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- 83rd Session (2025)
Senate Bill No. 9–Committee on Commerce and Labor
CHAPTER..........
AN ACT relating to insurance; revising provisions governing
certain duties of insurers and certain other providers of health
coverage with regard to coverage and claims for persons who
are eligible for or provided medical assistance under
Medicaid; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Under existing law, if a state agency is assigned any rights of a person who is
eligible for medical assistance under Medicaid, insurers and certain other providers
of health coverage are subject to certain requirements. Among other requirements,
existing law requires the insurer or other provider to: (1) respond to any inquiry by
the state agency re garding a claim for payment for the provision of any medical
item or service not later than 3 years after the date of the provision of the medical
item or service; and (2) agree not to deny a claim submitted by the state agency for
certain reasons. (NRS 68 9A.430, 689B.300, 695A.151, 695B.340, 695C.163,
695F.440)
Section 202 of the federal Consolidated Appropriations Act, 2022, Pub. L. No.
117-103, revised certain requirements for a state plan for medical assistance
concerning the liability of third parties for payment of a claim for a health care item
or service. (42 U.S.C. § 1396a) Sections 1-6 of this bill revise existing law to
comply with those requirements. Sections 1-6 require insurers and certain other
providers of health coverage that the state agency reasonably be lieves cover the
person who is eligible for medical assistance under Medicaid to respond to an
inquiry regarding a claim for payment for the provision of any medical item or
service not later than 60 days after receiving the inquiry. Sections 1-6 also require
insurers and certain other providers of health cover age to agree not to deny a claim
submitted by the state agency solely on the basis of lack of prior authorization if the
state agency authorized the medical item or service.
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 689A.430 is hereby amended to read as
follows:
689A.430 1. An insurer shall not, when considering
eligibility for coverage or making payments under a policy of health
insurance, consider the availability of, or eligibility of a person for,
medical assistance under Medicaid.
2. To the extent that payment has been made by Medicaid for
health care, an insurer:
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(a) Shall treat Medicaid as having a valid and enforceable
assignment of an insured’s benefits regardless of any exclusion of
Medicaid or the absence of a written assignment; and
(b) May, as otherwise allowed by the policy, evidence of
coverage or contract and applicable law or regulation concerning
subrogation, seek to enforce any right of a recipient of Medicaid to
reimbursement against any other liable party if:
(1) It is so authorized pursuant to a contract with Medicai d
for managed care; or
(2) It has reimbursed Medicaid in full for the health care
provided by Medicaid to its insured.
3. If a state agency is assigned any rights of a person who is:
(a) Eligible for medical assistance under Medicaid; and
(b) Covered by a policy of health insurance,
the insurer that issued the policy shall not impose any
requirements upon the state agency except requirements it imposes
upon the agents or assignees of other persons covered by the policy.
4. If a state agency is ass igned any rights of an insured who is
eligible for medical assistance under Medicaid, an insurer shall:
(a) Upon request of the state agency, provide to the state agency
information regarding the insured to determine:
(1) Any period during which the ins ured or the insured’s
spouse or dependent may be or may have been covered by the
insurer; and
(2) The nature of the coverage that is or was provided by the
insurer, including, without limitation, the name and address of the
insured and the identifying nu mber of the policy, evidence of
coverage or contract;
(b) [Respond to ] Not later than 60 days after receiving any
inquiry by the state agency regarding a claim for payment for the
provision of any medical item or service to the person who is
eligible for medical assistance under Medicaid and who the state
agency reasonably believes is covered by the insurer that is
submitted not later than 3 years after the date of the provision of the
medical item or service [;] , respond to such inquiry; and
(c) Agree not to deny a claim submitted by the state agency
solely on the basis of [the] :
(1) Lack of prior authorization if the state agency
authorized the medical item or service; or
(2) The date of submission of the claim, the type or format of
the claim form or failure to present proper documentation at the
point of sale that is the basis for the claim if:
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[(1)] (I) The claim is submitted by the state agency not later
than 3 years after the date of the provision of the medi cal item or
service; and
[(2)] (II) Any action by the state agency to enforce its rights
with respect to such claim is commenced not later than 6 years after
the submission of the claim.
5. As used in this section, “insurer” includes, without
limitation, a self -insured plan, group health plan as defined in
section 607(1) of the Employee Retirement Income Security Act of
1974, 29 U.S.C. § 1167(1), service benefit plan or other
organization that has issued a policy of health insurance or any other
party d escribed in section 1902(a)(25)(A), (G) or (I) of the Social
Security Act, 42 U.S.C. § 1396a(a)(25)(A), (G) or (I), as being
legally responsible for payment of a claim for a health care item or
service.
Sec. 2. NRS 689B.300 is hereby amended to read as follows:
689B.300 1. An insurer shall not, when considering
eligibility for coverage or making payments under a group health
policy, consider the availability of, or eligibility of a person for,
medical assistance under Medicaid.
2. To the extent that payment has been made by Medicaid for
health care, an insurer:
(a) Shall treat Medicaid as having a valid and enforceable
assignment of an insured’s benefits regardless of any exclusion of
Medicaid or the absence of a written assignment; and
(b) May, as otherwise allowed by the policy, evidence of
coverage or contract and applicable law or regulation concerning
subrogation, seek to enforce any rights of a recipient of Medicaid to
reimbursement against any other liable party if:
(1) It is so authorized pursuant to a contract with Medicaid
for managed care; or
(2) It has reimbursed Medicaid in full for the health care
provided by Medicaid to its insured.
3. If a state agency is assigned any rights of a person who is:
(a) Eligible for medical assistance under Medicaid; and
(b) Covered by a group health policy,
the insurer that issued the policy shall not impose any
requirements upon the state agency except requirements it imposes
upon the agents or assignees of other persons covered by the policy.
4. If a state agency is assigned any rights of an insured who is
eligible for medical assistance under Medicaid, an insurer shall:
(a) Upon request of the state agency, provide to the state agency
information regarding the insured to determine:
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(1) Any period during which the insured or the spouse or
dependent of the insured may be or may have been covered by the
insurer; and
(2) The nature of the coverage that is or was provided by the
insurer, including, without limitation, the name and address of the
insured and the identifying number of the policy;
(b) [Respond to ] Not later than 60 days after receiving any
inquiry by the state agency regarding a claim for payment for the
provision of any medical item or service to the person who is
eligible for medical assistance under Medicaid and who the state
agency reaso nably believes is covered by the insurer that is
submitted not later than 3 years after the date of the provision of the
medical item or service [;] , respond to such inquiry; and
(c) Agree not to deny a claim submitted by the state agency
solely on the basis of [the] :
(1) Lack of prior authorization if the state agency
authorized the medical item or service; or
(2) The date of submission of the claim, the type or format of
the cla im form or failure to present proper documentation at the
point of sale that is the basis for the claim if:
[(1)] (I) The claim is submitted by the state agency not later
than 3 years after the date of the provision of the medical item or
service; and
[(2)] (II) Any action by the state agency to enforce its rights
with respect to such claim is commenced not later than 6 years after
the submission of the claim.
5. As used in this section, “insurer” includes, without
limitation, a self -insured plan, gro up health plan as defined in
section 607(1) of the Employee Retirement Income Security Act of
1974, 29 U.S.C. § 1167(1), service benefit plan or other
organization that has issued a group health policy or any other party
described in section 1902(a)(25)(A), (G) or (I) of the Social Security
Act, 42 U.S.C. § 1396a(a)(25)(A), (G) or (I), as being legally
responsible for payment of a claim for a health care item or service.
Sec. 3. NRS 695A.151 is hereby amended to read as follows:
695A.151 1. A society shall not, when considering eligibility
for coverage or making payments under a certificate for health
benefits, consider the availability of, or eligibility of a person for,
medical assistance under Medicaid.
2. To the extent that payment has been made by Medicaid for
health care, a society:
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(a) Shall treat Medicaid as having a valid and enforceable
assignment of an insured’s benefits regardless of any exclusion of
Medicaid or the absence of a written assignment; and
(b) May, as otherwise allowed by its certificate for health
benefits, evidence of coverage or contract and applicable law or
regulation concerning subrogation, seek to enforce any
reimbursement rights of a recipient of Medicaid against any other
liable party if:
(1) It is so authorized pursuant to a contract with Medicaid
for managed care; or
(2) It has reimbursed Medicaid in full for the health care
provided by Medicaid to its insured.
3. If a state agency is assigned any rights of a person who is:
(a) Eligible for medical assistance under Medicaid; and
(b) Covered by a certificate for health benefits,
the society that issued the health policy shall not impose any
requirements upon the state agency except requirements it imposes
upon the agents or assignees of other persons covered by the
certificate.
4. If a state agency is assigned any rights of an insured who is
eligible for medical assistance under Medicaid, a society that issues
a certificate for health benefits, evidence of coverage or contr act
shall:
(a) Upon request of the state agency, provide to the state agency
information regarding the insured to determine:
(1) Any period during which the insured, a spouse or
dependent of the insured may be or may have been covered by the
society; and
(2) The nature of the coverage that is or was provided by the
society, including, without limitation, the name and address of the
insured and the identifying number of the certificate for health
benefits, evidence of coverage or contract;
(b) [Respond to ] Not later than 60 days after receiving any
inquiry by the state agency regarding a claim for payment for the
provision of any medical item or service to the person who is
eligible for medical assistance under Medicaid and who the state
agency reason ably believes is covered by the society that is
submitted not later than 3 years after the date of the provision of the
medical item or service [;] , respond to such inquiry; and
(c) Agree not to deny a claim submitted by the state agency
solely on the basis of [the] :
(1) Lack of prior authorization if the state agency
authorized the medical item or service; or
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(2) The date of submission of the claim, the type or format of
the cl aim form or failure to present proper documentation at the
point of sale that is the basis for the claim if:
[(1)] (I) The claim is submitted by the state agency not later
than 3 years after the date of the provision of the medical item or
service; and
[(2)] (II) Any action by the state agency to enforce its rights
with respect to such claim is commenced not later than 6 years after
the submission of the claim.
Sec. 4. NRS 695B.340 is hereby amended to read as follows:
695B.340 1. A corporation shall not, when considering
eligibility for coverage or making payments under a contract,
consider the availability of, or any eligibility of a person for,
medical assistance under Medicaid.
2. To the extent that payment has b een made by Medicaid for
health care, a corporation:
(a) Shall treat Medicaid as having a valid and enforceable
assignment of benefits of a subscriber or policyholder or claimant
under the subscriber or policyholder regardless of any exclusion of
Medicaid or the absence of a written assignment; and
(b) May, as otherwise allowed by the policy, evidence of
coverage or contract and applicable law or regulation concerning
subrogation, seek to enforce any rights of a recipient of Medicaid
against any other liable party if:
(1) It is so authorized pursuant to a contract with Medicaid
for managed care; or
(2) It has reimbursed Medicaid in full for the health care
provided by Medicaid to its subscriber or policyholder.
3. If a state agency is assigned any rights of a person who is:
(a) Eligible for medical assistance under Medicaid; and
(b) Covered by a contract,
the corporation that issued the contract shall not impose any
requirements upon the state agency except requirements it imposes
upon the agents or assignees of other persons covered by the same
contract.
4. If a state agency is assigned any rights of a subscriber or
policyholder who is eligible for medical assistance under Medicaid,
a corporation shall:
(a) Upon request of the state agency, provide to the state agency
information regarding the subscriber or policyholder to determine:
(1) Any period du ring which the subscriber or policyholder,
the spouse or a dependent of the subscriber or policyholder may be
or may have been covered by a contract; and
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(2) The nature of the coverage that is or was provided by the
corporation, including, without limita tion, the name and address of
the subscriber or policyholder and the identifying number of the
contract;
(b) [Respond to ] Not later than 60 days after receiving any
inquiry by the state agency regarding a claim for payment for the
provision of any medical item or service to the person who is
eligible for medical assistance under Medicaid and who the state
agency reasonably believes is covered by a contract that is
submitted not later than 3 years after the date of the provision of the
medical item or service [;] , respond to such inquiry; and
(c) Agree not to deny a claim submitted by the state agency
solely on the basis of [the] :
(1) Lack of prior authorization if the state agency
authorized the medical item or service; or
(2) The date of submission of the claim, the type or format of
the claim form or failure to present proper documentation at the
point of sale that is the basis for the claim if:
[(1)] (I) The claim is submitted by the state agency not later
than 3 years after the date of the provision of the medical item or
service; and
[(2)] (II) Any action by the state agency to enforce its rights
with respect to such claim is commenced not later than 6 years after
the submission of the claim.
Sec. 5. NRS 695C.163 is hereby amended to read as follows:
695C.163 1. A health maintenance organization shall not,
when considering eligibility for coverage or making payments under
a health care plan, consider the availability of, or eligibility of a
person for, medical assistance under Medicaid.
2. To the extent that payment has been made by Medicaid for
health care, a health maintenance organization:
(a) Shall treat Medicaid as having a valid and enforceable
assignment of benefits due an enrollee or claimant under the
enrollee regardless of any exclusion of Medicaid or the absence of a
written assignment; and
(b) May, as otherwise allowed by its plan, evidence of coverage
or contract and applicable law or regulation concerning subrogation,
seek to enforce any rights of a recipient of Medicaid to
reimbursement against any other liable party if:
(1) It is so authorized pursuant to a contract with Medicaid
for managed care; or
(2) It has reimbursed Medicaid in full for the health care
provided by Medicaid to its enrollee.
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3. If a state agency is assigned any rights of a person who is:
(a) Eligible for medical assistance under Medicaid; and
(b) Covered by a health care plan,
the organization responsible for the health care plan shall not
impose any requirements upon the state agency except requirements
it imposes upon the agents or assignees of other persons covered by
the same plan.
4. If a state agency is assigned any rig hts of an enrollee who is
eligible for medical assistance under Medicaid, a health
maintenance organization shall:
(a) Upon request of the state agency, provide to the state agency
information regarding the enrollee to determine:
(1) Any period during w hich the enrollee, the spouse or a
dependent of the enrollee may be or may have been covered by the
health care plan; and
(2) The nature of the coverage that is or was provided by the
organization, including, without limitation, the name and address of
the enrollee and the identifying number of the health care plan;
(b) [Respond to ] Not later than 60 days after receiving any
inquiry by the state agency regarding a claim for payment for the
provision of any medical item or service to the person who is
eligible for assistance under Medicaid and who the state agency
reasonably believes is covered by the health care plan that is
submitted not later than 3 years after the date of the provision of the
medical item or service [;] , respond to such inquiry; and
(c) Agree not to deny a claim submitted by the state agency
solely on the basis of [the] :
(1) Lack of prior authorization if the state agency
authorized the medical item or service; or
(2) The date of submission of the claim, the type or format of
the claim form or failure to present proper documentation at the
point of sale that is the basis for the claim if:
[(1)] (I) The claim is submitted by the state agency not later
than 3 years after the date of the provision of the medical item or
service; and
[(2)] (II) Any action by the state agency to enforce its rights
with respect to such claim is commenced not later than 6 years after
the submission of the claim.
Sec. 6. NRS 695F.440 is hereby amended to read as follows:
695F.440 1. An organization shall not, when considering
eligibility for coverage or making payments under any evidence of
coverage, consider the availability of, or eligibility of a person for,
medical assistance under Medicaid.
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2. To the ext ent that payment has been made by Medicaid for
health care, a prepaid limited health service organization:
(a) Shall treat Medicaid as having a valid and enforceable
assignment of benefits due a subscriber or claimant under the
subscriber regardless of any exclusion of Medicaid or the absence of
a written assignment; and
(b) May, as otherwise allowed by its evidence of coverage or
contract and applicable law or regulation concerning subrogation,
seek to enforce any rights of a recipient of Medicaid agains t any
other liable party if:
(1) It is so authorized pursuant to a contract with Medicaid
for managed care; or
(2) It has reimbursed Medicaid in full for the health care
provided by Medicaid to its subscriber.
3. If a state agency is assigned any rights of a person who is:
(a) Eligible for medical assistance under Medicaid; and
(b) Covered by any evidence of coverage,
the prepaid limited health service organization that issued the
evidence of coverage shall not impose any requirements upon the
state agency except requirements it imposes upon the agents or
assignees of other persons covered by any evidence of coverage.
4. If a state agency is assigned any rights of a subscriber who is
eligible for medical assistance under Medicaid, a prepaid limited
health service organization shall:
(a) Upon request of the state agency, provide to the state agency
information regarding the subscriber to determine:
(1) Any period during which the subscriber, the spouse or a
dependent of the subscriber may be or may have been covered by
the organization; and
(2) The nature of the coverage that is or was provided by the
organization, including, without limitation, the name and address of
the subscriber and the identifying number of the evidence of
coverage;
(b) [Respond to ] Not later than 60 days after receiving any
inquiry by the state agency regarding a claim for payment for the
provision of any medical item or service to the person who is
eligible for medical assistance under Medicaid and who the state
agency reasonably believes is covered by the organization that is
submitted not later than 3 years after the date of the provision of the
medical item or service [;] , respond to such inquiry; and
(c) Agree not to deny a claim submitted by the state agency
solely on the basis of [the] :
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(1) Lack of prior authorization if the state agency
authorized the medical item or service; or
(2) The date of submission of the claim, the type or format of
the claim form or failure to present proper documentation at the
point of sale that is the basis for the claim if:
[(1)] (I) The claim is submitted by the state agency not later
than 3 years after the date of the provision of the medical item or
service; and
[(2)] (II) Any action by the state agency to enforce its rights
with respect to such claim is commenced not later than 6 years after
the submission of the claim.
Sec. 7. This act becomes effective upon passage and approval.
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