AB 408 — Revises provisions relating to Medicaid and health insurance. (BDR 38-957)

(h) Screening for hepatitis B infection for persons who are at a hig(i) Screening for hepatitis C infection for persons who are at a high risk of contracting hepatitis B;C;

(i) Screening for hepatitis C infection for persons who are at a high risk of contracting hepatitis C;

To obtain any benefit provided in the Plan pursuant to subsectionsub(a) 1,Pay a recipienthigher ofdeductible, Medicaidany mustcopayment notor becoinsurance; required to:

(a) Pay a higher deductible, any copayment or coinsurance;

- *AB408_R3* – 7 – (a) “Computed tomography” means the process of producing sectional and three-dimensional images using external ionizing radiation.

- 79th Session (2017) – 7 – Sec.

(b) Smoking cessation programs;

The Director shall include in the State Plan for Medicaidexpenditures aincurred requirementfor:t that the State pay the nonfederal share of expenditures1. incurred for:

1.

- *AB408_R3* – 8 – Sec.

and (b) Administering the human papillomavirus vaccine [to women and girls] at such ages as recommended for vaccination by a competent authority, including, without limitation, the Centers for - 79th Session (2017) – 8 – Disease Control and Prevention of the United States Department of Health and Human Services, the Food and Drug Administration or the manufacturer of the vaccine.

For the purposes of this section, “human papillomavirus vaccine” means the Quadrivalent Human Papillomavirus Recombinant Vaccine or its successor which is approved by thetheavirus Food and Drug Administration to be used for the prevention of human papillomavirus infection and cervical cancer.

and (c) Review and approve, based on clinical evidence and best clinical practice guidelines and without consideration of the cost of the prescription drugs being considered, step therapy protocols used by the Medicaid program for prescription drugs.drugs.herapy protocols used 3.

3.

The Department shall accept recommendations from the Drug Use Review Board as the basis for developing or revising step - *AB408_R3* – 9 – therapy protocols and prior authorization policies and procedures used by the Medicaid program for prescription drugs.

The governing body of any county, school district, municipal corporation, politicalsubdivision,political subdivision, public - 79th Session (2017) – 9 – corporation or other local governmental agency of the State of Nevada may:

(a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on the insurance.

Any independent administrator of a fund created under this section is subject to the licensing requirements of chapter 683Awith ofan NRS,independent andadministrator must be aapproved residentby thentract Commissioner of thisInsurance State.as to the reasonableness of administrative charges in relation to contributions collected and benefits provided.

Any contract with an independent administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided.

- *AB408_R3* – 10 – (d) Defray part or all of the cost of maintenance of a self- insurance fund or of the premiums upon insurance.

The money for contributions must be budgeted for in accordance with the laws - 79th Session (2017) – 10 – governing the county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada.

If a school district offers group insurance to its officers and employees pursuant to this section, members of the board of trustees of the school district must not be excluded from participating in the group insurance.

and (b) Must be required by the contract to pay the premiums or contributions for all insurance which they elect to accept or of which they authorize the purchase.

- *AB408_R3*79th Session (2017) – 11 – Sec.

If the governing body of any county, school district, municipal corporation, politicalsubdivision,political subdivision, public corporation or other local governmental agency of the State of Nevada provides health insurance through a plan of self-insurance, the plan must provide coverage for benefits payable for expensesexpensese, incurred for administering the human papillomavirus vaccine [to women and girls] at such ages as recommended for vaccination by a competent authority, including, without limitation, the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the Food and Drug Administration or the manufacturer of the vaccine.

A plan of self-insurance described in subsection 1 which is delivered, issued for delivery or renewed on or after July 1, 2007, has the legal effect of including the coverage required by subsection 1, and any provision of the plan which is in conflict with subsection 1 is void.

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 689B.255, 695G.150, 695G.160, 695G.162, 695G.164, 695G.1645,695G.1645,of NRS 695G.1665, 695G.167, 695G.170 to 695G.173, inclusive, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, and sections 83 to 89, inclusive, of this act, in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

- 79th Session (2017) – 12 – 2.

A provider of health care may make distinctions in providing health care services based on sex or gender identity or expression if the provider has an exceedingly persuasive - *AB408_R3* – 12 – justification for the distinction, which may include, without limitation, that the distinction is substantially related to the achievement of an important health or scientific objective.objective.o the 3.

3.

Except as otherwise provided in subsections 2 and 3, pursuant to a valid prescription or order for a drug to be used for contraception or its therapeutic equivalent which has been approvedshall:ed by the Food and Drug Administration a pharmacist shall:(a) The first time dispensing the drug or therapeutic equivalent to the patient, dispense up to a 3-month supply of the drug or therapeutic equivalent.

(a) The first time dispensing the drug or therapeutic equivalent to the patient, dispense up to a 3-month supply of the drug or therapeutic equivalent.

(c) For a refill in a plan year following the initial dispensing of a drug or therapeutic equivalent pursuant to paragraphs (a) and (b), dispense up to a 12-month supply of the drug or therapeutic equivalent or any amount which covers the remainder of the plan - 79th Session (2017) – 13 – year if the patient is covered by a health care plan, whichever is less.

(a) The drug for contraception or the therapeutic equivalent of such drug is the same drug or therapeutic equivalent which waswast -of *AB408_R3* – 13 – previously prescribed or ordered pursuant to paragraph (a) of subsection 1;

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

and patient pursuant to a prescription or order as (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

- 79th Session (2017) – 14 – 2.

[A] Except as otherwise provided in section 11.3 of this act, a pharmacist may, in his or her professional judgment and pursuant to a valid prescription that specifies an initial amount of less than a 90-day supply of a drug other than a controlled substance followed by periodic refills of the initial amount of the drug, dispense not more than a 90-day supply of the drug if:

of the drug, dispense not (a) The patient has used an initial 30-day supply of the drug or the drug has previously been prescribed to the patient in a 90-day supply;

- *AB408_R3* – 14 – (b) The total number of dosage units that are dispensed pursuant to the prescription does not exceed the total number of dosage units, including refills, that are authorized on the prescription by the prescribing practitioner;

Such discriminatory actionsact(a) include,Cancelling withouta limitation:policy;mitation:

(a) Cancelling a policy;

- 79th Session (2017) – 15 – 4.

6.(a) “Gender identity or expression” has the meaning ascribed to it in NRS 193.0148.

As used in this section:

- *AB408_R3* – 15 – (a) “Gender identity or expression” has the meaning ascribed to it in NRS 193.0148.

- 79th Session (2017) – 16 – (a) Any preexisting medical condition of the person, including, without limitation, any physical or mental illness;

(c)(d) GeneticAny informationincreased relatingrisk tofor illness, injury or any other medical condition of the person;person, including, without limitation, any medical condition caused by an act of domestic violence.

and (d) Any increased risk for illness, injury or any other medical condition of the person, including, without limitation, any medical condition caused by an act of domestic violence.

or (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance - *AB408_R3* – 16 – based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured or the covered dependent of such an insured who does not have such a health status.

Nothing in this section shall be construed as requiring an insurer to make coverage available for a dependent of an adult childchiSec. of an insured.

Sec.

1.1.red.

- 79th Session (2017) – 17 – (c) Insertion of a device for contraception or removal of such a device if the device was inserted while the insured was covered by the same policy of health insurance;

(d) Education and counseling relating to the initiation of the usesuch ofuse;ntraception contraception and any necessary follow-up after initiating such(e) use;Management of side effects relating to contraception;

(e) Management of side effects relating to contraception;

- *AB408_R3* – 17 – 4.

(d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

Except as otherwise provided in subsection 7, a policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any - 79th Session (2017) – 18 – provision of the policy or the renewal which is in conflict with this section is void.

An insurer that offers or issues a policy of health insurance and which is affiliated with a religious organization is not required to provide the coverage required by subsection 1 if the insurer objects on religious grounds.

For each of the 18 methods of contraception listed in subsection 10 that have been approved by the Food and Drug Administration, a policy of health insurance must include at least one drug or device for contraception within each method for - *AB408_R3* – 18 – which no deductible, copayment or coinsurance may be charged to the insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

(e)(f) Progesterone-basedInjections;e-based intrauterine devices;

(f) Injections;

and - 79th Session (2017) – 19 – (r) Ulipristal acetate for emergency contraception.

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

(a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or - *AB408_R3* – 19 – prescription drug use.

The term does not includeinc(c) an“Provider arrangementof forhealth care” has the financingmeaning ofascribed premiums.to it in NRS 629.031.

(c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

- 79th Session (2017) – 20 – (a) Counseling and support for breastfeeding, including breastfeeding equipment, counseling and education during the antenatal, perinatal and postpartum period for not more than 1 year;

(b) Screening and counseling for interpersonal and domestic violence for women at least annually, with initial intervention services consisting of education, strategies to reduce harm, supportive services or a referral for any other appropriate services;

(g) Such well-woman preventive visits as recommended by the Health Resources and Services Administration, which must - *AB408_R3* – 20 – include at least one such visit per year beginning at 14 years of age;

(i) Aspirin for the prevention of preeclampsia for women who areof determinedgestation;d to be at a high risk of that condition after 12 weeks (j) Medication to prevent breast cancer for women who are at a high risk of gestation;developing breast cancer and have a low risk of adverse side effects from the medication;

(j) Medication to prevent breast cancer for women who are at a high risk of developing breast cancer and have a low risk of adverse side effects from the medication;

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or - 79th Session (2017) – 21 – other condition to obtain any benefit provided in the policy of health insurance pursuant to subsection 1;

(b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for orpolicy coveredof byhealth insurance pursuant to subsection 1;rovided in the policy(c) usesOffer or maypay useany atype benefitof providedmaterial ininducement theor policyfinancial ofincentive healthto insurancean pursuantinsured to subsectiondiscourage 1;the insured from obtaining any such benefit;

(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to - *AB408_R3* – 21 – determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to useuse6.or forAs suchused treatment.in this section:

6.

As used in this section:

- 79th Session (2017) – 22 – Sec.

(b) Statin preventive medication for persons between the ages of 40 and 75 years who do not have a history of cardiovascularcardiovasculares disease, but who have:

(g) One abdominal aortic screening by ultrasound to detect abdominal aortic aneurisms for men between the ages of 65 and 75 years who have smoked during their lifetimes;

-(h) *AB408_R3*Screening –for 22hepatitis –B (h)infection for persons who are at a hig(i) Screening for hepatitis BC infection for persons who are at a high risk of contracting hepatitis B;C;

(i) Screening for hepatitis C infection for persons who are at a high risk of contracting hepatitis C;

and - 79th Session (2017) – 23 – (n) Screening for lung cancer using low-dose computed tomography for persons between the ages of 55 and 80 years who:

(2) Smoke or have stopped smoking within the immediately precedingpreced(3) 15Do years;not suffer from a health problem that substantially limits the life expectancy of the person or the willingness of the person to undergo curative surgery.

and (3) Do not suffer from a health problem that substantially limits the life expectancy of the person or the willingness of the person to undergo curative surgery.

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, - *AB408_R3* – 23 – reduce, withhold, limit or delay access to any such benefit to an insured;

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit - 79th Session (2017) – 24 – required by this section or the type of provider of health care to use for such treatment.

(a) “Computed tomography” means the process of producing sectionalradiation.and and three-dimensional images using external ionizing radiation.(b) “Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

(b) “Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

(a)(b) ScreeningAll vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for depression;Disease Control and Prevention of the United States Department of Health and Human Services or its successor organization;

(b) All vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and - *AB408_R3* – 24 – Prevention of the United States Department of Health and Human Services or its successor organization;

- 79th Session (2017) – 25 – 3.

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or otherhealth conditioninsurance pursuant to obtainsubsection any1;ided in the policy of (b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use a benefit provided in the policy of health insurance pursuant to subsection 1;

(b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use a benefit provided in the policy of health insurance pursuant to subsection 1;

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

- *AB408_R3* – 25 – (a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use.

(b) “Network plan” means a policy of 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, through a defined set of providers of - 79th Session (2017) – 26 – health care under contract with the insurer.

Sec.follows:20.

20.NRS 689A.0405 is hereby amended to read as 689A.0405 1.

NRS 689A.0405 is hereby amended to read as follows:

689A.0405 1.

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or otherplan conditionpursuant to obtainsubsection any1;benefit benefit provided in the health benefit plan(b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use a benefit provided in the policy of health insurance pursuant to subsection 1;

(b)(c) RefuseOffer to issue a policy of health insurance or cancelpay aany policytype of healthmaterial insuranceinducement solely because the person applying for or coveredfinancial byincentive theto policyan usesinsured orto maydiscourage use a benefit provided in the policyinsured offrom healthobtaining insuranceany pursuantsuch tobenefit; subsection 1;

- *AB408_R3* – 26 – (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, - 79th Session (2017) – 27 – reduce, withhold, limit or delay access to any such benefit to an insured;

4.delivered, issued for delivery or renewed on or after [October 1,is 1989,] January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with [subsection 1] this section is void.

A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after [October 1, 1989,] January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with [subsection 1] this section is void.

(c)NRS “Provider629.031.ider of health care” has the meaning ascribed to it in NRSSec. 629.031.

Sec.

and - *AB408_R3* – 27 – (b) Any] any type of hormone replacement therapy [, ¬] which is lawfully prescribed or ordered and which has been approved by the Food and Drug Administration.

- 79th Session (2017) – 28 – (a) Require an insured to pay a higher deductible, copayment or coinsurance or require a longer waiting period or other condition for coverage for a prescription for [a contraceptive or] hormone replacement therapy than is required for other prescription drugs cov(b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy;policy uses or may use in the future [any of the services listed in subsection 1;] hormone replacement therapy;

(b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use in the future [any of the services listed in subsection 1;] hormone replacement therapy;

(a)(b) RequireProhibit an insurer tofrom providerequiring coveragean forinsured fertilityto drugs.pay arugs.

(b) Prohibit an insurer from requiring an insured to pay a deductible, copayment or coinsurance for the coverage required by [paragraphs (a) and (b) of] subsection 1 that is the same as the insured is required to pay for other prescription drugs covered by the policy.

Such an insurer shall, before the issuance of a policy of health insurance and before the renewal of such a policy, provide to the prospective - *AB408_R3* – 28 – insured, written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

- 79th Session (2017) – 29 – 6.] As used in this section, “provider of health care” has the meaning ascribed to it in NRS 629.031.

689A.0417an] 1.An insurer that offers or issues a policy of health insurance 5, which provides coverage for outpatient care shall include in the policy coverage for any health care service related to [contraceptives or] hormone replacement therapy.

[Except as otherwise provided in subsection 5, an] An insurer that offers or issues a policy of health insurance which provides coverage for outpatient care shall include in the policy coverage for any health care service related to [contraceptives or] hormone replacement therapy.

or (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce,reduce,er withhold, limit or delay [any of the services listed in subsection 1] hormone replacement therapy to an insured.

- *AB408_R3*79th Session (2017) – 2930 – 5.

[An insurer which offers or issues such a policy of health insurance and which is affiliated with a religious organization is not required to provide the coverage for health care service related to contraceptives required by this section if the insurer objects on religiouspolicy grounds.of health insurance and before the renewal of such a policy, provide to the prospective insured written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

Such an insurer shall, before the issuance of a policy of health insurance and before the renewal of such a policy, provide to the prospective insured written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

The provisions of this subsection do not apply to any individual health benefit plan in any case in which the decision to discharge the mother or newborn infant before the expiration of the minimum length of stay set forth in this subsection is made by the attending physician of the mother or newborn infant.

- 79th Session (2017) – 31 – (b) Provide monetary payments or rebates to a mother to encourage her to accept less than the minimum protection available pursuant to this section;

- *AB408_R3* – 30 – (c) Penalize, or otherwise reduce or limit, the reimbursement of an attending provider of health care because the attending provider of health care provided care to a mother or newborn infant ininovider accordance with the provisions of this section;

(b) Prohibits an arrangement for payment between an individual health benefit plan and a provider of health care that uses capitation or other financial incentives, if the arrangement is designed to provide services efficiently and consistently in the best interest of the(c) Prevents an individual health benefit plan from negotiating with a provider of health care concerning the motherlevel and hertype newbornof infant.reimbursement to be provided in accordance with this section.

(c) Prevents an individual health benefit plan from negotiating with a provider of health care concerning the level and type of reimbursement to be provided in accordance with this section.

- 79th Session (2017) – 32 – (a) Deoxyribonucleic acid testing for high-risk strains of the human papillomavirus every 3 years for women 30 years of age or older;

and (b) Administering the human papillomavirus vaccine as recommended for vaccination by a competent authority, including, - *AB408_R3* – 31 – without limitation, the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the Food and Drug Administration or the manufacturer of the vaccine.

(d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursementrei(e) Offer or pay any type of thematerial inducement, bonus or other financial incentive to a provider of health care;care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, - 79th Session (2017) – 33 – including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

6.(a) “Human papillomavirus vaccine” means the Quadrivalent Human Papillomavirus Recombinant Vaccine or its successor which is approved by the Food and Drug Administration for the prevention of human papillomavirus infection and cervical cancer.

As used in this section:

(a) “Human papillomavirus vaccine” means the Quadrivalent Human Papillomavirus Recombinant Vaccine or its successor which - *AB408_R3* – 32 – is approved by the Food and Drug Administration for the prevention of human papillomavirus infection and cervical cancer.

689A.330 If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public officer of that other state has informed the Commissioner that the policy is not subject to approval or disapproval by that officer, the Commissioner may by ruling require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and sections 15 to 19, inclusive, of this act.

- 79th Session (2017) – 34 – Sec.

(a) Up to a 12-month supply, per prescription, of any type of drug forfo(1) contraceptionLawfully prescribed or itsordered;equivalent therapeutic equivalent which is:

(1) Lawfully prescribed or ordered;

- *AB408_R3* – 33 – (2) Approved by the Food and Drug Administration;

If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care mustmus4.be beExcept coveredas byotherwise theprovided insurer.in subsections 9, 10 and 12, an insurer that offers or issues a policy of group health insurance shall not:

4.

Except as otherwise provided in subsections 9, 10 and 12, an insurer that offers or issues a policy of group health insurance shall not:

- 79th Session (2017) – 35 – (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

Except as otherwise provided in subsection 7, a policy subject to the provisions of this chapter that is delivered, issued for - *AB408_R3* – 34 – delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.

9.deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

An insurer may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of the drug.

- 79th Session (2017) – 36 – (b) Surgical sterilization implants for women;

(f) Injections;

- *AB408_R3* – 35 – (q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

An insurer shall not use medical management techniques to require an insured to use a different method of contraception other than the method prescribed or ordered by a provider of healthhea14. care.

14.caAn insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

An insurer must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the insurer to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

- 79th Session (2017) – 37 – (b) “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, through a defined set of providersdoes not include an arrangement for the financing of healthpremiums.term care(c) under“Provider contractof withhealth care” has the insurer.meaning ascribed to it in NRS 629.031.

The term does not include an arrangement for the financing of premiums.

(c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

- *AB408_R3* – 36 – Sec.

(c) Behavioral counseling concerning sexually transmitted diseases from a provider of health care for sexually active women who are at increased risk for such diseases;

(g) Such well-woman preventive visits as recommended by the Health Resources and Services Administration, which must - 79th Session (2017) – 38 – include at least one such visit per year beginning at 14 years of age;

(i) Aspirin for the prevention of preeclampsia for women who are determined to be at a high risk of that condition after 12 weeks of gestation;

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or - *AB408_R3* – 37 – other condition to obtain any benefit provided in the policy of group health insurance pursuant to subsection 1;

(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any(d) Penalize a provider of health care who provides any such benefit;benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

(d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any - 79th Session (2017) – 39 – provision of the policy or the renewal which is in conflict with this section is void.

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit to required by this section or the type of provider of health care to use for such treatment.

- *AB408_R3* – 38 – Sec.

(b) Statin preventive medication for persons between the ages of 40 and 75 years who do not have a history of cardiovascular disease,diseas(1) butOne whoor have:more risk factors for cardiovascular disease;

(1) One or more risk factors for cardiovascular disease;

- 79th Session (2017) – 40 – (e) Tuberculosis screenings for latent tuberculosis infection in persons with increased risk of contracting tuberculosis;

(g) One abdominal aortic screening by ultrasound to detect abdominal aortic aneurisms for men between the ages of 65 and 75 years who have smoked during their lifetimes;

- *AB408_R3* – 39 – (1) Have a smoking history of 30 pack-years;

and (3) Do not suffer from a health problem that substantially limits the life expectancy of the person or the willingness of the person to undergo curative surgery.

(b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying for or covered by the policy uses or may use a - 79th Session (2017) – 41 – benefit provided in the policy of group health insurance pursuant to subsection 1;

(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any(d) Penalize a provider of health care who provides any such benefit;benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

(d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

- *AB408_R3* – 40 – (a) “Computed tomography” means the process of producing sectionalradiation.and and three-dimensional images using external ionizing radiation.(b) “Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

(b) “Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

(e) “Network plan” means a policy of 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, through a defined set of providers of - 79th Session (2017) – 42 – health care under contract with the insurer.

(f) “Pack-year” means the product of the number of packs of cigarettes smoked per day and the number of years that the person has(g) “Provider of health care” has smoked.the meaning ascribed to it in NRS 629.031.

(g) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit provided in the policy of gro(b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying for or covered by the policy uses or may use a benefit provided in the policy of group health insurance pursuant to subsection 1;

- *AB408_R3* – 41 – (b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying for or covered by the policy uses or may use a benefit provided in the policy of group health insurance pursuant to subsection 1;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, - 79th Session (2017) – 43 – reduce, withhold, limit or delay access to any such benefit to an insured;

4.provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.

A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.

(c)NRS “Provider629.031.ider of health care” has the meaning ascribed to it in NRSSec. 629.031.

- *AB408_R3* – 42 – Sec.

- 79th Session (2017) – 44 – 2.

[A policy of group health insurance must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.] An insurer must ensure that the benefits required by subsection 1 are made available to an insured through athe providerinsurer.f of health care who participates in the network plan of the3. insurer.

3.

or (f) Impose any other restrictions or delays on the access of an insuredins4.ed A policy of group health insurance subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after [July 1, 2007,] January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any suchprovision benefit.of the policy or the renewal which is in conflict with [subsection 1] this section is void.

4.

A policy of group health insurance subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after [July 1, 2007,] January 1, 2018, has the legal - *AB408_R3* – 43 – effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with [subsection 1] this section is void.

- 79th Session (2017) – 45 – (a) “Human papillomavirus vaccine” means the Quadrivalent Human Papillomavirus Recombinant Vaccine or its successor which is approved by the Food and Drug Administration for the prevention of human papillomavirus infection and cervical cancer.

(b) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use.

(b) Counseling concerning genetic testing for breast cancer for women who are at a high risk of developing breast cancer;

andandr for (c) Counseling concerning breast cancer chemoprevention for women who are at risk of developing breast cancer.

[A policy of group health insurance must not require an insured to obtain prior authorization for any service provided - *AB408_R3* – 44 – pursuant to subsection 1.] An insurer must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or - 79th Session (2017) – 46 – other condition to obtain any benefit provided in the policy of group health insurance pursuant to subsection 1;

(b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying for or covered by the policy uses or may use a benefit provided in the policy of group health insurance pursuant to subsection 1;

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

- *AB408_R3* – 45 – (b) “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, through a defined set of providers of health care under contract with the insurer.

- 79th Session (2017) – 47 – (c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

689B.0376an] 1.An insurer that offers or issues a policy of group healthion 5, insurance which provides coverage for prescription drugs or devices shall include in the policy coverage for [:

[Except as otherwise provided in subsection 5, an] An insurer that offers or issues a policy of group health insurance which provides coverage for prescription drugs or devices shall include in the policy coverage for [:

(d) Penalize a provider of health care who provides [any of the services listed in subsection 1] hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

[Except as otherwise provided in subsection 5, a] A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any - *AB408_R3* – 46 – provision of the policy or the renewal which is in conflict with this section is void.

- 79th Session (2017) – 48 – (b) Prohibit an insurer from requiring an insured to pay a deductible, copayment or coinsurance for the coverage required by [paragraphs (a) and (b) of] subsection 1 that is the same as the insured is required to pay for other prescription drugs covered by the policy.pol5.y.

5.

[Except as otherwise provided in subsection 5, an] An insurer that offers or issues a policy of group health insurance which provides coverage for outpatient care shall include in[contraceptives theor] policyhormone coveragereplacement fortherapy.ce any health care service related to [contraceptives2. or] hormone replacement therapy.

2.

- *AB408_R3* – 47 – (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing - 79th Session (2017) – 49 – [any of the services listed in subsection 1;] hormone replacement therapy;

(d) Penalize a provider of health care who provides [any of the services listed in subsection 1] hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

orortion, reducing the reimbursement (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay [any of the services listed in subsection 1] hormone replacement therapy to an insured.

Such an insurer shall, before the issuance of a policy of group health insurance and before the renewal of such a policy, provide to the group policyholder or prospective insured, as applicable, written notice of the coverage that the insurer refuses to provide pursuant to this subsection.

The insurer shall provide noticenoticeo to each insured, at the time the insured receives his or her certificate of coverage or evidence of coverage, that the insurer refused to provide coverage pursuant to this subsection.

689B.500 [A carrier that issues a group health plan or coverage under blanket accident and health insurance or group health - *AB408_R3*79th Session (2017) – 4850 – insurance shall not deny, exclude or limit a benefit for a preexisting condition.] 1.

An insurer shall offer or issue a policy of group health insurance to any person regardless of the health status of the personincludes, orwithout anylimitation:e dependent of the person.

Such health status includes,(a) Any preexisting medical condition of the person, including, without limitation:limitation, any physical or mental illness;

(a) Any preexisting medical condition of the person, including, without limitation, any physical or mental illness;

Sec.689B.520 NR1.68Except as otherwise provided in this subsection, a group health plan or coverage offered under group health insurance issued pursuant to this chapter [that includes coverage for maternity care and pediatric care for newborn infants] may not restrict benefits for any length of stay in a hospital in connection with childbirth for a mother or newborn infant covered by the plan or coverage to:

32.

NRS 689B.520 is hereby amended to read as follows:

689B.520 1.

Except as otherwise provided in this subsection, a group health plan or coverage offered under group health insurance issued pursuant to this chapter [that includes coverage for maternity care and pediatric care for newborn infants] may not restrict benefits for any length of stay in a hospital in connection with childbirth for a mother or newborn infant covered by the plan or coverage to:

¬ If a different length of stay is provided in the guidelines established by the American College of Obstetricians and Gynecologists, or its successor organization, and the American Academy of Pediatrics, or its successor organization, the group health plan or health insurance coverage may follow such guidelines - 79th Session (2017) – 51 – in lieu of following the length of stay set forth above.

The provisions of this subsection do not apply to any group health plan - *AB408_R3* – 49 – or health insurance coverage in any case in which the decision to discharge the mother or newborn infant before the expiration of the minimumattending lengthphysician of staythe setmother forthor innewborn thisinfant.is subsection is made by the attending2. physician of the mother or newborn infant.

2.

or (e) Except as otherwise provided in subsection 4, restrict benefits for any portion of a hospital stay required pursuant to the provisions of this section in a manner that is less favorable than the benefits provided for any preceding portion of that stay.

(b) Prohibits an arrangement for payment between a group health plan or carrier and a provider of health care that uses - 79th Session (2017) – 52 – capitation or other financial incentives, if the arrangement is designed to provide services efficiently and consistently in the best interest of the mother and her newborn infant.

- *AB408_R3* – 50 – (c) Prevents a group health plan or carrier from negotiating with a provider of health care concerning the level and type of reimbursement to be provided in accordance with this section.

(a) Up to a 12-month supply, per prescription, of any type of drug forfo(1) contraceptionLawfully prescribed or itsordered;equivalent therapeutic equivalent which is:

(1) Lawfully prescribed or ordered;

- 79th Session (2017) – 53 – (e) Management of side effects relating to contraception;

A carrier must ensure that the benefits required by subsection 1 are made available to an insured through a provider of 3.altIf a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care whodeems participatesa incovered thetherapeutic networkequivalent planto be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the carrier.

- *AB408_R3* – 51 – 3.

If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care must be covered by the carrier.

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;ins(f) Impose any other restrictions or delays on the access of an insured to any such benefit.

or (f) Impose any other restrictions or delays on the access of an insured to any such benefit.

Such a carrier shall, before the issuance of - 79th Session (2017) – 54 – a health benefit plan and before the renewal of such a plan, provide to the prospective insured written notice of the coverage that the carrier refuses to provide pursuant to this subsection.

A carrier may require an insured to pay a higher deductible, copayment or coinsurance for a drug for contraception if the insured refuses to accept a therapeutic equivalent of thethen drug.

- *AB408_R3* – 52 – 9.

(l)(m) DiaphragmsSponges with spermicide;spermicide;de;

(m) Sponges with spermicide;

- 79th Session (2017) – 55 – 12.

13.expedited process which is not unduly burdensome by which annd insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the carrier to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

A carrier must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management - *AB408_R3* – 53 – technique used by the carrier to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

(b) Screening and counseling for interpersonal and domestic violence for women at least annually, with initial intervention services consisting of education, strategies to reduce harm, - 79th Session (2017) – 56 – supportive services or a referral for any other appropriate services;ser(c) Behavioral counseling concerning sexually transmitted diseases from a provider of health care for sexually active women who are at increased risk for such diseases;

(c) Behavioral counseling concerning sexually transmitted diseases from a provider of health care for sexually active women who are at increased risk for such diseases;

- *AB408_R3* – 54 – (f) Screening for cervical cancer at such intervals as are recommended by the American College of Obstetricians and Gynecologists or its successor organization;

(h) A daily dose of 0.4 to 0.8 milligrams of folic acid for wom(i) Aspirin for the prevention of preeclampsia for women who are capabledetermined to be at a high risk of becomingthat pregnant;condition after 12 weeks of gestation;

(i) Aspirin for the prevention of preeclampsia for women who are determined to be at a high risk of that condition after 12 weeks of gestation;

(b) Refuse to issue a health benefit plan or cancel a health benefit plan solely because the person applying for or covered by the plan uses or may use a benefit provided in the health benefit plan pursuant to subsection 1;

- 79th Session (2017) – 57 – (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

(d) Penalize a provider of health care who provides any such benefitreimbursement toof anthe insured,provider including,of withouthealth limitation,care;itation, reducing the reimbursement(e) Offer or pay any type of thematerial inducement, bonus or other financial incentive to a provider of health care;care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage - *AB408_R3* – 55 – required by subsection 1, and any provision of the plan or the renewal which is in conflict with this section is void.

The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devicesdev(b) based“Network onplan” cost,means typea health benefit plan offered by a carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or methodin part, through a defined set of administration.providers of health care under contract with the carrier.

(b) “Network plan” means a health benefit plan offered by a carrier 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 of health care under contract with the carrier.

- 79th Session (2017) – 58 – (b) Statin preventive medication for persons between the ages of 40 and 75 years who do not have a history of cardiovascular disease, but who have:

do not have a history of cardiovascular (1) One or more risk factors for cardiovascular disease;

- *AB408_R3* – 56 – (f) Screening for high blood pressure to confirm a diagnosis mademad(g) outsideOne aabdominal clinicalaortic settingscreening beforeby treatmentultrasound isto commenced;detect;

(g) One abdominal aortic screening by ultrasound to detect abdominal aortic aneurisms for men between ages of 65 and 75 years who have smoked during their lifetimes;

(m) If a person engages in risky or hazardous consumption of alcohol, as determined by the screening described in paragraph (l), behavioral counseling to reduce such behavior;

andandragraph (n) Screening for lung cancer using low-dose computed tomography for persons between the ages of 55 and 80 years who:

- 79th Session (2017) – 59 – (2) Smoke or have stopped smoking within the immediately preceding 15 years;

and (3) Do not suffer from a health problem that substantially limits the life expectancy of the person or the willingness of the personper2.n tA carrier must ensure that the benefits required by subsection 1 are made available to undergoan curativeinsured surgery.through a provider of health care who participates in the network plan of the carrier.

2.

A carrier must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the carrier.

- *AB408_R3* – 57 – (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

or (f)insured Imposeto any othersuch restrictionsbenefit.rictions or delays on the access of an insured4. to any such benefit.

4.

- 79th Session (2017) – 60 – (a) “Computed tomography” means the process of producing sectional and three-dimensional images using external ionizing radiation.

(b) “Facility for the dependent” has the meaning ascribed to it in (c) “Medical facility” has the meaning ascribed to it in NRS 449.0045.449.0151.

(c) “Medical facility” has the meaning ascribed to it in NRS 449.0151.

- *AB408_R3* – 58 – Sec.

(b) All vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and PreventionServices ofor theits Unitedsuccessor Statesorganization;ent Department of Health and Human (c) Screening, tests and counseling for such other health conditions and diseases as recommended by the Health Resources and Services orAdministration itsfor successorpersons organization;less than 18 years of age;

(c) Screening, tests and counseling for such other health conditions and diseases as recommended by the Health Resources and Services Administration for persons less than 18 years of age;

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or - 79th Session (2017) – 61 – other condition to obtain any benefit provided in the health benefit plan pursuant to subsection 1;

(b) Refuse to issue a health benefit plan or cancel a health benefit plan solely because the person applying for or covered by the plan usespursuant orto maysubsection use1;efit a benefit provided in the health benefit plan(c) pursuantOffer or pay any type of material inducement or financial incentive to subsectionan 1;insured to discourage the insured from obtaining any such benefit;

(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

Except as otherwise provided in this section and federal law, a carrier may use medical management techniques, - *AB408_R3* – 59 – including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to useuse6.or forAs suchused treatment.in this section:

6.

As used in this section:

- 79th Session (2017) – 62 – Sec.

(a) Deoxyribonucleic acid testing for high-risk strains of the human papillomavirus every 3 years for women 30 years of age or older;old(b) Administering the human papillomavirus vaccine as recommended for vaccination by a competent authority, including, without limitation, the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the Food and Drug Administration or the manufacturer of the vaccine.

and (b) Administering the human papillomavirus vaccine as recommended for vaccination by a competent authority, including, without limitation, the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the Food and Drug Administration or the manufacturer of the vaccine.

- *AB408_R3* – 60 – (d) Penalize a provider of health care who provides any such benefitreimbursement toof anthe insured,provider including,of withouthealth limitation,care;itation, reducing the reimbursement(e) Offer or pay any type of thematerial inducement, bonus or other financial incentive to a provider of health care;care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

Except as otherwise provided in this section and federal law, a carrier may use medical management techniques, - 79th Session (2017) – 63 – including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

6.

As used in this section:

(b) Counseling concerning genetic testing for breast cancer for wom(c) Counseling concerning breast cancer chemoprevention for women who are at a high risk of developing breast cancer;cancer.

and - *AB408_R3* – 61 – (c) Counseling concerning breast cancer chemoprevention for women who are at risk of developing breast cancer.

(b) Refuse to issue a health benefit plan or cancel a health benefit plan solely because the person applying for or covered by - 79th Session (2017) – 64 – the plan uses or may use a benefit provided in the health benefit plan pursuant to subsection 1;

(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any(d) Penalize a provider of health care who provides any such benefit;benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

(d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

(a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescriptionuse drugof use.step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

The(b) term“Network includes,plan” withoutmeans limitation,a health benefit plan offered by a carrier under which the usefinancing and delivery of stepmedical therapy,care, priorincluding authorizationitems orand categorizingservices drugspaid andfor devicesas basedmedical oncare, cost,are typeprovided, in whole or methodin part, through a defined set of administration.providers of health care under contract with the carrier.

- *AB408_R3* – 62 – (b) “Network plan” means a health benefit plan offered by a carrier 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 of health care under contract with the carrier.

689C.159 The provisions of NRS 689C.156 [and 689C.190] do not apply to health benefit plans offered by a carrier if the carrier - 79th Session (2017) – 65 – makes the health benefit plan available in the small employer market only through a bona fide association.

689C.190 [A carrier serving small employers that issues a healthpreexisting benefitcondition.]ll plan shall not deny, exclude or limit a benefit for a preexisting condition.] 1.

3.not adjust a premium, deductible, copay or coinsurance for anyshall insured on the basis of genetic information relating to the insured or the covered dependent of the insured.

ASec. carrier that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any insured on the basis of genetic information relating to the insured or the covered dependent of the insured.

- *AB408_R3* – 63 – Sec.

A carrier that offers health insurance coverage to small employers pursuant to this chapter shall not establish rules of eligibility, including, but not limited to, rules which define applicable waiting periods, for the initial or continued enrollment - 79th Session (2017) – 66 – under a health benefit plan offered by the carrier that are based on the following factors relating to the eligible employee or a dependent of the eligible employee:

(b)or Medicalboth.edical condition, including physical and mental illnesses, or(c) both.Claims experience.

(c) Claims experience.

(b) Prevents a carrier from establishing premium discounts or rebates or from modifying otherwise applicable copayments or deductibles in return for adherence by the insured person to programs of health promotion and disease prevention;

ororon to (c) Precludes a carrier from establishing rules relating to employer contribution or group participation when offering health insurance coverage to small employers in this State.

- *AB408_R3* – 64 – (a) “Contribution” means the minimum employer contribution toward the premium for enrollment of participants and beneficiaries in a health benefit plan.

- 79th Session (2017) – 67 – Sec.

Except as otherwise provided in this subsection, a health benefit plan issued pursuant to this chapter [that includes coverage for maternity care and pediatric care for newborn infants] may not restrict benefits for any length of stay in a hospital in connection with childbirth for a mother or newborn infant covered by the plan to:

(a) Deny a mother or her newborn infant coverage or continued coverage under the terms of the plan if the sole purpose of the denial of coverage or continued coverage is to avoid the requirements of thi(b) Provide monetary payments or rebates to a mother to encourage her to accept less than the minimum protection available pursuant to this section;

(b) Provide monetary payments or rebates to a mother to encourage her to accept less than the minimum protection available pursuant to this section;

(d) Provide incentives of any kind to an attending physician to induce the attending physician to provide care to a mother or - *AB408_R3* – 65 – newborn infant in a manner that is inconsistent with the provisions of this section;

or (e) Except as otherwise provided in subsection 4, restrict benefits for any portion of a hospital stay required pursuant to the - 79th Session (2017) – 68 – provisions of this section in a manner that is less favorable than the benefits provided for any preceding portion of that stay.

(a) Prohibits a health benefit plan or carrier from imposing a deductible, coinsurance or other mechanism for sharing costs relating to benefits for hospital stays in connection with childbirth for a mother or newborn child covered by the plan, except that such coinsurance or other mechanism for sharing costs for any portion of a hospital stay required by this section may not be greater than the coinsurance or other mechanism for any preceding portion of that stay.

The Commissioner shall adopt regulations which require a carrier to file with the Commissioner, for approval by the Commissioner, a disclosure offered by the carrier to a small employer.

and - *AB408_R3* – 66 – (e) [The provisions relating to any preexisting condition;

and - 79th Session (2017) – 69 – (f)] Any other information that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of a policy or contract of insurance issued pursuant to this chapter.

The disclosure must be written in language which is easily understood and must include a statement that the disclosure is a summary of the policy only, and that the policy itself should be read to determine the governing contractual provisions.

(a)limitation Anythat significantapplies exception,to priora contract;r authorization, reduction or limitation(b) thatAny appliesrestrictions toon apayments contract;for emergency care, including, without limitation, related definitions of an emergency and medical necessity;

(b) Any restrictions on payments for emergency care, including, without limitation, related definitions of an emergency and medical necessity;

The disclosure must be written in a language which is easily understood and must include a statement that the disclosure is a - *AB408_R3*79th Session (2017) – 6770 – summary of the contract only, and that the contract itself should be read to determine the governing contractual provisions.

The Commissioner shall not approve any proposed disclosure submitted to the Commissioner pursuant to this section whichapplicable doesregulations.ith not comply with the requirements of this section and the applicableSec. regulations.

Sec.

or (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situateddoes insurednot orhave thesuch covereda dependenthealth status.endent of such an insured who does3. not have such a health status.

3.

- 79th Session (2017) – 71 – Sec.

- *AB408_R3* – 68 – (a) Up to a 12-month supply, per prescription, of any type of drug forfo(1) contraceptionLawfully prescribed or itsordered;equivalent therapeutic equivalent which is:

(1) Lawfully prescribed or ordered;

If a covered therapeutic equivalent listed in subsection 1 is not available or a provider of health care deems a covered therapeutic equivalent to be medically inappropriate, an alternate therapeutic equivalent prescribed by a provider of health care mustmus4.be beExcept coveredas byotherwise theprovided society.in subsections 8, 9 and 11, a society that offers or issues a benefit contract shall not:

4.

Except as otherwise provided in subsections 8, 9 and 11, a society that offers or issues a benefit contract shall not:

- 79th Session (2017) – 72 – (d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursement of the provider of health care;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

or - *AB408_R3* – 69 – (f) Impose any other restrictions or delays on the access of an insured to any such benefit.

9.subsection 10 that have been approved by the Food and Drug in Administration, a benefit contract must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the society may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

For each of the 18 methods of contraception listed in subsection 10 that have been approved by the Food and Drug Administration, a benefit contract must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the society may charge a deductible, copayment or coinsurance for any other drug or device that provides the same method of contraception.

- 79th Session (2017) – 73 – (f) Injections;

(j)(k) Estrogen-Vaginal andcontraceptive progestin-basedrings;d patches;

(k) Vaginal contraceptive rings;

- *AB408_R3* – 70 – (o) Female condoms;

A society must provide an accessible, transparent and expedited process which is not unduly burdensome by which an insured, or the authorized representative of the insured, may request an exception relating to any medical management technique used by the society to obtain any benefit required by this section without a higher deductible, copayment or coinsurance.

- 79th Session (2017) – 74 – (c) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(1) Contains an identical amount of the same active ingredientsanother indrug;n the same dosage and method of administration as (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

- *AB408_R3* – 71 – Sec.

(e) Screening for blood pressure abnormalities and diabetes, including gestational diabetes, after at least 24 weeks of gestation or as ordered by a provider of health care;

- 79th Session (2017) – 75 – (j) Medication to prevent breast cancer for women who are at a high risk of developing breast cancer and have a low risk of adverse side effects from the medication;

and (k) Prophylactic ocular tubal medication for the prevention of gonococcalgon2.occA ophthalmiasociety must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in newborns.the network plan of the society.

2.

A society must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the society.

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or - *AB408_R3* – 72 – other condition to obtain any benefit provided in the benefit contract pursuant to subsection 1;

or (f)insured Imposeto any othersuch restrictionsbenefit.rictions or delays on the access of an insured4. to any such benefit.

4.

- 79th Session (2017) – 76 – (a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use.

The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devicesdev(b) based“Network onplan” cost,means typea 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 methodin part, through a defined set of administration.providers of health care under contract with the society.

(b) “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 of health care under contract with the society.

- *AB408_R3* – 73 – (a) Counseling relating to the dietary needs of adults who are at a high risk of chronic diseases;

(d) Vitamin D supplements for persons who are at least 65 years of age to prevent the person from falling if the person:

(g) One abdominal aortic screening by ultrasound to detect abdominal aortic aneurisms for men between the ages of 65 and 75 years who have smoked during their lifetimes;

- 79th Session (2017) – 77 – (i) Screening for hepatitis C infection for persons who are at a high risk of contracting hepatitis C;

(k)(k)(1) ScreeningAre for65 osteoporosisyears forof womenage who:and older;

(1)or Arewho: 65 years of age and older;

or (2) Have a risk of fracturing a bone equal to or greater than that of a woman who is 65 years of age without any additional risk factors;

- *AB408_R3* – 74 – (2) Smoke or have stopped smoking within the immediately preceding 15 years;

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit provided in the benefitbenefitr contract pursuant to subsection 1;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, - 79th Session (2017) – 78 – reduce, withhold, limit or delay access to any such benefit to an insured;

4.that is delivered, issued for delivery or renewed on or afterchapter January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the contract or the renewal which is in conflict with this section is void.

A benefit contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the contract or the renewal which is in conflict with this section is void.

- *AB408_R3* – 75 – (b) “Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

(e) “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 of health care under contract with the society.

- 79th Session (2017) – 79 – (b) All vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention of the United States Department of Health and Human Services or its successor organization;

(c) Screening, tests and counseling for such other health conditions and diseases as recommended by the Health Resources and Services Administration for persons less than 18 years of age;

(b) Refuse to issue a benefit contract or cancel a benefit contract solely because the person applying for or covered by the - *AB408_R3* – 76 – contract uses or may use a benefit provided in the benefit contract pursuant to subsection 1;

(d) Penalize a provider of health care who provides any such benefit to an insured, including, without limitation, reducing the reimbursementrei(e) Offer or pay any type of thematerial inducement, bonus or other financial incentive to a provider of health care;care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

Except as otherwise provided in this section and federal law, a society may use medical management techniques, including, without limitation, any available clinical evidence, to - 79th Session (2017) – 80 – determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.

(a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use.

and - *AB408_R3* – 77 – (b) Less than 96 hours after a cesarean section.

¬ If a different length of stay is provided in the guidelines established by the American College of Obstetricians and Gynecologists, or its successor organization, and the American Academy of Pediatrics, or its successor organization, the benefit contract may follow such guidelines in lieu of following the length of stay set forth above.

The provisions of this subsection do notnotth apply to any benefit contract in any case in which the decision to discharge the mother or newborn infant before the expiration of the minimum length of stay set forth in this subsection is made by the attending physician of the mother or newborn infant.

- 79th Session (2017) – 81 – (b) Provide monetary payments or rebates to a mother to encourage her to accept less than the minimum protection available pursuant to this section;

(c) Penalize, or otherwise reduce or limit, the reimbursement of an attending provider of health care because the attending provider of health care provided care to a mother or newbornnewborng infant in accordance with the provisions of this section;

- *AB408_R3* – 78 – (b) Prohibits an arrangement for payment between a benefit contract or society and a provider of health care that uses capitation or other financial incentives, if the arrangement is designed to provide services efficiently and consistently in the best interestint(c) Prevents a benefit contract or society from negotiating with a provider of health care concerning the motherlevel and hertype newbornof infant.reimbursement to be provided in accordance with this section.

(c) Prevents a benefit contract or society from negotiating with a provider of health care concerning the level and type of reimbursement to be provided in accordance with this section.

- 79th Session (2017) – 82 – (a) Deoxyribonucleic acid testing for high-risk strains of the human papillomavirus every 3 years for women 30 years of age or older;

and (b) Administering the human papillomavirus vaccine as recommended for vaccination by a competent authority, including, without limitation, the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the Food and Drug Administration or the manufacturer of the vaccine.

- *AB408_R3* – 79 – (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

Except as otherwise provided in this section and federal law, a society may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit - 79th Session (2017) – 83 – required by this section or the type of provider of health care to use for such treatment.

(a) “Human papillomavirus vaccine” means the Quadrivalent Human Papillomavirus Recombinant Vaccine or its successor which is approved by the Food and Drug Administration for the prevention of human papillomavirus infection and cervical cancer.

and (c) Counseling concerning breast cancer chemoprevention for womenwom2. who are at risk of developing breast cancer.

-whA *AB408_R3*society –must 80ensure –that 2.the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the society.

A society must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the society.

- 79th Session (2017) – 84 – (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

(d) Penalize a provider of health care who provides any such benefitreimbursement toof anthe insured,provider including,of withouthealth limitation,care;itation, reducing the reimbursement(e) Offer or pay any type of thematerial inducement, bonus or other financial incentive to a provider of health care;care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devicesdev(b) based“Network onplan” cost,means typea 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 methodin part, through a defined set of administration.providers of health care under contract with the society.

(b) “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 - *AB408_R3* – 81 – provided, in whole or in part, through a defined set of providers of health care under contract with the society.

An insurer shall offer or issue a contract for hospital or medical service to any person regardless of the health - 79th Session (2017) – 85 – status of the person or any dependent of the person.

(b) The claims history of the person, including, without limitation, any prior health care services received by the person;

2.hospital or medical service corporation to make coverage available for a dependent of an adult child of an insured.

Nothing in this section shall be construed as requiring a hospital or medical service corporation to make coverage available for a dependent of an adult child of an insured.

- *AB408_R3* – 82 – (a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

and - 79th Session (2017) – 86 – (3) Listed in subsection 11;

(d) Education and counseling relating to the initiation of the use of contraception and any necessary follow-up after initiating such use;

(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, - *AB408_R3* – 83 – reduce, withhold, limit or delay access to any such benefit to an insured;

- 79th Session (2017) – 87 – 6.

Except as otherwise provided in subsection 7, a contract for hospital or medical service subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2018, has the legal effect of including the coverage required by subsection 1, and any provision of the contract or the renewal which is in conflict with this section is void.void.ract or the 7.

7.

For each of the 18 methods of contraception listed in subsection 11 that have been approved by the Food and Drug Administration, a contract for hospital or medical service must include at least one drug or device for contraception within each method for which no deductible, copayment or coinsurance may be charged to the insured, but the insurer may charge a deductible, copayment or coinsurance for any other drug or device thattha11.rovThe providesfollowing the18 samemethods method of contraception.contraception must be covered pursuant to this section:

11.

The following 18 methods of contraception must be covered pursuant to this section:

- *AB408_R3* – 84 – (i) Extended- or continuous-regimen drugs;

- 79th Session (2017) – 88 – (m) Sponges with spermicide;

(q) Combined estrogen- and progestin-based drugs for emergency contraception or progestin-based drugs for emergency contraception;

(a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescriptionuse drugof use.step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

- *AB408_R3*79th Session (2017) – 8589 – (1) Contains an identical amount of the same active ingredientsanother indrug;n the same dosage and method of administration as (2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

(b) Screening and counseling for interpersonal and domestic violence for women at least annually, with initial intervention services consisting of education, strategies to reduce harm, supportive services or a referral for any other appropriate services;ser(c) Behavioral counseling concerning sexually transmitted diseases from a provider of health care for sexually active women who are at increased risk for such diseases;

(c) Behavioral counseling concerning sexually transmitted diseases from a provider of health care for sexually active women who are at increased risk for such diseases;

(h) A daily dose of 0.4 to 0.8 milligrams of folic acid for wom(i) Aspirin for the prevention of preeclampsia for women who are capabledetermined to be at a high risk of becomingthat pregnant;condition after 12 weeks of gestation;

(i)- Aspirin79th forSession the(2017) prevention– of90 preeclampsia– (j) Medication to prevent breast cancer for women who are determined to be at a high risk of thatdeveloping conditionbreast aftercancer 12and weekshave a low risk of gestation;adverse side effects from the medication;

(j)and Medication(k) toProphylactic preventocular breasttubal cancermedication for womenthe whoprevention areof atgon2.occAn ainsurer highmust riskensure ofthat developingthe breastbenefits cancerrequired andby havesubsection a1 loware riskmade available to an insured through a provider of adversehealth sidecare effectswho fromparticipates in the medication;network plan of the insurer.

and - *AB408_R3* – 86 – (k) Prophylactic ocular tubal medication for the prevention of gonococcal ophthalmia in newborns.

2.

An insurer must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

orhhold, limit or delay access to any such benefit to an (f) Impose any other restrictions or delays on the access of an insured to any such benefit.

Except as otherwise provided in this section and federal law, an insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit - 79th Session (2017) – 91 – required by this section or the type of provider of health care to use for such treatment.

(a) “Medical management technique” means a practice which is used to control the cost or utilization of health care services or prescription drug use.

The term includes, without limitation, thethes -or *AB408_R3* – 87 – use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

and (2) A calculated risk of at least 10 percent of acquiring car(c) Aspirin for persons between the ages of 50 and 59 years who have a calculated risk of at least 10 percent of acquiring cardiovascular disease within the next 10 years and a life expectancy of at least 10 years;

(c) Aspirin for persons between the ages of 50 and 59 years who have a calculated risk of at least 10 percent of acquiring cardiovascular disease within the next 10 years and a life expectancy of at least 10 years;

- 79th Session (2017) – 92 – (g) One abdominal aortic screening by ultrasound to detect abdominal aortic aneurisms for men between the ages of 65 and 75 years who have smoked during their lifetimes;

(h) Screening for hepatitis B infection for persons who are at a hig(i) Screening for hepatitis C infection for persons who are at a high risk of contracting hepatitis B;C;

(i) Screening for hepatitis C infection for persons who are at a high risk of contracting hepatitis C;

- *AB408_R3* – 88 – (k) Screening for osteoporosis for women who:

An insurer must ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.

- 79th Session (2017) – 93 – (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from obtaining any such benefit;

(d) Penalize a provider of health care who provides any such benefitreimbursement toof anthe insured,provider including,of withouthealth limitation,care;itation, reducing the reimbursement(e) Offer or pay any type of thematerial inducement, bonus or other financial incentive to a provider of health care;care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

- *AB408_R3* – 89 – 4.

(b) “Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

for the dependent” has the meaning ascribed to it (c) “Medical facility” has the meaning ascribed to it in NRS 449.0151.

The - 79th Session (2017) – 94 – term does not include an arrangement for the financing of premiums.

(f) “Pack-year” means the product of the number of packs of cigarettes smoked per day and the number of years that the person has(g) “Provider of health care” has smoked.the meaning ascribed to it in NRS 629.031.

(g) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

- *AB408_R3* – 90 – (c) Screening, tests and counseling for such other health conditions and diseases as recommended by the Health Resources and Services Administration for persons less than 18 years of age;

(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition to obtain any benefit provided in the contract for hospital or medical service pursuant to subsection 1;

- 79th Session (2017) – 95 – (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay access to any such benefit to an insured;

or (f)insured Imposeto any othersuch restrictionsbenefit.rictions or delays on the access of an insured4. to any such benefit.