SB 56 — Revises provisions governing insurance coverage of behavioral health services. (BDR 57-124)

5.6.

NRS 695C.050 is hereby amended to read as follows:

695C.050 1.

Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter.

This provision does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a health maintenance organization authorized and regulated pursuant to this chapter.

2.

Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art.

3.

Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS.

- *SB56_R1* – 12 – 4.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to 695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services.

This subsection does not exempt a health maintenance organization from any provision of this chapter for services provided pursuant to any other contract.

5.

The provisions of NRS 695C.1694 to 695C.1698, inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731, 695C.17345, 695C.1735, 695C.1745 and 695C.1757 and, to the extent provided in that section, section 5.3 of this act apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

Sec.

A health care plan of a health maintenance organization must include coverage for :services provided to an enrollee through telehealth to the same extent as though provided in person or by other means.

(a) Behavioral health services provided to an enrollee through telehealth or by standard telephone to the same extent and in the same amount as though provided in person or by other means;

and (b) Other services provided to an enrollee through telehealth to the same extent as though provided in person or by other means.

(a) Require an enrollee to establish a relationship in person with a provider of health care or provide any additional consent to or reason for obtaining behavioral health services through telehealth or by standard telephone or other services through telehealth as a condition to providing the coverage described in subsection 1;

- *SB56* – 11 – (b) Require a provider of health care to [demonstrate]demonstrate :that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1;

(1)(c) DemonstrateRefuse that it is necessary to provide behavioralthe healthcoverage servicesdescribed toin ansubsection enrollee1 throughbecause telehealthof orthe bydistant standardsite telephonefrom orwhich othera servicesprovider toof anhealth enrolleecare provides services through telehealth asor athe conditionoriginating tosite providingat thewhich coveragean describedenrollee inreceives subsectionservices 1;through telehealth;

or [receive](d) (2)Require Receivecovered anyservices additional type of certification or license to providebe behavioralprovided health services through telehealth or by standard telephone or other services through telehealth as a condition to providing the coverage describedfor insuch subsectionservices. 1;

(c) Refuse to provide the coverage described in subsection 1 because of [the] :

(1) The distant site from which a provider of health care provides behavioral health services through telehealth or by standard telephone or other services through telehealth ;

or [the] (2) The originating site at which an enrollee receives behavioral health services through telehealth or by standard telephone or other services through telehealth;

or (d) Require covered behavioral health services to be provided through telehealth or by standard telephone or require other covered services to be provided through telehealth as a condition to providing coverage for such services.

A health care plan of a health maintenance organization must not require an enrollee to obtain prior authorization for any behavioral health service provided through telehealth or by standard telephone or any other service provided through telehealth that is not required for the service when provided in person.

Such a health care plan may require prior authorization for a behavioral health service provided through telehealth or- by*SB56_R1* standard– telephone13 or– another service provided through telehealth if such prior authorization would be required if the service were provided in person or by other means.

(a) Ensure that covered services are available to an enrollee through telehealth or by standard telephone at a particular originating site;

or - *SB56* – 12 – (c) Enter into a contract with any provider of health care or cover any service if the health maintenance organization is not otherwise required by law to do so.

6.3.

NRS 695C.330 is hereby amended to read as follows:

695C.330 1.

The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuant to the provisions of this chapter if the Commissioner finds that any of the following conditions exist:

(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the Commissioner;

(b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services - *SB56_R1* – 14 – which do not comply with the requirements of NRS 695C.1691 to 695C.200, inclusive, and section 5.3 of this act or 695C.207;

(c) The health care plan does not furnish comprehensive health care services as provided for in NRS 695C.060;

(d) The Commissioner certifies that the health maintenance organization:

(1) Does not meet the requirements of subsection 1 of NRS 695C.080;

or (2) Is unable to fulfill its obligations to furnish health care services as required under its health care plan;

(e) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;

(f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to participate in matters relating to the content of programs pursuant to NRS 695C.110;

(g) The health maintenance organization has failed to put into effect the system required by NRS 695C.260 for:

(1) Resolving complaints in a manner reasonably to dispose of valid complaints;

and (2) Conducting external reviews of adverse determinations that comply with the provisions of NRS 695G.241 to 695G.310, inclusive;

(h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;

(i) The continued operation of the health maintenance organization would be hazardous to its enrollees or creditors or to the general public;

(j) The health maintenance organization fails to provide the coverage required by NRS 695C.1691;

or (k) The health maintenance organization has otherwise failed to comply substantially with the provisions of this chapter.

2.

A certificate of authority must be suspended or revoked only after compliance with the requirements of NRS 695C.340.

3.

If the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of that suspension, enroll any additional groups or new individual contracts, unless those groups or persons were contracted for before the date of suspension.

4.

If the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may be - *SB56_R1* – 15 – essential to the orderly conclusion of the affairs of the organization.

It shall engage in no further advertising or solicitation of any kind.

The Commissioner may, by written order, permit such further operation of the organization as the Commissioner may find to be in the best interest of enrollees to the end that enrollees are afforded the greatest practical opportunity to obtain continuing coverage for health care.

Sec.

6.6.

Chapter 695G of NRS is hereby amended by adding thereto a new section to read as follows:

1.

Except as otherwise provided in subsection 4, a health care plan issued by a managed care organization must include coverage for behavioral health services provided to an insured by standard telephone to the same extent and in the same amount as though provided in person, through telehealth or by other means.

2.

Coverage of behavioral health services provided pursuant to this section is subject to the provisions of NRS 695G.162 to the same extent as if those behavioral health services were provided by telehealth.

3.

Evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by this section, and any provision of the plan or the renewal which is in conflict with this section is void.

4.

A managed care organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services is only required to comply with the provisions of this section with regard to those health care services to the extent that federal financial participation to include such coverage in the State Plan for Medicaid is available pursuant to subsection 2 of NRS 422.2721.

5.

As used in this section:

(a) “Behavioral health services” has the meaning ascribed to it in NRS 422.2721.

(b) “Telehealth” has the meaning ascribed to it in NRS 629.515.

Sec.

A health care plan issued by a managed care organization for group coverage must include coverage for :services provided to an insured through telehealth to the same extent as though provided in person or by other means.

(a) Behavioral health services provided to an insured through telehealth or by standard telephone to the same extent and in the same amount as though provided in person or by other means;

and (b) Other services provided to an insured through telehealth to the same extent as though provided in person or by other means.

(a) Require an insured to establish a relationship in person with a provider of health care or provide any additional consent to or reason- for*SB56_R1* obtaining– behavioral16 health– servicesreason throughfor telehealthobtaining or by standard telephone or other services through telehealth as a condition to providing the coverage described in subsection 1;

(b) Require a provider of health care to [demonstrate]demonstrate :that it is necessary to provide services to an insured through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1;

(1)(c) DemonstrateRefuse that it is necessary to provide behavioralthe healthcoverage servicesdescribed toin ansubsection insured1 throughbecause telehealthof orthe bydistant standardsite telephonefrom orwhich othera servicesprovider toof anhealth insuredcare provides services through telehealth asor athe conditionoriginating tosite providingat thewhich coveragean describedinsured inreceives subsectionservices 1;through telehealth;

or [receive](d) (2)Require Receivecovered anyservices additional type of certification or license to providebe behavioralprovided health services through telehealth or by standard telephone or other services through telehealth as a condition to providing the coverage describedfor insuch subsectionservices. 1;

- *SB56* – 13 – (c) Refuse to provide the coverage described in subsection 1 because of [the] :

(1) The distant site from which a provider of health care provides services through telehealth ;

or [the] (2) The originating site at which an insured receives behavioral health services through telehealth or by standard telephone or other services through telehealth;

or (d) Require covered behavioral health services to be provided through telehealth or by standard telephone or require other covered services to be provided through telehealth as a condition to providing coverage for such services.

A health care plan of a managed care organization must not require an insured to obtain prior authorization for any behavioral health service provided through telehealth or by standard telephone or any other service provided through telehealth that is not required for the service when provided in person.

Such a health care plan may require prior authorization for a behavioral health service provided through telehealth or by standard telephone or another service provided through telehealth if such prior authorization would be required if the service were provided in person or by other means.

(a) Ensure that covered services are available to an insured through telehealth or by standard telephone at a particular originating site;

- *SB56* – 14 – [(b)] (c) “Originating site” has the meaning ascribed to it in NRS 629.515.

- *SB56_R1* – 17 – [(c)] (d) “Provider of health care” has the meaning ascribed to it in NRS 439.820.

(a) A requirement that the State, and, to the extent applicable, any of its political subdivisions, shall pay for the nonfederal share of expenses for [services]services :provided to a person through telehealth to the same extent as though provided in person or by other means;

(1) Behavioral health services provided to a person through telehealth or by standard telephone to the same extent and in the same amount as though provided in person or by other means;

and (2) Other services provided to a person through telehealth to the same extent as though provided in person or by other means;

(1) Requiring a person to obtain prior authorization that would not be required if a service were provided in person or through other means, establish a relationship with a provider of health care or provide any additional consent to or reason for obtaining behavioral health services through telehealth or by standard telephone or other services through telehealth as a condition to paying for services as described in paragraph (a).

The State Plan for Medicaid may require prior authorization for a behavioral health service provided through telehealth or by standard telephone or another service provided through telehealth if such prior authorization would be required if the service were provided in person or through other means.

(2) Requiring a provider of health care to [demonstrate]demonstrate :[that it is necessary to provide] services to a person through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to paying for services as described in paragraph (a).

(I)(3) DemonstrateRefusing thatto itpay isfor necessaryservices toas providedescribed behavioralin healthparagraph services(a) tobecause of the distant site from which a personprovider throughof telehealthhealth orcare byprovides standardservices telephonethrough telehealth or otherthe servicesoriginating tosite at which a person throughwho telehealthis ascovered aby conditionthe toState payingPlan for servicesMedicaid asreceives describedservices inthrough paragraphtelehealth. (a);

or(4) [receive]Requiring (II)services Receive any additional type of certification or license to providebe behavioralprovided health services through telehealth or by standard telephone or other services through telehealth as a condition to paying for servicessuch asservices. described in paragraph (a).

(3) Refusing to pay for services as described in paragraph (a) because of [the] :

- *SB56* – 15 – (I) The distant site from which a provider of health care provides behavioral health services through telehealth or by standard telephone or other services through telehealth ;

or [the] (II) The originating site at which a person who is covered by the State Plan for Medicaid receives behavioral health services through telehealth or by standard telephone or other services through telehealth.

(4) Requiring behavioral health services to be provided through telehealth or by standard telephone or requiring other services to be provided through telehealth as a condition to paying for such services.

IfThe theDirector Stateshall Planapply for Medicaid includes a requirement that the State, and, to the extentSecretary applicable, any of itsHealth politicaland subdivisions,Human mustServices pay for theany nonfederalwaiver share of expensesfederal forlaw behavioralnecessary healthto servicesreceive providedfederal infinancial theparticipation hometo ofinclude ain person,the suchState paymentPlan mustfor notMedicaid dependcoverage onof thebehavioral geographichealth locationservices atprovided whichto thea homeperson isby located.standard telephone.

If such a waiver is granted or federal financial participation for such coverage is otherwise available under federal law:

(a) The Director must include such coverage in the State Plan for Medicaid;

and (b) To the extent authorized by the terms of the waiver or federal law, that coverage is subject to the provisions of this - *SB56_R1* – 18 – section to the same extent as behavioral health services provided to a person through telehealth.

If the State Plan for Medicaid includes a requirement that the State, and, to the extent applicable, any of its political subdivisions, must pay for the nonfederal share of expenses for behavioral health services provided in the home of a person, such payment must not depend on the geographic location at which the home is located.

4.

(1) Ensure that covered services are available to a recipient of Medicaid through telehealth or by standardaudio-only telephonetechnology at a particular originating site;

[3.] 4.5.

NRS(Deleted 616C.730by isamendment.) herebySec. amended to read as follows:

616C.730 1.

Every policy of insurance issued pursuant to chapters 616A to 617, inclusive, of NRS must include coverage for :

(a) Behavioral health services provided to an employee through telehealth or by standard telephone to the same extent - *SB56* – 16 – and in the same amount as though provided in person or by other means;

and (b) Other services provided to an employee through telehealth to the same extent as though provided in person or by other means.

2.

An insurer shall not:

(a) Require an employee to establish a relationship in person with a provider of health care or provide any additional consent to or reason for obtaining behavioral health services through telehealth or by standard telephone or other services through telehealth as a condition to providing the coverage described in subsection 1;

(b) Require a provider of health care to [demonstrate] :

(1) Demonstrate that it is necessary to provide behavioral health services to an employee through telehealth or by standard telephone or other services to an employee through telehealth as a condition to providing the coverage described in subsection 1;

or [receive] (2) Receive any additional type of certification or license to provide behavioral health services through telehealth or by standard telephone or other services through telehealth as a condition to providing the coverage described in subsection 1;

(c) Refuse to provide the coverage described in subsection 1 because of [the] :

(1) The distant site from which a provider of health care provides behavioral health services through telehealth or by standard telephone or other services through telehealth ;

or [the] (2) The originating site at which an employee receives behavioral health services through telehealth or by standard telephone or other services through telehealth;

or (d) Require covered behavioral health services to be provided through telehealth or by standard telephone or require other covered services to be provided through telehealth as a condition to providing coverage for such services.

3.

A policy of insurance issued pursuant to chapters 616A to 617, inclusive, of NRS must not require an employee to obtain prior authorization for any behavioral health service provided through telehealth or by standard telephone or any other service provided through telehealth that is not required for the service when provided in person.

Such a policy of insurance may require prior authorization for a behavioral health service provided through telehealth or by standard telephone or another service provided through telehealth if such prior authorization would be required if the service were provided in person or by other means.

4.

If a policy of insurance issued pursuant to chapters 616A to 617, inclusive, of NRS includes coverage for behavioral health - *SB56* – 17 – services provided in the home of an employee, such coverage must not depend on the geographic location at which the home is located.

5.

The provisions of this section do not require an insurer to:

(a) Ensure that covered services are available to an employee through telehealth or by standard telephone at a particular originating site;

(b) Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care;

or (c) Enter into a contract with any provider of health care or cover any service if the insurer is not otherwise required by law to do [5.] 6.

A policy of insurance subject to the provisions of chapters 616A to 617, inclusive, of NRS that is delivered, issued for delivery or renewed on or after July 1, [2015,] 2021, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.

[6.] 7.

As used in this section:

(a) “Behavioral health services” has the meaning ascribed to it in NRS 422.2721.

(b) “Distant site” has the meaning ascribed to it in NRS 629.515.

[(b)] (c) “Originating site” has the meaning ascribed to it in NRS 629.515.

[(c)] (d) “Provider of health care” has the meaning ascribed to it in NRS 439.820.

[(d)] (e) “Telehealth” has the meaning ascribed to it in NRS 629.515.

Sec.

H - *SB56**SB56_R1*