, are provided, in whole or in part,
through a defined set of providers under contract with the hospital
or medical services corporation. The term does not include an
arrangement for the financing of premiums.
(b) “Primary care physician” has the meaning ascribed to it in
NRS 695G.060.
Sec. 5. NRS 695C.050 is hereby amended to read as follows:
695C.050 1. Except as otherwise provided in this chapter or
in specific provisions of this title, the provisions of this title are not
applicable to any health maintenance organization granted a
certificate of authority under this chapter. This provision does not
apply to an insurer licensed and regulated pursuant to this title
except with respect to its activities as a health maintenance
organization authorized and regulated pursuant to this chapter.
2. Solicitation of enrollees by a health maintenance
organization granted a certificate of authority, or its representatives,
must not be construed to viol ate any provision of law relating to
solicitation or advertising by practitioners of a healing art.
3. Any health maintenance organization authorized under this
chapter shall not be deemed to be practicing medicine and is exempt
from the provisions of chapter 630 of NRS.
4. The provisions of NRS 695C.110, 695C.125, 695C.1691,
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to
695C.1712, inclusive, 695C.1717 to 695C.173, inclusive,
695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755,
695C.1759, 695C.176 to 695C.200, inclusive, and 695C.265 do not
apply to a health maintenance organization that provides health care
services through managed care to recipients of Medicaid under the
State Plan for Medicaid or insurance pursuant to the Children’s
Health Insurance Program pursuant to a contract with the Division
of Health Care Financing and Policy of the Department of Health
and Human Services. This subsection does not exempt a health
maintenance organization from any provision of this chapter for
services provided pursuant to any other contract.
5. The provisions of NRS 695C.16932 to 695C.1699,
inclusive, 695C.1701, 695C.1708, 695C.1713, 695C.1728,
695C.1731, 695C.17333, 695C.17345, 695C.17347, 695C.1736 to
695C.1745, inclusive, 695C.1757 and 695C.204 apply to a health
maintenance organization that provides health care services through
managed care to recipients of Medicaid under the State Plan for
Medicaid.
6. The provisions of NRS 695C.17095 do not apply to a health
maintenance organization that pro vides health care services to
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members of the Public Employees’ Benefits Program. This
subsection does not exempt a health maintenance organization from
any provision of this chapter for services provided pursuant to any
other contract.
7. The provisions of NRS 695C.1735 do not apply to a health
maintenance organization that provides health care services to:
(a) The officers and employees, and the dependents of officers
and employees, of the governing body of any county, school district,
municipal corpora tion, political subdivision, public corporation or
other local governmental agency of this State; or
(b) Members of the Public Employees’ Benefits Program.
This subsection does not exempt a health maintenance
organization from any provision of this cha pter for services
provided pursuant to any other contract.
Sec. 5.5. NRS 695C.1713 is hereby amended to read as
follows:
695C.1713 1. A health care plan must include a provision
authorizing a woman covered by the plan to [obtain] :
(a) Obtain covered gynecological or obstetrical services without
first receiving authorization or a referral from her primary care
physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Participates in the network plan of the health
maintenance organization;
(2) Satisfies the criteria established by the health
maintenance organization for designation as a primary c are
provider under the health care plan; and
(3) Agrees to abide by all terms and conditions imposed by
the health maintenance organization on other primary care
physicians generally.
2. [The provisions of this section do not authorize a woman
covered by a health care plan to designate an obstetrician or
gynecologist as her primary care physician.
3.] An evidence of coverage subject to the provisions of this
chapter that is delivered, issued for delivery or renewed on or after
[October] January 1, [1999,] 2026, has the legal effect of including
the coverage required by this section, and any provision of the
evidence of coverage or the renewal which is in conflict with this
section is void.
[4.] 3. As used in this section [, “primary] :
(a) “Network plan” means a health care plan offered by a
health maintenance organization under which the financing and
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delivery of medical care, including items and services paid for as
medical care, are provided, in whole or in part, through a defined
set of providers under contract with the health maintenance
organization. The term does not include an arrangement for the
financing of premiums.
(b) “Primary care physician” has the meaning ascribed to it in
NRS 695G.060.
Sec. 6. Chapter 695G of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A managed care organization that offers or issues a health
care plan shall include in the plan a provision authorizing a
woman covered by the plan to:
(a) Obtain covered gynecological or obstetrical services
without first receiving authorization or a referral from her
primary care physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Participates in the network plan of the ma naged care
organization;
(2) Satisfies the criteria established by the managed care
organization for designation as a primary care provider under the
health care plan; and
(3) Agrees to abide by all terms and conditions imposed by
the managed care orga nization on other primary care physicians
generally.
2. A health care plan subject to the provisions of this chapter
that is delivered, issued for delivery or renewed on or after
January 1, 2026, has the legal effect of including the coverage
required by this section, and any provision of the plan or renewal
of the plan which is in conflict with this section is void.
3. As used in this section, “network plan” means a health
care plan offered by a managed care organization under which the
financing and d elivery of medical care, including items and
services paid for as medical care, are provided, in whole or in part,
through a defined set of providers under contract with the
managed care organization. The term does not include an
arrangement for the financing of premiums.
Sec. 7. NRS 232.320 is hereby amended to read as follows:
232.320 1. The Director:
(a) Shall appoint, with the consent of the Governor,
administrators of the divisions of the Department, who are
respectively designated as follows:
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(1) The Administrator of the Aging and Disability Services
Division;
(2) The Administrator of the Division of Welfare and
Supportive Services;
(3) The Administrator of the Division of Child and Family
Services;
(4) The Administrator of the Division of Health Care
Financing and Policy; and
(5) The Administrator of the Division of Public and
Behavioral Health.
(b) Shall administer, through the divisions of the Department,
the provisions of chapters 63, 424, 425, 427A, 432A to 442,
inclusive, 446 to 450, inclusive, 458A and 656A of NRS, NRS
127.220 to 127.310, inclusive, 422.001 to 422.410, inclusive, and
section 9 of this act, 422.580, 432.010 to 432.133, inclusive,
432B.6201 to 432B.626, inclusive, 444.002 to 444.430, inclusive,
and 445A.010 to 445A.055, inclusive, and all other provisions of
law relating to the functions of the divisions of the Department, but
is not responsible for the clinical activities of the Division of Public
and Behavioral Health or the professi onal line activities of the other
divisions.
(c) Shall administer any state program for persons with
developmental disabilities established pursuant to the
Developmental Disabilities Assistance and Bill of Rights Act of
2000, 42 U.S.C. §§ 15001 et seq.
(d) Shall, after considering advice from agencies of local
governments and nonprofit organizations which provide social
services, adopt a master plan for the provision of human services in
this State. The Director shall revise the plan biennially and delive r a
copy of the plan to the Governor and the Legislature at the
beginning of each regular session. The plan must:
(1) Identify and assess the plans and programs of the
Department for the provision of human services, and any
duplication of those services by federal, state and local agencies;
(2) Set forth priorities for the provision of those services;
(3) Provide for communication and the coordination of those
services among nonprofit organizations, agencies of local
government, the State and the Federal Government;
(4) Identify the sources of funding for services provided by
the Department and the allocation of that funding;
(5) Set forth sufficient information to assist the Department
in providing those services and in the planning and budgeting for the
future provision of those services; and
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(6) Contain any other information necessary for the
Department to communicate effectively with the Federal
Government concerning demographic trends, formulas for the
distribution of federal money and any ne ed for the modification of
programs administered by the Department.
(e) May, by regulation, require nonprofit organizations and state
and local governmental agencies to provide information regarding
the programs of those organizations and agencies, excluding
detailed information relating to their budgets and payrolls, which the
Director deems necessary for the performance of the duties imposed
upon him or her pursuant to this section.
(f) Has such other powers and duties as are provided by law.
2. Notwithstanding any other provision of law, the Director, or
the Director’s designee, is responsible for appointing and removing
subordinate officers and employees of the Department.
Sec. 8. NRS 287.04335 is hereby amended to read as follows:
287.04335 If the Board provides health insurance through a
plan of self -insurance, it shall comply with the provisions of NRS
439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409,
687B.692, 687B.723, 687B.725, 687B.805, 689B.0 353, 689B.255,
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162,
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167,
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to
695G.174, inclusive, and section 6 of this act, 695G.176,
695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to
695G.310, inclusive, 695G.405 and 695G.415, in the same manner
as an insurer that is licensed pursuant to title 57 of NRS is required
to comply with those provisions.
Sec. 9. Chapter 422 of NRS is hereby amended by adding
thereto a new section to read as follows:
1. The Department shall include under Medicaid a provision
authorizing a woman who is a recipient of Medicaid to:
(a) Obtain covered gynecological or obstetrical services
without first receiving authorization or a referral from her
primary care physician.
(b) Designate as her primary care physician an obstetrician or
gynecologist who:
(1) Satisfies the criteria established by the Department for
designation as a primary care provider under Medicaid; and
(2) Agrees to abide by all terms and conditions imposed by
the Department on other primary care physicians generally.
2. As used in this section, “primary care physician” has the
meaning ascribed to it in NRS 695G.060.
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Sec. 9.5. The provisions of NRS 354.599 do not apply to any
additional expenses of a local government that are related to the
provisions of this act.
Sec. 10. 1. This section becomes effective upon passage and
approval.
2. Sections 1 to 9.5, inclusive, of this act become effective:
(a) Upon passage and approval for the purpose of adopting any
regulations and performing any other preparatory administrative
tasks that are necessary to carry out the provisions of this act; and
(b) On January 1, 2026, for all other purposes.
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